title: Dialysis modality decision-making for older adults with chronic kidney disease.
abstract: OBJECTIVE
  To examine the personal and structural facilitators and barriers for home-dialysis decision-making for older adults with chronic kidney disease.
  
  
  BACKGROUND
  Chronic illness is a global problem. Older adults with chronic kidney disease form a large and growing segment of the dialysis population in many high-income countries but are less likely to uptake home-dialysis despite its benefits.
  
  
  METHODS
  This qualitative ethnography framed in social theory took place in Canada and included adults with chronic kidney disease not on dialysis, older than 65 years of age.
  
  
  METHODS
  Thirteen people (seven men and six women, aged 65-83 years of age) who received care in a team chronic kidney disease clinic took part. Persons with chronic kidney disease were interviewed and group interviews were conducted with four of their chronic kidney disease clinic healthcare professionals. Content analysis was used for data analysis.
  
  
  RESULTS
  The factors influencing older adults' chronic kidney disease modality decisions are similar to younger adults. However, older adults with chronic kidney disease are in a precarious state with persistent uncertainty. Age imposes some limitations on modality options and transplantation. Modality decisions were influenced by health status, gender, knowledge, values, beliefs, past experience, preferences, lifestyle and resources. Support from family and healthcare professionals was the largest determinant to home-dialysis selection.
  
  
  CONCLUSIONS
  The social and contextual factors associated with age influenced home-dialysis decision-making. Adequate social support, functional status and resources enabled home-dialysis selection.
  
  
  CONCLUSIONS
  Understanding more about the decision-making processes for older adults with chronic kidney disease is important for quality interventions and the economic sustainability of dialysis services.
authors.affiliation: London Health Sciences Centre, London, ON, Canada; University of Alberta, Edmonton, AB, Canada; Arthur Labatt and Family School of Nursing, Western University, London, ON, Canada.
authors.forename: Lori
authors.initials: L
authors.lastname: Harwood
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Clark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003657:Decision Making; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007676:Kidney Failure, Chronic / Q000451:nursing / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis
keywords: chronic kidney disease; critical realism; decision-making; home-dialysis