Special considerations of hyponatremia in the elderly patient

Hyponatremia is the most common electrolyte disorder, particularly in older adults. Its high prevalence in this population is driven by underlying conditions such as heart and kidney failure, as well as by factors like polypharmacy and malnutrition. Rising global temperatures have also been linked to increased hyponatremia rates. Chronic hyponatremia is associated with elevated risks of falls, osteoporosis, fractures, cognitive and muscular impairment, and mortality. Despite these adverse outcomes, the condition is often underdiagnosed and undertreated, partly due to the complexity of its evaluation. Simplified, step-by-step diagnostic algorithms in future guidelines may help address this gap. Evidence increasingly supports the clinical benefits of correcting hyponatremia, prompting investigation into novel therapies. Among these, SGLT2 inhibitors and protein supplementation are especially promising, offering efficacy not only in raising plasma sodium but also in providing broader health benefits. This review explores the impact of hyponatremia in the elderly, summarizes its leading causes, and evaluates diagnostic strategies alongside the advantages and limitations of current treatment options.