Breaking the cycle of functional decline in older dialysis patients

Abstract

Currently, older adults comprise nearly one-third of prevalent US dialysis patients, and this proportion will increase as the population ages. Older dialysis patients experience greater morbidity and mortality than nondialysis patients of the same age, and in part, it is related to progressive functional decline. Progressive functional decline, characterized by need for assistance with more than 2 activities of daily living, contributes to risk of hospitalization, further functional decline, and subsequent nursing home placement when a patient no longer functions independently at home. Progressive functional decline may appear to be unavoidable for older dialysis patients; however, comprehensive geriatric assessment (CGA) may alleviate the prevalence and severity of functional decline. This editorial summarizes common risk factors of functional decline and introduces CGA as a potentially transformative approach to breaking the cycle of functional decline in older dialysis patients.

Figure 1. Risk Factors for Functional Decline in Older Dialysis Patients

This figure depicts a conceptual framework of risk factors for functional decline (frailty, other geriatric syndromes, physical disability, comorbidity burden, and low physical activity) that interact and contribute to functional decline in a synergistic manner. Increasing age yields a patient who is more sensitive to these risk factors. Geriatric syndromes include falls, incontinence, delirium, and pressure ulcers. Physical disability refers to diminished capacity in vision, hearing, or mobility.