Community Flashcards
What should you include in your medical hx of an older person?
Current reason for admission
Falls history
Assessment of cognition- collateral history to ascertain if theres any change
Continence assessment (bowels and bladder Hx)
PMH and disease severity
Current med list and compliance
Drug allergies
Social and functional history
Alcohol intake and smoking hx
Further systemic enquiry
Enquire about wishes and advance decisions if appropriate- some people may not want investigations etc or have advance directives
What is a comprehensive geriatric assesment?
Comprehensive geriatric assessment is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological, and functional capabilities of a frail older person in order to develop a coordinated and integrated plan for treatment and long-term follow-up
Why is a CGA important?
CGA leads to better outcomes, including reduced readmissions, reduced long-term care, greater patient satisfaction and lower costs
- CGA emphasises quality of life and functional status, prognosis, and outcome
What does a typical CGA team comprise of?
A typical CGA team comprises geriatrician, nurse specialist, occupational therapist, physiotherapist, pharmacist and others as needed (speech and language therapist, dietician)
What does the domains of a CGA include?
o Problem list – current and past
o Medication review
o Nutritional status
o Mental health – cognition, mood and anxiety, fears
o Functional capacity - basic activities of daily living , gait and balance, activity/exercise status, instrumental activities of daily living
o Social circumstances - informal support available from family or friends, social network such a visitors or daytime activities, eligibility for being offered care resources
o Environment - home environment, facilities and safety within the home environment, transport facilities ,accessibility to local resources
What is a comprehensive geriatric assesment?
A process of good holistic care delivered within a geriatric medicine focused MDT, which goes above and beyond simply managing the acute problem the person presented with
What does a CGA comprise of?
Physical symptoma- pain, continence, sensory impairement, MSK problems, nutritional and skin assesment
Mental health symptoms- mood, cognitive impairement
Functional abilities and living environment
Social support networks
What is the perk of CGA?
Those who underwent a CGA were more likely to be alive, less likely to have physically deteriorated and more likely to be living with a lower level of dependency than those who did not. The effect was seen at both 6 and 12 months later.
Those who underwent a CGA were more likely to be alive, less likely to have physically deteriorated and more likely to be living with a lower level of dependency than those who did not. The effect was seen at both 6 and 12 months later.
What would mimic dementia and delirium?
Mood disorder (depression or mania)
Hypothyroidism
Hyperthyroidism
Stroke
What is frailty?
A clinically recognized state of increased vulnerability as a result of ageing, associated with a decline in the bodys psychological and physical reserves
Not inevitable, most people will experience frailty
How is frailty identified?
Any interaction between a healthcare individual with an elderly person should include an assesment which aims to identify frailty
Various types of assesment exist…
Gait speed
Timed up and go
Prisma 7 questionare
What can be done to stratify frailty?
Electronic frailty index
How do you support patients with frailty as inpatients?
Prevention is best
Inpatient with frailty…
- avoid unnecessary admission, this increases risk of hospital infections and falls
- Good discharge planning and post discharge support are essential
- Identify and manage the mental health needs
How do you support patients with frailty in the community?
Inactivity leads to further loss of reserves, try and maintain activity and encourage independence
At least one substantial meal per day- nutrition, supplementation with calcium and vit D is helpful
STOPP tool to prevent polypharmacy
Screen for loneliness and poor mental health
What is a comprehensive geriatric assesment?
Multidimensional interdisciplinary diagnostic process which is focused on determining a frail older persons medical, psychological and functional capability in order to develop a co ordinated and integrated plan for treatment and long term follow up.
