Farragher Janine, Jassal Sarbjit Vanita
Department of Nephrology, University Health Network, Toronto, Canada.
Semin Dial. 2012 Nov-Dec;25(6):649-56. doi: 10.1111/sdi.12014. Epub 2012 Oct 24.
Dialysis is offered to patients with end-stage renal disease as a life-sustaining therapy. However, studies have shown that elderly patients experience high rates of functional disability, hospitalization, institutionalization, and mortality on chronic dialysis therapy, and that the initiation of dialysis is in fact associated with an acceleration in functional decline. These findings have sparked debate about the utility of dialysis for elderly renal patients. In this article, it is proposed that geriatric rehabilitation can prevent, reverse or delay the onset of functional disability and associated adverse outcomes in older dialysis patients, and thus should be incorporated routinely into standard geriatric dialysis care. We outline the causes of disability in elderly dialysis patients, and demonstrate the potential impact of rehabilitation using a case scenario. Models of rehabilitation that have been shown to be effective in improving outcomes for elderly renal and nonrenal populations, including inpatient rehabilitation, exercise training, falls prevention, and home-based models, are reviewed.
透析作为一种维持生命的疗法提供给终末期肾病患者。然而，研究表明，老年患者在慢性透析治疗中出现功能残疾、住院、入住机构和死亡的比率很高，而且开始透析实际上与功能衰退加速有关。这些发现引发了关于透析对老年肾病患者效用的争论。在本文中，有人提出老年康复可以预防、逆转或延迟老年透析患者功能残疾及相关不良后果的发生，因此应常规纳入标准的老年透析护理中。我们概述了老年透析患者残疾的原因，并通过一个病例展示了康复的潜在影响。本文还综述了已被证明对改善老年肾病和非肾病人群结局有效的康复模式，包括住院康复、运动训练、预防跌倒和居家模式。
