Deidra C. Crews
A home-based program improved both the physical and social functioning of older adults with ESRD who were being treated with hemodialysis and who were of low socioeconomic status, according to a study published in Kidney Medicine.
“It may be possible to improve physical and social functioning of older adults on hemodialysis via a home-based intervention, which could have implications for their ability to age in place, without requiring nursing home placement, and to have fewer hospitalizations,” Deidra C. Crews, MD, ScM, associate professor of medicine in the division of nephrology at Johns Hopkins University School of Medicine, told Healio/Nephrology.
To test the feasibility and acceptability of the home-based intervention, researchers conducted the Seniors Optimizing Community Integration to Advance Better Living with ESRD (SOCIABLE) study. For this qualitative study, researchers first performed two focus groups at hemodialysis centers in Baltimore, Maryland of 12 African-American adults aged 60 years or older who had limitations in physical function and who had less than a high school education, were unemployed and/or had an annual household income of less than $25,000.
Questions asked in the focus group centered on knowledge and beliefs about health and functional status (mean disability score for activities of daily living [ADL], 4.4 out of 16; mean score for Instrumental ADLs [IADL], 6.3 out of 16), patients’ needs, and acceptable interventions to support physical and social functioning. More specifically, some themes addressed included fatigue, lack of social support and desire to live independently. Researchers then randomized participants to either intervention (immediate treatment) or control (delayed treatment), with the control group receiving the intervention after serving as the controls.
The intervention program lasted for 5 months and consisted of home-visits by an occupational therapist, a nurse and a handyman. The occupational therapist and nurse helped patients identify three achievable goals per discipline and examined barriers to achieving these goals, while the handyman made structural improvements to the home to remove some barriers to optimal physical functioning.
A home-based program improved both the physical and social functioning of older adults with ESRD who were being treated with hemodialysis and who were of low socioeconomic status.
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Researchers found all treated participants had improved ADL and IADL disability scores (by 2.3 and 4.6, respectively). In addition, social support and social network scores improved by 4.8 and 4.6, respectively.
“Full-scale interventions testing home-based approaches such as this are needed to determine whether they can ... reduce hospitalizations and increase home dialysis and transplantation consideration[s] among low socioeconomic-status older adults treated with dialysis,” Crews said. – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.