Signs and symptoms of low-intake dehydration do not work in older care home residents - DRIE diagnostic accuracy study

Bunn, Diane and Hooper, Lee (2019) Signs and symptoms of low-intake dehydration do not work in older care home residents - DRIE diagnostic accuracy study. Journal of the American Medical Directors Association. ISSN 1525-8610

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              Abstract

              Objectives: To assess the diagnostic accuracy of commonly-used signs and symptoms of low-intake dehydration in older care home residents. Design: Prospective diagnostic accuracy study. Setting: 56 care homes offering residential, nursing and/or dementia care to older adults in Norfolk and Suffolk, UK. Participants: 188 consecutively recruited care home residents aged ≥65 years, without cardiac or renal failure and not receiving palliative care. 66% female, mean age 85.7 years (SD:7.8), median MMSE score 23 (IQR:18-26). Index tests: Over 2 hours, participants underwent double-blind assessment of 49 signs and symptoms of dehydration and measurement of serum osmolality from a venous blood sample. Signs and symptoms included skin turgor, mouth, skin and axillary dryness, capillary refill, sunken eyes, blood pressure on resting and after standing, body temperature, pulse rate, self-reported feelings of thirst and wellbeing. Reference standard: Serum osmolality, with current dehydration defined as >300mOsm/kg, and impending dehydration ≥295mOsm/kg. Outcome measures: For dichotomous tests, we aimed for sensitivity and specificity >70% and for continuous tests, an area under the curve (AUC) in receiver operating characteristic (ROC) plots, of >0.7. Results: Although 20% of residents had current low-intake dehydration and a further 28% impending dehydration, none of the commonly-used clinical signs and symptoms usefully discriminated between participants with or without low-intake dehydration at either cut-off. Conclusions/implications: This study consolidates evidence that commonly used signs and symptoms of dehydration lack even basic levels of diagnostic accuracy in older adults, implying that many who are dehydrated are not being identified, thus compromising their health and wellbeing. We suggest these tests are withdrawn from practice and replaced with a two-stage screening process, whereby serum osmolarity, calculated from sodium, potassium, urea and glucose (assessed routinely using the Khajuria and Krahn equation) should be instituted, followed by serum osmolality measurement for those identified as high risk (calculated serum osmolarity >295mmol/L).

              Item Type: Article
              Uncontrolled Keywords: aged,dehydration,osmolar concentration,sensitivity and specificity,drinking,diagnosis,health professions(all),medicine(all),nursing(all) ,/dk/atira/pure/subjectarea/asjc/3600
              Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
              Faculty of Medicine and Health Sciences > Norwich Medical School
              Depositing User: LivePure Connector
              Date Deposited: 18 Jan 2019 10:30
              Last Modified: 09 Apr 2019 14:05
              URI: https://ueaeprints.uea.ac.uk/id/eprint/69610
              DOI: 10.1016/j.jamda.2019.01.122

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