Tyrrell J, Paturel L, Cadec B, Capezzali E, Poussin G
Laboratoire de Psychologie Clinique et de Psychopathologie, Université Pierre Mendès France, Grenoble.
Aging Ment Health. 2005 Jul;9(4):374-9. doi: 10.1080/13607860500089518.
An increasing number of older patients receive dialysis treatment to compensate for deficient kidneys due to end-stage renal disease (ESRD). Ethical questions arise about the benefits of dialysis when a patient appears unwilling or unable to comply with this treatment procedure. Such attitudes and behaviour may be due to psychological factors, but these are not routinely assessed. The purpose of this study was to evaluate levels of cognitive impairment, depressive mood and self-reported quality of life in older dialysis patients (>70 years). A total of 51 outpatients receiving dialysis were assessed by psychologists, using a depression scale (MADRS), two cognitive tests (MMSE and BEC 96), and a quality of life questionnaire (NHP). Sixty percent of the patients were depressed, and between 30-47% had cognitive impairment. Almost half of the depressed patients were also cognitively impaired. The scores for self-reported quality of life varied widely within the sample. Cognitive impairment and depressive mood are often overlooked and underestimated in this population. Regular assessments of depressive mood, cognitive ability and quality of life are recommended, given the prevalence of problems in these domains for older dialysis patients. The information obtained should assist staff as they reflect on individual cases where the benefits of continuing treatment are being examined.
越来越多的老年患者因终末期肾病（ESRD）接受透析治疗以代偿肾脏功能不足。当患者似乎不愿意或无法遵守这种治疗程序时，就会出现关于透析益处的伦理问题。这种态度和行为可能是由心理因素导致的，但这些因素并未得到常规评估。本研究的目的是评估老年透析患者（>70岁）的认知障碍水平、抑郁情绪和自我报告的生活质量。共有51名接受透析的门诊患者由心理学家使用抑郁量表（MADRS）、两项认知测试（MMSE和BEC 96）以及生活质量问卷（NHP）进行评估。60%的患者有抑郁症状，30 - 47%有认知障碍。几乎一半的抑郁患者也有认知障碍。自我报告的生活质量得分在样本中差异很大。在这一人群中，认知障碍和抑郁情绪常常被忽视和低估。鉴于老年透析患者在这些领域问题的普遍性，建议定期评估抑郁情绪、认知能力和生活质量。所获得的信息应有助于工作人员在思考继续治疗益处的个别案例时提供参考。
