Table 3 Lessons learned and considerations for NGA implementing into routine clinical practice
Patients’ involvement and potential benefits • Clear communication of goals and outcomes (and interpretation) of tests • Consider the burden for patients individually, pay attention to results that might be confrontational • Spending 45–90 min in total to complete the NGA is acceptable and feasible • Repeated measurements to assess progression and to identify the need for additional supportive interventions • Caregivers can provide important information about patients’ situation at home | |
Selecting the right test set • Legibility and masked illiteracy can be important barriers • Adaptation of CGA into a smaller set for nephrology (NGA) is possible and feasible • Different instruments are suitable for usage in routine clinical practice, as long as all geriatric domains (i.e. somatic, social, functional and cognitive) are covered • Uniform implementation of NGA is necessary in response to the need for scientific evidence of geriatric measures on outcomes to predict individual progress of the disease. | |
Sufficient expertise and multidisciplinary cooperation • Collaboration between nephrology and geriatrics departments is of utmost importance to provide complementary patient care • Multidisciplinary team meetings are key to success • Assessment of geriatric domains can be done by either the nephrology and geriatrics department, once professionals are trained and experienced • Barriers for successful cooperation between the geriatric and nephrology department include: apprehension among nephrologists about loss of span of control, sparse knowledge and use of geriatric tools, and a high turnover of doctors | |
Supporting structures • Sufficient management support providing essential resources (e.g. time and money) for innovations • Securing the appropriate workforce, especially the availability of geriatricians • Value of NGA should be proven, resulting in evidence and directive guidelines |