Diagnosing dehydration in the nursing home: international consensus based on a modified Delphi study

Simone J. C. Paulis*, Irma H. J. Everink, Ruud J. G. Halfens, Christa Lohrmann, Regina Roller Wirnsberger, Adam L. Gordon, Jos M. G. A. Schols

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Web of Science)


Key summary pointsAim To assess which method (or combination of methods) are relevant and feasible to diagnose dehydration in nursing home residents. Findings International experts agreed on the relevance and feasibility of 9 anamnestic items, 8 physical symptoms and 3 blood tests to diagnose dehydration. This resulted in a diagnostic strategy consisting of a suspicion phase (including anamnestic items and physical symptoms) and a confirmation phase (including blood tests). Message This is the first study reaching international consensus about a strategy to diagnose dehydration in the nursing home.

Purpose Even though dehydration is a big problem among nursing home residents, a universally agreed method to diagnose dehydration among nursing home residents is missing. Therefore, this study aimed to establish consensus on a method to diagnose dehydration in this population. Methods Using an international Delphi study, 53 experts (physicians and advanced nurse practitioners) were asked to judge various methods to diagnose dehydration on relevance and feasibility in the nursing home. Based on the methods that gained consensus in the first and second round (>= 75% consensus), a step-by-step diagnostic strategy was developed which was presented to, and judged by, the experts in round three. Results After the first and second round, consensus was reached on nine anamnestic items, eight physical symptoms and three blood tests. In the third round, 24 experts agreed with the developed step-by-step diagnostic strategy as a standard to diagnose dehydration in nursing home residents. Conclusion This is the first study reaching international consensus on a strategy to diagnose dehydration in the nursing home. This strategy comprehends a presumption phase, where anamnestic items and physical symptoms are examined, followed by a confirmation phase with blood tests to confirm the diagnosis of dehydration. Using this strategy, it is important to take the individual characteristics (e.g. co-morbidity) of the resident and its care environment (e.g. ambient temperature) into account.

Original languageEnglish
Pages (from-to)393-402
Number of pages10
JournalEuropean Geriatric Medicine
Issue number3
Publication statusPublished - Jun 2020


  • Expert opinion
  • Diagnostic strategy
  • Anamnesis
  • Physical symptoms
  • Blood tests
  • CARE

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