Caring for the Teenager in an Adult Unit

Adolescence is known as a period of transition toward adulthood that is characterized by significant developmental changes in cognitive, emotional, and social domains. For adolescent/young adult dialysis patients, this process also involves the acquisition of self-managed medical care. For many patients, this time is also marked by treatment nonadherence, lapses in medical care, and poor outcomes. As this transition progresses, patients must transfer from pediatric care to an adult treatment setting at some specific point. This change represents a distinct shift from supervisory, child-centered care to self-directed treatment, thus moving from a more dependent to independent role. The exact timing of transfer often varies based on patient- and site-specific factors, and therefore, offering a standardized approach is challenging. This chapter provides a review of issues relevant to the management of teenage and young adult dialysis patients receiving care in the adult nephrology setting. Recent empirically supported approaches to addressing transition and transfer of care are presented, followed by a discussion of functional outcomes during this time. Other special considerations for this patient population, including perspectives of transitioning patients and families and other posttransfer recommendations, are also reviewed.