Geriatric patient in dialysis care - experience form the Centre for post-acute care at the Motol hospital
Abstract
Dialysis care in developed countries is widely available for all people, regardless of their age, present diseases or social situation. According to statistical data it is obvious, that population of dialyzed patients moves to older age groups.
Majority of patients who started dialysis during the last decades belong to the age group of 75 years and more. While providing complex care for older patients on dialysis program it is important to consider their polymorbidity, frailty status, level of cognitive impairment and low functional abilities as these factors have high impact on patient's prognosis, their overall survival and quality of life.
The decision about the optimal treatment of End Stage Renal Disease (ESRD) has to be strictly individualized with understanding of each patient's value system and shared decision-making. The Centre for Post-acute Care of the Faculty Hospital Motol hospitalized 136 older patients 65+ on dialysis treatment during the period 2013-2016.
We have analysed their morbidity status, presence of frailty and/or disability. Average age was 79 years and majority were polymorbid, frail and severely disabled.
While on continuous dialysis program more than a half of patients had severe complication during hospitalization as serious infection, heart failure, stroke or local complication of AV shunt. Another major problem in those who could be discharged was to find suitable long-term care placement as dialysis treatment is overt or covert limitation for their placement.
In our sample we successfully discharged only less than 10 percent of cases. Our experience confirms that there is no problem with starting dialysis in frail geriatric patient, but the main problem is continuity of care especially social and nursing care, because the functional ability of patients is seriously reduced by dialysis.