Nagae Masaaki, Umegaki Hiroyuki, Komiya Hitoshi, Fujisawa Chisato, Watanabe Kazuhisa, Yamada Yosuke, Miyahara Shuzo
Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Eur Geriatr Med. 2023 Feb;14(1):113-121. doi: 10.1007/s41999-022-00722-5. Epub 2022 Nov 29.
Dehydration is highly prevalent in hospitalized older adults and has been linked to poor outcomes. It is considered a modifiable factor, so early identification and intervention may avoid adverse events and improve quality of life after discharge. Hospital-associated disability (HAD) is known to be a poor prognostic factor and can be categorized into mobility impairment and self-care impairment in setting goals for management. Few studies have directly examined the association between dehydration and HAD and therefore here we examined whether dehydration is a predictor of HAD categorized into mobility and self-care impairment among acute hospitalized older adults.
Patients aged 65 years or older who were admitted to the geriatric ward of an acute hospital were recruited for this prospective cohort study. Estimated serum osmolarity > 300 mOsm/kg was defined as current dehydration. HAD was assessed between baseline and discharge and at 3 months after discharge, and was evaluated separately for mobility and self-care impairments.
In total, 192 patients (mean age, 84.7 years; male, 41.1%; dehydration, 31.3%) were analyzed. The occurrence of HAD was significantly higher in the dehydrated group than in the non-dehydrated group (42.4% vs 26.5%) from baseline to 3 months after discharge. In multiple logistic regression analysis, dehydration was significantly associated with HAD in self-care from baseline to 3 months after discharge (odds ratio, 2.25; 95% confidence interval, 1.03-4.94).
Dehydration could predict the occurrence of HAD in acute hospitalized older adults. A multifaceted approach may be necessary to improve the management of dehydration in these patients.
脱水在住院老年患者中非常普遍，且与不良预后相关。它被认为是一个可改变的因素，因此早期识别和干预可能避免不良事件并改善出院后的生活质量。医院相关残疾（HAD）是已知的不良预后因素，在设定管理目标时可分为行动能力障碍和自我护理障碍。很少有研究直接探讨脱水与HAD之间的关联，因此我们在此研究急性住院老年患者中脱水是否是HAD（分为行动能力和自我护理障碍）的预测因素。
本前瞻性队列研究招募了入住急性医院老年病房的65岁及以上患者。估计血清渗透压>300 mOsm/kg被定义为当前脱水。在基线、出院时和出院后3个月评估HAD，并分别评估行动能力和自我护理障碍。
共分析了192例患者（平均年龄84.7岁；男性占41.1%；脱水患者占31.3%）。从基线到出院后3个月，脱水组HAD的发生率显著高于非脱水组（42.4%对26.5%）。在多因素逻辑回归分析中，从基线到出院后3个月，脱水与自我护理方面的HAD显著相关（比值比为2.25；95%置信区间为1.03 - 4.94）。
脱水可预测急性住院老年患者HAD的发生。可能需要采取多方面的方法来改善这些患者的脱水管理。
