Abstract: FR-PO924
Improving Physical Function and Social Networks of Older Adults with ESRD: Development and Testing of Seniors Optimizing Community Integration to Advance Better Living with ESRD (SOCIABLE)
Session Information
- Geriatric Nephrology
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Geriatric Nephrology
- 901 Geriatric Nephrology
Authors
- Crews, Deidra C., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Delaney, Alice M, University of Maryland, Essex, Maryland, United States
- Walker, Janiece L, Johns Hopkins School of Nursing, Baltimore, Maryland, United States
- Cudjoe, Thomas Km, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
- Evelyn-Gustave, Allyson, Johns Hopkins University, Baltimore, Maryland, United States
- Roth, Jill, Johns hopkins School of Nursing, Baltimore, Maryland, United States
- Roth, David L, Johns Hopkins University , Baltimore, Maryland, United States
- Szanton, Sarah, Johns Hopkins University, Baltimore, Maryland, United States
Background
Older adults with ESRD have increased morbidity, life constraining fatigue and decreased physical function. These conditions can inhibit self-care and social engagement while restricting ability to leave home. We developed a home-based program to improve physical and social functioning of low income, older adults on hemodialysis (HD).
Methods
We 1) identified daily functional needs and home environmental barriers to engaging social networks among low income older patients on HD through focus groups (n=7 patients); 2) mapped focus group findings onto aspects of an established program for low income older adults with physical limitations (which includes home visits with an occupational therapist, nurse and handyman to provide ≦$1300 worth of repairs, modifications and devices) tailoring the newly developed program (SOCIABLE) to the needs of HD patients; and 3) piloted the program among 12 patients. We used a randomized wait list design to deliver the services in a staggered fashion that allowed a control comparison.
Results
Focus group themes included those in the Table. We adapted the original program using these themes to produce SOCIABLE, which we tested. All participants were African American (50% male), mean age was 68 (SD= 5.9). From baseline to 6 month follow up, participants improved on average from 2.3 in Activities of Daily Living (ADL) difficulties (scale of 8) and improved 2.5 (scale of 8) Instrumental ADL difficulties. Participants’ mean social network scores increased from 18.4 to 23.1 (out of a possible 40). Satisfaction with social support improved less.
Conclusion
Our results show that it is possible to improve physical and social function of low income older adults with ESRD via a home based intervention. As people with ESRD have low quality of life and account for substantial costs to the U.S. health system ($33 Billion), it is important to better understand how to improve life and decrease costs for this population with a full-scale efficacy trial.
Representative Focus Group Quotes
| Theme | Quote |
| Desire to live Independently | In reference to Nursing Home: "Where you have no independence. It’s, you’re at their beck and call for everything. Even when you don’t want to eat, for an example, you’re stuck." |
| Fatigue | "So after dialysis I am, I feel like I’m not tired until I actually leave. That’s when it starts... That’s my main thing, I have to rest." |
| Lack of Social Support | "They kind of like, they distance themselves, and they do it, they try to do it in different ways. And I can tell, because you don’t hear from them as often as you did at first." |
Funding
- Other NIH Support