Geriatric Assessment in CKD Care: An Implementation Study

Kidney Medicine, vol. 6, pp. 100809

Abstract

Rationale & Objective: Older people with progressive chronic kidney disease (CKD) have complex health care needs. Geriatric evaluation preceding decision making for kidney replacement is recommended in guidelines, but implementation is lacking in routine care. We aimed to evaluate implementation of geriatric assessment in CKD care. Study Design: Mixed methods implementation study. Setting & Participants: . Quality Improvement Activities/Exposure: We implemented a consensus-based nephrology-tailored geriatric assessment: a patient questionnaire and professionally administered test set comprising 16 instruments covering functional, cognitive, psychosocial, and somatic domains and patient-reported outcome measures. Outcomes: We aimed for implementation in 10 centers and 200 patients. Implementation was evaluated by (i) perceived enablers and barriers of implementation, including integration in work routines (Normalization Measure Development Tool) and (ii) relevance of the instruments to routine care for the target population. Analytical Approach: Variations in implementation practices were described based on field notes. The postimplementation survey among health care professionals was analyzed descriptively, using an explanatory qualitative approach for open-ended questions. Results: Geriatric assessment was implemented in 10 centers among 191 patients. Survey respondents (n = 71, 88% response rate) identified determinants that facilitated implementation, ie, multidisciplinary collaboration (with geriatricians) -meetings and reports and execution of assessments by nurses. Barriers to implementation were patient illiteracy or language barrier, time constraints, and patient burden. Professionals considered geriatric assessment sufficiently integrated into work routines (mean, 6.7/10 ± 2.0 [SD]) but also subject to improvement. Likewise, the relevance of geriatric assessment for routine care was scored as 7.8/10 ± 1.2. The Clinical Frailty Score and Montreal Cognitive Assessment were perceived as the most relevant instruments. Limitations: Selection bias of interventions' early adopters may limit generalizability. Conclusions: Geriatric assessment could successfully be integrated in CKD care and was perceived relevant to health care professionals.

Authors 27

1. Carlijn G. N. Voorend corresponding Aachen Department of Internal Medicine

   Leiden University Medical Center

   Affiliation as printed

   Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands

2. Noeleen C. Berkhout-Byrne Aachen Department of Internal Medicine

   Leiden University Medical Center

   Affiliation as printed

   Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands

3. Leti van Bodegom‐Vos Aachen Department of Biomedical Data Sciences Section Medical Decision Making

   Leiden University Medical Center

   Affiliation as printed

   Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands

4. Adry Diepenbroek

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

5. Casper F. M. Franssen

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

6. Hanneke Joosten

   Maastricht University Medical Centre · Maastricht University

   Affiliation as printed

   Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands

7. Simon P. Mooijaart Aachen Department of Gerontology and Geriatrics LUMC Center for Medicine for Older People Leiden Center for Medicine for Older People

   Leiden University Medical Center

   Affiliation as printed

   Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands

   LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands

   Leiden Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands

8. Willem Jan W. Bos Aachen Department of Internal Medicine

   Leiden University Medical Center · St. Antonius Ziekenhuis

   Affiliation as printed

   Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands

   Department of Internal Medicine St. Antonius Hospital, Nieuwegein, The Netherlands

   Department of Internal Medicine St, Antonius Hospital, Nieuwegein, the Netherlands

9. Marjolijn van Buren Aachen Department of Internal Medicine

   Leiden University Medical Center · Haga Hospital

   Affiliation as printed

   Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands

   Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands

10. Arjan van Alphen
11. Fenna van Breda
12. Henk Boom
13. Mariëlle H. Emmelot‐Vonk
14. Sandrine Gaillard
15. Nel Groeneweg-Peeters
16. Bettie Hoekstra
17. Nienke Hommes
18. Francoise Hoornaar
19. Joep Lagró
20. Elisabeth J R Litjens
21. Femke M. Molenaar
22. Aegida Neradová
23. Michelle Troost
24. Wilma Veldman
25. Lidwien Westerbos
26. Carlijne Westerman-van der Wijden
27. Judith M. Wierdsma