Older adult kidney disease self-management behaviors and their relationship to depression, self-efficacy, illness perceptions, and social support

One-half of older adults live with two or more chronic conditions, and this number will increase over the next two decades. Among the conditions affecting older adults is chronic kidney disease, characterized by a gradual decline in kidney functioning. It is estimated that up to 26 million people live with chronic kidney disease, many of who are unaware that they have the condition. This dissertation focuses end-stage renal disease (ESRD), the irreversible stage of chronic kidney disease in which life-sustaining renal replacement therapy is required. Older adults living with ESRD experience significant physical and psychosocial life changes. Self-management can lessen the burden of ESRD, yet the self-management behaviors in this population are not well-understood. To address this knowledge gap, the three studies comprising this dissertation identify the self-management behaviors performed by older ESRD patients (study one); clarify potential mediators of depression, (the most prevalent mental health issue in ESRD patients) and fluid adherence, an important self-management behavior (study two); as well as the relationship of social support to self-management, and examine the psychometric properties of a social support measure (study three). A total of 107 hemodialysis patients aged 50 and older were interviewed from four North Carolina hemodialysis facilities. In study one, age was significantly associated with self-management, and older adults were engaging in more self-management behaviors than they actually reported in open-ended questioning. In study two, depression and age were significantly associated with fluid adherence, and when self-efficacy was added to the model, the negative association between depression and fluid adherence was no longer significant. Finally, in study three, social support was associated with four self-management behaviors (i.e., advance directive status, cognitive symptom management, communication with physicians, and weekly exercise). Also, the Lubben Social Network Scale was found to be a reliable measure of social support. Taken together, the studies provide an understanding about the self-management of older ESRD patients and a foundation for self-management intervention research with the older ESRD population to include self-efficacy training and engagement with social networks.