Use of community support services and activity limitations among older adults with chronic kidney disease.

BACKGROUND: There is a lack of population-based data on associations between chronic kidney disease (CKD) and the functional status/independence of older adults. We assessed prospective associations between CKD and (a) use of community support services and/or reliance on nonspouse family/friend support and (b) activities of daily living measures among older adults.

METHODS: A total of 1,952 participants from the Blue Mountains Eye Study aged 50 years or older at baseline were examined between 1992-1994 and 2002-2004. CKD was defined as Modification of Diet in Renal Disease Study estimated glomerular filtration rate of less than 60mL(.)min(-1)·1.73·m(-2). Use of services and nonspouse family/friend support was self-reported at baseline and follow-up. Functional status was determined by the Older Americans Resources and Services activities of daily living scale.

RESULTS: After adjusting for age, sex, education level, receipt of pension, living status, poor self-rated health, hypertension, diabetes, number of hospital admissions, walking disability, and visual impairment, participants with CKD had increased odds of using community support services, odds ratio, 1.75 (95% confidence interval: 1.06-2.89). With increasing severity of CKD at baseline, the likelihood of using community support services 10 years later increased significantly, p trend = .02. After multivariable adjustment, participants with CKD had a greater likelihood of incident impaired instrumental activities of daily living after 10 years, odds ratio, 2.02 (95% confidence interval: 1.15-3.57). Increasing severity of CKD at baseline was associated with increased likelihood of incident impaired instrumental activities of daily living, p trend = .02.

CONCLUSIONS: CKD could be a potential barrier to independent living for older adults, as shown by the increased need for formal home care services.