SP418
Frailty and falls: A qualitative study exploring the experiences of patients living with end-stage renal disease and haemodialysis

INTRODUCTION: Frailty develops earlier and advances at an accelerated rate in patients receiving haemodialysis. Outcomes are poor and include increased risk of falls. This study explored the experiences of patients living with haemodialysis, frailty and falls. This information is crucial to enhancing patient safety and care, and to inform tailored interventions designed to improve outcomes.

METHODS: A purposive sample of vulnerable or frail (Clinical Frailty Scale, CFS Score 4-7) adult haemodialysis patients who had experienced at least one fall within the last six months were recruited. In-depth, semi-structured qualitative interviews were digitally recorded, transcribed verbatim and analysed using a constant comparative approach.

RESULTS: Twenty-four frail HD patients (14 women; median age, 68 (IQR 16-70) years; time on HD 25 (IQR 15-75) months, 12 white British, CCI 6 (IQR 5-7)) who had experienced a median of 3 (IQR 2-4) falls within the last 6 months, were interviewed.

Exhaustion and weakness were the most prevalent characteristics of frailty, which led to ‘slowing down’ and low levels of physical activity, worsened by hospital admissions and inactivity during haemodialysis. Unintentional weight loss was more complex. Some participants reported gaining weight due to fluid overload, whilst others reported weight loss that was attributed to forgetting or choosing not to eat and difficulties with following a renal diet.

Participants described difficulty managing multiple conflicting health issues, struggling with functional activities, pain and loneliness. They attributed falls to multiple factors, particularly lower limb weakness. Balance dysfunction whilst walking outdoors, negotiating stairs and slopes, turning, and performing multiple tasks simultaneously, was also common.

Falls were rarely reported and often normalised. Those who did discuss their falls with the healthcare team felt their concerns were ignored or explained away. None had been referred to a falls clinic or prevention programme. Consequences of falling included; fracture, damage to their dialysis access, long-term musculoskeletal complications, pain, loss of confidence and disruption to the wider family.

Participants predominantly used problem-focused coping strategies to help them to live with frailty and falls, primarily relying upon family support and adapting challenging activities and environments. Emotion-focused coping was used to a lesser extent and included avoidance, practicing gratitude and acceptance. Not all strategies appeared to result in positive adaptation or prevention of further falls.

CONCLUSIONS: This is the first study to describe the experiences of haemodialysis patients who are frail and fall. Healthcare professionals involved in the care of patients receiving haemodialysis should routinely screen for frailty, ask about falls and refer to rehabilitation services. Existing services could be improved by organising care to reduce duplication and patient burden, involving family in care decisions, and by utilising empathetic communication. Approaches to care and rehabilitation that foster positive coping mechanisms and build resilience may be more beneficial than those that encourage reliance on adaptations and aids.