Faculty ProfilesLouise Walter, MD
3333 Calif. St,Laurel Heights
San Francisco, CA 94118
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.
Education and Training
|Location||Degree or Training||Specialty||Date|
|University of California, San Francisco||Residency||Internal Medicine|
Awards and Honors
Elected into Alpha Omega Alpha Honor Medical Society, UCSF Medical Student Class of 2016, 2016
Outstanding Research Mentor of the Year, Society of General Internal Medicine, 2013
Elected into American Society for Clinical Investigation (ASCI), 2012
Academic Senate Distinction in Faculty Mentoring Award, UCSF, 2010
Outstanding Scientific Achievement for Clinical Investigation Award, American Geriatrics Society, 2009
Related Web Sites
In the News
- Elderly Prisoners Need Better Medical Care (Jun 14, 2012)
- Health, Prognosis Not Taken Into Account When Treating Older Lung Cancer Patients, Study Finds (May 01, 2012)
- Prostate Cancer Screenings at VA Hospitals Don't Follow Guidelines for Elderly, Study Says (Jan 10, 2012)
- Pursuit of Health Care Quality Standards May Harm the Elderly (Oct 04, 2011)
Recent Articles (88)
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. Impact of age and comorbidity on treatment of non-small cell lung cancer recurrence following complete resection: A nationally representative cohort study. Lung Cancer. 2016 Dec; 102:108-117.
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. NCCN Guidelines Insights: Older Adult Oncology, Version 2.2016. J Natl Compr Canc Netw. 2016 Nov; 14(11):1357-1370.
Suskind AM, Jin C, Cooperberg MR, Finlayson E, Boscardin WJ, Sen S, Walter LC. Preoperative Frailty Is Associated With Discharge to Skilled or Assisted Living Facilities After Urologic Procedures of Varying Complexity. Urology. 2016 Nov; 97:25-32.
MacKintosh FR, Sprenkle PC, Walter LC, Rawson L, Karnes RJ, Morrell CH, Kattan MW, Nawaf CB, Neville TB. Age and Prostate-Specific Antigen Level Prior to Diagnosis Predict Risk of Death from Prostate Cancer. Front Oncol. 2016; 6:157.
Tang VL, Shi Y, Fung K, Tan J, Espaldon R, Sudore R, Wong ML, Walter LC. Clinician Factors Associated With Prostate-Specific Antigen Screening in Older Veterans With Limited Life Expectancy. JAMA Intern Med. 2016 May 1; 176(5):654-61.
Breslau ES, Gorin SS, Edwards HM, Schonberg MA, Saiontz N, Walter LC. An Individualized Approach to Cancer Screening Decisions in Older Adults: A Multilevel Framework. J Gen Intern Med. 2016 May; 31(5):539-47.
Braithwaite D, Walter LC, Izano M, Kerlikowske K. Benefits and Harms of Screening Mammography by Comorbidity and Age: A Qualitative Synthesis of Observational Studies and Decision Analyses. J Gen Intern Med. 2016 May; 31(5):561-72.
Suskind AM, Walter LC, Jin C, Boscardin J, Sen S, Cooperberg MR, Finlayson E. Impact of frailty on complications in patients undergoing common urological procedures: a study from the American College of Surgeons National Surgical Quality Improvement database. BJU Int. 2016 May; 117(5):836-42.
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. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015 Oct 20; 314(15):1599-614.
Perissinotto CM, Walter LC. Capsule Commentary on Wolff, et al., A Look at Person- and Family-Centered Care Among Older Adults: Results from a National Survey. J Gen Intern Med. 2015 Oct; 30(10):1536.
Duralde ER, Walter LC, Van Den Eeden SK, Nakagawa S, Subak LL, Brown JS, Thom DH, Huang AJ. Bridging the gap: determinants of undiagnosed or untreated urinary incontinence in women. Am J Obstet Gynecol. 2016 Feb; 214(2):266.e1-9.
Lewis CL, Adams J, Tai-Seale M, Huang Q, Knowles SB, Nielsen ME, Pignone MP, Walter LC, Frosch DL. A Randomized Controlled Effectiveness Trial for PSA Screening Decision Support Interventions in Two Primary Care Settings. J Gen Intern Med. 2015 Jun; 30(6):810-6.
Huang AJ, Gregorich SE, Kuppermann M, Nakagawa S, Van Den Eeden SK, Brown JS, Richter HE, Walter LC, Thom D, Stewart AL. 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. 2015 Feb; 22(2):144-54.
Partin MR, Burgess DJ, Burgess JF, Gravely A, Haggstrom D, Lillie SE, Nugent S, Powell AA, Shaukat A, Walter LC, Nelson DB. Organizational predictors of colonoscopy follow-up for positive fecal occult blood test results: an observational study. Cancer Epidemiol Biomarkers Prev. 2015 Feb; 24(2):422-34.
Shi Y, Fung KZ, Freedland SJ, Hoffman RM, Tang VL, Walter LC. Statin medications are associated with a lower probability of having an abnormal screening prostate-specific antigen result. Urology. 2014 Nov; 84(5):1058-65.
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. A framework for crafting clinical practice guidelines that are relevant to the care and management of people with multimorbidity. J Gen Intern Med. 2014 Apr; 29(4):670-9.
Espaldon R, Kirby KA, Fung KZ, Hoffman RM, Powell AA, Freedland SJ, Walter LC. Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold. Urology. 2014 Mar; 83(3):599-605.
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. Senior adult oncology, version 2.2014: clinical practice guidelines in oncology . J Natl Compr Canc Netw. 2014 Jan; 12(1):82-126.
Walter LC, Fung KZ, Kirby KA, Shi Y, Espaldon R, O'Brien S, Freedland SJ, Powell AA, Hoffman RM. Five-year downstream outcomes following prostate-specific antigen screening in older men. JAMA Intern Med. 2013 May 27; 173(10):866-73.
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.
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. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013 Mar-Apr; 63(2):107-17.
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. 2013; 346:e8441.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.