Breaking the cycle of functional decline in older dialysis patients

Hall, Rasheeda K.; McAdams‐DeMarco, Mara

doi:10.1111/sdi.12695

Cited by 18 publications

(23 citation statements)

References 55 publications

(87 reference statements)

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“…For example, if a patient is not able to do grocery shopping anymore, this can lead to less mobilization, which can eventually lead to further loss of physical fitness, which can subsequently lead to difficulties in housekeeping, transportation, and malnutrition. This theory is also referred to as the geriatric snowball effect (36).…”

Section: Discussionmentioning

confidence: 99%

Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Goto

Loon

Boereboom

et al. 2019

CJASN

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Background and objectives Little is known about the functional course after initiating dialysis in elderly patients with ESKD. The aim of this study was to assess the association of the initiation of dialysis in an elderly population with functional status and caregiver burden. Design, setting, participants & measurements This study included participants aged $65 years with ESKD who were enrolled in the Geriatric Assessment in Older Patients Starting Dialysis study. All underwent a geriatric assessment and a frailty screening (Fried Frailty Index and Groningen Frailty Indicator) at dialysis initiation. Functional status (activities of daily life and instrumental activities of daily life) and caregiver burden were assessed at baseline and after 6 months. Decline was defined as loss of one or more domains in functional status, stable as no difference between baseline and follow-up, and improvement as gain of one or more domains in functional status. Logistic regression was performed to assess the association between the combined outcome functional decline/death and potential risk factors. Results Of the 196 included participants functional data were available for 187 participants. Mean age was 7567 years and 33% were women. At the start of dialysis, 79% were care dependent in functional status. After 6 months, 40% experienced a decline in functional status, 34% remained stable, 18% improved, and 8% died. The prevalence of high caregiver burden increased from 23%-38% (P=0.004). In the multivariable analysis age (odds ratio, 1.05; 95% confidence interval, 1.00 to 1.10 per year older at baseline) and a high Groningen Frailty Indicator compared with low score (odds ratio, 1.97; 95% confidence interval, 1.05 to 3.68) were associated with functional decline/death. Conclusions In patients aged $65 years, functional decline within the first 6 months after initiating dialysis is highly prevalent. The risk is higher in older and frail patients. Loss in functional status was mainly driven by decline in instrumental activities of daily life. Moreover, initiation of dialysis is accompanied by an increase in caregiver burden.

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Section: Discussionmentioning

confidence: 99%

Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Goto

Loon

Boereboom

et al. 2019

CJASN

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“… 4 However, there are no systematic approaches to providing such integrated care to older adults receiving dialysis. 5 …”

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confidence: 99%

Unmet Needs of Older Adults Receiving In-Center Hemodialysis: A Qualitative Needs Assessment

et al. 2020

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Rationale & Objective Attention to geriatric impairments is not routinely provided to older adults receiving dialysis. Our objective was to identify patient and personnel perspectives on experiences with geriatric problems, unmet needs that may affect a patient’s ability to maintain his or her functional status, and preferences for design of a geriatric model of care tailored to address the unmet needs. Study Design Qualitative study using semi-structured interviews and focus groups. Setting & Participants 14 hemodialysis patients 55 years and older and 24 dialysis unit personnel (eg, nephrologists, nurses, patient care technicians, and social workers) representing 5 dialysis units. Analytical Approach Content analysis to identify themes reflecting unmet needs and design considerations for a geriatric model of care for older adults receiving dialysis. Results 4 themes (or unmet needs) identified from both patient and personnel transcripts were: (1) mobility, which referred to the insufficient mobility assessment and transportation services; (2) medications, which referred to insufficient attention to appropriate prescribing and medication self-management; (3) social support, which referred to insufficient support for activities of daily living and emotional problems; and (4) communication, which referred to insufficient patient-provider and interprofessional communication, including data transfer across separate health systems. Although participants generally acknowledged that an integrated model of care could result in benefits across all 4 areas of unmet need, they noted that the program design would need to minimize disruption of current workflow and practices in dialysis units. Limitations The findings may not be broadly representative of all older adults receiving dialysis and dialysis unit personnel. Conclusions There is insufficient attention to mobility, medication management, social support, and communication needs for older adults receiving in-center hemodialysis. Addressing these unmet needs in a geriatric model of care and measuring its effectiveness are areas of future research.

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“…It is encouraging that these interventions can indeed have such a profound effect on health and quality of life, as was demonstrated in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, an ongoing multi‐center trial of healthy community‐dwelling older adults followed for 20+ years . The likelihood of success among patients with ESKD may be especially hopeful given the high burden of cognitive impairment, and therefore, greater room for improvement in the face of these interventions; cognitive screening as part of a comprehensive geriatric assessments may help identify those ESKD patients who may benefit most from ET and/or CT …”

Section: Future Researchmentioning

confidence: 99%

Exercise and cognitive function in patients with end‐stage kidney disease

Chu

McAdams‐DeMarco

2019

Seminars in Dialysis

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In this review we summarize the research pertaining to the role of exercise in preventing cognitive decline in patients with end‐stage kidney disease (ESKD). Impairment in cognitive function, especially in executive function, is common in patients with ESKD, and may worsen with maintenance dialysis as a result of retention of uremic toxins, recurrent cerebral ischemia, and high burden of inactivity. Cognitive impairment may lead to long‐term adverse consequences, including dementia and death. Home‐based and intradialytic exercise training (ET) are among the nonpharmacologic interventions identified to preserve cognitive function in ESKD. Additionally, cognitive training (CT) is an effective approach recently identified in this population. While short‐term benefits of ET and CT on cognitive function were consistently observed in patients undergoing dialysis, more studies are needed to replicate these findings in diverse populations including kidney transplant recipients with long‐term follow‐up to better understand the health and quality of life consequences of these promising interventions. ET as well as CT are feasible interventions that may preserve or even improve cognitive function for patients with ESKD. Whether these interventions translate to improvements in quality of life and long‐term health outcomes, including dementia prevention and better survival, are yet to be determined.

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Breaking the cycle of functional decline in older dialysis patients

Cited by 18 publications

References 55 publications

Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Unmet Needs of Older Adults Receiving In-Center Hemodialysis: A Qualitative Needs Assessment

Exercise and cognitive function in patients with end‐stage kidney disease

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