Mobility of older hemodialysis 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 血液透析(HD)患者是血液透析人口中规模最大、增长最快的一部分。她的长期工作 目标是成为一名独立的临床研究员，开发干预措施以改善老年HD患者的机动性 病人。机动性，即可靠和安全地移动的能力，意味着独立，是自我价值的组成部分。 近70%的HD患者行走困难。行动不便的HD患者死亡或死亡的可能性增加一倍 住院治疗。最重要的是，患者认为行动不便是导致生活质量不佳的主要原因。 虽然流动性差的风险因素已经在其他老年人群中进行了研究，但这样的见解可能还没有 适用于老年HD患者。老年HD患者面临着独特的挑战，比如经常出差接受HD治疗 以及常规的HD后疲劳，这使得常规的活动治疗，如监督运动，变得极其困难。 为了成功地解决老年HD患者行动不便的问题，适合他们特定需求的治疗方法是 必填项。世界卫生组织表示，个人、环境和健康因素会影响流动性。 但除了生理健康因素外，目前还没有对哪些因素产生影响的系统调查。 老年HD患者的活动能力。照顾者的支持可能会影响行动能力。家庭环境起着一定的作用。 认知是非常相关的；焦虑、抑郁和自我效能感可能也会影响行动能力。知识鸿沟 关于老年HD患者行动不便的潜在可改变危险因素阻碍了改善的努力 对于这一高度脆弱的人口来说，流动性和生活质量是至关重要的。刘博士将调查 照顾者支持、家庭环境、认知、焦虑、抑郁和行动能力的自我效能 在老年HD患者中，采用序贯混合方法。首先，在目标1中，她将扮演关键的线人 采访40名老年HD患者和他们家中的28名照顾者，以确定照顾者如何支持 而家庭环境也会影响移动性。然后，她将招募86名老年HD患者进行 家庭评估1)认知，2)焦虑，抑郁和自我效能感，3)行动能力。在目标2中， 队列数据将用于确定认知如何影响老年HD患者的活动能力。在《目标3》中，这群人 数据将被用来确定焦虑、抑郁和自我效能如何影响老年HD患者的活动能力。 在确定了与流动性最相关的因素后，刘博士将制定一个多因素 干预以改善老年HD患者的活动能力，她将在R系列应用程序中进行测试。这项研究是 身处肾病学、老年病学和康复学的交汇点；刘医生是为数不多的临床医生研究人员之一。 专注于这一领域。在她的主要合作导师Daniel Weiner博士和Jonathan Bean博士的带领下，刘博士 优秀的指导团队是多学科、跨机构的，是协作型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和 作为一名致力于改善老年HD患者行动能力的临床医生研究员，获得独立的技能。

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.