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Royal College 2023 > CGA/Role of geriatrician > Flashcards

CGA/Role of geriatrician Flashcards

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1
Q

5 outcomes to measure effectiveness of ACE unit

A

Functional disability/BADL*
LTC admission*
Cost of hospitalization
Length of stay
Readmission to hospital
Other: restrained patients, satisfaction*, falls, delirium, pressure ulcers

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2
Q

5 ACE unit principles

A
  1. Prepared environment
  2. Patient centered bedside care*
  3. Comprehensive discharge planning
  4. Medical care review*
  5. Early rehabilitation*
    * more important as per JAGS 2013 review
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3
Q

ACE unit vs. ACE order set JAGS 2022 Norman and Sinha

A

ACE more likely to be discharged home
In hospital mortality lower but non significant

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4
Q

JAGS 2012 Systematic review for ACE

A

Significant: less falls, delirium, functional decline, discharge to LTC, shorter LOS, lower costs
Trend: pressure ulcers
No difference: functional decline b/w hospital admission, mortality, hospital admissions

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5
Q

Topics for health promotion

A
  1. Healthy eating
  2. Physical activity
  3. Falls prevention
  4. Tobacco control
  5. Social connectedness
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6
Q

10 reasons to refer to geriatric consult team

A
  1. Delirium
  2. Dementia
  3. Falls
  4. Fracture
  5. Polypharmacy
  6. Frailty
  7. Mood
  8. Urinary incontinence
  9. Parkinsonism
  10. Sleep
    Other: driving, capacity
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7
Q

ACE Unit which patients benefit

A

> 70 yo
General medicine patients
Community dwellers

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8
Q

Who is needed for ACE unit?

A
  1. RN for patient entered care
  2. PT/OT for early rehab
  3. SW for discharge planning
  4. Geriatrician for medical care review
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9
Q

Positive outcomes found for geriatric day hospital

A

Cochrane 2015
Only significant findings is for GDH vs. no care did show improvement for ADL deterioration and composite of death/poor outcome (institutional, dependency, dec physical function)

2020 study
Difference in fear of falling, functional exercise capacity and balance
No difference in caregiver stress

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10
Q

What is the definition of a CGA?

A

Multidimensional, interdisciplinary diagnostic process to determine medical, psychosocial and functional capabilities of frail elderly person to develop integrated treatment plan

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11
Q

Core components of CGA

A

Medical/surgical history
Social History
Functional history (Katz, Lawton)
Physical assessment (Tinetti, Get up and go, gait speed)
Cognition (MMSE, MOCA, CAM)
Mood/mental health (GDS, Cornell, PHQ-9)
Falls
Sleep
Pain
Nutrition (mini nutritional assessment)
Continence
Polypharmacy

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12
Q

Cochrane 2022 Outcomes of CGA community dwelling, high risk, frail

A

Little to no difference in mortality
Little to no difference nursing home
May decrease risk of unplanned hospital admission (14 months)
Effect on ED visits uncertain

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13
Q

5 primary prevention programs in elderly

A
  1. Vaccinations
    Herpes - 2 doses once 50+
    Flu - annual
    PNA - 1 dose once 65+ or in LTC
  2. Physical fitness
  3. Good nutritional status
  4. Smoking cessation
  5. Reduce alcohol intake
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14
Q

5 secondary prevention programs in elderly

A
  1. FRAX for females 65+
  2. HTN - BP at all appropriate GP visits
  3. Breast cancer - mammogram q2-3 years 50-74
  4. Diabetes A1c q3-5 years if high risk
  5. Lung cancer - low dose CT x 3 between 55-74 if 30 pyx and quit <15 years ago
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15
Q

Cochrane 2017 review CGA for patients admitted to hospital

A
  1. Increased likelihood patients will be alive and in their own home 3-12 mos
  2. Less likely to be admitted to nursing home 3-12 mos
  3. Little or no difference mortality 3-12 mos
  4. Little or no difference in dependence
  5. No meaningful conclusions for cognitive function, LOS, cost and QALY
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16
Q

4 Ms of Age Friendly health system

A
  1. Mobility
  2. Medication
  3. Mentation
  4. Matters Most
17
Q

Steps to integrate 4 Ms into care

A
  1. Understand current state
  2. Describe care consistent with 4Ms
  3. Design/adapt workflow
  4. Provide care
  5. Study performance
  6. Improve and sustain care
18
Q

5 outcomes in Cochrane 2018 review on CGA for surgical service

A

Improved
1. Reduce mortality
2. Reduce discharge to inc level of care
3. Reduce LOS
4. Reduce total cost
No difference
1. Readmission rates
2. Major post op complications
3. Delirium rates

19
Q

9 outcomes for CGA

A
  1. Admission to LTC
  2. Mortality
  3. Hospital admission
  4. ED visits
  5. Delirium
  6. Falls
  7. Pressure sores
  8. LOS
  9. Cost
20
Q

Age/Ageing 2022 CGA review

A
  1. Hospital: reduce nursing home, reduce risk of falls, reduce pressure sores
  2. Hip fracture reduce delirium
  3. Community: decrease risk of physical frailty
  4. Improve clinical outcomes in oncology, hematology and ED
21
Q

Review of all evidence

A

ACE 2012 JAGS
- Improved: falls, delirium, functional dependence, LTC, COS, LOS
- Trend: pressure injuries
- No evidence: hospital admission, func decline b/w admissions, mortality

GDH
- Fear of falling
- Functional exercise capacity
- Balance

CGA – Community Cochrane 2022
- Little to no difference: mortality, LTC
- Unsure: ED visit
- Maybe: unplanned hospital admissions

CGA – Hospital Cochrane 2017
- Improve: less likely LTC 3-12 mos, more likely alive and in home 3-12 mos
- Little to no difference: mortality, dependence
- Unsure: LOS, COS, Cognition, QALY

CGA – Surgical Cochrane 2018
- Improve: LOS, COS, mortality, discharge to LTC
- Little to no difference: readmission, post op delirium, complications

CGA – Multiple Age/Ageing 2022
- Hospital: fall, pressure injury, LTC
- Hip fracture – reduce delirium
- Community – reduce physical frailty
- Outcomes in onc, heme, ED

Royal College 2023 (79 decks)

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