Abstract
Chronic kidney disease stage 5 is a global health challenge in the context of population ageing across the world. The range of treatment options available to patients at all ages has increased and includes transplantation and dialysis. However, these options are often seen as inappropriate for older frailer patients who are now offered the option of conservative kidney management, which is presented as a non-invasive alternative to dialysis, involving symptom management and addressing psychosocial needs. In this study, we conducted qualitative interviews with 26 close persons caring for someone with chronic kidney disease stage 5 in the United Kingdom to investigate how conservative kidney management interacted with implicit ideas of ageing, in both the experience of conservative kidney management and the understanding of the prognosis and future care of the kidney disease. Our findings highlighted participant confusion about the nature of conservative kidney management, which stems from an initial lack of clarity about how conservative kidney management differed from conventional treatments for chronic kidney disease stage 5. In particular, some respondents were not aware of the implicit palliative nature of the intervention or indeed the inevitable end-of-life issues. Although these findings can be situated within the context of communication failure, we would further argue that they also bring to the surface tensions in the discourses surrounding ageing and old age, drawing on the use of a ‘natural’ and a ‘normal’ paradigm of ageing. In the context of chronic kidney disease stage 5, more patients are being dialysed at older ages, but conservative kidney management is being advanced as a better option than dialysis in terms of quality of life and experience. However, in doing so, conservative kidney management implicitly draws on a notion of older age that echoes natural ageing rather than advocate a more interventionist approach. The role of discourses of ageing in the provision of treatments for conservative kidney management has not previously been acknowledged, and this article addresses this gap.
Highlights
The nature of ageing and of old age has become an important dimension for understanding health and illness in contemporary societies (Jones and Higgs, 2010)
Our study aimed to explore the impact of age and disability on the experience of close persons caring for a person with chronic kidney disease stage 5 (CKD5) on conservative kidney management (CKM)
Our findings would appear to support the idea that CKM is organised around the discourses of ‘natural ageing’ where later life is seen to be defined by decline and eventual death – even though this is itself becoming confused and subject to partial medicalisation (Jones and Higgs, 2010)
Summary
The nature of ageing and of old age has become an important dimension for understanding health and illness in contemporary societies (Jones and Higgs, 2010). Once confined to the edges of health care and catered for by specialties such as geriatric medicine, the challenges and problems of individual longevity have forced mainstream biomedicine to have more contact with older patients and their problems This has meant that services and procedures have had to adapt to this situation, but in doing so, implicit understandings of what was ‘natural’ about ageing have become challenged by what has become ‘normal’ about it (Pickard, 2011). We argue that it is important to understand how the different discourses of natural and normal ageing influence the experiences and expectations of the ‘close persons’ providing care for a person with CKD with both physical and emotional support We assert that such discourses situate their satisfaction with services provided for older people with CKD and provide an additional perspective on these engagements, one not always evident when looking at patient and providers alone
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