Analyses of Factors Preventing Returning Home in Elderly Patients on Dialysis

A significant number of elderly patients who begin dialysis are not able to return home even after attaining stable dialysis. The aim of the present study is to clarify the factors preventing returning home. Patients aged over 60 years who had newly started dialysis (103 cases) were studied. These w...

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Published inNihon Rōnen Igakkai zasshi Vol. 37; no. 8; pp. 627 - 632
Main Authors Hirashima, Tokuji, Fujimaki, Hiroshi, Takahashi, Sachiko, Kasuya, Yutaka, Kagami, Shino, Takahashi, Tadao, Koga, Shiro, Mizuno, Shoichi
Format Journal Article
LanguageJapanese
Published Japan The Japan Geriatrics Society 2000
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ISSN0300-9173
DOI10.3143/geriatrics.37.627

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Abstract A significant number of elderly patients who begin dialysis are not able to return home even after attaining stable dialysis. The aim of the present study is to clarify the factors preventing returning home. Patients aged over 60 years who had newly started dialysis (103 cases) were studied. These were 58 men and 45 women. The age was 73±7years (mean±standard deviation).In each patient, the cause of renal failure (non-diabetes/diabetes), nutritional state, complications, ambulation, cognitive function, urgency of the initiation into dialysis therapy, occurrence of access failure, presence or absence of the partner, presence or absence of members of the younger generation living in the same house, and the outcome (returning home or prolonged hospitalization) were surveyed. Of the 103 patients, 80 could return home, and 23 could not. First, we investigated the influence of the differences in each factor on the outcome. The subjects were divided into two groups by two categories in each factor. The numbers of patients who could not return home was calculated respectively. Comparisons were carried out by the χ2 test. Statistically significant factors were ambulation (p<0.0001), cognitive function (p<0.0001), and cause of renal failure (p:0.049). Multivariant logistic regression analysis was also performed using back-ground factors as explanatory variables and the outcome as a dependent variable. The factors presented by the nominal scale were converted to dummy variables. Statistically significant factors were ambulation (p<0.0001), cognitive function (p:0.001), and presence or absence of a partner (p:0.012). Inability to walk, impaired cognitive function, and absence of a partner were the factors preventing returning home.
AbstractList A significant number of elderly patients who begin dialysis are not able to return home even after attaining stable dialysis. The aim of the present study is to clarify the factors preventing returning home. Patients aged over 60 years who had newly started dialysis (103 cases) were studied. These were 58 men and 45 women. The age was 73 +/- 7 years (mean +/- standard deviation). In each patient, the cause of renal failure (non-diabetes/diabetes), nutritional state, complications, ambulation, cognitive function, urgency of the initiation into dialysis therapy, occurrence of access failure, presence or absence of the partner, presence or absence of members of the younger generation living in the same house, and the outcome (returning home or prolonged hospitalization) were surveyed. Of the 103 patients, 80 could return home, and 23 could not. First, we investigated the influence of the differences in each factor on the outcome. The subjects were divided into two groups by two categories in each factor. The numbers of patients who could not return home was calculated respectively. Comparisons were carried out by the chi 2 test. Statistically significant factors were ambulation (p < 0.0001), cognitive function (p < 0.0001), and cause of renal failure (p: 0.049). Multivariant logistic regression analysis was also performed using back-ground factors as explanatory variables and the outcome as a dependent variable. The factors presented by the nominal scale were converted to dummy variables. Statistically significant factors were ambulation (p < 0.0001), cognitive function (p: 0.001), and presence or absence of a partner (p: 0.012). Inability to walk, impaired cognitive function, and absence of a partner were the factors preventing returning home.A significant number of elderly patients who begin dialysis are not able to return home even after attaining stable dialysis. The aim of the present study is to clarify the factors preventing returning home. Patients aged over 60 years who had newly started dialysis (103 cases) were studied. These were 58 men and 45 women. The age was 73 +/- 7 years (mean +/- standard deviation). In each patient, the cause of renal failure (non-diabetes/diabetes), nutritional state, complications, ambulation, cognitive function, urgency of the initiation into dialysis therapy, occurrence of access failure, presence or absence of the partner, presence or absence of members of the younger generation living in the same house, and the outcome (returning home or prolonged hospitalization) were surveyed. Of the 103 patients, 80 could return home, and 23 could not. First, we investigated the influence of the differences in each factor on the outcome. The subjects were divided into two groups by two categories in each factor. The numbers of patients who could not return home was calculated respectively. Comparisons were carried out by the chi 2 test. Statistically significant factors were ambulation (p < 0.0001), cognitive function (p < 0.0001), and cause of renal failure (p: 0.049). Multivariant logistic regression analysis was also performed using back-ground factors as explanatory variables and the outcome as a dependent variable. The factors presented by the nominal scale were converted to dummy variables. Statistically significant factors were ambulation (p < 0.0001), cognitive function (p: 0.001), and presence or absence of a partner (p: 0.012). Inability to walk, impaired cognitive function, and absence of a partner were the factors preventing returning home.
