Comprehensive Geriatric Assessment 1

Question 1

Comprehansive Geriatric Assessment (CGA) - what is it?

Answer 1

A process to assess and manage disruption to health in older people with frailty

An entire process, not just an assessment

Question 2

Ageing - Not about age alone, about dealing with people with _____

Answer 2

frailty

Question 3

Ageing and redundancy - Progressive _________ of ________ to a complex system resulting in aggregate loss of system _________

Answer 3

accumulation

damage

redundancy

Question 4

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?

Answer 4

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

Question 5

Loss of system redundancy leads to decreased __________ to overcome ___________ ______

Answer 5

resilience

environmental stress

If system stressed then less able to overcome the problem

Question 6

Loss of system redundancy leads to decreased resilience to overcome environmental stress

what does this lead to?

Answer 6

Leads to increased risk of system failure

(Or a break in the system)

Question 7

what are the Effects of Ageing (Senescence)?

Answer 7

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

Question 8

Frailty = A state of ___________

Answer 8

susceptibility

(To acquiring disease and functional decline in the context of disease)

Question 9

Multimorbidity - A multimorbid world

graph showing how people can live with many diseases

Answer 9

Majority of people have no chronic disease

Question 10

Multimorbidity is the norm for people accessing ___________

Answer 10

healthcare

Question 11

Old + Multimorbid ≠ ______

Answer 11

Frail

Question 12

How do we identify someone as ‘frail’?

Answer 12

Various ways

Question 13

what is the frailty index?

Answer 13

Give a point for every impairment of disease in this list

Question 14

what is the fried criteria?

Answer 14

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

Question 15

‘traditional’ view

Answer 15

Spectrum view:

There is a spectrum from a little bit to very frail and more susceptible

Some people can improve

Question 16

what is the lcinical frailty scale?

Answer 16

Rothwoods clinical frailty scale is commonly used now a days

Question 17

Tend to present with ‘Frailty syndromes’ - what are they?

Answer 17

• 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

Question 18

Tend to present with ‘Frailty syndromes’:

• Falls
• Immobility
• Delirium
• Functional decline

These are _______ ________ presentations

Answer 18

system failure

Question 19

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?

Answer 19

Problem with this leads to a fall

MSK, brain, circulation involved and more

Question 20

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?

Answer 20

delirium

Question 21

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?

Answer 21

Present with functional decline

Question 22

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?

Answer 22

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

Question 23

How do you assess these things?

Answer 23

Taking a ‘functional history’