title: ExplorinG frailty and mild cognitive impairmEnt in kidney tRansplantation to predict biomedicAl, psychosocial and health cost outcomeS (GERAS): protocol of a nationwide prospective cohort study.
abstract: OBJECTIVE
  To present the rationale, design and methodology of the GERAS project, which examines whether assessment of frailty and mild cognitive impairment could enhance risk prediction for biomedical, psychosocial outcomes and foster efficient resource allocation in kidney transplantation.
  
  
  BACKGROUND
  For the burgeoning cohort of older patients considered for kidney transplantation, evidence gaps regarding frailty and mild cognitive impairment limit clinical decision-making and medical management. As known risk factors for 'hard' clinical outcomes in chronic illness, both require further study in transplantation. Integrating these and other bio-psychosocial factors into a comprehensive pre-transplant patient assessment will provide insights regarding economic implications and may improve risk prediction.
  
  
  METHODS
  A nation-wide multi-centre prospective cohort study nested in the Swiss Transplant Cohort Study.
  
  
  METHODS
  Our nationally representative convenience sample includes 250 adult kidney transplant recipients. Data sources include the Swiss Transplant Cohort Study and primary data collected at time of transplantation, 6 months, 1 and 2 years post-transplant via established measures (the Montreal Cognitive Assessment, Psychosocial Questionnaire, Fried Frailty Instrument and a blood analysis), investigator-developed instruments and datasets compiled by hospitals' management control units, sickness funds, the Swiss Federal Statistical Office and the European Renal Association. Descriptive, competing risk survival and mixed effects analyses will be performed. Research Ethics Committee approval was obtained in January 2016.
  
  
  CONCLUSIONS
  This pioneering project jointly examines frailty and mild cognitive impairment from bio-psychosocial and health economic perspectives. Results may significantly inform risk prediction, care tailoring and resource optimization to improve health outcomes in the ageing kidney transplant cohort.
authors.affiliation: Institute of Nursing Science, University of Basel, Switzerland.
authors.forename: Oliver
authors.identifier: http://orcid.org/0000-0002-6207-0069
authors.initials: O
authors.lastname: Mauthner
authors.affiliation: Institute of Nursing Science, University of Basel, Switzerland.
authors.forename: Veerle
authors.initials: V
authors.lastname: Claes
authors.affiliation: Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Walston
authors.affiliation: Institute of Nursing Science, University of Basel, Switzerland.|School of Nursing, University of Pittsburgh, Pennsylvania, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Engberg
authors.affiliation: Clinic of Nephrology and Transplantation Medicine, Cantonal Hospital St Gallen, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Binet
authors.affiliation: Department for Transplantation-Immunology and Nephrology, University Hospital Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Dickenmann
authors.affiliation: Transplantation Centre and Transplantation Immunopathology Laboratory, University Hospital Lausanne, Switzerland.
authors.forename: Déla
authors.initials: D
authors.lastname: Golshayan
authors.affiliation: Department of Nephrology, University Hospital Geneva, Switzerland.
authors.forename: Karine
authors.initials: K
authors.lastname: Hadaya
authors.affiliation: University Clinic for Nephrology, Hypertension and Clinical Pharmacology, University Hospital Bern, Switzerland.
authors.forename: Uyen
authors.initials: U
authors.lastname: Huynh-Do
authors.affiliation: Institute of Economics, University of Lugano, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Calciolari
authors.affiliation: Institute of Nursing Science, University of Basel, Switzerland.|Academic Center for Nursing and Midwifery, KU Leuven, Belgium.
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology*; D016330:Frail Elderly; D017048:Health Care Costs; D006801:Humans; D016030:Kidney Transplantation; D011446:Prospective Studies; D018570:Risk Assessment; D013557:Switzerland
keywords: frailty; health economics; kidney transplantation; midwives; mild cognitive impairment; nurses; nursing; older patients; risk prediction, multi-centre prospective cohort study