Systematic comprehensive geriatric assessment in elderly patients on chronic dialysis: a cross-sectional comparative and feasibility study.
BACKGROUND
Elderly dialysis patients are prone to disabilities and functional decline. This aggravates their last period of life. It would be valuable to be able to preserve daily function and quality of life. Identification of domains requiring additional attention is not common practice in standard care. Therefore, we performed a systematic Comprehensive Geriatric Assessment (CGA) to assess physical and psychosocial function and tested its feasibility in daily practice. The CGA is used more frequently in the assessment of elderly cancer patients, and we therefore compared the outcomes to this group.


METHODS
A cross-sectional, multicenter study, between June 1st and September 31st, 2009, in four Dutch outpatient dialysis units. Fifty patients aged 65 years or above who received dialysis because of end-stage renal disease (ESRD) were randomly included. We assessed the CGA during a systematic interview with patients and their caregivers. The cancer patients had had a similar CGA in an earlier study. We compared prevalences between groups.


RESULTS
In the dialysis population (68.0% 75 years or above, 76.6% on haemodialysis) caregivers often observed behavioral changes, such as deviant eating habits (34.0%) and irritability (27.7%). In 84.4%, caregivers felt overburdened by the situation of their family member. Somatic and psychosocial conditions were frequently found (polypharmacy (94.6%), depression (24.5%)) and prevalence of most geriatric conditions was comparable to those in elderly cancer patients.


CONCLUSIONS
Geriatric conditions were highly prevalent among elderly dialysis patients and prevalences were comparable in both populations. The CGA proved feasible for recognition of these conditions and of overburdened caregivers. This could prevent further functional decline and preserve quality of life.
Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Room F4-108, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. j.l.parlevliet@amc.uva.nl
Juliette L
JL
Parlevliet
Bianca M
BM
Buurman
Marja M Hodac
MM
Pannekeet
Els M
EM
Boeschoten
Lucia
L
ten Brinke
Marije E
ME
Hamaker
Barbara C
BC
van Munster
Sophia E
SE
de Rooij
D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D008297:Male; D006435:Renal Dialysis / Q000523:psychology; D011795:Surveys and Questionnaires