Ageism in renal replacement therapy

Munshi, Sunil; Bell, Sarah; Vijayakumar, Narayanaswamy; Warwick, Graham

doi:10.7748/nop2003.12.15.9.14.c2283

Cited by 3 publications

(2 citation statements)

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“…There is limited evidence to determine which patients are least likely to benefit from dialysis, but those who are elderly (over 75 years old), frail, dependent, and have multiple co-morbid conditions do less well (2)(3)(4). Between 1990 and 1999, almost all European countries have seen large increases in the numbers of patients over 75 years having dialysis, although this hides considerable variation, ranging from doubling in the incidence rate (rate per million population) in the Netherlands to a 30-fold increase in Finland (5).…”

Section: The Context Of Conservative Management (Without Dialysis)mentioning

confidence: 99%

Symptom Management in Patients With Established Renal Failure Managed Without Dialysis

et al. 2006

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Increasing numbers of patients with chronic kidney disease Stage 5 (GFR <15ml/minute) are being managed without dialysis, either through their own preference or because dialysis is unlikely to benefit them. This growing group of patients has extensive health care needs. Their overall symptom burden is high, and symptom prevalence matches or exceeds that in other end of life populations, both with cancer and other non-cancer diagnoses. These symptoms may often go unrecognised and under-treated. Regular symptom assessment is necessary, together with pro-active management of identified symptoms. Pain can be managed using the principles of the World Health Organisation analgesic ladder. Not all opioid medications are recommended for these patients. Paracetamol, tramadol, and fentanyl are the most appropriate medications for steps 1, 2 and 3 respectively. There is limited evidence on the use of buprenorphine, oxycodone and hydromorphone. Methadone is safe but should only be prescribed by a clinician experienced in its use. Morphine and diamorphine are not recommended because of metabolite accumulation. Pruritus is also challenging to manage. The evidence for pharmacological interventions to alleviate pruritus is summarized, and a pragmatic approach to management suggested. Emollients, capsaisin cream, antihistamines, thalidomide and ondansetron may be helpful, according to the extent and pattern of pruritus. Symptoms may frequently be due to co-morbid conditions, not renal disease itself, and managing them is difficult because of the constraints on the use of medication which kidney failure imposes. Collaboration between renal and palliative specialists can help identify ways to achieve best care for these patients.

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Section: The Context Of Conservative Management (Without Dialysis)mentioning

confidence: 99%

Symptom Management in Patients With Established Renal Failure Managed Without Dialysis

et al. 2006

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“…Collier (2005: 42) refers to an Age Concern report (Turning your Back on Us) which describes the practice of general practitioners not referring patients to secondary care because they are deemed to have lived long enough. Studies show that older adults in the U.K. have been underrepresented in the provision of renal dialysis (Munshi et al 2003), underdiagnosed for chronic kidney disease (Pulse 2003), viewed as less desirable (than younger) patients by mental health practitioners (Adams and Manthorpe 2003), encountered barriers to having their preferences for care honored (Miller et al 2004;Parkinson 2004) and even been denied a dignified death due to age discrimination (Dobson 2005). "A King's Fund survey of senior managers working in health and social services in 2001 found that three out of four believed age discrimination existed in some for in services in their areas" (Levenson 2003: 42) and a poll for the Institute for Public Policy Research indicated that "one in three believe older people experience discrimination in receiving social services" (Roberts 2003: 23).…”

Section: Age Discrimination Law and Gerontological Theorymentioning

confidence: 99%

Age Discrimination Legislation in the U.K.: A Comparative and Gerontological Analysis

Filinson

2008

J Cross Cult Gerontol

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The three fold purpose of this study is to (1) review the incipient age discrimination legislation in the U.K., (2) offer comparisons with the U.S., Australia, and Canada and (3) examine the new legislation in relation to relevant gerontological theory and research. Reviewed are Britain's Employment Equality Age Regulations, the Age Discrimination in Employment Act of the U.S., the Age Discrimination Act of 2004 in Australia, and Canadian Human Rights Act of 1985. A comparison of the new legislation on age discrimination in the U.K. with existing legislation of this type in the U.S., Canada, and Australia reveals that the British law appears to be weaker on many facets relative to those in the other countries. By permitting more exceptions to the law than are allowed under other types of civil rights statutes, restricting applicability of the law to the workplace, and maintaining compulsory retirement, the power of the law may be circumscribed. Gerontological theory and research do not, by and large, support these choices comprising the new British law.

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