Unmet Needs of Older Adults Receiving In-Center Hemodialysis: A Qualitative Needs Assessment.

RATIONALE & OBJECTIVE: Attention to geriatric impairments is not routinely provided to older adults receiving dialysis. Our objective was to identify patient and personnel perspectives on experiences with geriatric problems, unmet needs that may affect a patient's ability to maintain his or her functional status, and preferences for design of a geriatric model of care tailored to address the unmet needs. STUDY DESIGN: Qualitative study using semi-structured interviews and focus groups. SETTING & PARTICIPANTS: 14 hemodialysis patients 55 years and older and 24 dialysis unit personnel (eg, nephrologists, nurses, patient care technicians, and social workers) representing 5 dialysis units. ANALYTICAL APPROACH: Content analysis to identify themes reflecting unmet needs and design considerations for a geriatric model of care for older adults receiving dialysis. RESULTS: 4 themes (or unmet needs) identified from both patient and personnel transcripts were: (1) mobility, which referred to the insufficient mobility assessment and transportation services; (2) medications, which referred to insufficient attention to appropriate prescribing and medication self-management; (3) social support, which referred to insufficient support for activities of daily living and emotional problems; and (4) communication, which referred to insufficient patient-provider and interprofessional communication, including data transfer across separate health systems. Although participants generally acknowledged that an integrated model of care could result in benefits across all 4 areas of unmet need, they noted that the program design would need to minimize disruption of current workflow and practices in dialysis units. LIMITATIONS: The findings may not be broadly representative of all older adults receiving dialysis and dialysis unit personnel. CONCLUSIONS: There is insufficient attention to mobility, medication management, social support, and communication needs for older adults receiving in-center hemodialysis. Addressing these unmet needs in a geriatric model of care and measuring its effectiveness are areas of future research.

Duke Scholars

Author Cathleen Sellner Colon-Emeric Medicine, Geriatrics and Palliative Care

Author Rasheeda Hall Medicine, Nephrology

Author Laura Jane Fish Family Medicine and Community Health, Prevention Research