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Dialysis modality decision-making for older adults with chronic kidney disease

Authors

  • Lori Harwood RN(EC),

    PhD candidate, Nurse Practitioner, Doctoral candidate, Adjunct Assistant Professor, Corresponding author
    1. London Health Sciences Centre, London, ON, Canada
    2. University of Alberta, Edmonton, AB, Canada
    3. Arthur Labatt and Family School of Nursing, Western University, London, ON, Canada
    • Correspondence: Lori Harwood, Nurse Practitioner, London Health Sciences Centre, Victoria Hospital, Rm A2-335, 800 Commissioner's Road, London, ON, Canada N6A 4G5. Telephone: +1 519 685 8500 ext 57241.

      E-mail: lori.harwood@lhsc.on.ca

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  • Alexander M Clark PhD, RN

    Professor, Associate Dean Research
    1. Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Abstract

Aims and objectives

To examine the personal and structural facilitators and barriers for home-dialysis decision-making for older adults with chronic kidney disease.

Background

Chronic illness is a global problem. Older adults with chronic kidney disease form a large and growing segment of the dialysis population in many high-income countries but are less likely to uptake home-dialysis despite its benefits.

Design

This qualitative ethnography framed in social theory took place in Canada and included adults with chronic kidney disease not on dialysis, older than 65 years of age.

Methods

Thirteen people (seven men and six women, aged 65–83 years of age) who received care in a team chronic kidney disease clinic took part. Persons with chronic kidney disease were interviewed and group interviews were conducted with four of their chronic kidney disease clinic healthcare professionals. Content analysis was used for data analysis.

Results

The factors influencing older adults' chronic kidney disease modality decisions are similar to younger adults. However, older adults with chronic kidney disease are in a precarious state with persistent uncertainty. Age imposes some limitations on modality options and transplantation. Modality decisions were influenced by health status, gender, knowledge, values, beliefs, past experience, preferences, lifestyle and resources. Support from family and healthcare professionals was the largest determinant to home-dialysis selection.

Conclusion

The social and contextual factors associated with age influenced home-dialysis decision-making. Adequate social support, functional status and resources enabled home-dialysis selection.

Relevance to clinical practice

Understanding more about the decision-making processes for older adults with chronic kidney disease is important for quality interventions and the economic sustainability of dialysis services.

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