Mortality, morbidity, and life satisfaction in the very old dialysis patient

The average age of dialysis patients is rapidly increasing. In our present program, 20-25% of all patients are 70 yrs or older. We performed survival analysis of all 157 patients 70 yrs and above (mean age 75 yrs) and evaluated risk factors associated with dialysis survival using the Cox proportional hazards model. Morbidity, biochemical status, clinical results and life satisfaction were evaluated in a prevalence study of all 53 in-center and 26 home dialysis patients. In the survival analysis, we found improved survival since January 1, 1976, indicating improvement in dialysis technique up until that time. The 1, 3, and 5 yr survival were 78%, 47%, and 22% respectively. Only arteriosclerotic heart disease and year of entry were significant risk factors; advancing age over age 70 and in-center dialysis were only of marginal importance. The home patients had fewer dialysis symptoms than in-center patients. Almost all patients lived at home. Five patients (6%) were in nursing homes. Most patients were very satisfied with their lives, regarded their health as better than other 70 year old persons, spent time outdoors, participated in church activities, had active hobbies, enjoyed life very much, and scored high on the Karnofsky activity scale. We conclude older patients are excellent dialysis candidates and it is wrong not to consider them for dialysis.