Examining Quality-of-Life Priorities of Older Adults Receiving Hemodialysis: A Q-Methodology Study.

RATIONALE & OBJECTIVE: Older adults represent the fastest-growing demographic group initiating hemodialysis (HD) in the United States. Compared with older adults who do not receive HD, they commonly report a lower quality of life (QOL). However, their perspectives on QOL are poorly understood. The objective of this study was to identify and characterize QOL priorities of older adults receiving HD. STUDY DESIGN: Cross-sectional study using Q-methodology. SETTING & PARTICIPANTS: Participants were recruited from dialysis centers in and around Durham, North Carolina. Each participant sorted 35 QOL statements based on the level of agreement (eg, agree, disagree, or neutral). ANALYTICAL APPROACH: Factor analysis of the Q-sorts was performed using the PQ Method software. Factors were interpreted and described as QOL priorities. Demographic and clinical characteristics were summarized overall and based on factors. RESULTS: 29 older adults were recruited with a mean age of 76.2 ± 5.6 years, a median dialysis vintage of 3 (1-4.8) years, and 18 (62.1%) women. Ten (34%) participants screened positive for frailty questionnaire responses and 16 (55.2%) participants reported using an assisted device. Factor analysis revealed the following 2 distinct QOL prioritization profiles: (1) "Everyday Well-Being" and (2) "Safety and Security." "Everyday Well-Being," defined using 16 Q-sorts, represented a perspective that highly valued cognitive function (memory/thinking ability), spirituality, adequate pain control, and well-functioning dialysis access. "Safety and Security," defined using 11 Q-sorts, represented a perspective that highly valued socioeconomic stability, including financial stability, access to reliable transportation, and safety. We observed no difference in age, dialysis vintage, or performance on cognitive, physical function, and frailty assessments between participants whose Q-sorts defined each prioritization profile. LIMITATIONS: Cross-sectional design, confinement to 1 geographical region. CONCLUSIONS: Using Q-methodology, we identified 2 dominant profiles of QOL priorities among older adults receiving HD. These findings highlight heterogeneity in what matters most to older adults receiving HD and the need for personalized, patient-centered approaches to evaluating and improving their QOL.

Duke Scholars

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

Author Rasheeda Hall Medicine, Nephrology

Author John Keith Roberts Medicine, Nephrology

Author Anika Michelle Lucas Medicine, Nephrology