Goals of Frail Older People Living With Chronic Kidney Disease: A Mixed Methods Study

Background: Frail older adults with chronic kidney disease (CKD) have complex care needs, and their priorities may differ from those assumed by healthcare providers. Understanding their goals is crucial to delivering person-centred care. This study aimed to identify and categorize the goals of this population and determine any association with participants' frailty status, quality of life, and CKD stage.

Methods: We report the goals of frail older people living with moderate to severe CKD enrolled as participants in the GOAL trial, a cluster-randomized controlled trial assessing the effectiveness of comprehensive geriatric assessment. This study employs a mixed-methods approach, utilizing a triangulation design and a data transformation model. Participants set goals by Goal Attainment Scaling. Deductive content analysis was undertaken, aided by a pre-specified matrix (physical health; psychological health; function; planning; social engagement). Descriptive statistics assessed the relationships between goals and participant characteristics.

Results: The 224 participants (mean age 77 [±6.7]; 56% male; 84% white/European; median FI 0.39 [IQR: 0.33-0.47]) set 408 goals in the categories of function, physical health, social engagement and leisure, psychological health, and future readiness. Most participants set one or two goals (n = 183, 82%). They were most frequently set in the function (n = 172, 42%), physical health (n = 86, 21%), and social engagement and leisure (n = 79, 19%) domains. The number and nature of the set goals were similar across participant frailty status, quality of life (EQ-5D-5L) scores, and CKD stage.

Conclusion: Frail older adults with CKD most frequently focus their goals on function, physical health, social engagement, and leisure. These goals did not vary by participants' frailty status or CKD stage. This study's findings can guide healthcare professionals in ensuring management plans consider these identified priorities. Geriatricians may have a role in managing this population, given the commonality of these goals with those of older people more generally.