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Correlates of ADL difficulty in a large hemodialysis cohort
Author(s) -
Kutner Nancy G.,
Zhang Rebecca,
Allman Richard M.,
Bowling C. Barrett
Publication year - 2014
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12098
Subject(s) - medicine , activities of daily living , weakness , odds ratio , cohort , physical therapy , quality of life (healthcare) , confidence interval , psychological intervention , hemodialysis , balance (ability) , cohort study , surgery , nursing , psychiatry
Abstract Needing assistance with activities of daily living ( ADL ) is an early indicator of functional decline and has important implications for individuals' quality of life. However, correlates of need for ADL assistance have received limited attention among patients undergoing maintenance hemodialysis ( HD ). A multicenter cohort of 742 prevalent HD patients was assessed in 2009–2011 and classified as frail, prefrail and nonfrail by the F ried frailty index (recent unintentional weight loss, reported exhaustion, low grip strength, slow walk speed, low physical activity). Patients reported need for assistance with 4 ADL tasks and identified contributing symptoms/conditions (pain, balance, endurance, weakness, others). Nearly 1 in 5 patients needed assistance with 1 or more ADL . Multivariable analysis showed increased odds for needing ADL assistance among frail (odds ratio [ OR ] 11.35; 95% confidence interval [ CI ] 5.50–23.41; P < 0.001) and prefrail ( OR 1.93; 95% CI 1.01–3.68; P = 0.046) compared with non‐frail patients. In addition, the odds for needing ADL assistance were lower among blacks compared with whites and were higher among patients with diabetes, lung disease, and stroke. Balance, weakness, and “other” (frequently dialysis‐related) symptoms/conditions were the most frequently named reasons for ADL difficulty. In addition to interventions such as increasing physical activity that might delay or reverse the process of frailty, the immediate symptoms/conditions to which individuals attribute their ADL difficulty may have clinical relevance for developing targeted management and/or treatment approaches.