B - Comprehensive geriatric assessment and acute illness

Question 1

When clerking in a geriatric patient, what is the assessment called that helps with the care of the person known as?

Answer 1

Comprehensive geriatric assessment

Question 2

What are the 4 steps in creating a comprehensive geriatric assessment? (how does a problems list differ from differentials)

Answer 2

Create a problems list - this differs from differentials as it covers all possible problems the patient may have instead of only forming differentials for a singular problem Agree upon objectives of care Develop an individual management plan for the patient Review patient regularly

Question 3

“multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s medical, psychological and functional capability in order to develop a co-ordinated and integrated plan for treatment and long term follow up” What is this?

Answer 3

This is a comprehensive geriatric assessment - allows you to create a co-ordinated plan for the patient

Question 4

What are the main aspects looked at in a CGA?

Answer 4

Medical - create a problems list, review medication and nutritional status Psychological - patient mental status and cognition and depression Functional - Basic ADL Social/environment -social circle and safety

Question 5

Many elderly patients can present with various symptoms due to side effects of drugs This usually due to polypharmacy What is polypharmacy?

Answer 5

Polympharmacy is the use of four or more medications by patients - generally over the age of 65

Question 6

What are the benefits of a comprehensive geriatric assessment?

Answer 6

It reduces the mortality rate of the patient at 6 months and improves function and cognition

Question 7

MRs G is a 78-year-old lady admitted with falls and increasing confusion. She has been struggling at home and was unkempt on admission She appeared to have lost weight as her clothes were loose fitting She has hypertension, COPD, osteoarthritis and diabetes and is on 12 medications Create a problems list?

Answer 7

Dehydration Polypharmacy Malnutrition Social isolation Anaemic

Question 8

Older people do not always present as per the textbook Older people can present with an MI without having any chest pain, what disease is this also seen in?

Answer 8

It is seen in diabetes for people to present without chest pain when having an MI

Question 9

As stated, young people present with an MI showing pain generally, what symptoms to older patients show?

Answer 9

No chest pain in 1/3rd Confusion Dizziness Breathlessness

Question 10

What is the initial treatment of a MI?

Answer 10

Morphine Oxygen GTN Asprin + Clopidogrel

Question 11

What is given to treat the infarct normallyy?- before 120 minutes and after if STEMI on ECG

Answer 11

If patient has STEMI on ECG - then PCI if available with in 120minutes If not then thrombolyse

Question 12

What is the normal follow up treatment of an MI?

Answer 12

Statin Ace inhibitor Beta blocker Aspirin + clopidogrel

Question 13

Why might the medication have worse side effects in an older patient?

Answer 13

Older patient may be unable to tolerate the dual anti-platelet therapy Also a beta blocker may slow the heart rate too much and statin could cause muscle weakness in an already weak patient

Question 14

What are the known side effects of her medication and what caused the diarrhoea?

Answer 14

Cocodamol - can cause constipation which could lead to incontinency Aspirin - can cause interstitial nephritis, worsen hard failure due to fluid retention in kidneys and cause GI bleeds The antibitoic probably caused the Cdiff toxin on stool culture causing the diarrhoea

Question 15

Why can cocodamol lead to delerium in an elderly patient?

Answer 15

Can cause constipation leading to urinary retention which is a known factor in delirium

Question 16

What is used to treat non severe, severe and recurring Cdiff?

Answer 16

Non severe - oral metronidazole Severe - oral vancomycin Recurring - fidaxomicin Suspect C. difficile infection in patients with diarrhoea who are on antibiotics, or who have had antibiotics in preceding 12 weeks

Question 17

Acute illness carries a much higher mortality rate in older people Impaired physiology, multimorbidity etc They therefore tend to decompensate faster Run over again the main points of a CGA and the 4 main subtopics?

Answer 17

Create a problems list Agree on objective of care Develop a management plan for patient Review regularly Medication, psychological, functional and social/environment