Dialysis in an octagenarian: prolonging suffering or quality of life?

[weekapaugjz]

i posted this in one of the other threads by mistake.

hey doc,

my grandfather has had a string of medical problems dealing with a stroke, several heart attacks, and recently has been having trouble with his kidneys. he has been in the hospital for the last several days for swelling and infections in his legs (i think i heard adema) and that the water pills he is taking for his kidneys have played a major part of this.

it seems like different doctors are saying different things about whether they should be more worried about the heart or the kidneys. my aunt told me that several weeks ago that my grandfather got information about dialysis and does not want to go through this procedure.

he is not very mobile and it would be very stressful on my grandmother to get him to the hospital 3 times a week for the treatment. he is 84 years old and says he has lived a very good life. does dialysis work as well on older patients or is it really only delaying the inevitable. i do not know much about this treatment and could use some more information.

thanks so much for any help.

--jz

[Dr Steve]

i posted this in one of the other threads by mistake.

hey doc,

my grandfather has had a string of medical problems dealing with a stroke, several heart attacks, and recently has been having trouble with his kidneys. he has been in the hospital for the last several days for swelling and infections in his legs (i think i heard adema) and that the water pills he is taking for his kidneys have played a major part of this.

it seems like different doctors are saying different things about whether they should be more worried about the heart or the kidneys. my aunt told me that several weeks ago that my grandfather got information about dialysis and does not want to go through this procedure.

he is not very mobile and it would be very stressful on my grandmother to get him to the hospital 3 times a week for the treatment. he is 84 years old and says he has lived a very good life. does dialysis work as well on older patients or is it really only delaying the inevitable. i do not know much about this treatment and could use some more information.

thanks so much for any help.

--jz

JZ:

first, I'm sorry to hear about your grandfather. These are always tough things to deal with.

Your grandfather sounds as if he's between the proverbial rock and a hard place. On the one hand, he's filling up with fluid, which will affect his breathing, but on the other hand the fluid pills they're giving him to get rid of the fluid are reducing the blood flow to the kidney and are making his kidneys fail.

Dialysis is indeed effective in elderly folks, but you've nailed the sucky part of it...going to the dialysis unit every other day for the rest of your life.

There is a thing called peritoneal dialiysis that you can do at home, but it's a complicated thing and one missstep and you've contaminated your peritoneal cavity and now you have a bad problem. I've had bedbound patients go for this though.

With regard to prolonging the inevitable...

Modern medicine is a wonderful thing, but it has its limitations; if that wasn't true there'd be at least one or two 400 year old people running around. If we get to a place where we can't add days to someone's life without adding misery (and I'm not saying we're there in your grandfather...in the end it's his decision), if we shift our focus from adding days (traditional medicine) to a comfort-focused model (hospice or palliative care), it does tend to open up a lot of new options.

We can't always add days to someone's life, but we can ALMOST always make everyone comfortable until it is their time to leave this world.

Your grandfather retains the right to choose or decline any medical procedure or treatment he wants. If in the end he decides to go home and be made comfortable, more power to him.

One thing about dialysis....statistical studies seem to illustrate that needing dialysis but not taking it leaves you with an average of 1 year of life. IF you take dialysis for awhile and then QUIT, it leaves you with an average of 1 week of life. So it's better not to do it in the first place, then to do it and quit in less than a year. At least statistically, and we know statistics don't apply well to the individual.

I hope this helps. Let me know if you need further information.


your friend,



steve

[weekapaugjz]

There is a thing called peritoneal dialiysis that you can do at home, but it's a complicated thing and one missstep and you've contaminated your peritoneal cavity and now you have a bad problem. I've had bedbound patients go for this though.

in the conversation with my aunt, she brought this up and how careful the caretaker has to be with about keeping places clean of bacteria and infection. she also said that it is very difficult to find a nurse in our area that is willing to perform this service. my aunt said she would learn how to do it but my grandfather refuses saying she can't give up her own life to take care of him.

With regard to prolonging the inevitable...

Modern medicine is a wonderful thing, but it has its limitations; if that wasn't true there'd be at least one or two 400 year old people running around. If we get to a place where we can't add days to someone's life without adding misery (and I'm not saying we're there in your grandfather...in the end it's his decision), if we shift our focus from adding days (traditional medicine) to a comfort-focused model (hospice or palliative care), it does tend to open up a lot of new options.

We can't always add days to someone's life, but we can ALMOST always make everyone comfortable until it is their time to leave this world.

Your grandfather retains the right to choose or decline any medical procedure or treatment he wants. If in the end he decides to go home and be made comfortable, more power to him.

hospice care was mentioned in one brief conversation i had with my aunt. my grandfather seems to be so uncomfortable in the hospital. i just want to see him be comfortable. the doctors are saying about six months. they want to get his heart more stable before getting him home.

One thing about dialysis....statistical studies seem to illustrate that needing dialysis but not taking it leaves you with an average of 1 year of life. IF you take dialysis for awhile and then QUIT, it leaves you with an average of 1 week of life. So it's better not to do it in the first place, then to do it and quit in less than a year. At least statistically, and we know statistics don't apply well to the individual.

thank you for this information. i will definitely bring it up with my aunt the next time i talk to her.

thanks again for all the help. it is much appreciated.