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
when to discharge someone
when benefits are reducing but risks are increasing
different for every individual - i.e. it may be further along for some people and sooner for others
individual assessment - is this person benefitting from being in hospital or is it putting them at more risk
OR simply when goals are met and the person is able to function and life at home
