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Older Patients' Perspectives on Managing Complexity in CKD Self-Management
C Barrett Bowling1,2, Ann E Vandenberg1,2, Lawrence S Phillips2
1Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Atlanta Veterans Affairs, Medical Center, Decatur, Georgia; and.
Insights
Managing chronic kidney disease (CKD) is complex for older adults due to multiple health conditions. Integrating care across conditions is key for effective CKD self-management in elderly patients.
Area of Science:
- Gerontology
- Nephrology
- Public Health
Background:
- Chronic kidney disease (CKD) self-management requires adherence to complex regimens.
- Aging impacts functional capacity, potentially making self-management more challenging for older adults.
- Specific challenges older adults face in CKD self-management are not well understood.
Purpose of the Study:
- To explore factors influencing CKD self-management in older adults.
- To understand the relationship between multimorbidity and CKD self-management challenges.
- To identify strategies for improving self-management support in this population.
Main Methods:
- Exploratory qualitative study using six focus groups.
- Participants: 30 veterans aged 70+ with moderate-to-severe CKD.
- Data analysis: Grounded theory with constant comparative method.
Main Results:
- Managing complexity emerged as a central theme.
- Participants often had multiple co-occurring conditions (multimorbidity).
- Discordant treatment recommendations and prioritization/simplification strategies were noted.
Conclusions:
- Multimorbidity significantly challenges CKD self-management in older veterans.
- An integrated treatment approach is crucial for supporting self-management across conditions.
- Addressing multimorbidity is essential for effective CKD care in the elderly.
Background And Objectives:
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.
Design, Setting, Participants, & Measurements:
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 (n=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.
Results:
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 (e.g., arthritis and CKD). Prioritization emerged as one effective strategy for managing complexity (e.g., focusing on BP control). Some patients arrived at the conclusion that they could group concordant recommendations to simplify their regimens (e.g., protein restriction for both gout and CKD).
Conclusions:
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.