Mentes et al used the Dehydration Risk Appraisal Checklist (DRAC) to screen elderly adults for risk factors associated with dehydration. Different organizations may have checklists with minor modifications. The authors are from the University of Iowa and Iowa VA Research Consortium.
Patient selection: older adult, typically in a nursing home
Demographic data:
(1) age > 85 years
(2) female gender
(3) abnormal body mass index (BMI < 21 or > 27 kg per square meter)
Comorbid conditions:
(1) dementia, confusion or cognitive impairment
(2) depression
(3) stroke (cerebrovascular accident)
(4) diabetes mellitus
(5) urinary incontinence
(6) major psychiatric disorder
(7) vomiting
(8) renal disease or decreased urine output
(9) cardiac arrhythmia or heart failure
(10) malnutrition
(11) history of dehydration
(12) history of repeated infections
(13) fever or current infection
(14) diarrhea or constipation
(15) restraints
(16) >= 4 chronic health conditions
(17) language or speech difficulties, difficulty communicating
Medications:
(1) laxatives
(2) corticosteroids
(3) ACE inhibitors
(4) diuretics
(5) psychotropic drugs (antipsychotic, antidepressant, anxiolytic)
(6) > 4 medications
Intake behaviors:
(1) needs assistance to eat or drink
(2) difficulty swallowing
(3) forgets to drink
(4) poor eating (less than 50% of food)
(5) receiving intravenous fluid therapy
(6) drools
(7) refuses fluids
(8) fluid intake < 1,500 mL per day
(9) spills fluids
(10) receives tube feedings
(11) spits out food or fluid
(12) holds food or fluid in mouth
(13) fluid restriction or NPO status
Laboratory findings:
(1) urine specific gravity > 1.020
(2) urine color dark yellow
(3) serum BUN to creatinine ratio > 20 or rising BUN while creatinine stable
(4) serum sodium > 150 mmol/L
(5) serum osmolality > 300 mmol per kg water
(6) elevated hematocrit (hemoconcentration)
