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Author Notes:

Address correspondence to Rasheeda Hall, MD, MBA, MHS Duke University, Box DUMC 2747, 2424 Erwin Road Suite 605, Durham, NC 27710. E-mail: rasheeda.stephens@dm.duke.edu

Study concept and design: Rasheeda K. Hall, Carol Haines, Steven M. Gorbatkin, Lynn Schlanger, Hesham Shaban, Jane O. Schell, Susan B. Gurley, Cathleen S. Colón-Emeric, C. Barrett Bowling

Acquisition of subjects and/or data: Rasheeda K. Hall, Carol Haines, Steven M. Gorbatkin, Lynn Schlanger, Hesham Shaban, Jane O. Schell, C. Barrett Bowling

Analysis and interpretation of data: Rasheeda K. Hall and C. Barrett Bowling

Preparation of manuscript: Rasheeda K. Hall, Carol Haines, Steven M. Gorbatkin, Lynn Schlanger, Hesham Shaban, Jane O. Schell, Susan B. Gurley, Cathleen S. Colón-Emeric, C. Barrett Bowling

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.

Subject:

Research Funding:

This study is supported by the Veterans’ Affairs (VA) Office of Rural Health T21Program, the VA Office of Geriatrics and Extended Care Patient Centered Alternatives to Institutional Care T21Program, and a Career Development Award from the US Department of Veterans Affairs (1IK2CX000856-01A1 to CBB).

National Institutes of Health support provided through the Claude D. Pepper Older Americans Independence Center (P30 AG028716), R03 AG050834, and K24 AG049077-01A1.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Geriatrics & Gerontology
  • Gerontology
  • renal insufficiency
  • functional status
  • veterans
  • frail elderly
  • dialysis decision-making
  • CHRONIC KIDNEY-DISEASE
  • OLDER-ADULTS
  • CONTROLLED-TRIALS
  • DIALYSIS
  • HEMODIALYSIS
  • MORTALITY
  • FRAILTY
  • COHORT
  • CKD

Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data from Two Models of Care

Tools:

Journal Title:

Journal of the American Geriatrics Society

Volume:

Volume 64, Number 10

Publisher:

, Pages 2154-2158

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Older adults with advanced chronic kidney disease (CKD) experience functional impairment that can complicate CKD management. Failure to recognize functional impairment may put these individuals at risk of further functional decline, nursing home placement, and missed opportunities for timely goals-of-care conversations. Routine geriatric assessment could be a useful tool for identifying older adults with CKD who are at risk of functional decline and provide contextual information to guide clinical decision-making. Two innovative programs were implemented in the Veterans Health Administration that incorporate geriatric assessment into a nephrology visit. In one program, a geriatrician embedded in a nephrology clinic used standardized geriatric assessment tools with individuals with CKD aged 70 and older (Comprehensive Geriatric Assessment for CKD) (CGA-4-CKD). In the second program, a nephrology clinic used comprehensive appointments for individuals aged 75 and older to conduct geriatric assessments and CKD care (Renal Silver). Data on 68 veterans who had geriatric assessments through these programs between November 2013 and May 2015 are reported. In CGA-4-CKD, difficulty with one or more activities of daily living (ADLs), history of falls, and cognitive impairment were each found in 27.3% of participants. ADL difficulty was found in 65.7%, falls in 28.6%, and cognitive impairment in 51.6% of participants in Renal Silver. Geriatric assessment guided care processes in 45.4% (n = 15) of veterans in the CGA-4-CKD program and 37.1% (n = 13) of those in Renal Silver. Findings suggest there is a significant burden of functional impairment in older adults with CKD. Knowledge of this impairment is applicable to CKD management.

Copyright information:

© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society

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