Inadequate self-care knowledge among elderly hemodialysis patients: assessing its prevalence and potential causes

The purpose of this study was to determine how well informed elderly hemodialysis patients (EHP) are about information needed for self-care and to identify factors that might lead their self-care knowledge to be inadequate.

The sample included 142 patients over the age of 65 in 17 outpatient hemodialysis units in three Eastern states.

Interviews were conducted to test factual knowledge of dialysis and to assess how well informed EHP thought they were about self-care related issues. Interviewers also asked demographic questions and administered the Mini-Mental State Exam (MMSE) to assess cognitive capacity.

Seventy-five percent of patients believed they were well informed; however, only 14% answered all three questions correctly. The average number correct on a three-question, self-care knowledge measure was only 1.67. Knowledge was lowest for older, poorly-educated patients with diminished cognitive capacity (DCC) who had recently begun dialysis (mean correct score 1.1). Thirty-nine percent of our sample had DCC.

Because a majority of EHP lack information needed for self-care and many have DCC, nurses should not unquestioningly accept EHP claims that they are well informed. EHP with DCC, less than a high school education, and advanced age require extra educational efforts closer monitoring, and more family involvement in decision making. Using the MMSE to identify patients with DCC is one of six recommendations we offer to improve EHP self-care.