1) A study examined how hydration status affects quality of life in elderly residents of care facilities. It found that poorer scores on indicators of hydration, falls, and depression were most strongly associated with lower quality of life, suggesting these are key areas for clinical management. 2) A review of data from a 2003 European heat wave found it resulted in over 15,000 excess deaths, with mortality highest in the elderly, women, and those living alone. Deaths from dehydration and heat-related causes increased significantly. Maintaining hydration may help reduce risks. 3) A French study evaluated the impact of public health initiatives after the 2003 heat wave aimed at encouraging hydration. It found shifts in

1.
Hydration Scientific Library (Volume 1)
Index
• Is hydration associated with quality of life?
• Hot weather is not always good news
• Prevention policy initiatives aimed at encouraging euhydration
may have an impact on the health of elderly people
• How hydration status affects the diuretic effect of beer

2. 3. EHI Update: May 2010
· HYDRATION SCIENTIFIC LIBRARY
A decline in both physical and mental capacity is an inevitable part of the
aging process and this has implications for Quality of Life (QoL) in the
elderly. Those in residential care, either for medical reasons or because
of the absence of family carers, may be especially vulnerable. This study
assessed the relationship between clinical care indicators (CCI) and QoL
in 82 residents of four Australian residential care facilities. Standard
analytical tools were used for CCI, covering 23 different areas of care,
and QoL, which was assessed as a profile of six domains (physical,
psychological, independence, social relationships, environmental, and
spiritual).
The study found, perhaps not surprisingly, that poorer scores in the
clinical care indicators adversely influenced QoL. All QoL domains
were affected to some degree, with the greatest impact on the social
and spiritual domains. Poorer status in hydration, falls and depression
were the three factors most strongly associated with lower QoL scores,
suggesting those three indicators could represent key areas for clinical
management in residential aged care.
It is important to recognise that this study does not show that improving
the quality of care in these three areas will necessarily improve the
quality of life of the elderly living in care. However, improving hydration
status does seem to be a low cost intervention that deserves further
investigation.
Courtney M, M O’Reilly, H Edwards, S Hassall (2009). The relationship
between clinical outcomes and quality of life for residents of aged care
facilities. Australian Journal of Advanced Nursing 26, 49-57
It is important to
recognise that this study
does not show that
improving the quality
of care in these three
areas will necessarily
improve the quality
of life of the elderly
living in care. However,
improving hydration
status does seem to be
a low cost intervention
that deserves further
investigation.
IS HYDRATION ASSOCIATED
WITH QUALITY OF LIFE?
a review by Ronald J. Maughan - Chairman of the Science Advisory Board
www.europeanhydrationinstitute.org

3. 3. EHI Update: July 2010
· HYDRATION SCIENTIFIC LIBRARY
With the arrival of another European summer and the prospect of warm
weather conditions it may be wise to reflect on the impact that environmental
heat waves can have on the health and wellbeing of the population. Scientific
findings from data collected during the summer of 2003 give good insight
into potential problems that can occur. Between the 1st and 20th of August
2003, the mean maximum temperature in France exceeded the seasonal
norm by 11–12°C on nine consecutive days. The number of deaths observed
from August to November 2003 was compared to the number expected on the
basis of the mortality rates observed from the years 2000 to 2002 and the 2003
population estimates.
The study found that from August 1st to 20th 2003, 15,000 excess deaths were
observed and from the age of 35 years, the excess mortality was marked and
showed an increase with increasing age. There was also a 15% higher mortality
in women than in men of comparable age. Excess mortality occurring at home
and in retirement institutions was greater than that occurring in hospitals and
the mortality of widowed, single and divorced subjects was greater than that
of married people. It is of interest to note that deaths directly related to heat,
heatstroke, hyperthermia and dehydration increased massively, but there
was also an increase in the number of deaths from causes that might not
seem to be directly related to the heat. Similar patterns were observed in
several other European countries.
It is important to recognise that while the elderly and people living alone
are particularly vulnerable to heat waves, no group in the population may be
considered completely protected from the risks associated with heat waves,
and there was a higher than expected number of fatalities even in the young
and apparently healthy. Whilst there are many aspects of warm weather
conditions that we cannot control, some simple precautions may reduce
the risk of adverse events. Maintaining an appropriate hydration status and
making use of cool indoor environments are two such behaviours that should
be considered.
A. Fouillet, G. Rey, F. Laurent, G. Pavillon, S. Bellec, C. Guihenneuc-Jouyaux,
J. Clavel, E. Jougla, D. Hémon (2006), Excess mortality related to the August
2003 heat wave in France. Int Arch Occup Environ Health 80: 16–24
It is of interest to note
that deaths directly
related to heat,
heatstroke, hyperthermia
and dehydration
increased massively,
but there was also an
increase in the number
of deaths from causes
that might not seem to
be directly related to the
heat.
Hot weather is not always
good news
Dr. Susan Shirreffs
www.europeanhydrationinstitute.org

