Geriatric Nephrology: The Medical, Psychosocial, Nursing, Financial and Ethical Issues of Treating End-Stage Renal Disease in the Elderly

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Dimitrios G. Oreopoulos
Springer Science & Business Media, Jun 30, 1986 - Medical - 293 pages
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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.
 

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Contents

1 INTRODUCTION
1
2 PHYSIOLOGY OF AGING
5
PSYCHOSOCIAL ASPECTS OF AGING
11
4 PHARMACOKINETICS AND PHARMACODYNAMICS IN THE ELDERLY
19
5 FLUID AND ELECTROLYTE DISORDERS IN THE ELDERLY
27
6 SODIUM HOMEOSTASIS WITH SPECIAL REFERENCE TO FRACTIONAL EXCRETION OF SODIUM AND PLASMA PROSTAGLANDIN E1...
37
7 AGING AND BODY WATER
41
8 ENDSTAGE RENAL DISEASE IN THE ELDERLY A GERIATRICIANS VIEWPOINT
49
15 HEMODIALYSIS OF THE ELDERLY
135
16 PERITONEAL DIALYSIS IN THE ELDERLY
147
THE RECENT UNITED STATES EXPERIENCE AND RESULTS FROM A SINGLE INSTITUTION
157
THE CANADIAN EXPERIENCE
169
19 NURSING ASPECTS OF THE ELDERLY PATIENT ON DIALYSIS
175
20 THE ELDERLY PATIENT ON DIALYSISPSYCHOSOCIAL CONSIDERATIONS
183
21 REFUSAL OR TERMININATION OF A LIFESUPPORT PROGRAM LEGAL ASPECTS
203
CAN WE AFFORD TO TREAT EVERYONE?
221

MECHANISMS RISK FACTORS AND THERAPEUTIC IMPLICATIONS
57
10 PREVENTABLE CAUSES OF RENAL FAILURE IN THE ELDERLY
73
11 BACTERIURIA IN THE ELDERLY SUBJECT ITS RELATIONSHIP TO SURVIVAL
95
12 ACUTE RENAL FAILURE IN THE ELDERLY
103
13 CHRONIC RENAL FAILURE IN THE ELDERLY
117
14 NUTRITIONAL NEEDS FOR THE ELDERLY HEMODIALYSIS PATIENT
127
23 CAN WE AFFORD TO TREAT EVERYBODY? THE UK VIEW
227
24 IT IS HAPPENING HERE
241
APPENDIX
247
DISCUSSIONS
249
INDEX
289
Copyright

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