Goals of Frail Older People Living With Chronic Kidney Disease: A Mixed Methods Study

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2025-03-05 DOI:10.1111/jgs.19421

Benignus Logan, Kristiana Ludlow, Elaine M. Pascoe, Andrea K. Viecelli, David W. Johnson, Carmel M. Hawley, Laura E. Hickey, Charani Kiriwandeniya, Misa Matsuyama, Allison Jaure, Ruth E. Hubbard

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Abstract

Background

Frail older adults with chronic kidney disease (CKD) have complex care needs, and their priorities may differ from those assumed by healthcare providers. Understanding their goals is crucial to delivering person-centred care. This study aimed to identify and categorize the goals of this population and determine any association with participants' frailty status, quality of life, and CKD stage.

Methods

We report the goals of frail older people living with moderate to severe CKD enrolled as participants in the GOAL trial, a cluster-randomized controlled trial assessing the effectiveness of comprehensive geriatric assessment. This study employs a mixed-methods approach, utilizing a triangulation design and a data transformation model. Participants set goals by Goal Attainment Scaling. Deductive content analysis was undertaken, aided by a pre-specified matrix (physical health; psychological health; function; planning; social engagement). Descriptive statistics assessed the relationships between goals and participant characteristics.

Results

The 224 participants (mean age 77 [±6.7]; 56% male; 84% white/European; median FI 0.39 [IQR: 0.33–0.47]) set 408 goals in the categories of function, physical health, social engagement and leisure, psychological health, and future readiness. Most participants set one or two goals (n = 183, 82%). They were most frequently set in the function (n = 172, 42%), physical health (n = 86, 21%), and social engagement and leisure (n = 79, 19%) domains. The number and nature of the set goals were similar across participant frailty status, quality of life (EQ-5D-5L) scores, and CKD stage.

Conclusion

Frail older adults with CKD most frequently focus their goals on function, physical health, social engagement, and leisure. These goals did not vary by participants' frailty status or CKD stage. This study's findings can guide healthcare professionals in ensuring management plans consider these identified priorities. Geriatricians may have a role in managing this population, given the commonality of these goals with those of older people more generally.

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老年慢性肾病患者的目标：一项混合方法研究

背景：患有慢性肾脏疾病（CKD）的虚弱老年人有复杂的护理需求，他们的优先事项可能与医疗保健提供者所假设的不同。了解他们的目标对于提供以人为本的护理至关重要。本研究旨在确定和分类这一人群的目标，并确定与参与者的虚弱状态、生活质量和CKD阶段的任何关联。方法：我们报告了患有中重度CKD的体弱老年人作为GOAL试验的参与者，这是一项评估综合老年评估有效性的集群随机对照试验。本研究采用混合方法，利用三角测量设计和数据转换模型。参与者通过目标实现量表设定目标。在预先指定的矩阵(身体健康；心理健康;函数;规划;社会交往)。描述性统计评估了目标与参与者特征之间的关系。结果：224名参与者(平均年龄77[±6.7]；男性56%;84%的白人/欧洲;中位数FI为0.39 [IQR: 0.33-0.47])，在功能、身体健康、社会参与和休闲、心理健康和未来准备等方面设定了408个目标。大多数参与者设定了一个或两个目标（n = 183, 82%）。它们最常被设置在功能（n = 172, 42%）、身体健康（n = 86, 21%）和社会参与和休闲（n = 79, 19%）领域。设定目标的数量和性质在参与者的虚弱状态、生活质量（EQ-5D-5L）评分和CKD分期中是相似的。结论：患有慢性肾病的虚弱老年人最常将他们的目标集中在功能、身体健康、社会参与和休闲上。这些目标不因参与者的虚弱状态或CKD分期而变化。本研究的发现可以指导医疗保健专业人员确保管理计划考虑这些确定的优先事项。鉴于这些目标与更普遍的老年人的目标具有共性，老年病学专家可能在管理这一人群方面发挥作用。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.

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