A significant number of elderly patients who begin dialysis are not able to return home even after attaining stable dialysis. The aim of the present study is to clarify the factors preventing returning home. Patients aged over 60 years who had newly started dialysis (103 cases) were studied. These were 58 men and 45 women. The age was 73 +/- 7 years (mean +/- standard deviation). In each patient, the cause of renal failure (non-diabetes/diabetes), nutritional state, complications, ambulation, cognitive function, urgency of the initiation into dialysis therapy, occurrence of access failure, presence or absence of the partner, presence or absence of members of the younger generation living in the same house, and the outcome (returning home or prolonged hospitalization) were surveyed. Of the 103 patients, 80 could return home, and 23 could not. First, we investigated the influence of the differences in each factor on the outcome. The subjects were divided into two groups by two categories in each factor. The numbers of patients who could not return home was calculated respectively. Comparisons were carried out by the chi 2 test. Statistically significant factors were ambulation (p < 0.0001), cognitive function (p < 0.0001), and cause of renal failure (p: 0.049). Multivariant logistic regression analysis was also performed using back-ground factors as explanatory variables and the outcome as a dependent variable. The factors presented by the nominal scale were converted to dummy variables. Statistically significant factors were ambulation (p < 0.0001), cognitive function (p: 0.001), and presence or absence of a partner (p: 0.012). Inability to walk, impaired cognitive function, and absence of a partner were the factors preventing returning home.
A significant number of elderly patients who begin dialysis are not able to return home even after attaining stable dialysis. The aim of the present study is to clarify the factors preventing returning home. Patients aged over 60 years who had newly started dialysis (103 cases) were studied. These were 58 men and 45 women. The age was 73±7years (mean±standard deviation).In each patient, the cause of renal failure (non-diabetes/diabetes), nutritional state, complications, ambulation, cognitive function, urgency of the initiation into dialysis therapy, occurrence of access failure, presence or absence of the partner, presence or absence of members of the younger generation living in the same house, and the outcome (returning home or prolonged hospitalization) were surveyed. Of the 103 patients, 80 could return home, and 23 could not. First, we investigated the influence of the differences in each factor on the outcome. The subjects were divided into two groups by two categories in each factor. The numbers of patients who could not return home was calculated respectively. Comparisons were carried out by the χ2 test. Statistically significant factors were ambulation (p<0.0001), cognitive function (p<0.0001), and cause of renal failure (p:0.049). Multivariant logistic regression analysis was also performed using back-ground factors as explanatory variables and the outcome as a dependent variable. The factors presented by the nominal scale were converted to dummy variables. Statistically significant factors were ambulation (p<0.0001), cognitive function (p:0.001), and presence or absence of a partner (p:0.012). Inability to walk, impaired cognitive function, and absence of a partner were the factors preventing returning home.
Author Hirashima, Tokuji
Mizuno, Shoichi
Takahashi, Tadao
Kasuya, Yutaka
Takahashi, Sachiko
Fujimaki, Hiroshi
Koga, Shiro
Kagami, Shino
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  fullname: Mizuno, Shoichi
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References 10) 一松珠紀, 浜田博文, 窪田正大, 鮫島亮子, 神宮裕見, 梅本昭英: 脳卒中患者の家庭復帰に影響を及ぼす要因の検討-家庭復帰群と在院群との比較より. 鹿大医短紀要1998; 8: 83-88.
18) Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, et al.: Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. Kidney Int 1998; 54: 245-254.
4) 日本透析医学会統計調査委員会: わが国の慢性透析療法の現況 (1998年12月31日現在). 透析会誌 2000; 33: 1-27.
9) 湯元均, 大泉嘉彦, 大嶋峻: 身体的・社会的背景が家庭復帰に与える影響. 北海道理学療法 1988; 5: 9-14.
7) 浜田知久馬: オッズ比とロジスティック回帰入門. 学会・論文発表のための統計学真興交易医書出版部, 東京, 1999, p135-165.
13) 西浦公朗: 大都市近郊にある老人保健施設入所者の家庭復帰に関連する要因について. 日老医誌 1999; 36: 479-488.
1) 澤畠雅子: 長期入院患者の家庭復帰-人工透析を必要とする視力障害者の事例. 臨床透析 1988; 4: 1895-1899.
5) 川口良人, 和田孝雄, 二瓶宏, 杉野信博, 繁田幸雄, 黒川清ほか: 血液透析-透析導入基準の見直しと最近の考え方. 内科 1993; 72: 301-307.
17) Kutner NG, Lin LS, Fielding B, Brogan D, Hall WD: Continued survival of older hemodialysis patients: Investigation of psychosocial predictors. Am J Kidney Dis 1994; 24: 42-49.
14) Nissenson AR: Dialysis therapy in the elderly patient. Kidney Int 1993; 43: s51-s57.
12) 佐々木和人, 鈴木英二, 田所雄二, 重原恵美子, 松井博行, 渡辺彰ほか: 老人保健施設入所患者が家庭復帰可能となる要因とその対策. 総合リハ 1997; 25: 465-471.
6) 柄澤昭秀: 行動評価による老人知能の臨床的判定基準. 老年期痴呆 1989; 3: 81-85.
