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Voorend CG, Berkhout-Byrne NC, van Bodegom-Vos L, Diepenbroek A, Franssen CF, Joosten H, Mooijaart SP, Bos WJW, van Buren M. Geriatric Assessment in CKD Care: An Implementation Study. Kidney Med 2024; 6:100809. [PMID: 38660344 PMCID: PMC11039322 DOI: 10.1016/j.xkme.2024.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Rationale & Objective Older people with progressive chronic kidney disease (CKD) have complex health care needs. Geriatric evaluation preceding decision making for kidney replacement is recommended in guidelines, but implementation is lacking in routine care. We aimed to evaluate implementation of geriatric assessment in CKD care. Study Design Mixed methods implementation study. Setting & Participants Dutch nephrology centers were approached for implementation of geriatric assessment in patients aged ≥70 years and with an estimated glomerular filtration rate of ≤20 mL/min/1.73 m2. Quality Improvement Activities/Exposure We implemented a consensus-based nephrology-tailored geriatric assessment: a patient questionnaire and professionally administered test set comprising 16 instruments covering functional, cognitive, psychosocial, and somatic domains and patient-reported outcome measures. Outcomes We aimed for implementation in 10 centers and 200 patients. Implementation was evaluated by (i) perceived enablers and barriers of implementation, including integration in work routines (Normalization Measure Development Tool) and (ii) relevance of the instruments to routine care for the target population. Analytical Approach Variations in implementation practices were described based on field notes. The postimplementation survey among health care professionals was analyzed descriptively, using an explanatory qualitative approach for open-ended questions. Results Geriatric assessment was implemented in 10 centers among 191 patients. Survey respondents (n = 71, 88% response rate) identified determinants that facilitated implementation, ie, multidisciplinary collaboration (with geriatricians) -meetings and reports and execution of assessments by nurses. Barriers to implementation were patient illiteracy or language barrier, time constraints, and patient burden. Professionals considered geriatric assessment sufficiently integrated into work routines (mean, 6.7/10 ± 2.0 [SD]) but also subject to improvement. Likewise, the relevance of geriatric assessment for routine care was scored as 7.8/10 ± 1.2. The Clinical Frailty Score and Montreal Cognitive Assessment were perceived as the most relevant instruments. Limitations Selection bias of interventions' early adopters may limit generalizability. Conclusions Geriatric assessment could successfully be integrated in CKD care and was perceived relevant to health care professionals.
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Affiliation(s)
- Carlijn G.N. Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Noeleen C. Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper F.M. Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W. Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolijn van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
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2
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Kennard AL, Glasgow NJ, Rainsford SE, Talaulikar GS. Narrative Review: Clinical Implications and Assessment of Frailty in Patients With Advanced CKD. Kidney Int Rep 2024; 9:791-806. [PMID: 38765572 PMCID: PMC11101734 DOI: 10.1016/j.ekir.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 05/22/2024] Open
Abstract
Frailty is a multidimensional clinical syndrome characterized by low physical activity, reduced strength, accumulation of multiorgan deficits, decreased physiological reserve, and vulnerability to stressors. Frailty has key social, psychological, and cognitive implications. Frailty is accelerated by uremia, leading to a high prevalence of frailty in patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) as well as contributing to adverse outcomes in this patient population. Frailty assessment is not routine in patients with CKD; however, a number of validated clinical assessment tools can assist in prognostication. Frailty assessment in nephrology populations supports shared decision-making and advanced communication and should inform key medical transitions. Frailty screening and interventions in CKD or ESKD are a developing research priority with a rapidly expanding literature base.
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Affiliation(s)
- Alice L. Kennard
- Department of Renal Medicine, Canberra Health Services, Australian Capital Territory, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas J. Glasgow
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Suzanne E. Rainsford
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Girish S. Talaulikar
- Department of Renal Medicine, Canberra Health Services, Australian Capital Territory, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
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3
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Wu HH, Poulikakos D, Hurst H, Lewis D, Chinnadurai R. Delivering Personalized, Goal-Directed Care to Older Patients Receiving Peritoneal Dialysis. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:358-370. [PMID: 37901709 PMCID: PMC10601915 DOI: 10.1159/000531367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/26/2023] [Indexed: 10/31/2023]
Abstract
Background An aging population living with chronic kidney disease and progressing to kidney failure, subsequently receiving peritoneal dialysis (PD) is growing. A significant proportion of these patients are also living with multi-morbidities and some degree of frailty. Recent practice recommendations from the International Society of Peritoneal Dialysis advocate for high-quality, goal-directed PD prescription, and the Standardized Outcomes of Nephrology-PD initiative emphasized the need for an individualized, goal-based care approach in all patients receiving PD treatment. In older patients, this approach to PD care is even more important. A frailty screening assessment, followed by a comprehensive geriatric assessment (CGA) prior to PD initiation and when dictated by change in relevant circumstances is paramount in tailoring PD care and prescription according to the needs, life goals, as well as clinical status of older patients with kidney failure. Summary Our review aimed to summarize the different dimensions to be taken into account when delivering PD care to the older patient - from frailty screening and CGA in older patients receiving PD to employing a personalized, goal-directed PD prescription strategy, to preserving residual kidney function, optimizing blood pressure (BP) control, and managing anemia, to addressing symptom burden, to managing nutritional intake and promoting physical exercise, and to explore telehealth opportunities for the older PD population. Key Messages What matters most to older PD patients may not be simply extending survival, but more importantly, to be living comfortably on PD treatment with minimal symptom burden in a home environment and to minimize treatment complications.
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Affiliation(s)
- Henry H.L. Wu
- Department of Renal Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
- Renal Research, Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Dimitrios Poulikakos
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Helen Hurst
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Paula Ormandy School of Health and Society, University of Salford, Salford, UK
| | - David Lewis
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
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4
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Hurst H, Young HML, Nixon AC, Ormandy P, Brettle A, Winterbottom A, Bekker H, Brown EA, Murtagh FEM, Da Silva-Gane M, Coyle D, Finnigan R. Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease: a multi-professional scoping review. Age Ageing 2022; 51:6964934. [PMID: 36580559 DOI: 10.1093/ageing/afac296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Indexed: 12/30/2022] Open
Abstract
The growing older population with advanced chronic kidney disease (ACKD stages 4-5) poses a challenge for healthcare worldwide. The high prevalence of frailty and associated adverse health outcomes highlights concerns for management and interventions specific to this population. The aim was to objectively review the evidence relating to older people (≥65 years) living with frailty and ACKD. More specifically how frailty is identified, what interventions have been studied and what outcomes have been reported including outcomes important to patients, families and carers. A scoping review was undertaken following the PRISMA-Scr guidelines. Nine databases were searched and a review team of five people followed a process using defined inclusion and exclusion criteria. Data were then analysed to answer the specific questions of the review. The World Health Organization's International Classification of Functioning Disability and Health was used to map outcomes across the domains. A total of 90 studies were included. The most reported frailty measure was the frailty phenotype. The most reported outcomes were mortality, hospitalisation and healthcare utilisation. Health-related quality of life was the most common patient-reported outcome measure. There were few intervention studies and limited evidence of patient and carer perspectives. This scoping review highlights important areas for further research in older people living with frailty and ACKD. This includes a 'gold standard' measure for identifying frailty, interventions and improvements in outcome measures that matter to patients (including studies that focus on carers and carer burden) and priority setting for future research.
