Writing in the New York Times this week, Judith Graham examines the role of age in the decision to undergo dialysis treatment—drawing on almost two dozen studies and a handful of experts in the field. Fifty-year-old dialysis treatment questioned. Older patients on dialysis have a significantly shortened life expectancy, compared with healthy peers in their age group, Graham writes.
Their risk of mortality increases even more when they have another chronic condition, such as diabetes, heart disease, or dementia. He adds that dialysis particularly affects patients with ischemic heart disease—the "condition alone is sufficient to negate any potential benefit from dialysis in the elderly.
According to a Mayo study of patients ages 75 and up on dialysis, patients who begin dialysis in the ICU fare especially poorly. Graham writes that the bottom line is that "older patients and their families deserve to understand what they can expect when a physician recommends dialysis. To avoid a scenario where older adults feel pushed into a hasty decision to begin dialysis, physicians should start discussing options early in the course of chronic kidney disease. Arnold, MD, the Leo H.
Criep chair of patient care and director of the Institute for Doctor-Patient Communication at the University of Pittsburgh. I think that nephrologists are more likely to have that conversation these days. Ann Russ, PhD, a medical anthropologist who conducted interviews among renal dialysis unit patients aged 70 and older and their families for several National Institutes of Health projects undertaken with Sharon Kaufman, PhD, at the University of California, San Francisco, describes both dialysis initiated in an emergency situation and, more commonly reported, a passive acceptance of dialysis that contrasts with a proactive choice of these treatments.
Patients who started dialysis in an emergency situation may not have realized they were entering into a permanent life-support therapy. Others who were gradually prepped would often eventually move on to the procedure. It became this question for me: How did that happen? The third type of therapy, nondialytic treatment, is also a valid consideration. For patients who value quality of life much more than quantity of life or who have a poor prognosis even with dialysis, conservative therapy should not be overlooked.
Although dialysis effectively addresses one significant problem, other related difficulties arise. Older patients seem to adapt to those problems better than we healthy people think that they will. Hemodialysis patients may become disheartened by having to spend so many hours away from home, and a lengthy commute to a dialysis clinic can turn a tiring three-hour treatment into an exhausting five- or six-hour ordeal. Physicians caring for these patients build that discussion into their care for their patients with kidney disease.
They were also less likely to die prematurely. Data on 32, dialysis patients at facilities in 12 nations were analyzed in this study, which reflects some country-to-country differences. Professional geriatric care managers are a small but growing professional group that helps older patients navigate and coordinate their own care.
One observation that Bergman has made in some older clients is the avoidance of addressing renal failure problems and treatments. However, he was ambulatory with a walker when he returned home from the hospital and was able to take a cab to the clinic. Once you become dependent on the public venue, you have to have patience. On the other hand, relying on family members for transportation can also become burdensome when dialysis continues for a long time.
Essentially, the success of dialysis often comes down to how patients function after they start dialysis. More than half of older adults who started dialysis died within a year of beginning treatment, according to the research, and nearly one in four succumbed to the disease within a month of doing so.
More than , people in the United States started dialysis in , half of them older than Dialysis, which involves the use of a machine to purify a patient's blood from toxins, is commonly used as a treatment for end-stage kidney disease. For some dialysis is a bridge to kidney transplantation, but the majority of dialysis patients, particularly those who are older, do not get kidney transplants.
The newly reported death rates are almost twice as high as widely cited statistics from government data sources, a finding that suggests physicians and patients may be basing treatment decisions on overly optimistic survival estimates, the researchers said. The results are based on an analysis of a small but representative sample of national outcomes data among Medicare patients, 65 and older, who started receiving dialysis between and The sample included outcomes for such patients.
Of those, 68 were 85 years of age or older, 89 required assistance with daily activities and had four or more major medical problems.
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