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Biopsychosocial experiences and coping strategies of elderly ESRD patients: a qualitative study to inform the development of more holistic and person-centred health services in Singapore.
BMC Public Health. 2019 Aug 14; 19(1):1107.BP

Abstract

BACKGROUND

As the incidence and prevalence rates of end stage renal disease (ESRD) rise globally, a disproportionate increase has been observed in the elderly population. Singapore has the fifth highest incidence of treated ESRD worldwide, with the upward trend of ESRD being most apparent among those aged 70 years and older. Although it is well-documented that ESRD patients suffer an impaired quality of life compared to the general population, there is limited research focusing on the unique experiences and needs of elderly ESRD patients in Asian populations. To address the knowledge gap, this study seeks to explore the impact of ESRD and dialysis on the quality of life of elderly (≥70 years old) ESRD patients in Singapore and examine the coping strategies utilised by these patients.

METHODS

This qualitative study involved semi-structured, in-depth interviews with 7 peritoneal dialysis patients, 5 haemodialysis patients, 4 patients on non-dialysis supportive care and 7 caregivers in Singapore. Interviews were conducted in English, Chinese, and Malay and fully transcribed. QSR NVivo 11 software was used for analysis.

RESULTS

Participants reported that ESRD and dialysis had an impact on three highly interconnected areas of their quality of life: (a) biological/physical (general symptoms, neuromuscular problems, skin problems and poor sleep quality); (b) psychological (depressive symptoms, anxiety and fears, stress and negative self-perceptions); and (c) social (increased dependence on family and loss of social life). There were four key strategies that participants used to cope with these biopsychosocial challenges: (a) family support (financial, practical and emotional support); (b) religious/spiritual support (experiencing gratitude/contentment, the power of prayer and belonging to a faith community); (c) avoidance (cognitive avoidance and distraction techniques); and (d) acceptance (positive thinking and problem solving).

CONCLUSIONS

This study has provided insights into the biopsychosocial impact of ESRD and dialysis, as well as cultural and religious factors that shape the experiences and coping mechanisms of elderly ESRD patients and caregivers in Singapore, which can be used to further the development and implementation of more holistic and person-centred services to help each patient achieve a better quality of life.

Authors+Show Affiliations

Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore.Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore. ephfs@nus.edu.sg.Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore.Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore.Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore.Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-03H, Tahir Foundation Building, Singapore, 117549, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31412824

Citation

Han, Emeline, et al. "Biopsychosocial Experiences and Coping Strategies of Elderly ESRD Patients: a Qualitative Study to Inform the Development of More Holistic and Person-centred Health Services in Singapore." BMC Public Health, vol. 19, no. 1, 2019, p. 1107.
Han E, Shiraz F, Haldane V, et al. Biopsychosocial experiences and coping strategies of elderly ESRD patients: a qualitative study to inform the development of more holistic and person-centred health services in Singapore. BMC Public Health. 2019;19(1):1107.
Han, E., Shiraz, F., Haldane, V., Koh, J. J. K., Quek, R. Y. C., Ozdemir, S., Finkelstein, E. A., Jafar, T. H., Choong, H. L., Gan, S., Lim, L. W. W., & Legido-Quigley, H. (2019). Biopsychosocial experiences and coping strategies of elderly ESRD patients: a qualitative study to inform the development of more holistic and person-centred health services in Singapore. BMC Public Health, 19(1), 1107. https://doi.org/10.1186/s12889-019-7433-6
Han E, et al. Biopsychosocial Experiences and Coping Strategies of Elderly ESRD Patients: a Qualitative Study to Inform the Development of More Holistic and Person-centred Health Services in Singapore. BMC Public Health. 2019 Aug 14;19(1):1107. PubMed PMID: 31412824.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biopsychosocial experiences and coping strategies of elderly ESRD patients: a qualitative study to inform the development of more holistic and person-centred health services in Singapore. AU - Han,Emeline, AU - Shiraz,Farah, AU - Haldane,Victoria, AU - Koh,Joel Jun Kai, AU - Quek,Rina Yu Chin, AU - Ozdemir,Semra, AU - Finkelstein,Eric Andrew, AU - Jafar,Tazeen Hasan, AU - Choong,Hui-Lin, AU - Gan,Sheryl, AU - Lim,Lydia W W, AU - Legido-Quigley,Helena, Y1 - 2019/08/14/ PY - 2019/01/31/received PY - 2019/08/01/accepted PY - 2019/8/16/entrez PY - 2019/8/16/pubmed PY - 2019/11/15/medline KW - Coping mechanisms KW - ESRD KW - Elderly KW - End stage renal disease KW - Lived experiences KW - Qualitative research KW - Quality of life SP - 1107 EP - 1107 JF - BMC public health JO - BMC Public Health VL - 19 IS - 1 N2 - BACKGROUND: As the incidence and prevalence rates of end stage renal disease (ESRD) rise globally, a disproportionate increase has been observed in the elderly population. Singapore has the fifth highest incidence of treated ESRD worldwide, with the upward trend of ESRD being most apparent among those aged 70 years and older. Although it is well-documented that ESRD patients suffer an impaired quality of life compared to the general population, there is limited research focusing on the unique experiences and needs of elderly ESRD patients in Asian populations. To address the knowledge gap, this study seeks to explore the impact of ESRD and dialysis on the quality of life of elderly (≥70 years old) ESRD patients in Singapore and examine the coping strategies utilised by these patients. METHODS: This qualitative study involved semi-structured, in-depth interviews with 7 peritoneal dialysis patients, 5 haemodialysis patients, 4 patients on non-dialysis supportive care and 7 caregivers in Singapore. Interviews were conducted in English, Chinese, and Malay and fully transcribed. QSR NVivo 11 software was used for analysis. RESULTS: Participants reported that ESRD and dialysis had an impact on three highly interconnected areas of their quality of life: (a) biological/physical (general symptoms, neuromuscular problems, skin problems and poor sleep quality); (b) psychological (depressive symptoms, anxiety and fears, stress and negative self-perceptions); and (c) social (increased dependence on family and loss of social life). There were four key strategies that participants used to cope with these biopsychosocial challenges: (a) family support (financial, practical and emotional support); (b) religious/spiritual support (experiencing gratitude/contentment, the power of prayer and belonging to a faith community); (c) avoidance (cognitive avoidance and distraction techniques); and (d) acceptance (positive thinking and problem solving). CONCLUSIONS: This study has provided insights into the biopsychosocial impact of ESRD and dialysis, as well as cultural and religious factors that shape the experiences and coping mechanisms of elderly ESRD patients and caregivers in Singapore, which can be used to further the development and implementation of more holistic and person-centred services to help each patient achieve a better quality of life. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/31412824/Biopsychosocial_experiences_and_coping_strategies_of_elderly_ESRD_patients:_a_qualitative_study_to_inform_the_development_of_more_holistic_and_person_centred_health_services_in_Singapore_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7433-6 DB - PRIME DP - Unbound Medicine ER -