부산대학교 도서관

Objectives: An increasing number of studies have shown that, compared to dialysis, conservative or palliative care for elderly patients with advanced kidney disease reports a similar mortality rate but offers a better quality of life. The study accordingly aimed to explor the factors prompting elderly patients with advanced kidney disease to choose palliative care. Methods: The retrospective study exmained patients over 65 years old who were asked to consider dialysis after visiting the nephrology outpatient department of a medical center in southern Taiwan during the period from October 2010 to October 2019. The patients and their families were provided detailed information about dialysis and palliative care to assist them in decision making. Patients' baseline characteristics (demographics, comorbidities, laboratory parameters, do-not-resuscitate signature status) and outcomes (hospitalization, emergency room visit, etc.) and related data were collected and analyzed with SPSS software for chi-square test, t-test, and binary logistic regression analysis. Results: Of the 78 patients examined, 28 chose and 50 declined palliative care. There were no significant difference in age, gender, Charlson comorbidity index, and lab data between the two groups of patients. In both groups, patients with cancer (p=0.03) and those hospitalized in the past 30 days (p＜0.01) were more likely to choose palliative care. After adjustment by logistic regression analysis, those hospitalized in the past 30 days were more likely to choose palliative care. The palliative care group reduced hospitalization by 0.25 times in one month. Conclusion: Recent experience of hospitalization appears to make it more likely for elderly patients with advanced kidney disease to choose palliative care over hemodialysis, and palliative care is associated with a lower unumber of short-term hospitalization among these patients.