Mobility of older hemodialysis patients

老年血液透析患者的活动能力

基本信息

批准号：
10200622
负责人：
Christine K Liu
金额：
$ 18.73万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10200622
关键词：
Accelerometer Address Affect Anemia Anxiety Area Award Beck depression inventory Beds Boston Caregiver support Caregivers Caring Cessation of life Chronic Clinical Clinical Trials Cognition Cognitive Therapy Data Dialysis procedure Digit structure Elderly Environment Environmental Health Equipment and supply inventories Exercise Fatigue Future Geriatrics Goals Health Heart failure Hemodialysis Home Home environment Individual Intervention Interview Investigation Knowledge Light Measures Medical Care Costs Medicine Memory Mental Depression Mentored Patient-Oriented Research Career Development Award Mentors Methods Moderate Activity Nephrology Older Population Organizational Models Outcome Pain Patients Performance Personal Satisfaction Physical Performance Physiological Population Psychological Factors Psychological Impact Psychology Qualitative Methods Qualitative Research Quality Indicator Quality of life Rehabilitation therapy Research Research Personnel Research Training Risk Factors Role Schedule Self Efficacy Series Supervision Testing Time Training Travel Universities Visit Vulnerable Populations Walking World Health Organization base bean career cognitive testing cohort design disability experience improved improved mobility informant insight instrument modifiable risk multidisciplinary physical conditioning professor recruit secondary outcome skills targeted treatment therapy design tool

项目摘要

Dr. Liu is a geriatrician and Assistant Professor of Medicine at Boston University (BU) who studies older (≥65 years) hemodialysis (HD) patients, the biggest and fastest-growing segment of the HD population. Her long-term goal is to be an independent clinician investigator developing interventions to improve mobility in older HD patients. Mobility, the ability to move reliably and safely, signifies independence and is integral to self-worth. Almost 70% of HD patients have difficulty walking. HD patients with poor mobility are twice as likely to die or be hospitalized. Most importantly, poor mobility is cited by patients as a major contributor to poor quality of life. While risk factors for poor mobility has been studied in other older populations, such insights may not be applicable to older HD patients. Older HD patients have unique challenges, like frequent travel for HD treatment and routine post-HD fatigue,that make usual mobility treatments, such as supervised exercise, extremely difficult. To successfully address poor mobility in older HD patients, a treatment approach fitting their specific needs is required. The World Health Organization states that personal, environmental, and health factors impact mobility. But aside from physiologic health factors, there has not been a systematic investigation of what factors impact mobility in older HD patients. Caregiver support likely affects mobility. The home environment has a role. Cognition is very relevant; anxiety, depression, and self-efficacy likely also impact mobility. The knowledge gap about the potentially modifiable risk factors for poor mobility in older HD patients is impeding efforts to improve mobility and thus quality of life for this highly vulnerable population. Dr. Liu will investigate the relationship of caregiver support, the home environment, cognition, anxiety, depression, and self-efficacy with mobility in older HD patients, using a sequential mixed methods approach. First, in Aim 1, she will perform key informant interviews with 40 older HD patients and 28 of their caregivers in their homes to determine how caregiver support and the home environment influences mobility. Then she will recruit a cohort of 86 older HD patients to perform in-home assessments of 1) cognition, 2) anxiety, depression, and self-efficacy, and 3) mobility. In Aim 2, the cohort data will be used to determine how cognition affects mobility in older HD patients. In Aim 3, the cohort data will be used to determine how anxiety, depression, and self-efficacy impact mobility in older HD patients. After determining the most relevant factors associated with mobility, Dr. Liu will develop a multi-factorial intervention to improve mobility in older HD patients that she will test in an R-series application. This research is at the intersection of nephrology, geriatrics, and rehabilitation; Dr. Liu is one of only a few clinician investigators focusing in this area. Led by her Primary Co-mentors, Drs. Daniel Weiner and Jonathan Bean, Dr. Liu’s outstanding mentoring team is multi-disciplinary and cross-institutional, emblematic of the collaborative BU training environment. The proposed research and training will furnish Dr. Liu with the needed experience and skills to achieve independence as a clinician investigator dedicated to improving the mobility of older HD patients.

刘博士是波士顿大学 (BU) 的老年病学家和医学助理教授，研究老年人（≥65 年）血液透析（HD）患者是 HD 长期人群中规模最大且增长最快的部分。目标是成为一名独立的临床研究者，开发干预措施以改善老年 HD 的活动能力移动性，即可靠、安全移动的能力，意味着独立性，是自我价值不可或缺的一部分。近 70% 的 HD 患者有行走困难，活动能力差的 HD 患者死亡或死亡的可能性是其他患者的两倍。最重要的是，患者认为行动不便是导致生活质量差的主要原因。虽然已经在其他老年人群中研究了行动不便的风险因素，但这种见解可能并不适用。适用于老年 HD 患者老年 HD 患者面临独特的挑战，例如频繁出差接受 HD 治疗。以及日常的 HD 后疲劳，这使得常规的活动治疗（例如监督锻炼）变得极其困难。为了成功解决老年 HD 患者活动能力差的问题，需要一种适合其特定需求的治疗方法世界卫生组织指出，个人、环境和健康因素会影响流动性。但除了生理健康因素外，还没有系统调查哪些因素会影响老年 HD 患者的活动能力家庭环境可能会影响其活动能力。认知非常相关；焦虑、抑郁和自我效能感也可能影响流动性。关于老年 HD 患者活动能力差的潜在可改变危险因素正在阻碍改善的努力刘博士将调查这一高度弱势群体的流动性和生活质量之间的关系。照顾者支持、家庭环境、认知、焦虑、抑郁和行动能力的自我效能在老年 HD 患者中，使用顺序混合方法首先，在目标 1 中，她将执行关键信息提供。采访 40 名老年 HD 患者和 28 名其家中的护理人员，以确定护理人员如何提供支持然后，她将招募 86 名老年 HD 患者进行实验。家庭评估 1) 认知，2) 焦虑、抑郁和自我效能，以及 3) 行动能力。队列数据将用于确定认知如何影响老年 HD 患者的活动能力。在目标 3 中，队列数据。数据将用于确定焦虑、抑郁和自我效能如何影响老年 HD 患者的活动能力。在确定与流动性最相关的因素后，刘博士将制定一个多因素她将在 R 系列应用中测试该干预措施，以改善老年 HD 患者的活动能力。刘博士是肾病学、老年病学和康复学交叉领域的少数临床研究者之一；由她的主要合作导师 Daniel Weiner 博士和 Jonathan Bean 博士领导。优秀的导师团队是多学科、跨机构的，是协作BU的象征拟议的研究和培训将为刘博士提供所需的经验和知识。作为一名致力于改善老年 HD 患者活动能力的临床研究者，实现独立的技能。