Management of Dehydration in Elderly Patients

Electrolyte abnormalities and dehydration in elderly patients is relatively easy to treat, but the diagnosis of dehydration considered difficult, due to the lack of supervision and constraints to accurately assess fluid balance. Clinical manifestations of dehydration may include dry skin, decreased skin turgor, and dry mucous membranes. However, reduced skin turgor can also occur due to aging and dry mouth, also can be caused by breathing through the mouth.

Clinical features :

• Dryness of mucous membranes.
• Dry skin.
• Decreased skin turgor.
• Decreased sweating armpits.
• Orthostatic hypotension.
• Tachycardia and hypotension (show shock).
• Cognitive impairment.
• Reduced urine output.
• Concentrated urine and high osmolality.

In addition, patients with cognitive disorders such as dementia have a relatively high incidence of dehydration. Elderly patients with dementia often forget to drink, causing an increase in the incidence of dehydration in this patient population.

Due to a change in the pathophysiology of fluid and electrolyte balance due to aging, elderly patients tend to suffer from dehydration and electrolyte imbalance perioperative. Morbidity that may occur due to salt retention among other cardiorespiratory complications, increased risk of infection, and impaired wound healing. While the disorder can affect fluid balance disturbances in the function of the gastrointestinal (GI).

Fluid therapy to prevent dehydration, especially in elderly patients perioperative emphasis on strict monitoring of fluid balance and serum electrolyte levels, to prevent morbidity due to fluid retention and salt. A meta-analysis showed a decrease of 41% postoperative complications and length of stay in hospital shorter by providing near zero fluid balance method. Several other studies showed colloid bolus administration of small doses (200-250 mL) intraoperative can increase stroke volume and significantly improve clinical outcome.

In conclusion, the treatment of dehydration in elderly patients, particularly perioperative needs monitoring of fluid and electrolyte balance very tight given that there are changes in the pathophysiology of fluid and electrolyte balance in this patient population, such as fluid and salt retention due to the decrease in renal function. Strictly maintain fluid balance can improve the clinical outcome of patients with advanced age, especially during the perioperative.