None listed
Conditions
Brief summary
This project addresses a key area of older adults’ medical care. In New Zealand and internationally, the proportion of older people with CKD in rising rapidly, with the resultant increase in costly renal replacement therapy (RRT) ($65 - $80,000/year/person). Assumptions are made that dialysis is appropriate for all individuals; this may not be valid. Older patients who do not commence dialysis often survive many months and some may have a better quality of life (HRQoL) than those on dialysis. The aim of this project is to obtain sufficient HRQoL data to inform clinicians’ and patients’ decision-making with respect to dialysis in New Zealand. The Health of Older People strategy (MOH 2002) states older people with high and complex health and disability support needs, need access to flexible, timely and co-ordinated services and living options that take account of family/whanau carer needs. Determinants of successful dialysis in older people are multifactorial, including –degree of autonomy or control related to managing dialysis, associated co-morbidity and socio-economic factors and the aging process. The impact of these factors on outcome and HRQoL for the individual and their family/whanau is largely unknown. HRQoL is determined, not only by the disease process itself, but also by the individual’s physical and mental state, as well as the availability of support from family and community. This project will address the relevance, timeliness, and sustainability of dialysis in the older age group. Information about dialysis choices among this age group, related to their expectations and HRQoL, will iinfluence delivery of healthcare. This multi-disciplinary project will provide essential data immediately relevant to decision-making by the clinical team, the individual patient and the patient’s family/whanau. It is vital for future health care delivery of renal replacement therapy for those aged 65 years or over in New Zealand that reliable data are obtained.
Interventions
A 3 year prospective longitudinal observational survey of health-related quality of life (HRQOL) outcomes for individuals aged 65 years or older on, or eligible for, dialysis therapy linked to survival outcomes.
Data collected by yearly one-on-one structured interviews with participants by trained health care interviewers either face to face or by telephone.
Data collected by yearly structured interviews with participants will be linked to co-morbidity data, health service use, and laboratory i
A 3 year prospective longitudinal observational survey of health-related quality of life (HRQOL) outcomes for individuals aged 65 years or older on, or eligible for, dialysis therapy linked to survival outcomes. Data collected by yearly one-on-one structured interviews with participants by trained health care interviewers either face to face or by telephone. Data collected by yearly structured interviews with participants will be linked to co-morbidity data, health service use, and laboratory information collected from health records, and analysed with respect to survival. In parallel, a qualitative project with 20 participants from the main study will be undertaken. Qualitative interviews will undertaken by trained health care professionals.
Sponsors
University of Otago
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1) Prevalent dialysis patients aged 65 years or over, who have been on dialysis for 90 days prior to survey date will be eligible to participate in the study. 2) Incident (new) chronic kidney disease patients aged 65 years or over, with an eGFR equal to or less than 15 ml/min/1.73m2 presenting to the same services for consideration of dialysis will be eligible to participate in the study. A proportion of these incident patients will decide not to undertake dialysis. They will provide important data to compare and contrast with those who commence dialysis. At present, no data are collected in New Zealand about proportion of patients who decide not to enter a dialysis programme for end stage renal failure, although we estimate this to be 10 of the 40 incident patients recruited to the study each year. 3) Patients aged =65 years who present with hitherto unrecognized renal failure requiring immediate dialysis will be eligible if their renal failure is deemed permanent by the treating nephrologist, and if dialysis is intended to be an indefinite treatment.
Exclusion criteria
1) Inability to give informed consent, 2) Inability to participate in a telephone or face-to-face interview 3) Intercurrent illness requiring hospitalisation (current and within 2 weeks of the survey period) and of sufficient severity to affect patient’s ability to take part in the opinion of the treating physician (interviews for this last group will be rescheduled for 1 month later).
Outcome results
None listed