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Elderly patients are prone to hypovolemia for the following two major reasons:
1. They have a decreased thirst response.
2. They have decreased renal vasopressin response to hypovolemia.
The result is that elderly patients have an impaired ability to compensate for a decreased cardiac output, which causes them to develop shock earlier and more easily with stressor.
Takeaway point: Always assume that most elderly patients are hypovolemic, and when they are stressed, give them fluids early!