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Decision making in elderly patients with advanced kidney disease
Holly M Koncicki1, Mark A Swidler
1Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. holly.koncicki@mssm.edu
Clinics in Geriatric Medicine
|July 16, 2013
Summary
Geriatricians increasingly guide end-stage renal disease treatment for older adults. Shared decision-making for dialysis or nondialysis medical therapy (NDMT) requires considering medical factors, patient wishes, and quality of life.
Area of Science:
- Geriatrics
- Nephrology
- Medical Ethics
Background:
- The fastest-growing dialysis patient demographic is over 75 years old.
- Geriatricians play a crucial role in managing end-stage renal disease (ESRD) in elderly populations.
- Shared decision-making (SDM) is essential for ESRD treatment choices.
Purpose of the Study:
- To outline a framework for geriatricians and nephrologists in SDM for dialysis versus nondialysis medical therapy (NDMT).
- To emphasize the integration of patient preferences and quality of life in ESRD treatment decisions.
- To provide guidance on discussing prognosis and functional status with patients and families.
Main Methods:
- Review of current literature on geriatric care in ESRD.
- Analysis of ethical considerations in medical treatment decisions for older adults.
- Incorporation of guidelines from the Renal Physician Association on SDM.
Main Results:
- A comprehensive SDM approach for dialysis or NDMT should integrate medical indications, patient values, quality of life, and functional age.
- Prognosis and expected performance on dialysis must be clearly communicated.
- Existing guidelines offer a foundation for effective SDM in ESRD.
Conclusions:
- Geriatricians are integral to SDM for elderly patients with ESRD.
- A patient-centered approach enhances treatment appropriateness and outcomes.
- Effective communication regarding prognosis and functional status is paramount.
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