Clinical indicators of dehydration severity in elderly patients

Study Objective: To determine which of the signs and symptoms of dehydration obtainable from patient history and physical examination in the emergency department are most useful in assessing the severity of dehydration in elderly patients. Design: Prospective, correlational study. Setting: Two university teaching hospitals. Patients: Fifty-five patients aged 60 or older presenting to the emergency department with suspected dehydration were studied. Measurements and Main Results: In the emergency department, patients were evaluated by a standardized history and physical examination that included assessment of 38 signs and symptoms commonly attributed to dehydration. The relationships between the presence and intensity of these putative dehydration indicators and an independent rating of dehydration severity based on a comprehensive review of the medical record were evaluated. Also evaluated were the relationships between these dehydration indicators and patient age. Indicators that correlated best with dehydration severity but were unrelated to patient age included: tongue dryness (P < 0.001), longitudinal tongue furrows (P < 0.001), dryness of the mucous membranes of the mouth (P < 0.001), upper body muscle weakness (P < 0.001), confusion (P < 0.001), speech difficulty (P < 0.01), and sunkenness of eyes (P < 0.01). Other indicators had only weak associations with dehydration severity or were also related to age. Patient thirst was unrelated to dehydration severity. Conclusions: A set of signs and symptoms related to dehydration severity in elderly patients has been identified. These indicators may be more useful for evaluation of dehydration severity in the emergency department than other commonly used indicators.