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[Survey of hemodialysis inpatients in long-term care facilities].

OBJECTIVE
In Japan, the number of elderly patients on hemodialysis has markedly increased in recent years. We conducted a survey to confirm the current status of inpatient hemodialysis patients and dialysis facilities with the aim of providing better care.


MATERIAL AND METHODS
The subjects were 57 dialysis patients admitted to the Jishu Hospital for three consecutive months or longer as of February 2004. The survey was conducted by obtaining informed-consent from the patients and their families. The patients were interviewed and a questionnaire was sent to their families. The survey items were as follows; 1) patient characteristics, 2) domestic status, 3) physical and mental condition and 4) awareness concerning the hospital.


RESULTS
The survey showed that dementia is present in almost all elderly hemodialysis patients and they require some degree of assistance for the activities of daily living. In addition, 57.9% patients had already been admitted to or had visited two or more hospitals. The current status of inpatients had improved slightly. Although the period of hospitalization was longer than one year in 64.9% of respondents, it had decreased by around 13% in comparison with that in the previous survey at 1997. These results were considered to be caused by increases in inpatient dialysis facilities, aging-related deaths, and by patients switching to home care after discharge because of the higher economic burden. In the interview, some patients were satisfied with inpatient life, but about one half of the patients said they wanted home care. Key caregivers for patients are mainly middle-aged or older family members (> 50 years old), indicating that caregivers are aging. On the other hand, the present study showed that hospitalization provides advantages for family life, such as improvements in peace of mind, life rhythm, leisure time and physical condition.


CONCLUSION
Since the aging of dialysis patients results in a decrease in physical activity and progression of dementia, long-term hospitalization has a high potential to induce bedridden patients. In addition to the requirement for more long-term facilities, efforts should be made to improve physical activities and inhibit the progression of dementia.