Cognition and adherence in older adults undergoing hemodialysis

Background. Adherence to the behavioral change component of the hemodialysis regimen is difficult for many reasons; when individuals fail to adhere, the nurses often become frustrated and individuals may be labeled nonadherent leading to inappropriate interventions. As the number of older adults starting hemodialysis increases, one contributing factor to nonadherence in this population may be cognitive impairment. Objective. The overall purpose of the study was to explore differences in global cognition, in self-report cognition, and in language ability relative to adherence in a sample of older adults undergoing hemodialysis. Methods. This pilot study examined the differences in cognition and adherence of older adults (≥60 years) undergoing out-patient hemodialysis three times a week for at least one year. Nonprobability purposive sampling was used to obtain a sample from multiple centers which offered a diverse sample of study participants (n=63). Stories of the challenges of making life style changes were audiotaped and analyzed with linguistic analysis and word count (LIWC) software and various standardized instruments that measure global cognition (3MS and MMSE), self-report cognition (KDQOL-CF) and language ability (COWA, subsets of BDAE Reading: Sentence and Paragraph and BDAE Complex Ideation) were administered during hemodialysis. Determination of adherence or nonadherence (based on literature) was completed as the last activity of data collection. Results. Statistical significance was not achieved when exploring the difference of global cognition, self-report cognition, and language ability relative to adherence (p > .05). A relationship between structural elements of big words, cognitive process and insight words used in story and measures of adherence was revealed (p < .05). Although statistical significance was not reached the descriptive data supports that a relationship between cognitive impairment and measures of adherence were present across groups. The majority (64%) of nonadherent participants had cognitive impairment; 34% of the middle group and 5% of the adherent group had cognitive impairment. Discussion. Cognitive impairment is prevalent among older adults undergoing hemodialysis, however a relationship between cognitive impairment and adherence was not revealed in this study. This may be the result of the small sample size and adherence markers that were not sensitive in this population. This preliminary work offered a descriptive foundation which generated more questions that may be answered with further research.