Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Geriatrics > CGA > Flashcards

CGA Flashcards

1
Q

What is CGA?

A

A process to assess and manage disruption to health in older people with frailty

“A multidimensional interdisciplinary diagnostic process focused on determining a frail elderly person’s medical, psychological and functional capability in order to develop a co-ordinated and integrated plan for treatment and long term follow up”
Rubenstein, 1991

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is ageing?

A

Progressive accumulation of damage to a complex system resulting in aggregate loss of system redundancy

Loss of redundancy leads to frailty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does loss of system redundancy lead to?

A

Decreased resilience to overcome environmental stress-leads to increased risk of system failure

Our aging strategy is that we have high levels of redundancy and low levels of repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the effects of ageing (senescence) and how does it lead to frailty?

A

Age related decline leads to:
- Impairment of individual organ function
- Breakdown of the complex interplay between organ systems (dyshomeostasis)

This leads to
Increased susceptibility to environmental stress= FRAILTY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is frailty a state of?

A

A state of susceptibility to acquiring disease and susceptibility to functional decline in the context of disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Is multimorbidity the norm?

A

Multimorbidity-idea of having more than one chronic diseases is the norm for people who access health care and it gets worse as you get older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If you are old + multimorbid does it mean you are frail?

A

NOOO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do we identify someone as ‘frail’?

A

Use the frailty index

  • More points the more frail you are
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The frailty phenotype applies in Fried at al model if have 3 of what 5 criteria?

A

Unintentional weight loss
Exhaustion
Weak grip strength
Slow walking speed
Low physical activity

Special cut offs for each of these things

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the spectrum view of frailty?

A

Spectrum between minimal and severe frailty

Some people can improve, get less frail or improve their resilience, improve their health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the clinical frailty scale?

A

1-9

From very fit to terminally ill

(scoring frailty in people with dementia differs-degree of frailty corresponds to the degree of dementia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In what conditions to people tend to present with frailty syndromes?

A

Falls
Immobility
Delirium
Functional decline

These are system failure presentations

Decompensated frailty syndromes – often present with multiple frailty syndromes at once

Environmental stress leading to breakdown of the whole system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What characterises a system failure?

A

System failure leads to fault-delirium-functional decline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does taking a functional Hx show?

A

Ability to live a life independently

  • What did you do to get up and go into work today?-asks about ability to do these things
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the ADLs?

A

Transfers
Mobility
Toileting
Washing
Dressing
Meal preparation
Feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do system failure presentations cause?

A

Decompensated frailty syndromes

17
Q

What is the role of the doctor in a person’s story?

A

Take the story where the person wants their plot to go- or help give it a happy ending (good palliative care)

Goal and focus is the life and not the disease

Goal centredness
Person centredness
Wellbeing
Realistic Medicine

18
Q

What is goal centredness in CGA?

A

The right thing to do=We do what the person wants, not what the doctor wants

The easy thing to do:
Multimorbidity
Conflicting ‘disease priorities’
Polypharmacy

19
Q

What is health realistically?

A

A dynamic process rather than a binary state

Health isn’t solely the concept of disease or this narrow medical view

20
Q

What does illness in frail people lead to and what can it be triggered by?

A

Leads to disruption in multiple health domains

Can be triggered by disruption in any health domain

21
Q

What is the difference between pathological and physiological?

A

Pathological – ‘disease’
Physiological – ‘normal ageing’

Reversible
Non-reversible

Multiple concomitant problems
Iatrogenic harm

Few things in med are ‘curable’

Aim to preserve function in chronic disease – organ function or overall function- and looking to reduce exacerbations

Infection and iatrogenic harm can be cured

22
Q

What does spiritual care mean?

A

Person centred care

Acknowledge persons meaning

23
Q

What psychological issues should be addressed commonly when thinking about frailty and ageing?

A

Mood:
Low mood
Anxiety

Confidence:
‘fear of falling syndrome’

Cognition:
Delirium
Dementia

24
Q

What functional issues should be addressed?

A

Mobility:
Transfers
Mobilising

Activities of Daily Living

Community living skills-higher level function that you need to do to exist in the society

25
Q

What behaviours should be looked at in a CGA?

A

Behavioural determinants of ill health-Unhealthy eating/smoking/drinking

Activities/Pastimes

Occupation

26
Q

What nutritional aspects should be thought about and what screening tool can be used?

A

Poor nutrition leads to ill health

Ill health leads to poor nutrition

MUST screening tool

27
Q

What environmental factors and social factors should be addressed?

A

Environmental:
Housing
Heating
Sanitation
Adaptation

Social:
Support networks
- Practical/emotional
- Formal/informal
Potential for abuse
(Financial, Physical, Sexual, Neglect)

28
Q

What are some societal issues with views on ageing?

A

Attitudes to ageing/the aged
- Asset vs. burden
- Paternalism

Technological advance-Enabling vs. disabling

Political/Regulations
- Money (eg. Winter heating allowance/pensions)
- Accessibility (eg. Free bus passes/Disabled access)

29
Q

What is crucial about CGA?

A
  • Goal centredness
  • Multidimensional/’holistic’ approach
30
Q

How does CGA work as an inpatient?

A

MDT assessment
- Form a combined view
- Importance of goal directedness
- Come up with a plan-out of hosp and maintenance of future health or palliative
- Discharge planning

31
Q

If someone cannot be made better when can they be discharged from hospital?

A

Hosp benefits:
Access to clinical expertise
Access to complex tests and interventions
Rapid access to supervised care support

Risks of Hosp:
Disorientation and delirium
Learned dependency
Deconditioning-particularly if immobile-rapidly lose muscle strength and develop all the complications of immobility
Iatrogenic harm
Hospital Acquired Infection

Optimal discharge based on individual assessment (when risk outweighs benefit) or simply discharge when goals are met

32
Q

What is the evidence for CGA?

A

Compared to standard medical care this has better outcomes for older people with frailty

33
Q

What are the geriatric giants now known as frailty syndromes?

A
  • Instability
  • Immobility
  • Incontinence
  • (cognitive) Impairment
34
Q

What are some reasons that patients may fall?

A

Poor footwear
Intoxication
Degenerative brain conditions
Meds
Postural instability
Cognitive impairment
Urinary urgency

35
Q

What are reasons that a patient may not be able to walk?

A

Loss of muscle mass-sarcopenia
SOB
Pain
Postural instability

36
Q

What are some reasons for incontinence?

A

Weakened pelvic floor
Infection
Constipation-faecal incontinence due to overflow
Caffeine

37
Q

Reasons for a patient being cognitively impaired?

A
  • Collateral Hx
  • Dementia
  • Delirium

SDH
Intoxication
Brain disease
Constipation

38
Q

What Hx & examinations are recommended in a geriatric patient?

A

Hx:
- Collateral Hx
- GP, care home
- Meds
- Social Hx

Exam:
Resp/CVS/Abdo
Neurology - Focused neurological examination
Gait
Lying and Standing BP
Look at the skin
Incontinent?
PR +/- external PV-Look for prolapse

Geriatrics (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions