The potential of mHealth for older adults on dialysis and their care partners: What's been done and where do we go from here?

The paper addresses how mobile health (mHealth) could support self-care among older adults with chronic kidney disease (CKD) who progress to end-stage kidney disease (ESKD) and require dialysis, as well as their care partners. Older adults often have lower engagement in CKD self-care due to multimorbidity, functional and cognitive limitations, frailty, socioeconomic challenges, and other geriatric conditions. As dialysis begins, self-care becomes more complex, leading to increased dependence on care partners who provide transportation, medication and diet assistance, and symptom monitoring. Despite their vital role, care partners often experience burden and lack adequate guidance and support from healthcare systems. The study explores whether mHealth—defined here as user-friendly mobile and wireless tools (texting, apps, wearables) within the broader umbrella of telehealth—can simplify self-care, enhance patient and care partner outcomes, and complement conventional clinical care, especially given accelerated adoption during the COVID-19 pandemic.

The paper synthesizes existing research on mHealth in dialysis and related chronic conditions. Few clinical trials in ESKD have focused on mHealth, primarily testing smartphone/tablet-based remote monitoring or self-monitoring interventions. Patients report high acceptability and willingness to continue mHealth use, with studies indicating feasibility for self-care and potential cost savings due to reduced utilization, medications, and hospitalizations. However, many trials show non-significant improvements in traditional clinical outcomes (e.g., blood pressure, ultrafiltration, laboratory profiles, interdialytic weight gain), likely due to few trials, small samples, and short durations. mHealth appears promising for patient-reported outcome measures (PROMs) and engagement, offering real-time monitoring and personalized education/tailoring compared to conventional care’s delayed feedback and limited PROM focus. Viecelli et al. demonstrated that real-time PROM monitoring via mHealth facilitated prompt discussions and engagement. The review contrasts mHealth with conventional care across economic, clinical, person-centered, and accessibility dimensions, highlighting potential advantages (e.g., personalization, cultural tailoring, real-time data, improved engagement) and disadvantages (e.g., privacy/security concerns, unsupervised care safety, workflow impact, reduced in-person interaction). The digital divide—driven by costs, limited access to advanced technology, and low technology literacy—particularly affects older adults on dialysis, who also face higher rates of comorbidity, frailty, and cognitive impairment. Despite barriers, interest among dialysis patients in using mHealth is high, but research to date often neglects older adults’ specific needs. The paper also reviews mHealth for care partners in other conditions (dementia, stroke), where interventions improved caregiver physical/mental health, self-efficacy, and reduced burden. Effective domains include relationship building (support, services), patient care support (education, reminders, symptom monitoring), and caregiver-focused support (therapy, self-care). Barriers for care partners include accessibility, usability (small fonts, lack of subtitles), low health/technology literacy, high costs, and fragmented app ecosystems requiring multiple tools. The literature underscores the need to include both patients and care partners as stakeholders and end-users in design and implementation.

This is a narrative perspective/review article. It summarizes and critiques existing evidence from prior clinical trials, scoping and systematic reviews, and related studies on mHealth in ESKD, older adults, and caregiver populations. No primary data collection or formal systematic review methods are reported. The authors derive recommendations and a conceptual framework from the synthesized literature and stakeholder considerations.

- Few mHealth trials exist in ESKD; those conducted largely test remote/self-monitoring via mobile devices and show high patient acceptability and feasibility for self-care. - Economic analyses suggest potential cost savings through reduced healthcare utilization, medications, and hospitalizations with remote monitoring. - Clinical outcome improvements are often non-significant, likely reflecting limited sample sizes, short follow-up, and few trials; thus, definitive clinical effectiveness remains uncertain. - mHealth shows strong potential to improve patient-reported outcomes and engagement via real-time PROM monitoring, personalized education, and cultural tailoring; studies (e.g., Viecelli et al.) indicate timely feedback can prompt efficient patient–provider discussions. - Major barriers include the digital divide (cost, access, technology literacy), reduced in-person interaction, privacy/security concerns, and potential safety issues with unsupervised care and workflow disruptions. - Older adults and care partners are underrepresented both in trials and as co-design stakeholders; care partners’ needs are rarely targeted directly in ESKD mHealth despite evidence from dementia/stroke populations showing caregiver benefits (reduced burden, improved health and self-efficacy). - The authors propose involving multidisciplinary stakeholders and adopting a person-centered framework to design, test, and implement mHealth tailored to older dialysis patients and care partners.

The review indicates that while mHealth may not yet demonstrate consistent improvements in traditional clinical metrics for dialysis patients, it holds notable promise for enhancing engagement, self-management, and PROMs—areas crucial for older adults with complex needs. By offering personalized education, cultural tailoring, real-time symptom and PROM monitoring, and streamlined communication, mHealth can address well-documented shortcomings of conventional clinical care (e.g., delayed feedback, limited PROM use, low engagement). Including care partners in design and as direct end-users could alleviate caregiver uncertainty and burden while improving dyadic health outcomes. However, successful integration requires addressing accessibility, usability, safety, privacy, and workflow challenges and closing the digital divide through thoughtful design and supportive policies. The authors argue that rigorous, stakeholder-engaged research with larger samples and longer follow-up is needed to establish clinical effectiveness and safety in older adults on dialysis.

mHealth shows considerable potential to support self-care, increase patient activation, and enhance well-being among older adults receiving dialysis and their care partners. Realizing this potential depends on systematically incorporating these key stakeholders into clinical trials and co-design processes, prioritizing person-centered needs at the individual and dyadic levels, and fostering ongoing collaboration among clinicians, patients, care partners, and other stakeholders to adapt to evolving health trajectories and technologies. Until such inclusive collaboration is routine, mHealth’s impact on patient outcomes will remain limited.

- Evidence base limitations: Few ESKD mHealth trials, small sample sizes, short durations, and mixed findings for traditional clinical outcomes limit conclusions about clinical effectiveness and safety. - Population gaps: Older adults and care partners are underrepresented in trials and in co-design processes, reducing generalizability and relevance to those most affected. - Implementation constraints: Digital divide (cost, access, literacy), privacy/security concerns, reduced in-person contact, and workflow disruptions may limit real-world adoption and effectiveness. - Article scope: As a narrative perspective/review without systematic methods, selection bias in cited literature is possible.