Mobility in older hemodialysis patients

老年血液透析患者的活动能力

• 批准号: 9770747
• 负责人: Christine K Liu
• 金额: $ 18.83万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9770747
• 关键词: Accelerometer; Address; Affect; Anemia; Anxiety; Area; Award; Beck depression inventory; Beds; Boston; Caregiver support; Caregivers; Caring; Cessation of life; Chronic; Clinical; Clinical Trials; Cognition; Cognitive Therapy; Data; Dialysis procedure; Digit structure; Elderly; Environment; Environmental Health; Equipment and supply inventories; Exercise; Fatigue; Future; Geriatrics; Goals; Health; Heart failure; Hemodialysis; Home environment; Individual; Intervention; Interview; Investigation; Knowledge; Light; Measures; Medical Care Costs; Medicine; Memory; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Moderate Activity; Nephrology; Older Population; Organizational Models; Outcome; Pain; Patients; Performance; Personal Satisfaction; Physical Performance; Physiological; Population; Psychological Factors; Psychological Impact; Psychology; Qualitative Methods; Qualitative Research; Quality Indicator; Quality of life; Rehabilitation therapy; Research; Research Personnel; Research Training; Risk Factors; Role; Schedule; Self Efficacy; Series; Supervision; Testing; Time; Training; Travel; Universities; Visit; Vulnerable Populations; Walking; World Health Organization; base; bean; career; cognitive testing; cohort; design; disability; experience; improved; improved mobility; informant; insight; instrument; modifiable risk; multidisciplinary; physical conditioning; professor; recruit; secondary outcome; skills; targeted treatment; therapy design; tool

Dr. Liu is a geriatrician and Assistant Professor of Medicine at Boston University (BU) who studies older (≥65 years) hemodialysis (HD) patients, the biggest and fastest-growing segment of the HD population. Her long-term goal is to be an independent clinician investigator developing interventions to improve mobility in older HD patients. Mobility, the ability to move reliably and safely, signifies independence and is integral to self-worth. Almost 70% of HD patients have difficulty walking. HD patients with poor mobility are twice as likely to die or be hospitalized. Most importantly, poor mobility is cited by patients as a major contributor to poor quality of life. While risk factors for poor mobility has been studied in other older populations, such insights may not be applicable to older HD patients. Older HD patients have unique challenges, like frequent travel for HD treatment and routine post-HD fatigue,that make usual mobility treatments, such as supervised exercise, extremely difficult. To successfully address poor mobility in older HD patients, a treatment approach fitting their specific needs is required. The World Health Organization states that personal, environmental, and health factors impact mobility. But aside from physiologic health factors, there has not been a systematic investigation of what factors impact mobility in older HD patients. Caregiver support likely affects mobility. The home environment has a role. Cognition is very relevant; anxiety, depression, and self-efficacy likely also impact mobility. The knowledge gap about the potentially modifiable risk factors for poor mobility in older HD patients is impeding efforts to improve mobility and thus quality of life for this highly vulnerable population. Dr. Liu will investigate the relationship of caregiver support, the home environment, cognition, anxiety, depression, and self-efficacy with mobility in older HD patients, using a sequential mixed methods approach. First, in Aim 1, she will perform key informant interviews with 40 older HD patients and 28 of their caregivers in their homes to determine how caregiver support and the home environment influences mobility. Then she will recruit a cohort of 86 older HD patients to perform in-home assessments of 1) cognition, 2) anxiety, depression, and self-efficacy, and 3) mobility. In Aim 2, the cohort data will be used to determine how cognition affects mobility in older HD patients. In Aim 3, the cohort data will be used to determine how anxiety, depression, and self-efficacy impact mobility in older HD patients. After determining the most relevant factors associated with mobility, Dr. Liu will develop a multi-factorial intervention to improve mobility in older HD patients that she will test in an R-series application. This research is at the intersection of nephrology, geriatrics, and rehabilitation; Dr. Liu is one of only a few clinician investigators focusing in this area. Led by her Primary Co-mentors, Drs. Daniel Weiner and Jonathan Bean, Dr. Liu’s outstanding mentoring team is multi-disciplinary and cross-institutional, emblematic of the collaborative BU training environment. The proposed research and training will furnish Dr. Liu with the needed experience and skills to achieve independence as a clinician investigator dedicated to improving the mobility of older HD patients.

刘博士是波士顿大学（BU）的老年病学家和医学助理教授，研究老年人（≥65岁 年）血液透析（HD）患者，HD人群中最大和增长最快的部分。她的长期 我的目标是成为一名独立的临床研究者，制定干预措施，以改善老年HD患者的活动能力 患者移动性，即可靠和安全移动的能力，意味着独立性，是自我价值的组成部分。 近70%的HD患者行走困难。活动能力差的HD患者死亡的可能性是其他患者的两倍， 住院治疗。最重要的是，患者认为流动性差是生活质量差的主要原因。 虽然已经在其他老年人群中研究了流动性差的风险因素，但这种见解可能不是 适用于老年HD患者。老年HD患者面临独特的挑战，例如频繁旅行进行HD治疗 以及常规的HD后疲劳，这使得常规的移动性治疗，如监督锻炼，非常困难。 为了成功解决老年HD患者的活动能力差问题， 必需的.世界卫生组织指出，个人、环境和健康因素都会影响流动性。 但除了生理健康因素外，还没有系统的调查哪些因素会影响 老年HD患者的活动能力。照顾者的支持可能会影响流动性。家庭环境有一定的作用。 认知是非常相关的;焦虑，抑郁和自我效能也可能影响流动性。的知识差距 关于老年HD患者活动性差的潜在可改变的风险因素，阻碍了改善 流动性，从而提高这一高度弱势群体的生活质量。刘医生将研究 护理人员支持、家庭环境、认知、焦虑、抑郁和行动能力自我效能 在老年HD患者中，使用序贯混合方法。首先，在目标1中，她将执行关键线人 访谈了40名老年HD患者和28名他们的护理人员，以确定护理人员如何支持 家庭环境也会影响移动性。然后，她将招募86名老年HD患者， 家庭评估：1）认知，2）焦虑、抑郁和自我效能，以及3）移动性。在目标2中， 队列数据将用于确定认知如何影响老年HD患者的活动性。目标3： 数据将用于确定焦虑、抑郁和自我效能如何影响老年HD患者的行动能力。 在确定与流动性相关的最相关因素后，刘博士将制定一个多因素 她将在R系列应用程序中进行测试。本研究是 在肾脏病学，老年病学和康复的交叉点;刘博士是为数不多的临床研究者之一 专注于这个领域。在她的主要共同导师丹尼尔韦纳博士和乔纳森比恩博士的带领下，刘博士的 优秀的指导团队是多学科和跨机构的，是协作BU的象征 训练环境。拟议的研究和培训将为刘博士提供所需的经验， 技能，以实现独立的临床研究者致力于改善老年HD患者的流动性。