The feasibility of integrating a home telehealth model for older persons living with hemodialysis.

BACKGROUND: In Thailand, there is a rapidly increasing population of older persons living with hemodialysis (OPLWH) for whom quality of life and clinical outcomes are their main focus. This study aims to assess the feasibility of an integrated home telehealth model on quality of life and laboratory parameters of OPLWH. METHODS: In this study, the second phase of a mixed methods exploratory sequential design was conducted using a repeated measures experimental design. Participants met the inclusion criteria, which included being an OPLWH at a single hemodialysis center of one hospital in Chiang Mai province, Thailand, during the experimental period between 1 April and 30 September 2018, and willing to participate in the study. The 54 participants were purposively selected and randomly assigned to receive either an intervention (n = 24) consisting of health education and health monitoring using a telehealth device (an iPad) and a web application, or usual care (n = 30). The instruments included a demographic data form, which was analyzed using the chi-square test. The health-related quality of life questionnaire (the 9-item Thai Health Status Assessment questionnaire) and blood chemistry (BUN, Cr, Hb, Hct, Alb, K, Kt/V, and nPCR) were compared and measured at baseline, and at 3 and 6 months after enrolment using independent t-test and one-way repeated measures ANOVA. RESULTS: The comparison of quality of life between the two groups at the two points of repeated measurement (after 3 months) showed a statistically significant difference in mental health scores at P < 0.05. Six months after the intervention, mean scores for health outcomes and patients' quality of life improved; however, this change did not reach statistical significance. CONCLUSIONS: An integrated home telehealth model implemented by a hemodialysis nurse is a feasible holistic care approach for OPLWH. However, the absence of statistical significance may partly be associated with the clinical characteristics of frailty and risk factors such as increased age, hypertension, diabetes, heart disease, longer dialysis time, and inadequacy of Kt/V. Large-scale multi-centre trials are warranted to fully examine the acceptability of the model. The duration and long-term effects of the telehealth model are also recommended for further investigation. PATIENT OR PUBLIC CONTRIBUTION: The development of a home telehealth model was a collaborative process between patients, caregivers, healthcare professionals from the hemodialysis unit, and the research team.

Effectiveness of a self-management retraining program improving the quality of life of people receiving continuous ambulatory peritoneal dialysis.

People receiving continuous ambulatory peritoneal dialysis (CAPD) are often faced with technical difficulties while performing self-dialysis, which can compromise outcomes and health-related quality of life. This mixed-methods exploratory sequential study aims to implement a repeated-measures experimental design to assess the effectiveness of a self-management retraining program. The sample consisted of 41 participants living with chronic kidney disease aged 20 to 80 years who were receiving CAPD. Participants were purposively selected and randomized into experimental and control groups. The experimental group received the self-management retraining program. The control group received standard care. We compared health-related quality of life, self-management behavior, and perceived self-management self-efficacy levels at baseline and 3 and 6 months after enrollment. Participants demonstrated statistically significant increases in self-management behavior (medical adherence) and mental health status. Perceived self-efficacy in self-management was improved; however, this change did not reach statistical significance. We conclude that an self-management retraining program can improve self-management, self-efficacy behaviors, and health-related quality of life in persons receiving CAPD.

Experiences and needs of older people with end stage renal disease: bereaved carers perspective.

BACKGROUND: There is a growing population of older patients with End Stage Renal Disease (ESRD) managed without dialysis in Thailand, and services have yet to be developed to specifically respond to the needs of this group. As a consequence this population are likely to have unmet needs with respect to health care and suffer from symptoms that could be better managed. OBJECTIVE: This qualitative study explored experiences and health care needs during the last year of life among older people with ESRD, managed without dialysis, from the perspective of bereaved carers. METHODS: A retrospective post-bereavement approach was adopted to collect qualitative interview data. Purposive sampling was used to select 12 bereaved relatives of older patients with ESRD, managed without dialysis, who had died in the previous 5-10 months. Semi-structured interviews were conducted. Data were digitally recorded, transcribed and analysed through framework analysis. RESULTS: Four main themes were identified: symptom experiences, impacts of being managed without dialysis, symptom management, and health care needs and utilisation of services. CONCLUSIONS: Findings confirmed patients' needs were not being met and identified the need to develop approaches to symptom management at home, health education, and psychological and spiritual support at the end of life.

