The elderly patient on dialysis: geriatric considerations
The elderly patient on dialysis: geriatric considerations
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DOI：
10.1093/ndt/gft246
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发表时间：
2014-05-01
影响因子：
6.1
通讯作者：
Unruh, Mark
中科院分区：
文献类型：
--
作者：
Singh, Pooja;Germain, Michael J.;Unruh, Mark
老年透析患者人口的迅速增长为提供个性化护理提供了机会。老年透析人群的慢性健康状况负担很重，生活质量下降，死亡风险很高。为了应对这些挑战，这篇综述将建议常规地通过使用预测工具来确定预后，并将这些发现传达给老年患者。成人终末期肾病(ESRD)的预后面临的挑战包括临床判断的主观性、适当预后工具的应用以及与患者和照顾者沟通的结果。我们认为这些对话很少与透析人群发生的原因有三个。首先，以前还没有临床实用的工具来确定接受维持性血液透析(HD)的人死亡风险最高的人。其次，肾脏科医生没有接受过关于预后和临终关怀的培训。第三，除了住院和新诊断的累积之外，没有针对接受透析支持的患者的自然里程碑指南。预后可用于共同决策，以确定护理目标、透析支持的限制或退出透析的参数。随着患有终末期肾病的老年人从肾移植中受益，预后也可以用来决定谁应该转诊给肾移植小组进行评估。对老年人预后的使用可能决定从临终关怀到肾移植等各种方法来优化老年人的幸福感和个性化护理。
The burgeoning population of older dialysis patients presents opportunities to provide personalized care. The older dialysis population has a high burden of chronic health conditions, decrements in quality of life and a high risk of death. In order to address these challenges, this review will recommend routinely establishing prognosis through the use of prediction instruments and communicating these findings to older patients. The challenges to prognosis in adults with end-stage renal disease (ESRD) include the subjective nature of clinical judgment, application of appropriate prognostic tools and communication of findings to patients and caregivers. There are three reasons why we believe these conversations occur infrequently with the dialysis population. First, there have previously been no clinically practical instruments to identify individuals undergoing maintenance hemodialysis (HD) who are at highest risk for death. Second, nephrologists have not been trained to have conversations about prognosis and end-of-life care. Third, other than hospitalizations and accrual of new diagnoses, there are no natural milestone guidelines in place for patients supported by dialysis. The prognosis can be used in shared decision-making to establish goals of care, limits on dialysis support or parameters for withdrawal from dialysis. As older adults with ESRD benefit from kidney transplantation, prognosis can also be used to determine who should be referred for evaluation by a kidney transplant team. The use of prognosis in older adults may determine approaches to optimize well-being and personalize care among older adults ranging from hospice to kidney transplantation.