Design of a consensus-based geriatric assessment tailored for older chronic kidney disease patients: results of a pragmatic approach

• Published in: European geriatric medicine 2021-10, Vol.12 (5), p.931-942
• Main Authors: Voorend, Carlijn G. N., Joosten, Hanneke, Berkhout-Byrne, Noeleen C., Diepenbroek, Adry, Franssen, Casper F. M., Bos, Willem Jan W., Van Buren, Marjolijn, Mooijaart, Simon P.
• Format: Article
• Language: English
• Subjects: Aged; Consensus; Geriatric Assessment; Geriatrics/Gerontology; Humans; Internal Medicine; Medicine; Medicine & Public Health; Nephrology; Nutritional Status; Renal Insufficiency, Chronic - diagnosis; Research Paper
• ISSN: 1878-7649; 1878-7657; 1878-7657
• DOI: 10.1007/s41999-021-00498-0

Key Summary points Aim To propose a consensus-based geriatric assessment for optimizing both routine care and research in older patients with advanced chronic kidney disease. Findings Using a pragmatic approach, we reached consensus on a suitable nephrology-tailored geriatric assessment to routinely identify major geriatric impairments in older patients with advanced chronic kidney disease. This geriatric assessment contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains, and can be administered with patient questionnaires and professional-administered instruments by nurse (practitioners) in approximately 20 and 40 minutes, respectively. Message We propose a consensus test set for standardized nephrology-tailored geriatric assessment, which is currently being implemented in multiple hospitals and studies, to benefit clinical care for older patients with advanced chronic kidney disease and enhance research comparability. 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, 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 (practitio