Design of a consensus-based geriatric assessment tailored for older chronic kidney disease patients: results of a pragmatic approach

Abstract

Purpose Unidentified cognitive decline and other geriatric impairments are prevalent in older patients with advanced chronic kidney disease (CKD). Despite guideline recommendation of geriatric evaluation, routine geriatric assessment is not common in these patients. While high burden of vascular disease and existing pre-dialysis care pathways mandate a tailored geriatric assessment, no consensus exists on which instruments are most suitable in this population to identify geriatric impairments. Therefore, the aim of this study was to propose a geriatric assessment, based on multidisciplinary consensus, to routinely identify major geriatric impairments in older people with advanced CKD. Methods A pragmatic approach was chosen, which included focus groups, literature review, inventory of current practices, an expert consensus meeting, and pilot testing. In preparation of the consensus meeting, we composed a project team and an expert panel (n = 33), drafted selection criteria for the selection of instruments, and assessed potential instruments for the geriatric assessment. Results Selection criteria related to general geriatric domains, clinical relevance, feasibility, and duration of the assessment. The consensus-assessment contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains. Administration of (seven) patient questionnaires and (ten) professional-administered instruments, by nurse (practitioners), takes estimated 20 and 40 min, respectively. Results are discussed in a multidisciplinary meeting including at least nephrology and geriatric expertise, informing nephrology treatment decisions, and follow-up interventions among which comprehensive geriatric assessment. Conclusion This first multidisciplinary consensus on nephrology-tailored geriatric assessment intent to benefit clinical care and enhance research comparability for older patients with advanced CKD.

Living with frailty and haemodialysis: a qualitative study

“…Barriers to implementation are not well established within the literature, but include uncertainty about how to identify and target suitable recipients [ 18 , 32 ], lack of time and knowledge [ 18 , 12 ], concern about participant burden [ 18 ] and inconsistent access to a broad multi-disciplinary team [ 12 ]. Whilst it is not yet known if CGA leads to improved outcomes in people with chronic kidney disease, existing evidence suggests that CGA can successfully be integrated, in a modified format, into routine kidney care, leading to improved experience, identification of geria tric impairments, and initiation of discussion around treatment decisions [ 11 , 12 , 33 – 35 ]. These modified versions of CGA are typically completed by one or two assessors (usually a nurse and/ or nephrologist) who conduct a streamlined version of the CGA.…”

Targeted Non-Pharmacological Interventions for People Living with Frailty and Chronic Kidney Disease

“…Using a structured geriatric assessment, van Loon et al [47] demonstrated that nearly half of older people starting dialysis had three or more geriatric impairments. Voorend et al [49] demonstrated that geriatric assessment was useful to identify trends in geriatric domains and provided a reason to set targeted interventions. In addition, geriatric assessment helped to initiate dialogue on treatment decisions, including prompting the consideration of different treatment options [49].…”

“…Voorend et al [49] demonstrated that geriatric assessment was useful to identify trends in geriatric domains and provided a reason to set targeted interventions. In addition, geriatric assessment helped to initiate dialogue on treatment decisions, including prompting the consideration of different treatment options [49]. It is not yet known if CGA leads to improved outcomes in people with CKD; however, studies are underway [49][50][51].…”

“…In addition, geriatric assessment helped to initiate dialogue on treatment decisions, including prompting the consideration of different treatment options [49]. It is not yet known if CGA leads to improved outcomes in people with CKD; however, studies are underway [49][50][51]. Existing evidence suggests that CGA or modified versions can be used to assess people with frailty and CKD to identify associated geriatric impairments, which in turn can guide future targeted interventions.…”

Self‐management interventions for issues identified in a geriatric assessment: A systematic review

“…For older adults, geriatric assessment (GA) is recommended to help with treatment decision-making for diseases such as cancer or chronic kidney disease or for surgery, yet shortages of geriatric teams and the growing number of older adults limit access to GA. [1][2][3] An online self-assessed GA could make GA more accessible. GA consists of several questionnaires and tests that assess the medical, physical, social, and psychological functioning of older adults to identify deficits that may be amenable to targeted interventions in order to optimize health and well-being.…”