Living with frailty and haemodialysis: a qualitative study

Young, Hannah; Ruddock, Nicki; Harrison, Mary; Goodliffe, Samantha; Lightfoot, Courtney J; Mayes, Juliette; Nixon, Andrew; Greenwood, Sharlene; Conroy, Simon; Singh, Sally; Burton, James O.; Smith, Alice C.; Eborall, Helen

doi:10.1186/s12882-022-02857-w

Cited by 5 publications

(2 citation statements)

References 42 publications

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“…In addition, the implementation of the frailty screening program led to major improvements in the management of the hemodialysis unit, the optimization of the nurses’ workloads and more efficient allocation of resources. Similar projects have been implemented elsewhere, with generally positive results [ 7 , 8 ]. In recent years, the paradigm of quality of care for patients with ESKD has changed, making necessary the introduction of models that include evaluation of frailty in clinical practice to improve resource management.…”

Section: Discussionmentioning

confidence: 90%

Frailty in hemodialysis patients: results of a screening program and multidisciplinary interventions

Arias‐Guillén

Romano-Andrioni

Yuguero-Ortiz

et al. 2023

Clinical Kidney Journal

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Background The number of frail patients of advanced age with end-stage chronic kidney disease (ESKD) undergoing hemodialysis is increasing globally. Here we evaluated a frailty screening program of ESKD patients starting hemodialysis, and subsequent multidisciplinary interventions. Methods This was a prospective observational study of ESKD patients in a hemodialysis program. Patients were evaluated for frailty (Fried frail phenotype) before and after a 12-month period. Patients followed standard clinical practice at our hospital, which included assessment and multidisciplinary interventions for nutritional (malnutrition-inflammation score [MIS]; protein-energy wasting), physical (short physical performance battery [SPPB]), and psychological status. Results A total of 167 patients (mean age, 67.8 ± 15.4 years) were screened for frailty, and 108 completed the program. At screening, 27.9% of the patients were frail, 40.0% pre-frail, and 32.1% non-frail. Nutritional interventions (enrichment, oral nutritional supplements, intradialytic parenteral nutrition) resulted in stable nutritional status for most frail and pre-frail patients after 12 months. Patients following recommendations for intradialytic, home-based, or combined physical exercise presented improved or stable in SPPB scores after 12 months, compared with those that did not follow recommendations, especially in the frail and pre-frail population (p = 0.025). A rate of 0.05 falls/patient/year was observed. More than 60% of frail patients presented high scores of sadness and anxiety. Conclusions Frailty screening, together with coordinated interventions by nutritionists, physiotherapists, psychologists, and nurses, preserved the health status of ESKD patients starting hemodialysis. Frailty assessment helped advising patients on individual nutritional, physical or psychological needs.

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Section: Discussionmentioning

confidence: 90%

Frailty in hemodialysis patients: results of a screening program and multidisciplinary interventions

Arias‐Guillén

Romano-Andrioni

Yuguero-Ortiz

et al. 2023

Clinical Kidney Journal

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“…Patients on HD feel frustrated and helpless because of poor quality sleep with daytime tiredness from inadequate sleep impairing their health-related quality of life (HRQOL) [ 50 ]. Sleep disturbances arising from pain and chronic musculoskeletal impairments predicted frailty in HD patients [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Symptom burden, fatigue, sleep quality and perceived social support in hemodialysis patients with musculoskeletal discomfort: a single center experience from Egypt

