Palliation Versus Dialysis for End-Stage Renal Disease in the Oldest Old: What are the Considerations?

As the US population continues to age, new cases of end-stage renal disease (ESRD) in individuals, aged 85 years or older (the oldest old), are increasing. Many patients who begin hemodialysis despite questionable benefit may struggle with high symptom burden and rapid functional decline. This article reviews the history regarding the funding and development of the Medicare ESRD program, reviews current approaches to the oldest old with ESRD, and considers strategies to improve the management approach of this vulnerable population

The relationship between adolescents’ civic knowledge, civic attitude, and civic behavior and their self-reported future likelihood of voting

A long-standing objective of American public education is fostering civically engaged youth. Identifying characteristics associated with likelihood of future voting, a measure of democratic participation that predicts future voting behavior, might yield targets for education programs to increase civic participation. Survey data from urban adolescents were analyzed to elucidate how civic knowledge, civic attitudes, and civic behaviors are associated with self-reported likelihood of future voting. In a multivariable ordered logistic regression model with latent constructs for civic knowledge, attitudes, and behavior, two civic knowledge constructs and two civic attitude constructs maintained a positive, statistically significant independent association with future voting likelihood after adjusting for race/ethnicity and advanced coursework: knowledge of American governance, current events knowledge, general self-efficacy, and skill-specific self-efficacy. Further research is necessary to determine whether education programs can intervene upon these civic knowledge and civic attitude factors to increase voting participation later in life