Dialysis for the Elderly: New Evidence from Mayo Clinic to Guide Shared Decision-Making
Nov 7, 2013 - 4:50:16 PM
"Many elderly patients and their families feel that they have no choice but to start dialysis, with several expressing regret from having initiated therapy," says primary care physician Bjorg Thorsteinsdottir, M.D., lead study author and a health care delivery scholar with the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. "The goal of our study was to develop evidence about dialysis outcomes to help guide shared decision-making among the patient, family members and care team."
Researchers reviewed four years of medical records for 379 patients who were at least 75 years old when they began dialysis treatment at Mayo Clinic in Rochester. The majority (76 percent) started dialysis while in the hospital for a chronic illness or sudden medical event such as pneumonia.
Mortality was very high, with 40 percent of patients dying within six months. The highest mortality rates were seen in patients who started dialysis in the intensive care unit. Only 27 percent were alive after six months.
Patients who started dialysis in the hospital often were not able to return home. Of the patients admitted to the hospital from home, 28 percent died while in the hospital or were discharged to hospice, 28 percent were discharged to a nursing home, and only 37 percent were able to return home to independent living.
Age alone was not a good predictor of survival, and healthier elderly patients did better. Most deaths were preceded by a decision to withdraw life support, including dialysis.
"We hope that these study results will help inform the difficult decisions that patients and family members must make about whether or not to begin dialysis," says Dr. Thorsteinsdottir. "We want to make sure that the treatment is congruent with our patients' goals and values."
Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of "the needs of the patient come first." More than 3,700 physicians, scientists and researchers, and 50,100 allied health staff work at Mayo Clinic, which has campuses in Rochester, Minn; Jacksonville, Fla; and Scottsdale/Phoenix, Ariz.; and community-based providers in more than 70 locations in southern Minnesota., western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education, visitwww.mayo.edu.
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