4. 3. EHI Update: October 2010
Data collected after the heat wave occurring in France
in August of 2003 showed that elderly people are mostly
vulnerable to environmental heat stress; an excess
mortality of 55% was observed in comparison to 2000-
2002 in France, 79% of which involved subjects aged 75
and over.
Behavioural changes aimed at encouraging euhydration,
particularly during heat waves, were promoted by the
“National heat wave response plan”, issued by the
French government in 2004: environmental conditions
are monitored and, during heat waves, drinking of still
water and protection from sun and heat are advised,
while local and national public services are mobilized to
prevent health consequences.
The objective of a recent study was to evaluate the impact
of behavioural changes proposed by the “National
heat wave response plan” on the hydration status
of elderly citizens in France. Administrative data on
23,022 inpatients aged over 70 years admitted between
2000 and 2006 at Hôpital Saint Antoine, Paris, France,
provided information on vital status at discharge,
Charlson comorbidity scores and blood tests within the
first 24 h after admission. Plasma tonicity and blood
urea nitrogen/creatine (BUNC) ratio were matched with
daily temperatures before admission and in-hospital
mortality, thus allowing the evaluation of changes in
hydration profiles and in-hospital mortality 3 years
before and after the 2003 heat wave.
The main study results showed that, after adjusting
for gender, age, Charlson comorbidity index and daily
temperatures, the risk of having plasma tonicity higher
than 300 mOsm/l, a value reflecting body water deficit,
had increased in 2003 and decreased in 2004-2006,
with reference to 2000-2002. However, the risk of
having plasma tonicity lower than 275 mOsm/l, a value
reflecting body water excess, increased in 2004-2006.
Unexpectedly, the risk of having BUNC ratio>100, a value
reflecting reduced systemic perfusion, had decreased in
2003 and was even lower in 2004-2006, but BUNC may be
a marker of low specificity for extracellular dehydration.
Mortality risk did not vary between these periods, when
associated with plasma tonicity <275 or >300 mOsm/l
but was lower in 2003 when associated with BUNC
ratio>100. These results suggest shifts in hydration
profiles through and after the 2003 heat wave that may
be attributed to adoption of advice from the “National
heat wave response plan”.
The study shows that prevention policy initiatives aiming
to encourage euhydration may have a positive impact on
the health of elderly people. Consequently it encourages
further exploitation of the impact of hydration tips issued
by various bodies which promote hydration from various
foods and drinks in addition to still water.
Eur J Epidemiol (2010) 25:517–524 The 2003 heat wave
in France: hydration status changes in older inpatients
A. Kettaneh, L. Fardet, N. Mario, A. Retbi m N. Taright, K.
Tiev, I. Reinhard, B. Guidet, J. Cabane
PREVENTION POLICY INITIATIVES AIMED
AT ENCOURAGING EUHYDRATION MAY
HAVE AN IMPACT ON THE HEALTH OF
ELDERLY PEOPLE.
Asst. Prof. Maria Kapsokefalou
www.europeanhydrationinstitute.org
HYDRATION SCIENTIFIC LIBRARY

5. 3. EHI Update: December 2010
It is well known that alcohol has an
acute diuretic effect. In fact there is
an increase in urine output during
the first three hours after consuming
an alcoholic beverage, but six hours
after ingestion, the antidiuretic effects
start and these can last up to 12 hours
after consuming the drink. This effect
is possibly due to the suppression
of vasopressin. However, some
authors argue that the consumption
of alcoholic beverages such as beer
may be useful in the rehydration of the
athlete or worker after a prolonged
physical effort.
The aim of this research from Hobson
& Maughan was to analyze the effect
of a small dose of alcohol intake on
urine production in both euhydrated
and hypohydrated individuals in order
to further the understanding of the
effects of alcohol consumption in
different physiological states. Twelve
males completed an intermittent
protocol that initially produced a
dehydration of near 2% of the body
mass. The experiment was repeated
twice, once after rehydrating them
and the second time remaining
hypohydrated. The day after, one
litre of beer (regular -4% alcohol- or
alcohol free) was given to the group
on two different occasions, and
participants remained in the unit for a
4 hour monitoring period for urine and
blood collections.
The volume of urine was higher after
alcohol intake only in euhydrated
subjects: alcohol did not cause a
significant diuresis when the subjects
were hypohydrated.
The results from Hobson and
Maughan suggest that when the
body is hypohydrated the diuretic
action of alcohol is blunted in an
attempt to restore fluid balance. The
great variability in urine volumes
produced after a single dose of
alcoholic beverages may suggest a
potential phenotype response as well
as a certain habituation in regular
consumers compared with non-
consumers or occasional ones.
Hobson RM, Maughan RJ. Hydration
status and the diuretic action of a
small dose of alcohol. Alcohol &
Alcoholism, 2010; 45: 366-373.
The results from Hobson
and Maughan suggest
that the diuretic action of
alcohol is blunted when the
body is hypohydrated in
an attempt to restore fluid
balance.
HOW HYDRATION STATUS
AFFECTS THE DIURETIC
EFFECT OF BEER
A review by Prof. Dr. Lluis Serra-Majem
www.europeanhydrationinstitute.org
HYDRATION SCIENTIFIC LIBRARY

6.
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