Volume 29 Issue 2 - May 8, 2015 PDF
Estimation of physical functional disabilities and long-term care needs for patients under maintenance hemodialysis
Mei-Chuan Hung1, Junne-Ming Sung2, Yu-Tzu Chang2, Jing-Shiang Hwang3, Jung-Der Wang1, 2, 4,*
1 Department of Public Health, National Cheng Kung University College of Medicine
2 Department of Internal Medicine, National Cheng Kung University Hospital
3 Institute of Statistical Science, Academia Sinica;
4 Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital
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Background and objectives: Physical functional disabilities in hemodialysis (HD) patients may increase their mortality and long-term care needs. This study aims to estimate the changes of proportion for different physical functional disabilities and the lifelong care needs along time after beginning HD.

Methods: We used a population-based cohort consisting of 84,657 incident HD patients in Taiwan between 1998 and 2009 to estimate the survival function and extrapolate to lifetime through a semi-parametric method. The Barthel Index (BI) was used to measure functional disability levels cross-sectionally in 1,334 HD patients recruited from 9 HD centers. A BI score less than 50 was considered as severe disability. Lifetime care needs were obtained by extrapolating the age-stratified survival functions to lifetime and then multiplying them with proportions of different kinds of functional disabilities over time.

Results: On average, HD patients had at least 6.4, 2.0, and 1.3 years without disability, with moderate disability, and severe disability, respectively. The most common care needs were stair-climbing and bathing which were 3.0 and 1.7 years, respectively. HD patients were expected to have about 3 years living with disabilities for those beginning HD at an age above 35; however, the older the patient, the higher the proportion of functional disabilities and care needs.

Conclusions: HD patients are in need of long-term care and require early intervention and resource planning. The method developed in this study can also be applied to other chronic illnesses with various functional disabilities.

Figure 1. The lifetime health-adjusted survival of hemodialysis (HD) patients. Each panel illustrates the sum of expected years of life lost (shaded area between the solid and dotted curves) and the lifespan with functional disabilities (shaded area between the dotted and dashed curves) for HD patients stratified by age.
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