Chronic kidney disease (CKD) places substantial physical, psychological, and economic burdens on individuals, especially older adults. Effective self-care is crucial for managing CKD, yet older adults often face challenges due to factors like multi-morbidity, functional limitations, and cognitive decline. Their care partners play a vital role, but also experience significant burden and often lack support. mHealth, encompassing mobile and wireless communication devices, offers a promising strategy for improving self-care for both patients and their partners. While mHealth has shown success in managing other chronic conditions, its application in the dialysis population, particularly among older adults, remains limited. This paper examines the current state of mHealth use in older dialysis patients and their care partners, identifies gaps in research and practice, and proposes future directions to enhance its effectiveness and accessibility.

The literature review examines existing research on mHealth interventions for chronic diseases, particularly those relevant to CKD, including diabetes, hypertension, and cardiovascular disease. Studies demonstrate improvements in patient-provider communication, clinical outcomes, patient activation, and reduced healthcare utilization with mHealth interventions. However, there's a significant scarcity of mHealth research specifically tailored to the needs of older adults with ESKD and their care partners. The review also explores studies on care partners in other chronic disease settings (dementia and stroke), highlighting the potential benefits of mHealth for reducing caregiver burden and improving their well-being. This section establishes the rationale for focusing on a population currently underserved by mHealth technologies.

This is a review paper; therefore it does not involve a specific methodology like a randomized controlled trial. The authors conducted a thorough review of existing literature on mHealth interventions for chronic kidney disease, focusing specifically on the experiences and needs of older adults on dialysis and their care partners. They synthesized information from clinical trials, qualitative studies, and review articles to assess the current state of mHealth adoption, identify existing gaps, and propose directions for future research and development. The authors categorized the potential impacts of mHealth and conventional clinical care into four major themes: economic, clinical, person-centered, and accessibility, comparing the advantages and disadvantages of each. The review also considers the existing literature on mHealth interventions targeting care partners in other disease areas to suggest potential adaptations for the CKD population. The process involved systematically searching databases for relevant articles, selecting studies based on inclusion/exclusion criteria, and extracting key information for analysis. This approach aimed to provide a comprehensive overview of the existing evidence and identify key areas for future research.

The review revealed that while a few studies have explored mHealth interventions in dialysis patients, most have focused on lifestyle changes via smartphone apps and tablets. These trials, often with small sample sizes and short durations, showed high patient satisfaction and potential for cost savings through reduced healthcare utilization. However, improvements in traditional clinical outcomes (blood pressure, weight gain) were often non-significant. Table 1 in the paper summarizes the potential advantages and disadvantages of mHealth compared to conventional clinical care across four domains: economic, clinical, person-centered, and accessibility. mHealth demonstrated potential for cost savings and improved person-centered care through personalized resources and real-time updates. However, disadvantages include limited access to technology, privacy concerns, and a need for more personal interaction with the clinical team. A crucial finding highlights the underrepresentation of older adults and their care partners in mHealth research, resulting in a gap in knowledge about their specific needs and barriers to adoption. The lack of tailored interventions is a major obstacle. The study finds evidence that mHealth interventions, adapted from dementia and stroke caregiving research, could improve care partner well-being and reduce burden. However, existing mHealth applications rarely consider the care partner as the primary user.

The findings highlight the significant potential of mHealth to improve self-care among older adults on dialysis and their care partners, but only if these stakeholders are actively involved in the design and implementation of interventions. The lack of patient and care partner engagement in research and technology development contributes to the limited impact of existing mHealth applications. The inconsistent results regarding clinical outcomes may be attributed to this lack of a person-centered approach. By prioritizing the needs and perspectives of these key stakeholders, future mHealth interventions can be designed to be more relevant, effective, and accessible. The paper underscores the importance of addressing technological literacy, ensuring adequate privacy and security, and offering culturally appropriate support. The integration of existing mHealth strategies from other caregiving contexts provides a pathway for developing more effective and comprehensive interventions tailored specifically to the needs of older adults with ESKD and their care partners.

mHealth holds significant promise for improving self-care and well-being among older adults on dialysis and their care partners, but its potential remains untapped due to the insufficient involvement of these stakeholders in research and development. Future research should prioritize a person-centered approach involving multidisciplinary teams to address barriers to mHealth adoption. This includes focusing on technology literacy, addressing privacy and security concerns, and creating tailored mHealth tools that meet the unique needs of this population. By incorporating the voices and perspectives of patients and care partners, mHealth can be leveraged to improve clinical outcomes, reduce burden, and enhance the overall quality of life for individuals with ESKD.

As a review paper, this study is limited by the availability and quality of existing research. The focus on older adults on dialysis and their care partners inherently restricts the generalizability of the findings to other populations. The review relies on the existing literature, which may not fully capture the diversity of experiences and needs within this population. The recommendations for future research are based on the authors' interpretation of the current evidence and may not encompass all possible perspectives or approaches. Further, the definition of mHealth itself lacks universal consensus, adding to the complexity of the analysis and its interpretations.