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Abstract: PO1688

Mobility in Older Hemodialysis Patients: A Mixed Methods Study

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Liu, Christine, Boston University, Boston, Massachusetts, United States
  • Seo, Janet J., Mount Sinai Health System, New York, New York, United States
  • Wright, Kristen A., Boston University, Boston, Massachusetts, United States
  • Lee, Dayeun, Boston University, Boston, Massachusetts, United States
  • Moye, Jennifer, VA Boston Health Care System Boston Vet Center, Boston, Massachusetts, United States
  • Bean, Jonathan, VA Boston Health Care System Boston Vet Center, Boston, Massachusetts, United States
  • Weiner, Daniel E., Tufts University, Medford, Massachusetts, United States
Background

Mobility, or the ability to move reliably and safely, impacts quality of life and predicts future disability and mortality. This is especially relevant for older adults, who comprise a large part of the hemodialysis (HD) population. For older hemodialysis patients, factors that limit mobility and which specific components of mobility are involved are not well-defined. Using a mixed methods approach, we investigated these factors and components in older HD patients.

Methods

Eligibility criteria were age ≥60 years and receipt of maintenance HD. Participants had a single in-person assessment that occurred in their home when feasible. We administered the Short Physical Performance Battery (SPPB) to assess balance, walking speed, and lower leg strength (range 0-12 for full SPPB, range 0-4 for individual domains). We conducted semi-structured key informant interviews, using an interview guide based on the literature. Interview transcripts were descriptively coded and major themes were extracted using both deductive and inductive approaches.

Results

A total of 31 persons enrolled, with a mean age of 72.5±8.1(S.D.) years and mean vintage of 4.6±3.5 years; 42% were female and 68% African-American. Mean overall SPPB was 4.4±2.3 points; mean scores for balance, walking and lower leg strength were 2.3±1.1, 1.8±1, and 1.3±0.7 points, respectively. Mean gait speed was 0.46±0.22 meters/second. Coding inter-rater reliability > 0.8. Three major themes emerged: 1) losses in balance and walking are the most debilitating, 2) fluctuations in mobility are frequent, and 3) post-HD procedure fatigue and the presence of amputations limit mobility (Table).

Conclusion

In a diverse sample of older HD patients, mobility is significantly limited with multiple domains affected. Patients identified balance and walking as the most problematic, and cope with frequent changes in mobility. Future studies should focus on improving balance and walking, and include strategies to mitigate fluctuations in mobility.

Key themes regarding mobility in older hemodialys patients
ThemeQuote
Specific domains of mobility that are limited: balance and walking"Oh, give me more balance so my back don’t hurt when I try to walk around.”
-Female, age in 70s
Frequent changes in mobility"I get off the machine, crawl around the corner to the car. 'Cause I have my good days and my bad days on dialysis… It seems like it's miles and miles and miles down the road when it's only right around the corner."
-Male, age in 60s
Impact of post-HD procedure fatigue on mobility"'Cause you're on dialysis three days a week for hours, and then you're tired when you come home…After I came on, my walking got considerably worse. That's why I had to go to the walker. I'm hoping that's where it ends at."
-Female, age in 70s

Funding

  • Other NIH Support