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Enabling good outcomes in older adults on dialysis: a qualitative study

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Raj, R ORCID: 0000-0003-4781-3255, Brown, B, Ahuja, K ORCID: 0000-0002-0323-4692, Frandsen, M ORCID: 0000-0001-7027-1445 and Jose, M ORCID: 0000-0002-9589-0071 2020 , 'Enabling good outcomes in older adults on dialysis: a qualitative study' , BMC Nephrology, vol. 21, no. 1 , pp. 1-12 , doi: 10.1186/s12882-020-1695-1.

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Abstract

Background: Older patients on dialysis may not have optimal outcomes, particularly with regards to quality of life.Existing research is focused mainly on survival, with limited information about other outcomes. Such informationcan help in shared decision-making around dialysis initiation; it can also be used to improve outcomes in patientsestablished on dialysis. We used qualitative research methods to explore patient perspectives regarding theirexperience and outcomes with dialysis.Methods: Semi-structured interviews with participants aged ≥70, receiving dialysis at a regional Australian hospital,were recorded and transcribed. From participants’ responses, we identified descriptive themes using aphenomenological approach, with verification by two researchers. Factors affecting outcomes were derivedreflexively from these themes.Results: Seventeen interviews were analysed prior to saturation of themes. Participants (12 on haemodialysis, 5 onperitoneal dialysis) had spent an average of 4.3 years on dialysis. There were 11 males and 6 females, with mean age76.2 years (range 70 to 83). Experiences of dialysis were described across four domains - the self, the body, effects ondaily life and the influences of others; yielding themes of (i) responses to loss (of time, autonomy, previous life), (ii)responses to uncertainty (variable symptoms; unpredictable future; dependence on others), (iii) acceptance /adaptation (to life on dialysis; to ageing) and (iv) the role of relationships / support (family, friends and clinicians).Conclusions: Older patients experience the effects of dialysis across multiple domains in their lives. They endurefeelings of loss and persistent uncertainty, but may also adapt successfully to their new circumstances, aided by thesupport they receive from family, health professionals and institutions. From these insights, we have suggestedpractical measures to improve outcomes in older patients.

Item Type: Article
Authors/Creators:Raj, R and Brown, B and Ahuja, K and Frandsen, M and Jose, M
Keywords: elderly, ESKD, dialysis outcomes, lived experience, quality of life, qualitative research
Journal or Publication Title: BMC Nephrology
Publisher: BioMed Central
ISSN: 1471-2369
DOI / ID Number: 10.1186/s12882-020-1695-1
Copyright Information:

© The Author(s). 2020. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) http://creativecommons.org/licenses/by/4.0/The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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