Understanding Home Dialysis: Benefits, Barriers, and Impacts on Elderly Patients and the Healthcare System
More often, kidney diseases result in kidney failure, thus, necessitates dialysis or kidney transplant to sustain a patient when the kidneys do not function anymore. Dialysis removes waste materials from the blood after the kidneys stop working. Kidney failure happens in two lines of attack. One is acute kidney failure, which implies that the function of the kidney suddenly drops, but this is often temporary as, with time, it can result in complete kidney failure. Chronic kidney disease is the other way that the kidney can stop functioning. More frequently, kidney function deteriorates with time. This means that one can seek early medical advice when one finds out one has the disease. Medication and nutritional and lifestyle changes can boost the life of one’s kidneys and maintain a patient’s health for the longest possible time. Life with chronic kidney disease generally involves managing other chronic conditions; for instance, hypertension and diabetes demand a change in the patient’s lifestyle. Therapeutic and emotional features of the disease must be treated, symptoms understood and described, relationships with health care providers formed, and new funds utilized. Medical practitioners can assist patients in maneuvering this primarily scary and, at times, difficult terrain with tactics adapted to the phase of the illness. This paper looks at home dialysis benefits and barriers, impacts of chronic illness, such as chronic kidney disease on the elderly and the impacts on the health care system, quality of life for these patients, economic factors and care of these elderly patients.
Researchers have long investigated the techniques individuals employ to live with the disease and what ‘self-management’ actually signifies to those with chronic sickness. Curtin and Mapes observed patients with continuing dialysis and came up with the definition of self-management. They defined self-management as the constructive efforts of the patients geared to overseeing and participating in their health care to optimize health, prevent difficulties, control symptoms, mobilize medical resources, and minimize the ailment’s interference with their chosen living. Despite the confirmation that chronic disease self-management ameliorates results, it still needs to be revised, though it is clear to nurses that the efficient management of chronic kidney illness depends upon recognizing the patient as the key illness manager. Furthermore, proficiency in particular skills and undertakings is essential for self-management, for which nursing maintenance is crucial.
Home Dialysis Benefits
The advantages of home dialysis have been acknowledged in peer-reviewed medical literature, including betterments in bodily and mental health and dietary status. For example, since HHD provides more regular and enduring dialysis sessions, research indicates that patients recover within a short time following treatment and their chances of physiotherapy are enhanced. Moreover, patients under home dialysis undergo less depressing side effects, such as sickness, weight gain, and nutritional limitations, compared to the in-center patients. Home Dialysis also offers major financial and daily life benefits, especially to older people. Some of the benefits include:
Increased Self-Sufficiency and Flexibility over When to Dialyze
Home dialysis offers patients control over when to do dialysis; they can decide the time within limits for excellent dialysis results. One does not have to ask for permission or scheduled time alterations from a dialysis department to go anywhere, as the patient is responsible for deciding his/her own time. Home dialysis treatment schedules are determined by the patient in collaboration with their health care group. In the best case, at least fifteen hours per week is required in normal sessions. This permits utmost flexibility for work, everyday life activities and times spent with one’s family. The options provided include the following:
- Daytime dialysis or nocturnal dialysis
- Long sessions ranging from two to eight hours per session, normally performed overnight
- Sessions from three to seven times weekly
Reduced Reliance on Transportation
Since dialysis is home-based, patients are not supposed to go to a health center for treatments, saving time and money that could have otherwise been used for the trip. This is also conducive for the elderly with chronic kidney disease, as they will not have to go back and forth to the clinic all the time, thus getting sufficient time to rest. Since cars are not that dependable, in case of any delays, for example, traffic jams, engine failure, flat tire or even road accidents, it can cause the patient to be in a critical condition if the therapy session is missed.
Ability to Work
Patients receiving home dialysis can work or perform other easy household chores. This is made possible by the flexible treatment, making it more conducive for employment, as confirmed by the high employment rates amongst home dialysis patients. Easy work can also make the patient active and feel better. Moreover, this will help the patient feel that he or she is productive and feels acceptable and productive to the family, not just a burden.
More Frequent Dialysis
Home dialysis enables the patient to carry out more frequent and extended analysis sessions, which could improve medical outcomes. Frequent dialysis will help the patient’s kidney act as a normal kidney with no side effects. The kidneys operate twenty-four hours a day; as a result, dialysis should be done more often to help the kidneys work more efficiently. Moreover, regular dialysis is also healthier for the heart.
Ease and Convenience
Performing dialysis at home facilitates the treatment and is more comfortable. The patients need not dedicate their entire existence to dialysis. In addition, the new apparatus is easier to operate than the previous ones, making home dialysis effective. Patient instruction at a home education center is vital for a thriving home program, and continuous stand-by nursing care is critical. Most individuals straightforwardly learn the management of home dialysis. More than fifty percent of elderly patients, mostly above eighty-five, are on home dialysis programs across Australia. All the necessary types of equipment are provided to the patient’s home, and even the waste can be put in the patient’s garbage can. Some supervision measures may be required when the patient adapts to the new practice.
The hemodialysis machine is given free and installed in the patient’s home free of charge. This cuts down the expenses that would have been used for purchasing the equipment. Most homes are appropriate, but sometimes, a community center is utilized when the home is not suitable, which is also not charged. The health care group can respond to questions regarding the patient’s home. Exceptional plumbing will be set up in the patient’s house, and the quality of his/her home water supply will be tried. All materials are brought at no cost to the patient’s home.
Dialysis education is made by a nurse at the patient’s speed. It is provided to the patient with his/her assistant if he/she chooses to have one. Once trained, dialysis can be carried out independently but with on-duty support. Again, it is free.
Improved Rest Time
Home hemodialysis offers substantial benefits over dialysis performed within medical surroundings for patients ailing from chronic kidney sickness. Home hemodialysis is a feasible opportunity for stable dialysis patients as it offers sufficient time for rest.
Home Dialysis Barriers
There are several hurdles hindering the widespread application of home dialysis in Australia, which need to be dealt with by the patients, the physicians, and the government. Some hindrances to home hemodialysis include fear of alteration and the need for self-confidence by patients and practitioners. Insufficient payment to practitioners for home hemodialysis education may also prevent general practitioners from advocating for a home program. Other obstacles include:
Dread of Cannulation and Managing at Home with Dialysis
Home dialysis can bring worries to the family members or the person looking after the patient since no error should be done on the machine used. It can be difficult for the residence dialysis team and pre-dialysis instructor to support the individual and conquer most doubts. Training on how the machine works can be a problem for the patient or the family members, who need to be more educated or able to read the manual effectively, making it difficult to use it at home. The personal drive can also be a decisive aspect to consider, whereby fear should be overcome early to allow home training to be started. One way to subdue fear is by conducting a self-test using online facilities to overcome initial doubts.
Several dialysis programs need more familiarity with dialysis modality, which causes has slowed adoption. However, with widespread patient and general practitioner guidance, nursing education and endorsement from health centers and infirmaries, home dialysis will function for several other patients with chronic kidney ailments.
Vulnerability to Infections
As a result of frequent buttonhole cannulation that is widely used in home dialysis, the patient is more likely to get infections easily. This can worsen the condition of the patient, more especially those who cannulate frequently. Therefore, patients and their nurses should be trained to observe highly hygienic measures, especially when cannulating.
The hurdle that can be tricky for support systems and home dialysis patients to overcome is the need for more interaction and rejection. In spite of this, it is unusual that a home dialysis patient tries to go back to in-center tending. Support groups, helpers, and normal respite dialysis are possible resolutions to this fear.
There are high costs involved in home dialysis programs, including high energy and water costs. Depending on their background, some patients may be unable to cater to these costs, thus hindering home dialysis programs from being widely implemented. Nevertheless, the health system should identify these expenses and reimburse them. This way, all chronic kidney patients, especially the elderly ones, will get proper care and attention at home. Victoria has already taken a step forward in finding a solution to this problem of home dialysis.
