Hall Rasheeda K, McAdams-DeMarco Mara A
Durham VA Geriatric Research, Education and Clinical Center, Durham, NC, USA.
Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Semin Dial. 2018 Sep;31(5):462-467. doi: 10.1111/sdi.12695. Epub 2018 Apr 11.
Currently, older adults comprise nearly one-third of prevalent US dialysis patients, and this proportion will increase as the population ages. Older dialysis patients experience greater morbidity and mortality than nondialysis patients of the same age, and in part, it is related to progressive functional decline. Progressive functional decline, characterized by need for assistance with more than 2 activities of daily living, contributes to risk of hospitalization, further functional decline, and subsequent nursing home placement when a patient no longer functions independently at home. Progressive functional decline may appear to be unavoidable for older dialysis patients; however, comprehensive geriatric assessment (CGA) may alleviate the prevalence and severity of functional decline. This editorial summarizes common risk factors of functional decline and introduces CGA as a potentially transformative approach to breaking the cycle of functional decline in older dialysis patients.
目前，美国透析患者中老年人占近三分之一，且随着人口老龄化这一比例还将上升。老年透析患者比同龄非透析患者的发病率和死亡率更高，部分原因与功能逐渐衰退有关。功能逐渐衰退的特征是日常生活中超过两项活动需要他人协助，这会增加患者住院风险、导致功能进一步衰退，若患者在家中无法独立生活，还会促使其随后入住养老院。老年透析患者的功能逐渐衰退似乎不可避免；然而，综合老年评估（CGA）或许可以减轻功能衰退的发生率和严重程度。这篇社论总结了功能衰退的常见风险因素，并介绍了CGA，认为它是一种可能具有变革性的方法，有助于打破老年透析患者功能衰退的恶性循环。
