Incidence, prevalence, and outcomes of end-stage renal disease patients placed in nursing homes.
We prospectively surveyed the 156 dialysis centers in Network 5 (MD, VA, WV, DC) for end-stage renal disease (ESRD) patients admitted to or begun on dialysis in nursing homes during a 21-month period (April 1, 1990 to December 31, 1991). In addition to this incidence data, information on patient demographics, social characteristics, pre-existent illnesses, and functional capacity (measured by activity of daily living [ADL] scores) was obtained. One hundred thirty-two centers (close to 90% of Network 5's approximately 9,000 patients) responded to the survey. Outcome data were gathered throughout the 21-month period and the subsequent 5 months. Seventy-three centers dialyzed 228 such patients during the 18-month period. Five centers that were located in the same building as a nursing home cared for 67 patients. The 228 patients, aged 17 to 101 years, were older (65.50 years +/- 14.2 [SD] v 53.7 +/- 16.4 years), and disproportionately female (62.2% v 48.3%), white (46.5% v 37.4%), and diabetic (57.9% v 29%) compared with the general network ESRD population (P < 0.05). On admission to the nursing home 47% of patients had organic heart disease, 35% had an organic brain syndrome, 22% had cerebrovascular diseases, 19% had amputations, and 18% were blind. The mean admission ADL score was 8.1 +/- 5.2 (maximum function, 18) and the patients did not differ regarding age, sex, race, or diabetes. Forty-three percent of patients lived alone or in sheltered housing before being placed in the nursing home.(ABSTRACT TRUNCATED AT 250 WORDS)
Renal Division, Francis Scott Key Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224.
J E
JE
Anderson
J
J
Kraus
D
D
Sturgeon
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States