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The elderly patient on dialysis: geriatric considerations
Pooja Singh1, Michael J Germain, Lewis Cohen
1Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.
Summary
Older dialysis patients need personalized care. Routinely establishing and communicating prognosis using prediction tools can improve shared decision-making and optimize well-being for elderly individuals with end-stage renal disease.
Area of Science:
- Nephrology
- Geriatrics
- Palliative Care
Background:
- The aging population on dialysis faces significant health challenges, including chronic conditions, reduced quality of life, and high mortality risk.
- Personalized care for older dialysis patients is crucial but hindered by difficulties in prognosis assessment and communication.
Purpose of the Study:
- To recommend the routine establishment and communication of prognosis for older dialysis patients.
- To address challenges in applying prognostic tools and discussing findings with patients and caregivers.
Main Methods:
- This review synthesizes current knowledge on prognosis in end-stage renal disease (ESRD).
- It identifies barriers to prognostic communication in the dialysis population and proposes solutions.
Main Results:
- Lack of practical prognostic instruments for maintenance hemodialysis (HD) patients has been a barrier.
- Nephrologists require training in discussing prognosis and end-of-life care.
- Absence of clear guidelines for discussing prognosis in dialysis patients limits shared decision-making.
Conclusions:
- Routinely establishing and communicating prognosis is vital for older adults with ESRD.
- Prognosis informs shared decision-making regarding goals of care, dialysis limits, and transplantation referrals.
- Utilizing prognosis can personalize care, from hospice to kidney transplantation, optimizing well-being.
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