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Dialysis modality decision‐making for older adults with chronic kidney disease

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  • Lori Harwood
  • Alexander M Clark

Abstract

Aims and objectives To examine the personal and structural facilitators and barriers for home‐dialysis decision‐making for older adults with chronic kidney disease. Background Chronic illness is a global problem. Older adults with chronic kidney disease form a large and growing segment of the dialysis population in many high‐income countries but are less likely to uptake home‐dialysis despite its benefits. Design This qualitative ethnography framed in social theory took place in Canada and included adults with chronic kidney disease not on dialysis, older than 65 years of age. Methods Thirteen people (seven men and six women, aged 65–83 years of age) who received care in a team chronic kidney disease clinic took part. Persons with chronic kidney disease were interviewed and group interviews were conducted with four of their chronic kidney disease clinic healthcare professionals. Content analysis was used for data analysis. Results The factors influencing older adults' chronic kidney disease modality decisions are similar to younger adults. However, older adults with chronic kidney disease are in a precarious state with persistent uncertainty. Age imposes some limitations on modality options and transplantation. Modality decisions were influenced by health status, gender, knowledge, values, beliefs, past experience, preferences, lifestyle and resources. Support from family and healthcare professionals was the largest determinant to home‐dialysis selection. Conclusion The social and contextual factors associated with age influenced home‐dialysis decision‐making. Adequate social support, functional status and resources enabled home‐dialysis selection. Relevance to clinical practice Understanding more about the decision‐making processes for older adults with chronic kidney disease is important for quality interventions and the economic sustainability of dialysis services.

Suggested Citation

  • Lori Harwood & Alexander M Clark, 2014. "Dialysis modality decision‐making for older adults with chronic kidney disease," Journal of Clinical Nursing, John Wiley & Sons, vol. 23(23-24), pages 3378-3390, December.
    • Handle: RePEc:wly:jocnur:v:23:y:2014:i:23-24:p:3378-3390
    DOI: 10.1111/jocn.12582
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    References listed on IDEAS

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    1. Sharon R. Kaufman & Janet K. Shim & Ann J. Russ, 2006. "Old Age, Life Extension, and the Character of Medical Choice," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 61(4), pages 175-184.
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    Cited by:

    1. Nien‐Hsin Chen & Yu‐Ping Lin & Shu‐Yuan Liang & Heng‐Hsin Tung & Shiow‐Luan Tsay & Tsae‐Jyy Wang, 2018. "Conflict when making decisions about dialysis modality," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(1-2), pages 138-146, January.

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