Broadening options for long-term dialysis in the elderly

Abstract

Currently, older people predominantly begin treatment on haemodialysis (HD), with the proportion of people starting on peritoneal dialysis (PD) steadily declining over recent years despite survival and some quality of life (QOL) indicators appearing similar between those on PD and HD. This thesis explores whether PD is under-utilised by older people in the UK through three cross-sectional, multicentre studies focusing on QOL and the modality decision making process. The first study aims to extend knowledge of HD and PD QOL outcomes. Seventy older patients on PD were matched to patients on HD by age, sex, time on dialysis, ethnicity and index of deprivation. QOL assessments included the SF-12 and Illness Intrusiveness Ratings Scale. Regression analyses, adjusted for multiple variables including comorbidities, found that patients on PD experienced less illness and treatment intrusion than those on HD, with other QOL outcomes found to be similar between the two groups. The second study investigates the involvement that 65 older patients, new to HD, had in their modality selection. Data was collected using a questionnaire designed for the purpose. Only 52% of the sample perceived having had some involvement in their modality decision and 33% expressed a preference for greater involvement than that experienced. In the final study, experiences of modality decision making and life on dialysis were explored through qualitative analysis of narratives from 30 older patients on HD and PD. Findings demonstrate that decisions are influenced by patients’ prior experiences, as well as their medical and social context. Quality of education can impact on modality selection and the integration of dialysis into patients’ lives. In conclusion, a lack of involvement in modality selection can have a detrimental impact on older patients’ QOL. Healthcare professionals should, therefore, strive to implement effective shared decision making in the selection of a dialysis modality.