Hall, Rasheeda K.;
Haines, Carol;
Gorbatkin, Steven M.;
Schlanger, Lynn;
Shaban, Hesham;
Schell, Jane O.;
Gurley, Susan B.;
Colón‐Emeric, Cathleen S.;
Bowling, C. Barrett
Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data from Two Models of Care
You can manage bookmarks using lists, please log in to your user account for this.
Media type:
E-Article
Title:
Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data from Two Models of Care
Contributor:
Hall, Rasheeda K.;
Haines, Carol;
Gorbatkin, Steven M.;
Schlanger, Lynn;
Shaban, Hesham;
Schell, Jane O.;
Gurley, Susan B.;
Colón‐Emeric, Cathleen S.;
Bowling, C. Barrett
imprint:
Wiley, 2016
Published in:Journal of the American Geriatrics Society
Description:
<jats:p>Older adults with advanced chronic kidney disease (<jats:styled-content style="fixed-case">CKD</jats:styled-content>) experience functional impairment that can complicate <jats:styled-content style="fixed-case">CKD</jats:styled-content> 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 <jats:styled-content style="fixed-case">CKD</jats:styled-content> 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 <jats:styled-content style="fixed-case">CKD</jats:styled-content> aged 70 and older (Comprehensive Geriatric Assessment for <jats:styled-content style="fixed-case">CKD</jats:styled-content>) (<jats:styled-content style="fixed-case">CGA</jats:styled-content>‐4‐<jats:styled-content style="fixed-case">CKD</jats:styled-content>). In the second program, a nephrology clinic used comprehensive appointments for individuals aged 75 and older to conduct geriatric assessments and <jats:styled-content style="fixed-case">CKD</jats:styled-content> care (Renal Silver). Data on 68 veterans who had geriatric assessments through these programs between November 2013 and May 2015 are reported. In <jats:styled-content style="fixed-case">CGA</jats:styled-content>‐4‐<jats:styled-content style="fixed-case">CKD</jats:styled-content>, difficulty with one or more activities of daily living (<jats:styled-content style="fixed-case">ADL</jats:styled-content>s), history of falls, and cognitive impairment were each found in 27.3% of participants. <jats:styled-content style="fixed-case">ADL</jats:styled-content> 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 <jats:styled-content style="fixed-case">CGA</jats:styled-content>‐4‐<jats:styled-content style="fixed-case">CKD</jats:styled-content> 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 <jats:styled-content style="fixed-case">CKD</jats:styled-content>. Knowledge of this impairment is applicable to <jats:styled-content style="fixed-case">CKD</jats:styled-content> management.</jats:p>