Moreels Timothy, Van de Velde Dominique, Van Duyse Stephanie, Vanden Wyngaert Karsten, Leune Tamara, Van Biesen Wim, De Vriendt Patricia
Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Department of Nephrology, Ghent University Hospital, Ghent, Belgium.
Clin Kidney J. 2023 May 4;16(10):1674-1683. doi: 10.1093/ckj/sfad104. eCollection 2023 Oct.
Older adults with end-stage kidney disease experience a diminished ability to perform the activities of their daily life. For those living at home, the initiation of in-centre haemodialysis treatment (ICHD) carries a risk of cascading functional decline leading to early nursing home placement and mortality. Research on how older adults adapt to their newly impacted daily life is scarce.
Individual semi-structured interviews were conducted using a purposeful maximum variation sample of older adult (≥65 years) ICHD patients living at home. Interviews were conducted between October and December 2018. Interview coding followed an inductive and broad-based approach. Thematic analysis was used to group meaning units into common themes and subthemes.
Twenty patients (12 females) were interviewed. Analysis resulted in two main themes and seven subthemes. The first main theme showed the impact of ICHD on everyday roles and functioning through four subthemes: a stepwise decline in daily activities, managing time, role changes and an incomplete retirement. The second main theme showed potential areas of remediation through three subthemes: the social environment, developing new daily activity patterns and meaningful activities and goals.
The older adults experienced a process of adaptation that generally progressed from a phase of initial disruption towards a period of mere survival. Being able to accept a life on dialysis was intricately connected with the ability to perform activities that were personally meaningful. Early and continued support of meaningful activities may prove valuable in breaking or delaying the cycle of functional decline.
终末期肾病的老年人日常生活活动能力下降。对于那些居家生活的老年人来说，开始接受中心血液透析治疗（ICHD）有导致功能级联下降的风险，进而导致过早入住养老院和死亡。关于老年人如何适应其受到新影响的日常生活的研究很少。
采用目的抽样的最大变异样本，对居家的老年（≥65岁）ICHD患者进行个体半结构式访谈。访谈于2018年10月至12月进行。访谈编码采用归纳法和广泛的方法。采用主题分析法将意义单元归纳为共同的主题和子主题。
共访谈了20名患者（12名女性）。分析得出两个主要主题和七个子主题。第一个主要主题通过四个子主题展示了ICHD对日常角色和功能的影响：日常活动的逐步下降、时间管理、角色变化和不完全退休。第二个主要主题通过三个子主题展示了潜在的补救领域：社会环境、发展新的日常活动模式以及有意义的活动和目标。
老年人经历了一个适应过程，通常从最初的混乱阶段发展到仅仅为了生存的阶段。能够接受透析生活与进行有个人意义的活动的能力密切相关。对有意义活动的早期和持续支持可能对打破或延缓功能下降的循环很有价值。
