Association of initiation of maintenance dialysis with functional status and caregiver burden
| Autor: | Joy Lips, Hanna C. Willems, Yvonne C Schrama, Machiel A Siezenga, Michiel L. Bots, Hieronymus H. Vincent, Eric F.H. van Bommel, Peter J.G. van de Ven, Ismay N. van Loon, Ellen K. Hoogeveen, Franciscus T.J. Boereboom, Caroline E. Douma, N. A. Goto, Marielle H. Emmelot-Vonk, Laila E. Gamadia, Alferso C. Abrahams, Marije E. Hamaker, Marianne C. Verhaar |
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| Přispěvatelé: | Geriatrics, AMS - Ageing & Morbidty, APH - Aging & Later Life |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Activities of daily living Epidemiology medicine.medical_treatment Critical Care and Intensive Care Medicine Kidney Failure Elderly Life Internal medicine Functional decline Activities of Daily Living medicine Prevalence Journal Article Humans Prospective Studies Chronic Geriatric Assessment Dialysis Renal dialysis Aged Aged 80 and over Geriatric nephrology Transplantation Frailty business.industry Caregiver burden Odds ratio Confidence interval Patient Voice Logistic Models Caregivers Risk factors Nephrology Kidney Failure Chronic Female business Follow-Up Studies |
| Zdroj: | Clinical journal of the American Society of Nephrology, 14(7), 1039-1047. American Society of Nephrology Clin J Am Soc Nephrol Clinical Journal of the American Society of Nephrology, 14(7), 1039. American Society of Nephrology |
| ISSN: | 1046-6673 1555-9041 |
| Popis: | Background and objectives Little is known about the functional course after initiating dialysis in elderly patients with ESKD. The aim of this study was to assess the association of the initiation of dialysis in an elderly population with functional status and caregiver burden. Design, setting, participants & measurements This study included participants aged ≥65 years with ESKD who were enrolled in the Geriatric Assessment in Older Patients Starting Dialysis study. All underwent a geriatric assessment and a frailty screening (Fried Frailty Index and Groningen Frailty Indicator) at dialysis initiation. Functional status (activities of daily life and instrumental activities of daily life) and caregiver burden were assessed at baseline and after 6 months. Decline was defined as loss of one or more domains in functional status, stable as no difference between baseline and follow-up, and improvement as gain of one or more domains in functional status. Logistic regression was performed to assess the association between the combined outcome functional decline/death and potential risk factors. Results Of the 196 included participants functional data were available for 187 participants. Mean age was 75±7 years and 33% were women. At the start of dialysis, 79% were care dependent in functional status. After 6 months, 40% experienced a decline in functional status, 34% remained stable, 18% improved, and 8% died. The prevalence of high caregiver burden increased from 23%–38% (P=0.004). In the multivariable analysis age (odds ratio, 1.05; 95% confidence interval, 1.00 to 1.10 per year older at baseline) and a high Groningen Frailty Indicator compared with low score (odds ratio, 1.97; 95% confidence interval, 1.05 to 3.68) were associated with functional decline/death. Conclusions In patients aged ≥65 years, functional decline within the first 6 months after initiating dialysis is highly prevalent. The risk is higher in older and frail patients. Loss in functional status was mainly driven by decline in instrumental activities of daily life. Moreover, initiation of dialysis is accompanied by an increase in caregiver burden. |
| Databáze: | OpenAIRE |
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