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The seniors of today and tomorrow constitute a larger proportion of the population than in any previous generation. By the year 2041, the amount of people in Canada aged 85 years and older will approach 1.6 million. Moreover, the vast majority of seniors (approximately 70%) die in hospital. With these figures in mind care of dying individuals will continue, primarily in acute care settings, often with poor symptom management. This is particularly important for the end-stage renal disease population, which is increasingly elderly, suffering from multiple diseases and symptoms, and has a greatly reduced life expectancy. Quality of life is a major determinant for these patients; approximately 20% of them withdraw dialysis due to unacceptable quality of life. It is imperative that health care professionals who work with these patients and their families receive guidance in how to competently and compassionately care for seniors at the end-of-life.

The United States and United Kingdom have been in the forefront of developing standards and guidelines in end-of life care for this population. A commonality across these standards of practice is the emphases on care of the whole person, where the patient and family are considered a unit, built around their individual physical, emotional, psychosocial and spiritual needs and preferences. Other common components to the standards include: advance directives, decision-making and management of pain and symptom issues and support for family during the bereavement stage. Comprehensive, coordinated, and compassionate care can best be provided through a multidisciplinary team.

Although general nursing practice standards for end of life care have been published in Canada, no guidelines currently exist for nephrology patients at end of life. The international standards reviewed do create a foundation for the development of Canadian nursing standards for end-of-life care of nephrology patients and their families.