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Affiliation(s)
- Helen Hurst
- The University of Manchester, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Hannah M L Young
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.,Department of Research and Innovation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Salford, UK
| | - Alison Brettle
- School of Health and Society, University of Salford, Salford, UK
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5
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Wu HHL, Dhaygude AP, Mitra S, Tennankore KK. Home dialysis in older adults: challenges and solutions. Clin Kidney J 2022; 16:422-431. [PMID: 36865019 PMCID: PMC9972827 DOI: 10.1093/ckj/sfac220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Indexed: 11/14/2022] Open
Abstract
There is a rising demand for dialysis in the older population given the increased numbers of older adults living with chronic kidney disease (CKD) progressing to kidney failure. Home dialysis, i.e. peritoneal dialysis (PD) and home hemodialysis (HHD), has been available for decades, but more recently there has been a rapid increase in home dialysis utilization as patients and clinicians consider its practical and clinical advantages. For older adults, incident home dialysis utilization more than doubled and prevalent home dialysis growth nearly doubled over the past decade. Whilst its advantages and recent rise in popularity are evident, there are numerous barriers and challenges that are important to consider prior to initiating older adults on home dialysis. Some nephrology healthcare professionals do not view home dialysis as an option for older adults. Successful delivery of home dialysis for older adults may be made even more difficult by physical or cognitive limitations, concerns around dialysis adequacy, and treatment-related complications, as well as challenges relating to caregiver burnout and patient frailty that are unique to home dialysis and older adults. Ultimately, it would be important for clinicians, patients and their caregivers to define what constitutes a 'successful therapy' to ensure treatment goals are aligned towards each individual's priorities of care, considering the complex challenges that surround an older adult receiving home dialysis. In this review, we evaluate some of the key challenges surrounding the delivery of home dialysis to older adults and propose potential solutions based on updated evidence to overcome these challenges.
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Affiliation(s)
| | - Ajay P Dhaygude
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Sandip Mitra
- Department of Renal Medicine, Manchester Academy of Health Sciences Centre, Manchester University Hospitals, Manchester, UK
| | - Karthik K Tennankore
- Dalhousie University and Nova Scotia Health, Dickson Building, 5820 University Avenue, Halifax, Nova Scotia, Canada
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6
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Palliative Care for Patients with Kidney Disease. J Clin Med 2022; 11:jcm11133923. [PMID: 35807208 PMCID: PMC9267754 DOI: 10.3390/jcm11133923] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 11/16/2022] Open
Abstract
Interest in palliative care has increased in recent times, particularly in its multidisciplinary approach developed to meet the needs of patients with a life-threatening disease and their families. Although the modern concept of palliative simultaneous care postulates the adoption of these qualitative treatments early on during the life-threatening disease (and potentially just after the diagnosis), palliative care is still reserved for patients at the end of their life in most of the clinical realities, and thus is consequently mistaken for hospice care. Patients with acute or chronic kidney disease (CKD) usually experience poor quality of life and decreased survival expectancy and thus may benefit from palliative care. Palliative care requires close collaboration among multiple health care providers, patients, and their families to share the diagnosis, prognosis, realistic treatment goals, and treatment decisions. Several approaches, such as conservative management, extracorporeal, and peritoneal palliative dialysis, can be attempted to globally meet the needs of patients with kidney disease (e.g., physical, social, psychological, or spiritual needs). Particularly for frail patients, pharmacologic management or peritoneal dialysis may be more appropriate than extracorporeal treatment. Extracorporeal dialysis treatment may be disproportionate in these patients and associated with a high burden of symptoms correlated with this invasive procedure. For those patients undergoing extracorporeal dialysis, individualized goal setting and a broader concept of adequacy should be considered as the foundations of extracorporeal palliative dialysis. Interestingly, little evidence is available on palliative and end of life care for acute kidney injury (AKI) patients. In this review, the main variables influencing medical decision-making about palliative care in patients with kidney disease are described, as well as the different approaches that can fulfill the needs of patients with CKD and AKI.
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7
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Liu CK, Seo J, Lee D, Wright K, Kurella Tamura M, Moye J, Weiner DE, Bean JF. The Impact of Care Partners on the Mobility of Older Adults Receiving Hemodialysis. Kidney Med 2022; 4:100473. [PMID: 35663231 PMCID: PMC9157255 DOI: 10.1016/j.xkme.2022.100473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Rationale & Objective Many older adults receiving hemodialysis have mobility limitations and rely on care partners, yet data are sparse regarding the support provided by care partners. Our aim was to examine how care partners support the mobility of an older adult receiving hemodialysis. Study Design Qualitative study. Setting & Participants Using purposive sampling, we recruited persons aged 60 years or more receiving maintenance hemodialysis and care partners aged 18 years or more who were providing support to an older adult receiving hemodialysis. We conducted in-person semi-structured interviews about mobility with each individual. Analytical Approach We conducted descriptive and focused coding of interview transcripts and employed thematic analysis. Our outcome was to describe perceived mobility supports provided by care partners using qualitative themes. Results We enrolled 31 older adults receiving hemodialysis (42% women, 68% Black) with a mean age of 73 ± 8 years and a mean dialysis duration of 4.6 ± 3.5 years. Of these, 87% of patients used assistive devices and 90% had care partners. We enrolled 12 care partners (75% women, 33% Black) with a mean age of 54 ± 16 years. From our patient and care partner interviews, we found three themes: (1) what care partners see, (2) what care partners do, and (3) what care partners feel. Regarding what they see, care partners witness a decline in patient mobility. Regarding what they do, care partners guide and facilitate activities and manage others who also assist. Regarding what they feel, care partners respect the patient’s autonomy but experience frustration and worry about the patient’s future mobility. Limitations Modest sample size; single geographic area. Conclusions In older adults receiving hemodialysis, care partners observe a decline in mobility and provide support for mobility. They respect the patient’s autonomy but worry about future mobility losses. Future research should incorporate care partners in interventions that address mobility in older adults receiving hemodialysis.
