CGA

Question 1

What is frailty?

Answer 1

Loss of physiologic reserve

Question 2

Who is the CGA designed to aid?

Answer 2

Frail elderly most at risk of adverse events (not all elderly will benefit i.e. independent in community unlikely to benefit).
Challenge is to identify those who will benefit

Question 3

What are the geriatric syndromes?

Answer 3

• Incontinence
• Iatrogenesis
• Immobility
• Instability
• Intellectual decline (dementia, delirium)
• Functional decline
• Chronic wounds

Question 4

When was the CGA developed?

Answer 4

By Marjory Warren (surgeon) with RCT in 80s demonstrating 50% reduction in mortality

Question 5

What is the CGA?

Answer 5

Interdisciplinary, multidimensional assessment. Core components:

• functional (ADLs)
• medical (dx, Mx; cognitive assessment and Rx rv mandatory!)
• psychological (esp depression)
• social / environmental

Question 6

Who are commonly members of the CGA team?

Answer 6

• Medical doctor (usu geriatrician)
• Nurses
• Social worker
• OT
• PT
• Carers

Question 7

When are carers particularly important in conducting the CGA?

Answer 7

Acute setting when subtle to significantly different changes in current and pre-morbid function must be explored

Question 8

What are the social / environmental components of the CGA?

Answer 8

• Place of residence
• Current and available supports (formal and informal)
• Spirituality
• Financial situation

Question 9

What should be opportunistically discussed during the CGA?

Answer 9

Advance care planning including substitute decision makers and wishes in event of deteriorating health and inability to communicate

Question 10

What is the Barthel index?

Answer 10

Ordinal scale of ADLs. Variables:

• presence or absence of fecal incontinence
• presence or absence of urinary incontinence
• help needed with grooming
• help needed with toilet use
• help needed with feeding
• help needed with transfers (e.g. from chair to bed)
• help needed with walking
• help needed with dressing
• help needed with climbing stairs
• help needed with bathing

Question 11

How does CGA differ from disease centred approach?

Answer 11

Integration of medical, functional, cognitive and psychosocial components

Question 12

What are the target populations of CGA?

Answer 12

• Age >75
• Living alone
• Pre-existing cognitive impairment
• Dependence in at least one personal ADL and 2 community or domestic ADL’s
• Multiple health problems
• Reports of not managing well at home
• Carer stress
• Multiple hospital admissions
• Polypharmacy

Question 13

What are the personal ADLs?

Answer 13

• Personal ADL’s

- Dressing
- Showering
- Toileting
- Continence

Question 14

What are the domestic ADLs?

Answer 14

• Cooking

- Cleaning

Question 15

What are the community ADLs?

Answer 15

• Phone
• Shopping
• Banking
• Transport
• Driving

Question 16

What are the key domains of the functional assessment?

Answer 16

• Activity / function
• Mobility / walking / falls risk
• Transfers
• ADLs