Rehabilitation of the Geriatric Dialysis Patient

Abstract

Dialysis is offered to patients with end-stage renal disease as a life-sustaining therapy. However, studies have shown that elderly patients experience high rates of functional disability, hospitalization, institutionalization, and mortality on chronic dialysis therapy, and that the initiation of dialysis is in fact associated with an acceleration in functional decline. These findings have sparked debate about the utility of dialysis for elderly renal patients. In this article, it is proposed that geriatric rehabilitation can prevent, reverse or delay the onset of functional disability and associated adverse outcomes in older dialysis patients, and thus should be incorporated routinely into standard geriatric dialysis care. We outline the causes of disability in elderly dialysis patients, and demonstrate the potential impact of rehabilitation using a case scenario. Models of rehabilitation that have been shown to be effective in improving outcomes for elderly renal and nonrenal populations, including inpatient rehabilitation, exercise training, falls prevention, and home-based models, are reviewed.

Geriatric Assessment in Elderly Patients with End-Stage Kidney Disease

“…Second, the identification of geriatric impairments may guide preventive interventions. For instance, when functional impairment, malnutrition or accidental falling are present, it could ini- tiate rehabilitation, nutritional interventions and fall prevention programs, which could potentially improve health outcomes and/or quality of life [46][47][48][49]. Furthermore, early recognition of cognitive impairment allows for diagnosis and appropriate treatment, education, and psychosocial support.…”

Optimising Treatment of End-Stage Renal Disease in the Elderly

“…Appropriate multidisciplinary symptom management can lead to preservation of functional ability and also avoid unnecessarily early dialysis initiation for non-uraemic symptomatology [27,30]. Individualised nutritional and dietetic interventions coupled with physiotherapy regimes may lead to better functional status and core strength over time, reduce the incidence of falls and improve well-being in a particularly vulnerable group of people [31,32]. Although there are no trial data to support the use of such preparatory interventions, achieving an optimal physical and psychological state may influence the timing of dialysis initiation especially in the frail elderly who stand to benefit the most.…”

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

“…A key component of the medical assessment, done if possible in collaboration with a trained pharmacist, is to evaluate each medication and its need, placing a particularly high emphasis on the immediate benefits vs long-term benefits; the impact of subtle or 'unimportant' side effects such as constipation or dizziness; as well as considering any potential negative effects on other medical conditions. Multidisciplinary healthcare workers use the findings of the CGA to create a care plan that maximizes the functional and/or cognitive abilities of older individuals and provide support for the areas that are deficient, thus allowing them to remain in their home setting as long as possible (19).…”