Louise Walter, MD

Professor and Chief
Medicine
+1 415 221-4810 ext. 23052

Dr. Walter was appointed Chief of the UCSF Division of Geriatrics in July 2013 after serving as interim division chief since August 2012.

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 geriatrician at the San Francisco VA Medical Center.

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 $2.5 million Geriatric Workforce Enhancement Program grant from HRSA 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) and her receipt of the Society of General Internal Medicine's Research Mentor of the Year Award in 2013.

Dr. Walter is the Associate Director of the UCSF Clinical and Translational Science Institute Career Development (KL2) Program and Director of the San Francisco VA’s Health Services Research and Development Program to Improve Care for Veterans with Complex Comorbid Conditions. She also is the Core Leader of the Research Career Development Core (RCDC) for the UCSF Pepper Center for Aging Research.

Publications: 

Overactive Bladder Is Strongly Associated With Frailty in Older Individuals.

Urology

Suskind AM, Quanstrom K, Zhao S, Bridge M, Walter LC, Neuhaus J, Finlayson E

Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow-up for abnormal colorectal cancer screening test results.

Cancer

Partin MR, Gravely AA, Burgess JF, Haggstrom DA, Lillie SE, Nelson DB, Nugent SM, Shaukat A, Sultan S, Walter LC, Burgess DJ

The Timed Up and Go Test as a Measure of Frailty in Urologic Practice.

Urology

Pangilinan J, Quanstrom K, Bridge M, Walter LC, Finlayson E, Suskind AM

Predictors of the multidimensional symptom experience of lung cancer patients receiving chemotherapy.

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

Wong ML, Paul SM, Cooper BA, Dunn LB, Hammer MJ, Conley YP, Wright F, Levine JD, Walter LC, Cartwright F, Miaskowski C

Functional Outcomes After Transurethral Resection of the Prostate in Nursing Home Residents.

Journal of the American Geriatrics Society

Suskind AM, Walter LC, Zhao S, Finlayson E

Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection: A nationally representative cohort study.

Lung cancer (Amsterdam, Netherlands)

Wong ML, McMurry TL, Stukenborg GJ, Francescatti AB, Amato-Martz C, Schumacher JR, Chang GJ, Greenberg CC, Winchester DP, McKellar DP, Walter LC, Kozower BD

NCCN Guidelines Insights: Older Adult Oncology, Version 2.2016.

Journal of the National Comprehensive Cancer Network : JNCCN

VanderWalde N, Jagsi R, Dotan E, Baumgartner J, Browner IS, Burhenn P, Cohen HJ, Edil BH, Edwards B, Extermann M, Ganti AK, Gross C, Hubbard J, Keating NL, Korc-Grodzicki B, McKoy JM, Medeiros BC, Mrozek E, O'Connor T, Rugo HS, Rupper RW, Shepard D, Silliman RA, Stirewalt DL, Tew WP, Walter LC, Wildes T, Bergman MA, Sundar H, Hurria A

Barrett's Esophagus Commonly Diagnosed in Elderly Men with Limited Life Expectancy.

Journal of the American Geriatrics Society

Ko MS, Fung KZ, Shi Y, Espaldon R, Shergill A, Walter LC

Author Reply.

Urology

Suskind AM, Finlayson E, Walter LC

Age and Prostate-Specific Antigen Level Prior to Diagnosis Predict Risk of Death from Prostate Cancer.

Frontiers in oncology

MacKintosh FR, Sprenkle PC, Walter LC, Rawson L, Karnes RJ, Morrell CH, Kattan MW, Nawaf CB, Neville TB

Clinician Factors Associated With Prostate-Specific Antigen Screening in Older Veterans With Limited Life Expectancy.

JAMA internal medicine

Tang VL, Shi Y, Fung K, Tan J, Espaldon R, Sudore R, Wong ML, Walter LC

An Individualized Approach to Cancer Screening Decisions in Older Adults: A Multilevel Framework.

Journal of general internal medicine

Breslau ES, Gorin SS, Edwards HM, Schonberg MA, Saiontz N, Walter LC

Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.

