Geriatric assessment is ‘beneficial,’ may be integrated with CKD care in older patients
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Key takeaways:
- Geriatric assessment was successfully implemented in 10 Dutch centers with 191 patients.
- The relevance of geriatric assessment for routine care was rated 7.8 out of 10.
Geriatric assessment may be successfully applied to chronic kidney disease care for patients older than 70 years, and health care providers perceive it as relevant and beneficial, data show.
“Among the increasing population of older patients with kidney failure, unrecognized geriatric impairments are highly prevalent,” Carlijn G. N. Voorend, MSc, of the nephrology department at Leiden University Medical Center in the Netherlands, wrote with colleagues. Therefore, “understanding geriatric impairments can be valuable for decision-making for kidney replacement therapy choices and for risk stratification.”
In a mixed-methods implementation study of 10 Dutch nephrology centers, researchers evaluated 191 patients aged 70 years and older with an eGFR of 20 mL/min or lower. The aim was to apply consensus-based geriatric assessment in 10 centers and evaluate the outcomes for 200 patients. Implementation was measured by perceived enablers and barriers, such as integration in work routines, and relevance of the instruments to care.
The nephrology-based geriatric review included a test set of 16 instruments on functional, cognitive, psychosocial and somatic domains, and patient-reported outcome measures. Geriatric assessment was successfully implemented in all 10 centers and 191 patients, the findings showed.
Responses from health care professionals showed multidisciplinary collaboration, including meetings with geriatricians, and the involvement of nurses in assessments as determinants that facilitated implementation, Voorend and colleagues found. The researchers deemed the Clinical Frailty Score and Montreal Cognitive Assessment as the most pertinent instruments. Conversely, researchers also highlighted barriers in implementing the assessment such as patient illiteracy or language difficulties, time constraints and patient burden.
Overall, the relevance of geriatric assessment for routine care was rated 7.8 out of 10.
“Future research should evaluate implementation of management of geriatric impairments and establish efficacy of geriatric practices in nephrology, as was done in other medical fields,” the researchers wrote. Further work may also investigate “acceptability from [the] patient perspective and the use of cross-cultural instruments.”
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