Identifying Goals and Barriers to Exercise for Prehabilitation in Older Adults awaiting Kidney Transplantation and their Caregivers

确定等待肾移植的老年人及其护理人员进行康复训练的目标和障碍

• 批准号: 10027670
• 负责人: Anoop Sheshadri
• 金额: $ 16.15万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10027670
• 关键词: Address; Adherence; Adult; Age-Years; Aging; Caregiver Burden; Caregiver support; Caregivers; Caring; Clinical Trials; Consensus; Data; Development; Dialysis patients; Dialysis procedure; Disease; Dyspnea; Elderly; End stage renal failure; Enrollment; Equilibrium; Exercise; Fatigue; Fellowship; Focus Groups; Foundations; Future; Geriatrics; Goals; Group Interviews; Health Promotion; Heart failure; Impairment; Individual; Intervention; Interview; K-Series Research Career Programs; Kidney Transplantation; Lower Extremity; Lung diseases; Mentors; Mentorship; Mission; National Institute on Aging; Nephrology; Operative Surgical Procedures; Organ; Outcome; Participant; Patient Recruitments; Patients; Personal Satisfaction; Physical Function; Physical Performance; Physical activity; Physiological; Play; Polypharmacy; Population; Premature aging syndrome; Procedures; Process; Public Health; Qualitative Research; Quality of life; Randomized Controlled Trials; Recovery; Reporting; Research; Research Methodology; Risk; Role; Structure; System; Testing; Time; Training; Transplant Recipients; Transplantation; Transplanted Kidney Complication; United States; United States National Institutes of Health; Voice; Waiting Lists; Walking; Work; aged; care burden; career; cognitive interview; cohort; design; exercise adherence; exercise intervention; exercise program; expectation; experience; fear of falling; frailty; functional disability; functional loss; functional status; high risk; improved; improved functioning; individual patient; intervention effect; mortality; older patient; preference; recruit; screening; walking intervention

PROJECT SUMMARY: End-stage renal disease (ESRD) is a disease of premature aging and is associated with impairments in functional status and quality of life. The dialysis population is growing older each year, and older patients with ESRD are at very high risk for functional impairment. Kidney transplantation (KT) is a well- established therapy that has the potential to ameliorate the detrimental effects of ESRD on physical activity, quality of life, and functional status. However, KT alone may not meet the full extent of this potential, particularly for older or more impaired adults. In fact, physical activity declines immediately post-KT and fails to return to expected levels even up to 5 years post-KT. Older patients waitlisted for KT (most of whom are on dialysis) are therefore reliant on their pre-KT levels of exercise, which are also predictive of post-KT mortality. “Prehabilitation” has recently emerged as a strategy in other surgical populations to enhance recovery and minimize functional loss, and a structured exercise program may be beneficial in the pre-KT population. However, though exercise interventions have been successful in improving physical function and quality of life among patients with ESRD, only a small percentage of waitlisted patients may actually be able to participate in such interventions. Patients treated with dialysis in general have barriers such as severe fatigue, dyspnea, and lack of time or exercise partners. Older patients have additional barriers such as further impairments in mobility, fear of falling, and effects of polypharmacy. In addition, many older dialysis patients require caregiver support for transport and for adherence to such interventions. Therefore older patients are likely to have unique barriers to exercise interventions, and may also have specific goals for such an intervention. For an exercise intervention to be successful in this setting, it is necessary to conduct formal qualitative research that includes the voices of older adults awaiting KT as well the voices of their caregivers. The major goal of this study is to use qualitative research methodology to formally evaluate facilitators of and barriers to an exercise intervention for prehabilitation in older patients awaiting KT. We will perform one- on-one cognitive interviews of 30 older adults and 30 of their caregivers in paired dyads. We expect to elicit unmet needs of older patients awaiting KT and goals that may not be fully addressed by the procedure. We will then conduct semi-structured focus group interviews recruited from the cohort of patients and caregivers who have previously been interviewed to establish a consensus on prehabilitation, including details of a possible future intervention such as expected outcomes and specifics of coaching. Primary mentorship will be provided by Rebecca Sudore, MD (Geriatrics, Qualitative Research). Additional mentors are Jennifer C. Lai (Frailty in End-Organ Disease, Transplantation) and Kirsten Johansen (Exercise in ESRD). This study will provide valuable data on patient and caregiver experience of KT and potential prehabilitation and will serve as the foundation for future studies iterating, optimizing, and ultimately piloting the intervention in clinical trials.

项目摘要：终末期肾病（ESRD）是一种与早衰相关的疾病