Reduced Pneumonia Risk in Advanced Dementia Patients on Careful Hand Feeding Compared With Nasogastric Tube Feeding.

OBJECTIVES: To compare survival and pneumonia risk among hospitalized patients with advanced dementia on nasogastric tube feeding (NGF) vs careful hand feeding (CHF) and to examine outcomes by feeding problem type. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Advanced dementia patients aged ≥60 years with indication for tube feeding admitted to 2 geriatric convalescent hospitals between January 1, 2015, and June 30, 2019. METHODS: Comparison on the effect of NGF and CHF on survival and pneumonia risk using Kaplan Meier survival analysis and Cox proportional hazards models. RESULTS: Of the 764 patients (mean age 89 years, 61% female, 74% residential care home residents), 464 (61%) were initiated on NGF and 300 (39%) on CHF. The primary feeding problem types were dysphagia (50%), behavioral feeding problem (33%), or both (17%). There was no difference in 1-year survival rate between NGF and CHF groups (36% vs 37%, P = .71) and survival did not differ by feeding problem type. Nasogastric tube feeding was not a significant predictor for survival (adjusted hazard ratio 1.15, 95% CI 0.94-1.39). Among 577 (76%) patients who survived to discharge, pneumonia rates were lower in the CHF group (48% vs 60%, P = .004). After adjusting for cofounders, NGF was a significant risk factor for pneumonia (adjusted hazard ratio 1.41, 95% CI 1.08-1.85). In subgroup analyses, NGF was associated with increased pneumonia risk for patients with both dysphagia and behavioral feeding problem (P = .01) but not in patients with behavioral feeding problem alone (P = .24) or dysphagia alone (P = .30). CONCLUSIONS AND IMPLICATIONS: For advanced dementia patients with feeding problems, there is no difference in survival between NGF and CHF. However, NGF is associated with a higher pneumonia risk, particularly for patients with both dysphagia and behavioral feeding problem. Further research on how the feeding problem type impacts pneumonia risk for patients on NGF is needed.

Prevalence and risk factors of delirium and subsyndromal delirium in Chinese older adults.

AIM: To study the prevalence and risk factors of delirium and subsyndromal delirium (SSD) in Chinese older adults with acute medical illnesses. METHODS: A prospective cohort study was carried out in acute general medical wards in a university-affiliated hospital in Hong Kong. Patients were assessed by the confusion assessment method by geriatricians within 6 h after admission and classified into three mutually exclusive groups, namely delirium, SSD and those without both conditions. Predisposing factors and precipitating factors of delirium and SSD were retrieved from collateral information, clinical charts and electronic clinical records. RESULTS: A total of 575 patients with mean age of 80.8 years were recruited. A total of 73% of the patients did not have delirium, 15.8% of patients had delirium and 11.3% of patients had SSD. On multivariate analysis, patients with delirium or SSD were more likely to be current users of psychotropic medications, had hearing and visual impairment, had a major neurocognitive disorder as defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, and with a lower Barthel Index 20 points version than those without both conditions. Significant predisposing and precipitating factors of delirium included psychotropic medications, acute stroke and other causes of organic brain syndromes. Predisposing and precipitating factors of delirium and SSD were almost identical. CONCLUSIONS: Delirium and SSD are common among Chinese older adults with acute medical illnesses, with a combined prevalence of delirium and SSD of 27%. Important precipitating and predisposing factors include psychotropic medications, acute ischemic stroke and other causes of organic brain syndromes. Geriatr Gerontol Int 2018; 18: 1625-1628.

Role of Hand Hygiene Ambassador and Implementation of Directly Observed Hand Hygiene Among Residents in Residential Care Homes for the Elderly in Hong Kong.

OBJECTIVEMultidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.METHODSFrom July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum ß-lactamse (ESBL)-producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.RESULTSThe overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 [13.2%] vs 197 of 600 [32.8%]; P<.001) and CRA (56 of 600 [9.3%] vs 94 of 600 [15.7%]; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).CONCLUSIONSThe direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.Infect Control Hosp Epidemiol 2018;39:571-577.

Unexpectedly Higher Morbidity and Mortality of Hospitalized Elderly Patients Associated with Rhinovirus Compared with Influenza Virus Respiratory Tract Infection.