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8
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Gerogianni G, Polikandrioti M, Alikari V, Vasilopoulos G, Zartaloudi A, Koutelekos I, Kalafatakis F, Babatsikou F. Factors Affecting Anxiety and Depression in Caregivers of Hemodialysis Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1337:47-58. [PMID: 34972890 DOI: 10.1007/978-3-030-78771-4_6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anxiety and depression have high levels in caregivers of patients on hemodialysis and are strongly associated with demographic factors. The aim of this study was to evaluate the factors affecting anxiety and depression in caregivers of hemodialysis patients. Four hundred and fourteen (414) caregivers (98 males and 316 females) participated in this study. Depression and anxiety were assessed by the Hospital Anxiety and Depression Scale (HADS), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). Multinomial logistic regression was performed to estimate the factors being independently associated with anxiety and depression levels. Multiple linear regression was performed to estimate the factors being independently associated with Beck Depression Inventory and State-Trait Anxiety Inventory. From a total of 414 participants, 125 (30.2%) had depression and 215 (52%) had anxiety. The median age of respondents was 54.34 (43.9-66.28) years, with half of the sample's age ranging from 43.9 to 66.28 (IQR). Depression and anxiety were significantly associated with parents or siblings, low level of education, increased caregivers' age, retirement, poor financial condition, having children, and comorbidities. In this study, a significant proportion of caregivers were found to have high levels of depression and anxiety. Thus, a formal screening can contribute to early diagnosis and treatment of depression and anxiety in caregivers of patients on hemodialysis.
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Affiliation(s)
| | | | - Victoria Alikari
- Department of Nursing, University of West Attica, Athens, Greece
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9
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Wolfe WA. Loneliness: An Overlooked Contributing Factor in Anorexia of Older Patients With End-Stage Renal Disease and Focal Point for Interventions to Enhance Nutritional Status-An Overview of Evidence and Areas of Suggested Research. J Ren Nutr 2021; 32:498-502. [PMID: 34772602 DOI: 10.1053/j.jrn.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/20/2021] [Accepted: 10/03/2021] [Indexed: 11/11/2022] Open
Abstract
Although research has shown that loneliness can contribute to anorexia in older non-ESRD (end-stage renal disease) populations, and the benefits of its mitigation with improving appetite, nutrient, and caloric intake, its implications for older patients with ESRD have been overlooked. This article provides an overview of evidence on the potential contributing role of loneliness in anorexia of older patients with ESRD, and loneliness as a focal point for interventions to help improve nutritional status. Areas of needed research are suggested in the course of the analysis. With a 41%-83% projected rise in the prevalence of patients in the United States with ESRD by 2030, and demographic population trends showing that an ever-increasing number will be living alone, there is a long overdue need to better understand the implications of loneliness for this nutritionally vulnerable population. KEYWORDS: Chronic kidney disease; loneliness; anorexia; malnutrition; protein energy wasting.
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Affiliation(s)
- William A Wolfe
- Women's Institute for Family Health of Philadelphia, Consultant & University of Pennsylvania, School of Social Policy & Practice, Graduate Student Mentoring.
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10
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Ellis-Smith C, Tunnard I, Dawkins M, Gao W, Higginson IJ, Evans CJ. Managing clinical uncertainty in older people towards the end of life: a systematic review of person-centred tools. BMC Palliat Care 2021; 20:168. [PMID: 34674695 PMCID: PMC8532380 DOI: 10.1186/s12904-021-00845-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022] Open
Abstract
Background Older people with multi-morbidities commonly experience an uncertain illness trajectory. Clinical uncertainty is challenging to manage, with risk of poor outcomes. Person-centred care is essential to align care and treatment with patient priorities and wishes. Use of evidence-based tools may support person-centred management of clinical uncertainty. We aimed to develop a logic model of person-centred evidence-based tools to manage clinical uncertainty in older people. Methods A systematic mixed-methods review with a results-based convergent synthesis design: a process-based iterative logic model was used, starting with a conceptual framework of clinical uncertainty in older people towards the end of life. This underpinned the methods. Medline, PsycINFO, CINAHL and ASSIA were searched from 2000 to December 2019, using a combination of terms: “uncertainty” AND “palliative care” AND “assessment” OR “care planning”. Studies were included if they developed or evaluated a person-centred tool to manage clinical uncertainty in people aged ≥65 years approaching the end of life and quality appraised using QualSyst. Quantitative and qualitative data were narratively synthesised and thematically analysed respectively and integrated into the logic model. Results Of the 17,095 articles identified, 44 were included, involving 63 tools. There was strong evidence that tools used in clinical care could improve identification of patient priorities and needs (n = 14 studies); that tools support partnership working between patients and practitioners (n = 8) and that tools support integrated care within and across teams and with patients and families (n = 14), improving patient outcomes such as quality of death and dying and satisfaction with care. Communication of clinical uncertainty to patients and families had the least evidence and is challenging to do well. Conclusion The identified logic model moves current knowledge from conceptualising clinical uncertainty to applying evidence-based tools to optimise person-centred management and improve patient outcomes. Key causal pathways are identification of individual priorities and needs, individual care and treatment and integrated care. Communication of clinical uncertainty to patients is challenging and requires training and skill and the use of tools to support practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00845-9.
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Affiliation(s)
- Clare Ellis-Smith
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
| | - India Tunnard
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - Marsha Dawkins
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.,Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.,King's College Hospital NHS Foundation Trust, London, UK
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.,Sussex Community NHS Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, UK
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11
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Novais T, Pongan E, Gervais F, Coste MH, Morelon E, Krolak-Salmon P, Vernaudon J. Pretransplant Comprehensive Geriatric Assessment in Older Patients with Advanced Chronic Kidney Disease. Nephron Clin Pract 2021; 145:692-701. [PMID: 34261074 DOI: 10.1159/000517342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In older patients with advanced chronic kidney disease (CKD), the decision of kidney transplantation (KT) is a challenge for nephrologists. The use of comprehensive geriatric assessment (CGA) is increasingly gaining interest into the process of decision-making about treatment modality choice for CKD. The aim of this study was to assess the prevalence of geriatric impairment and frailty in older dialysis and nondialysis patients with advanced CKD using a pretransplant CGA model and to identify geriatric impairments influencing the geriatricians' recommendations for KT. METHODS An observational study was conducted with retrospective data from July 2017 to January 2020. Patients aged ≥65 years with advanced CKD, treated or not with dialysis, and referred by the nephrologist were included in the study. The CGA assessed comorbidity burden, cognition, mood, nutritional status, (instrumental) activities of daily living, physical function, frailty, and polypharmacy. Geriatric impairments influencing the geriatricians' recommendations for KT were identified using univariate and multivariate logistic regressions. RESULTS 156 patients were included (74.2 ± 3.5 years and 62.2% on dialysis). Geriatric conditions were highly prevalent in both dialysis and nondialysis groups. The rate of geriatric impairments was higher in dialysis patients regarding comorbidity burden, symptoms of depression, physical function, autonomy, and frailty. Geriatrician's recommendations for KT were as follows: favorable (79.5%) versus not favorable or multidisciplinary discussion needed with nephrologists (20.5%). Dependence for Instrumental Activities of Daily Living (IADL) (odds ratio [OR] = 3.01 and 95% confidence interval [CI] = 1.30-7.31), physical functions (OR = 2.91 and 95% CI = 1.08-7.87), and frailty (OR = 2.66 and 95% CI = 1.07-6.65) were found to be independent geriatric impairments influencing geriatrician's recommendations for KT. CONCLUSIONS Understanding the burden of geriatric impairment provides an opportunity to direct KT decision-making and to guide interventions to prevent functional decline and preserve quality of life.
