The influence of age on changes in health-related quality of life over three years in a cohort undergoing hemodialysis

Quality of Life (QOL) and Attitudes Toward Aging in Older Adults in Şanlıurfa, Turkey

Objectives: The purpose of this study was to investigate quality of life (QOL) and attitudes toward aging in older adults in a province in Turkey. Methods: This is a quantitative and descriptive study of QOL and the attitudes toward aging in older adults. Instruments: The data measurement instruments used in this study are the World Health Organization (WHO) Quality of Life Instrument–Older Adults Module (WHOQOL-OLD) and the WHO–Attitudes to Ageing Questionnaire (AAQ). Participants: The Turkish versions of the WHOQOL-OLD and AAQ were administered to 550 older adults living in şanlıurfa Province, Turkey. Results: The results indicated a significant relationship between QOL and attitudes toward aging in older adults. Two dimensions of attitudes toward aging (physical change and psychological growth) were significant predictors of QOL in older adults. It was found that gender, literacy, social security, age, and marital status affect some dimensions of QOL and some subscales of attitudes toward aging.

Factors associated with health-related quality of life in elderly patients on hemodialysis

OBJECTIVE

To identify factors associated with health-related quality of life in elderly patients on hemodialysis.

METHODS

Cross-sectional study including 223 patients aged > 60 years on hemodialysis conducted in dialysis centers in the city of Belo Horizonte, southeastern Brazil, in 2008. Health-related quality of life was measured with the Kidney Disease Quality of Life Short Form (KDQOL-SF) and the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36). The three KDQOL-SF component scores measured were: kidney disease component summary (11 subscales), physical component summary (four subscales) and mental component summary (four subscales).

RESULTS

Significant independent negative associations were found between the kidney disease and mental components and number of chronic diseases and treatment duration. A lower physical component was seen among women, those with more advanced age, more hospital admissions, and three or more chronic diseases.

CONCLUSIONS

The finding that health-related quality of life was consistently associated with chronic diseases points to the importance of the morbidity profile in elderly patients on hemodialysis. The associated factors identified including advanced age, female gender, number of hospital admissions and treatment duration can provide input for planning health actions that can more adequately meet this populations' needs.

Mortality and health-related quality of life in prevalent dialysis patients: Comparison between 12-items and 36-items short-form health survey

BACKGROUND

To assess health- related quality of life (HRQOL) with SF-12 and SF-36 and compare their abilities to predict mortality in chronic dialysis patients, after adjusting for traditional risk factors.

METHODS

The Short-Form Health Survey (SF-36) with the embedded SF-12 was applied in 301 dialysis patients cross-sectionally. Physical and mental component summary (PCS-36, MCS-36, PCS-12, and MCS-12) scores were calculated. Clinical and demographic data were collected. Mortality (followed for up to 4.5 years) was analyzed with Kaplan Meier plots and Cox proportional hazards, after censoring for renal transplantation. Exclusion factors were observation time <2 months (n = 21) and missing component summary scores (n = 10 for SF-36; n = 28 for SF-12), thus 252 patient were included in the analyses.

RESULTS

In 252 patients (60.2 ± 15.5 years, 65.9% males, dialysis vintage 9.0, IQR 5.0-23.0 months), mortality during follow-up was 33.7%.(85 deaths). Significant correlations were observed between PCS-36 and PCS-12 (ρ = 0.93, p < 0.001) and between MCS-36 and MCS-12 (ρ = 0.95, p < 0.001). Mortality rate was highest in patients in the lowest quartile of PCS-12 (χ² = 15.3, p = 0.002) and PCS-36 (χ² = 16.7, p = 0.001). MCS was not associated with mortality. Adjusted hazard ratios for mortality were 2.5 (95% CI 1.0-6.3, PCS-12) and 2.7 (1.1 - 6.4, PCS-36) for the lowest compared with the highest ("best perceived") quartile of PCS.

CONCLUSION

Compromised HRQOL is an independent predictor of poor outcome in dialysis patients. The SF-12 provided similar predictions of mortality as SF-36, and may serve as an applicable clinical tool because it requires less time to complete.

Psychosocial factors and health as determinants of quality of life in community-dwelling older adults

PURPOSE

It is important to understand the determinants of differences in quality of life in old age and to include a wide range of possible predictors. The present study investigated the determinants of quality of life in two groups of older adults for whom there was an unusually informative set of possible predictor variables.

METHOD

Participants were members of the Lothian Birth Cohorts of 1921 (n = 550) or 1936 (n = 1,091). Four facets of quality of life (QoL) and general QoL were measured using the WHOQOL-BREF. Possible determinants included personality traits, measured with the International Personality Item Pool (IPIP) scales; childhood and old age general cognitive ability, measured with the Moray House Test; minor psychological symptoms, measured with the Hospital Anxiety and Depression Scale (HADS); physical health, assessed by grip strength and cardiovascular disease history; and sociodemographic factors, assessed by interview.

