Background and objective The prevalence of hyponatremia is estimated to be significantly higher in the geriatric age group compared to non-geriatric patients. The clinical symptoms of hyponatremia are often subtle and interpreted as age-related in geriatric patients. In this study, we aimed to perform the baseline comprehensive geriatric assessment (CGA) among a group of geriatric population with hyponatremia. Methods We utilized four simple CGA parameters: the Hindi Mental State Examination (HMSE) to assess the cognition, the Barthel Index for Activities of Daily Living (ADL) for assessing the level of independence, the Timed Up and Go (TUG) test for risk of fall evaluation, and handgrip (HG) strength by hand dynamometer for frailty. All CGA parameters were analyzed at admission among 100 geriatric patients (>60 years old), and an assessment of their relationship with the severity of hyponatremia was done. An equal number of age-, comorbidity-, and reason for acute presentation-matched hyponatremic patients were enrolled as controls. The student's t-test and analysis of variance (ANOVA) were used for evaluation. Ethical clearance was obtained from the Institutional Ethics Committee, All India Institute of Medical Sciences, Rishikesh, and informed consent from patients or next of kin was taken before enrollment. Results The mean age of the study population was 68.1 ± 5.8 years, with a male-to-female ratio of 3:1. All CGA parameters tested showed lower values among hyponatremic patients compared to normonatremic patients, although only ADL (71.6 ± 12.3 vs. 76.7 ± 11.5, p=0.001) and HMSE (23.4 ± 3.1 vs. 24.4 ± 2.4, p=0.01) were statistically significant. All parameters were found to be worse in the severe group compared to moderate and mild groups, but significance was found only for TUG (17.9 ± 3.4 vs. 16.4 ± 4.2 vs. 14.6 ± 3.5, p=0.003, with higher values indicating worse status) and HMSE (21.1 ± 4.0 vs. 22.6 ± 2.8 vs. 24.1 ± 2.5, p=0.0007). Conclusion Based on our findings, hyponatremic patients have poor baseline CGA parameter values, and the severity of hyponatremia correlates with poor motor and cognitive functions. Hence, the prompt recognition and correction of hyponatremia should be prioritized in the elderly as both these parameters significantly impact the quality of life in this population. As the severity of hyponatremia increases, the elderly tend to have a higher incidence of the two main geriatric giants: impaired cognition and falls.
Keywords: barthel’s index of activities of daily living; cognition; frailty; hindi mental state examination; hmse; hyponatremia; timed up and go test.
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