Design of a consensus-based geriatric assessment tailored for older chronic kidney disease patients: results of a pragmatic approach
on behalf of the POLDER investigators
(2021) European Geriatric Medicine, volume 12, issue 5, pp. 931 - 942
(Article)
Abstract
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,
... read more
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.
show less
Download/Full Text
Keywords: Aged, Chronic kidney diseases, Clinical decision-making, Consensus development, Frailty, Geriatric assessment, Geriatrics and Gerontology, Gerontology, Journal Article
ISSN: 1878-7649
Publisher: Springer Science and Business Media Deutschland GmbH
Note: Funding Information: The study was funded by Dutch Kidney Foundation (A1D3P04), as part of a project to design and implement a nephrology-tailored geriatric care pathway: Pathway for OLDer patients reaching End-stage Renal disease (POLDER). The Dutch Kidney Foundation did not play any role in design, collection, analysis, and interpretation of data; writing the perspective; or the decision to submit for publication. The expert panel did not receive any fees or funding for travel. CV is partly funded by the Nephrosearch Foundation. Funding Information: We are grateful to all healthcare professionals who participated in the expert panel, and the patients and healthcare professionals who participated in pilot testing. The Pathway for older patients reaching end stage renal disease (POLDER) study group is a collaboration in the Netherlands that is established to study and implement a nephrology-tailored geriatric assessment in routine care. The POLDER investigators are (in alphabetical order): Arjan van Alphen, Maasstad Hospital Rotterdam; Noeleen Berkhout-Byrne, Leiden University Medical Centre; Fenna van Breda, Amsterdam University Medical Centre; Marjolijn van Buren, Haga Ziekenhuis The Hague; Henk Boom, Reiner de Graaf Hospital Delft; Willem Jan Bos, St. Antonius Hospital Nieuwegein; Adry Diepenbroek, University Medical Centre Groningen; Marielle Emmelot-Vonk, University Medical Centre Utrecht; Casper Franssen, University Medical Centre Groningen; Carlo AJM Gaillard, University Medical Centre Utrecht; Nel Groeneweg, Reinier de Graaf Hospital Delft; Bettie Hoekstra, Maasstad Hospital Rotterdam; Nienke Hommes, Haaglanden Medical Centre The Hague; Francoise Hoornaar, St. Antonius Hospital Nieuwegein; Hanneke Joosten, Maastricht University Medical Centre; Joep Lagr?, Haga Hospital; Elisabeth Litjens, Maastricht University Medical Centre; Femke Molenaar, University Medical Centre Utrecht; Simon P Mooijaart, Leiden University Medical Centre; Aegida Neradova, Dianet Amsterdam, Amsterdam University Medical Centre; Mike Peters, Amsterdam University Medical Centre; Wilma Veldman, University Medical Centre Groningen; Carlijn Voorend, Leiden University Medical Centre; Lidwien Westerbos, Amsterdam University Medical Centre; Carlijne Westerman- van der Wijden, Haaglanden Medical Centre The Hague; Judith Wierdsma, University Medical Centre Utrecht. POLDER advisory board members are: M. Hemmelder (Chair), Nefrovisie Foundation, and Department of Internal Medicine, Maastricht University Medical Centre; J.J Homan van der Heide, Amsterdam Medical University Centre; K. Prantl, Dutch Kidney Patients? Association Association of renal patients (NVN); A. J. Rabelink, Leiden University Medical Centre; S. de Rooij, University Medical Centre Groningen, Medisch Spectrum Twente hospital; C. Stehouwer, CARIM School for Cardiovascular Diseases, Maastricht University (UM), The Netherlands, and Department of Internal Medicine, Maastricht University Medical Center?+?(MUMC), The Netherlands. Publisher Copyright: © 2021, The Author(s).
(Peer reviewed)