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Affiliation(s)
- Teddy Novais
- Pharmaceutical Unit, Lyon Institute for Elderly, Charpennes Hospital, University Hospital of Lyon, Lyon, France.,EA-7425 HESPER, Health Services and Performance Research, University Lyon, Lyon, France.,Claude Bernard Lyon 1 University, University Lyon 1, Lyon, France
| | - Elodie Pongan
- Day-Care Unit, Lyon Institute for Elderly, Charpennes Hospital, University Hospital of Lyon, Lyon, France
| | - Frederic Gervais
- Pharmaceutical Unit, Lyon Institute for Elderly, Charpennes Hospital, University Hospital of Lyon, Lyon, France
| | - Marie-Hélène Coste
- Day-Care Unit, Lyon Institute for Elderly, Charpennes Hospital, University Hospital of Lyon, Lyon, France.,Clinical and Research Memory Centre of Lyon, Lyon Institute for Elderly, Charpennes Hospital, University Hospital of Lyon, Lyon, France
| | - Emmanuel Morelon
- Nephrology, Transplantation and Clinical Immunology Department, RTRS « Centaure », Edouard Herriot Hospital, University Hospital of Lyon, Lyon, France
| | - Pierre Krolak-Salmon
- Day-Care Unit, Lyon Institute for Elderly, Charpennes Hospital, University Hospital of Lyon, Lyon, France.,Clinical and Research Memory Centre of Lyon, Lyon Institute for Elderly, Charpennes Hospital, University Hospital of Lyon, Lyon, France.,INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon, France
| | - Julien Vernaudon
- Day-Care Unit, Lyon Institute for Elderly, Charpennes Hospital, University Hospital of Lyon, Lyon, France.,Clinical and Research Memory Centre of Lyon, Lyon Institute for Elderly, Charpennes Hospital, University Hospital of Lyon, Lyon, France
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12
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Voorend CGN, Joosten H, Berkhout-Byrne NC, Diepenbroek A, Franssen CFM, Bos WJW, Van Buren M, Mooijaart SP. Design of a consensus-based geriatric assessment tailored for older chronic kidney disease patients: results of a pragmatic approach. Eur Geriatr Med 2021; 12:931-942. [PMID: 33871790 PMCID: PMC8463384 DOI: 10.1007/s41999-021-00498-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/08/2021] [Indexed: 12/15/2022]
Abstract
Aim To propose a consensus-based geriatric assessment for optimizing both routine care and research in older patients with advanced chronic kidney disease. Findings Using a pragmatic approach, we reached consensus on a suitable nephrology-tailored geriatric assessment to routinely identify major geriatric impairments in older patients with advanced chronic kidney disease. This geriatric assessment contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains, and can be administered with patient questionnaires and professional-administered instruments by nurse (practitioners) in approximately 20 and 40 minutes, respectively. Message We propose a consensus test set for standardized nephrology-tailored geriatric assessment, which is currently being implemented in multiple hospitals and studies, to benefit clinical care for older patients with advanced chronic kidney disease and enhance research comparability. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00498-0. 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. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00498-0.
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Affiliation(s)
- Carlijn G N Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands.
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Noeleen C Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper F M Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St. Antonius hospital, Nieuwegein, The Netherlands
| | - Marjolijn Van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Haga Hospital, The Hague, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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13
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Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study. BMC Nephrol 2021; 22:9. [PMID: 33407240 PMCID: PMC7789317 DOI: 10.1186/s12882-020-02206-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022] Open
Abstract
Background Older patients with end-stage kidney disease (ESKD) often live with unidentified frailty and multimorbidity. Despite guideline recommendations, geriatric assessment is not part of standard clinical care, resulting in a missed opportunity to enhance (clinical) outcomes including quality of life in these patients. To develop routine geriatric assessment programs for patients approaching ESKD, it is crucial to understand patients’ and professionals’ experiences with and perspectives about the benefits, facilitators and barriers for geriatric assessment. Methods In this qualitative study, semi-structured focus group discussions were conducted with ESKD patients, caregivers and professionals. Participants were purposively sampled from three Dutch hospital-based study- and routine care initiatives involving geriatric assessment for (pre-)ESKD care. Transcripts were analysed inductively using thematic analysis. Results In six focus-groups, participants (n = 47) demonstrated four major themes: (1) Perceived characteristics of the older (pre)ESKD patient group. Patients and professionals recognized increased vulnerability and (cognitive) comorbidity, which is often unrelated to calendar age. Both believed that often patients are in need of additional support in various geriatric domains. (2) Experiences with geriatric assessment. Patients regarded the content and the time spent on the geriatric assessment predominantly positive. Professionals emphasized that assessment creates awareness among the whole treatment team for cognitive and social problems, shifting the focus from mainly somatic to multidimensional problems. Outcomes of geriatric assessment were observed to enhance a dialogue on suitability of treatment options, (re)adjust treatment and provide/seek additional (social) support. (3) Barriers and facilitators for implementation of geriatric assessment in routine care. Discussed barriers included lack of communication about goals and interpretation of geriatric assessment, burden for patients, illiteracy, and organizational aspects. Major facilitators are good multidisciplinary cooperation, involvement of geriatrics and multidisciplinary team meetings. (4) Desired characteristics of a suitable geriatric assessment concerned the scope and use of tests and timing of assessment. Conclusions Patients and professionals were positive about using geriatric assessment in routine nephrology care. Implementation seems achievable, once barriers are overcome and facilitators are endorsed. Geriatric assessment in routine care appears promising to improve (clinical) outcomes in patients approaching ESKD. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02206-9.
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Lindayani L, Darmawati I, Purnama H, Permana B. Integrating Comprehensive Geriatric Assessment Into HIV Care Systems in Indonesia: A Synthesis of Recent Evidence. Creat Nurs 2020; 26:9-16. [PMID: 32024732 DOI: 10.1891/1078-4535.26.1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Combination antiretroviral therapy (cART) has improved the health and life expectancy of people living with human immunodeficiency virus (HIV). Comorbidities and geriatric syndrome are more prevalent in patients with HIV than in the general population. As a result, people living with HIV may face unique characteristics and needs related to aging. Health-care systems need to prepare to encounter those issues that not only focus on virology suppression and cART management but also chronic non-AIDS comorbidities and geriatric syndrome. However, there are limited data on geriatric assessment among people living with HIV. The purpose of this article is to present findings of a literature search that integrate age-related issues in HIV care management for health-care professionals caring for people living with HIV in Indonesia to consider. Integrating comprehensive geriatric assessment (CGA) into HIV care is essential. However, some critical issues need to be considered prior to implementing CGA in HIV primary care, including social vulnerability, economic inequality, and aging-related stigma. Developing guidelines for implementing CGA in HIV primary clinics remains a priority. Studies of HIV in the aging population in Indonesia need to be conducted to understand the burden of geriatric syndrome.
