Primary Prevention of Acute and Chronic Kidney Disease in Older Adults

Introduction

Kidney disease is a health disparity that does not receive sufficient attention from the public and healthcare professionals. Despite this, it impacts millions of people in this country and leads to complications, among which there is kidney failure. The latter can be treated with transplantation, a cost-intensive and dangerous procedure, or dialysis, which must be done several times per week. This paper will review the problem of acute and chronic kidney disease from a perspective of population health and offer public announcements that will help the older adults of Passaic County recognize this disparity.

Problem Statement

Acute and chronic kidney disease are conditions that impair the functions of kidneys and can lead to complications such as high blood pressure, anemia, nerve damage, issues with bones, and nutrition problems. According to Thomas (2019), kidney disease is a common and dangerous condition, which in many cases can be treated or prevented. Moreover, the International Society of Nephrology (n.d.) aims to implement programs that will help mitigate all preventable deaths caused by acute and chronic kidney disease. Hence, acute, and chronic kidney disease complications and death can be addressed through public health services to promote the wellbeing of the community by raising awareness and encouraging people to be diagnosed at early stages.

Population

The population of Passaic County, NJ, is estimated at 501,826 (U.S. Census Bureau, 2019). This is a large community, with 15% of the citizens being over the age of 65 (U.S. Census Bureau, 2019). Hence, approximately 75,000 individuals in Passaic County are at risk of developing or having kidney disease, either acute or chronic, due to their age and age-related factors, such as high blood pressure. Additionally, this intervention should include patients who have diabetes, although the exact statistics for the number of the population with this diagnosis are not available.

Ideally, the kidney disease prevention initiative would target the entire population of the Passaic County to educate the older adults and ensure that they understand the principles that will allow them to have healthy kidneys. However, realistically, the budget and human resources for this initiative are limited, and therefore, selecting a population at risk of developing acute and chronic kidney disease is more attainable in real life. The National Kidney Association (n.d.) states that individuals with diabetes or hypertension are at a risk of having kidney disease.

Importance of the Project

The kidney disease prevention program is needed because kidney failure requires serious interventions, either transplantation or dialysis. However, acute, and chronic kidney disease is treatable and preventable, which means that people can change their lifestyle and take medications that will help them restore the kidney function and avoid having to go on dialysis or have a transplant in the future. Moreover, the large number of deaths attributed to acute and chronic kidney disease and the lack of public awareness about this condition also emphasize the importance of this project for the promotion of health at Passaic County.

Literature Review

Prevention is the key to combating acute and chronic kidney disease. According to The Centers for Disease Control and Prevention data, between 1996 and 2003, the number of acute and chronic kidney disease cases was reduced by 54% due to initiatives and programs that target prevention (as cited by The National Kidney Association, n.d.). Acute and chronic kidney disease burdens the healthcare system since, unlike many other serious illnesses and chronic conditions, it can be prevented or successfully treated if identified timely. According to Obrador (2021), the number of people with end-stage renal disease (ESRD) who are enrolled in the Medicare funding program is more than 500,000 as per 2015 statistics. This is a substantial increase from the 10,000 beneficiaries who received government aid for ESRN in 1973. This shows that both the amount of people who have ESRN has increased, and the burden of financing in care to maintain the quality of life for these people increased as well. According to Obrador (20201), ESRN patients “consume a disproportionate share of healthcare resources” (para. 4). This burden occurs despite acute and chronic kidney disease being preventable and treatable, although ESRN can be treated only through transplantation or continuous dialysis.

The general population does not recognize kidney malfunctioning as a serious health threat. The National Kidney Association (n.d.) states that kidney disease is an unrecognized health crisis of the nation because more patients die from kidney failure than from breast or prostate cancer, which are commonly acknowledged health threats. According to the association’s data, 15% of adults in this state have acute and chronic kidney disease, and 80 million are at risk of developing it. The biggest issue, however, is that 90% of kidney disease patients are not diagnosed and are unaware of their condition. If a person’s kidneys can no longer function, the only options for staying alive and healthy are transplantation or dialysis.

Public health programs that dress acute and chronic kidney disease are focused primarily on screening and early identification of the condition. Intervention programs that target kidney disease and population health were studied by Shlipak et al. (2021), who argue that “acute and chronic kidney disease screening coupled with risk stratification and treatment should be implemented immediately for high-risk persons” (p. 34). Moreover, these authors identify socioeconomically disadvantaged persons as the ones at a high risk of developing acute and chronic kidney disease and having management issues. Most notably, there is no government-led strategy or policy that would allow one to systematically identify and screen people who are at risk of developing acute and chronic kidney disease to prevent the development of this disease. Shlipak et al. (2021) note that this lack of a systemized approach is surprising, considering that kidney disease can be easily diagnosed even at early stages and treatments are available. Hence, there is a necessity to address the health concern for populations at risk of developing acute and chronic kidney disease because prevention of this condition is not challenging.

