Comphrensive Geriatric Assessment

Question 1

That does age related decline lead to?

Answer 1

Impairment of individual organ function
Breakdown of complex systems between organs (dyshomeostasis)

Leading to increased susceptibility to environmental stresses (frailty)

Question 2

What is frailty?

Answer 2

Increased risk of death of debility following exposure to an environmental stressor

Or

A reduced ability to withstand illness without loss of function

Question 3

What is involved in the illness trajectory of frailty?

Answer 3

A triggering event causes decline
Leading to a crisis, so there is an admission
Followed by a bit of reablement but patient will not return to pre-crisis functional ability

Question 4

What kind of a problem is functional decline in frailty?

Answer 4

Aggressive, self perpetuating problem

Question 5

What are the typical geriatric syndromes of presentation?

Answer 5

Falls
Immobility
Functional decline
Delirium

Question 6

What is the WHO definition of health?

Answer 6

A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity

Question 7

Why is the WHO definition of health BS?

Answer 7

Health is a dynamic rather than a binary state

Want to just make people feel better

Question 8

What are the health domains?

Answer 8

Medical
Psychological
Functional
Behavioural
Nutritional
Spiritual
Environmental
Societal
Social

Question 9

What does illness in frail people tend to lead to?

Answer 9

Disruption in multiple health domains

Can also be triggered by any disruption in any health domain

Question 10

What is our approach to treating elderly patients?

Answer 10

Try to make them feel better
Don’t just focus on the medical domain
Involve other health professionals/manage/coordinate care

Question 11

What is the purpose of the CGA?

Answer 11

Assess and manage illness in older people

Question 12

What does the CGA involve?

Answer 12

Determine what the problems are and what health domains are affected
Determine what can be improved/reversed
Make a management plan

Question 13

Why are the health domains complicated?

Answer 13

They are all interlinked and affected by one another

Question 14

What is involved in the medical health domain?

Answer 14

Pathological vs physiological
Determining if reversible or not
Avoiding iatrogenic harm and infections

Question 15

What is involved in the psychological domain?

Answer 15

Mood (low mood, anxiety)
Confidence, eg fear of falling
Cognition (delirium, dementia)

Question 16

What is involved in the functional health domain?

Answer 16

Mobility (transfers, mobilising)
Activities of daily living
Community living skills

Question 17

What is involved in the behaviour health domain?

Answer 17

Unhealthy eating, smoking, drinking
Activities/past times
Occupation

Question 18

What is involved in the nutritional health domain?

Answer 18

Poor health leads to poor nutrition, and vice versa

MUST is a screening tool

Question 19

What is the MUST screening tool used for and what does it involve?

Answer 19

????

Question 20

What is involved in the spiritual health domain?

Answer 20

How do you fit into the bigger picture?
What is important to you?
What’s the meaning of your life?
How do you like to project your self image?

Question 21

What is involved in the environmental health domain?

Answer 21

Housing
Heating
Sanitation
Adaptations

Question 22

What is involved in the social health domain?

Answer 22

Support network (practical/emotional, formal/informal)
Potential for abuse (financial, physical, sexual, neglect)

Question 23

What are some societal issues with ageing?

Answer 23

Attitudes to the aged (burden vs asset, paternalism)
Technological advance (enabling vs disabling) 
Political regulations (money, eg pensions/winter heating allowance or accessibility, eg free bus passes/disability badges)

Question 24

What are the key professionals involved in geriatric care?

Answer 24

Geriatric
OT
PT
skilled nurses

Question 25

What other professionals are involved in geriatric care?

Answer 25

``` GP Other doctors Social workers Home care Dietician SALT input ```

Question 26

What is involved in good geriatric care?

Answer 26

Early identification if need Early CGA Early provision of appropriate level of care for need

Question 27

What is the evidence for the benefit of the CGA?

Answer 27

Means patients are more likely to be alive or living at home in 6m/12m And less likely to be living in residential care With risk prediction we can prevent crisis and decline

Question 28

What improves elderly patients outcomes?

Answer 28

The earlier in the illness trajectory a frail person undergoes the process of CGA, the better the outcome is likely to be