MC Faes, MD, MSc, Department of Geriatric Medicine, University Medical Centre Nijmegen, The Netherlands.
MG Spigt, PhD, Department of General Practice/Research Institute CAPHRI, University of Maastricht, The Netherlands.
MGM Olde Rikkert MD, PhD, Department of Geriatric Medicine, University Medical Centre Nijmegen, The Netherlands.

Homeostasis of fluid balance is an important prerequisite for healthy aging. The high prevalence of disturbances of fluid balance among older adult patients has triggered clinical research on age- and disease-related changes in water homeostasis. Empirical findings on risk factors of dehydration and on diagnostic and therapeutic strategies are reviewed in this paper. No single measure has proved to be the gold standard in the diagnosis of dehydration. Diagnosing dehydration and monitoring fluid balance requires repeated measurements of weight, creatinine, and physical signs such as tongue hydration. Rehydration and prevention requires fluid on prescription (> 1.5 litre/day), and the route of fluid administration depends on the acuteness and severity of clinical signs.
Keywords: older adults, dehydration, fluid therapy, risk factors, diagnosis.

Sudeep Gill, MD and
Paula A. Rochon, MD MPH FRCPC
Baycrest Centre for Geriatric Care.

One of the goals of long-term care is to provide the patient with an appropriate level of care without unnecessarily disrupting his or her comfort and living situation. Older long-term care residents often suffer from acute intercurrent illnesses for which fluid replacement is an important component of treatment. If intravenous (IV) fluid replacement is not possible in these frail seniors, either because of regulations or due to staffing issues in the long-term care facility, it is often necessary to transfer them to an acute-care hospital setting.

In the institutionalized older patient, hypodermoclysis, which is the subcutaneous infusion of fluids, is an attractive alternative to the use of intravenous therapy for fluid replacement. It is a method that has been used since near the turn of the century. Although it has been employed with success for years at the Baycrest Centre for Geriatric Care, and a few other institutions, it remains under-recognized and underutilized as a valuable method for the management of mild to moderate dehydration in the long-term care setting.