Tam-Tham Helen, Perri Giulia-Anna, Freedman Amy
Family physician, palliative care consulting physician, and Clinical Assistant Professor in the departments of family medicine, oncology, and community health sciences at the University of Calgary in Alberta.
Palliative care physician and Medical Director for Palliative Care at Baycrest Health Sciences Centre in Toronto, Ont, and Assistant Professor in the Division of Palliative Care in the Department of Family and Community Medicine at the University of Toronto.
Can Fam Physician. 2025 Feb;71(2):122-127. doi: 10.46747/cfp.7102122.
To describe the provision of primary and specialist palliative care for older adults with advanced chronic kidney disease (CKD).
Population-based retrospective descriptive cohort study using electronic health records.
St Michael's Hospital Academic Family Health Team, including 5 clinics and an interdisciplinary home-based outreach team, in Toronto, Ont.
Older adults who are 65 years of age or older with advanced CKD and undergoing community-based nondialysis kidney care between April 1, 2012, and April 1, 2022, with at least 1 year of follow-up.
Prevalence of advance care planning, goals of care (GOC) discussions, access to specialized palliative care, frequency of hospitalizations, places of deaths, and mean survival time.
The study included 47 older adults with advanced CKD who were not undergoing dialysis and receiving primary care. Sixty-eight percent were female (n=32), and the mean (SD) age was 81 (8) years. The mean (SD) number of comorbidities was 5 (2). Almost half of the patients (n=22) lived alone. Seventy percent of the cohort (n=33) had a documented substitute decision maker. Approximately one-third of the cohort (n=16) had GOC conversations involving prognosis, hospital transfer, place of death, and treatment goals. Forty-seven percent (n=22) accessed specialist palliative care during follow-up. Seventy-four percent (n=35) had 1 or more hospitalization. Thirty-two percent (n=8) died at home. The mean (SD) survival time was 2 (2) years.
A palliative approach to care including advance care planning and GOC conversations would be appropriate for older adults with advanced CKD given their high rates of comorbidities, hospitalizations, and mortality. Primary care providers might experience challenges facilitating conversations in this population, highlighting opportunities for enhanced training and point-of-care interventions, and facilitating access to specialist palliative care consultations when appropriate.
描述为患有晚期慢性肾脏病（CKD）的老年人提供初级和专科姑息治疗的情况。
基于人群的回顾性描述性队列研究，使用电子健康记录。
安大略省多伦多市圣迈克尔医院学术家庭健康团队，包括5个诊所和一个跨学科的居家外展团队。
2012年4月1日至2022年4月1日期间年龄在65岁及以上、患有晚期CKD且正在接受社区非透析肾脏护理、随访时间至少1年的老年人。
预先护理计划的普及率、护理目标（GOC）讨论情况、获得专科姑息治疗的情况、住院频率、死亡地点及平均生存时间。
该研究纳入了47名未接受透析且正在接受初级护理的患有晚期CKD的老年人。68%为女性（n = 32），平均（标准差）年龄为81（8）岁。平均（标准差）合并症数量为5（2）种。近一半患者（n = 22）独居。70%的队列（n = 33）有记录在案的替代决策者。约三分之一的队列（n = 16）进行了涉及预后、转院、死亡地点和治疗目标的GOC对话。47%（n = 22）在随访期间获得了专科姑息治疗。74%（n = 35）有1次或更多次住院。32%（n = 8）在家中死亡。平均（标准差）生存时间为2（2）年。
鉴于患有晚期CKD的老年人合并症、住院率和死亡率较高，采用包括预先护理计划和GOC对话在内的姑息治疗方法是合适的。初级保健提供者在促进该人群的对话时可能会遇到挑战，这凸显了加强培训和即时护理干预的机会，并在适当时候促进获得专科姑息治疗咨询。
