Complying with ethical principles in elderly and frail patients with advanced chronic kidney disease
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.34632/cadernosdesaude.2019.5306 |
Resumo: | Introduction: In 2016, in Europe (EU), 27.3 million people were aged > 80 (the so-called "elderly people"), and this value will likely increase up to 7 million more in ten years time. Portugal follows that world trend and has presently the fifth highest proportion of elderly people in the EU. According to the data records from the Portuguese Society of Nephrology, the cohort of dialysis patients aged > 80 years appears in the tables as an individualized group with a significant and increasing prevalence since 2015. Overtreatment of elderly patients ESRD has gained attention in professional journals and the lay mediafueled by disturbing outcome data. Therefore, it is imperative to review the application of dialysis treatment. Patients should be informed about the options of treatment, including the more conservative, non-dialytic ones and the implications of the different options for their lives. Aims: To analyze ethically the problems faced in renal replacement therapy resulting from the aging of the population in Portugal. Materials and methods: A critical review and analysis was conducted to discuss the dilemmas and challenges to deal with the above critical situation, namely the approach dialysis versus conservative treatments. Results: The basis for all processes involved are, namely: (i) the ethics´ principles that are the key support to guide the care providers through the treatment options; (ii) the estimation of prognosis and shared decision-making and (iii) the palliative care, which is an area where the awareness of clinicians needs to be urgently improved. Conclusions: It is crucial the presentation to the patients of the several options of treatment aiming to achieve a better balance between risks and benefits and the best possible response to the goals and expectations of the patients. |
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Complying with ethical principles in elderly and frail patients with advanced chronic kidney diseaseCumprir com os princípios éticos em doentes idosos e frágeis com doença renal crónica avançadaIntroduction: In 2016, in Europe (EU), 27.3 million people were aged > 80 (the so-called "elderly people"), and this value will likely increase up to 7 million more in ten years time. Portugal follows that world trend and has presently the fifth highest proportion of elderly people in the EU. According to the data records from the Portuguese Society of Nephrology, the cohort of dialysis patients aged > 80 years appears in the tables as an individualized group with a significant and increasing prevalence since 2015. Overtreatment of elderly patients ESRD has gained attention in professional journals and the lay mediafueled by disturbing outcome data. Therefore, it is imperative to review the application of dialysis treatment. Patients should be informed about the options of treatment, including the more conservative, non-dialytic ones and the implications of the different options for their lives. Aims: To analyze ethically the problems faced in renal replacement therapy resulting from the aging of the population in Portugal. Materials and methods: A critical review and analysis was conducted to discuss the dilemmas and challenges to deal with the above critical situation, namely the approach dialysis versus conservative treatments. Results: The basis for all processes involved are, namely: (i) the ethics´ principles that are the key support to guide the care providers through the treatment options; (ii) the estimation of prognosis and shared decision-making and (iii) the palliative care, which is an area where the awareness of clinicians needs to be urgently improved. Conclusions: It is crucial the presentation to the patients of the several options of treatment aiming to achieve a better balance between risks and benefits and the best possible response to the goals and expectations of the patients.Introdução: Na Europa (EU), em 2016 27.3 milhões de pessoas apresentavam mais de 80 anos de idade (os denominados pessoas muito idosas), número com tendência para aumentar em 7 milhões no espaço de 10 anos. Portugal acompanha esta tendência sendo, atualmente, o 5º país da EU com a maior proporção de pessoas idosas. De acordo com dados da Sociedade Portuguesa de Nefrologia, a proporção de doentes em diálise nestas faixas etárias, tem aumentado significativamente desde 2015. O sobretratamento dos idosos com Insuficiência renal crónica em estádio terminal tem ganho atenção nas publicações científicas médicas, tendo em conta os resultados obtidos. Deste modo, é imperative rever a introdução/continuação dos tratamentos de diálise nesta população. Os doentes devem ser informados acerca das diferentes opções terapêuticas, nelas incluindo cada vez mais as mais conservativas, não dialíticas, assim como as implicações que cada opção terá na sua vida. Objetivos: Analisar eticamente os problemas do processo de tomada de decisão perante a terapêutica de substituição renal na população idosa em Portugal. Materiais e métodos: Realizada uma revisão e análise crítica para discutir os dilemas éticos no processo de decisão destas situações, nomeadamente, a opção entre diálise e tratamento conservador. Resultados: As bases de todos os processos envolvidos são, nomeadamente: (i) os princípios éticos, que constituem um suporte fundamental para guiar os profissionais de saúde através das várias opções de tratamento; (ii) a estimativa de prognóstico