Self-care Behavior and Physical Factors in Elderly Hemodialysis Patients

Transcription

1 Vol.128 (Healthcare and Nursing 2016), pp Self-care Behavior and Physical Factors in Elderly Hemodialysis Patients Su-Jeong Han 1, Hye-Won Kim 2 1 first author Department of Nursing, Konyang University, Daejeon, Korea, sjhan@konyang.ac.kr 2 corresponding author Seoul Women s College of Nursing, Seoul, Korea, hwkim@snjc.ac.kr Abstract. This study was performed to identify the dependence and related physical factors of the elderly on HD patients. The subjects for this study were 113 elderly patients on HD who visited in a tertiary hospital in Seoul between November 5 th and 30 th, 2012, and consented to participate in the study. The collected data were analyzed by the SPSS WIN 15.0 program. The mean score of self-care behavior was The self care activities scoring the highest was taking care of arteriovenous fistula, followed by taking medication. Engaging in social activities was lowest and diet control was. There were significantly negative correlations between self-care behaviors and serum phosphorus, and potassium concentration. It is considered that dialysis provider care to recognize self-care behavior as an important nursing issue for elderly on HD. It is also necessary to develop a nursing intervention for improving their self-care behavior. Keywords: self-care behavior, elderly, physical factors 1 Introduction Patients over the age of 75 have higher incidence rates of end-stage renal disease (ESRD) than younger patients and constitute the fastest growing segment of the ESRD population worldwide [1]. The burgeoning incidence of older dialysis patients has been demonstrated in recent data from the ERA-EDTA registry [2]. Up to onethird of elderly patients with ESRD have four or more chronic health conditions when they reach ESRD, and many are not considered candidates for kidney transplantation. Thus, the vast majority of elderly patients with ESRD face the prospect of dialysis therapy for the remainder of their lives. ESRD is an irreversible loss of kidney function to the point that the kidneys fail to support life. Hemodialysis is an expensive and time consuming procedure that requires patients to follow a strict treatment schedule and fluid and dietary restrictions so it accompanies wide range of life style changes [3][4]. Additionally, these patients encounter many physical and psychosocial stresses including hypertension, lack of appetite, anemia, sexual disorders, reduced or loss of financial income, social isolation, loss of sense of security, dependence on caregivers, etc [5][6]. Older hemodialysis patients with many physical and psychosocial stresses that negatively affect their quality of life. There is growing recognition that self-care in chronically ill ISSN: ASTL Copyright 2016 SERSC

2 patient is associated with improvement of quality of life [7]. Self-care is associated with several advantages, it improves coping with or adjustment to illness, increases sense of wellbeing, improves symptom control, decreases risk of complication, increases control and autonomy, increases functioning and finally enhances quality of life [8]. The purpose of this study was to measure the self-care behavior in older dialysis patients and to identify physical factors that are associated with self-care behavior. 2 Methods 2.1 Subjects and data collection The subjects for this study were 113 elderly patients on HD who visited in a tertiary hospital in Seoul between November 5 th and 30 th, 2012, and consented to participate in the study. Those who agreed to answer and participate were given the questionnaire. Data collected using face-to-face interview with a structured questionnaire. It took minutes to complete the questionnaire. An Electronic Medical Record(EMR) was referred to regarding Age, cause of ESRD, Number of medications, comorbidities, serum phosphorus and potassium concentration, and mean weight gains between dialysis sessions. 2.2 Instruments Self-care behavior To measure the levels of self-care behavior, the tool, which was first invented by Song Mi-Ryeong (1999) and then modified by Cho Mi-Kyoung (2008), was used. It consists of 35 questions with the 5- point Likert scale. There are 7 subscales of medication (2 items), fistula management (6 items), management of physical problems (11 items), diet (6 items), exercise and rest (4 items), management of bloody pressure and body weight (3 items), and social adjustment (3 items). The score of self-care behavior is distributed with points and higher scores means high performance of the self-care Physical factors Serum phosphorus and potassium concentration were measured at clinical laboratory and mean weight gains between dialysis sessions were measured in hemodialysis unit. Copyright 2016 SERSC 69

