Should the elderly be denied dialysis?

Oreopoulos, Dimitrios G.

doi:10.1007/bf01436045

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…The financial restrictions on dialysis resources have a powerful impact on patient selection; when the health care resources become limited, the elderly are one of the first groups to be considered expendable. In an interesting paper, Oreopoulos [20] made a convincing argument for the right and the necessity of dialyzing elderly ESRD patients. Shahid et al [21] in the UK did an elegant study of 292 dialysis patients who they followed for 4 years, with the objectives of determining those factors that influenced survival and the need for hospitalization and defining the potential basis for rationing access to renal replacement therapy.…”

Section: Ethical Issuesmentioning

confidence: 99%

Quality of life in the elderly patients on dialysis

Apostolou

2007

Int Urol Nephrol

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The pattern of end-stage renal disease (ESRD) has changed significantly with the emerging predominance of elderly patients. Age is no longer seen as a contraindication to dialysis. Based on 2004 data, in the USA, patients aged 45-64 years old comprise the largest portion of the incident population, while patients aged 75 and older have the highest incident rates of ESRD. Mortality is higher among the elderly dialysis patients for whom cardiovascular diseases and infections are the most common causes of death. The quality of life (QoL) of these patients has been found to vary in different investigations, dependent on such factors as the investigator(s), the composition of the study group and the criteria used, among others; however, age was always found one of the major determinants of their QoL. Quality-of-life data suggest that older dialysis patients have similar levels of social functioning and mental health as younger dialysis patients but that their level of physical functioning is poorer. As such, the survival and QoL of elderly patients depends mainly on the severity of the comorbid conditions. The rationing of dialysis on the basis of age alone is not justified as dialysis can provide elderly patients with the means to gain the health status that permits them to enjoy life, but in their own way.

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Section: Ethical Issuesmentioning

confidence: 99%

Quality of life in the elderly patients on dialysis

Apostolou

2007

Int Urol Nephrol

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“…It was written 15 years ago that ''the widespread availability of chronic hemodialysis for the treatment of ESRD in the elderly has become a reality only in the last decade'' (23), and that ''we must make available to the elderly the health care resources they need: anything less is a denial of their equality'' (24). A recent review article suggested that broader access to ESRD care, not the rising incidence of CKD in the elderly, was an important factor in the increase in treated ESRD (2).…”

Section: Increased Accessibilitymentioning

confidence: 99%

Aging and ESRD Demographics: Consequences for the Practice of Dialysis

Williams

Sandeep

Catic

2012

Seminars in Dialysis

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The disproportionate increase in the prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the elderly is now recognized as a national and global reality. Among the major contributing factors are the aging of the population, a growing prevalence of CKD, greater access to care, and increased comorbidities. The utilization of renal replacement therapy in the geriatric population has concomitantly increased. It is imposing enormous challenges to the practice of ESRD care, the largest of which may be to determine the best application of clinical performance targets to a population with limitations in life expectancy. Concurrently, increased focus on quality of life will be required. The effective dialysis practitioner will need to adapt to the aging ESRD demographics with an increased focus on physical and mental well-being of the geriatric patient.

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Elderly patients on dialysis: epidemiology of an epidemic

Piccoli

Mario

Barbara

et al. 1996

Nephrology Dialysis Transplantation

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The increase in the incidence of elderly patients starting dialysis has been as sharp, during the 1980s-1990s, as an epidemic (+70%, +150% in different settings). According to this study, performed in Piemonte, northern Italy, the process is still ongoing. During the period 1981-93, according to the Regional Registry of Dialysis and Transplantation (RPDT: data on 100% of centres and patients), the cohort on treatment increased by 79.5% and the annual incidence by 48.3%; the increase is limited to older people and is greater in males. Nephroangiosclerosis/ischaemic renal disease and diabetes mellitus are the main diagnoses. Since the increase of elderly patients is still ongoing, forecasts are difficult; according to a computer simulation, a plateau of patients on treatment is reached only if incidence is stabilized, While it is impossible to exclude a decrease in hidden selection or an increase in referral, complex modifications at the overall population level are presumably at the basis or the increase of elderly patients on dialysis. Despite the increase in average age, however, survival improved throughout the period; this confirms the interest towards the open dialysis system adopted in Piemonte, which is characterized by easy shifts among treatments and by the widespread use of high tolerance techniques.

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Should the elderly be denied dialysis?

Cited by 3 publications

References 6 publications

Quality of life in the elderly patients on dialysis

Quality of life in the elderly patients on dialysis

Aging and ESRD Demographics: Consequences for the Practice of Dialysis

Elderly patients on dialysis: epidemiology of an epidemic

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