Brainscape's Knowledge GenomeTM

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


See full index

Integrated Care > CGA > Flashcards

CGA Flashcards

1
Q

What is the purpose of the comprehensive geriatric assessment?

A

Hollistic management of older person
Reduce mortality and improve independence
Can reduce hospital admissions
Can be done by any member of the heath and social team

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

What are the stages of a comprehensive geriatric assessment?

A 
Assessment
Creating a problems list
Personalised care plan
Intervention
Regular planned review
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What assessments are done in a comprehensive geriatric assessment?

A 
Physical
Socioeconomoc/environmental
Functional
Mobility/balance
Psychological
Medication review
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the general considerations in physical assessment of an elderly patient?

A

Opportunistically assess gait and balance

Prioritise parts of examination as it can be tiring

May be limitations to posture and mobility so group examinations by position rather than system

Check capacity for non-concordant patients

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

What should be assessed within a physical exam in a comprehensive geriatric assessment?

A 
Sensory loss - hearing, vision, feet
Gait and balance
Lying and standing BP
Cognition and mood
Skin
Functional ability
Pain
Weight and nutrition
PR/genitalia exam
Continence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What changes are considered normal as a patient ages?

A

Skin changes - wrinkles, uneven colouration

Neurological - reduced ankle reflex, loss of vibration sense in toes

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

What would you consider abnormal on a blood pressure measurement for an elderly person?

A

Systolic <90

Drop >20 when standing

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

What are the 2 models of assessing an elderly patients social wellbeing?

A

Questioning model - assessor set agenda

Exchange model - patient is expert

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why are social and financial situations important for patient wellbeing?

A

Impact attendance and compliance to healthcare

Psychological wellbeing

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

What is assessed in the social assessment of the comprehensive geriatric assessment?

A

Living - who with? pets?
Financial - income support? Carer allowance? CHC funding?
Support - informal, formal, carers? how often?
Mobility - how often? how?
Other - power of attorney? capacity? care plan?

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

What is assessed in the environmental assessment of the comprehensive geriatric assessment?

A 
Nature of home circumstance
Specific information - buzzer, access to home
Stairs - rails, lift?
Toilet facilities - comode? where?
Room to room analysis
Telephone
Cooking facilities - who does shopping?
Heating and lighting
Risks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What factors are encompassed within functional assessment of comprehensive geriatric assessment?

A

ADL
Mobility
Technology use - telecare?
Sensory loss - coping mechanisms?

What can and what does the patient do
How recently has function changed

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

What can sudden loss of function indicate in an elderly patient?

A

Acute illness

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

What tools are used to assess functional ability in elderly patients?

A

Barthel index
Nottingham extended ADL scale
Timed up and go test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why is maximising an elderly patients mobility and balance so important?

A

Improve quality of life

Decrease need for health and social care - major risk factor for falls

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

Why is a diagnosis of gait and balance disturbance important before making physio referral?

A

Relevant referrals can be made
Guide patient expectation
Can’t control pain in arthritis so cant do certain physio exercises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the steps in assessing a patients gait and balance?

A

History
Referral to specialist
Watch patient walk - ideally when unaware

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do elderly patients tend to walk and what does this mean?

A

Shorter steps

More difficult to get up and do steps
Tendency to fall backwards

19
Q

What walking tests can be done to assess gait and balance?

A

Time up and go - 8-11s
180 degrees turn test - number of steps
Gait speed
Chair stand

20
Q

What are the parts of the psychological assessment in the comprehensive geriatric assessment?

A

Mood

Cognition

21
Q

Why is mood assessment important in the elderly and what should be done?

A

5-10% of >65yo depressed but often under recognised and attributed to other conditions

Results in increased mortality and poorer outcomes

Do geriatric depression score

22
Q

What screening questions should be asked to assess an elderly patients mood?

A 
How often have they felt down In the last month
Ever sit and cry for no reason?
Worry about future?
Anhedonia?
Lonely?

Ask questions when alone ideally

23
Q

What are the risk factors for suicide in the elderly?

A 
Male
Social isolation/bereavement
Hx of attempt/plan
Chronic illness
Drug/alcohol
Sleep disorder
24
Q

Why is cognition assessed in elderly patients?

A

Look for dementia and delirium

25
Q

How is cognition assessed in elderly patients?

A

Screening question about forgetfulness
GP-Cog
MMSE
AMTS

26
Q

What is involved in a medication review?

A 
Full medication history
Compliance
Does the drug work
Side effects
Medical history 
Drug-drug interactions

STOP START

27
Q

What is the NO TEARS tool for medication review?

A 
Need and indication
Open questions
Tests and monitoring
Evidence and guidelines
Adverse effects
Reduction
Simplification and switches
28
Q

What is the STOP START tool?

A

Document with various medications which should be commenced/stopped for patients >65yo with certain conditions

29
Q

How should a problem list be collated?

A

Develop in collaboration with patient
Acute, subacute and chronic problems

Tests and investigations if they alter the management plant

30
Q

What is care planning?

A

Conversation with patient to discuss priorities of treatment to create a holistic support plan

Identify best treatment and agree actions of both parties

Continuous process

Document needs, wishes and treatment plan

31
Q

Why do we want to use care planning?

A

Currently we are reactive and disease focussed in our approach. We provide fragmented care.

Care plans allow us to create a holistic management plan which is proactive and aims to prevent further hospitalisation. It aims to best use limited resources

32
Q

What are the 9 key areas in a care plan?

A 
Personal details
Views of patient and carer
Views of professionals
Care and support arrangements
Medication Hx
Identify goals
End of Life
Named contact
Action plan
33
Q

What are the stages of a care plan?

A

1 Prepare
2 Discuss
3 Document - goals and normal observations
4 Review

34
Q

What is an escalation plan (integrated care)?

A

Plan for what should be done if things deteriorate

35
Q

What is the issue with prescribing in the elderly population?

A

Age related organ changes alter drug pharmacokinetics

Multiple co-morbidities lead to cautions, CI and drug-drug interactions

36
Q

What are the aims of a medication review?

A

In agreement with patient on necessary medications

Optimise impact of medication

Reduce ADRs

Reduce waste

37
Q

What is the process for a medication review?

A 
List of medications
Assess compliance - do they take them all
Are they working?
Side effects? 
Over the counter medications?
Drug-drug interactions
38
Q

What must be considered when prescribing new medications in the frail population?

A 
Is it needed?
Start on lowest dose
Make instructions on usage clear
Dosette boxes?
Involve pharmacist
39
Q

Give examples of drug classes that can lead to elderly patients being hospitalised

A 
NSAID's 
Diuretics
ACE-Inhibitors
B-Blocker
Warfarin
Clopidogrel
Antidepressants
Opiates
Prednisolone
40
Q

What anti-depressants should be avoided in the elderly?

A

Amitriptyline - postural hypo

Serotenergic meds - agitation and seretonin syndrome

41
Q

What diabetic meds should be avoided in the elderly?

A

Long acting - risk of hypoglycaemia

42
Q

Why should you be wary when prescribing hyponotics in the elderly?

A

Can cause daytime drowsiness and unsteadiness –> falls

Benzo’s addictive

Sleep hygiene and non-pharmacological used first

43
Q

What key questions should be considered when making a care plan?

A

What is important to you?
What elements of care do you want?
What elements of care do you not want?
Who is going to speak for you?

44
Q

Why is care planning used?

A

Current methods are reactive and disease focussed

Care planning aims to be proactive - preventative and holistic with best use of resources

Integrated Care (9 decks)

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