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Frailty and dependence in elderly dialysis patients

机译：老年透析患者的虚弱和依赖性

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Patients older than 75 years of age currently represent more than 35% of the population that begins dialysis each year in most European registries; in our centre, at least 30 patients in this age bracket begin dialysis, which represent 45% of the total incident patients. The absence of systematic studies makes this patient category almost indistinguishable from other categories, even though its peculiarity is now becoming evident. At least 30-40% of elderly individuals are expected to be frail and/or dependent, but the incidence of frailty is likely to be higher in those undergoing haemodialysis. Due to severe physical and/or mental impairment and often because of social hardship, these patients rarely experience clinical stability and are dependent on third parties for their survival. Early symptoms of frailty consist of weakness, anorexia, weight loss, muscular atrophy, reactive depression and cognitive deficits. Commonly, early signs and symptoms are underestimated until patients become dependent as defined by the presence of several pathological conditions, such as instability, immobility, iatrogenic drug reactions, intellectual impairment, and incontinence. The last phase of the condition is that of acute complications - pathological fractures, pressure ulcers, delirium, infectious complications with multiple hospital admissions, which cause a significant reduction in patient survival. The care of these patients presents complex problems for welfare services, and has led to the re-organisation of in-patient and out-patient dialysis units. Repeated patient admissions to the hospital require a much greater use of facilities and staff compared to younger dialysis patients. Of 112 elderly patients consecutively admitted to our dialysis programme over a period of 10 years, we identified 35 dependent (defined here as the need for continual assistance) patients (31.2%). Dependence proved to be the only clinical parameter associated with survival, while co-morbidity (in particular cardiovascular disease that usually affects survival rates in younger age groups) did not seem to be discriminating risk factors in the elderly. Emerging data from larger studies will likely demonstrate that the elderly should be systematically monitored for frailty and dependence during dialysis, as is the case in exclusively geriatric fields. Many of the clinical problems of the dialysed elderly, such as sensory, mental, and functional impairment, are more the result of advanced age, pre-existent diseases, and social deprivation, rather than of uraemia and dialysis per se. Prevention, as well as a therapeutic approach specifically modelled on these conditions, could help to improve the prognosis of this patient category, which is becoming numerically predominant in dialysis units.
机译：目前，在大多数欧洲注册机构中，年龄超过75岁的患者占每年开始透析的人口的35％以上。在我们中心，这个年龄段的至少30位患者开始透析，占全部事件患者的45％。缺乏系统的研究使得该患者类别与其他类别几乎没有区别，尽管其独特性现在变得明显。预计至少有30-40％的老年人是虚弱的和/或依赖的，但是在进行血液透析的人中，虚弱的发生率可能会更高。由于严重的身体和/或精神障碍，并且经常由于社会困难，这些患者很少经历临床稳定，并且其生存依赖于第三方。体弱的早期症状包括虚弱，厌食，体重减轻，肌肉萎缩，反应性抑郁和认知障碍。通常，低估早期症状和体征，直到患者因多种病理状况（如不稳定，不动，医源性药物反应，智力障碍和失禁）而变得依赖为止。疾病的最后阶段是急性并发症-病理性骨折，压疮，del妄，多次住院的感染性并发症，这会导致患者生存率显着降低。这些患者的护理给福利服务带来了复杂的问题，并导致了住院和门诊透析单位的重组。与年轻的透析患者相比，反复入院患者需要更多的设施和人员使用。在过去10年中连续接受透析计划的112名老年患者中，我们确定了35名依赖患者（此处定义为需要持续协助）（31.2％）。事实证明，依赖性是与生存相关的唯一临床参数，而合并症（尤其是通常影响年轻年龄组生存率的心血管疾病）似乎并不能区分老年人的危险因素。来自较大研究的新数据可能会表明，应该对老年人进行透析期间的虚弱和依赖性系统监测，就像在老年医学领域那样。透析老人的许多临床问题，例如感觉，精神和功能障碍，更多是由于高龄，既往疾病和社会剥夺所致，而不是尿毒症和透析本身。预防以及针对这些情况的专门建模治疗方法，可以帮助改善该患者类别的预后，该类别在透析部门中已成为数字上占主导地位。

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  • 来源
    《Progress in Palliative Care》 |2009年第4期|196-202|共7页
  • 作者

    Panzetta G.; Artero M.; Grignetti M.; Lanche M.; Toigo G.;

  • 作者单位

    S.C. Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti di Trieste', Srada di Fiume 447, 34149 Trieste, Italy, Email: giovanni.panzetta@aots.sanita.fvg.it;

    S.C. Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti di Trieste', Trieste, Italy;

    S.C. Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti di Trieste', Trieste, Italy;

    S.C. Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti di Trieste', Trieste, Italy;

    S.C. Geriatria, Azienda Ospedaliero-Universitaria 'Ospedali Riuniti di Trieste', Trieste, Italy;

  • 收录信息 美国《科学引文索引》(SCI);美国《工程索引》(EI);美国《生物学医学文摘》(MEDLINE);
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