Strategies for enhancing compliance in the dialysis elderly

The Utility of a Structured Evaluation of Elderly Patients for Continuous Peritoneal Dialysis

The elderly comprise an increasing proportion of chronic dialysis patients. Recruiting them for continuous peritoneal dialysis (CPO) would help CPO programs maintain a patient population. We retrospectively studied the ability of a prospective evaluation to predict success with CPO in elderly (age >60 years) patients. PO nurses and a renal social worker assigned scores in 10 categories, which were then averaged to obtain an overall evaluation score. Scores were from 1–5 with 1 = good, 5 = poor, and 3 = average. Thirty-four elderly patients began CPO during the study period. Evaluation scores were available for 28 of these patients before they began dialysis. Evaluation scores <3 predicted success with CPO (2.2:1:0.2 versus 3.2:1:0.4 in patients transferring to hemodialysis, p<0.02). Patient motivation and preference were the categories that predicted success with CPO. Elderly patients were more likely than younger patients (those <60 years of age) to decline CPO for social reasons (46% versus 4% respectively, p<0.001). Elderly patients required more CPO training time than young patients (4.9:1:0.7 days versus 3.3:1:0.8 days respectively, p<0.01). We conclude that a prospective assessment of elderly patients can predict success with CPO and provide information important to individual structuring of CPO training and follow-up.

Medico-Social Problems in Bruneian Dialysis Patients

Objective

Our objective in the present study was to identify the medico-social problems in dialysis patients at the Department of Renal Medicine, RIPAS Hospital, Brunei Darussalam.

Patients and Methods

We retrospectively analyzed the social problems encountered by the patients in our dialysis program during the period January 2001 to June 2002. During that period, 285 patients were on hemodialysis (HD), and 65 patients were on continuous ambulatory peritoneal dialysis (CAPD). We made 302 referrals to the medical social unit.

Results

Of the 302 cases referred to the medical social unit, 35 (11.59%) were referred for welfare assistance from government or service clubs. Home assessments were conducted on 85 occasions (28.15%) during the study period. The HD section referred 18 (5.96%) patients to the medical social unit for assistance with employment- or work-related problems. The medical social unit also helped patients to settle medical bills (2 cases), acquire prosthetic equipment (9 cases), and obtain approval for housekeeping services applications (6 cases). Our medical social workers (MSWs) solved all 18 employment-related problems referred in HD cases. No cases were referred to the MSWs from the CAPD section for similar problems. It seems that employment-related problems are fewer in CAPD patients than in HD patients. However, long-term studies are required to confirm our findings.

Conclusion

The MSWs helped to improve the quality of life in patients undergoing dialysis in Brunei.

Psychosocial issues in end-stage renal disease: aging

Older end-stage renal disease (ESRD) patients presumably encounter multiple stressors: the need to undergo treatment for a chronic, life-threatening illness, age-related physical frailty and comorbidities, and exposure to psychosocial losses related to aging. However, most studies comparing older patients (typically patients aged 60 and older) with younger patients undergoing ESRD therapy indicate that the psychosocial well-being reported by older patients is at least as good as, and perhaps better than, the well-being reported by younger patients. These data reflect a health optimism generally characteristic of older persons, and ESRD patients' tendency to evaluate their functional status and their psychosocial well-being as largely independent domains. At the same time, availability of support from dialysis caregivers and from family members is acknowledged as a crucial variable affecting older patients' ability to successfully comply with treatment regimens and adjust to various ESRD therapies. Differential psychosocial outcomes related to older patients' sociodemographic characteristics are not well studied, but data from the United States show better perceived physical status and psychosocial well-being among older African-American patients than among older white patients on chronic dialysis. Suggestions are offered for methodological and conceptual refinements of research investigating the relation of age to psychosocial outcomes in ESRD.