Half of the patients currently beginning chronic kidney dialysis therapy each year in the United States are sixty years of age or older. This is expensive therapy, and patients must cope with limitations stemming from physical debilitation, disruption of normal living routines, and dialysis dependency. It is important, therefore, to investigate patients' views of the quality of their lives. As limitations associated with receipt of chronic dialysis are lessened, patients' overall psychological outlook tends to be increasingly positive. Adjustment problems may persist, however, for those who were especially active before their kidney failure and for those who are coping not only with their own physical adjustment to dialysis but also with family relationship problems. The social context of dialysis treatment can potentially compensate for several losses that often accompany aging, especially if dialysis staff have sufficient time and patience to address issues impacting the psychological well-being of their elderly patients.