Ahmed M El-Sharkawy1, Opinder Sahota2, Ron J Maughan3, Dileep N Lobo4. 1. Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre National Institute for Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK. 2. Department of Elderly Medicine, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK. 3. School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK. 4. Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre National Institute for Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK. Electronic address: Dileep.Lobo@nottingham.ac.uk.
Abstract
BACKGROUND & AIMS: Age-related physiological changes predispose even the healthy older adult to fluid and electrolyte abnormalities which can cause morbidity and mortality. The aim of this narrative review is to highlight key aspects of age-related pathophysiological changes that affect fluid and electrolyte balance in older adults and underpin their importance in the perioperative period. METHODS: The Web of Science, MEDLINE, PubMed and Google Scholar databases were searched using key terms for relevant studies published in English on fluid balance in older adults during the 15 years preceding June 2013. Randomised controlled trials and large cohort studies were sought; other studies were used when these were not available. The bibliographies of extracted papers were also searched for relevant articles. RESULTS: Older adults are susceptible to dehydration and electrolyte abnormalities, with causes ranging from physical disability restricting access to fluid intake to iatrogenic causes including polypharmacy and unmonitored diuretic usage. Renal senescence, as well as physical and mental decline, increase this susceptibility. Older adults are also predisposed to water retention and related electrolyte abnormalities, exacerbated at times of physiological stress. Positive fluid balance has been shown to be an independent risk factor for morbidity and mortality in critically ill patients with acute kidney injury. CONCLUSIONS: Age-related pathophysiological changes in the handling of fluid and electrolytes make older adults undergoing surgery a high-risk group and an understanding of these changes will enable better management of fluid and electrolyte therapy in the older adult.
BACKGROUND & AIMS: Age-related physiological changes predispose even the healthy older adult to fluid and electrolyte abnormalities which can cause morbidity and mortality. The aim of this narrative review is to highlight key aspects of age-related pathophysiological changes that affect fluid and electrolyte balance in older adults and underpin their importance in the perioperative period. METHODS: The Web of Science, MEDLINE, PubMed and Google Scholar databases were searched using key terms for relevant studies published in English on fluid balance in older adults during the 15 years preceding June 2013. Randomised controlled trials and large cohort studies were sought; other studies were used when these were not available. The bibliographies of extracted papers were also searched for relevant articles. RESULTS: Older adults are susceptible to dehydration and electrolyte abnormalities, with causes ranging from physical disability restricting access to fluid intake to iatrogenic causes including polypharmacy and unmonitored diuretic usage. Renal senescence, as well as physical and mental decline, increase this susceptibility. Older adults are also predisposed to water retention and related electrolyte abnormalities, exacerbated at times of physiological stress. Positive fluid balance has been shown to be an independent risk factor for morbidity and mortality in critically illpatients with acute kidney injury. CONCLUSIONS: Age-related pathophysiological changes in the handling of fluid and electrolytes make older adults undergoing surgery a high-risk group and an understanding of these changes will enable better management of fluid and electrolyte therapy in the older adult.
Authors: Ahmed M El-Sharkawy; Phillip Watson; Keith R Neal; Olle Ljungqvist; Ron J Maughan; Opinder Sahota; Dileep N Lobo Journal: Age Ageing Date: 2015-08-26 Impact factor: 10.668
Authors: Iftach Sagy; Alina Vodonos; Victor Novack; Boris Rogachev; Yosef S Haviv; Leonid Barski Journal: PLoS One Date: 2016-12-19 Impact factor: 3.240
Authors: Michael P Greenwood; Mingkwan Greenwood; Elena V Romanova; Andre S Mecawi; Alex Paterson; Olivera Sarenac; Nina Japundžić-Žigon; José Antunes-Rodrigues; Julian F R Paton; Jonathan V Sweedler; David Murphy Journal: Neurobiol Aging Date: 2018-01-31 Impact factor: 4.673