Rhinovirus is a common cause of upper and lower respiratory tract infections in adults, especially among the elderly and immunocompromised. Nevertheless, its clinical characteristics and mortality risks have not been well described. A retrospective analysis on a prospective cohort was conducted in a single teaching hospital center over a one-year period. We compared adult patients hospitalized for pneumonia caused by rhinovirus infection with those hospitalized for influenza infection during the same period. All recruited patients were followed up for at least 3 months up to 15 months. Independent risk factors associated with mortality for rhinovirus infection were identified. Between 1 March 2014 and 28 February 2015, a total of 1946 patients were consecutively included for analysis. Of these, 728 patients were hospitalized for rhinovirus infection and 1218 patients were hospitalized for influenza infection. Significantly more rhinovirus patients were elderly home residents and had chronic lung diseases (p < 0.001), whereas more influenza patients had previous stroke (p = 0.02); otherwise, there were no differences in the Charlson comorbidity indexes between the two groups. More patients in the rhinovirus group developed pneumonia complications (p = 0.03), required oxygen therapy, and had a longer hospitalization period (p < 0.001), whereas more patients in the influenza virus group presented with fever (p < 0.001) and upper respiratory tract symptoms of cough and sore throat (p < 0.001), and developed cardiovascular complications (p < 0.001). The 30-day (p < 0.05), 90-day (p < 0.01), and 1-year (p < 0.01) mortality rate was significantly higher in the rhinovirus group than the influenza virus group. Intensive care unit admission (odds ratio (OR): 9.56; 95% confidence interval (C.I.) 2.17-42.18), elderly home residents (OR: 2.60; 95% C.I. 1.56-4.33), requirement of oxygen therapy during hospitalization (OR: 2.62; 95% C.I. 1.62-4.24), and hemoglobin level <13.3 g/dL upon admission (OR: 2.43; 95% C.I. 1.16-5.12) were independent risk factors associated with 1-year mortality in patients hospitalized for rhinovirus infection. Rhinovirus infection in the adults was associated with significantly higher mortality and longer hospitalization when compared with influenza virus infection. Institutionalized older adults were particularly at risk. More stringent infection control among health care workers in elderly homes could lower the infection rate before an effective vaccine and antiviral become available.

Efficacy of Clarithromycin-Naproxen-Oseltamivir Combination in the Treatment of Patients Hospitalized for Influenza A(H3N2) Infection: An Open-label Randomized, Controlled, Phase IIb/III Trial.

BACKGROUND: Influenza causes excessive hospitalizations and deaths. The study assessed the efficacy and safety of a clarithromycin-naproxen-oseltamivir combination for treatment of serious influenza. METHODS: From February to April 2015, we conducted a prospective open-label, randomized, controlled trial. Adult patients hospitalized for A(H3N2) influenza were randomly assigned to a 2-day combination of clarithromycin 500 mg, naproxen 200 mg, and oseltamivir 75 mg twice daily, followed by 3 days of oseltamivir or to oseltamivir 75 mg twice daily without placebo for 5 days as a control method (1:1). The primary end point was 30-day mortality. The secondary end points were 90-day mortality, serial nasopharyngeal aspirate (NPA) virus titer, percentage of neuraminidase-inhibitor-resistant A(H3N2) virus (NIRV) quasispecies, pneumonia severity index (PSI), and duration of hospital stay. RESULTS: Among the 217 patients with influenza A(H3N2) enrolled, 107 were randomly assigned to the combination treatment. The median age was 80 years, and 53.5% were men. Adverse events were uncommon. Ten patients died during the 30-day follow-up. The combination treatment was associated with lower 30-day mortality (P = .01), less frequent high dependency unit admission (P = .009), and shorter hospital stay (P < .0001). The virus titer and PSI (days 1-3; P < .01) and the NPA specimens with NIRV quasispecies ≥ 5% (days 1-2; P < .01) were significantly lower in the combination treatment group. Multivariate analysis showed that combination treatment was the only independent factor associated with lower 30-day mortality (OR, 0.06; 95% CI, 0.004-0.94; P = .04). CONCLUSIONS: Combination treatment reduced both 30- and 90-day mortality and length of hospital stay. Further study of the antiviral and immunomodulatory effects of this combination treatment of severe influenza is warranted. TRIAL REGISTRY: BioMed Central; No.: ISRCTN11273879 DOI 10.1186/ISRCTN11273879; URL: www.isrctn.com/ISRCTN11273879.

