Rationale & Objective Attention to geriatric impairments is not routinely provided to older adults receiving dialysis. Our objective was to identify patient and personnel perspectives on experiences with geriatric problems, unmet needs that may affect a patient’s ability to maintain his or her functional status, and preferences for design of a geriatric model of care tailored to address the unmet needs. Study Design Qualitative study using semi-structured interviews and focus groups. Setting & Participants 14 hemodialysis patients 55 years and older and 24 dialysis unit personnel (eg, nephrologists, nurses, patient care technicians, and social workers) representing 5 dialysis units. Analytical Approach Content analysis to identify themes reflecting unmet needs and design considerations for a geriatric model of care for older adults receiving dialysis. Results 4 themes (or unmet needs) identified from both patient and personnel transcripts were: (1) mobility, which referred to the insufficient mobility assessment and transportation services; (2) medications, which referred to insufficient attention to appropriate prescribing and medication self-management; (3) social support, which referred to insufficient support for activities of daily living and emotional problems; and (4) communication, which referred to insufficient patient-provider and interprofessional communication, including data transfer across separate health systems. Although participants generally acknowledged that an integrated model of care could result in benefits across all 4 areas of unmet need, they noted that the program design would need to minimize disruption of current workflow and practices in dialysis units. Limitations The findings may not be broadly representative of all older adults receiving dialysis and dialysis unit personnel. Conclusions There is insufficient attention to mobility, medication management, social support, and communication needs for older adults receiving in-center hemodialysis. Addressing these unmet needs in a geriatric model of care and measuring its effectiveness are areas of future research.

Background: Potentially inappropriate medications, or medications that generally carry more risk of harm than benefit in older adults, are commonly prescribed to older adults receiving dialysis. Deprescribing, a systematic approach to reducing or stopping a medication, is a potential solution to limit potentially inappropriate medications use. Our objective was to identify clinicians and patient perspectives on factors related to deprescribing to inform design of a deprescribing program for dialysis clinics. Methods: We conducted rapid qualitative analysis of semi-structured interviews and focus groups with clinicians (dialysis clinicians, primary care providers (PCPs), and pharmacists) and patients (adults receiving hemodialysis aged ≥65 years and those aged 55-64 years who were pre-frail or frail ) from March 2019 to December 2020. Results: We interviewed 76 participants [53 clinicians (8 focus groups and 11 interviews) and 23 patients]. Among clinicians, 24 worked in dialysis clinics, 18 worked in primary care, and 11 were pharmacists. Among patients, 13 (56%) were aged ≥65 years, 14 (61%) were Black race, and 16 (70%) reported taking at least one potentially inappropriate medication. We identified four themes (and corresponding subthemes) of contextual factors related to deprescribing potentially inappropriate medications: 1) system-level barriers to deprescribing (limited electronic medical record interoperability, time constraints and competing priorities), 2) undefined co-management among clinicians (unclear role delineation, clinician caution about prescriber boundaries), 3) limited knowledge about potentially inappropriate medications (knowledge limitations among clinicians and patients), and 4) patients prioritize symptom control over potential harm (clinicians expect resistance to deprescribing, patient weigh risks and benefits). Conclusions: Challenges to integration of deprescribing into dialysis clinics included siloed health systems, time constraints, co-management behaviors, and clinician and patient knowledge and attitudes towards deprescribing.