Details

Autor(en) / Beteiligte

• Bowling, C Barrett
• Vandenberg, Ann E
• Phillips, Lawrence S
• McClellan, William M
• Johnson, 2nd, Theodore M
• Echt, Katharina V

Titel

Older Patients' Perspectives on Managing Complexity in CKD Self-Management

Ist Teil von

• Clinical journal of the American Society of Nephrology, 2017-04, Vol.12 (4), p.635-643

Ort / Verlag

United States: American Society of Nephrology

Erscheinungsjahr

2017

Link zum Volltext

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• Patients with CKD are asked to perform self-management tasks including dietary changes, adhering to medications, avoiding nephrotoxic drugs, and self-monitoring hypertension and diabetes. Given the effect of aging on functional capacity, self-management may be especially challenging for older patients. However, little is known about the specific challenges older adults face maintaining CKD self-management regimens. We conducted an exploratory qualitative study designed to understand the relationship among factors facilitating or impeding CKD self-management in older adults. Six focus groups ( =30) were held in August and September of 2014 with veterans≥70 years old with moderate-to-severe CKD receiving nephrology care at the Atlanta Veterans Affairs Medical Center. Grounded theory with a constant comparative method was used to collect, code, and analyze data. Participants had a mean age (range) of 75.1 (70.1-90.7) years, 60% were black, and 96.7% were men. The central organizing concept that emerged from these data were managing complexity. Participants typically did not have just one chronic condition, CKD, but a number of commonly co-occurring conditions. Recommendations for CKD self-management therefore occurred within a complex regimen of recommendations for managing other diseases. Participants identified overtly discordant treatment recommendations across chronic conditions ( arthritis and CKD). Prioritization emerged as one effective strategy for managing complexity ( , focusing on BP control). Some patients arrived at the conclusion that they could group concordant recommendations to simplify their regimens ( , protein restriction for both gout and CKD). Among older veterans with moderate-to-severe CKD, multimorbidity presents a major challenge for CKD self-management. Because virtually all older adults with CKD have multimorbidity, an integrated treatment approach that supports self-management across commonly occurring conditions may be necessary to meet the needs of these patients.