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Dehydration and diuretic use are common in older patients presenting with falls, particularly amongst the frail (350)

Alexander N Bennett 1 2 , Mark J Gillett 2 3 , Danijela Gnjidic 1 2 4 , Peter R Carroll 2 5 , Slade T Matthews 5 , Sarah N Hilmer 1 2
  1. Ageing and pharmacology, University of Sydney, St. Leonards, NSW, Australia
  2. Northern Clinical School, University of Sydney, St. Leonards, NSW, Australia
  3. Emergency, Royal North Shore Hospital, St Leonards, NSW, Australia
  4. Faculty of pharmacy, University of Sydney, Sydney, NSW, Australia
  5. Pharmacology, University of Sydney, Sydney, NSW, Australia

Introduction. In older people, falls are caused by the interaction of multiple predisposing risk factors. Medication effects are common potentially preventable or reversible causes of falls. Dehydration also contributes to the risk of falls, and may be precipitated by diuretic use. The coexistence of dehydration and diuretics in robust and frail hospitalised fallers has not been documented.
Aims. To measure the prevalence of dehydration and diuretic use in robust and frail older patients presenting with falls.
Methods. Patients ≥60 years admitted with a fall were recruited from a Sydney teaching hospital. Demographic, clinical, medication and falls data were collected at admission. Dehydration was defined as serum sodium concentration >145 mEq/L or serum urea:creatinine ratio >100. Diuretic exposure was defined as prescription of loop, thiazide or potassium sparing diuretics immediately prior to admission. The Reported Edmonton Frailty Scale assessed frailty.
Results. 204 (103 frail, 101 robust) participants were recruited with a mean age of 81 (± 8.3) years; 65% were female. Compared to robust, frail older fallers were more likely to use diuretics (34% frail, 14% robust; p=0.001), to be dehydrated (20%, 7%; p=0.001) and to have both diuretic use and dehydration (13%, 3%; p=0.01). In those who were dehydrated, diuretic use was significantly more common in the total (diuretic users 33%, non-diuretic users 7%; p<0.0001), frail (37%, 10%; p=0.001) and robust (21%, 5%; p=0.02) participants.
Discussion. Dehydration, potentially exacerbated by diuretic use, is common amongst older patients, particularly the frail, admitted after a fall. Diuretic use is a potentially reversible iatrogenic risk factor for falls in older people and should be reviewed frequently, especially in the frail.