Application of Dorothea Orem's Theory of Self-Care to the Elderly Patient on Peritoneal Dialysis

Headnote

Due to improvements in health care and increasing life expectancy, a greater number of elderly patients need renal replacement therapy. Dorothea Orem's Theory of Self-Care is an appropriate model to guide healthcare providers addressing the unique capabilities of this generation. The utilization and promotion of peritoneal dialysis as a therapy option offers the elderly an improved quality of life with a greater sense of self-worth. Literature has shown the elderly have superior technique and similar peritonitis-free survival rates as the younger population.

Key Words: Peritoneal dialysis, elderly, Dorothea Orem, self-care, self-care theory, teaching, peritoneal dialysis, and survival rates.

Goal

To provide an overview of the use of Orem's Theory of Self-Care to guide care for elderly patients on peritoneal dialysis.

Objectives

1. Define Orem's Theory of Self-Care.

2. Explain how Orem's Theories of Self-Care and self-care deficit can be adapted in providing home hemodialysis therapy in the elderly population.

Changes in life expectancy and in creases in incidences of hy - pertension, diabetes, and cardiac disease all correlate with a higher number of patients diagnosed with chronic kidney disease (CKD) (Elliott, 2012). The United States population is rising with the number of older adults expected to increase. In 2010, the number of adults older than 65 years of age was 13% of the population, whereas projections for 2020 predict a rise to 16.1% of the population (U.S. Department of Health and Human Services [DHHS], 2010).

Medical treatment appropriately suited to enhance life experiences and survival in the older adult requiring renal replacement therapy is an area of increasing debate among nephrology professionals (Mallappallil, Patel, & Friedman, 2012). The initiation of peritoneal dialysis as a treatment option has been used less often due to complications of cognitive functioning, depression, anxiety, dementia, and visual problems (Li et al., 2007). While the presence of co-morbid conditions as an indicator of all-cause mortality more closely aligns with the elderly patient than with the younger patient, Li et al. (2007) found that age is not a predictor in clinical outcomes in peritoneal dialysis. Moreover, Laudanski, Nowak, and Niemczyk (2013) found the elderly patient has developed advanced coping and critical thinking skills desirable for the self-care model, thus making the elderly patient a good candidate for peritoneal dialysis.

Nursing theorist...