Research Paper on "Dialysis Among the Elderly"

Research Paper 8 pages (2931 words) Sources: 10 Style: APA

[EXCERPT] . . . .

Nursing

Dialysis among the Elderly

The issues that surround the health of a person at the end of their life have started to attract growing attention over the last several years (Menec, Lix, Nowicki, and Ekuma, 2007). Many questions have been looked at surrounding this topic. Should older adults be able to choose to receive treatments that extend their lives? Are the treatments that they are available affecting the quality of life that these people are living? Are their alternatives that could be used instead? People who have renal disease often experience a decline in their state of health and the energy that is needed to keep up previously enjoyed activities (Curtis, Rothstein and Hong, 2009). The purpose of this paper is to conduct a literate review of how dialysis affects those who are suffering from End Stage Renal Disease along with examining the possibilities of what can be done differently. The history and description of dialysis will be looked at first with a discussion of current available treatment options. The implications of these treatment options will then be looked at with the discussion of a public policy regarding Chronic Kidney Disease.

End stage renal disease is an incapacitating chronic illness that requires care by health care professionals. The progress of the disease often affects the quality of a person's life. It has the potential to influence a person's physical and mental health which in turn affects their independence, personal relationships and social functioning (Cleary and Drennan, 2005). Treating end stage renal disease (ESRD) with dialysis is relatively new. In the beginning when intermittent hemodialysis for chronic renal failure (CRF) was first used patient selection was determined by clinical evaluation committees and committees of community members (Moss, 2000). During this time the medical profession did not often discuss end-of-life (EOL) or palliative care for patients on dialysis due to the fact that only the healthiest patients were selected to undergo dialysis, so there did not seem to be a need (Haras, 2008).

The nursing specialty of Nephrology has emerged because of the need to provide dialysis treatments in the hospital along with outpatient settings. The Canadian Society of Nephrology is a group of physicians and scientists that specialize in the care of people with kidney disease, and in research related to the kidney and kidney disease. Their mission statement consists of the following:

They work to promote the maximum quality of care for patients with renal diseases by setting high standards for medical training and education and to increase the knowledge, skills and attitudes of nephrologists.

They work to encourage research in biomedical sciences that are related to the kidney, kidney disorders and renal replacement therapies.

They work to advance the delivery of health care related to nephrology.

They work to encourage the continuing professional competence of nephrologists.

They work to support scholarly and ethical advances to the enhancement of the specialty (Who we are, n.d.).

There are a growing number of elderly patients with end-stage renal disease (ESRD) who are beginning to undergo dialysis. In 1999, residents in nursing homes accounted for 4% of all new patients with ESRD and 11% of new patients with ESRD who were older than 70 years old. The benefit of dialysis in these patients has yet to really be seen. Death in the first year after the start of dialysis is greater than 35% in patients who are 70 years old and older. The number exceeds 50% in patients 80 years old and older. The amount to which dialysis extends life and its effective on the quality of life in elderly patients remains a topic that is highly discussed among the experts. The extent to which dialysis affects a person's functional status or their ability to perform activities such as walking, bathing, dressing, getting out of bed, and using the toilet correlates with the quality of their life and often determines what care is needed (Tamura, Covinsky, Chertow and Yaffe, 2009).

The medium age of patients who were newly diagnosed with ESRD in 2005 was 64.6 years, and the rate of incidences has more than doubled in the past 10 years for people 75 years old and older. The over-65 group has been shown to be the fastest growing group of people ESRD undergoing dialysis. There have been some limited studies that have been done with individuals who are older than 80. One of these studies found that there was a 57% increase in persons older than 80 years who started dialysis from 1996 to 2003, and that the one-year mortality rate was at 46 (Haras, 2008).

The availability and methods of treatment for dialysis have improved over the years and yet patients who are beginning to undergo dialysis are becoming sicker and more debilitated than in the past. Even though dialysis can prolong life, the true benefit to individual patients varies a lot. A number of studies have shown that dialysis, as compared to conservative therapy, increases longevity in older people, but not in those patients who are the sickest. Other data has indicated that a growing numbers of coexisting conditions often predicts an early death in patients with ESRD (Arnold and Zeidel, 2009).

In a study done by Cook and Jassal (2008) that measured the functional status of elderly patients undergoing chronic hemodialysis therapy, the data presented showed a high rate of disability in activities that are required for independent living among older people. This high frequency of functional impairment is thought to contribute to a high mortality and morbidity rate. In one study of elderly patients who were undergoing dialysis, those who were non-ambulatory were shown to have a higher mortality rate than those who were able to get up and get around. Likewise in older populations who were not suffering from renal disease, functional impairment was closely associated with more frequent and prolonged hospitalizations, high morbidity, and high mortality rates. These findings are more interesting if you take into account the fact that treatment strategies such as geriatric assessment and multidisciplinary team care have been shown to be very effective in preventing functional decline in people. Disability among older dialysis patients problem that may have a substantial impact on nephrology health outcomes and care planning, but has not had much research done on it (Cook and Jassal, 2008).

The developments that have taken place in the areas of medical innovation and geriatric clinical intervention have had a tremendous impact on the people's later life. The potential for health in advanced age, medical decision making and family responsibility have all increased over time. The age of patients who undergo medical interventions in order to save and extend their lives is rapidly increasing. In recent years, physicians have become more successful at dialyzing patients who have complicated conditions, including many older patients. Many doctors feel that it is morally unjustified not to offer dialysis to any patient with ESRD regardless of their age (Kaufman, Shim and Russ, 2004).

It is thought that the goals of dialysis treatment have not developed over the years in accordance with the shift in demographics of most dialysis patients. The medical community has yet to address the role of palliative care and the acknowledgement of end of life issues in regards to these patients. Clinicians are often not inclined to discuss death with patients, thereby limiting the choice of death over dialysis as a medical option (Kaufman, Shim and Russ, 2006). It is thought that the goals of care are different among older patients, which can be seen in the lower rates of nephrology referrals among patients who are 75 years of age and older (O'Hare1, Bertenthal, Walter, Garg, Covinsky, Kaufman, Rodriguez and Allon, 2007).

End-stage renal disease and its resulting treatments have been shown to negatively affect quality of life in elderly patients. It is thought that if nurses were aware of this fact that they could begin to explore new ways to more accurately assess and identify the specific problem areas that individuals have and put into place actions to help improve these (Cleary and Drennan, 2005). Planning a good death is often a neglected, but essential, part of the care of patients who have end stage renal disease. Many of these patients do not have advance directives in place and very few use the palliative care that is available to them. Although guidelines regarding end-of-life issues and palliative care have been developed by medical and nursing associations they are not consistently used by the nephrology community. Nephrology nurses are often in a very good position to begin EOL discussions with patients and families, and advanced practice nurses are in an exclusive position to coordinate and facilitate a patient's transition from chronic to terminal illness and to increase the likelihood that the patient and family experience a good death (Haras, 2008).

Dialysis often plays a valid and important role in terminally ill patients when the promise of reversing acute renal failure seems desirable or when it can provide relief from other troublesome symptoms. Nevertheless,… READ MORE

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