Interviews with dialysis staff personnel, along with patients older than 55 years who were on in-center hemodialysis, revealed four areas that need more attention to improve the quality of care for these patients, according to researchers.
The identified areas of “unmet needs” are related to mobility, medications, social support and communication.
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According to Rasheeda Hall MD, MBA, MHS, of the Durham Veterans Affairs Healthcare System and Duke University, and colleagues, older adults receiving dialysis commonly experience problems, such as falls, limited mobility, polypharmacy and cognitive deficits.
“Attention to geriatric impairments is not routinely provided to older adults receiving dialysis,” they wrote. “Our objective was to identify patient and personnel perspectives on experiences with geriatric problems, unmet needs that may impact a patient’s ability to maintain their functional status, and preferences for design of a geriatric model of care tailored to address their unmet needs.”
To gain a wider perspective on ways to best treat this patient population, the researchers conducted semi-structured interviews and focus groups of 14 patients on hemodialysis and 24 dialysis unit personnel (including nephrologists, nurses, patient care technicians and social workers).
Patient and personnel transcripts revealed insufficient mobility assessment and transportation services, insufficient attention to appropriate prescribing and medication self-management, insufficient support for activities of daily living and emotional problems and insufficient communication between patients and providers, as well as interprofessional communication.
“These four unmet needs were interrelated because an unmet need in one area was often related to an unmet need in another,” the researchers added, providing an example of a patient with mobility limitations that may miss medications due to insufficient social support for organizing medications.
Certain issues were addressed more often by personnel than patients and included patients’ lack of financial resources and cognitive decline.
Personnel observed that patients’ lack of financial resources sometimes caused them not to be able to access costly medications and that they did not have enough social support to aid in accessing these medications. Personnel also observed patients “starting to fade,” or forgetfulness, changes in hygiene and difficulty taking their medications.
According to Hall and colleagues, this study builds on existing knowledge on the importance of incorporating dialysis personnel perspectives.
“Their perspectives not only confirm the unmet needs identified from patient experiences but also reveal how dialysis personnel are often frustrated by their inability to easily identify or intervene when geriatric problems develop,” the researchers wrote. “While the unmet needs are not unique to the older dialysis population, our study demonstrates that these needs persist despite the multidisciplinary dialysis care team and frequent exposure to the health care system.”
