ObjectiveElderly ESKD patients frequently experience a range of psychosocial difficulties, with Demoralization Syndrome (DS) being especially prevalent. This study sought to delineate distinct longitudinal trajectories of DS and to examine factors associated with trajectory membership.MethodsA prospective longitudinal cohort of 363 elderly ESKD patients was recruited from Department of Nephrology in grade a hospital in Anhui, China from January 2023 to December 2025. DS was measured 4 time points from the first hemodialysis session after diagnosis to the 18 month follow-up. LCGM was applied to identify latent DS trajectory classes. Differences among classes were explored with the Two-way ANOVA, Wilcoxon rank-sum test, and multinomial logistic regression was used to assess associations between baseline characteristics and trajectory membership.ResultsThree DS trajectories were identified: Severe Class (54.0%), Moderate Class (41.6%), and Mild Class (4.4%).Membership in the more adverse trajectories was significantly associated with higher use of negative coping styles, lower perceived social support, lower Barthel Index scores, and more negative perceptions of aging (all P < 0.05).ConclusionsConsiderable heterogeneity in DS trajectories exists among elderly ESKD patients, with the majority following a severe pattern. These findings suggest that clinicians should monitor physical and cognitive functioning, regularly assess DS levels, and consider interventions targeting social support and coping strategies to mitigate worsening demoralization over time.
Radically different