title: Estimation of physical functional disabilities and long-term care needs for patients under maintenance hemodialysis.
abstract: OBJECTIVE
  Physical functional disabilities in hemodialysis (HD) patients may increase their mortality and long-term care needs. The aim of this study was to estimate the changes of proportion for different physical functional disabilities along time after beginning HD and the lifelong care needs.
  
  
  METHODS
  We used a population-based cohort consisting of 84,657 incident HD patients in Taiwan between 1998 and 2009 to estimate the survival function and extrapolate to lifetime through a semiparametric method. The Barthel Index (BI) was used to measure the functional disability levels cross-sectionally in 1334 HD patients recruited from 9 HD centers. A BI score <50 was considered as severe disability. Lifetime care needs were obtained by extrapolating the age-stratified survival functions to lifetime and then multiplying them with proportions of different kinds of functional disabilities over time.
  
  
  RESULTS
  On average, HD patients had at least 6.4, 2.0, and 1.3 years without disability, with moderate disability, and severe disability, respectively. The most common care needs were stair-climbing and bathing, which were 3.0 and 1.7 years, respectively. HD patients were expected to have about 3 years living with disabilities for those beginning HD at an age above 35 years; however, the older the patient, the higher the proportion of functional disabilities and care needs.
  
  
  CONCLUSIONS
  HD patients are in need of long-term care and require early intervention and resource planning. The method developed in this study can also be applied to other chronic illnesses with various functional disabilities.
authors.affiliation: *Department of Public Health, National Cheng Kung University College of Medicine †Department of Internal Medicine, National Cheng Kung University Hospital ‡Institute of Statistical Science, Academia Sinica §Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Mei-Chuan
authors.initials: MC
authors.lastname: Hung
authors.forename: Junne-Ming
authors.initials: JM
authors.lastname: Sung
authors.forename: Yu-Tzu
authors.initials: YT
authors.lastname: Chang
authors.forename: Jing-Shiang
authors.initials: JS
authors.lastname: Hwang
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult