Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD

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 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) <30 ml/min/1.73 m2 who had an acute care encounter (emergency department visit or hospitalization) during follow-up (n=272). Predictors Demographic characteristics, eGFR, basic and instrumental activities of daily living (ADL/IADL) difficulty, symptom burden, cognition, depressive symptoms, social support. Outcomes 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.