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. 2014 Jan;52(1):63-70.
doi: 10.1097/MLR.0000000000000010.

Estimation of physical functional disabilities and long-term care needs for patients under maintenance hemodialysis

Mei-Chuan Hung  1 , Junne-Ming Sung, Yu-Tzu Chang, Jing-Shiang Hwang, Jung-Der Wang
Affiliations
Free PMC article

Estimation of physical functional disabilities and long-term care needs for patients under maintenance hemodialysis

Mei-Chuan Hung et al. Med Care. 2014 Jan.
Free PMC article

Abstract

Background and objectives: Physical functional disabilities in hemodialysis (HD) patients may increase their mortality and long-term care needs. The aim of this study was to estimate the changes of proportion for different physical functional disabilities along time after beginning HD and the lifelong care needs.

Methods: We used a population-based cohort consisting of 84,657 incident HD patients in Taiwan between 1998 and 2009 to estimate the survival function and extrapolate to lifetime through a semiparametric method. The Barthel Index (BI) was used to measure the functional disability levels cross-sectionally in 1334 HD patients recruited from 9 HD centers. A BI score <50 was considered as severe disability. Lifetime care needs were obtained by extrapolating the age-stratified survival functions to lifetime and then multiplying them with proportions of different kinds of functional disabilities over time.

Results: On average, HD patients had at least 6.4, 2.0, and 1.3 years without disability, with moderate disability, and severe disability, respectively. The most common care needs were stair-climbing and bathing, which were 3.0 and 1.7 years, respectively. HD patients were expected to have about 3 years living with disabilities for those beginning HD at an age above 35 years; however, the older the patient, the higher the proportion of functional disabilities and care needs.

Conclusions: HD patients are in need of long-term care and require early intervention and resource planning. The method developed in this study can also be applied to other chronic illnesses with various functional disabilities.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Dynamic change in different functional needs for caring for patients with severe disability after hemodialysis stratified by age.
FIGURE 2
FIGURE 2
The lifetime health-adjusted survival of hemodialysis (HD) patients. Each panel illustrates the sum of expected years of life lost (shaded area between the solid and dotted curves) and the lifespan with functional disabilities (shaded area between the dotted and dashed curves) for HD patients stratified by age.
None
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