comprehensive geriatric assessment Flashcards
what is comprehensive geriatric assessment (CGA)
a process to assess and manage disruption to health in older people w/ frailty
what is ageing and redundancy
progressive accumulation of damage to a complex system resulting in aggregate loss of system redundancy
what does loss of redundancy result in
loss of system redundancy leads to decreased resilience to overcome environmental stress
if the system is stressed you are less able to overcome the problem and that leads to increased risk of system failure or breakdown
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
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
what is frailty
a state of susceptibility
- to acquiring disease and to functional decline in the context of disease
what is multimorbidity
= the idea of having more than one chronic disease
the majority of people have no chronic disease
but as you do develop disease only the minority of people have one chronic disease
if you have any disease you’re much more likely to have >1 chronic morbidity
as you get older you are much more likely to have multiple problems
does being old + multimorbid mean you are frail
no
old + multimorbid ≠ frail
how do we identify someone as being frail
frailty index: 1 point for every disease/impairment you have from a list, more points = more frail - not particularly clinically useful
Fried et al: 3 of 5 criteria - unintentional weight loss, exhaustion, weak grip strength, slow walking speed, low physical activity
clinical frailty scale
there is a spectrum of frailty from minimal to severely frail
frailty and changes as we age
most people increase in their severity of frailty as they age
some people can improve and get less frail/improve their resilience
clinical frailty scale
what do frail people tend to present with
frailty syndromes: falls immobility delirium functional decline
these are system failure presentations
system failure
you need to do certain things to life and your body is designed to enable this
getting up and moving around
understanding, processing and reacting to the environment
being able to look after yourself
typical systems (MSK, CVS etc) are parts of these wider systems and work together
how do you assess a person’s function and ability to live independently
taking a ‘functional hx’
- what did you do to get up and go into work today and what is your ability to do these things
e. g. getting out of bed, mobilising to the toilet, washing and dressing, eating
what are ADLs
activities of daily living
transfers mobility toileting washing dressing meal prep feeding
3 important parts to CGA
goal centered
holistic
multidisciplinary
goal centered vs problem oriented
- story based approach
- take the person’s story where they want the plot to go
- focus on the life, not the disease
goal centredness in CGA - why is it important
the right thing to do - what the person wants, not the doctor
the easy thing to do - multimorbidity, conflicting disease priorities, polypharmacy
what is health
WHO definition - state of complete physical, mental and social well-being and not merely the absence of disease or infirmity - perhaps unachievable, nobody is in perfect health
it is a dynamic process rather than a binary state
a spectrum and multidimensional
goal is to try and get people living as healthy a life as is possible
health domains
medical psychological functional behavioural nutritional spiritual environmental social societal sexual
illness in frail people
leads to disruption in multiple health domains
can be triggered by disruption in any health domain
quickly leads to complexity
things to think about with medical problems
pathological vs physiological (disease or normal ageing) - not particularly helpful
instead: are the problems reversible vs non-reversible
multiple concomitant problems
iatrogenic harm - esp polypharmacy
aims when treating medical problems
majority of modern medicine is treating chronic disease (or acute exacerbations)
few things are curable
preserve function - organ or overall
reduce exacerbations
prevent infection and iatrogenic harm
spirital care (person centered care) - questions to ask
how do i fit into the bigger picture
what’s important to you
how do you like to project your self image
what’s the meaning of your life
- acknowledging the person and their meaning
