MO854: Implementation of a Geriatric Assessment in Elderly Hemodialysis Patients

Abstract

Abstract BACKGROUND AND AIMS Elderly patients who are on hemodialysis (HD) have a higher burden of multimorbidity and geriatric syndromes, that are underdiagnosed. These aspects affect quality of life and may lead to higher hospitalization rates and mortality rates. Despite guideline recommendations, geriatric assessment is not part of standard clinical care. The aim of this study was to assess the prevalence of geriatric impairments and frailty in patients ≥ 65 years old on maintenance HD by means of a geriatric assessment (GA). METHOD Cross-sectional study involving patients ≥ 65 years old on maintenance HD at a secondary Hospital in Ecuador between March and April 2021. Baseline demographic data, clinical and dialysis characteristics were collected from the medical charts and during the baseline assessment. All participants underwent a GA, including 5 domains: (1) comorbidity burden: Charlson comorbidity Index, (2) assessment of basic and instrumental activities of daily living (ADL: Barthel Index and iADL: Lawton and Brody index), (3) cognition: Pfeiffer Short Portable Mental Status Questionnaire, (4) mood: 5-item version of the Geriatric Depression Scale and (5) nutrition: Mini Nutritional Assessment (MNA) score. In addition, 3 frailty screening tools were applied: Frail-VIG Index (IF-VIG), Clinical Frailty Scale (CFS) and the clinical judgment of the nephrologist (surprise question). For the clinical judgment, the treating physician was asked to indicate if he would be surprised if the patient died in the next 6 months. Data were summarized using means with standard deviation or proportions when appropriate. Differences regarding baseline characteristics and outcomes between fit and frail patients stratified according to the Frail-VIG Index were assessed using Chi-squared tests and t-tests as appropriate. RESULTS Thirty-two patients were included, mean age 72.2 ± 5.83 years and 78.1% (n = 25) were men. Geriatric impairments were highly prevalent. Most frequently impaired geriatric domains were: functional performance (ADL 71.9% and iADL 75%), depression (40,6%), risk for malnutrition (68.8%), symptoms of cognitive decline (25%) and severe comorbidity (Charlson Index = 5.6 ± 2.3). The prevalence of frailty differed widely according to the different frailty screening tools. According to the IF-VIG, CFS and the clinical judgment, 56.2%, 37.7% and 35% of the patients were found frail, respectively. No differences between frail and fit patients were found in demographics nor in the prevalence of impairment in cognition, symptoms of depression, malnutrition, severe comorbidity or impairment in basic activities of daily living. Frail patients were more care dependent in their instrumental iADL compared with the fit group (P = 0.024) (Figure 1). CONCLUSION Geriatric impairments are highly prevalent in patients ≥ 65 years old on chronic HD. Since impairments can be missed when not searched for in regular dialysis care, the first step of improving nephrologic care is awareness of the extensiveness of geriatric impairment.