Implications for practice
| Domains to consider | Practical steps | Expected benefit in older adults |
| Making information easy to grasp for the older person | Specifically, in older individuals, consider how information is provided: avoid medical jargon, make allowances for cognitive impairment and depression | Promotes health awareness Strengthens decision-making Mitigates regret after starting treatment |
| Involvement of carers/family/friends | Proactively identify relevant carers especially in frail, dependent elders and include them in discussions or when planning support | Promotes carer involvement which is important to older patients Mitigates carer burden |
| Risk of disease progression to end-stage kidney disease | Use prognostic indices developed in the older population to provide realistic estimates of disease progression (see table 2) | Identifies patients less likely to progress and more suited for supportive measures at that particular time |
| Survival with end-stage kidney disease | Use prognostic indices developed in the older population to provide realistic estimates of survival (see table 2) | Fosters realistic expectations of survival benefit |
| Quality-of-life outcomes | Counsel older patients regarding possible adverse quality of life with treatment, including risk of physical deterioration Explore patients’ expectations from treatment and check alignment with patients’ values | Promotes the choice of therapy appropriate to patients’ values/expectations for life Fosters realistic expectations Mitigates regret after starting treatment |
| Lessons from the experiences of other older people | Counsel patients regarding lifestyle changes; functional worsening; impact on daily life, relationships; persistent symptom burden; time commitments; need for coping strategies |