e a formulação de uma decisão partilhada e (iv) os cuidados paliativos, que é uma área em que a consciencialização dos profissionais de saúde precisa urgentemente de ser melhorada. Conclusões: É crucial a apresentação aos doentes das várias opções de tratamento, de forma a conseguir um bom equilíbrio entre riscos e benefícios e dar a melhor resposta possível aos objetivos e expectativas do doente.Universidade Católica Portuguesa2019-06-02info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.34632/cadernosdesaude.2019.5306https://doi.org/10.34632/cadernosdesaude.2019.5306Cadernos de Saúde; Vol 11 No 2 (2019); 44-50Cadernos de Saúde; v. 11 n. 2 (2019); 44-502795-43581647-055910.34632/cadernosdesaude.2019.11.2reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://revistas.ucp.pt/index.php/cadernosdesaude/article/view/5306https://revistas.ucp.pt/index.php/cadernosdesaude/article/view/5306/9390Direitos de Autor (c) 2020 Ana Mateushttp://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessMateus, Ana2023-10-03T15:47:56Zoai:ojs.revistas.ucp.pt:article/5306Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:33:08.639732Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Complying with ethical principles in elderly and frail patients with advanced chronic kidney disease Cumprir com os princípios éticos em doentes idosos e frágeis com doença renal crónica avançada |
title |
Complying with ethical principles in elderly and frail patients with advanced chronic kidney disease |
spellingShingle |
Complying with ethical principles in elderly and frail patients with advanced chronic kidney disease Mateus, Ana |
title_short |
Complying with ethical principles in elderly and frail patients with advanced chronic kidney disease |
title_full |
Complying with ethical principles in elderly and frail patients with advanced chronic kidney disease |
title_fullStr |
Complying with ethical principles in elderly and frail patients with advanced chronic kidney disease |
title_full_unstemmed |
Complying with ethical principles in elderly and frail patients with advanced chronic kidney disease |
title_sort |
Complying with ethical principles in elderly and frail patients with advanced chronic kidney disease |
author |
Mateus, Ana |
author_facet |
Mateus, Ana |
author_role |
author |
dc.contributor.author.fl_str_mv |
Mateus, Ana |
description |
Introduction: In 2016, in Europe (EU), 27.3 million people were aged > 80 (the so-called "elderly people"), and this value will likely increase up to 7 million more in ten years time. Portugal follows that world trend and has presently the fifth highest proportion of elderly people in the EU. According to the data records from the Portuguese Society of Nephrology, the cohort of dialysis patients aged > 80 years appears in the tables as an individualized group with a significant and increasing prevalence since 2015. Overtreatment of elderly patients ESRD has gained attention in professional journals and the lay mediafueled by disturbing outcome data. Therefore, it is imperative to review the application of dialysis treatment. Patients should be informed about the options of treatment, including the more conservative, non-dialytic ones and the implications of the different options for their lives. Aims: To analyze ethically the problems faced in renal replacement therapy resulting from the aging of the population in Portugal. Materials and methods: A critical review and analysis was conducted to discuss the dilemmas and challenges to deal with the above critical situation, namely the approach dialysis versus conservative treatments. Results: The basis for all processes involved are, namely: (i) the ethics´ principles that are the key support to guide the care providers through the treatment options; (ii) the estimation of prognosis and shared decision-making and (iii) the palliative care, which is an area where the awareness of clinicians needs to be urgently improved. Conclusions: It is crucial the presentation to the patients of the several options of treatment aiming to achieve a better balance between risks and benefits and the best possible response to the goals and expectations of the patients. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-06-02 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
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publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.34632/cadernosdesaude.2019.5306 https://doi.org/10.34632/cadernosdesaude.2019.5306 |
url |
https://doi.org/10.34632/cadernosdesaude.2019.5306 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://revistas.ucp.pt/index.php/cadernosdesaude/article/view/5306 https://revistas.ucp.pt/index.php/cadernosdesaude/article/view/5306/9390 |
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Direitos de Autor (c) 2020 Ana Mateus http://creativecommons.org/licenses/by/4.0 info:eu-repo/semantics/openAccess |
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Direitos de Autor (c) 2020 Ana Mateus http://creativecommons.org/licenses/by/4.0 |
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openAccess |
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application/pdf |
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Universidade Católica Portuguesa |
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Universidade Católica Portuguesa |
dc.source.none.fl_str_mv |
Cadernos de Saúde; Vol 11 No 2 (2019); 44-50 Cadernos de Saúde; v. 11 n. 2 (2019); 44-50 2795-4358 1647-0559 10.34632/cadernosdesaude.2019.11.2 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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