title: Clinical outcome of elderly peritoneal dialysis patients with assisted care in a single medical centre: a 25 year experience.
abstract: OBJECTIVE
  Peritoneal dialysis (PD) is an alternative treatment for elderly patients with end-stage renal disease (ESRD). In Taiwan, non-professional personnel are employed to provide assisted care for elderly patients. Whether assisted care is appropriate for elderly patients is unknown. The aim of this paper is to evaluate the outcomes of assisted care in a single centre.
  
  
  METHODS
  This is a retrospective cohort study in a single medical centre. The outcomes were derived from the assessment of patient survival, technique survival and peritonitis incidence between self-care patients and assisted-care patients.
  
  
  RESULTS
  From 1984 to 2010, there were 138 elderly PD patients at Taichung Veterans General Hospital, of which 70% were assisted-care patients and 30% self-care patients. The mean duration of PD survival was 49.2 months in self-care patients, which was significantly longer than the 17.0 months of assisted-care patients (P < 0.05). Using the multivariate Cox proportion regression model to adjust for risk factors, it was found that self-care patients had a lower risk in both patient survival (Hazard Ratio 0.15; 95% confidence interval (CI) 0.2-0.94, P < 0.05) and technique survival (Hazard ratio; 0.11, 95% CI 0.1-0.9, P < 0.05). Fluid overloading was the major cause of technique failure in assisted-care patients. Type of assistance was not a risk factor for PD-related peritonitis.
  
  
  CONCLUSIONS
  Our elderly assisted care had patients had a poorer survival and technique survival rates than those of the self-care patients. We argue that this is because early recognition of medical deterioration and early medical intervention are necessary for a better outcome for elderly PD patients.
authors.affiliation: Institute of Medicine, Chung Shun Medical University, Taichung, Taiwan.|Department of Nephrology, Taichung Veterans General Hospital.|Department of Biotechnology, Hung Kuang University, Taichung, Taiwan.
authors.forename: Chi-Hung
authors.initials: CH
authors.lastname: Cheng
authors.affiliation: Department of Nephrology, Taichung Veterans General Hospital.
authors.forename: Kuo-Hsiung
authors.initials: KH
authors.lastname: Shu
authors.affiliation: Department of Nephrology, Taichung Veterans General Hospital.
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Chuang
authors.affiliation: Department of Nephrology, Taichung Veterans General Hospital.
authors.forename: Shih-Ting
authors.initials: ST
authors.lastname: Huang
authors.affiliation: Institute of Medicine, Chung Shun Medical University, Taichung, Taiwan.
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Chou
authors.affiliation: Institute of Medicine, Chung Shun Medical University, Taichung, Taiwan.
authors.forename: Horng-Rong
authors.initials: HR
authors.lastname: Chang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality; D010538:Peritonitis / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012648:Self Care / Q000009:adverse effects / Q000401:mortality; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome