Systematic comprehensive geriatric assessment in elderly patients on chronic dialysis: a cross-sectional comparative and feasibility study

Parlevliet, Juliette L.; Buurman, Bianca M.; Pannekeet, Marja M.; Boeschoten, Els M; Brinke, Lucia ten; Hamaker, Marije E.; Munster, Barbara C. Van; Rooij, Sophia E. de

doi:10.1186/1471-2369-13-30

Cited by 49 publications

(62 citation statements)

References 43 publications

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“…A GA has been proposed as a supportive instrument for treatment decision making in ESRD as well (4,26). It provides the best available evidence on the patients' physiologic reserves and consequently, a better estimation of residual life expectancy (47).…”

Section: Discussionmentioning

confidence: 99%

“…Concrete information on impaired domains that could compromise dialysis treatment may facilitate shared decision making with the patient and relatives. In addition, it may reveal treatable conditions that would otherwise be overlooked (4,48), thereby forming a starting point for (preventive) interventions to optimize quality of life, such as physical and ADL impairments and social problems (45,49). Finally, the information derived from a GA may help to estimate adverse outcomes of surgical interventions (50) and other complex interventions (51).…”

Section: Discussionmentioning

confidence: 99%

“…Underlying mechanisms, such as inflammation and microvascular damage, contribute to both decline of kidney function and development of impairment across other physiologic domains. Consequently, a high prevalence of impairment in physical and psychosocial domains, such as dependency in activities of daily living (ADLs), cognitive impairment, depression, and malnutrition, can be found in the dialysis population in both young (3) and older patients (4). There may be considerable interaction between various domains.…”

Section: Introductionmentioning

confidence: 99%

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The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Loon

Wouters²,

Boereboom

et al. 2016

CJASN

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Background and objectives With aging of the general population, patients who enter dialysis therapy will more frequently have geriatric impairments and a considerable comorbidity burden. The most vulnerable among these patients might benefit from conservative therapy. Whether assessment of geriatric impairments would contribute to the decision-making process of dialysis initiation is unknown.Design, setting, participants, & measurements A systematic Medline and Embase search was performed on December 1, 2015 to identify studies assessing the association between risk of mortality or hospitalization and one or more geriatric impairments at the start of dialysis therapy, including impairment of cognitive function, mood, performance status or (instrumental) activities of daily living, mobility (including falls), social environment, or nutritional status.Results Twenty-seven studies were identified that assessed one or more geriatric impairments with respect to prognosis. The quality of most studies was moderate. Only seven studies carried out an analysis of elderly patients ($70 years old). Malnutrition and frailty were systematically assessed, and their relation with mortality was clear. In addition, cognitive impairment and functional outcomes at the initiation of dialysis were related to an increased mortality in most studies. However, not all studies applied systematic assessment tools, thereby potentially missing relevant impairment. None of the studies applied a geriatric assessment across multiple domains.Conclusions Geriatric impairment across multiple domains at dialysis initiation is related to poor outcome. However, information in the elderly is sparse, and a systematic approach of multiple domains with respect to poor outcome has not been performed. Because a geriatric assessment has proved useful in predicting outcome in other medical fields, its potential role in the ESRD population should be the subject of future research.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Loon

Wouters²,

Boereboom

et al. 2016

CJASN

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“…Previous studies have also found that elderly dialysis patients frequently suffer from multiple geriatric impairments, not all of which are identified by the nephrology team. 24 This appears to be due in large part to the fact that these issues are not specifically looked for. In our study, we found that visual and hearing impairments, cognitive dysfunction and psychosocial issues were not reported most often.…”

Section: Discussionmentioning

confidence: 99%

Groningen frailty indicator in older patients with end-stage renal disease

et al. 2015

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Background: Currently over 55% of end-stage renal disease (ESRD) patients are aged 60 years and patients 475 years represent the fastest growing segment of the dialysis population. We aimed to assess whether the Groningen frailty indicator (GFI) can be used to distinguish fit older ESRD patients, likely able to tolerate and benefit from dialysis, from frail older patients who need further evaluation with a geriatrician's comprehensive assessment. Methods: All patients aged 65 years visiting the pre-dialysis unit at the Gelre hospital between 2007 and 2013 were included and underwent the GFI (n ¼ 65). Patients with GFI 4 (frail) were referred for geriatric consultation (n ¼ 13). Results of the GFI and nephrologists' evaluation were compared with geriatrician's assessment. Survival rates and outcomes after one year of follow up were recorded. Results: Twenty patients (32%) were identified as frail. Of the problems identified by the geriatrician in 13 patients, 55% were not reported in the nephrologists' notes. The first year after inclusion, 30% of patients with a GFI 4 died, compared to 9% of fit patients (p ¼ 0.04). Moreover, 90% of frail patients had been hospitalized one or more times, compared to 53% in the fit group (p ¼ 0.005). Conclusion: Although the GFI can be a useful instrument to identify ESRD patients at risk, both the GFI and the nephrologists' assessment failed to identify specific geriatric impairments. Further research is needed to develop a specific frailty indicator for ESRD patients and to determine the value and effect of a comprehensive geriatric assessment in ESRD patients.

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“…8 Decreased functional capacity, sensory deficits, cognitive impairment and depression have frequently been found in hemodialysis (HD) patients [9][10][11] but only a few studies used comprehensive geriatric assessment (CGA) to evaluate HD patients. [11][12][13][14] CGA is a multidimensional procedure designed to evaluate an older person's physical health, functional ability, cognition and mental health, and socioenvironmental circumstances, as well as an extensive review of prescriptions. It was developed in order to improve coordination and integration of treatment and follow-up of elderly patients, together with the outcome.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients

Račić

Petković

Bogićević³

et al. 2015

Renal Failure

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Backgrounds: The quality of life and survival of elderly depend not only on their age but on many social and health factors. In the present study, comprehensive geriatric assessment (CGA) was made in elderly patients on regular hemodialysis (HD) and those without chronic kidney disease recruited in primary health care in order to compare their sociodemographic characteristics, physical health, functional ability and social support. Method: The 106 HD patients and 300 primary care patients aged 70 years and more were studied. Data on sociodemographic characteristics, neurosensory deficits, pain, falls, polypharmacy, basic activities of daily living (ADL) questionnaire, instrumental activities of daily living (IADL) questionnaire were obtained during interview. The Timed Up and Go, Nutritional Health Checklist, Two Question Instrument for depression and Charlson comorbidity index (CCI) were applied. Results: No significant differences were found for age, gender, education level and dwelling between the two groups. A lower percentage of HD patients lived alone when compared with controls. BMI 425 kg/m 2 had 43.4% of HD patients and 49.3% of controls. CCI differed significantly between HD and primary care patients (median: 6 vs. 4) and significantly more HD patients reported depression. No significant difference was found between groups for cognitive dysfunction and ADL, but HD patients had significantly lower IADL scores than controls. The mobility of HD patients was worse; 45.7% of them reported falls in the previous year but only 9.7% from the controls. Conclusions: CGA revealed that HD patients had significantly higher CCI, worse IADL score, mobility and reported more frequent falls, depression and impaired vision than primary care patients.

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Systematic comprehensive geriatric assessment in elderly patients on chronic dialysis: a cross-sectional comparative and feasibility study

Cited by 49 publications

References 43 publications

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Groningen frailty indicator in older patients with end-stage renal disease

Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients

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