Hydration Status in Geriatric Patients-Subjective Impression or Objective Parameter? The Hydr-Age-Study.

Area of Science:

• Geriatric Medicine
• Diagnostic Accuracy
• Hydration Status Assessment

Background:

• Assessing hydration status in geriatric patients is challenging due to multimorbidity, polypharmacy, and cognitive impairment.
• Traditional indicators like skin turgor and mucous membrane moisture are unreliable in older adults.

Purpose of the Study:

• To evaluate the diagnostic accuracy of various clinical, laboratory, and instrumental methods for assessing hydration status in hospitalized older adults.
• To identify reliable indicators for hypohydration and hyperhydration in the geriatric population.

Main Methods:

• Prospective observational pilot study (Hydr-Age-Study) with post hoc analysis.
• Inclusion of medical history, clinical evaluation, laboratory tests, ultrasound, and bioimpedance analysis upon admission.
• Establishment of a clinical reference standard through expert consensus for evaluating diagnostic accuracy.

Main Results:

• Four out of twenty-six examined methods achieved an Area Under the Curve (AUC) > 0.8.
• Axillary dryness showed high accuracy for hypohydration (AUC = 0.854), with 83.3% sensitivity and 82.8% specificity.
• Inferior vena cava (IVC) ultrasound effectively detected both hypo- and hyperhydration, with specific diameter thresholds indicating dehydration or fluid overload.

Conclusions:

• Axillary dryness and IVC sonography are highly accurate methods for assessing hydration status in older adults.
• A structured clinical consensus serves as a feasible reference standard in the absence of a gold standard.
• Findings support the development of standardized hydration assessment protocols in geriatric medicine.