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Abstract: FR-PO899

Physical Function Before and After a Health Stressor in Older Veterans with Advanced CKD

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology


  • Burrows, Brett, Duke University School of Medicine, Durham, North Carolina, United States
  • Olsen, Maren, Duke University School of Medicine, Durham, North Carolina, United States
  • Berkowitz, Theodore S. Z., Durham VA Health Care System, Durham, North Carolina, United States
  • Smith, Battista L., Durham VA Health Care System, Durham, North Carolina, United States
  • Bowling, C. Barrett, Duke University School of Medicine, Durham, North Carolina, United States

Health stressors (HS), defined as acute health events that require an ED visit or hospitalization, are common among older adults with chronic kidney disease (CKD) and associated with functional decline. Describing the trajectory of function before and after a HS may be vital to predicting future functional status and developing strategies to improve functional recovery after health events.


The Physical Resilience Prediction in Advanced Renal Disease (PREPARED) is a national, prospective cohort study of Veterans ≥ 70 years old (n=412) with advanced CKD (eGFR <30 ml/min/1.73m2 (excluding dialysis or transplant)) who were tracked longitudinally to detect the occurrence of a HS in near real-time. Participants completed scheduled phone surveys of physical function every 8 weeks. For enrolled participants, if a HS was detected in the VA electronic health record during follow-up, additional phone surveys were conducted immediately following the HS, at 8-, and 16-weeks post-HS. This approach provided data on function approximately 16- and 8-weeks before and 8- and 16-weeks after a HS. Physical function was assessed at each timepoint using the Life-Space Assessment (LSA) score (0-120, higher scores reflect greater community mobility). Linear mixed models were used to assess the trajectory of function in relationship to the HS.


A total of 272 PREPARED participants (77.9 ± 6.4 years old, 98% male, 25% Black) had a HS. On average, LSA score was highest (54.0 ±26.2) at baseline (16-weeks prior to a HS). LSA scores declined 8-weeks prior to a HS (52.2 ±28.6). The lowest LSA score was immediately following the HS (45.3 ±28.6). LSA scores rebounded at 8-weeks (51.0 ±27.7) and 16-weeks post-HS (50.0 ±26.4) but did not return to pre-HS levels. Compared to baseline, statistically significant differences in LSA scores were seen immediately following the HS, and at 8- and 16-weeks post-HS (all p<0.01).


Among older Veterans with advanced CKD declines in physical function occurred leading up to and following a HS. Though physical function improved in the weeks following the HS, participants did not fully regain baseline physical function status even after 4 months. These data demonstrate the importance of developing strategies to bolster older adults’ ability to recover following an acute health event.


  • Veterans Affairs Support