Apports des consultations gériatriques dans un centre d’hémodialyse

Abstract : Background: the role of comprehensive geriatric assessment (CGA) in older patients with end-stage renal disease needs to be defined. No screening tool predictive for an abnormal CGA is validated in this population. Our study aims were to describe CGA results in older patients on hemodialysis, to describe CGA-based interventions, and to determine factors associated with an abnormal CGA. Methods: in this retrospective study, we included patients seen at the geriatric consultation implemented in a hemodialysis center from 2013 to 2017. We analyzed CGA results on 6 domains (dependency, cognition, locomotion, mood, nutrition and medications) and the CGA-based proposed interventions. Then we tested factors potentially associated with an abnormal CGA in at least 2 domains. Results: 56 patients were included, mean age was 79 years (69-91). 57% had a loss of independence, 37% cognitive impairment, 26% mood disturbance, 57% gait or balance disturbance, 49% malnutrition and 64% potentially inappropriate medications. 75% had at least 2 abnormal CGA domains. These patients more often had a history of hypertension (88 vs 57%, p=0.02) and had lower mean albumin level (35,8 vs 37,7 g/l, p=0.03). The most frequently proposed CGA-based interventions were to explore cognitive impairment with brain imaging, to add professional caregivers support and to modify inappropriate anti-hypertensive and psychotropic drugs. Conclusion: the availability of a geriatric consultation in a hemodialysis center allows to identify frequent and multiple geriatric syndromes in older patients, especially those with a history of hypertension or an hypoalbuminemia, and to propose geriatric interventions.
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Master Thesis
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Pauline Pinard. Apports des consultations gériatriques dans un centre d’hémodialyse. Médecine humaine et pathologie. 2018. ⟨dumas-02057368⟩

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