Geriatric Assessment, Falls and Rehabilitation in Patients Starting or Established on Peritoneal Dialysis

Abstract

Individuals aged over 70 years at the time of starting dialysis have a varied and often challenging existence on dialysis. Canadian data suggest those starting dialysis between the ages of 75 and 79 years will have an average life expectancy of 3.2 years, while based on US data, patients can expect an average life expectancy of 25 months. A substantial proportion of these patients will, however, experience transient or permanent loss of personal independence within the first few months to years on dialysis. Preliminary data from patients recently started on peritoneal dialysis (PD) suggest patients and families adapt, but that the adaptation often involves limiting activities and altering the social role the patient has within the family. As data emerge, it will be possible to hypothesize whether this adaptation is beneficial in the long term, or whether these adaptations are permissive, allowing the patient to play a sick role leading to an accelerated transition to frailty and possibly death. Future research will hopefully inform us whether the functional dependency can be identified early and whether it is preventable. In the interim, repair rather than prevention is possible through rehabilitation. We therefore advocate that programs providing PD care consider the integration of protocols whereby patients may undergo formal evaluation to identify those who would benefit from walking or personal care aids, rehabilitation interventions, and, when needed, personal support.

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

“…In addition, the predictive value of a GA itself has not been assessed so far, and this should be subject of additional research. Currently, there is no consensus on which domains a GA should comprise (6,52). In addition to the items discussed in this review, comorbidity burden and social status may be of added value when focusing on risk assessment, because both are associated with mortality.…”

“…However, for social status, this was assessed in the prevalent population only (53). A GA focusing on rehabilitation may additionally include geriatric syndromes, such as delirium, incontinence, constipation, osteoporosis, and sensory deficits, because these issues may be amenable to interventions that could potentially improve quality of life (52).…”

Is It Correct to Use a Unique Conventional Dialysis Prescription in the Elderly? Four Alternative Schedules for Dialyzing Elderly Patients

“…The treatment of frailty requires interdisciplinary interventions, including team member nurses, occupational therapists, physiotherapists, physicians, psychologists, phar macists, speech therapists and social workers [6,25]. Frailty therapeutic strategies are based on the prescription of rehabilitation, low-intensity resistance and aerobic exercise, adequate caloric and protein intake, vitamin supplementation and avoidance of polypharmacy [6,25].…”

“…Rehabilitation is a process by which form and function are restored following injury or illness, such that life can be lived to the fullest capacity compatible with the degree of abilities and disabilities. Rehabilitation can be performed in the home, as an outpatient or as an inpatient, depending on patient needs and resources [25]. Exercise has a positive effect on brain, skeletal muscles, immune and endocrine systems, as well as it improves patient's mobility and functional ability.…”

“…Exercise has a positive effect on brain, skeletal muscles, immune and endocrine systems, as well as it improves patient's mobility and functional ability. Exercise can be safely implemented in endstage renal disease patients and combined aerobic and resistance exercise, administered in the dialysis facility or outside of dialysis, have resulted in improvements in physical function [25,26]. However, the extent to which this greater degree of improvement in aerobic capacity translates to survival benefit is unclear.…”