1. 1. Something to Think About By, Cherise Gabir, RN, CCM, FAACM
2. 2. As a Registered Nurse for over 20 years and Certified Case Manager, I see elderly patients cycle through the various levels of care, as they receive their dialysis treatments and endure the debilitating effects of their multiple illnesses, including diabetes, heart failure, hypertension, strokes, and dementia.
3. 3. What is Dialysis?
4. 4. Hemodialysis uses an artificial kidney machine to remove toxins and extra fluid from the blood.
5. 5. Peritoneal dialysis cleans and removes fluid from the blood through the natural membrane in the abdomen.
6. 6. patients who start dialysis over age 85 have a 2 year life expectancy. Those who start between ages 75 to 79 have only a 3 year life expectancy. patients age 75 and older are the fastest growing group of dialysis patients
7. 7. pain physical disability poor appetite poor energy and functioning depression cognitive impairment (Dannelke) Frailty & falls
8. 8. Loss of bone density Weakness Weight Loss Functional decline
9. 9. high risk for increased illnesses Increased mortality increased hospitalization & nursing home placement.
10. 10. What is my quality of life now? Do I have multiple health problems? Do I have someone in my life who can care for me if I need it? Have I discussed my prognosis with my doctor? How important is independent functioning to me?
11. 11. Our elderly family members may make it clear that they do not wish to be hooked up to any life support devices; however, many people dont place dialysis in that category. Dialysis is a big deal. Its a life sustaining treatment. Its a life altering treatment
12. 12. Consider your current level of functioning Decide how you wish to spend the last years of your life Consider if and how your treatments will affect the lives of your loved ones Realize that dialysis is an option that can be declined Discuss your options and the implications with your doctor and your loved ones
13. 13. Appleby, Julie. "USA Today.com." 18 Oct. 2006. 15 Feb. 2015 . Buntin, John. Death Panels Rationed Care 50 Years Ago. 31 Aug. 2009. 15 Feb. 2015 . Dannelke, L. "Dialysis: A Forever Decision." 2011. www.todaysgeriatricmedicine.com. 25 April 2015 . Emanuel, L.L., et. al. "EPEC Handbook, Elements & Models of End-of-Life Care." 1999. AMA- ASSN.org. 15 Feb. 2015 . Graham, Judith. "Dialysis Raises Hard Questions For Older Patients." 4 Dec. 2003. 15 Feb. 2015. Jassal, S. and Watson, D. "Dialysis Late In Life: Benefit or burden." Nov 2009. CJASN.org. 25 April 2015 . Jecker, Nanacy. "Medical Futility." n.d. University of Washington School of Medicine. 13 Feb. 2015 . Keown, John. "Euthanasia, A Quality of Life Choice_benheis.pdf." n.d. 13 Feb. 2015. MacReady, Norra. "Skyrocketing Costs of Dialysis May Require Difficult Decisions." 9 Nov. 2009. Medscape Medical News. 15 Feb. 2015 . United States Renal Data Service. USRDS Statistics. 2011. 15 Feb. 2015 . University of Washington School of Medicine. Ethics Committees & Ethics Consultation: Ethical Topics in Medicine. n.d. 15 Feb. 2015 . unknown. What is the Quality of Life? A Euphemism for Euthanasia. n.d. 15 Feb 2015 .