Geriatric Assessment in Advanced Kidney Disease

Brown, Edwina A.; Farrington, Ken

doi:10.2215/cjn.14771218

Cited by 30 publications

(39 citation statements)

References 10 publications

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“…Geriatric impairments are strongly associated with adverse health outcomes such as hospitalisation and mortality in (pre-)ESKD patients [ 3 , 6 ]. Recently published ESKD guidelines recommend to frequently measure different geriatric domains and to use these outcomes in the decision making process [ 7 , 8 ], but this is not part of standard clinical care [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study

et al. 2021

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Background Older patients with end-stage kidney disease (ESKD) often live with unidentified frailty and multimorbidity. Despite guideline recommendations, geriatric assessment is not part of standard clinical care, resulting in a missed opportunity to enhance (clinical) outcomes including quality of life in these patients. To develop routine geriatric assessment programs for patients approaching ESKD, it is crucial to understand patients’ and professionals’ experiences with and perspectives about the benefits, facilitators and barriers for geriatric assessment. Methods In this qualitative study, semi-structured focus group discussions were conducted with ESKD patients, caregivers and professionals. Participants were purposively sampled from three Dutch hospital-based study- and routine care initiatives involving geriatric assessment for (pre-)ESKD care. Transcripts were analysed inductively using thematic analysis. Results In six focus-groups, participants (n = 47) demonstrated four major themes: (1) Perceived characteristics of the older (pre)ESKD patient group. Patients and professionals recognized increased vulnerability and (cognitive) comorbidity, which is often unrelated to calendar age. Both believed that often patients are in need of additional support in various geriatric domains. (2) Experiences with geriatric assessment. Patients regarded the content and the time spent on the geriatric assessment predominantly positive. Professionals emphasized that assessment creates awareness among the whole treatment team for cognitive and social problems, shifting the focus from mainly somatic to multidimensional problems. Outcomes of geriatric assessment were observed to enhance a dialogue on suitability of treatment options, (re)adjust treatment and provide/seek additional (social) support. (3) Barriers and facilitators for implementation of geriatric assessment in routine care. Discussed barriers included lack of communication about goals and interpretation of geriatric assessment, burden for patients, illiteracy, and organizational aspects. Major facilitators are good multidisciplinary cooperation, involvement of geriatrics and multidisciplinary team meetings. (4) Desired characteristics of a suitable geriatric assessment concerned the scope and use of tests and timing of assessment. Conclusions Patients and professionals were positive about using geriatric assessment in routine nephrology care. Implementation seems achievable, once barriers are overcome and facilitators are endorsed. Geriatric assessment in routine care appears promising to improve (clinical) outcomes in patients approaching ESKD.

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Section: Introductionmentioning

confidence: 99%

Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study

et al. 2021

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“…The CGA is defined as "a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/coordinated care plan to meet those needs" and is now the accepted standard of care of the older patient living with frailty (48). Studies have demonstrated that the CGA (or a modified version) is feasible within renal services and can be used to identify geriatric impairments in CKD populations (49). Goto et al (50) showed that geriatric impairments, such as impaired functional status and cognition, are highly prevalent in older patients with advanced CKD.…”

Section: Should the Potential Kidney Transplant Recipient Be Offered mentioning

confidence: 99%

Frailty and the Potential Kidney Transplant Recipient: Time for a More Holistic Assessment?

Woywodt

Nixon

2020

Kidney360

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“…Although its importance is recognized, the means to implement CGA in Nephrology units have not been established and require special skills. Several models have been studied: a geriatrician making part of the staff, nephrologists receiving additional training in geriatrics to perform these evaluations 41 , a geriatric nephrology nurse conducting interviews 42 or self-reported questionnaires answered by patients and caregivers. The most relevant reasons why there is no single way to perform CGA in Nephrology units are the barriers that have been identified.…”

Section: Scoring Frailty In People With Dementiamentioning

confidence: 99%

“…Recognizing these barriers, Brown et al have structured a feasibility project to determine whether a nephrology nurse could deliver a modified geriatric assessment (MGA. The MGA includes assessment of dependence on mobility aids, falls, presence of vision or hearing problems, and social support provided by family or other caregivers, as well as assessment of frailty and cognitive dysfunction 42 . It takes up to an hour which means that it could be completed while waiting for hemodialysis or in peritoneal dialysis clinic either as a whole or in smaller components on separate occasions.…”

Section: Scoring Frailty In People With Dementiamentioning

confidence: 99%

Comprehensive geriatric assessment in nephrology

Farinha

Duque

2019

pjnh

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In Portugal, in 2018, 64.5% of dialysis patients were elderly and nearly a quarter were older than 80 years. Aging is a heterogeneous process: in some patients, there is a marked clinical improvement under renal replacement therapy (RRT) although others show an inexorable functional decline. Despite advances in dialysis, patient mortality rates remain high. These two phenomena have been difficult to understand and it may be difficult to decide which patients may benefit from RRT or conservative care. Comprehensive Geriatric Assessment (CGA) is an instrument used by geriatricians to evaluate functionality and geriatric syndromes, allowing recognition of problems that would not otherwise be identified. It has been used to individualize and tailor therapies. CGA allows frailty identification (the major geriatric syndrome) and might better predict clinical prognosis and interventions' effectiveness. Physical frailty is a multifactorial condition that is common in chronic kidney disease (CKD) patients and its reversibility is hardly predictable when RRT is started so CGA might contribute to a better understanding of frailty in these patients. Therefore, it is possible that CGA application to CKD older patients would contribute to the selection of patients who might benefit the most from RRT and to improve patient clinical condition. This article aims to review geriatric syndromes and frailty in CKD patients, CGA potential to evaluate them and possible models to apply it.

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Geriatric Assessment in Advanced Kidney Disease

Cited by 30 publications

References 10 publications

Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study

Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study

Frailty and the Potential Kidney Transplant Recipient: Time for a More Holistic Assessment?

Comprehensive geriatric assessment in nephrology

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