Topical imiquimod before intradermal trivalent influenza vaccine for protection against heterologous non-vaccine and antigenically drifted viruses: a single-centre, double-blind, randomised, controlled phase 2b/3 trial.

BACKGROUND: Pretreatment with topical imiquimod, a synthetic agonist of toll-like receptor 7, significantly improved the immunogenicity of influenza vaccination in elderly people. We aimed to clarify its effect in a younger age group. METHODS: In this double-blind, randomised controlled trial, we enrolled healthy volunteers aged 18-30 years in early 2014 to receive the 2013-14 northern-hemisphere winter trivalent influenza vaccine at the Queen Mary Hospital, (Hong Kong, China). Eligible participants were randomly assigned (1:1:1:1) to one of the four vaccination groups: the study group, topical imiquimod-cream followed by intradermal trivalent influenza vaccine (INF-Q-ID), or one of three control groups, topical aqueous-cream control followed by intradermal trivalent influenza vaccine (INF-C-ID), topical aqueous-cream control followed by intramuscular trivalent influenza vaccine (INF-C-IM), and topical imiquimod-cream followed by intradermal normal-saline injection (SAL-Q-ID). Randomisation was by computer-generated lists in blocks of four. The type of topical treatment was masked from volunteers and investigators, although not from the study nurse. Serum haemagglutination-inhibition and microneutralisation-antibody titres were assayed. The primary outcome was seroconversion at day 7 after treatment for three vaccine strains of influenza (A/California/07/2009 H1N1-like virus [A/California/H1N1], A/Victoria/361/2011 H3N2-like virus [A/Victoria/H3N2], and B/Massachusetts/2/2012-like virus [B/Yamagata lineage]) and four non-vaccine strains (A/HK/485197/14 [H3N2 Switzerland-like lineage], prototype A/WSN/1933 [H1N1], A/HK/408027/09 [prepandemic seasonal H1N1], and B/HK/418078/11 [Victoria lineage]). Analysis was done on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT02103023. FINDINGS: We enrolled 160 healthy volunteers between March 1 and May 31, 2014, and 40 participants were randomly assigned to each study group. For the A/California/H1N1 strain, seroconversion at day 7 occurred in 39 participants (98%) in the INF-Q-ID group, 25 (63%) in the INF-C-ID group, 18 (45%) in the INF-C-IM group, and none in the SAL-Q-ID group; for the A/Victoria/H3N2, this was 30 (75%) in the INF-Q-ID group, four (10%) in the INF-C-ID group, four (10%) in the INF-C-IM group, and none in the SAL-Q-ID group; and for the B/Massachusetts (Yamagata lineage) strain, this was 36 (90%) in the INF-Q-ID group, 27 (68%) in the INF-C-ID group, 17 (43%) in the INF-C-IM group, and one (3%) in the SAL-Q-ID group (p<0·0001 for all three vaccine strains). Adverse reactions were infrequent and self-limited and did not differ between the four groups. Furthermore, the seroconversion rate against the four non-vaccine strains was better in the INF-Q-ID group than in the control groups on days 7 and 21 (p<0·0001). The most common adverse events were grade 1 redness (five participants in the INF-Q-ID group, three in INF-C-ID, one in INF-C-IM, and one in SAL-Q-ID) and grade 1 swelling (seven participants in INF-Q-ID group, five in INF-C-ID, three in INF-C-IM, and two in SAL-Q-ID. INTERPRETATION: Topical application of imiquimod before intradermal trivalent influenza vaccine significantly improved immunogenicity against the vaccine influenza strains in young healthy individuals and increased immunogenicity against the non-vaccine strains, especially the antigenically drifted H3N2 strain of 2015, which was not included in the 2013-14 recommended vaccine. Further studies should be done to establish the efficacy and safety of this approach for other injectable vaccines to augment the onset and range of protection. FUNDING: The Shaw Foundation Hong Kong, Health and Medical Research Fund (Hong Kong, China), The Consultancy Service for Enhancing Laboratory Surveillance of Emerging Infectious Disease for the HKSAR (Department of Health, Hong Kong, China), The Providence Foundation, Respiratory Viral Research Foundation.

