Geriatric Nephrology: The medical, psychosocial, nursing, financial and ethical issues of treating end-stage renal disease in the elderly (Developments in Nephrology, 12)

The year was 1943. As a third-year medical student at Stanford, I was about to witness the beginning of a medical miracle. Dr. Arthur Bloomfield, Professor of Medicine, had selected my patient, a middle aged man, who was dying of acute pneumococcal pneumonia, as one of the first patients to receive miniscule doses (by today's standards) of his meagre supply of a new drug - penicillin. The patient's response amazed everyone especially this impressionable medical student. The rest of the story is history. With one stroke, the introduction of penicillin removed from the medical scene the 'friend of the aged' - lobar pneumonia. The consequences, which no one could have imagined at the time, are still becoming manifest as other 'miracles' such as respirators, artificial kidneys and many potent new antibiotics have come upon the scene. All of us are aware that these miracles have created a variety of new challenges around the states of dying and near dying. We have no easy answers for these problems. Nevertheless as dialysis techniques, especially CAPD, are applied more widely to the treatment of the elderly, the task of helping the patient meet death with dignity becomes increasingly important and vexing because once begun, dialysis is difficult to terminate. Front Matter....Pages I-XVI Introduction....Pages 1-3 Physiology of Aging....Pages 5-10 Senility and Maturity: Psychosocial Aspects of Aging....Pages 11-18 Pharmacokinetics and Pharmacodynamics in the Elderly....Pages 19-26 Fluid and Electrolyte Disorders in the Elderly....Pages 27-36 Sodium Homeostasis with Special Reference to Fractional Excretion of Sodium and Plasma Prostaglandin E-1 in Elderly Hypertensives in Essential and Renovascular Hypertension....Pages 37-40 Aging and Body Water....Pages 41-48 End-Stage Renal Disease in the Elderly a Geriatrician’s Viewpoint....Pages 49-55 Decline of Renal Function with Age: Mechanisms, Risk Factors and Therapeutic Implications....Pages 57-71 Preventable Causes of Renal Failure in the Elderly....Pages 73-93 Bacteriuria in the Elderly Subject; Its Relationship to Survival....Pages 95-102 Acute Renal Failure in the Elderly....Pages 103-116 Chronic Renal Failure in the Elderly....Pages 117-126 Nutritional Needs for the Elderly Hemodialysis Patient....Pages 127-134 Hemodialysis of the Elderly....Pages 135-145 Peritoneal Dialysis in the Elderly....Pages 147-156 Renal Transplantation in the Middle-Aged and Elderly Uremic Patient....Pages 157-168 Renal Transplantation in the Elderly: The Canadian Experience....Pages 169-173 Nursing Aspects of the Elderly Patient on Dialysis....Pages 175-182 The Elderly Patient on Dialysis--Psychosocial Considerations....Pages 183-201 Refusal or Terminination of a Life-Support Program - Legal Aspects....Pages 203-219 Uremia in the Aged: Can We Afford to Treat Everyone?....Pages 221-226 Can We Afford to Treat Everybody? The UK View....Pages 227-239 It is Happening Here....Pages 241-246 Back Matter....Pages 289-293