Differences in quality of life and cognition between the elderly and the very elderly hemodialysis patients

Abstract

Introduction: In the last decades, there was an expressive increase in the number of elderly patients with chronic kidney disease starting hemodialysis. Thus, our goal was to evaluate the profile of the elderly in chronic hemodialysis and to compare the cognition and quality of life of the younger elderly with those of the very elderly. Methods: Patients on hemodialysis for at least 3 months, who were 65 years of age or older when they started dialysis were invited to participate, and stratified according to age (under or over 80 years). The participants answered a clinical-epidemiological questionnaire and underwent cognitive tests (Mini Mental State Exam [MMSE], clock drawing test [CDT] and verbal fluency test [VFT]) and a quality of life assessment 36- Item Short Form Health Survey). Results: Of the 125 eligible patients, 124 agreed to participate. The mean age was 76 ± 6 years (28% ≥ 80 years), 56% were men and 55% had ≥ 8 years of schooling. Depression was suggested in 38%. The prevalence of cognitive deficit was 38%, 70% and 30%, by MEEM, CDT and VFT, respectively. The prevalence of any deficit was higher among the very elderly (94% vs. 72%, p = 0.007). Quality of life scores were similar between the two age groups, except for the functional capacity domain, worse in the group with ≥ 80 years (p = 0.033). Conclusion: Elderly patients on chronic hemodialysis have a high prevalence of cognitive deficits, especially the very elderly, but this group does not have a worse quality of life, except for functional capacity.

Addressing Cognitive Function and Psychological Well-Being in Chronic Kidney Disease: A Systematic Review on the Use of Technology-Based Interventions

“…Cognitive symptoms are present in 20% to 60% of CKD patients and are linked to a higher risk of developing dementia [ 63 , 64 ]. Moreover, the importance of the development of different strategies to improve cognitive function in these patients has been highlighted by various studies [ 6 , 8 , 39 , 65 ].…”

Geriatric assessment in elderly hemodialysis patients

“…Viana et al demonstrated cognitive impairment in 31.8% of the elderly HD patients group using MMSE. Together with VFT and CDT, the prevalence of having any cognitive deficit reached 71.6% in the elderly group and 93.6% in the very elderly group 3. Indeed, using MMSE only may lead to underestimation of cognitive impairment in HD patients who predominantly exhibit cognitive deficits in executive, attention, and memory cognitive domains.…”

“…Cognitive dysfunction and frailty are two of the most important issues in this population since they are both associated with increased comorbidity burden and mortality 2. This editorial outlines the importance of geriatric assessment in elderly HD patients for geriatric impairments, particularly cognitive dysfunction and frailty, referring to a recent paper on the topic 3…”

“…The clock drawing test (CDT) for executive cognitive functions was not different among the groups. They also applied the Geriatric Depression Scale (GDS-15) and the Short Form Health Survey (SF-36) for evaluating the mood and general quality of life, and the very elderly group had worse scores only for functional capacity 3. Overall, their results indicated a higher prevalence of impaired cognition and decreased quality of life in very elderly patients with advanced CKD.…”

“…Quality of life questionnaires provide valuable information about the general health status and daily living complaints, but clinicians usually lack enough time to include these tools into everyday clinical practice. There are feasible tools for evaluating quality of life and activities of daily living such as the SF-36 and the Lawton Instrumental Activities of Daily Living (IADL) scale 3 , 7…”