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S 31 Plenary Session

Programme of the Session

Title: Renal care for an aging population

GS: Ann Bonner (Australia)
Options for older patients with chronic kidney disease

O 82
Involving patients and carers in research: shared decision-making in advanced kidney disease

Nicola Thomas (UK)
Karen Jenkins (UK)

O 83
One year of intradialytic physical exercise programme: results on functional capacity and body composition

Rui Camisa (Portugal)

O 84
Change of the age of patients between 1995-2015 and its effect on nursing care

Petr Radovič (Czech Republic)

O 85
How to maintain high quality of care when challenged by organisational changes?

Hanne Hermansen (Denmark)

 

Abstracts

GUEST SPEAKER
Options for older patients with chronic kidney disease

A. Bonner1, 2, 3
1School of Nursing, Queensland University of Technology, Brisbane, Australia; 2NHMRC Chronic Kidney Disease Centre of Research Excellence, University of Queensland, Brisbane, Australia; 3Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia

Background
Globally the prevalence of chronic kidney disease (CKD) is increasing, and it is associated with the ageing population in many developed and developing countries. At the same time, advances in health and medical technology has led to increased access for the general population to a variety of complex medical treatments not previously widely available. Renal replacement therapy is a treatment to sustain life in people with end stage kidney disease (ESKD), however for the older
individual who receives RRT, it can prove to be burdensome in terms of time, symptoms, and travel for treatment. There is growing evidence that suggests older patients are rarely informed about the various options about future health care. Frail older patients facing facing end of kidney life require access to a pathway of individualised care and treatment tailored to their needs. In its absence, patients are accessing high cost, high technological treatment options which can cause more suffering than provision of relief. RRT could be considered futile for some older patients. Cancer care, where symptom burden is
similar to ESKD, offers a model of seamless access to specialist palliative and supportive care however for older patients it is largely non-existent or at best on an ad hoc basis. Drawing from current research, various options for older patients will be examined within the context of multidisciplinary care teams.

BIOGRAPHY OF THE GUEST SPEAKER

O 82
Involving patients and carers in research: shared decision-making in advanced kidney disease

N. Thomas1, K. Jenkins2, J. Kent2, B. Murray2, R. Endacott3, S. Datta3, R. Moodley3, B. Gracey3, B. McManus3
1London South Bank University, London, United Kingdom; 2East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom; 3Barts Health, London, United Kingdom

Background
A systematic review (Moustakos et al 2012) made recommendations for further research in the area of shared decison-making in advanced CKD.

Objectives
The aim of this qualitative study was a) to involve patients and carers in the research process and b) to understand the experiences of shared decision-making in older people (over 70 years) in two hospitals. Patients and carers were involved in all aspects of the research process: writing the research proposal, developing interview questions, undertaking interviews and being involved in data analysis and dissemination of the findings.

Methods
The study team set up a Patient and Carer Group with six participants who co-led the project with the three researchers. The Group developed the interview questions and then undertook the interviews, lasting 10-45 minutes, with 28 people who had commenced dialysis, or had made a decision not to have dialysis, within the past six months. Interview data were then transcribed and analysed using thematic analysis.

Results
The majority of patients were satisfied with the amount of information that they had been given although some identified that the quality of the information could be improved i.e. more explanation of how daily living can be affected by dialysis. The importance of families in the decision-making process was identified. Many patients still wanted the doctor to decide what would be best for them.

Conclusion/Application to practice
Our study is innovative because patients/carers have been involved throughout. It is important to deliver patient information in different ways for older people to enable this age group to better understand the concept of shared decision making.

BIOGRAPHY OF THE SPEAKER

O 83
One year of intradialytic physical exercise programme: results on functional capacity and body composition

R. Camisa1, P. Martins1, M. Agostinho1, N. Gomes1, M. Marques1, A. Seabra1, J. Fazendeiro Matos2,
M. T. Parisotto3
1NephroCare Coimbra, Fresenius Medical Care, Coimbra, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Porto, Portugal; 3Care Value Management EMEA, Fresenius Medical Care, Bad Homburg, Germany

Background
Haemodialysis causes catabolism, sedentary lifestyle and immobility, all affecting body composition and functional capacity. Muscle catabolism is a predictor of mortality of haemodialysis patients.
There are many studies showing the benefits of physical exercise programmes in this population.