The Effectiveness of an Information-Motivation Behavioral Skill Health Promotion Video on Health Status Among Chiang Mai University Personnel During the COVID-19 Pandemic.

PURPOSE: The purpose of this research was to study the effectiveness of the IMB Educational Health Promotion (IMBEHP) video for improving quality of life, health risk awareness, and health promotion among Chiang Mai University (CMU) personnel. METHODS: This research was a quasi-experimental study with a 1-group pre-posttest design. The sample group included 528 CMU personnel who worked at the university between June 2020 and December 2021. Data collection was conducted before and after participants watched the IMB health promotion video. RESULTS: After watching the video, the participants' quality of life scores were at a medium level. Moreover, physical health, mental health, social relations, and total quality of life score measures showed statistically significant differences between before and after viewing, at P < .05. The mean total for quality of life increased from the prior intervention implementation. Understanding of health risks also increased after watching the video, and the levels of health risk increased as follows: low level of health risk increased to 343 (64.96%), followed by medium and high health risk, at 21.78% (n = 115) and 10.04% (n = 53), respectively. Lastly, awareness about nutrition was statistically significant at .05. CONCLUSIONS: The results of this study demonstrate the efficacy of video in educating, motivating, and developing health-promoting skills among this population. After watching the video, CMU personnel increased their awareness of chronic disease risk factors, health promotion practice, illnesses prevention, healthy behaviors, and improvement of quality of life.

Experiences of symptoms and health service preferences among older people living with chronic diseases during the last year of life.

BACKGROUND:: There is limited understanding of the symptoms that older people living with cancer, chronic obstructive pulmonary disease and chronic kidney disease experience during the last year of life in Thailand, in addition to their health service preferences. AIMS:: To survey the symptom experiences and health service preferences at the end of life of older people with chronic illnesses from the perspective of bereaved carers. METHODS:: The study used a retrospective post-bereavement approach to collect quantitative data. Purposive sampling was used to select 76 bereaved relatives of older people living with chronic illnesses who had died in the previous 5 to10 months. Telephone interviews and a translated version of the Views of Informal Carers-Evaluation Services (VOICES) questionnaire were conducted. Data were analysed using the statistical package SPSS version 17. FINDINGS:: The overall quality of care received by older people living with chronic diseases during the last three months of life was described as 'good' (36%). However, in comparing the quality of care from different settings, most of the subjects (63%) thought that the quality of care at home should be rated as 'poor'. During the last twelve months, 35% of the respondents rated pain and poor appetite as the main symptoms, while 25% described experiencing 'worry' related to being at the end of life. The severity of many symptoms increased during the last three months of life; 21% of carers recommended that pain caused the most suffering to their relatives at 'all times', when compared with other symptoms of end of life. Around 21-35% reported that their relatives 'sometimes' experienced worry, low mood, breathlessness and oedema. During the last three days of life, it was reported by 97% of respondents that their relatives spent all of their time in hospital, and no respondents reported that their relatives had died at home. CONCLUSION:: The study indicates that older people living with chronic diseases in Thailand are less likely to access specialist palliative care and are more likely to have poor symptom control at the end of life. It indicates that health services may not be meeting patients' needs and that there was clearly insufficient healthcare provision at home for older people to help them to manage their symptoms such as pain and breathlessness.

Embedding Palliative Care Into Healthy Aging: A Narrative Case Study From Thailand.

This article provides a conceptual framework for understanding the relationship between palliative care and healthy aging using a narrative case study from Thailand. The Thai context is used to clarify two concepts: healthy aging and good death. This case study describes a Thai female older adult's perspective and her drive to stay physically, cognitively, and socially active for as long as possible-strong indicators of healthy aging until the end of life. Family support is a vital part of helping older adults stay active and achieve a good death. The Thai healthy aging model explains a lifelong process of how to be a healthy ager in the Thai context. The model is closely related to a palliative care philosophy, which focuses on dying without unnecessary suffering and promotes closeness to family. This model supports the inclusion of palliative care in healthy aging strategies to maximize quality of life and well-being, particularly in older adults experiencing multimorbidity and health inequalities. Improved healthy aging is integrally related to the provision of high-quality palliative care. The earlier systems and providers can promote healthy aging across contexts, the more effectively interventions can be targeted to encourage and improve the experience of care at the end of life.