The impact of in-centre haemodialysis treatment on the everyday life of older adults with end-stage kidney disease: a qualitative study

Lay Summary For older adults (>= 65 years) with end-stage kidney disease (ESKD), beginning haemodialysis (HD) treatment can significantly impact their daily life and activities. For older adults living at home, this impact can lead to premature relocation to a nursing home and death. There is limited information on how older adults living at home adapt to these changes. With this study, we aimed to explore how in-centre HD affects daily activity and to identify potential areas of support. We interviewed 20 older adults (12 females) and found that they had experienced a gradual decline in activity since starting dialysis that appeared to first affect their most personally meaningful activities. To better support the physical activity levels and coping abilities of older adults with ESKD, it may be beneficial to identify and support these meaningful activities early on and consistently throughout their lives. Background Older adults with end-stage kidney disease experience a diminished ability to perform the activities of their daily life. For those living at home, the initiation of in-centre haemodialysis treatment (ICHD) carries a risk of cascading functional decline leading to early nursing home placement and mortality. Research on how older adults adapt to their newly impacted daily life is scarce. Methods Individual semi-structured interviews were conducted using a purposeful maximum variation sample of older adult (>= 65 years) ICHD patients living at home. Interviews were conducted between October and December 2018. Interview coding followed an inductive and broad-based approach. Thematic analysis was used to group meaning units into common themes and subthemes. Results Twenty patients (12 females) were interviewed. Analysis resulted in two main themes and seven subthemes. The first main theme showed the impact of ICHD on everyday roles and functioning through four subthemes: a stepwise decline in daily activities, managing time, role changes and an incomplete retirement. The second main theme showed potential areas of remediation through three subthemes: the social environment, developing new daily activity patterns and meaningful activities and goals. Conclusions The older adults experienced a process of adaptation that generally progressed from a phase of initial disruption towards a period of mere survival. Being able to accept a life on dialysis was intricately connected with the ability to perform activities that were personally meaningful. Early and continued support of meaningful activities may prove valuable in breaking or delaying the cycle of functional decline.