Heterogeneous trajectories of family resilience and their predictors among family caregivers of older adults receiving maintenance hemodialysis: a longitudinal study

OBJECTIVE: To identify heterogeneous trajectories of family resilience among family caregivers of older adults receiving Maintenance Hemodialysis (MHD) and to explore their key baseline predictors. METHODS: A convenience sample of 237 primary family caregivers from five tertiary hospitals was assessed at four time points: initiation of dialysis (T0), and at 3 (T1), 6 (T2), and 12 (T3) months post-initiation. Family resilience, caregiver burden, and social support were measured using validated scales. Latent Class Growth Modeling (LCGM) was used to identify distinct resilience trajectory classes. Multinomial logistic regression was employed to analyze baseline predictors of class membership. RESULTS: Three distinct trajectories of family resilience were identified: a 'Persistently Low-Level' class (44.7%), a 'Progressively Enhancing' class (32.9%), and a 'Persistently High-Level' class (22.4%). Multivariate analysis revealed that the caregiver's chronic illness status, the number of patient complications, caregiver burden score, and social support score were significant baseline predictors differentiating these resilience trajectories. CONCLUSION: Family resilience among caregivers of older adults receiving MHD follows heterogeneous dynamic pathways. Early identification of families with these baseline characteristics may be beneficial for developing targeted support strategies.