Older patients undergoing dialysis treatment: Cognitive functioning, depressive mood and health-related quality of life

Abstract

An increasing number of older patients receive dialysis treatment to compensate for deficient kidneys due to end-stage renal disease (ESRD). Ethical questions arise about the benefits of dialysis when a patient appears unwilling or unable to comply with this treatment procedure. Such attitudes and behaviour may be due to psychological factors, but these are not routinely assessed. The purpose of this study was to evaluate levels of cognitive impairment, depressive mood and self-reported quality of life in older dialysis patients (>70 years). A total of 51 outpatients receiving dialysis were assessed by psychologists, using a depression scale (MADRS), two cognitive tests (MMSE and BEC 96), and a quality of life questionnaire (NHP). Sixty percent of the patients were depressed, and between 30-47% had cognitive impairment. Almost half of the depressed patients were also cognitively impaired. The scores for self-reported quality of life varied widely within the sample. Cognitive impairment and depressive mood are often overlooked and underestimated in this population. Regular assessments of depressive mood, cognitive ability and quality of life are recommended, given the prevalence of problems in these domains for older dialysis patients. The information obtained should assist staff as they reflect on individual cases where the benefits of continuing treatment are being examined.

Kognitiv svikt ved terminal nyresykdom

“…De viktigste nyere studiene (gjort etter 1995, med antall pasienter ≥ 30 og med gjennomsnittsalder på pasientene ≥ 55 år) er vist i tabell 1 (5,(7)(8)(9)(10)(11).…”

“…Det er høy forekomst av søvnforstyrrelser og depresjon hos hemodialysepasienter (8,32,33). Begge faktorer har ugunstig innvirkning på kognitiv funksjon (34).…”

“…Kognitiv svikt og demens hos dialysepasienter er i liten grad erkjent av behandlende helsepersonell (7,8,10). Oppmerksomhet omkring kognitiv funksjon hos den enkelte pasient er avgjørende for at man skal kunne identifisere dem som har svikt på dette området.…”

Declínio cognitivo, depressão e qualidade de vida em pacientes de diferentes estágios da doença renal crônica

“…6 The cognitive function, depression and quality of life were evaluated in 51 patients undergoing dialysis through a depression test (The Montgomery Asberg Depression Rating Scale (MADRS), two cognitive tests (MMSE and BEC 96) and a quality of life questionnaire (NHP-Nottingham Health Profile). 7 Sixty percent of the patients were depressed and 30% to 47% presented cognitive impairment. The authors recommended regular assessments of depression, cognitive skills and quality of life, especially in elderly patients undergoing dialysis.…”

“…The authors recommended regular assessments of depression, cognitive skills and quality of life, especially in elderly patients undergoing dialysis. 7 The diagnosis of dementia currently consists in integrated clinical evaluations. The neuropsychological test alone cannot be used with the objective of diagnosing and must be selectively used in clinical adjustments.…”