title: Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data from Two Models of Care.
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.
authors.affiliation: Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina. rasheeda.stephens@dm.duke.edu.|Renal Section, Durham Veterans Affairs Medical Center, Durham, North Carolina. rasheeda.stephens@dm.duke.edu.|Department of Medicine, Duke University Medical Center, Durham, North Carolina. rasheeda.stephens@dm.duke.edu.
authors.forename: Rasheeda K
authors.initials: RK
authors.lastname: Hall
authors.affiliation: Renal Section, Durham Veterans Affairs Medical Center, Durham, North Carolina.
authors.forename: Carol
authors.initials: C
authors.lastname: Haines
authors.affiliation: Nephrology Service, Atlanta Veterans Affairs Medical Center, Decatur, Georgia.|Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Gorbatkin
authors.affiliation: Nephrology Service, Atlanta Veterans Affairs Medical Center, Decatur, Georgia.|Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Lynn
authors.initials: L
authors.lastname: Schlanger
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Hesham
authors.initials: H
authors.lastname: Shaban
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jane O
authors.initials: JO
authors.lastname: Schell
authors.affiliation: Renal Section, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Gurley
authors.affiliation: Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Cathleen S
authors.initials: CS
authors.lastname: Colón-Emeric
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia.|Geriatric Research, Education and Clinical Center, Birmingham/Atlanta Veterans Affairs Medical Center, Decatur, Georgia.
authors.forename: C Barrett
authors.initials: CB
authors.lastname: Bowling
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged; D000066491:Clinical Decision-Making; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D016743:Mental Competency; D017146:Models, Organizational; D009398:Nephrology / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014481:United States; D058014:Veterans Health
keywords: dialysis decision-making; frail elderly; functional status; renal insufficiency; veterans