Development of a Palliative Care Model for the Elderly with End Stage Renal Disease in LOEI Hospital

Abstract

This research and development aimed to develop a model for delivering palliative care to the elderly with end-stage renal disease without receiving appropriate kidney replacement therapy within the network of Loei province and evaluate the effectiveness of the model. The samples were 43 elderly patients with end-stage renal disease in LOEI Hospital. The research instruments consisted of a questionnaire of personal characteristics and the outcome assessment form for palliative care in elderly patients with end-stage renal disease, and the Quality of Life questionnaire for Chronic Kidney Disease. We collected data from April 2022 to May 2023. The statistics used for data analysis included frequency, percentage, mean, standard deviation, median, maximum, minimum, and Wilcoxon signed rank Test.          

Result for the model of care for the elderly with end-stage renal disease, the appropriateness of treatment options was discussed among patients, doctors, and the treatment team. The topics included the pros and cons of various treatment methods based on clinical symptoms, age, severity, comorbidities of the patient, social and caregiver factors, and the methods of care throughout the course of illness until death. The research result revealed that elderly patients with end-stage renal disease in LOEI Hospital had a median of age (yrs)=72 (Max-Min=62-90) and a median of renal function (eGFR)=8.92 (Max-Min=15.71-1.60). There was a statistically significant reduction in the mean score of disturbance at 0.05. The difference between test results, the mean scores, and quality of life outcomes increased statistically significantly (p<0.05).

Recommendations for the care model for the elderly with end-stage renal disease considered accepting the patient into palliative care. Patients and relatives should be discussed with a Nephrologist and nurse specialist in kidney disease for information about each treatment option. Each has advantages, disadvantages, and details. The information should include disease conditions, prognosis, survival time, benefits, risks, and quality of life that will be received in each option throughout the course of the disease. Several aspects need to be taken into consideration including age, co-morbidities, prognosis, as well as social and contextual factors involved. The model of palliative care for the elderly with end-stage renal disease has resulted in a good quality of life for patients, reducing complications and suffering from disease, and providing personalized care to each patient.