Managing Urological Health in Elderly Care: A Case Study and Expert Insights

Q: Managing Urological Health in Elderly Care: A Case Study and Expert Insights

Hello, sir： Thank you for your inquiry. <br>I would like to respond to your question and provide the following advice： Your father's condition is quite complex, and whether he requires dialysis should be discussed with his nephrologist. <br>I apologize for not being able to provi

Inquiry about disease management for elderly care (related to kidneys and bladder)?

Hello Director Lin,
My father (82 years old) is a veteran and his condition is as follows:
1.
He previously underwent surgery for prostate issues.
2.
Four years ago, he experienced a mild stroke which led to mobility difficulties.
3.
Two and a half years ago, he had surgery to remove a left kidney due to renal disease, and after a difficult recovery, he was placed in a nursing home where he has been in a continuous state of drowsiness, unable to respond normally even when his eyes are open.
4.
Nine months ago, an abnormal tumor was found in his bladder, and he underwent endoscopic removal surgery.
5.
Three months ago, the same issue recurred, and he had another removal surgery along with bladder irrigation.
6.
Three weeks ago, due to persistent fever, the nursing home used suppositories to reduce the fever, which were ineffective, leading to his transfer to the emergency department at the Veterans General Hospital.
7.
In the emergency department, diuretics and anti-inflammatory medications were administered, stabilizing his condition.
8.
The doctor suggested dialysis; if we were unwilling, we would need to sign a do-not-resuscitate consent form, but my sister and I felt this was not appropriate.
9.
Since returning to the nursing home on July 1 for observation, my father continues to experience shortness of breath, and his lower abdomen remains distended.
My mother, feeling anxious, wishes to hold a family meeting to discuss this, so we would like to seek your advice on the following:
1.
Is dialysis feasible and what would be its effectiveness?
2.
Are there any other medical recommendations?
3.
How can we arrange for his care moving forward?
Thank you very much!
Vincent

vincent, 40~49 year old female. Ask Date: 2010/07/06

Dr. Lin Hexing reply Urology

Hello, sir: Thank you for your inquiry.
I would like to respond to your question and provide the following advice: Your father's condition is quite complex, and whether he requires dialysis should be discussed with his nephrologist.
I apologize for not being able to provide an answer online.
Wishing you peace and happiness~~

Reply Date: 2010/07/06

More Info

Dear Vincent,
Thank you for reaching out with your father's complex medical history. Managing urological health in elderly patients, especially those with multiple comorbidities, can be quite challenging. Based on the details you've provided, I will address your questions and offer some insights into your father's situation.

1. Feasibility and Effectiveness of Dialysis: Given your father's history of kidney disease and recent complications, the decision to initiate dialysis should be made carefully. Dialysis can be beneficial for patients with significant kidney dysfunction, especially if they are experiencing symptoms such as fluid overload, electrolyte imbalances, or uremic symptoms (like nausea, fatigue, or confusion). However, considering your father's advanced age, history of stroke, and current state of health (including his ongoing weakness and lack of responsiveness), the potential benefits of dialysis must be weighed against the risks and burdens it may impose. In elderly patients, especially those with limited functional status, dialysis may not always lead to improved quality of life. A thorough discussion with a nephrologist who specializes in geriatric care would be essential to evaluate whether dialysis is appropriate for your father.

2. Other Medical Recommendations: Given your father's recurrent bladder tumors and recent urinary issues, it may be beneficial to consult with a urologist who can provide insights into the management of his bladder health. Regular monitoring through imaging and cystoscopy may be necessary to keep track of any new developments. Additionally, addressing his urinary symptoms, such as urgency or incontinence, can significantly improve his quality of life. Medications or bladder training techniques might be considered, depending on his overall health status.

3. Future Arrangements: As you consider your father's ongoing care, it may be helpful to involve a multidisciplinary team, including a geriatrician, nephrologist, urologist, and palliative care specialist. Palliative care can provide support in managing symptoms and improving quality of life, focusing on comfort rather than aggressive treatments if that aligns with your father's wishes. Family meetings, like the one you mentioned, can be crucial in discussing care goals and preferences. It's important to ensure that your father's values and desires are at the forefront of any decisions made.

In summary, managing your father's urological health requires a careful balance of medical intervention and quality of life considerations. Engaging with specialists who understand the complexities of geriatric care will be vital in navigating this challenging situation. I encourage you to have open discussions with his healthcare team to explore all available options and make informed decisions that align with your father's needs and preferences.

Wishing you and your family strength during this difficult time.

Best regards,
Doctor Q&A Teams

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