Association between body mass index and cause-specific mortality as well as hospitalization in frail Chinese older adults.

AIM: A U-shaped relationship between body mass index (BMI) and all-cause mortality has been reported, but there are few studies examining the association between BMI and cause-specific mortality and hospitalization. We carried out a longitudinal study to examine these associations in Chinese older adults with multiple comorbidities, which could provide a reference for the recommended BMI in this population. METHODS: From 2004 to 2013, a retrospective cohort of Chinese older adults was selected from a geriatric day hospital in Hong Kong. They were divided into groups according to their BMI: BMI <16; BMI 16-18; BMI 18.1-20; BMI 20.1-22; BMI 22.1-24; BMI 24.1-26; BMI 26.1-28; BMI 28.1-30 and BMI >30. Other assessments included medical, functional, cognitive, social and nutritional assessment. RESULTS: A total of 1747 older adults (mean age 80.8 ± 7.1 years, 44.1% male, 46.1% living in nursing homes, Charlson Comorbidity Index 2.0 ± 1.6) with a median follow up of 3.5 years were included. Older adults with BMI 24-28 had the lowest all-cause, infection-related and cardiovascular mortality (P < 0.001). Multivariate analysis showed that there was an inverted J-shaped association between BMI and hazard ratio for all-cause and infection-related mortality in both nursing home and community-dwelling older adults. The rate of all-cause hospitalization was lower in older adults with BMI 22-28 (P = 0.002). Multivariate analysis showed that there was an inverted J-shaped association between the odds ratio of recurrent hospitalization and BMI. CONCLUSION: Chinese older adults with BMI 24-28 had lower all-cause mortality, infection-related mortality, cardiovascular-related mortality and all-cause hospitalization. This study provides a reference for the recommended BMI in this population.

Immunogenicity of intradermal trivalent influenza vaccine with topical imiquimod: a double blind randomized controlled trial.

BACKGROUND: Imiquimod, a synthetic Toll-like receptor 7 agonist enhanced immunogenicity of influenza vaccine in a mouse model. We hypothesized that topical imiquimod before intradermal influenza vaccination (TIV) would produce similar effect in human. METHODS: We performed a prospective 1-year follow-up, double-blind, randomized, controlled trial with adults with comorbidities. Participants were randomized to 1 of the following 3 vaccinations: topical 5% 250 mg imiquimod ointment followed by intradermal TIV, topical aqueous-cream followed by intradermal TIV, or topical aqueous-cream followed by intramuscular TIV. Patients and investigators were blinded to the type of topical treatment applied. Hemagglutination inhibition (HI) and microneutralization antibody titers were measured. The primary outcome was the day 7 seroconversion rate. RESULTS: Ninety-one recruited participants completed the study. The median age was 73 years. On day 7, 27/30 (90%) patients who received imiquimod and intradermal TIV achieved seroconversion against the H1N1 strain by HI, compared with 4/30 (13.3%) who received aqueous-cream and intramuscular TIV (P < .001), and 12/31 (38.7%) who received aqueous-cream and intradermal TIV (P < .001). The seroconversion, seroprotection, and geometric mean titer-fold increase were met in all 3 strains in the imiquimod and intradermal TIV group 2 weeks earlier, and the better seroconversion rate was sustained from day 7 to year 1 (P ≤ .001). The better immunogenicity was associated with fewer hospitalizations for influenza or pneumonia (P < .05). All adverse reactions were self-limited. CONCLUSIONS: Pretreatment with topical imiquimod significantly expedited, augmented, and prolonged the immunogenicity of influenza vaccination. This strategy for influenza immunization should be considered for the elderly population.

Immunogenicity and safety of intradermal trivalent influenza vaccination in nursing home older adults: a randomized controlled trial.

