DOPPS and the Elderly: Implications for Nephrology Social Work Practice.

Abstract

Over the past three and a half decades, since Medicare funding became available for people with end-stage renal disease in the United States, the numbers of elderly on dialysis have increased dramatically and now represent well over half of the dialysis population. Beginning in the late 1970s, psychosocial issues and challenges faced by elderly people on dialysis emerged in the literature. Among other findings, these studies identified increased comorbidities and depressive symptomatology, decreased physical and mental functioning, and improved compliance. These studies were limited in size and represented either single facilities or multiple regional facilities. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an observational, longitudinal study providing a wide
range of data on a sample of people on hemodialysis randomly selected from nationally representative samples of dialysis facilities in 12 countries. In the current investigation, DOPPS findings indicate that the mean age of people on hemodialysis in nearly all study countries is at least 60 years, that cardiac disease is one of the most common comorbidities, that elderly patients are at significantly greater risk for malnutrition, and that compliance with treatment schedules is significantly better in elderly people. Health-Related Quality of Life scores demonstrate that physical functioning is markedly decreased, though mental component summary scores did not decrease with age. Finally, risk of death and withdrawal from dialysis are significantly higher for the elderly. Psychosocial evaluation of the elderly and social work intervention to maximize social, psychological, mental, and physical functioning are addressed, as well as end-of-life issues.