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15
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Apports d’une consultation gériatrique dans une association d’antennes d’auto-dialyse. Nephrol Ther 2020; 16:364-371. [DOI: 10.1016/j.nephro.2020.07.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/16/2020] [Accepted: 07/10/2020] [Indexed: 11/18/2022]
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16
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Potok OA, Rifkin DE. Applying a Geriatrics Framework to Older Dialysis Patients’ Needs: Getting There Is Half the Battle. Kidney Med 2020; 2:514-516. [PMID: 33095846 PMCID: PMC7568080 DOI: 10.1016/j.xkme.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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17
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Sugisawa H, Shinoda T, Shimizu Y, Kumagai T, Sugisaki H, Sugihara Y. Caregiving for Older Adults Requiring Hemodialysis: A Comparison Study. Ther Apher Dial 2019; 24:423-430. [PMID: 31693297 DOI: 10.1111/1744-9987.13453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
This study examined differences in caregiving appraisal between primary family caregivers of disabled older adults receiving hemodialysis (PFCGs-wHD) and disabled older adults not receiving dialysis (PFCGs-woD). A total of 242 PFCGs-wHD and 335 PFCGs-woD were included in the analyses. We used adjustment by propensity score to control for bias by confounding factors. Caregiving appraisal was measured in terms of role strain, emotional exhaustion, and caregiving satisfaction. On the first task, PFCGs-wHD demonstrated significantly worse levels on all three appraisal indicators than did PFCGs-woD. On the second task, only higher emotional exhaustion was significantly mediated by higher role strain in PFCGs-wHD. Further, PFCGs-wHD status directly influenced lower caregiving satisfaction without mediation by higher role strain. Caregiving for disabled older adults receiving HD may be associated with significant challenges for caregivers.
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Affiliation(s)
- Hidehiro Sugisawa
- Graduate School of Gerontology, J. F. Oberlin University, Tokyo, Japan
| | - Toshio Shinoda
- Faculty of Health and Medical Science, Tsukuba International University, Ibaraki, Japan
| | - Yumiko Shimizu
- Faculty of Nursing, The Jikei University School of Medicine, Tokyo, Japan
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18
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van Loon IN, Goto NA, Boereboom FTJ, Bots ML, Hoogeveen EK, Gamadia L, van Bommel EFH, van de Ven PJG, Douma CE, Vincent HH, Schrama YC, Lips J, Siezenga MA, Abrahams AC, Verhaar MC, Hamaker ME. Geriatric Assessment and the Relation with Mortality and Hospitalizations in Older Patients Starting Dialysis. Nephron Clin Pract 2019; 143:108-119. [PMID: 31408861 DOI: 10.1159/000501277] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/01/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A geriatric assessment (GA) is a structural method for identifying frail patients. The relation of GA findings and risk of death in end-stage kidney disease (ESKD) is not known. The objective of the GA in OLder patients starting Dialysis Study was to assess the association of GA at dialysis initiation with early mortality and hospitalization. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Patients ≥65 years old were included just prior to dialysis initiation. All participants underwent a GA, including assessment of (instrumental) activities of daily living (ADL), mobility, cognition, mood, nutrition, and comorbidity. In addition, a frailty screening (Fried Frailty Index, [FFI]) was applied. Outcome measures were 6- and 12-month mortality, and 6-month hospitalization. Associations with mortality were assessed with cox-regression adjusting for age, sex, comorbidity burden, smoking, residual kidney function and dialysis modality. Associations with hospitalization were assessed with logistic regression, adjusting for relevant confounders. RESULTS In all, 192 patients were included, mean age 75 ± 7 years, of whom 48% had ≥3 geriatric impairments and were considered frail. The FFI screening resulted in 46% frail patients. Mortality rate was 8 and 15% at 6- and 12-months after enrolment, and transplantation rate was 2 and 4% respectively. Twelve-month mortality risk was higher in patients with ≥3 impairments (hazard ratio [HR] 2.97 [95% CI 1.19-7.45]) compared to less impaired patients. FFI frail patients had a higher risk of 12-month mortality (HR 7.22 [95% CI 2.47-21.13]) and hospitalization (OR 1.93 [95% CI 1.00-3.72]) compared to fit patients. Malnutrition was associated with 12-month mortality, while impaired ADL and depressive symptoms were associated with 12-month mortality and hospitalization. CONCLUSIONS Frailty as assessed by a GA is related to mortality in elderly patients with ESKD. Individual components of the GA are related to both mortality and hospitalization. As the GA allows for distinguishing between frail and fit patients initiating dialysis, it is potentially of added value in the decision-making process concerning dialysis initiation.
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Affiliation(s)
- Ismay N van Loon
- Dianet Dialysis Center, Utrecht, The Netherlands, .,Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands, .,Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Namiko A Goto
- Department of Geriatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Franciscus T J Boereboom
- Dianet Dialysis Center, Utrecht, The Netherlands.,Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen K Hoogeveen
- Department of Internal Medicine Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Laila Gamadia
- Department of Internal Medicine Tergooi Hospital, Hilversum, The Netherlands
| | - E F H van Bommel
- Department of Internal Medicine Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - P J G van de Ven
- Department of Internal Medicine Maasstad Hospital, Rotterdam, The Netherlands
| | - Caroline E Douma
- Department of Internal Medicine Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - H H Vincent
- Department of Internal Medicine Antonius Hospital, Nieuwegein, The Netherlands
| | - Yvonne C Schrama
- Department of Internal Medicine St. Franciscus Hospital, Rotterdam, The Netherlands
| | - Joy Lips
- Department of Internal Medicine Bernhoven Hospital, Uden, The Netherlands
| | - Machiel A Siezenga
- Department of Internal Medicine Gelderse Vallei Hospital, Ede, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije E Hamaker
- Department of Geriatrics University Medical Center Utrecht, Utrecht, The Netherlands
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19
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Alencar SBVD, de Lima FM, Dias LDA, Dias VDA, Lessa AC, Bezerra JM, Apolinário JF, de Petribu KC. Depression and quality of life in older adults on hemodialysis. ACTA ACUST UNITED AC 2019; 42:195-200. [PMID: 31389496 PMCID: PMC7115449 DOI: 10.1590/1516-4446-2018-0345] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/03/2019] [Indexed: 01/28/2023]
Abstract
Objective: Depression is highly prevalent in hemodialysis patients, but few studies have evaluated older hemodialysis patients. The aim of this study was to evaluate the prevalence of depression, its associated factors and its impact on quality of life in an older population on hemodialysis. Methods: This was a cross-sectional study including 173 hemodialysis patients aged 60 years or older in Recife, Brazil. Depression was evaluated using the Mini-International Neuropsychiatric Interview when depressive symptoms (according to the 5-item Geriatric Depression Scale) were present. Quality of life was assessed with the Control, Autonomy, Self-realization and Pleasure Questionnaire (CASP-16). Data were also collected on sociodemographic, laboratory (albumin, parathormone, hemoglobin, and phosphorus) and dialysis (dialysis vintage, vascular access and hemodialysis adequacy) characteristics. Results: Depression was present in 22.5% of the sample. Depressed patients presented low CASP-16 quality of life scores (31.6 vs. 24.2, p < 0.001), twice the odds of albumin levels < 3.8 g/dL (OR 2.36; 95%CI 1.10-5.07; p = 0.027) and higher parathormone levels (OR 1.06; 95%CI 1.00-1.13; p = 0.05). Conclusion: Older hemodialysis patients have a high prevalence of depression. Depressed patients presented poor quality of life, lower serum albumin and higher parathormone levels. Teams dealing with older hemodialysis patients should include depression and quality of life assessments in care protocols.