RESULTS

Linear regression analyses revealed that HADS depression had the greatest influence on quality of life. Personality traits, most notably Emotional Stability, also predicted quality of life to varying degrees, along with factors reflecting current life circumstances. There were differences between the two cohorts in the variables which predicted quality of life. There were different, conceptually relevant, contributions to the different QoL facets.

CONCLUSIONS

Personality traits and minor depressive symptoms have an important influence on self-reported quality of life in old age. Quality of life may be influenced more by current than past circumstances, and this relationship may change with age.

Impact of sleep quality on cardiovascular outcomes in hemodialysis patients: results from the frequent hemodialysis network study

BACKGROUND

Poor sleep quality is a common, persistent, and important problem to patients with end-stage renal disease (ESRD). This report examines whether sleep quality is associated with dialysis treatment factors and other modifiable clinical factors in a large group of hemodialysis (HD) patients.

METHODS

Cross-sectional analyses were conducted on baseline data collected from participants in the Frequent Hemodialysis Network trials. Sleep quality was measured using the Medical Outcomes Study Sleep Problems Index II (SPI II), a 9-item measure of sleep quality with higher scores reflecting poorer sleep quality.

RESULTS

The participants had an age of 51.2 ± 13.6 years, 61% were male, 38% were black, and 42% had diabetes. Higher pre-dialysis serum phosphorus (per 0.5 mg/ml) (OR 0.91; 95% CI 0.85, 0.96) and depression (OR 0.16; 95% CI 0.10, 0.25) were independently associated with decrements in sleep quality. There was also a difference in time to recovery from dialysis for the fourth versus the first SPI II quartile (5.1 h; p < 0.0001).

CONCLUSION

These findings underscore the link between sleep and daytime function and suggest that improving sleep may provide an opportunity to improve outcomes in ESRD. Whether sleep problems may be improved by reduction of serum phosphorus or treatment of depression in the HD population merits further investigation.

Should there be an expanded role for palliative care in end-stage renal disease?

PURPOSE OF REVIEW

In this review, we outline the rationale for expanding the role of palliative care in end-stage renal disease (ESRD), describe the components of a palliative care model, and identify potential barriers in implementation.

RECENT FINDINGS

Patients receiving chronic dialysis have reduced life expectancy and high rates of chronic pain, depression, cognitive impairment, and physical disability. Delivery of prognostic information and advance care planning are desired by patients, but occur infrequently. Furthermore, although hospice care is associated with improved symptom control and lower healthcare costs at the end of life, it is underutilized by the ESRD population, even among patients who withdraw from dialysis. A palliative care model incorporating communication of prognosis, advance care planning, symptom assessment and management, and timely hospice referral may improve quality of life and quality of dying. Resources and clinical practice guidelines are available to assist practitioners with incorporating palliative care into ESRD management.

SUMMARY

There is a large unmet need to alleviate the physical, psychosocial, and existential suffering of patients with ESRD. More fully integrating palliative care into ESRD management by improving end-of-life care training, eliminating structural and financial barriers to hospice use, and identifying optimal methods to deliver palliative care are necessary if we are to successfully address the needs of an aging ESRD population.

Predialysis therapeutic care and health-related quality of life at dialysis onset (The pharmacoepidemiologic AVENIR study)

BACKGROUND

To determine the impact of the quality of pre-dialysis nephrological care on health-related quality of life (HRQoL) at dialysis onset, which has not been well evaluated.

METHODS

All adults who began a dialysis treatment in the administrative region of Lorraine (France) in 2005 or 2006, were enrolled in this prospective observational study. HRQoL was measured using the Kidney Disease Quality of Life V36 questionnaire, which enables calculation of two generic (physical and mental) and three specific dimensions (Symptoms/problems, Effects and Burden of kidney disease). The specific dimensions were scored from 0 to 100 (worst to best possible functioning). Pre-dialysis nephrological care was measured using three indicators: quality of therapeutic practices (evaluated across five main aspects: hypertension/proteinuria, anemia, bone disease, metabolic acidosis and dyslipidemia), time since referral to a nephrologist and number of nephrology consultations in the year preceding dialysis treatment.

RESULTS

Two thousand and eighty-three (67.4%) patients were referred to a nephrologist more than 1 month before dialysis initiation and completed the HRQoL questionnaire. Quality of therapeutic practices was significantly associated with the Mental component. Time since referral to a nephrologist was associated with Symptoms/problems and the Effects of kidney disease dimensions, but no relationship was found between the number of nephrology consultations and HRQoL.

CONCLUSIONS

HRQoL at dialysis onset is significantly influenced by the quality of pre-dialysis nephrological care. Therefore, disease management should be emphasized.