JAMA

Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, Walter LC, Church TR, Flowers CR, LaMonte SJ, Wolf AM, DeSantis C, Lortet-Tieulent J, Andrews K, Manassaram-Baptiste D, Saslow D, Smith RA, Brawley OW, Wender R

Bridging the gap: determinants of undiagnosed or untreated urinary incontinence in women.

American journal of obstetrics and gynecology

Duralde ER, Walter LC, Van Den Eeden SK, Nakagawa S, Subak LL, Brown JS, Thom DH, Huang AJ

Treatment patterns for older veterans with localized prostate cancer.

Cancer epidemiology

Hoffman RM, Shi Y, Freedland SJ, Keating NL, Walter LC

A Randomized Controlled Effectiveness Trial for PSA Screening Decision Support Interventions in Two Primary Care Settings.

Journal of general internal medicine

Lewis CL, Adams J, Tai-Seale M, Huang Q, Knowles SB, Nielsen ME, Pignone MP, Walter LC, Frosch DL

Day-to-Day Impact of Vaginal Aging questionnaire: a multidimensional measure of the impact of vaginal symptoms on functioning and well-being in postmenopausal women.

Menopause (New York, N.Y.)

Huang AJ, Gregorich SE, Kuppermann M, Nakagawa S, Van Den Eeden SK, Brown JS, Richter HE, Walter LC, Thom D, Stewart AL

The burden of nocturia among middle-aged and older women.

Obstetrics and gynecology

Hsu A, Nakagawa S, Walter LC, Van Den Eeden SK, Brown JS, Thom DH, Lee SJ, Huang AJ

Organizational predictors of colonoscopy follow-up for positive fecal occult blood test results: an observational study.

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology

Partin MR, Burgess DJ, Burgess JF, Gravely A, Haggstrom D, Lillie SE, Nugent S, Powell AA, Shaukat A, Walter LC, Nelson DB

Reply: To PMID 25443902.

Urology

Shi Y, Boscardin WJ, Walter LC

Lag time to benefit for preventive therapies--reply.

JAMA

Lee SJ, Leipzig RM, Walter LC

A framework for crafting clinical practice guidelines that are relevant to the care and management of people with multimorbidity.

Journal of general internal medicine

Uhlig K, Leff B, Kent D, Dy S, Brunnhuber K, Burgers JS, Greenfield S, Guyatt G, High K, Leipzig R, Mulrow C, Schmader K, Schunemann H, Walter LC, Woodcock J, Boyd CM

Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold.

Urology

Espaldon R, Kirby KA, Fung KZ, Hoffman RM, Powell AA, Freedland SJ, Walter LC

Senior adult oncology, version 2.2014: clinical practice guidelines in oncology .

Journal of the National Comprehensive Cancer Network : JNCCN

Hurria A, Wildes T, Blair SL, Browner IS, Cohen HJ, Deshazo M, Dotan E, Edil BH, Extermann M, Ganti AK, Holmes HM, Jagsi R, Karlekar MB, Keating NL, Korc-Grodzicki B, McKoy JM, Medeiros BC, Mrozek E, O'Connor T, Rugo HS, Rupper RW, Silliman RA, Stirewalt DL, Tew WP, Walter LC, Weir AB, Bergman MA, Sundar H

Disability during the last two years of life.

JAMA internal medicine

Smith AK, Walter LC, Miao Y, Boscardin WJ, Covinsky KE

Patient-reported problems after office procedures.

JAMA internal medicine

Linos E, Wehner MR, Frosch DL, Walter L, Chren MM

Five-year downstream outcomes following prostate-specific antigen screening in older men.

JAMA internal medicine

Walter LC, Fung KZ, Kirby KA, Shi Y, Espaldon R, O'Brien S, Freedland SJ, Powell AA, Hoffman RM

Talking about stopping cancer screening-not so easy.

JAMA internal medicine

Schonberg MA, Walter LC

American Cancer Society lung cancer screening guidelines.

