Low-intake dehydration prevalence in non-hospitalised older adults: Systematic review and meta-analysis

Parkinson, Ellice ORCID: https://orcid.org/0000-0002-0226-4099, Hooper, Lee ORCID: https://orcid.org/0000-0002-7904-3331, Fynn, Judith, Howard Wilsher, Stephanie ORCID: https://orcid.org/0000-0002-3060-3270, Oladosu, Titilopemi ORCID: https://orcid.org/0000-0001-8492-0960, Poland, Fiona ORCID: https://orcid.org/0000-0003-0003-6911, Roberts, Simone, Van Hout, Elien ORCID: https://orcid.org/0000-0002-2956-7575 and Bunn, Diane (2023) Low-intake dehydration prevalence in non-hospitalised older adults: Systematic review and meta-analysis. Clinical Nutrition, 42 (8). pp. 1510-1520. ISSN 0261-5614

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Abstract

Background and Aims: Low-intake dehydration amongst older people, caused by insufficient fluid intake, is associated with mortality, multiple long-term health conditions and hospitalisation. The prevalence of low-intake dehydration in older adults, and which groups are most at-risk, is unclear. We conducted a high-quality systematic review and meta-analysis, implementing an innovative methodology, to establish the prevalence of low-intake dehydration in older people (PROSPERO registration: CRD42021241252).   Method: We systematically searched Medline (Ovid), Cochrane CENTRAL, Embase (Ovid), CINAHL and Proquest from inception until April 2023 and Nutrition and Food Sciences until March 2021. We included studies that assessed hydration status for non-hospitalised participants aged ≥65 years, by directly-measured serum/plasma osmolality, calculated serum/plasma osmolarity and/or 24-hour oral fluid intake. Inclusion, data extraction and risk of bias assessment was carried out independently in duplicate.   Results: From 11,077 titles and abstracts, we included 61 (22,398 participants), including 44 in quality-effects meta-analysis.   Meta-analysis suggested that 24% (95% CI: 0.07, 0.46) of older people were dehydrated (assessed using directly-measured osmolality >300mOsm/kg, the most reliable measure). Subgroup analyses indicated that both long-term care residents (34%, 95% CI: 0.09, 0.61) and community-dwelling older adults (19%, 95% CI: 0.00, 0.48) were highly likely to be dehydrated. Those with more pre-existing illnesses (37%, 95% CI: 0.14, 0.62) had higher low-intake dehydration prevalence than others (15%, 95% CI: 0.00, 0.43), and there was a non-significant suggestion that those with renal impairment (42%, 95% CI: 0.23, 0.61) were more likely to be dehydrated than others (23%, 95% CI: 0.03, 0.47), but there were no clear differences in prevalence by age, sex, functional, cognitive or diabetic status. GRADE quality of evidence was low as to the exact prevalence due to high levels of heterogeneity between studies.   Conclusion: Quality-effects meta-analysis estimated that a quarter of non-hospitalised older people were dehydrated. Widely varying prevalence rates in individual studies, from both long-term care and community groups, highlight that dehydration is preventable amongst older people.   Implications: One in every 4 older adults has low-intake dehydration. As dehydration is serious and prevalent, research is needed to better understand drinking behaviour and assess effectiveness of drinking interventions for older people.

Item Type: Article
Additional Information: Funding information: Ellice Parkinson (UEA) is supported by the National Institute for Health and Social Care Research (NIHR) Applied Research Collaboration East of England (NIHR ARC EoE) at Cambridge and Peterborough NHS Foundation Trust. The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care. Ellice Parkinson’s PhD programme is also supported by funding from the University of East Anglia and South Norfolk and Suffolk CCG.
Uncontrolled Keywords: aged,dehydration,dementia,geriatrics,prevalence,systematic review,critical care and intensive care medicine,nutrition and dietetics,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2706
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Institute for Volunteering Research
Faculty of Medicine and Health Sciences > Research Groups > Health Promotion
Faculty of Medicine and Health Sciences > Research Groups > Dementia & Complexity in Later Life
Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging
Faculty of Medicine and Health Sciences > Research Groups > UEA Hydrate Group
Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023)
Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care
Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Faculty of Social Sciences > Research Centres > Water Security Research Centre
Faculty of Medicine and Health Sciences > Research Centres > Population Health
Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 12 Jun 2023 13:31
Last Modified: 06 May 2024 01:27
URI: https://ueaeprints.uea.ac.uk/id/eprint/92364
DOI: 10.1016/j.clnu.2023.06.010

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