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Affiliation(s)
- Saulo B V de Alencar
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Fábia M de Lima
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Luana do A Dias
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Victor do A Dias
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Anna C Lessa
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Jéssika M Bezerra
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Julianna F Apolinário
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
| | - Kátia C de Petribu
- Departamento de Nefrologia e Psiquiatria, Universidade de Pernambuco, Recife, PE, Brazil
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20
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Goto NA, van Loon IN, Boereboom FTJ, Emmelot-Vonk MH, Willems HC, Bots ML, Gamadia LE, van Bommel EFH, Van de Ven PJG, Douma CE, Vincent HH, Schrama YC, Lips J, Hoogeveen EK, Siezenga MA, Abrahams AC, Verhaar MC, Hamaker ME. Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden. Clin J Am Soc Nephrol 2019; 14:1039-1047. [PMID: 31248948 PMCID: PMC6625621 DOI: 10.2215/cjn.13131118] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/12/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Little is known about the functional course after initiating dialysis in elderly patients with ESKD. The aim of this study was to assess the association of the initiation of dialysis in an elderly population with functional status and caregiver burden. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS This study included participants aged ≥65 years with ESKD who were enrolled in the Geriatric Assessment in Older Patients Starting Dialysis study. All underwent a geriatric assessment and a frailty screening (Fried Frailty Index and Groningen Frailty Indicator) at dialysis initiation. Functional status (activities of daily life and instrumental activities of daily life) and caregiver burden were assessed at baseline and after 6 months. Decline was defined as loss of one or more domains in functional status, stable as no difference between baseline and follow-up, and improvement as gain of one or more domains in functional status. Logistic regression was performed to assess the association between the combined outcome functional decline/death and potential risk factors. RESULTS Of the 196 included participants functional data were available for 187 participants. Mean age was 75±7 years and 33% were women. At the start of dialysis, 79% were care dependent in functional status. After 6 months, 40% experienced a decline in functional status, 34% remained stable, 18% improved, and 8% died. The prevalence of high caregiver burden increased from 23%-38% (P=0.004). In the multivariable analysis age (odds ratio, 1.05; 95% confidence interval, 1.00 to 1.10 per year older at baseline) and a high Groningen Frailty Indicator compared with low score (odds ratio, 1.97; 95% confidence interval, 1.05 to 3.68) were associated with functional decline/death. CONCLUSIONS In patients aged ≥65 years, functional decline within the first 6 months after initiating dialysis is highly prevalent. The risk is higher in older and frail patients. Loss in functional status was mainly driven by decline in instrumental activities of daily life. Moreover, initiation of dialysis is accompanied by an increase in caregiver burden.
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Affiliation(s)
- Namiko A Goto
- Dianet Dialysis Center, Utrecht, The Netherlands; .,Department of Geriatrics
| | - Ismay N van Loon
- Dianet Dialysis Center, Utrecht, The Netherlands.,Department of Nephrology and Hypertension, and
| | | | | | - Hanna C Willems
- Department of Geriatrics, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laila E Gamadia
- Department of Internal Medicine, Tergooi Hospital, Hilversum, The Netherlands
| | - Eric F H van Bommel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Caroline E Douma
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - Yvonne C Schrama
- Department of Internal Medicine, St. Franciscus Hospital, Rotterdam, The Netherlands
| | - Joy Lips
- Department of Internal Medicine, Bernhoven Hospital, Uden, The Netherlands
| | - Ellen K Hoogeveen
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands; and
| | - Machiel A Siezenga
- Department of Internal Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | | | | | - Marije E Hamaker
- Department of Geriatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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Gilbertson EL, Krishnasamy R, Foote C, Kennard AL, Jardine MJ, Gray NA. Burden of Care and Quality of Life Among Caregivers for Adults Receiving Maintenance Dialysis: A Systematic Review. Am J Kidney Dis 2018; 73:332-343. [PMID: 30454885 DOI: 10.1053/j.ajkd.2018.09.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/16/2018] [Indexed: 01/11/2023]
Abstract
RATIONALE & OBJECTIVE Dialysis is a burdensome and complex treatment for which many recipients require support from caregivers. The impact of caring for people dependent on dialysis on the quality of life of the caregivers has been incompletely characterized. STUDY DESIGN Systematic review of quantitative studies of quality of life and burden to caregivers. SETTING & STUDY POPULATION Caregivers of adults receiving maintenance dialysis. SELECTION CRITERIA FOR STUDIES The Cochrane Library, Embase, PsycINFO, CINAHL, PubMed, and MEDLINE were systematically searched from inception until December 2016 for quantitative studies of caregivers. Pediatric and non-English language studies were excluded. Study quality was assessed using a modified Newcastle-Ottawa scale. DATA EXTRACTION 2 independent reviewers selected studies and extracted data using a prespecified extraction instrument. ANALYTICAL APPROACH Descriptive reports of demographics, measurement scales, and outcomes. Quantitative meta-analysis using random effects when possible. RESULTS 61 studies were identified that included 5,367 caregivers from 21 countries and assessed the impact on caregivers using 70 different scales. Most (85%) studies were cross-sectional. The largest identified group of caregivers was female spouses who cared for recipients of facility-based hemodialysis (72.3%) or peritoneal dialysis (20.6%). Caregiver quality of life was poorer than in the general population, mostly comparable with caregivers of people with other chronic diseases, and often better than experienced by the dialysis patients cared for. Caregiver quality of life was comparable across dialysis modalities. LIMITATIONS Heterogeneity in study design and outcome measures made comparisons between studies difficult and precluded quantitative meta-analysis. Study quality was generally poor. CONCLUSIONS Quality of life of caregivers of dialysis recipients is poorer than in the general population and comparable to that of caregivers of individuals with other chronic diseases. The impact of caring for recipients of home hemodialysis or changes in the impact of caring over time have not been well studied. Further research is needed to optimally inform dialysis programs how to educate and support caregivers.
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Affiliation(s)
- Elise L Gilbertson
- Department of Nephrology, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland; The University of Queensland, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland; The University of Queensland, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland
| | - Celine Foote
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia; Concord and Repatriation General Hospital, Concord, New South Wales, Australia
| | - Alice L Kennard
- Department of Nephrology, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland
| | - Meg J Jardine
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia; Concord and Repatriation General Hospital, Concord, New South Wales, Australia
| | - Nicholas A Gray
- Department of Nephrology, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland; The University of Queensland, Sunshine Coast Clinical School, Sunshine Coast University Hospital, Birtinya, Queensland.
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22
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Goto NA, van Loon IN, Morpey MI, Verhaar MC, Willems HC, Emmelot-Vonk MH, Bots ML, Boereboom FTJ, Hamaker ME. Geriatric Assessment in Elderly Patients with End-Stage Kidney Disease. Nephron Clin Pract 2018; 141:41-48. [PMID: 30384369 PMCID: PMC6381867 DOI: 10.1159/000494222] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 12/25/2022] Open
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.
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Affiliation(s)
- Namiko A Goto
- Dianet Dialysis Center, Utrecht, The Netherlands,
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands,
| | - Ismay N van Loon
- Dianet Dialysis Center, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Moira I Morpey
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hanna C Willems
- Department of Geriatrics, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | | | - Michiel L Bots
- Julius center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Franciscus T J Boereboom
- Dianet Dialysis Center, Utrecht, The Netherlands
- Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Marije E Hamaker
- Department of Geriatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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23
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A holistic approach to factors affecting depression in haemodialysis patients. Int Urol Nephrol 2018; 50:1467-1476. [PMID: 29779116 DOI: 10.1007/s11255-018-1891-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/10/2018] [Indexed: 12/26/2022]
Abstract
Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients' feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals.
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24
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Singh HK, Del Carmen T, Freeman R, Glesby MJ, Siegler EL. From One Syndrome to Many: Incorporating Geriatric Consultation Into HIV Care. Clin Infect Dis 2018; 65:501-506. [PMID: 28387803 DOI: 10.1093/cid/cix311] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/03/2017] [Indexed: 12/25/2022] Open
Abstract
Antiretroviral therapy has enabled people to live long lives with human immunodeficiency virus (HIV). As a result, most HIV-infected adults in the United States are >50 years of age. In light of this changing epidemiology, HIV providers must recognize and manage multiple comorbidities and aging-related syndromes. Geriatric principles can help meet this new challenge, as preservation of function and optimization of social and psychological health are relevant to the care of aging HIV-infected adults, even those who are not yet old. Nonetheless, the field is still in its infancy. Although other subspecialties have started to explore the role of geriatricians, little is known about their role in HIV care, and few clinics have incorporated geriatricians. This article introduces basic geriatric nomenclature and principles, examines several geriatric consultation models from other subspecialties, and describes our HIV and Aging clinical program to encourage investigation of best practices for the care of this population.
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Affiliation(s)
| | - Tessa Del Carmen
- Geriatrics and Palliative Medicine, Weill Cornell Medical College
| | - Ryann Freeman
- Geriatrics and Palliative Medicine, Weill Cornell Medical College
- ACRIA, Center on HIV and Aging, New York
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25
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Hall RK, McAdams-DeMarco MA. Breaking the cycle of functional decline in older dialysis patients. Semin Dial 2018; 31:462-467. [PMID: 29642268 DOI: 10.1111/sdi.12695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Currently, older adults comprise nearly one-third of prevalent US dialysis patients, and this proportion will increase as the population ages. Older dialysis patients experience greater morbidity and mortality than nondialysis patients of the same age, and in part, it is related to progressive functional decline. Progressive functional decline, characterized by need for assistance with more than 2 activities of daily living, contributes to risk of hospitalization, further functional decline, and subsequent nursing home placement when a patient no longer functions independently at home. Progressive functional decline may appear to be unavoidable for older dialysis patients; however, comprehensive geriatric assessment (CGA) may alleviate the prevalence and severity of functional decline. This editorial summarizes common risk factors of functional decline and introduces CGA as a potentially transformative approach to breaking the cycle of functional decline in older dialysis patients.
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Affiliation(s)
- Rasheeda K Hall
- Durham VA Geriatric Research, Education and Clinical Center, Durham, NC, USA.,Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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26
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Nixon AC, Bampouras TM, Pendleton N, Woywodt A, Mitra S, Dhaygude A. Frailty and chronic kidney disease: current evidence and continuing uncertainties. Clin Kidney J 2018; 11:236-245. [PMID: 29644065 PMCID: PMC5888002 DOI: 10.1093/ckj/sfx134] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/16/2017] [Indexed: 12/12/2022] Open
Abstract
Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization. In recent years there have been efforts to create an operationalized definition of frailty to aid its diagnosis and to categorize its severity. Two principal concepts are described, namely the Fried Phenotype Model of Physical Frailty and the Cumulative Deficit Model of Frailty. There is no agreement on which frailty assessment approach is superior, therefore, for the time being, emphasis should be placed on any efforts to identify frailty. Recognizing frailty should prompt a holistic assessment of the patient to address risk factors that may exacerbate its progression and to ensure that the patient has appropriate psychological and social support. Adequate nutritional intake is essential and individualized exercise programmes should be offered. The acknowledgement of frailty should prompt discussions that explore the future care wishes of these vulnerable patients. With further study, nephrologists may be able to use frailty assessments to inform discussions with patients about the initiation of renal replacement therapy.
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Affiliation(s)
- Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | | | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre and NIHR Devices for Dignity, Health Technology Cooperative, Manchester, UK
| | - Ajay Dhaygude
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
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27
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Hall RK, Haines C, Gorbatkin SM, Schlanger L, Shaban H, Schell JO, Gurley SB, Colón-Emeric CS, Bowling CB. Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data from Two Models of Care. J Am Geriatr Soc 2016; 64:2154-2158. [PMID: 27377350 PMCID: PMC5073016 DOI: 10.1111/jgs.14262] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Rasheeda K Hall
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
- Renal Section, Durham Veterans Affairs Medical Center, Durham, North Carolina.
- Department of Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Carol Haines
- Renal Section, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Steven M Gorbatkin
- Nephrology Service, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Lynn Schlanger
- Nephrology Service, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Hesham Shaban
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jane O Schell
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan B Gurley
- Renal Section, Durham Veterans Affairs Medical Center, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Cathleen S Colón-Emeric
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - C Barrett Bowling
- Department of Medicine, Emory University, Atlanta, Georgia
- Geriatric Research, Education and Clinical Center, Birmingham/Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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28
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van Loon IN, Wouters TR, Boereboom FT, Bots ML, Verhaar MC, Hamaker ME. The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review. Clin J Am Soc Nephrol 2016; 11:1245-1259. [PMID: 27117581 PMCID: PMC4934838 DOI: 10.2215/cjn.06660615] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 03/22/2016] [Indexed: 12/31/2022]
Abstract
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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Affiliation(s)
- Ismay N. van Loon
- Dianet Dialysis Center, Utrecht, The Netherlands
- Departments of Internal Medicine and
- Department of Nephrology and Hypertension and
| | | | | | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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29
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Ma L, Zhang L, Tang Z, Sun F, Diao L, Wang J, Zhao X, Ge G. Use of the frailty index in evaluating the prognosis of older people in Beijing: A cohort study with an 8-year follow-up. Arch Gerontol Geriatr 2016; 64:172-7. [PMID: 26778493 DOI: 10.1016/j.archger.2015.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 01/22/2015] [Accepted: 11/03/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Frailty is a significant healthcare challenge in China. However, the relationship between frailty and the prognosis of older people in China remains unclear. The present study aimed to evaluate the prevalence of frailty and determine if the frailty index, a comprehensive geriatric assessment, was associated with the prognosis of older people in a Chinese population. METHODS Data were drawn from the Beijing Longitudinal Study of Aging, a representative cohort study with an 8-year follow-up. Evaluations based on the use of the frailty index were performed in a cohort of 1808 people aged 60 years and over residing in Beijing urban and rural areas. The initial survey was conducted in 2004, with follow-up surveys at 3, 5, and 8 years. Mortality data for all individuals were collected and analyzed. RESULTS The frailty index and the age of individuals showed the same trend, with a higher frailty index expected as age increased. Respondents with the same frailty index level differed across factors such as sex and location. Male individuals, rural dwellers, and older individuals showed higher frailty rates than female individuals, urban dwellers, and younger individuals. CONCLUSIONS Frailty is a condition associated with problems across multiple physiological systems. The frailty index increases with age, and may be a significant tool for evaluation of the prognosis of older people in China.
