Diarrhea and ypovolemia in older individuals

PURPOSE: To review the risks associated with diarrhea and hypovolemia in the older US population, and discuss how and why to administer oral rehydration therapy (ORT) for this group. EPIDEMIOLOGY: Older patients are involved in 26% of hospitalizations for diarrhea in the United States and 51% to 85% of diarrheal deaths. REVIEW SUMMARY: Certain risk factors for diarrhea are more common in older than in younger adults, including institutional exposure to infectious agents, diminished host defenses, and increased use of antimicrobials and other diarrhea-inducing medications. Compared with their younger counterparts, older adults are less likely to be able to compensate for hypovolemia from diarrhea, placing them at a greater risk of cardiovascular, cerebral, and renal complications. ORT usually can be initiated by patients themselves without waiting for a diagnostic evaluation. With the exception of Clostridium difficile infection, antibiotics are of marginal value in treating diarrheas and pose a risk of exacerbating postantibiotic diarrhea. Early feeding with complex carbohydrates (eg, banana, rice, or cereal) is indicated. Antimotility drugs are contraindicated for diarrhea because of the presence of invasive organisms, but preparations containing bismuth subsalicylate often are helpful in stopping diarrhea. TYPE OF AVAILABLE EVIDENCE: Prospective cohort studies, systematic reviews, and meta-analyses. GRADE OF AVAILABLE EVIDENCE: Good. CONCLUSION: ORT is a simple, inexpensive, science-based treatment for volume depletion resulting from diarrhea. It is likely to be as effective in older adults as in young children, and it is as applicable in the United States-given the need to contain healtncare costs-as in developing countries that often lack basic facilities for intravenous therapy.