16) 藤巻博: 保存療法から血液浄化法への転換期における諸問題-高齢者における腎不全の場合. 臨床透析 1990; 6: 1633-1635.
11) 岡本五十雄, 菅沼宏之, 鎌倉嘉一郎, 塩川哲男: 家庭復帰, 施設入所に影響する諸条件. 北海道リハビリ 1999; 27: 51-57.
15) Hirsch DJ, West ML, Cohen AD, Jindal KK: Experience with not offering dialysis to patients with a poor prognosis. Am J Kidney Dis 1994; 23: 463-466.
3) 遠藤ミネ子, 中村祐子, 勝久美子: 高齢透析患者の看護-入院が長期化している高齢透析患者の家庭復帰に向けた援助. 看護技術 1994; 40: 728-732.
2) 飯田喜俊: 高齢者透析の問題点とその対策-入院透析の是非とその基準. 腎と透析 1992; 32: 557-562.
8) Norusis MJ: Logistic regression. In: SPSS Advanced Statistics 6.1. SPSS Inc, Chicago, IL, 1994, p392-404.
References_xml – reference: 8) Norusis MJ: Logistic regression. In: SPSS Advanced Statistics 6.1. SPSS Inc, Chicago, IL, 1994, p392-404.
– reference: 9) 湯元均, 大泉嘉彦, 大嶋峻: 身体的・社会的背景が家庭復帰に与える影響. 北海道理学療法 1988; 5: 9-14.
– reference: 5) 川口良人, 和田孝雄, 二瓶宏, 杉野信博, 繁田幸雄, 黒川清ほか: 血液透析-透析導入基準の見直しと最近の考え方. 内科 1993; 72: 301-307.
– reference: 1) 澤畠雅子: 長期入院患者の家庭復帰-人工透析を必要とする視力障害者の事例. 臨床透析 1988; 4: 1895-1899.
– reference: 13) 西浦公朗: 大都市近郊にある老人保健施設入所者の家庭復帰に関連する要因について. 日老医誌 1999; 36: 479-488.
– reference: 11) 岡本五十雄, 菅沼宏之, 鎌倉嘉一郎, 塩川哲男: 家庭復帰, 施設入所に影響する諸条件. 北海道リハビリ 1999; 27: 51-57.
– reference: 15) Hirsch DJ, West ML, Cohen AD, Jindal KK: Experience with not offering dialysis to patients with a poor prognosis. Am J Kidney Dis 1994; 23: 463-466.
– reference: 16) 藤巻博: 保存療法から血液浄化法への転換期における諸問題-高齢者における腎不全の場合. 臨床透析 1990; 6: 1633-1635.
– reference: 6) 柄澤昭秀: 行動評価による老人知能の臨床的判定基準. 老年期痴呆 1989; 3: 81-85.
– reference: 18) Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, et al.: Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. Kidney Int 1998; 54: 245-254.
– reference: 7) 浜田知久馬: オッズ比とロジスティック回帰入門. 学会・論文発表のための統計学真興交易医書出版部, 東京, 1999, p135-165.
– reference: 3) 遠藤ミネ子, 中村祐子, 勝久美子: 高齢透析患者の看護-入院が長期化している高齢透析患者の家庭復帰に向けた援助. 看護技術 1994; 40: 728-732.
– reference: 14) Nissenson AR: Dialysis therapy in the elderly patient. Kidney Int 1993; 43: s51-s57.
– reference: 4) 日本透析医学会統計調査委員会: わが国の慢性透析療法の現況 (1998年12月31日現在). 透析会誌 2000; 33: 1-27.
– reference: 2) 飯田喜俊: 高齢者透析の問題点とその対策-入院透析の是非とその基準. 腎と透析 1992; 32: 557-562.
– reference: 12) 佐々木和人, 鈴木英二, 田所雄二, 重原恵美子, 松井博行, 渡辺彰ほか: 老人保健施設入所患者が家庭復帰可能となる要因とその対策. 総合リハ 1997; 25: 465-471.
– reference: 10) 一松珠紀, 浜田博文, 窪田正大, 鮫島亮子, 神宮裕見, 梅本昭英: 脳卒中患者の家庭復帰に影響を及ぼす要因の検討-家庭復帰群と在院群との比較より. 鹿大医短紀要1998; 8: 83-88.
– reference: 17) Kutner NG, Lin LS, Fielding B, Brogan D, Hall WD: Continued survival of older hemodialysis patients: Investigation of psychosocial predictors. Am J Kidney Dis 1994; 24: 42-49.
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Snippet A significant number of elderly patients who begin dialysis are not able to return home even after attaining stable dialysis. The aim of the present study is...
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SubjectTerms Aged
Dialysis
Elderly
Factor Analysis, Statistical
Female
Humans
Kidney Failure, Chronic - therapy
Male
Middle Aged
Multivariant logistic regression analysis
Multivariate Analysis
Regression Analysis
Renal Dialysis
Returning home
Title Analyses of Factors Preventing Returning Home in Elderly Patients on Dialysis
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