SPECIALIZED CHRONIC CARE FOR DIALYSIS PATIENTS - A 5-YEAR STUDY

Background: At least 40% of those starting onto renal dialysis at the present time are aged over 65 years old. With old age comes increased comorbidity and decreased functional status. The long term management of older patients is limited by the need for rehabilitation and by pla cement concerns. We describe a 5-year experience of a pilot program, c reated in 1991 on the recommendation of the Metropolitan Toronto Distr ict Health Council, to rehabilitate and care for elderly and disabled patients on either hemodialysis or peritoneal dialysis. Methods and Re sults: This retrospective, observational study reports on a total of 1 85 patients admitted over a 5-year period to the Riverdale Chronic Dia lysis Unit for chronic care or rehabilitation. The mean age of patient s admitted was 67 years (quartiles 61 and 75 years). Eighty-five perce nt of patients had 2 or more severe comorbidities, while 60% had 3 or more active medical issues. The most commonly used dialysis modality w as hemodialysis (80%). Of the 185 patients followed 34% were discharge d home, 35% died and 13% were still resident at the time of completion of the study. The most common acute medical problems seen in these pa tients related to their vascular access and necessitated temporary tra nsfer to an acute nephrology center. A total of 4.7 transfers were rec orded for each patient-year of follow up. Conclusions: This study desc ribes the adaptation of facilities already present in our area, to all ow better management and placement of older dialysis patients. Transfe r of patients from a high level acute care facility to a chronic care facility makes economic and practical sense and may allow better long term health care planning as well as more stability for the family or care-givers.