Guerville Florent, Pépin Marion, Garnier-Crussard Antoine, Beuscart Jean-Baptiste, Citarda Salvatore, Hocine Aldjia, Villain Cédric, Tannou Thomas
Clinical Gerontology Department, Bordeaux University Hospital, Pessac, France.
Immunoconcept Lab, CNRS UMR 5164, Inserm ERL 1303, Bordeaux University, Bordeaux, France.
Clin Kidney J. 2024 Sep 9;17(10):sfae281. doi: 10.1093/ckj/sfae281. eCollection 2024 Oct.
Improving care for older people with end-stage kidney disease (ESKD) requires the adaptation of standards to meet their needs. This may be complex due to their heterogeneity in terms of multimorbidity, frailty, cognitive decline and healthcare priorities. As benefits and risks are uncertain for these persons, choosing an appropriate treatment is a daily challenge for nephrologists. In this narrative review, we aimed to describe the issues associated with healthcare for older people, with a specific focus on decision-making processes; apply these concepts to the context of ESKD; identify components and modalities of shared decision-making and suggest means to improve care pathways. To this end, we propose a geronto-nephrology dynamic, described here as the necessary collaboration between these specialties. Underscoring gaps in the current evidence in this field led us to suggest priority research orientations.
改善终末期肾病（ESKD）老年患者的护理需要调整标准以满足他们的需求。由于他们在多重疾病、虚弱、认知衰退和医疗保健优先事项方面存在异质性，这可能会很复杂。由于这些患者的益处和风险尚不确定，选择合适的治疗方法对肾病学家来说是一项日常挑战。在这篇叙述性综述中，我们旨在描述与老年人医疗保健相关的问题，特别关注决策过程；将这些概念应用于ESKD的背景下；确定共同决策的组成部分和方式，并提出改善护理途径的方法。为此，我们提出了一种老年肾病学动态，在此将其描述为这些专业之间的必要协作。强调该领域当前证据中的差距促使我们提出优先研究方向。
