Accepting or declining dialysis: considerations taken into account by elderly patients with end-stage renal disease

BACKGROUND: Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy. METHOD: In-depth interviews were conducted to gain an enhanced understanding of the considerations in treatment decision-making. Fourteen patients aged 65 years or older participated in the interviews, of whom 8 patients had made the decision to start, and 6 patients the decision to decline, dialysis. RESULTS: All participating patients had a variety of health problems, but appeared to have normal cognitive functions. Patients who declined dialysis were older and more often men and widow(er)s compared with patients who accepted dialysis. Patients chose to start dialysis because they enjoyed life, were not prepared to face the end of life, felt they had no other choice or had care-giving responsibilities for family members. Patients declined dialysis because of the speculated loss of autonomy, their age-associated decrease in vitality, distance from dialysis center and reluctance to think about the future. CONCLUSION: Results suggest that patients' decisions to decline or accept dialysis are not based on the effectiveness of the treatment, but rather on personal values, beliefs and feelings toward life, suffering and death, and the expected difficulties in fitting the treatment into their life

Vascular burden and cognitive function in late-life depression

Item does not contain fulltextOBJECTIVE: To evaluate the relation of vascular risk factors, subclinical, and manifest vascular disease with four domains of cognitive functioning in a large sample of clinically depressed older persons. METHODS: A cross-sectional analysis was used, and depressed patients were recruited from general practices and mental healthcare institutes. Presence of a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, depressive episode was established with the Composite International Diagnostic Interview. Framingham Risk Score (FRS) was used as a measure for vascular risk profile, ankle-brachial index for subclinical vascular disease, and history of a cardiovascular event as a measure for manifest vascular disease. Three neurocognitive tasks evaluated processing speed, working memory, verbal memory, and interference control. Results : In 378 participants, linear regression analysis showed that FRS was related to poorer interference control (t = -2.353; df = 377; p <0.05) but to no other cognitive domain after adjustment for age, sex, education level, and depressive symptom severity. Lower ankle-brachial index and history of cardiovascular event were related to slower processing speed (t = 2.659; df = 377; p <0.05 and t = -3.328; df = 377; p <0.01, respectively) but to no other cognitive domain. In 267 participants without manifest vascular disease, higher FRS was related to slower processing speed (t = -2.425; df = 266; p <0.05) and poorer interference control (t = -2.423; df = 266; p <0.05), and lower ankle brachial index was related to slower processing speed (t = 2.171; df = 266; p <0.05). CONCLUSION: In depressed older persons, vascular burden is related to slower processing speed also in the absence of manifest vascular disease. Poorer interference control was only related to vascular risk factors but not to subclinical or manifest vascular disease

Pharmacological treatment of increased vascular risk and cognitive performance in middle-aged and old persons: six-year observational longitudinal study

Background: Lowering vascular risk is associated with a decrease in the prevalence of cardiovascular disease and dementia. However, it is still unknown whether lowering of vascular risk with pharmacological treatment preserves cognitive performance in general. Therefore, we compared the change in cognitive performance in persons with and without treatment of vascular risk factors. Methods: In this longitudinal observational study, 256 persons (mean age, 58 years) were treated for increased vascular risk during a mean follow-up period of 5.5 years (treatment group), whereas 1678 persons (mean age, 50 years) did not receive treatment (control group). Cognitive performance was three times measured during follow-up using the Ruff Figural Fluency Test (RFFT) and Visual Association Test (VAT), and calculated as the average of standardized RFFT and VAT score per participant. Because treatment allocation was nonrandomized, additional analyses were performed in demographic and vascular risk-matched samples and adjusted for propensity scores. Results: In the treatment group, mean (SD) cognitive performance changed from - 0.30 (0.80) to - 0.23 (0.80) to 0.02 (0.87), and in control group, from 0.08 (0.77) to 0.24 (0.79) to 0.49 (0.74) at the first, second and third measurement, respectively (p trend < 0.001). After adjustment for demographics and vascular risk, the change in cognitive performance during follow-up was not statistically significantly different between the treatment and control group: mean estimated difference, - 0.10 (95%CI - 0.21 to 0.01; p = 0.08). Similar results were found in matched samples and after adjustment for propensity score. Conclusion: Change in cognitive performance during follow-up was similar in treated and untreated persons. This suggests that lowering vascular risk preserves cognitive performance

Validation of the CAM-ICU as performed by bed-side ICU nurses : A multicentre study

Delirium is a frequent disorder in the ICU associated with poor outcome. Several organizations, including the SCCM and the APA, therefore recommend standard screening for delirium to improve early diagnosis and treatment. The CAM-ICU is the most frequently used delirium detection tool in the Netherlands. Numerous studies to validate the CAM-ICU always yielded excellent sensitivity and specificity, but were all performed by a limited number of research nurses

Exploration of the difference in incidence of renal replacement therapy in elderly patients in Flanders and the Netherlands--a comparison of referral policy

BACKGROUND: The incidence of renal replacement therapy (RRT) among patients aged >/=65 years is much higher in Flanders, the Dutch speaking region of Belgium, than in the Netherlands. We studied whether differences in referral policy to nephrologists by primary care physicians (PCPs) and specialists between Flanders and the Netherlands may play a role. METHODS: A vignette study was performed among 329 PCPs and 96 specialists in Flanders and compared to the vignette study that was conducted among 209 PCPs and 162 specialists in the Netherlands. Physicians were offered six vignettes concerning case reports of patients with chronic kidney disease and varying co-morbidities or social circumstances. Each vignette was presented for a 65- and an 80-year-old patient. Physicians were asked about the likelihood of referral of the patients in the given circumstances. Univariate and logistic regression analyses were performed to identify whether country affected the likelihood of referral. RESULTS: Univariate analyses showed that the percentage of PCPs who would probably or definitely refer a 65- or an 80-year-old patient with less severe co-morbidity was significantly (P </= 0.001) higher in the Netherlands than in Flanders. However, the likelihood of referral of PCPs-concerning patients with more severe co-morbidity did not differ significantly. Specialists in Flanders did not differ in the likelihood to refer patients from that of specialists in the Netherlands. Logistic regression analysis showed that country (higher referral in the Netherlands) was an important predictor for the referral of PCPs, and this was especially the case for patients with less severe co-morbidity. These patterns persisted, even after controlling for other possible predictors as physicians' age, gender, religion and years in practice. CONCLUSIONS: This study suggests that the lower RRT incidence in the Netherlands cannot be explained by a more restrictive referral policy among physicians in the Netherlands. The data suggested that the latter group had a similar or even more liberal attitude to the referral of older patients than physicians in Flanders

Data from: Reference data for the Ruff Figural Fluency Test stratified by age and educational level

The Ruff Figural Fluency Test (RFFT) was developed to avoid the difficulties that were encountered in earlier tests of figural fluency. Although the test characteristics of the RFFT seem to be good and it is a valuable addition to neuropsychological assessments, reference data are still scarce. To this aim, we required 2,404 community dwelling persons in Groningen, the Netherlands to perform the RFFT. All 1,651 persons with a complete RFFT and known educational level formed the reference sample. Their age ranged from 35 to 82 years and their educational level from primary school to university grade. Ninety-six percent of the persons were of Western European descent. All tests were analyzed by two independent examiners and subsequently three measures were calculated: number of unique designs, number of perseverative errors and error ratio. The main finding was that performance on the RFFT was dependent on age and educational level. This was not only observed in older persons but also in young and middle-aged persons. Reference data for the three RFFT measures are presented in groups of five years of age ranging from 35-39 years to 75 years or older