Comprehensive Geriatric Assessment 2 Flashcards
what is the best way to assess and manage health in older people with frailty?
Comprehensive Geriatric Assessment
what are the main things involved in the CGA?
- Goal centred (not disease centred)
- Holistic
- Multidisciplinary
Goal centred vs problem centred
We focus on peoples problems rather than what we are trying to achieve
We think of a person as a group of diseases but infact people are stories and need to understand how they ended up infront of you
The role of the doctor is to take the person’s story where they want the ____ to go (or to help give it a happy ending)
The goal and the focus is the ____, not the ______
We may ____ the person live their life by managing their _______
plot
life
disease
help
disease
related concepts
- Goal centredness
- Person centredness
- Wellbeing
- Realistic Medicine
Got to think about ____ centeredness rather than ________ centeredness
goal
problem
Goal centredness in CGA - whats the right thing to do and whats the easy thing to do?
- The right thing to do - We do what the person wants, not what the doctor wants (Try preserve the persons autonomy)
- The easy thing to do
- Multimorbidity
- Conflicting ‘disease priorities’
- Polypharmacy
In order to manage a multimorbid person you need to focus on the goals rather than the problems otherwise you would get caught up in too many problems
what is health?
What is health? - ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’ - WHO = Rubbish! This is a concept of perfect health, More than just physical problems/medical aspects of disease as it states
A dynamic process rather than a binary state (not just healthy or unhealthy)
Health can change very quickly, can feel good one moment and not the other
No such thing as perfect health as its unachievable, try to get people to live a life and be as healthy as possible
Health is not just disease, lots of aspects
what are the different health domains?
Medical
Psychological
Functional
Behavioural
Nutritional
Spiritual
Environmental
Social
Societal
Sexual
Disruption in any of these domains can make you feel unhealthy and unwell
Illness in frail people:
- Leads to disruption in multiple _____ _______
- Can be triggered by ________ in any health domain
health domains
disruption
Quickly leads to complexity
One problem triggers other problems
Difficult mess that hard to untangle
Medical:
Pathological = ???
Physiological = ???
‘disease’
‘normal ageing’
problems can be _________ or _________
Reversible
Non-reversible
Multiple concomitant problems - what happens if you focus on jsut one problem?
Can present with many problems at once and if you focus on one then you miss the other parts
how may Iatrogenic harm be caused?
Iatrogenic harm particularly through polypharmacy (given too many drugs)
Medical:
Majority of modern medicine is treating/ ameliorating _______ disease (or acute exacerbations of chronic disease)
Few things in medicine are ________
chronic
‘curable’ - Infection and Iatrogenic harm are cureable (stop drugs that are causing them the harm)
what spiritual quesitons may be asked?
How do I fit in to the bigger picture?
What’s important to you?
How do you like to project your self-image?
What’s the meaning of your life?
Spiritual care = ____________ care
Person-centred
Acknowledging the person hood and the persons meaning
what psychological problems if there that you should think about in older people?
Mood:
- Low mood
- Anxiety
Confidence - ‘fear of falling syndrome’
Cognition:
- Delirium
- Dementia
what things may be involved in a functional history?
Mobility:
- Transfers
- Mobilising
Activities of Daily Living
Community Living Skills
what are some behavioural determinants of health to think about?
Behavioural determinants of ill health - Unhealthy eating/smoking/drinking
Activities/Pastimes
Occupation
what are some nutrional aspects of health to think about?
Poor nutrition leads to ill health
Ill health leads to poor nutrition
MUST screening tool
what are some Environmental aspects of health to think about?
Housing
Heating
Sanitation
Adaptation
what are some social aspects of health?
Support networks:
- Practical/emotional
- Formal/informal
Potential for abuse:
- Financial
- Physical
- Sexual
- Neglect
Potential for vulnerable older people with frailty or be abused. Elder abuse is a common thing, particularly financial abuse
Societal aspects are very important to health
Hard for us as doctors to impact on, more for politicians
what are some societal aspects of health?
Attitudes to ageing/the aged:
- Asset vs. burden
- Paternalism
Technological advance - Enabling vs. disabling
Political/Regulations:
- Money (eg. Winter heating allowance/pensions)
- Accessibility (eg. Free bus passes/Disabled access)
Summary:
•CGA
- Goal centredness (rather than problem centeredness)
- Multidimensional/’holistic’ approach (rather than focusing purely on the medical domain)