3 2.2.3 Other variables Gender, age, marital status, education level, cause of ESRD, Number of medications and comorbidities were determined from interview and EMR reviews. 2.3 Data anaylsis Collected data were statistically analyzed with SPSS WIN (ver. 15.0) program. Analysis included percentage, average, standard deviation, and Pearson s correlation coefficient. 2.4 Ethnical consideration Standard ethical can legal points were followed regarding the use of reporting subjects in research, salient, relative points were explained to all subjects. 3 Results 3.1 General characteristics of patients The general characteristics were presented in Table 1. Sixty-one percent of patients were male, with a mean age of 72.4 years. Diabetes and Hypertension were the most common causes of end stage renal disease (ESRD). Subjects had comorbidities conditions and were taking multiple medications. Table 1. General characteristics of patients Variables N=113 N(%) or Mean±SD Gender Male 69(61.1) Female 44(38.9) Age (years) 72.4±6.8 Marital status Single 20(17.7) Married 93(82.3) Years of education 11.0±4.4 Cause of ESRD Diabetes Hypertension Glomerulonephritis 60(53.1) 39(34.5) 4(12.4) Number of medication 10.2±3.8 Comorbidities 2.3±1.1 ESRD, end stage renal disease 70 Copyright 2016 SERSC

4 3.2 Self-care behavior The mean score of self-care behavior was 3.14<Table 2>. The self care activities scoring the highest was taking care of arteriovenous fistula, followed by taking medication. Engaging in social activities was lowest and diet control was. Table 2. Self-care behavior Categories medication fistula management management of physical problems diet exercise and rest management of bloody pressure and body weight social adjustment N=113 Mean±SD 3.86± ± ± ± ± ± ±.5 Total 3.14± Correlation between self-care behavior and physical factors There were significantly negative correlations self-care behaviors and serum phosphorus(r=-.27, p<.001), and potassium concentration(r=-.35, p<.001)<table 3>. Table 3. Correlation between dependence and physical function serum phosphorus potassium concentration interdialysis weight gain *p<.05 self-care behavior p <.001 * <.001 * Discussion This study was to measure the self-care behavior and physical factors in older hemodialysis patients and to identify physical factors that are associated with self-care behavior. We found that elderly on HD had low performance of the self-care. The self care activities scoring the highest was taking care of arteriovenous fistula, followed by taking medication. Engaging in social activities was lowest and diet control was. It is also self-care behavior and physical factors were identified to have significant relationship. Copyright 2016 SERSC 71

5 As a conclusion of these findings, it is considered that dialysis provider care to recognize self-care behavior as an important nursing issue for elderly on HD. And it is necessary to routinely identify those older HD patients at self-care behavior and to develop a nursing intervention for improving their quality of life. References 1. Collins AJ, Kasiske B, Herzog C, et al: Excerpts from the United States Renal Data System 2006 Annual Data Report. Am J Kidney Dis 49(1 Suppl 1):A6-A7. S1-296, (2007) 2. Kramer A, Stel V, Zoccali C, et al: An update on renal replacement therapy in Europe: ERA-EDTA Registry data from 1997 to Nephrol Dial Transplant 24: , (2009) 3. Moattari, M., Ebrahimi, M., Sharifi, N. and Rouzbeh, J.: The effect of empowerment on the self-efficacy, quality of life and clinical and laboratory indicators of patients treated with hemodialysis: A randomized controlled trial. Health and quality of life outcomes, 10, 115, (2012) 4. Qian, H. and Yuan, C.: Factors associated with self-care self-efficacy among gastric and colorectal cancer patients. Cancer nursing, 35, E22 E31, (2012) 5. Moshtagh, Z., Naeeni, K., Hamzezade, M. and Arasteh, A.: The effects of nutrition education on mental health of the hemodialysis patients in maragheh, east-azerbaijan, iran. Life Science Journal, 10, (2013) 6. Heidarzadeh, M., Atashpeikar, S. and Jalilazar, T.: Relationship between quality of life and self-care ability in patients receiving hemodialysis. Iranian journal of nursing and midwifery research, 15, 71, (2010) 7. Seto, E., Leonard, K. J., Cafazzo, J. A., Masino, C., Barnsley, J. and Ross, H. J.: Self-care and quality of life of heart failure patients at a multidisciplinary heart function clinic. Journal of Cardiovascular Nursing, 26, , (2011) 8. Reid C, Hall J, Boys J, Lewis S, Chang A: Self management of haemodialysis for End Stage Renal Disease: a systematic review. The Joanna Briggs Library of systematic Reviews 9(3):69 103, (2011) 72 Copyright 2016 SERSC