Home Medical Care in Elderly Patients on Peritoneal Dialysis in Japan

Background: With the increasing elderly population in Japan, the number of elderly dialysis patients aged over 70 years are now more than 50%. Although peritoneal dialysis (PD) offers advantages for elderly patients, such as fewer dietary restriction and better quality of life, they often have difficulty in self-care. To address this, we have been initiating PD by assisted PD using a home medical care system. The purpose of the present study is to determine the role of home medical care in elderly PD patients at our hospital. Methods: We retrospectively analyzed PD patients treated at Tohoku Medical and Pharmaceutical University Hospital between April 1, 2016 and April 30, 2024. Medical record were reviewed to assess the number of elderly PD patients, those with assisted PD, and those utilizing home medical care services. Results: A total of 474 PD patients were recorded between 2016 to 2024. Of those, 171 patients used home nursing services, 71 utilized nursing facilities, and 110 received home medical doctors. A total of 83 PD patients died at home or in the nursing facilities. In 2024, 65 patients initiated PD: 25 patients were 70s, 15 patients were 80s, 3 patients were 90s (total 66% aged ≥ 70). In comparison, in 2018, 45 patients initiated PD, with 13 in 70s, 8 in 80s, and 5 in 90s (total 58% aged ≥ 70). In 2024, 65 patients (46%) received assisted PD: 33 were assisted by family, by both family and home care nurses, and 22 in the nursing facilities. The number of PD patients using home nursing were 49, those using nursing facilities were 29, and those using home medical doctors were 26 in 2024. In 2018, those numbers were 51, 6, and 26, respectively. Conclusion: The number of elderly PD patients has increased from 2018 to 2024, with a notable rise in the use of nursing facilities. Home medical care plays a critical role in supporting assisted PD in elderly PD patients, particularly as self-care becomes more challenging with age.