Quality of life in older Norwegian adults living at home: a cross-sectional survey

The term quality of life (QoL) has been used in nursing for several years despite having neither a common conceptual model nor a common definition. The Wilson and Cleary Model (WCM), defined in 1995, is used as a conceptual model to identify suitable variables important in planning nursing care in a study among Norwegian older adults. The objective of this study was to investigate how the relationships among depressive symptoms, physical function, health satisfaction, age and environment may predict QoL in a model based on the WCM. The overall model provides empirical evidence for linkages in the WCM. Results showed that QoL is likely to be influenced by the direct effects of environmental conditions, health satisfaction and age. In addition, environmental conditions and age had indirect effects on QoL, in particular via depressive symptoms. Environment had both a significant direct and an indirect effect on QoL. An indirect effect of environment on QoL was shown with depressive symptoms, physical function and perceived health as mediators. There was only a small amount of evidence for age predicting QoL. This model may help nurses and other health care workers to collect and assess information, to suggest suitable interventions and to guide decision making.

Health-related quality of life and depression in dialysis patients: associations with current smoking

OBJECTIVE

The study explored health-related quality of life (HRQoL) and depression in a culturally homogeneous dialysis patient population. Furthermore, the associations between HRQoL and depression with current smoking were elaborated.

MATERIAL AND METHODS

In a cross-sectional study of 301 dialysis patients from 10 dialysis centres in Norway, HRQoL was evaluated with the Kidney Disease and Quality of Life Short Form, version 1.3. Physical component summary scores (PCS) and mental component summary scores (MCS) were computed. Depression was assessed using the Beck Depression Inventory (BDI), and Cognitive Depression Index (CDI) was calculated. Depression was defined as a BDI score greater than 14.

RESULTS

HRQoL was poorer in dialysis patients compared with population norms. Depression was prevalent (33.2%), and differed significantly between smokers and non-smokers (52.8 vs 26.4%, p < 0.001). MCS was significantly reduced in smokers compared with non-smokers (44.1 +/- 12.2 vs 48.7 +/- 10.3, p < 0.001), but there was no difference in PCS (35.7 +/- 10.2 vs 37.1 +/- 10.4, not significant). Current smoking was independently associated with higher BDI score (p = 0.039), as well as with higher CDI score (p = 0.005) and worse score on MCS (p = 0.002), after adjustments for multiple covariates.

CONCLUSIONS

HRQoL is lower in Norwegian dialysis patients than in the general population, and depression is prevalent. The study suggests that poor perceived mental aspects of HRQoL and depression are associated with current smoking in dialysis patients, but a causal relationship remains to be shown.

Incidence, management, and outcomes of end-stage renal disease in the elderly

PURPOSE OF REVIEW

The elderly constitute a substantial and growing fraction of the end-stage renal disease (ESRD) population. We review recent studies on ESRD incidence, management, and outcomes in the elderly.

RECENT FINDINGS

Rates of treated ESRD among the elderly (>80 years) have risen by more than 50% in the last decade. In studies with a large number of elderly patients, median survival after dialysis initiation is modest, and although a majority have reasonable life expectancy, a substantial minority of elderly patients experience very high early mortality rates after dialysis initiation. Quality of life results are mixed--compared with younger ESRD patients or non-ESRD elderly, mental well being is similar and physical well being is reduced in elderly patients with ESRD. In several studies, elderly patients with ESRD initiating peritoneal dialysis had higher mortality rates than elderly patients with ESRD initiating hemodialysis. Strategies such as nondialytic management of ESRD or dietary protein restriction and delayed dialysis initiation may be alternatives for elderly patients wishing to avoid dialysis initiation, but further studies are needed to determine the patients best suited for these approaches. Quality improvement initiatives in geriatric ESRD care have been successfully implemented in some centers and may ultimately improve care for elderly patients with ESRD.

SUMMARY

These findings should help to clarify some of the risks and benefits of dialysis in the elderly and may be useful in dialysis decision-making and management.

Individual quality of life in chronic kidney disease: influence of age and dialysis modality

BACKGROUND AND OBJECTIVES

Novel individualized quality-of-life (IQOL) measures permit patients with chronic kidney disease (CKD) to nominate unique areas of their lives that contribute to their well-being. This study assessed for differences in domains nominated by patients with CKD. We also examined the strength of association between (1) multidimensional health-related quality-of-life measures and IQOL and (2) psychosocial factors and IQOL.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We performed a cross-sectional study of 151 patients who were undergoing peritoneal dialysis or hemodialysis or had stages 4 through 5 CKD. Patients completed the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQOL-DW), an instrument that assesses IQOL on the basis of patient-identified domains. Patients also completed health-related quality-of-life and psychosocial health measures.

RESULTS

Patients with CKD nominated many domains on the SEIQOL-DW, but family and health were the most common for all groups. Kidney disease was listed more frequently by peritoneal dialysis compared with hemodialysis patients or patients with CKD (31 versus 14 versus 5%, respectively). There were no significant differences in SEIQOL-DW scores between subgroups. SEIQOL-DW scores correlated with mental well-being and inversely correlated with chronic stress and depression.

CONCLUSIONS

Patients with advanced CKD demonstrate compromised quality-of-life scores comparable to dialysis patients. IQOL measures provide unique information that may help guide interventions that are better tailored to address patients' concerns about their well-being. These findings also suggest that renal clinics should have staff available to address psychosocial aspects of patient well-being.