Abstract
【Objective】Among dialysis patients, those who are diabetic or elderly require longer term hospitalization and may develop serious complications. ADL was compared between outpatients and inpatients receiving hemodialysis. Comparison was made using FIM, which has been established in the field of rehabilitation, and the causes of decreased ADL among dialysis patients were examined. 【Methods】Seventy-one patients (31 outpatients and 40 inpatients) receiving hemodialysis care and rehabilitation at our hospital were investigated. Basic information on patients, primary disease causing chronic renal failure, complications and FIM were investigated. 【Results】A greater proportion of inpatients showed diabetes mellitus as the primary disease compared to that among outpatients. Among diabetics, the probability of being hospitalized due to complications was high. There was significant locomotor rehabilitation in 87% of outpatients. However, there was a marked incidence of cerebrovascular disease and rehabilitation for disuse atrophy in 65% of inpatients (p<0.0001). FIM of inpatients was 65±33 points compared with 124±4 points in outpatients and the difference was highly significant (p<0.0001). There were 16 patients with stroke (infarction 8, hemorrhage 7, anoxia encephalosis 1), and palsy significantly decreased ADL when complications of inpatients were examined. Orthopedic conditions were noted in 8 patients (femur the neck bone fracture 4, lumbar spine compression fracture 4). ASO was found in 7 patients (unilateral below knee amputation 2, bilateral above knee/bilateral below knee/unilateral above knee amputation each 1, intractable ulcer 2). Six anima patients were diagnosed (cyclophrenia 1, mental retardation 2, serious affiliation symptom 3). There were 3 seriously ill patients (poorly controlled diabetes mellitus 2, cardiac decompensation 1). However, there were several inpatients with good ADL. 【Conclusion】FIM of inpatients showed more extreme problems than that of outpatients. Complications significantly deteriorate ADL, and long-term admission promotes deterioration. Accordingly, prevention of the complications indicated above is important to maintain dialysis. It is thought that promoting body control and maintenance of ADL by exercise therapy is necessary. Rationalization of dialysis care and Long Term Care Insurance, institutions that accept dialysis patient further augmentation of connections among dialysis hospitals and institutions are immediately necessary.
