Comprehensive Geriatric Assessment 1 Flashcards
Comprehansive Geriatric Assessment (CGA) - what is it?
A process to assess and manage disruption to health in older people with frailty
An entire process, not just an assessment
Ageing - Not about age alone, about dealing with people with _____
frailty
Ageing and redundancy - Progressive _________ of ________ to a complex system resulting in aggregate loss of system _________
accumulation
damage
redundancy
2 strategies for ageing: high levels of redundancy and low need for repair, versus lower levels of redundancy and higher needs for repair
what is the human body like out of these 2?
Humans have high levels of redundancy and low levels of repair but it does mean as you accumulate the damage and don’t repair it your system has less resilience to overcome problems
Loss of system redundancy leads to decreased __________ to overcome ___________ ______
resilience
environmental stress
If system stressed then less able to overcome the problem
Loss of system redundancy leads to decreased resilience to overcome environmental stress
what does this lead to?
Leads to increased risk of system failure
(Or a break in the system)
what are the Effects of Ageing (Senescence)?
Age related decline leads to:
- Impairment of individual organ function
- Breakdown of the complex interplay between organ systems (dyshomeostasis)
This leads to:
Increased susceptibility to environmental stress
= FRAILTY
Frailty = A state of ___________
susceptibility
(To acquiring disease and functional decline in the context of disease)
Multimorbidity - A multimorbid world
graph showing how people can live with many diseases
Majority of people have no chronic disease
Multimorbidity is the norm for people accessing ___________
healthcare
Old + Multimorbid ≠ ______
Frail
How do we identify someone as ‘frail’?
Various ways
what is the frailty index?
Give a point for every impairment of disease in this list
what is the fried criteria?
Frailty phenotype:
•Fried et al. 3 of 5 criteria
- Unintentional weight loss
- Exhaustion
- Weak grip strength
- Slow walking speed
- Low physical activity
Your frail if you have 3 of the 5 criteria
‘traditional’ view
Spectrum view:
There is a spectrum from a little bit to very frail and more susceptible
Some people can improve
what is the lcinical frailty scale?
Rothwoods clinical frailty scale is commonly used now a days
Tend to present with ‘Frailty syndromes’ - what are they?
- Falls
- Immobility
- Delirium
- Functional decline
Decompensated frailty syndromes
People with frailty more likely to acquire disease
Reasons why illness in the body leads to these frailty syndromes is because these are system failure presentations
Tend to present with ‘Frailty syndromes’:
- Falls
- Immobility
- Delirium
- Functional decline
These are _______ ________ presentations
system failure
System failure:
•You need to do certain things to live – your body is designed to enable you to do these things
‘Getting up and moving around’ system - failure of this may lead to what?
Problem with this leads to a fall
MSK, brain, circulation involved and more
System failure:
•You need to do certain things to live – your body is designed to enable you to do these things
‘Understanding, processing and reacting to the environment’ system - failure of this may lead to what?
delirium
System failure:
•You need to do certain things to live – your body is designed to enable you to do these things
‘Being able to look after yourself’ system - failure of this may lead to what?
Present with functional decline
You need to do certain things to live – your body is designed to enable you to do these things:
- ‘Getting up and moving around’ system
- ‘Understanding, processing and reacting to the environment’ system
- ‘Being able to look after yourself’ system
are these linked?
Think of these as system/body failure presentations
These things are linked together so often present with many like delirium and fall or with immobility and functional etc as these things are all linked together
How do you assess these things?
Taking a ‘functional history’
