Dialysis is a medical treatment that performs the functions of failing kidneys. When kidneys no longer adequately filter blood, waste products and excess fluid can build up in the body, leading to severe health issues. Dialysis artificially removes these harmful substances and extra water from the bloodstream. This procedure is crucial for individuals experiencing kidney failure, as without it, the accumulation of toxins can become life-threatening.
Is Dialysis an Option for 90-Year-Olds?
Age alone does not disqualify a 90-year-old from receiving dialysis. While it is medically possible for individuals in this age group to undergo the treatment, the decision is rarely straightforward and requires careful consideration. Medical suitability for dialysis is highly individualized, focusing on a person’s overall health, functional capabilities, and personal preferences rather than chronological age alone.
The number of older adults with kidney failure has been increasing, and age is no longer a definitive reason to exclude someone from dialysis. Instead, healthcare providers assess health indicators to determine if dialysis would benefit the patient’s well-being and quality of life. This evaluation ensures treatment aligns with the individual’s health profile and goals.
Factors Guiding the Decision
When considering dialysis for an older adult, several interconnected factors influence the decision. Co-morbidities, such as advanced heart disease, severe diabetes, certain cancers, or chronic lung disease, play a significant role. These conditions can affect how well a patient tolerates dialysis, their prognosis, and increase treatment risks.
A patient’s functional status, or ability to perform daily activities like walking, dressing, and eating, is an important consideration. Studies indicate that dialysis can lead to a decline in functional status for older adults, affecting their independence and overall life experience. Assessing baseline functional ability helps determine if dialysis demands are realistic.
Cognitive function also weighs heavily. A patient’s mental clarity and ability to understand their condition and participate in care are important for managing dialysis complexities. Substantial cognitive impairment can affect adherence to treatment schedules, dietary restrictions, and medication regimens, impacting dialysis effectiveness and safety.
Ultimately, the patient’s wishes and values are paramount. Patient preferences regarding quality of life versus life prolongation are given considerable weight. Advance directives, legal documents outlining healthcare wishes, can guide these difficult conversations and ensure autonomy. These discussions involve medical teams and family members, ensuring a shared understanding of the patient’s goals.
Understanding Dialysis Options
For individuals pursuing dialysis, two primary methods are available: hemodialysis and peritoneal dialysis. Hemodialysis diverts blood through an external machine that filters waste and excess fluid before returning it to the body. This typically occurs at a dialysis center three times a week, with each session lasting around four hours. Regular travel to a clinic and the time commitment can be a logistical challenge for older patients and caregivers.
Peritoneal dialysis, by contrast, uses the lining of the patient’s abdomen (peritoneum) to filter the blood internally. A special fluid, called dialysate, is introduced into the peritoneal cavity through a catheter, where it absorbs waste products and excess fluid. After a few hours, the used fluid is drained and replaced with fresh fluid.
This method can often be performed at home, either manually several times a day or overnight using an automated machine. While offering more flexibility and avoiding clinic visits, it requires the patient or a caregiver to manage the procedure, maintain sterility, and store supplies at home. The choice between these two methods depends on the patient’s lifestyle, physical capabilities, and the availability of support at home.
Managing Expectations and Quality of Life
When a 90-year-old begins dialysis, outcomes can vary significantly compared to younger patients. While dialysis can extend life, it may not always improve physical functioning or quality of life. Some elderly patients may experience improved well-being, but for others, treatment burden can outweigh benefits. Studies show physical quality of life tends to be poorer in older dialysis patients, even if mental health and social functioning remain similar to younger patients.
The impact on daily life can be substantial. Dialysis treatments are time-consuming and can lead to fatigue, limiting a patient’s energy levels and participation in social activities. For hemodialysis, the schedule of clinic visits dictates much of the week. Even with home-based peritoneal dialysis, the daily routine of exchanges requires significant commitment. A strong support system, often involving family or professional caregivers, is important to manage these demands.
Considering Alternatives to Dialysis
For some older adults, especially those with multiple health conditions, choosing not to pursue dialysis is a medically appropriate and often preferred alternative. This approach is known as conservative kidney management or supportive care. It focuses on prioritizing comfort and quality of life rather than extending life through intensive interventions.
Conservative management involves symptom management to alleviate discomfort caused by kidney failure. This includes addressing nausea, fatigue, fluid overload, and itching through medications and dietary adjustments. The medical team, including nephrologists, palliative care specialists, nurses, and dietitians, works to ensure the patient’s dignity and well-being.
This path allows patients to avoid the physical demands and lifestyle changes associated with dialysis treatments. While it does not cure kidney failure, it aims to provide the best possible quality of life by controlling symptoms and supporting physical and emotional health. For many elderly individuals, particularly those with significant frailty, conservative management offers a gentler approach that aligns with their goals of comfort and autonomy.