#4186 FEASIBILITY OF NEPHROLOGY-TAILORED GERIATRIC ASSESSMENT: AN IMPLEMENTATION STUDY

Abstract

Abstract Background and Aims Geriatric evaluation of older patients with progressive chronic kidney disease is recommended in guidelines to enhance decision-making for kidney replacement choices. Although frailty, physical and cognitive impairments, and depression are prevalent, routine identification of geriatric impairments is lacking. Therefore, we aimed to study feasibility and determinants of successful implementation of a novel approach: nephrology-tailored geriatric assessment. Method In a mixed-methods implementation study, we investigated the feasibility of implementation of a consensus-based geriatric assessment [1] in Dutch nephrology centers. Feasibility was assessed through hospital participation and patient inclusion (among patients aged 70+ years with eGFR≤20mL/min/1.73 m2). We also evaluated determinants of successful implementation with a post-implementation survey among healthcare professionals covering (i) perceived enablers and barriers of implementation, (ii) perceived integration in work routines (Normalization MeAsure Development tool), and (iii) perceived relevance of the instruments. In addition, patients were asked if the geriatric assessment provided them with new insights for their future treatment decision for kidney failure. Results Feasibility was substantiated in implementation of geriatric assessment in 10 hospitals among 191 patients, i.e. 100% and 96% of our aimed goals. According to participating healthcare professionals (n = 71), determinants that facilitated implementation were: collaboration with the geriatric department, multidisciplinary meetings and reports, and execution of assessments by nurses. Most frequently mentioned barriers to implementation were: patient illiteracy or language barrier, lack of time, and burden for patients. Professionals considered geriatric assessment sufficiently integrated into work routines (mean 6.7 of 10, SD 2.0), but also subject to improvement (Figure 1). Implementation of geriatric assessment was considered sufficiently relevant for routine care (mean score 7.8 of 10, SD 1.2). Half of the patients (n = 42/82) stated that the geriatric assessment provided them with new insights, whereas 27% (n = 22) responded not to have gained new insights from the tests. Conclusion Multicenter implementation of nephrology-tailored geriatric assessment seems feasible and relevant. For future implementation we recommend involving the geriatric department, using multidisciplinary teams and -meetings, acknowledging the pivotal role of nurse practitioners, and using a flexible approach matching local resources.