title: An integrative approach to advanced kidney disease in the elderly.
abstract: Chronic kidney disease (CKD) has increasingly become a "geriatric" disease, with a dramatic rise in incidence in the aging population. Patients aged >75 years have become the fastest growing population initiating dialysis. These patients have increased comorbid diseases and functional limitations which affect mortality and quality of life. This review describes the challenges of dialysis initiation and considerations for management of the elderly subpopulation. There is a need for an integrative approach to care, which addresses management issues, health-related quality of life, and timely discussion of goals of care and end-of-life issues. This comprehensive approach to patient care involves the integration of nephrology, geriatric, and palliative medicine practices.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC 27705-3860, USA. jane.schell@duke.edu <jane.schell@duke.edu>
authors.forename: Jane O
authors.initials: JO
authors.lastname: Schell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Germain
authors.forename: Fred O
authors.initials: FO
authors.lastname: Finkelstein
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.forename: Lewis M
authors.initials: LM
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D055048:Integrative Medicine; D007674:Kidney Diseases / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D011788:Quality of Life; D006435:Renal Dialysis