Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data from Two Models of Care
Incorporating Geriatric Assessment into a Nephrology Clinic: Preliminary Data from Two Models of Care
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DOI：
10.1111/jgs.14262
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发表时间：
2016-10-01
影响因子：
6.3
通讯作者：
Bowling, C. Barrett
中科院分区：
文献类型：
--
作者：
Hall, Rasheeda K.;Haines, Carol;Bowling, C. Barrett
患有晚期慢性肾脏病（CKD）的老年人会出现功能障碍，这可能会使CKD管理复杂化。未能认识到功能障碍可能会使这些人面临进一步功能下降的风险，养老院安置，以及错过及时进行护理目标对话的机会。常规老年评估可能是一个有用的工具，用于识别患有CKD的老年人，他们有功能下降的风险，并提供背景信息来指导临床决策。在退伍军人健康管理局实施了两项创新计划，将老年评估纳入肾脏病学访视。在一个项目中，一位肾脏病诊所的老年病医生对70岁及以上的CKD患者使用标准化的老年病评估工具（CKD综合老年病评估）（CGA-4-CKD）。在第二个项目中，一家肾病诊所对75岁及以上的个人进行全面预约，以进行老年评估和CKD护理（肾银）。报告了2013年11月至2015年5月期间通过这些计划进行老年评估的68名退伍军人的数据。在CGA-4-CKD中，在27.3%的参与者中发现一种或多种日常生活活动（ADL）困难、福尔斯史和认知障碍。在肾银组的参与者中，65.7%的人发现ADL困难，28.6%的人发现福尔斯，51.6%的人发现认知障碍。在CGA-4-CKD项目中，45.4%（n = 15）的退伍军人和肾银项目中，37.1%（n = 13）的退伍军人的老年评估指导护理过程。研究结果表明，患有慢性肾脏病的老年人存在显着的功能障碍负担。对这种损害的了解适用于CKD管理。
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.