End-Stage Renal Disease Among Older Adults: Self-Management, Age, Cognition, and Self-Efficacy

Purpose: This study examines the self-management behaviors of older adults living with end-stage renal disease (ESRD), a significant chronic disease affecting over 800,000 people in the United States. Older adults have the highest ESRD incident rates, and are especially burdened by depression, low health-related quality of life, and declined functional status. Older adults primarily select hemodialysis (HD) treatment which is associated with poorer blood pressure control, cardiovascular instability, and decreased independence compared to other ESRD treatment modalities. Social workers in HD settings can help patients and their families learn better self-management strategies to lessen the burden of ESRD and HD, however, little is known about the self-management behaviors of older adults undergoing HD.

Methods: This study employs mixed methods to examine the relationships between age, cognition, self-efficacy and five self-management behaviors: exercise, communication with physicians, cognitive symptom management, fluid adherence, and diet adherence. A total of 107 HD patients aged 50 and older were interviewed from four North Carolina HD facilities.

Results: Overall, participants had low mean scores for exercise (2.46), communication with physicians (2.50), and cognitive symptom management (0.89) and were adherent for greater than 11 days in a two week period with fluid (11.86) and diet (11.65) regimens. There were statistically significant age group differences in the self-management behavior of fluid adherence (p < .05) and communication with physicians (p = 0.05). There were no statistically significant differences in self-management by cognitive status or self-efficacy.  None of the respondents discussed communicating with their physicians or cognitive symptom management, yet 90% and 77% of the respondents reported engaging in these behaviors on their Communication with Physicians and Cognitive Symptom Management scales, respectively.

Implications: The findings from this study support the need for interventions aimed at increasing self-management behaviors to reduce the burden of ESRD and HD in older patients. The potential to introduce a self-management intervention is promising given the amount of time ESRD patients spend in HD facilities, and the existence of interdisciplinary teams in those facilities to help patients maximize their self-management.