An article in USA Today highlights the difficult choices that must made as we face the spiraling costs of health care. This is the lesson of Saturn (tests and challenges) traveling through Virgo (the care and maintenance of the body):
Within a year of starting dialysis, more than half of older nursing home residents die, and nearly another third experience a significant decline in their ability to perform simple tasks, such as feeding themselves, researchers report today.
The fastest-growing group of U.S. patients starting dialysis is those 75 and older, many of whom have health problems other than kidney failure, such as dementia or heart disease.
Some observers have questioned whether dialysis, which typically is performed three days a week for three or four hours at a time, is the best option for such patients.
Many doctors assume that palliative care is “a death sentence” for patients with permanent kidney failure, internist Robert Arnold, director of palliative care at the University of Pittsburgh, and nephrologist Mark Zeidel, of Harvard University, write in an editorial accompanying the study.
But, they write, small studies of frail elderly patients with permanent kidney failure suggest that death rates and quality of life don’t differ much between those who go on dialysis and those who don’t. “We must define who among this population will benefit most from dialysis and who will benefit most from conservative therapy.”
Conservative punduts decrying the use of “death panels” ignore the fact that such panels actually exist today. It’s unfortunate that politics have gotten in the way of a serious conversation about these matters, which are crucial to a real understanding of what is needed to improve the quality of end of life care as well as health care for everyone else.
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