Comphrensive Geriatric Assessment Flashcards
That does age related decline lead to?
Impairment of individual organ function
Breakdown of complex systems between organs (dyshomeostasis)
Leading to increased susceptibility to environmental stresses (frailty)
What is frailty?
Increased risk of death of debility following exposure to an environmental stressor
Or
A reduced ability to withstand illness without loss of function
What is involved in the illness trajectory of frailty?
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
What kind of a problem is functional decline in frailty?
Aggressive, self perpetuating problem
What are the typical geriatric syndromes of presentation?
Falls
Immobility
Functional decline
Delirium
What is the WHO definition of health?
A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity
Why is the WHO definition of health BS?
Health is a dynamic rather than a binary state
Want to just make people feel better
What are the health domains?
Medical Psychological Functional Behavioural Nutritional Spiritual Environmental Societal Social
What does illness in frail people tend to lead to?
Disruption in multiple health domains
Can also be triggered by any disruption in any health domain
What is our approach to treating elderly patients?
Try to make them feel better
Don’t just focus on the medical domain
Involve other health professionals/manage/coordinate care
What is the purpose of the CGA?
Assess and manage illness in older people
What does the CGA involve?
Determine what the problems are and what health domains are affected
Determine what can be improved/reversed
Make a management plan
Why are the health domains complicated?
They are all interlinked and affected by one another
What is involved in the medical health domain?
Pathological vs physiological
Determining if reversible or not
Avoiding iatrogenic harm and infections
What is involved in the psychological domain?
Mood (low mood, anxiety)
Confidence, eg fear of falling
Cognition (delirium, dementia)
What is involved in the functional health domain?
Mobility (transfers, mobilising)
Activities of daily living
Community living skills
What is involved in the behaviour health domain?
Unhealthy eating, smoking, drinking
Activities/past times
Occupation
What is involved in the nutritional health domain?
Poor health leads to poor nutrition, and vice versa
MUST is a screening tool
What is the MUST screening tool used for and what does it involve?
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What is involved in the spiritual health domain?
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?
What is involved in the environmental health domain?
Housing
Heating
Sanitation
Adaptations
What is involved in the social health domain?
Support network (practical/emotional, formal/informal) Potential for abuse (financial, physical, sexual, neglect)
What are some societal issues with ageing?
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)
What are the key professionals involved in geriatric care?
Geriatric
OT
PT
skilled nurses
What other professionals are involved in geriatric care?
GP Other doctors Social workers Home care Dietician SALT input
What is involved in good geriatric care?
Early identification if need
Early CGA
Early provision of appropriate level of care for need
What is the evidence for the benefit of the CGA?
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
What improves elderly patients outcomes?
The earlier in the illness trajectory a frail person undergoes the process of CGA, the better the outcome is likely to be
