Relationships Between Aging Attitudes and Successful Aging Outcomes in Middle-age and Older Women.

OBJECTIVES: This study aimed to explore the relationships between aging attitudes and the outcomes of successful aging, including whether aging attitudinal types moderate psychological adjustment in the context of medical and mental health diagnoses. METHODS: In total, 409 community-dwelling women aged 40-79 years in Australia completed the Reactions to Aging Questionnaire (RAQ), Geriatric Depression Scale, Center of Epidemiological Studies Depression Scale, and Geriatric Anxiety Inventory. Information about medical and mental health diagnoses were collected. RESULTS: Overall, aging attitudes and all three RAQ subscales were negatively correlated with scores on measures of depression and anxiety, and number of medical diagnoses. Attitudinal types toward aging were found to moderate the relationship between the number of mental health diagnoses and scores on the psychological measures of depression but not anxiety. Unique RAQ domain-specific relationships were found with the number of mental health diagnoses. CONCLUSIONS: The findings support the link between aging attitudes and psychological outcomes, the potential clinical value of RAQ attitudinal typologies classification as well as a multidimensional conceptualization of aging attitudes. CLINICAL IMPLICATIONS: The findings reinforce the need for efforts to reduce ageism on a societal level, as well as informing clinical decision-making with older clients.

Treatment-related decisional conflict in pre-dialysis chronic kidney disease patients in Singapore: Prevalence and determinants.

BACKGROUND: In advanced chronic kidney disease (CKD), patients face complex decisions related to renal replacement modality that can cause decisional conflict and delay. This study aimed to evaluate the prevalence of severe decisional conflict across decision types and to identify the psychosocial and clinical factors associated with decisional conflict in this population. DESIGN: Observational cross-sectional study. METHODS: Patients with CKD in renal care were recruited. The Decisional Conflict Scale (DCS), Functional, Communicative, and Critical Health Literacy (FCCHL), Health Literacy Questionnaire (HLQ), Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (BIPQ), and the Kidney-disease Quality of Life (KDQOL) questionnaires were used. Clinical data were obtained from medical records. Bivariate and multivariable logistic regression models were used to identify predictors of severe decisional conflict (DCS score ≥ 37.5). RESULTS: Participants (N = 190; response rate = 56.7%; mean age = 62.8 ± 10.8) reported moderate levels of decisional conflict (29.7 ± 14.5). The overall prevalence of severe decisional conflict was 27.5% (n = 46) with no significant differences across decision types (dialysis, modality, access). Ethnicity (Chinese), marital status (married), BIPQ treatment control, coherence, KDQOL staff encouragement, and all health literacy domains, except functional health literacy, were significant predictors of decisional conflict in the unadjusted models. In the multivariable model, only the health literacy domains of FCCHL Communicative, and HLQ Active Engagement remained significant. CONCLUSION: Even after pre-dialysis education, many CKD patients in this study still report severe decisional conflict, with rates remaining substantial across decision junctures. The associations of decisional conflict and health literacy skills related to communication and engagement with healthcare providers indicate that more collaborative and patient-centric pre-dialysis programs may support patient activation and resolve decisional conflict.

Psychosocial Factors, Intentions to Pursue Arteriovenous Dialysis Access, and Access Outcomes: A Cohort Study.

