Department of Internal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Nephrol Dial Transplant. 2011 May;26(5):1723-8. doi: 10.1093/ndt/gfq642. Epub 2010 Oct 12.
Non-adherence to the post-transplant regime is a common problem in kidney transplant patients and may lead to rejection or even graft failure. This study investigated attitudes towards the post-transplant regime of immunosuppressive medication among the ever growing population of elderly kidney recipients.
Q methodology was used to explore attitude profiles. Participants (> 65 years) were asked to rank-order opinion statements on issues associated with (non-)adherence. The rankings were subject to by-person factor analysis, and the resulting factors were interpreted and described as attitudes.
Twenty-six elderly renal transplant recipients participated in the study. All passed the Mini-Mental State Examination. Two attitude profiles were found: (i) satisfied and easy-going (attitude A), and (ii) reserved and concerned (attitude B). Elderly patients with attitude A want to enjoy the new life following their kidney transplant, are not very concerned about having to recommence dialysis, now and then even forget their regime, and do not really worry about it. Elderly patients with attitude B feel more insecure about their kidney transplant, are fairly concerned over issues like rejection or going back on dialysis, and try to adapt their way of life to the regime. One-third of these elderly patients forget their medication at least once a month, but there was no difference between attitude groups.
Attitudes about the post-transplant regime differ among elderly patients, implying different needs for assistance, monitoring and risk of non-adherence to the regime. The proportion of elderly patients who forget their medication is considerable, but may be much higher among those with mild and severe cognitive limitations.
肾移植患者普遍存在不遵守移植后治疗方案的情况，这可能导致排斥反应甚至移植物失功。本研究调查了不断增长的老年肾移植受者群体对免疫抑制药物移植后治疗方案的态度。
采用 Q 分类法探索态度概况。要求参与者（>65 岁）对与（不）依从性相关的问题的意见陈述进行排序。对排名进行个体因素分析，并对得出的因素进行解释和描述为态度。
26 名老年肾移植受者参与了研究。所有人均通过了简易精神状态检查。发现了两种态度：（i）满足和随和（态度 A），以及（ii）保留和担忧（态度 B）。具有态度 A 的老年患者希望享受肾移植后的新生活，对不得不重新开始透析并不太担心，偶尔甚至会忘记自己的方案，并不真正担心。具有态度 B 的老年患者对肾移植感到更不安，对排斥或重新开始透析等问题相当关注，并试图适应他们的生活方式以适应方案。这些老年患者中有三分之一的人每月至少忘记服药一次，但在态度组之间没有差异。
老年患者对移植后治疗方案的态度存在差异，这意味着他们对辅助、监测和不遵守治疗方案的风险存在不同需求。忘记服药的老年患者比例相当大，但在认知能力轻度和重度受限的患者中可能更高。
