Listening to Older People Who Want to Stop Dialysis

A study published in JAMA Internal Medicine found older adults with advanced kidney disease who want to skip dialysis often encounter resistance from physicians, reports Kaiser Health News . The researchers reviewed medical charts of 851 older adults with chronic kidney disease who refused dialysis at the Veterans Affairs Puget Sound Health Care System in Seattle from 2000 to 2011. Physicians often made speculations that subjects were incompetent, depressed, suicidal, or irrational. They often labeled people expressing reservations about dialysis as difficult or unprepared to cope with the reality of their disease, even when they firmly declined the procedure. "Clinical practice guidelines for advanced kidney disease are geared toward survival, not what would give beneficiaries the best quality of life or the greatest functional capacity," said University of Washington Professor Susan Wong. Discussions about the potential benefits and hardships of dialysis, as well as alternatives, are especially important for frail persons 75 and up who have multiple chronic conditions and difficulty with daily activities such as bathing or walking. "We shouldn't limit access to dialysis based on age, but we should have meaningful conversations about goals of care and make it clear that dialysis is a choice and that people have alternatives," suggested Mayo Clinic Professor Bjorg Thorsteinsdottir.