Table 1.
Evidence-based recommendations regarding low-intake dehydration (adapted from [4]) §).
| Research Question (RQ) | Recommendation § | Grade of Recommendation * | |
|---|---|---|---|
| 1 |
How should low-intake dehydration be identified in older persons?
(RQ 1.1, 1.2, 1.3) |
An action threshold of directly measured serum osmolality > 300 mOsm/kg should be used to identify low-intake dehydration in older adults | B |
| Where directly measured osmolality is not available then the osmolarity equation (osmolarity = 1.86 × (Na+ + K+) + 1.15 × glucose + urea + 14 (all measured in mmol/L) with an action threshold of >295 mmol/L) should be used to screen for low-intake dehydration in older persons | B | ||
| Simple signs and tests commonly used to assess low-intake dehydration such as skin turgor, mouth dryness, weight change, urine color or specific gravity, shall NOT be used to assess hydration status in older adults. | A | ||
| Bioelectrical impedance shall NOT be used to assess hydration status in older adults as it has not been shown to be usefully diagnostic | A | ||
| 2 | What interventions may help to support older persons to drink well and prevent low-intake dehydration? | To prevent dehydration in older persons living in residential care, institutions should implement multicomponent strategies across their institutions for all residents | B |
| These strategies should include high availability of drinks, varied choice of drinks, frequent offering of drinks, staff awareness of the need for adequate fluid intake, staff support for drinking and staff support in taking older adults to the toilet quickly and when they need it. | B | ||
| Strategies to support adequate fluid intake should be developed including older persons themselves, staff, management, and policymakers | A | ||
| 3 | How much should older people drink each day? | Older women should be offered at least 1.6 L of drinks each day, while older men should be offered at least 2.0 L of drinks each day unless there is a clinical condition that requires different approach | B |
| 4 | What should older people drink each day? | A range of appropriate (i.e., hydrating) drinks should be offered to older people according to their preferences | B |
* See details for grades of recommendation in [4]. § ESPEN guideline contain two more evidence-based recommendations regarding treatment of low-intake dehydration (recommendation 72 and 73). The recommendation is to offer subcutaneous or intravenous fluids. As this is often not feasible outside the hospital, these two recommendations are not included.