Skip to main content
Journal cover image

Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD.

Publication ,  Journal Article
Bowling, CB; Berkowitz, TSZ; Burrows, BT; Ma, JE; Whitson, HE; Smith, B; Crowley, SD; Wang, V; Maciejewski, ML; Olsen, MK
Published in: Am J Kidney Dis
March 12, 2024

RATIONALE & OBJECTIVE: Although functional impairment is common among older adults with chronic kidney disease (CKD), functional reserve before an acute health event and physical resilience after the event have not been characterized in this population. The purpose of this study was to identify distinct patterns of physical function before and after an acute health event among older veterans with stage 4 CKD. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: National sample of veterans≥70 years of age with an estimated glomerular filtration rate (eGFR) of<30mL/min/1.73m2 who had an acute care encounter (emergency department visit or hospitalization) during the follow-up period (n = 272). PREDICTORS: Demographic characteristics, eGFR, basic and instrumental activities of daily living (ADL/IADL) difficulty, symptom burden, cognition, depressive symptoms, social support. OUTCOME: Function measured using the life-space mobility assessment obtained by telephone survey before and after an acute care encounter. ANALYTICAL APPROACH: General growth mixture models to identify classes of functional trajectories. Calculation of percentages for demographic characteristics and means for eGFR, ADL/IADL difficulty, symptom burden, cognition, depressive symptoms, and social support by trajectory class. RESULTS: Four trajectory classes were identified and characterized by different levels of life-space mobility before (reserve) and change in life-space mobility after (resilience) an acute care encounter: (1) low reserve, low resilience (n=91), (2) high reserve, high resilience (n=23), (3) moderate reserve, moderate resilience (n=89), and (4) high reserve, low resilience (n=69). Mean levels of ADL/IADL difficulty, symptom burden, cognition, and depressive symptoms, but not demographic characteristics, eGFR, or social support, differed by trajectory class. LIMITATIONS: Veteran cohort was primarily male. CONCLUSIONS: Among older adults with stage 4 CKD, physical function trajectories before and after an acute health event vary. Integrating reserve and resilience into care for this population may be useful for anticipating changes in function and developing tailored treatment plans.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

March 12, 2024

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • 3202 Clinical sciences
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bowling, C. B., Berkowitz, T. S. Z., Burrows, B. T., Ma, J. E., Whitson, H. E., Smith, B., … Olsen, M. K. (2024). Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD. Am J Kidney Dis. https://doi.org/10.1053/j.ajkd.2024.01.529
Bowling, C Barrett, Theodore S. Z. Berkowitz, Brett T. Burrows, Jessica E. Ma, Heather E. Whitson, Battista Smith, Steven D. Crowley, Virginia Wang, Matthew L. Maciejewski, and Maren K. Olsen. “Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD.Am J Kidney Dis, March 12, 2024. https://doi.org/10.1053/j.ajkd.2024.01.529.
Bowling CB, Berkowitz TSZ, Burrows BT, Ma JE, Whitson HE, Smith B, et al. Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD. Am J Kidney Dis. 2024 Mar 12;
Bowling, C. Barrett, et al. “Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD.Am J Kidney Dis, Mar. 2024. Pubmed, doi:10.1053/j.ajkd.2024.01.529.
Bowling CB, Berkowitz TSZ, Burrows BT, Ma JE, Whitson HE, Smith B, Crowley SD, Wang V, Maciejewski ML, Olsen MK. Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD. Am J Kidney Dis. 2024 Mar 12;
Journal cover image

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

March 12, 2024

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • 3202 Clinical sciences
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences