 Louise Walter, MD
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| Title | Professor in Residence |
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| School | UCSF School of Medicine |
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| Department | Medicine |
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| Address | 4150 Clement Street
San Francisco CA 94143
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| Phone | 415-221-4810x3052 |
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 Biography | 2012 | | Elected into American Society for Clinical Investigation (ASCI) | | UCSF | 2010 | | Academic Senate Distinction in Faculty Mentoring Award | | American Geriatrics Society | 2009 | | Outstanding Scientific Achievement for Clinical Investigation Award |
Overview Dr. Walter is the Interim Chief of the Division of Geriatrics and Co-Director of the UCSF Geriatrics Research Program.
Dr. Walter is a clinician-researcher who is a national leader in evaluating the real-world risks and benefits of cancer screening in older patients. Dr. Walter received her MD from Stanford University in 1995. She completed a residency in internal medicine and a fellowship in geriatrics at UCSF. Dr. Walter joined the UCSF faculty in July 2001, and she is a staff physician at the San Francisco VA where she is a primary care geriatrician for older veterans.
Dr. Walter has transformed our approach to cancer screening in older adults. She has developed novel methodology demonstrating the fundamental importance of life expectancy rather than age in determining benefits and risks of screening. Virtually every cancer screening guideline cites her research. Further, her studies of older adults in poor health documented the extent to which screening can lead to clinical harm. Her approach also forms the basis for the management of other chronic diseases (e.g., diabetes) in older adults.
In addition, Dr. Walter led a series of seminal studies demonstrating decisions to screen older adults for cancer are often dictated more by age than health such that many patients in poor health continue to undergo screening while many healthy older patients fail to get screened. Also, she discovered that cancer screening frequently leads to significant harms without benefit in patients in poor health and developed a taxonomy and quantification of screening harms. This research changed national VA quality indicators and convinced California state auditors to abandon their mandatory mammography policy for health plans that care for frail elders.
Dr. Walter is Principal Investigator of a $1.8 million R01 grant from the National Cancer Institute to investigate outcomes of prostate-specific antigen screening in older men and Principal Investigator of a K24 mentoring award from the National Institute on Aging. Dr. Walter is strongly committed to mentoring the next generation of clinical investigators as evidenced by her receipt of the 2010 UCSF Academic Senate Distinction in Mentoring Award (given annually to one Associate Professor who provides exceptional mentoring). Dr. Walter is the Associate Director of the UCSF Clinical and Translational Science Institute Career Development (KL2) Program, an Associate Editor for the JAMA series, "Care of the Aging Patient: From Evidence to Action," and Director of the San Francisco VA’s Health Services Research and Development Program to Improve Care for Veterans with Complex Comorbid Conditions.
Bibliographic
Publications listed below are automatically derived from MEDLINE/PubMed and other sources, which might result in incorrect or missing publications.
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Schonberg MA, Walter LC. Talking About Stopping Cancer Screening-Not So Easy Comment on "Older Adults and Forgoing Cancer Screening: 'I Think It Would be Strange'". JAMA Intern Med. 2013 Apr 8; 173(7):532-3.
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Thai JN, Walter LC, Eng C, Smith AK. Every patient is an individual: clinicians balance individual factors when discussing prognosis with diverse frail elderly adults. J Am Geriatr Soc. 2013 Feb; 61(2):264-9.
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Wender R, Fontham ET, Barrera E, Colditz GA, Church TR, Ettinger DS, Etzioni R, Flowers CR, Scott Gazelle G, Kelsey DK, Lamonte SJ, Michaelson JS, Oeffinger KC, Shih YC, Sullivan DC, Travis W, Walter L, Wolf AM, Brawley OW, Smith RA. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013 Mar; 63(2):106-17.
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Eckstrom E, Feeny DH, Walter LC, Perdue LA, Whitlock EP. Individualizing cancer screening in older adults: a narrative review and framework for future research. J Gen Intern Med. 2013 Feb; 28(2):292-8.
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Williams BA, Goodwin JS, Baillargeon J, Ahalt C, Walter LC. Addressing the aging crisis in U.S. criminal justice health care. J Am Geriatr Soc. 2012 Jun; 60(6):1150-6.
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Freedland SJ, Walter LC. 80 is the new 60: implications of irrational exuberance regarding longevity on prostate cancer treatment decisions. J Gen Intern Med. 2012 May; 27(5):485-6.
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Wang S, Wong ML, Hamilton N, Davoren JB, Jahan TM, Walter LC. Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans. J Clin Oncol. 2012 May 1; 30(13):1447-55.
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Hurria A, Browner IS, Cohen HJ, Denlinger CS, deShazo M, Extermann M, Ganti AK, Holland JC, Holmes HM, Karlekar MB, Keating NL, McKoy J, Medeiros BC, Mrozek E, O'Connor T, Petersdorf SH, Rugo HS, Silliman RA, Tew WP, Walter LC, Weir AB, Wildes T. Senior adult oncology. J Natl Compr Canc Netw. 2012 Feb; 10(2):162-209.
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Dinh TA, Alperin P, Walter LC, Smith R. Impact of comorbidity on colorectal cancer screening cost-effectiveness study in diabetic populations. J Gen Intern Med. 2012 Jun; 27(6):730-8.
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Lee SJ, Boscardin WJ, Stijacic-Cenzer I, Conell-Price J, O'Brien S, Walter LC. Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ. 2012; 346:e8441.
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So C, Kirby KA, Mehta K, Hoffman RM, Powell AA, Freedland SJ, Sirovich B, Yano EM, Walter LC. Medical center characteristics associated with PSA screening in elderly veterans with limited life expectancy. J Gen Intern Med. 2012 Jun; 27(6):653-60.
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Walter LC. What is the right cancer screening rate for older adults. Arch Intern Med. 2011 Dec 12; 171(22):2037-9.
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Ahalt C, Walter LC, Yourman L, Eng C, Pérez-Stable EJ, Smith AK. "Knowing is better": preferences of diverse older adults for discussing prognosis. J Gen Intern Med. 2012 May; 27(5):568-75.
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Lee SJ, Walter LC. Quality indicators for older adults: preventing unintended harms. JAMA. 2011 Oct 5; 306(13):1481-2.
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Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc. 2011 Oct; 74(4):885-96.
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Pham AN, Datta SK, Weber TJ, Walter LC, Colón-Emeric CS. Cost-effectiveness of oral bisphosphonates for osteoporosis at different ages and levels of life expectancy. J Am Geriatr Soc. 2011 Sep; 59(9):1642-9.
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Huang AJ, Brown JS, Boyko EJ, Moore EE, Scholes D, Walter LC, Lin F, Vittinghoff E, Fihn SD. Clinical significance of postvoid residual volume in older ambulatory women. J Am Geriatr Soc. 2011 Aug; 59(8):1452-8.
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Mehta KM, Pierluissi E, Boscardin WJ, Kirby KA, Walter LC, Chren MM, Palmer RM, Counsell SR, Landefeld CS. A clinical index to stratify hospitalized older adults according to risk for new-onset disability. J Am Geriatr Soc. 2011 Jul; 59(7):1206-16.
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Kistler CE, Kirby KA, Lee D, Casadei MA, Walter LC. Long-term outcomes following positive fecal occult blood test results in older adults: benefits and burdens. Arch Intern Med. 2011 Aug 8; 171(15):1344-51.
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Day LW, Walter LC, Velayos F. Colorectal cancer screening and surveillance in the elderly patient. Am J Gastroenterol. 2011 Jul; 106(7):1197-206;quiz 1207.
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Carlson CM, Kirby KA, Casadei MA, Partin MR, Kistler CE, Walter LC. Lack of follow-up after fecal occult blood testing in older adults: inappropriate screening or failure to follow up? Arch Intern Med. 2011 Feb 14; 171(3):249-56.
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Kistler CE, Walter LC, Mitchell CM, Sloane PD. Patient perceptions of mistakes in ambulatory care. Arch Intern Med. 2010 Sep 13; 170(16):1480-7.
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Chang A, Walter LC. Recognizing dementia as a terminal illness in nursing home residents: Comment on "Survival and comfort after treatment of pneumonia in advanced dementia". Arch Intern Med. 2010 Jul 12; 170(13):1107-9.
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Mehta KM, Fung KZ, Kistler CE, Chang A, Walter LC. Impact of cognitive impairment on screening mammography use in older US women. Am J Public Health. 2010 Oct; 100(10):1917-23.
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Hoffman RM, Walter LC. Colorectal cancer screening in the elderly: the need for informed decision making. J Gen Intern Med. 2009 Dec; 24(12):1336-7.
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Kao H, Walter LC. Improvement of hospital care of elderly patients: thinking outside the (hospital) box: comment on "hospital at home for elderly patients with acute decompensation of chronic heart failure". Arch Intern Med. 2009 Sep 28; 169(17):1576-7.
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Williams BA, Baillargeon JG, Lindquist K, Walter LC, Covinsky KE, Whitson HE, Steinman MA. Medication prescribing practices for older prisoners in the Texas prison system. Am J Public Health. 2010 Apr; 100(4):756-61.
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Williams BA, Lindquist K, Hill T, Baillargeon J, Mellow J, Greifinger R, Walter LC. Caregiving behind bars: correctional officer reports of disability in geriatric prisoners. J Am Geriatr Soc. 2009 Jul; 57(7):1286-92.
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Walter LC, Lindquist K, Nugent S, Schult T, Lee SJ, Casadei MA, Partin MR. Impact of age and comorbidity on colorectal cancer screening among older veterans. Ann Intern Med. 2009 Apr 7; 150(7):465-73.
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Schane RE, Walter LC, Dinno A, Covinsky KE, Woodruff PG. Prevalence and risk factors for depressive symptoms in persons with chronic obstructive pulmonary disease. J Gen Intern Med. 2008 Nov; 23(11):1757-62.
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Williams BA, Lindquist K, Sudore RL, Covinsky KE, Walter LC. Screening mammography in older women. Effect of wealth and prognosis. Arch Intern Med. 2008 Mar 10; 168(5):514-20.
