It was pointed out to me that most countries cut off payment for dialysis at age 65. It was further pointed out to me that only the wealthy who can pay for services themselves are allowed to continue their dialysis in these countries. If this is true, which nations cut-off dialysis at age 65?
Hi Jane,
I believe that’s a myth, and am not aware of any countries that currently use an arbitrary age cut-off to decide who does or doesn’t get dialysis. The UK may have had such a cut-off in the distant past, but not any time recently. There was a wonderful old gentleman (Oldborris) on the dialysis-support listserv who was in his 80’s who lived in the UK and dialyzed until he chose to stop due to other health problems.
There is a recent study that came out and found that people in nursing homes who were given dialysis had very poor survival. That’s not a function of age; it’s a function of being very debilitated and having multiple complex medical problems. The truth is that not everyone should get dialysis. Not because of their age, but because they won’t benefit from it–it will just make their last days more painful and confusing.
It has seemed to me that I have read where a few patients on the net from other countries have stated that there was no cut-off age. Also, when it comes to patients from nursing homes, I have seen them transported to dialysis, and whereas the recent article states dialysis does not benefit them due to their debilitated condition, I have to wonder about that, too, in one important sense. The reason I say this is because any patient, no matter what the age, is a sitting duck for hopelessness, depression, injury and death if they are not educated on their tx thus able to protect themselves in clinics where nurses/techs do not do proper assessments, where scrips are not individualized, or where staff errors are routine thus causing patients to be taken down fast. This is something the public, or those not sufficiently educated on the tx and intimately aware of what dialysis patients suffer in subpar clinics (and this includes the very professionals who work with and care for the patients day in and day out), know nothing about. The sad truth is, I have witnessed with my own eyes how one patient after another gives up the fight quickly as they can not sustain the emotional and physical assault on their bodies. I have seen stalwart men well over 6 ft. tall drop like trees. Not that a person’s height and size make them any stronger then a little ole grandma, but just to make the point that no one is immune from the effects of poor dialysis care. Although I have been a totally pro-active patient from day #1, I have not a single doubt that I would be a statistic, too, if not for my ability to persevere thus the answers and support that have come to me because of it. If in-center patients only realized in time that there are better ways to do dialysis and had the support they need that would keep them safe and prolong their lives, we wouldn’t have the drastic statistics we have.
Excellent, excellent point, Jane. If anyone might be extra-vulnerable to depression, it would probably be someone who is already in a nursing home, too.
In your experience, what has helped the most to combat feelings of depression or hopelessness?
We have a person in the clinic I go to who is on Dialysis and I believe he is between 87 and 89. I cant remember exactly. Not only is he on Dialysis, but he is on Home Dialysis and perfors most of the setup himself. I believe his wife does help out.
I think this is great that some clinics do not look at age as a factor of not being able to perform home dialysis. He is very alert and responsible with his treatments.
This just goes to show, if there is a will to do it, it can be done even in the elderly population.
If anyone is denied dialysis no matter what their age - any type - home or in center should be considered a crime.
Anyone should have the right to dialyze.
///MM
I absolutely hate it when studies are published that use old data. The nursing home study that was just published used data on nursing home patients from 1998-2000. That data is now a decade old.
http://www.usatoday.com/news/health/2009-10-14-dialysis-elderly_N.htm
Are nursing home patients doing better or worse now? Who knows. But to report data that old that may affect policy is irresponsible in my opinion. If the researchers wanted to study nursing home patients, they should have gotten the data from USRDS in 2002 and published the study within a year or two.
As a social worker, I believe strongly in educating and identifying and treating depression and debilitation in patients. Patients have much more hope when they understand what their role is in doing well and living longer. There are things that can be done to effectively treat depression from talk therapy to drug therapy to a combination of both and physical debilitation can be improved through physical rehabilitation. Patients living in nursing homes today may even be able to live independently with a higher quality of life and lower cost with help from their families and the community.
At the same time, for some patients the burden of kidney disease and treatment exceeds the benefits dialysis offers. There are patients who are cognitively impaired to the point that they cannot make their own decisions. Some have no family or family who don’t know enough to make the decision for them. This is where the doctor has an ethical duty to share the patient’s medical condition and prognosis and describe what dialysis will and will not do. I’ve known doctors will dialyze everyone, including patients in persistent vegetative states from which no one expects improvement no matter what treatments are provided.
When I hear of these situations, it confirms the importance of everyone having that very important discussion with his/her family about end of life issues and writing an advance directive that states exactly what what to do and not do to prolong life.
Hi y’all,
Here’s a disturbing abstract from ASN about the cost of saving more lives–but it doesn’t say anything about the productivity and contributions of the lives saved. 
[SA-FC347] Can We Afford To Improve Survival in Patients Receiving Hemodialysis?
Philip McFarlane, David C. Mendelssohn. Division of Nephrology, University of Toronto, Toronto, ON, Canada
Patients receiving hemodialysis have reduced survival compared to healthy controls. Unfortunately, randomized trials have failed to identify strategies that improve survival on dialysis. However, the economic impact of improving dialysis survival has not been examined. Given that hemodialysis may be the most expensive chronic intervention for which society is willing to pay to improve survival, and given the new emphasis on comparative effectiveness research (CER), it is important to examine whether we can afford to improve survival on dialysis.
We created a Markov decision analysis model, which simulated the states of hemodialysis, transplantation, and death. The first year of dialysis was modeled separately from subsequent years. The model accounted for expected growth in incidence, and inflation. Our base scenario modeled dialysis growth patterns as predicted by recent trends. The comparator examined growth assuming that survival could be improved by 22% (as anticipated in recent trials). The perspective was that of the hemodialysis unit, and excluded costs of transplantation and the cost of the hypothetical intervention that improved survival.
Over 10 years, our model predicts that a 100-person dialysis unit will grow to 170 patients. With improved survival, the unit will grow to 179 patients, accumulating 58 additional patient-years of survival and $5,171,000 additional costs. When projected to a regional level (for example, the Province of Ontario, Canada), a population of 7,500 dialysis patients would grow to about 12,729. With improved survival, the population grows to 13,390, accumulating 4,374 additional patient-years and $387,833,884 of additional costs. The cost per life year in these models varied between $77,250 and $88,660. The estimates were stable in sensitivity analyses.
While improving survival on dialysis may have an acceptable cost-effectiveness ratio, the budgetary impact is significant and perhaps prohibitive in some jurisdictions. This is a best-case scenario given that we excluded the intervention’s cost. Strictly applied CER may lead to stagnation of dialysis care. We suggest that the dialysis community needs to develop approaches to these potential challenges.
To combat depression, I simply tune out the foolishness from the home clinic.