Next, one issue that leads to health problems and disparities among those who are at risk of developing kidney issues is lack of health literacy. Notably, Taylor et al. (2018) argues that 25% of people who are already diagnosed with kidney disease have health literacy problems. These statistics mean that these individuals lack an understanding of their condition, its causes, and consequences, and therefore ways of preventing or self-managing this health disparity. Considering this, the general population may have an even more limited understanding of kidney problems, which may lead to insufficient early identification and treatment. Apart from this, health literacy within patients who have acute and chronic kidney disease leads to more “hospitalizations, emergency department use, missed dialysis sessions, cardiovascular events, and mortality” (Taylor et al., 2018, p. 1545). Hence, a health promotion program that targets kidney disease will be suitable for helping not only patients who may have acute and chronic kidney disease for early identification, but also for the people who already have this diagnosis as this will promote the understanding of the condition and ways of managing it effectively.

Goal Statement

The goals and objectives of this initiative will be set using the SMART criteria, which will allow having specific and measurable objectives. First and foremost, most people with kidney disease are not diagnosed until the condition reaches an acute stage, this initiative should promote diagnostics for populations at risk, for example, individuals with diabetes or hypertension and those over the age of 65 years old. The goal of this intervention is by 2023, at least 20% to raise awareness among the community of older adults over 65 years old about acute and chronic kidney disease and inform the general population of Passaic County regarding this disease and ways of identifying and managing it in two years.

This program will help notify those with diabetes or hypertension who are over the age of 65 years old about the risk of kidney disease and promote diagnostics. In terms of measurability, at least 10% of this population should be screened for acute and chronic kidney disease. With this initiative, the main barrier to attainability is the large number of people that live in this county and are at risk of having acute and chronic kidney disease and the limited number of resources. Hence, the objective will be to complete all activities within the budget of $100,000, with a focus on public announcements rather than face-to-face communication.

A realistic goal is to increase the number of people who undergo screening for acute and chronic kidney disease in the Passaic County by 20 percent, as opposed to ensuring that all population is checked. Hence, by encouraging people with symptoms of acute and chronic kidney disease or comorbid conditions to go through a check-up and increasing the Passaic County’s diagnosis rate by 10%, the initiative will contribute to public health. The timeframe for this initiative is limited, and considering the budget, all activities should last no longer than two years.

Objectives

Objective 1. The first objective is to launch and implement public service announcement convention disseminating the primary and prevention information on acute and chronic kidney disease for 15% of older adults at Passaic County.

Activity 1. Create posters with primary prevention information on acute and chronic kidney disease that will be disseminated at local hospitals and Senior care facilities in the Passaic County.

Assessment measure. Print 2,000 posters and distribute them to the local care providers, which will present this information to older adults over the age of 65 with kidney disease.

Activity 2. Place 10 billboards on the highway of route 80 the Passaic County, which are West and East, with messages about the prevention of acute and chronic kidney disease.

Assessment measure. Billboards are placed on the highway route 80 West and East and will remain there until the end of 2021.

Objective 2. By 2022 go to a hospital and unite with a dietitian to raise awareness among 15% of Passaic County’s population with acute and chronic kidney disease to raise awareness about their condition.

Activity 3. Partner with a dietitian who practices at Passaic County to create a diet program that considers the habits and environmental specifics of the local population.

Assessment measure. The dietitian has created 1 diet plan suitable for older adults with kidney disease by June 2022.

Activity 4. Disseminate the dietitian’s program to 15% of the older adults with acute or chronic kidney disease at Passaic County through follow-up calls scheduled after these patients visit their health providers.

Assessment measure. 15% of the older adults at Passaic County received follow-up calls with dietary recommendations by the end of 2022.

Objective 3. By 2023, is to target the older adults in Senior Centers at Passaic County with primary prevention education acute and chronic kidney disease to 20% of the population.

Activity 5. By June 2023, find and contact senior care facilities and agree upon holding regular lectures on preventative care for kidney disease until the end of 2023.

Assessment measure. At least 20 senior care facilities at Passaic and schedule 1 preventative care lecture at each Senior Care facility.

Activity 6. By December 2023, partner with dietitian’s healthcare facilities and provide them with 15,000 information brochures containing survey of preventative care information for acute and chronic kidney disease, which will be given to senior care facilities.

Assessment measure. By the end of 2023, the printed 15,000 brochures containing surveys and distributed them among the Senior Care facilities would be to access the statistics of screenings before the brochures and after the feedback results.