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Carey EC, Covinsky KE, Lui LY, Eng C, Sands LP, Walter LC. Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc. 2008 Jan; 56(1):68-75.
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Walter LC, Lewis CL. Maximizing informed cancer screening decisions. Arch Intern Med. 2007 Oct 22; 167(19):2027-8.
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O'Hare AM, Choi AI, Bertenthal D, Bacchetti P, Garg AX, Kaufman JS, Walter LC, Mehta KM, Steinman MA, Allon M, McClellan WM, Landefeld CS. Age affects outcomes in chronic kidney disease. J Am Soc Nephrol. 2007 Oct; 18(10):2758-65.
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Lee SJ, Moody-Ayers SY, Landefeld CS, Walter LC, Lindquist K, Segal MR, Covinsky KE. The relationship between self-rated health and mortality in older black and white Americans. J Am Geriatr Soc. 2007 Oct; 55(10):1624-9.
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O'Hare AM, Bertenthal D, Walter LC, Garg AX, Covinsky K, Kaufman JS, Rodriguez RA, Allon M. When to refer patients with chronic kidney disease for vascular access surgery: should age be a consideration? Kidney Int. 2007 Mar; 71(6):555-61.
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Steinman MA, Maaravi Y, Walter LC, Hammerman-Rozenberg R, Stessman J. Evolution of medication use in Jerusalem elders: Results from the Jerusalem Longitudinal Study. Drugs Aging. 2007; 24(2):133-45.
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Walter LC, Bertenthal D, Lindquist K, Konety BR. PSA screening among elderly men with limited life expectancies. JAMA. 2006 Nov 15; 296(19):2336-42.
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Williams BA, Lindquist K, Moody-Ayers SY, Walter LC, Covinsky KE. Functional impairment, race, and family expectations of death. J Am Geriatr Soc. 2006 Nov; 54(11):1682-7.
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Gupta S, Vittinghoff E, Bertenthal D, Corley D, Shen H, Walter LC, McQuaid K. New-onset diabetes and pancreatic cancer. Clin Gastroenterol Hepatol. 2006 Nov; 4(11):1366-72; quiz 1301.
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Lewis CL, Kistler CE, Amick HR, Watson LC, Bynum DL, Walter LC, Pignone MP. Older adults' attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities. BMC Geriatr. 2006; 6:10.
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Walter LC, Lindquist K, O'Hare AM, Johansen KL. Targeting screening mammography according to life expectancy among women undergoing dialysis. Arch Intern Med. 2006 Jun 12; 166(11):1203-8.
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Williams BA, Lindquist K, Sudore RL, Strupp HM, Willmott DJ, Walter LC. Being old and doing time: functional impairment and adverse experiences of geriatric female prisoners. J Am Geriatr Soc. 2006 Apr; 54(4):702-7.
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Kistler CE, Lewis CL, Amick HR, Bynum DL, Walter LC, Watson LC. Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey. BMC Fam Pract. 2006; 7:9.
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O'Hare AM, Bertenthal D, Covinsky KE, Landefeld CS, Sen S, Mehta K, Steinman MA, Borzecki A, Walter LC. Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol. 2006 Mar; 17(3):846-53.
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Walter LC, Lewis CL, Barton MB. Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence. Am J Med. 2005 Oct; 118(10):1078-86.
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Carey EC, Walter LC, Lindquist K, Covinsky KE. Development and validation of a functional morbidity index to predict mortality in community-dwelling elders. J Gen Intern Med. 2004 Oct; 19(10):1027-33.
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Walter LC, Davidowitz NP, Heineken PA, Covinsky KE. Pitfalls of converting practice guidelines into quality measures: lessons learned from a VA performance measure. JAMA. 2004 May 26; 291(20):2466-70.
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Walter LC, Lindquist K, Covinsky KE. Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age. Ann Intern Med. 2004 May 4; 140(9):681-8.
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Walter LC, de Garmo P, Covinsky KE. Association of older age and female sex with inadequate reach of screening flexible sigmoidoscopy. Am J Med. 2004 Feb 1; 116(3):174-8.
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Walter LC, Lui LY, Eng C, Covinsky KE. Risk of hip fracture in disabled community-living older adults. J Am Geriatr Soc. 2003 Jan; 51(1):50-5.
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Covinsky KE, Eng C, Lui LY, Sands LP, Sehgal AR, Walter LC, Wieland D, Eleazer GP, Yaffe K. Reduced employment in caregivers of frail elders: impact of ethnicity, patient clinical characteristics, and caregiver characteristics. J Gerontol A Biol Sci Med Sci. 2001 Nov; 56(11):M707-13.
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Walter LC, Eng C, Covinsky KE. Screening mammography for frail older women: what are the burdens? J Gen Intern Med. 2001 Nov; 16(11):779-84.
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Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, Covinsky KE. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA. 2001 Jun 20; 285(23):2987-94.
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Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001 Jun 6; 285(21):2750-6.
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Covinsky KE, Palmer RM, Counsell SR, Pine ZM, Walter LC, Chren MM. Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports. J Am Geriatr Soc. 2000 Feb; 48(2):164-9.
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