RATIONALE & OBJECTIVE: Suboptimal dialysis preparation of patients with chronic kidney disease (CKD) is common, but little is known about its relationship to psychosocial factors. This study aimed to assess patients' attitudes about access creation and to identify factors associated with patients' intentions regarding dialysis access creation and outcomes. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 190 patients with stage 4/5 CKD not receiving dialysis treated at 2 hospitals in Singapore and 128 of their family members. PREDICTORS: Self-reported measures of illness perception, health-related quality of life, and attitudes toward access creation. Sociodemographic and clinical measures were also obtained. OUTCOME: Intention to create an arteriovenous fistula (AVF; ie, proceed with access vs wait and see) and time to creation of a functional AVF. ANALYTICAL APPROACH: Exploratory factor analysis (EFA) was undertaken to construct internally consistent subscales for a newly developed questionnaire about attitudes toward access creation. Logistic regression and cause-specific hazards models were conducted to identify psychosocial factors associated with patients' access creation intentions and access outcomes, respectively. RESULTS: EFA (explained 50.1% variance) revealed 4 domains: access and dialysis concerns, need for dialysis, worry about cost, and value of access. A high risk of intention to delay access creation (51.1%) was found among patients despite early referral and education. Multivariable analysis (R2=0.45) showed that the intention to proceed with access creation was associated with greater perceived value from access (odds ratio, 2.61; 95% CI, 1.46-4.65; P<0.001). LIMITATIONS: Limited generalization, as only those already receiving nephrology care were studied. CONCLUSIONS: Approximately half of the patients studied planned to delay access creation. The questionnaire developed to evaluate attitudes about access creation may help identify individuals for whom decision-support programs would be useful. These findings highlight the need to understand and address patients' concerns about access creation.

Patient-Related Barriers to Timely Dialysis Access Preparation: A Qualitative Study of the Perspectives of Patients, Family Members, and Health Care Providers.

RATIONAL & OBJECTIVE: A key aspect of smooth transition to dialysis is the timely creation of a permanent access. Despite early referral to kidney care, initiation onto dialysis is still suboptimal for many patients, which has clinical and cost implications. This study aimed to explore perspectives of various stakeholders on barriers to timely access creation. STUDY DESIGN: Qualitative study. SETTING & PARTICIPANTS: Semi-structured interviews with 96 participants (response rate, 67%), including patients with stage 4 chronic kidney disease (n = 30), new hemodialysis patients with (n = 18) and without (n = 20) permanent access (arteriovenous fistula), family members (n = 19), and kidney health care providers (n = 9). ANALYTICAL APPROACH: Thematic analysis. RESULTS: Patients reported differential levels of behavioral activation toward access creation: avoidance/denial, wait and see, or active intention. 6 core themes were identified: (1) lack of symptoms, (2) dialysis fears and practical concerns (exaggerated fear, pain, cost, lifestyle disruptions, work-related concerns, burdening their families), (3) evaluating value against costs/risks of access creation (benefits, threat of operation, viability, prompt for early initiation), (4) preference for alternatives, (5) social influences (hearsay, family involvement, experiences of others), and (6) health care provider interactions (mistrust, interpersonal tension, lack of clarity in information). Themes were common to all groups, whereas nuanced perspectives of family members and health care providers were noted in some subthemes. LIMITATIONS: Response bias. CONCLUSIONS: Individual, interpersonal, and psychosocial factors compromise dialysis preparation and contribute to suboptimal dialysis initiation. Our findings support the need for interventions to improve patient and family engagement and address emotional concerns and misperceptions about preparing for dialysis.

Effectiveness of a day care program in supporting patients on peritoneal dialysis and their caregivers.

PURPOSE: Physical inactivity and social isolation are major problems faced by peritoneal dialysis (PD) patients. Respite care is also an unmet need for their caregivers. The study aimed to evaluate the benefits of day care service for PD patients. METHOD: Khoo Teck Puat Hospital collaborated with St Luke's Eldercare (SLEC) to provide day care services for PD patients. The day care provided assistance with two PD exchanges and activities for patients to maintain health and improve social interaction. Outcome indicators included: (1) enrollment status, length of stay and peritonitis rate; (2) quality of life and mental status evaluations on patients and caregivers with the 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale and Zarit Burden Interview Short-Form 12; and (3) qualitative data collected via interviews with patients, caregivers, healthcare providers and SLEC staff. RESULTS: Sixty-four patients were referred, and 16 eventually participated. Mean age of participants was 67.2 (range 54-85) years. For patients who stayed >1 month (n = 9), length of stay was 205.0 days (58-428) and frequency of attendance was 2.9 (0.6-4.8) times/week. There were no peritonitis episodes while patients were in the program. Mental improvement was noticed for most patients and caregivers, but physical improvement was less obvious. Caregivers also felt less burden. CONCLUSIONS: Day care service is effective in alleviating the burden of caregivers and beneficial to patients with relatively good functional status. However, persuading patients and their caregivers to take up the program was a challenge.