Impacts of Chronic Illness on the Elderly and Health Care System
The HOME Network is a nationwide program to engage healthcare experts in home dialysis, empowering them to come up with solutions to overcome the difficulties that slow the adoption of home therapies within Australia. Home hemodialysis in Australia is exercised by just about ten percent of the patients on dialysis. From research, it has been established that home therapy is the best option for elderly patients as it leads to good quality of living, improves life expectancies and reduces the amount of time spent in the hospital. Elderly patients suffering from chronic illnesses undergo several significant consequences. Their conditions give rise to acute sicknesses, such as influenza and scarlet fever, and a few chronic diseases, particularly stroke, cancer, and heart diseases. Moreover, these patients tend to experience some difficulties when dealing with basic tasks like lifting objects or even walking for some distance.
The hospital may experience a decreasing number of in-center kidney failure patients as many settle for a home dialysis program, which is flexible and comfortable. Additionally, if effectively carried out, home dialysis may eliminate the need for kidney transplants; hence, hospitals will also experience fewer patients requiring such an operation. Home dialysis is becoming more popular, and nurses may want to encourage their patients to opt for this treatment method.
Quality of Life for the Patients
Self-management is imperative for home dialysis. As soon as a patient is authorized, they will be far more accomplished in making their own choices concerning their care and will most probably adhere to the prescribed regimens. The values are shared management and instructing the patient on how to make decisions. Grown-up education principles are also essential. Self-management suggests that the patient is offered support in the:
- Understanding the nature of their situation together with risk factors and the relative incidence of the disease
- Having the knowledge of their management options and being in a position to make well-versed decisions about treatments
- Actively taking part in decision-making in the company of health expertise, relatives and caregivers and other support teams in terms of progressing care
- Following a treatment arrangement that has been discussed and approved with healthcare providers, relatives and caregivers, and other groups, as well as non-government and end-user organizations
- Monitoring the indications of alteration in their physical condition and having an action plan to act in response to the described changes
- Managing the effects of the condition on their bodily, emotional and public life and acquiring better mental health and welfare as an outcome
- Adopting a standard of living that minimizes risk and encourages health through deterrence and early intercession
- Having self-confidence in one’s capacity to make use of support services and make decisions about their well-being and quality of living
Economic Factors and Care of the Elderly Patients
Patients on home dialysis care may be entitled to economic assistance for expenses relating to, but not limited to, electricity and water. The government provides some reimbursements for these medical costs, making nearly all patients with kidney failures afford home dialysis and live a normal life. Center-link also pays a twelve-monthly $140 reimbursement to individuals who experience added increases in home electricity expenses from the application of vital medical apparatus to manage their medical condition. Home Dialysis patients have greatly benefited from this endeavor. In addition, patients, who travel to the city for intervention, may be entitled to a government system to offer financial support for travel and accommodation. However, most patients may need to be notified of eligibility for this assistance.
Home dialysis treatment is cheap, convenient and easy to operate; therefore, medical practitioners should encourage their patients to adopt the system. However, even though home-based hemodialysis machine has become easier to operate in recent years, the technology is constantly changing, and the equipment is available to a small percentage of dialysis patients in Australia. The dialysis equipment should be widely available to patients to ensure its uptake. Nurses and patients should also be frequently updated on new technologies and efficiently instructed on operating the new equipment. Given the ease and the diverse health and lifestyle benefits associated with home dialysis, patients should feel much better at home and improve their well-being than in the in-center treatment. The patient can choose when to dialyze during the day or at night. Home dialysis is a viable option for patients suffering from chronic kidney disease. It is the best method of therapy.
1. Acton, QA 2011, Issues in kidney disease research and treatment, Scholarly Editions
2. Curtin, RB & Mapes, D 2001, “Health care management strategies of long-term dialysis survivors”, Nephrology Nursing Journal, p. 385.
3. Department of Health, State of Western Australia 2011, Framework to improve home dialysis therapy in Western Australia, Department of Health, Western Australia
4. Kidney Health Australia 2012, Home dialysis, viewed 23 October 2012, https://www.kidney.org.au/
5. Rioux, JP, Cheema, H, Bargman, J, Watson, D& Chan, C 2011, “Effect of an in-hospital chronic kidney disease education program among patients with unplanned urgent-start dialysis”, Clinical Journal of the American Society of Nephrology, pp. 799-804.
6. Teaching self-management 2012, viewed 23 October 2012