OBJECTIVE: To compare the immunogenicity and safety between full-dose (15 µg) intramuscular (i.m.) and full-dose (15 µg) intradermal (i.d.) immunization of the trivalent influenza vaccine in nursing home older adults. DESIGN: A single-center, randomized, controlled, open-label, parallel group trial from October 2013 to April 2014. SETTING: Nine nursing homes in Hong Kong. PARTICIPANTS: Hundred nursing home older adults (mean age: 82.9 ± 7.4 years). INTERVENTION: Fifty received i.d. (Intanza) and 50 received i.m. (Vaxigrip) vaccination. MEASUREMENTS: Baseline measurements included demographics, comorbidity, frailty and nutritional status. Day 21 and day 180 immunogenicity (seroconversion rate, seroprotection rate, geometric mean titer [GMT] fold increase in antibody titer) using hemagglutination-inhibition and adverse events were measured. Noninferiority and superiority of i.d. compared with i.m. vaccination in immunogenicity were analyzed. The study was registered on ClinicalTrials.gov; identifier: NCT 01967368. RESULTS: At day 21, noninferiority in immunogenicity of the i.d. vaccination was demonstrated. The seroconversion rate of the H1N1 strain was significantly higher in the i.d. group. At day 180, immunogenicity of both groups fell but the GMT of all strains in i.d. group was higher and the difference was significant for H3N2 strain. The seroconversion rate and GMT fold increase of H3N2 strain was significantly higher in the i.d. group. Local adverse events was significantly more in i.d. group, but they were mild and resolved in 72 hours. CONCLUSIONS: I.d. vaccination is noninferior, and even superior in some parts of immunogenicity assessment, to i.m. vaccination without compromising safety in nursing home older adults. I.d. vaccination is a good alternative to i.m. vaccination in this population.

Proactive infection control measures to prevent nosocomial transmission of vancomycin-resistant enterococci in Hong Kong.

BACKGROUND/PURPOSE: The study describes a proactive infection control approach to prevent nosocomial transmission of vancomycin-resistant enterococci (VRE) and tests if this approach is effective for controlling multiple-drug resistant organisms in a nonendemic setting. METHODS: In response to the increasing prevalence of VRE in Hong Kong since 2011, we adopted a multifaceted assertive approach in our health care network. This included active surveillance culture, extensive contact tracing, directly observed hand hygiene in conscious patients before they received meals and medications, stringent hand hygiene and environmental cleanliness, and an immediate feedback antimicrobial stewardship program. We report the occurrence of VRE outbreaks in our hospital after institution of these measures and compared with the concurrent occurrence in other public hospitals in Hong Kong. RESULTS: Between July 1, 2011 and November 13, 2013, VRE was identified in 0.32% (50/15,851) of admission episodes by active surveillance culture. The risk of VRE carriage was three times higher in patients with a history of hospitalization outside our hospital networks in the past 3 months (0.56% vs. 0.17%; p = 0.001) compared with those who were not. Extensive contact tracing involving 3277 patient episodes was performed in the investigation for the 25 VRE index patients upon whom implementation of contact precautions was delayed (more than 48 hours of hospitalization). One episode of VRE outbreak was identified in our hospital network, compared with the 77 VRE outbreaks reported in the other hospital networks (controls) without these proactive infection control measures. CONCLUSION: Our multifaceted assertive proactive infection control approach can minimize the nosocomial transmission and outbreak of VRE in a nonendemic area.

Validation study of Charlson Comorbidity Index in predicting mortality in Chinese older adults.

AIM: The Charlson Comorbidity Index (CCI) is commonly studied for predicting mortality, but there is no validation study of it in Chinese older adults. The objective of the present study was to validate the use of CCI in Chinese older adults for predicting mortality. METHOD: We carried out a retrospective cohort study from 2004 to 2013 for patients discharged from a geriatric day hospital in Hong Kong. Comorbidity was quantified using CCI, and patients were divided into six groups according to their score of CCI: CCI-0, CCI-1, CCI-2, CCI-3, CCI-4 and CCI ≥ 5. Other data collected included demographics, and functional, nutritional, cognitive and social assessment. The outcome measure was 1-year mortality. RESULTS: At 1-year follow up, 3.8% (n = 17), 5.9% (n = 37), 9.2% (n = 35), 12.9% (n = 20), 16.9% (n = 23) and 19.3% (n = 60) of CCI-0, CCI-1, CCI-2, CCI-3, CCI-4 and CCI ≥ 5 died, respectively (P < 0.001). Multivariate analysis showed that CCI-1, CCI-2, CCI-3, CCI-4 and CCI ≥ 5 have a hazard ratio (HR) of 1.34 (confidence interval [CI] 1.04-2.12), 2.18 (CI 1.03-4.61), 3.44 (CI 1.52-7.81), 3.74 (CI 1.35-10.39) and 4.63 (CI 2.28-9.43), respectively, compared with CCI-0. The area under the curve of the receiver operating characteristic curves of CCI in predicting 1-year mortality for older adults was 0.68 (CI 0.64-0.72). CONCLUSION: There is a significant dose-response relationship in the hazard ratio between CCI and 1-year mortality in Chinese older adults, but involvements of functional, nutritional and social assessments are important for comprehensive quantification of health status in older adults.

