Skip to main content

Advertisement

Advertisement

Advertisement

ADVERTISEMENT

Podcasts

Melissa Wachterman Podcast: Dialysis and Hospice

 


This is the first in a two part series on Geriatrics, Palliative Care, and Chronic Kidney Disease.

One of our most popular GeriPal posts ever is titled, "Dying without Dialysis".  That post discusses an article on the symptomatic experience of persons who decided not initiate dialysis in the setting of advanced kidney disease.

This is obviously a compelling topic, given the high prevalence of kidney disease among older adults.

Medicare policy that poses tremendous barriers to continuing dialysis while enrolling in hospice.  This sets up an either-or dichotomy that leads to low rates of hospice use, and among those who use hospice, lengths of stay that are frequently 3 days or fewer.

This week, Eric and I talked with Melissa Wachterman, a physician researcher from the Dana Farber Cancer Institute and Harvard Medical School.  Melissa used a national dataset of people receiving hemodialysis linked to Medicare claims for older adults who died.  She found:

 

  • 20% used hospice (compared to 48% hospice use among all Medicare decedents)
  • Of those who used hospice, 42% used hospice for 3 days or fewer.
This is a complex issue, with not only the structural policy barriers, but also major communication issues, including lack of prognostic discussion and honesty.  
 
Links:


-by Alex Smith, @AlexSmithMD

Listen to GeriPal Podcasts on:

To read the transcript to this podcast, click here

Comment at GeriPal.org


For more Annals of Long-Term Care articles, visit the homepage

To view the Annals of Long-Term Care print issue, click here

Advertisement

Advertisement