Objectives
To assess the influence of an intradialytic exercise programme on functional capacity and body composition.

Methods
We developed a randomised controlled trial with 40 patients, 20 in each group. Sit-to-Stand (STS) and Up and Go (UG) tests were applied in order to assess functional capacity. Body composition (lean tissue index_LTI, fat tissue index_FTI) was evaluated with bioimpedance spectroscopy and the body mass index (BMI) was determined. Experimental group performed intradialytic exercise training. During the first 6 months, patients performed an intradialytic aerobic training in cycle ergometer. In the last 6 months, a strength training of the lower limbs was also included. Control group had no intervention.

Results
After 6 months there weren’t any significant statistical differences in body composition. However, after one year, the experimental group increased LTI on average by 3.13% (p=0.024) and decreased FTI on average by 9.26% (p=0.05), this was not verified by the control group (p=0.893 and p=0.521). No significant statistical differences were observed relating to BMI in both groups.
Related to functional capacity, immediately after three months, the experimental group improved in STS (p=0.007) and UG (p=0.008), while the control group didn't have significant statistical results (p=0.308 and p=0.51).

Conclusion/Application to practice
Intradialytic exercise programme improved functional capacity, LTI and lowered FTI. Haemodialysis patients benefit from physical exercise programmes.

BIOGRAPHY OF THE SPEAKER

O 84
Change of the age of patients between 1995-2015 and its effect on nursing care

P. Radovič1
1Dialysis Unit, B. Braun Avitum s.r.o., Prague, Czech Republic

Background
The average age of patients treated by haemodialysis is increasing in the world and the number of patients with limited mobility is going up correspondingly.

Objectives
Adaptation of nursing care to polymorbid and immobile patients to HD.

Methods
Comparison of statistical average ages of patients in 1995 with patients treated in our dialysis centre in 2015.

Results
Age                                            year 1995                                                              year 2015
50 years and less                                           28%                                                       12.5%
60 years and less                                           22%                                                       12.5%
70 years and less                                           35%                                                       33.5%
Over 70 years                                                  15%                                                      41.5%
The comparison shows almost a three times higher number of patients aged 70+.

Conclusion/Application to practice
Nursing care is changing as a result of a significant increase in the average age of the patient. The personnel is subject to higher demands in nursing care with respect to the necessary assistance in positioning and securing bodily comfort; communication with patients with limited cognitive functions is more difficult, securing quality care requires more frequent contact with the family. In addition to nursing skills, increased psychological skills within communication are expected from the personnel.

Practical Recommendations: Based on these findings, we perform changes in the nursing process so as to adequately respond to the changing conditions of our patients, who tend to be older and more ill. With the new findings and procedures, we endeavour to secure adequate quality of life and satisfaction of our patients.

BIOGRAPHY OF THE SPEAKER

O 85
How to maintain high quality of care when challenged by organisational changes?

H. Hermansen1, L. Streubel-Kristensen1, A. Soerensen1
1The Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark

Background
In Denmark there is an ongoing demand for reducing costs and increasing quality of health services. In 2016,  our haemodialysis unit at a university hospital is challenged by staff reduction of 10% while maintaining high quality of care.

Objectives
To create a sustainable organisation, with optimal use of ressources, to involve patients in their treatment and to initiate for more home based treatments.

Methods
The process started with a brainstorm generating general themes. Based on these themes an interviewguide was designed and a third of the staff was interviewed. Their statements were used by task groups to plan specific actions. Deming's Plan-Do-Check-Act cycle was used as a method to test these actions. Questionnaires and staff meetings were used to monitor the process. The nursing staff was highly involved throughout the process.

Results
Development of a method to use in organisational changes with high level of staff involvement.

Conclusion/Application to practice
High involvement of staff in the process of organisational changes has contributed to maintain high quality for patients, a good working environment and at the same time a reduction of costs. Development of this method may be usefull in future organisational changes. Furthermore, the method might be modified and applied in other organisations.

BIOGRAPHY OF THE SPEAKER