Older Patients' Perspectives on Managing Complexity in CKD Self-Management
Older Patients' Perspectives on Managing Complexity in CKD Self-Management
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DOI：
10.2215/cjn.06850616
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发表时间：
2017-04-01
影响因子：
9.8
通讯作者：
Echt, Katharina V.
中科院分区：
文献类型：
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作者：
Bowling, C. Barrett;Vandenberg, Ann E.;Echt, Katharina V.
背景和目的CKD患者被要求执行自我管理任务，包括饮食改变、坚持服药、避免肾毒性药物、自我监测高血压和糖尿病。考虑到衰老对功能能力的影响，自我管理对老年患者来说可能尤其具有挑战性。然而，对于老年人维持慢性肾病自我管理方案所面临的具体挑战知之甚少。我们进行了一项探索性质的研究，旨在了解促进或阻碍老年人CKD自我管理的因素之间的关系。6个焦点组（n=30）于2014年8月和9月在亚特兰大退伍军人事务医疗中心接受肾脏病治疗的中重度CKD退伍军人>= 70。基于理论的恒定比较方法被用于收集、编码和分析数据。结果参与者平均年龄（范围）为75.1（70.1-90.7）岁，60%为黑人，96.7%为男性。从这些数据中产生的中心组织概念是管理复杂性。参与者通常不是只有一种慢性疾病CKD，而是许多常见的共同发生的疾病。因此，CKD自我管理的建议出现在管理其他疾病的建议的复杂方案中。参与者明确了慢性疾病（如关节炎和慢性肾病）的治疗建议明显不一致。优先排序成为管理复杂性的一种有效策略（例如，专注于BP控制）。一些患者得出结论，他们可以将一致的建议分组以简化他们的方案（例如，痛风和CKD的蛋白质限制）。结论：在中重度CKD老年退伍军人中，多病是CKD自我管理的主要挑战。因为几乎所有患有慢性肾病的老年人都有多种疾病，所以一种支持自我管理的综合治疗方法可能是必要的，以满足这些患者的需求。
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.