Section of Geriatrics, Division of Primary Care and Population Health, Stanford University, School of Medicine, Stanford, California, USA.
Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA.
J Am Geriatr Soc. 2023 May;71(5):1378-1385. doi: 10.1111/jgs.18256. Epub 2023 Feb 15.
Nearly half of the persons receiving dialysis in the United States are aged 65 years or older. Kidney failure occurs most frequently in older adults, and typically triggers a discussion regarding dialysis treatment. In this Special Article, we describe the journey of Mr. Howard Russell, an older adult who experienced kidney failure and underwent dialysis. Using the experience of Mr. Russell, we illustrate the complexity of dialysis decision-making, including how disease trajectory and health policy can potentially impede older adults from achieving "what matters." Our intent is to provide guidance regarding these barriers and support to clinicians who are sharing similar journeys with older adults making decisions about dialysis. Based on Mr. Russell's journey, we suggest that when discussing dialysis with an older adult, four points be considered: (1) recognize if dialysis is needed long-term; (2) understand what matters for the older adult; (3) sync the treatment plan when what matters changes; and (4) set up with resources for kidney failure, which is limited but evolving.
在美国接受透析的患者中，近一半年龄在 65 岁或以上。肾衰竭最常发生在老年人中，通常会引发关于透析治疗的讨论。在这篇专题文章中，我们描述了霍华德·拉塞尔先生的经历，他是一位经历肾衰竭并接受透析的老年人。通过拉塞尔先生的经历，我们说明了透析决策的复杂性，包括疾病轨迹和健康政策如何可能阻碍老年人实现“重要的事情”。我们的目的是为正在与决定接受透析的老年人分享类似经历的临床医生提供这些障碍的指导和支持。基于拉塞尔先生的经历，我们建议在与老年人讨论透析时考虑以下四点：（1）认识到是否需要长期进行透析；（2）了解对老年人重要的事情；（3）当重要的事情发生变化时同步治疗计划；（4）为肾衰竭设置资源，尽管有限但在不断发展。
