| [ Summary ] |
The aging of the maintenance dialysis patient population has become quite evident and problems related to initiating dialysis for dementia patients as well as the onset of dementia after initiating dialysis have become very serious. There are believed to be two common conditions in the terminal stage of dementia patients ; (1) dementia worsens resulting in immobility or loss of the ability to eat or, (2) there is no change in the severity of dementia yet their physical condition worsens brought about by renal failure. Whatever the patien's condition is, if it becomes impossible to perform dialysis or it is clearly difficult or dangerous, decision making should be carried out following the "Dialysis Withdrawal" proposal of the Japanese Society for Dialysis Therapy. On the other hand, even if dialysis can be performed, in cases involving severe dementia, can measures be taken to clearly determine the patient's intentions such as an advanced directive or conversations with family, surrogate decisions by the family or medical staff respecting this information to the fullest are necessary and should be allowed. In the event of the patient's intentions being completely unknown, the best possible plan is for the patient's desires to be determined by the family members or other concerned persons. |