Comprehensive Geriatric Assessment 3 Flashcards
Person presents with a decompensated frailty syndrome - what are they?
Fall
Delirium
Immobility
Functional decline
who is involved in the MDT assessment of a patinet and what do they do?
- Doctors - Look at medical contributors to disruption to health and take a broad overview/responsibility (for the patient)
- Physiotherapists - Assess mobility
- Occupational therapists - Assess function (ADLs - activities of daily living)
- Nurses - Provide care needs and assessment over longer period of time, Nurses are with the patient most of the time
what other professionals may be involved?
- Pharmacists
- Social Work
- Speech and Language therapists
- Dietitians
- etc, etc
Importance of goal directedness
Come up with a plan - what is this?
•For the majority of people:
- Goal is to enable someone to live a life
- In hospital, that translates to ‘what do I need to do to get this person functioning at a level they can go home’
- Secondary consideration is what needs to be done to maintain future health
•For the minority of people (around 10% in our system), that is recognising that someone’s life is coming to an end
If it looks like someone may not survive then you need to involve them – do they still want lots of treatment or just have a comfortable death
Our role isn’t to always get patients to perfect health, it about what?
enabling people to live a life
Hospital has benefits such as what?
- Access to clinical expertise
- Access to complex tests and interventions
- Rapid access to supervised care support (Can rapidly make sure someone is being looked at 24 hours a day)
hospital has risks such as what?
- Disorientation and delirium
- Learned dependency (We do things for people in hospital and soon people may not be able to do things for themselves)
- Deconditioning (if immobile rapidly lose muscle strength)
- Iatrogenic harm
- Hospital Acquired Infection
Risks are magnified for old people with frailty
when is benefit of being in hospital highest?
Benefits of being in hospital is highest when you first come into hospital and rapidly reduce over time
when is risk of being in hospital highest and lowest?
Risks are lowest when you first come in but increase longer you are in hospital
when is the optimal time to discharge someone form hospital?
You want to discharge someone when you think the risks of being in hospital outweigh the benefits
optimal discharge is different for different people
Want to get this person out as soon as
Need to do an individualised assessment for each patient
OR, simply discharge when _____ are met
goals
When the person is able to function and live a life at home
what are the 3 concepts of the process of CGA?
- Goal centred
- Holistic
- Multidisciplinary
what is the definition of CGA?
“A multidimensional interdisciplinary diagnostic process focused on determining a frail elderly person’s medical, psychological and functional capability in order to develop a co-ordinated and integrated plan for treatment and long term follow up”
Evidence for CGA
Strong evidence that compared to normal health care there is better outcomes for old people with frailty
Living at home at 6 months*
- CGA Ward, selected by age alone - Living at Home at interim analysis NNT 25
- CGA Ward, selected by need (ie targetting people with frailty syndromes) - Living at Home at interim analysis NNT 6
*in reality a bit more complicated than this, but read the paper!!