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Affiliation(s)
- Lina Ma
- Department of Epidemiology and Social Medicine, Xuan Wu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing 100053, China; Department of Geriatrics, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Li Zhang
- Department of Epidemiology and Social Medicine, Xuan Wu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing 100053, China; Department of Geriatrics, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhe Tang
- Department of Epidemiology and Social Medicine, Xuan Wu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing 100053, China.
| | - Fei Sun
- Department of Epidemiology and Social Medicine, Xuan Wu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing 100053, China
| | - Lijun Diao
- Department of Epidemiology and Social Medicine, Xuan Wu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing 100053, China
| | - Jianping Wang
- Department of Epidemiology and Social Medicine, Xuan Wu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing 100053, China
| | - Xiaoling Zhao
- Department of Epidemiology and Social Medicine, Xuan Wu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing 100053, China
| | - Gaizhen Ge
- Department of Epidemiology and Social Medicine, Xuan Wu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing 100053, China
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30
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Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int 2015; 88:1178-86. [DOI: 10.1038/ki.2015.245] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/23/2015] [Accepted: 06/25/2015] [Indexed: 12/14/2022]
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31
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Meulendijks FG, Hamaker ME, Boereboom FTJ, Kalf A, Vögtlander NPJ, van Munster BC. Groningen frailty indicator in older patients with end-stage renal disease. Ren Fail 2015; 37:1419-24. [PMID: 26337636 DOI: 10.3109/0886022x.2015.1077315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Currently over 55% of end-stage renal disease (ESRD) patients are aged ≥60 years and patients >75 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 = 65). Patients with GFI ≥ 4 (frail) were referred for geriatric consultation (n = 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 = 0.04). Moreover, 90% of frail patients had been hospitalized one or more times, compared to 53% in the fit group (p = 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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Affiliation(s)
- F G Meulendijks
- a Department of Internal Medicine , Diakonessenhuis Utrecht , The Netherlands
| | - M E Hamaker
- b Department of Geriatric Medicine , Diakonessenhuis Utrecht , The Netherlands
| | - F T J Boereboom
- a Department of Internal Medicine , Diakonessenhuis Utrecht , The Netherlands
| | - A Kalf
- c Department of Geriatric Medicine , Gelre Hospitals , Apeldoorn , The Netherlands
| | - N P J Vögtlander
- d Department of Internal Medicine , Gelre Hospitals , Apeldoorn , The Netherlands , and
| | - B C van Munster
- c Department of Geriatric Medicine , Gelre Hospitals , Apeldoorn , The Netherlands .,e Department of Medicine , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
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32
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Račić M, Petković N, Bogićević K, Marić I, Matović J, Pejović V, Kovačević M, Djukanović L. Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients. Ren Fail 2015; 37:1126-31. [PMID: 26099293 DOI: 10.3109/0886022x.2015.1057459] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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 >25 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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Affiliation(s)
- Maja Račić
- a Faculty of Medicine Foča , University of East Sarajevo , The Republic of Srpska , Bosnia and Herzegovina
| | - Nenad Petković
- b Fresenius Medical Center - Hemodialysis Center in Šamac , The Republic of Srpska , Bosnia and Herzegovina
| | - Koviljka Bogićević
- c Fresenius Medical Center - Hemodialysis Center in Zvornik , The Republic of Srpska , Bosnia and Herzegovina
| | - Ivko Marić
- d Special Hospital for Endemic Nephropathy , Lazarevac , Serbia
| | - Jelena Matović
- e Health Center Foča , The Republic of Srpska , Bosnia and Herzegovina , and
| | - Velimirka Pejović
- e Health Center Foča , The Republic of Srpska , Bosnia and Herzegovina , and
| | - Marijana Kovačević
- a Faculty of Medicine Foča , University of East Sarajevo , The Republic of Srpska , Bosnia and Herzegovina
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Abstract
The aging phenomenon of dialysis patients is a worldwide reality, observed in developed and developing countries. Those patients have high incidence of chronic conditions along with high mortality rates and for some of them a decline in functional status within the first 12 months of dialysis therapy. Nevertheless, the elderly dialysis patients represent a very heterogeneous group where prognostic tools may help the decision-making process together with family members, medical staff and the patients. Despite the fact that there are many validated prognostic tools in elderly population, no score has the aim to guide the decision to withhold or withdrawn the dialysis procedure; therefore, in many cases, a time-limited trial is supported. After the failure of improvement in life quality and certitude of the poor prognosis, the withdrawing from renal replacement therapy can be done. Medical literature, from developed countries, brings robust evidence that the process of withdrawing the dialysis procedure, after a fail in the so-called “time-limited trial”, along with good quality palliative care in this scenario is related to a good quality of death. We, on the other hand, believe that the withdrawing process in countries where hospice and good palliative care is not a reality may be associated with bad outcomes. Therefore, this review discusses a way to improve end-of-life symptoms in countries where palliative care facilities are not a reality, the so-called “palliative dialysis”.
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Affiliation(s)
- Thiago Gomes Romano
- Nephrology Department, ABC Medical School, Brazil ; Sirio Libanes Hospital, Intensive Care Unit, Brazil ; Sancta Maggiori Hospital, Brazil
| | - Henrique Palomba
- Sancta Maggiori Hospital, Brazil ; Albert Einstein Hospital, Intensive Care Unit, Brazil
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34
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Monaro S, Stewart G, Gullick J. A ‘lost life’: coming to terms with haemodialysis. J Clin Nurs 2014; 23:3262-73. [PMID: 24810661 DOI: 10.1111/jocn.12577] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Susan Monaro
- Sydney Nursing School; University of Sydney; Sydney NSW Australia
- Level 3 West Cardiovascular Service; Concord Repatriation General Hospital; Concord NSW Australia
| | - Glenn Stewart
- Level 4 North Renal Medicine; Concord Repatriation General Hospital; Concord NSW Australia
| | - Janice Gullick
- Master of Emergency Nursing; Master of Intensive Care Nursing; Sydney Nursing School; University of Sydney; Sydney NSW Australia
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