Each objective of the activity targets the campaign’s goal of informing 20% of the population at Passaic County, who are over the age of 65 years old and at risk of developing kidney disease, about acute and chronic kidney disease. The assessment measures will be calculated considering the number of older adults in local senior homes and the number of information brochures the announcing management will print out and distribute. The first objective allows engaging public service announcement into this public health project, that will help contact local providers and senior homes, and by creating the posters will assist during the public launch of this announcement. The second objective allows to partner with a local dietary specialist to create education materials and distribute them among the general population. The final objective requires the management and a dietitian to collaborate with senior homes, healthcare providers, and hold lectures or disseminate brochures about acute and chronic kidney disease.

Since the goal is to enhance awareness about acute and chronic kidney disease among the population that is at risk of developing it, which are people with diabetes, hypertension, and older adults, and increase the number of acute and chronic kidney disease screenings, there is a necessity to use the help of dietitians to disseminate data. Encourage community over 65 years old for this public health announcement, help disseminate information, and prepare with the activities. Over the course of this announcement, the dietitian will contact the Senior facilities and healthcare providers to spread information about this public service announcement and disseminate posters that contain contact information and requirements for the older adults. Since this is a public service announcement with a limited budget, the available human resources will also be limited, which will decrease the efficiency of these efforts. The dietitians will help with the outreach through follow-up phone calls and dissemination of health education materials.

Among the information that will be provided to the public through lectures and information sheets, the announcement can also use statistical data. This will be achieved by spreading messages with statistics, such as “15% of the population has acute and chronic kidney disease” and “90% of the community in older adults with a kidney condition are undiagnosed” and an encouragement to get screened and a message that includes the characteristics of populations at risk, which are patients with hypertension, diabetes, and in older adults (The National Kidney Association, n.d.). These messages will be spread through social media and billboards across the Passaic County. This will help ensure that the Passaic County community in older adults become familiar with this kidney disease condition, prompting them to seek screening or advice their family members to undergo one if they are a high-risk population.

Finally, the overall goal is to target the general population of the Passaic County, notify them about the condition such as acute and chronic kidney disease problems, the warning signs, the populations at risk. With this step, the older adults will be encouraged to ensure that their family members and loved ones at risk of acute and chronic kidney disease undergo diagnostics, for example, through the launch of this public service announcement in posters, billboards, and brochures. These activities will encourage people over the age of 65 years old to undergo screening for kidney disease. Additionally, the dietitians of this program will help contact the patients at risk directly and discuss potential options for screening at local hospitals such as St. Mary’s Hospital and St. Joseph University Health.

Discussion and Recommendations

A health promotion initiative can enhance the awareness of a problem and increase the number of older adults who undergo screenings. Since one of the core strategies with acute and chronic kidney disease is prevention, as the condition can be avoided altogether, this initiative targets different segments of the population to help them recognize the warning signs, encourage screening, and undergo the tests that are needed to determine if they have kidney disease. Moreover, this program will contribute to the health literacy of the older adults, who live in this Passaic County, since it will disseminate general information about acute and chronic kidney disease, which should address the health literacy disparity discussed by Taylor et al. (2018). In general, as a public health initiative, this program will promote the health and wellbeing of the older adults’ population in Passaic County, NJ.

Conclusion

Overall, this paper discusses the plan for promoting population health in Passaic County, located in New Jersey. Acute and chronic kidney disease is an unrecognized public health concern in this state that causes a substantial number of deaths, yet not many public health initiatives target kidney disease. This project’s goal is to increase the awareness of kidney problems among the general population and older adults with comorbid conditions, such as hypertension or diabetes. The goals are created to hold the public service announcement from 2021 until 2023 and reach from 15% to 20% of the targeted population each year.

References

The National Kidney Association. (n.d.). Kidney disease. Web.

Obrador, G. T. (2021). Epidemiology of chronic kidney disease. UpToDate. Web.

Shlipak, M. G., Tummalapalli, S. L., Boulware, L. E., Grams, M. E., Ix, J. H., Jha, V., Kengne, A., Madero, M., Mihaylova, B., Tangri, N., Cheung, M., Jadoul, M., Winkelmayer, W. C., Zoungas, S., Abraham, G., Ademi, Z., Alicic, R. Z., de Boer, I., Deo, R., … & Zomer, E. (2021). The case for early identification and intervention of chronic kidney disease: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney International, 99(1), 34-47.

Taylor, D., Fraser, S., Dudley, C., Oniscu, G., Tomson, C., Ravanan, R., & Roderick, P. (2018). Health literacy and patient outcomes in chronic kidney disease: A systematic review. Nephrology Dialysis Transplantation, 33(9), 1545–1558.

Thomas, N. (2019). Renal nursing: Care and management of people with kidney disease. Wiley.

U. S. Census Bureau. (2019). Quick facts. Passaic County, New Jersey. Web.