Effectiveness of influenza vaccination in institutionalized older adults: a systematic review.

INTRODUCTION: Influenza infection is common among institutionalized older adults. Many nonrandomized observational studies on influenza vaccination suggested that it could reduce influenza-related hospitalizations and mortality in institutionalized older adults. Criticism regarding the effectiveness of influenza vaccine estimated by nonrandomized observational studies include the frailty selection bias and use of nonspecific outcome, such as all-cause mortality. METHODS: We conducted a systematic review of studies of influenza vaccination in institutionalized older adults to determine the effects on clinical outcomes. We searched for studies from 3 databases from 1946 to June 2013 assessing effectiveness against influenza infection. We selected studies with good comparability between vaccine group and control group. We expressed vaccine effectiveness (VE) as a proportion, using the formula VE = 1-relative risk or 1-odds ratio. We focused on the following outcomes: influenza-like illness (ILI), laboratory confirmed influenza, hospitalizations due to ILI, or pneumonia and death due to influenza or pneumonia. We did not include all-cause mortality. RESULTS: Eleven studies that satisfied the inclusion criteria were identified, representing 11,262 institutionalized older adults. After meta-analysis, we found a significant reduction in pneumonia (VE: 37%, 95% confidence interval [CI]: 18%-53%, P = .001) and death due to pneumonia or influenza (VE: 34%, CI: 10%-53%, P = .01). There was no significant heterogeneity between studies. There was no significant publication bias. CONCLUSION: Influenza vaccination in institutionalized older adults could reduce pneumonia and death due to pneumonia or influenza. Influenza vaccination is recommended for institutionalized older adults.

Outcomes in older adults with stage 5 chronic kidney disease: comparison of peritoneal dialysis and conservative management.

BACKGROUND: Data on the outcomes of older adults receiving peritoneal dialysis (PD), especially those who are dependent and have multiple comorbidities, are scarce. METHODS: In a retrospective cohort study, we compared older adults (≥65 years) with stage 5 chronic kidney disease receiving PD (PD group) with those receiving conservative management (conservative group). Baseline characteristics (demographics and clinical, functional, socioeconomic, and laboratory parameters) were collected, and study outcomes (patient survival, emergency hospitalization, institutionalization, and palliative and end-of-life care) were compared between groups. RESULTS: We included 199 eligible participants aged 65-90 years (mean ± standard deviation 73.8 ± 5.4 years; 157 in the PD group and 42 in the conservative group). The PD group had a longer survival (median [interquartile range]: 3.75 [2.49-5.25] vs 2.35 [1.13-3.71] years, p < .001), lower emergency hospitalization rates (1.63 [0.82-2.92] vs 3.51 [1.06-7.16] per person-year, p < .01) and hospital days (16.17 [6.29-43.32] vs 38.01 [6.75-76.56] days per person-year, p = .03), and no increased risk of institutionalization compared with the conservative group. Age (hazard ratio [HR] for 1-year increase 1.06, 95% confidence interval [CI] 1.02-1.10), modified Charlson's Comorbidity Index (HR 1.36, 95% CI 1.18-1.56), impairment in basic activities of daily living (HR 2.11, 95% CI 1.28-3.46), and emergency dialysis (HR 1.67, 95% CI 1.11-2.53) were independent predictors of mortality in the PD group. CONCLUSION: PD is a viable treatment option in older adults with stage 5 chronic kidney disease. Age alone should not preclude dialysis. Comprehensive geriatric assessment can prognosticate and facilitate shared decision making to commence dialysis in older adults.