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Decision-making about dialysis: Beyond just dialysis or death
Christine Kee Liu1,2, Leah Taffel3, Matthew Russell4
1Section of Geriatrics, Division of Primary Care and Population Health, Stanford University, School of Medicine, Stanford, California, USA.
Journal of the American Geriatrics Society
|February 15, 2023
Summary
Older adults often face complex decisions about dialysis for kidney failure. This article guides clinicians on supporting elderly patients by focusing on individual needs and aligning treatment with personal values.
Area of Science:
- Gerontology
- Nephrology
- Health Policy
Background:
- Kidney failure disproportionately affects older adults (≥65 years), frequently initiating dialysis discussions.
- The decision-making process for dialysis in older populations is complex and influenced by various factors.
Purpose of the Study:
- To illustrate the complexities of dialysis decision-making for older adults using a case study.
- To provide guidance and support for clinicians assisting older adults in making dialysis decisions.
- To identify barriers that may prevent older adults from achieving personal goals ('what matters') during end-of-life care.
Main Methods:
- A case study approach detailing the journey of an older adult (Mr. Howard Russell) undergoing dialysis.
- Analysis of how disease trajectory and health policy impact treatment choices for elderly patients.
Main Results:
- Dialysis decision-making for older adults involves intricate considerations beyond clinical necessity.
- Disease progression and health policies can create significant barriers to patient-centered care.
- Personal values and evolving life circumstances ('what matters') must be integrated into treatment planning.
Conclusions:
- Clinicians should consider four key points when discussing dialysis with older adults: assess long-term need, understand patient values, adapt plans as values change, and connect patients with kidney failure resources.
- Addressing barriers in healthcare policy and patient support is crucial for improving the dialysis experience for older adults.
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