CA: a cancer journal for clinicians

Wender R, Fontham ET, Barrera E, Colditz GA, Church TR, Ettinger DS, Etzioni R, Flowers CR, Gazelle GS, Kelsey DK, LaMonte SJ, Michaelson JS, Oeffinger KC, Shih YC, Sullivan DC, Travis W, Walter L, Wolf AM, Brawley OW, Smith RA

Individualizing cancer screening in older adults: a narrative review and framework for future research.

Journal of general internal medicine

Eckstrom E, Feeny DH, Walter LC, Perdue LA, Whitlock EP

Addressing the aging crisis in U.S. criminal justice health care.

Journal of the American Geriatrics Society

Williams BA, Goodwin JS, Baillargeon J, Ahalt C, Walter LC

Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

Wang S, Wong ML, Hamilton N, Davoren JB, Jahan TM, Walter LC

Senior adult oncology.

Journal of the National Comprehensive Cancer Network : JNCCN

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

Impact of comorbidity on colorectal cancer screening cost-effectiveness study in diabetic populations.

Journal of general internal medicine

Dinh TA, Alperin P, Walter LC, Smith R

Medical center characteristics associated with PSA screening in elderly veterans with limited life expectancy.

Journal of general internal medicine

So C, Kirby KA, Mehta K, Hoffman RM, Powell AA, Freedland SJ, Sirovich B, Yano EM, Walter LC

What is the right cancer screening rate for older adults.

Archives of internal medicine

Walter LC

"Knowing is better": preferences of diverse older adults for discussing prognosis.

Journal of general internal medicine

Ahalt C, Walter LC, Yourman L, Eng C, Pérez-Stable EJ, Smith AK

Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis.

Gastrointestinal endoscopy

Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M

Cost-effectiveness of oral bisphosphonates for osteoporosis at different ages and levels of life expectancy.

Journal of the American Geriatrics Society

Pham AN, Datta SK, Weber TJ, Walter LC, Colón-Emeric CS

Clinical significance of postvoid residual volume in older ambulatory women.

Journal of the American Geriatrics Society

Huang AJ, Brown JS, Boyko EJ, Moore EE, Scholes D, Walter LC, Lin F, Vittinghoff E, Fihn SD

A clinical index to stratify hospitalized older adults according to risk for new-onset disability.

Journal of the American Geriatrics Society

Mehta KM, Pierluissi E, Boscardin WJ, Kirby KA, Walter LC, Chren MM, Palmer RM, Counsell SR, Landefeld CS

Long-term outcomes following positive fecal occult blood test results in older adults: benefits and burdens.

Archives of internal medicine

Kistler CE, Kirby KA, Lee D, Casadei MA, Walter LC

Colorectal cancer screening and surveillance in the elderly patient.

The American journal of gastroenterology

Day LW, Walter LC, Velayos F

Lack of follow-up after fecal occult blood testing in older adults: inappropriate screening or failure to follow up?

Archives of internal medicine

Carlson CM, Kirby KA, Casadei MA, Partin MR, Kistler CE, Walter LC

Patient perceptions of mistakes in ambulatory care.

Archives of internal medicine

Kistler CE, Walter LC, Mitchell CM, Sloane PD

Impact of cognitive impairment on screening mammography use in older US women.

American journal of public health

Mehta KM, Fung KZ, Kistler CE, Chang A, Walter LC

Colorectal cancer screening in the elderly: the need for informed decision making.

Journal of general internal medicine

Hoffman RM, Walter LC

Medication prescribing practices for older prisoners in the Texas prison system.

American journal of public health

Williams BA, Baillargeon JG, Lindquist K, Walter LC, Covinsky KE, Whitson HE, Steinman MA

Caregiving behind bars: correctional officer reports of disability in geriatric prisoners.

Journal of the American Geriatrics Society

Williams BA, Lindquist K, Hill T, Baillargeon J, Mellow J, Greifinger R, Walter LC

Impact of age and comorbidity on colorectal cancer screening among older veterans.