Nassar,

Tharwat,

Abdel-Gawad

et al. 2023

BMC Musculoskelet Disord

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Background and aims Musculoskeletal disorders (MSDs) are commonly encountered in hemodialysis (HD) patients. However, the causes linked to these disorders are still partially defined. The aim of this study was to determine the frequency of MSDs and their relationship to a variety of clinico-social characteristics such as sleep quality, mood disorders, fatigue, and social support, in addition to the patients’ clinical and therapeutic profile. Method The study included 94 patients on maintenance HD. Clinical and Sociodemographic data was gathered. To investigate the prevalence and trends of MSDs, the Nordic Musculoskeletal Questionnaire (NMQ-E) was employed. Patients completed the modified Edmonton Symptom Assessment System, Pittsburgh Sleep Quality Index (PSQI), multidimensional Fatigue Inventory (MFI-20), and Perceived Social Support from Family Scales. Univariate and multivariate regression analysis were used to assess the determinants of MSDs. Results The patients' mean age was 49.73 and 59.6% were males. Seventy-two percent of patients were afflicted by MSDs. Knee pain (48.9%), low back pain (43.6%), shoulder pain (41.6%), hip/thigh pain (35.1%), and neck pains (35.1%) were the most reported MSD domains. Pain (p = 0.001), fatigue (p = 0.01), depression (p = 0.015), and anxiety (p = 0.003) scores were substantially higher in patients with MSDs. Furthermore, patients with MSDs engaged in less physical activity (p = 0.02) and perceived less social support (p = 0.029). Patients with MSDs had lower subjective sleep quality, daytime dysfunction domains, and global PSQI scores (p = 0.02, 0.031, 0.036, respectively). Female gender (p = 0.013), fatigue (p = 0.012), depression (p = 0.014), anxiety (p = 0.004), lower activity (p = 0.029), and PSQI score (0.027), use of erythropoiesis-stimulating agents (ESAs), antihypertensive drugs, calcium and Iron supplementation were all significantly associated with MSDs. At the multivariable regression model, administration of ESAs (p = 0.017) and pain score (p = 0.040) were the only independent variables associated with the outcome. Conclusion MSDs are quite common among HD patients. Female gender, pain, fatigue, depression, anxiety, reduced activity, poor sleep quality, and use of ESAs are all significantly associated with MSDs in HD patients. Patients with MSD perceived less social support compared to the other group. Patients treated with antihypertensive drugs, calcium and iron supplements were more likely to suffer MSDs.

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Physical activity and sedentary behaviour interventions for people living with both frailty and multiple long-term conditions and their informal carers: a scoping review and stakeholder consultation

Young,

Henson,

Dempsey

et al. 2024

Age and Ageing

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Introduction This scoping review mapped evidence on physical activity (including structured exercise) and sedentary behaviour interventions (interventions to reduce sedentary behaviour) in people living with both frailty and multiple long-term conditions (MLTCs) and their informal carers. Methods Ten databases and grey literature were searched from 2000 to October 2023. Two reviewers screened studies and one extracted data. Results were shared with three stakeholder groups (n = 21) in a consultation phase. Results After screening, 155 papers from 144 studies (1 ongoing) were retained. The majority were randomised controlled trials (86, 55%). Participants’ mean age was 73 ± 12 years, and 73% were of White ethnicity. MLTC and frailty measurement varied widely. Most participants were pre-to-moderately frail. Physical health conditions predominated over mental health conditions. Interventions focused on structured exercise (83 studies, 60%) or combined interventions (55 studies, 39%). Two (1%) and one (0.7%) focused solely on habitual physical activity or sedentary behaviour. Adherence was 81% (interquartile range 62%–89%) with goal setting, monitoring and support important to adherence. Carers were only involved in 15 (11%) studies. Most interventions reported positive outcomes, primarily focusing on body functions and structures. Conclusions A modest volume of evidence exists on multicomponent structured exercise interventions, with less focus on habitual physical activity and sedentary behaviour. Interventions report largely positive effects, but an updated systematic review is required. The field could be advanced by more rigorous characterisation of MLTCs, socioeconomic status and ethnicity, increased informal carer involvement and further evaluation of habitual physical activity and sedentary behaviour interventions.

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Living with frailty and haemodialysis: a qualitative study

Cited by 5 publications

References 42 publications

Frailty in hemodialysis patients: results of a screening program and multidisciplinary interventions

Frailty in hemodialysis patients: results of a screening program and multidisciplinary interventions

Symptom burden, fatigue, sleep quality and perceived social support in hemodialysis patients with musculoskeletal discomfort: a single center experience from Egypt

Physical activity and sedentary behaviour interventions for people living with both frailty and multiple long-term conditions and their informal carers: a scoping review and stakeholder consultation

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