UCSF Department Of Medicine | Division of Geriatrics

Louise C. Walter is an Associate Professor of Medicine in the Division of Geriatrics and is the Co-Director of the UCSF Geriatrics Research Program.

Dr. Walter is a clinician-researcher. Her experience as a doctor caring for older patients informs her research. She has often said "the advantage of being a clinician-researcher is that you know what would really help improve the care of your patients, so you know what questions to ask in your research." Dr. Walter's research is focused on how age and health affect the use and outcomes of cancer screening in older patients to better inform individualized screening decisions. Through her high-impact publications and policy work she has become a national leader in evaluating the real-world risks and benefits of cancer screening in older patients. She is currently a Robert Wood Johnson Physician Faculty Scholar, the Principal Investigator on a VA Health Services Research & Development grant to determine the use and outcomes of colorectal cancer screening in older adults, and the Principal Investigator on an National Cancer Institute R01 grant to determine the downstream consequences of prostate-specific antigen screening in older men. She is also a mentor for junior clinician-researchers through the UCSF Clinical and Translational Science Institute Career Development (KL2) Program.

Dr. Walter received her MD from Stanford University School of Medicine 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 Medical Center.

Clinical Activities

Dr. Walter provides primary care for elderly veterans at the San Francisco VA Geriatrics Clinic. She provides care for about one hundred older veterans who have an average age of at least 80. She also attends on the Inpatient Medical Service at the San Francisco VA and provides night coverage for the San Francisco VA Nursing Home and Palliative Care Services.

Research Activities

Dr. Walter's research focuses on cancer screening in older people. How do you decide who is most likely to benefit from a screening test, and who is most likely to be harmed? Her goal is to help clinicians and patients make better individualized cancer screening decisions that do not rely simply on age cutoffs but take a patient's preferences and health conditions into account.

Dr. Walter first became interested in the issue of cancer screening when her patients began asking her whether or not they should receive a screening test. In response, she developed a conceptual framework to guide cancer screening decisions in older patients in a more sensible way than relying on age alone. Since her framework was published in 2001, it has appeared in numerous cancer screening guidelines and is widely used in medical schools across the country to teach decision-making. Dr. Walter has also led a series of other high-impact studies that use this framework to identify ways to improve current cancer screening practices. Through her research she has become a leader in the national conversation about cancer screening in older adults.

The goal of Dr. Walter's research is to help clinicians avoid a "one-size-fits-all approach" to cancer screening. Dr. Walter says, "As a group, older people are really diverse, from bed-bound nursing home patients to individuals who are out hiking and running marathons. The decision to screen or not should reflect the situation of the individual, not just their age."

Selected Publications:

Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA 2001;285:2750-2756.
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;285:2987-2994.
Walter LC, Eng C, Covinsky KE. Screening mammography for frail older women: what are the burdens? J Gen Intern Med. 2001;16:779-784.
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;140:681-688.

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; 291:2466-2470.
Walter LC, Lewis CL, Barton MB. Colorectal, breast, and cervical cancer screening in the elderly: a review of the evidence. Am J Med. 2005;118:1078-1086.
Walter LC, Bertenthal D, Lindquist K, Konety BR. PSA screening among elderly men with limited life expectancies. JAMA 2006;296:2336-2342.
Walter LC, Lewis CL. Maximizing informed cancer screening decisions. Arch Intern Med. 2007;167:2027-2028.
Williams BA, Lindquist K, Sudore RL, Covinsky KE, Walter LC. Screening mammography in older women: effect of wealth and prognosis. Arch Intern Med. 2008;168:514-520.
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 (in press).