Geriatric Assessment in Elderly Patients with End-Stage Kidney Disease

Abstract

Background/Aims: Decision-making in elderly patients considering dialysis is highly complex. With the increasing number of elderly with end-stage kidney disease (ESKD), it may be important to assess geriatric impairments in this population. The aim of the Geriatric assessment in OLder patients starting Dialysis (GOLD) study was to assess the prevalence of geriatric impairments and frailty in the elderly ESKD population by means of a geriatric assessment (GA), which is a comprehensive tool for overall health assessment. Methods: This study included 285 patients ≥65 years: 196 patients at the time of dialysis initiation and 89 patients who chose maximal conservative management (MCM). The GA assessed cognition, mood, nutritional status, (instrumental) activities of daily living (ADL), mobility, comorbidity burden, quality of life and overall frailty. Results: The mean age of the participants was 78 years and 36% were women. Of the incident dialysis patients, 77% started haemodialysis and 23% started peritoneal dialysis. Geriatric impairments were highly prevalent in both dialysis and MCM patients. Most frequently impaired geriatric domains in the dialysis group were functional performance (ADL 29%, instrumental ADL (iADL) 79%), cognition (67%) and comorbidity (41%). According to the GA, 77% in the dialysis group and 88% in the MCM group had 2 or more geriatric impairments. In the MCM group, functional impairment (ADL 45%, iADL 85%) was highly prevalent. Conclusions: Geriatric impairments are highly prevalent in the elderly ESKD population. Since impairments can be missed when not searched for in regular (pre)dialysis care, the first step of improving nephrologic care is awareness of the extensiveness of geriatric impairment.

Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

“…Notably, all patients experienced problems with IADLs. Previous studies have demonstrated a high prevalence of problems with IADLs in advanced CKD [28][29][30] and an association between problems with IADLs and hospitalisation and mortality [27]. Given the high prevalence of problems with IADLs, the high proportion of patients considered at risk of future falls is unsurprising.…”

<p>Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3–5: A Case–Control Study</p>

“…6 Frailty patients are characterized by fatigue, weight loss, muscle weakness and decreased functioning, often leading to an increased risk of falls, disability and hospitalization. 7 The current assessment methods of frailty, such as frailty index 8 and comprehensive geriatric assessment (CGA), 9 all include the assessment of physical functions of the elderly, one of which is activities of daily living (ADL). ADL is a convenient way to assess a person's functional level, referring to the ability of a person to perform his or her daily activities.…”

Disability of Dialysis Patients and the Condition of Blood Vessels

“…Half of the studied population (48% of patients) was functionally dependent and their Barthel index was lower than <80 points, which means that they need support in at least one ADL. Previous studies reported the approximate rates of functional impairment in ADLs (29–52%) [ 11 , 12 ]. The prevalence of disability among patients with chronic kidney disease (CKD), not receiving dialysis, accounts for 18–24% of elderly patients over 65 years.…”