Annals of internal medicine

Walter LC, Lindquist K, Nugent S, Schult T, Lee SJ, Casadei MA, Partin MR

Prevalence and risk factors for depressive symptoms in persons with chronic obstructive pulmonary disease.

Journal of general internal medicine

Schane RE, Walter LC, Dinno A, Covinsky KE, Woodruff PG

Screening mammography in older women. Effect of wealth and prognosis.

Archives of internal medicine

Williams BA, Lindquist K, Sudore RL, Covinsky KE, Walter LC

Prediction of mortality in community-living frail elderly people with long-term care needs.

Journal of the American Geriatrics Society

Carey EC, Covinsky KE, Lui LY, Eng C, Sands LP, Walter LC

Maximizing informed cancer screening decisions.

Archives of internal medicine

Walter LC, Lewis CL

Age affects outcomes in chronic kidney disease.

Journal of the American Society of Nephrology : JASN

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

The relationship between self-rated health and mortality in older black and white Americans.

Journal of the American Geriatrics Society

Lee SJ, Moody-Ayers SY, Landefeld CS, Walter LC, Lindquist K, Segal MR, Covinsky KE

When to refer patients with chronic kidney disease for vascular access surgery: should age be a consideration?

Kidney international

O'Hare AM, Bertenthal D, Walter LC, Garg AX, Covinsky K, Kaufman JS, Rodriguez RA, Allon M

Evolution of medication use in Jerusalem elders: Results from the Jerusalem Longitudinal Study.

Drugs & aging

Steinman MA, Maaravi Y, Walter LC, Hammerman-Rozenberg R, Stessman J

PSA screening among elderly men with limited life expectancies.

JAMA

Walter LC, Bertenthal D, Lindquist K, Konety BR

Functional impairment, race, and family expectations of death.

Journal of the American Geriatrics Society

Williams BA, Lindquist K, Moody-Ayers SY, Walter LC, Covinsky KE

New-onset diabetes and pancreatic cancer.

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

Gupta S, Vittinghoff E, Bertenthal D, Corley D, Shen H, Walter LC, McQuaid K

Targeting screening mammography according to life expectancy among women undergoing dialysis.

Archives of internal medicine

Walter LC, Lindquist K, O'Hare AM, Johansen KL

Being old and doing time: functional impairment and adverse experiences of geriatric female prisoners.

Journal of the American Geriatrics Society

Williams BA, Lindquist K, Sudore RL, Strupp HM, Willmott DJ, Walter LC

Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey.

BMC family practice

Kistler CE, Lewis CL, Amick HR, Bynum DL, Walter LC, Watson LC

Mortality risk stratification in chronic kidney disease: one size for all ages?

Journal of the American Society of Nephrology : JASN

O'Hare AM, Bertenthal D, Covinsky KE, Landefeld CS, Sen S, Mehta K, Steinman MA, Borzecki A, Walter LC

Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence.

The American journal of medicine

Walter LC, Lewis CL, Barton MB

Development and validation of a functional morbidity index to predict mortality in community-dwelling elders.

Journal of general internal medicine

Carey EC, Walter LC, Lindquist K, Covinsky KE

Association of older age and female sex with inadequate reach of screening flexible sigmoidoscopy.

The American journal of medicine

Walter LC, de Garmo P, Covinsky KE

Risk of hip fracture in disabled community-living older adults.

Journal of the American Geriatrics Society

Walter LC, Lui LY, Eng C, Covinsky KE

Reduced employment in caregivers of frail elders: impact of ethnicity, patient clinical characteristics, and caregiver characteristics.

The journals of gerontology. Series A, Biological sciences and medical sciences

Covinsky KE, Eng C, Lui LY, Sands LP, Sehgal AR, Walter LC, Wieland D, Eleazer GP, Yaffe K

Screening mammography for frail older women: what are the burdens?

Journal of general internal medicine

Walter LC, Eng C, Covinsky KE

Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization.

JAMA

Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, Covinsky KE

Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports.

Journal of the American Geriatrics Society

Covinsky KE, Palmer RM, Counsell SR, Pine ZM, Walter LC, Chren MM