Comprehensive Geriatric Assessment Flashcards

1
Q

What number of people in hospital are over 65?

A

2/3rd

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2
Q

Frailty is not an illness itself, it is what?

A

A susceptibility state - frail individuals are more at risk of disability and multi-morbidity

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3
Q

What does progressive accumulation of damage to a complex system result in?

A

Aggregate loss of system redundancy

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4
Q

What happens as systems age?

A

The ability of the body to repair minor damages in its redundant state becomes reduced, resulting in more multi-morbidities, disability and medical intervention

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5
Q

What does age-related decline lead to?

A

Impairment of individual organ function
Breakdown of the complex interplay between organ systems (dyshomeostasis)
Increased susceptibility to environmental stress resulting in frailty

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6
Q

What is the definition of frailty according to Rockwood?

A

A reduced ability to withstand illness without loss of function

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7
Q

What methods are there to help identify frail people?

A

Frailty index
Frailty phenotype
Frailty syndromes
HIS ‘Think Frailty’

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8
Q

How is frailty identified?

A

Can use methods such as frailty index, but largely it is something that can be seen on observation and examination

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9
Q

3 of the 5 criteria in the frailty phenotype are needed to identify someone as frail, what are these criteria?

A
Unintentional weight loss
Exhaustion 
Weak grip strength 
Slow walking speed
Low physical activity
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10
Q

What are some frailty syndromes?

A

Falls
Immobility
Delirium
Functional loss

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11
Q

What does dyshomeostasis lead to in illness?

A

Multiple body systems being involved in one illness

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12
Q

What are frailty syndromes?

A

Essentially presentations of system failures

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13
Q

What are the criteria of HIS ‘Think Frailty’?

A

Functional impairment in context of significant multiple conditions (new or pre-existing)
Resident in a care home
Acute confusion, diagnosis of dementia or history of chronic confusion
Immobility or falls in last 3 months
List of six or more medicines (poly pharmacy)

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14
Q

Rather than a binary concept, what should frailty be viewed as?

A

A spectrum, ranging from minimal frailty to severe frailty

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15
Q

Repeated insults result in what?

A

Gradually decompensated frailty

Axis of increasing complexity (i.e. more multi-morbidity and disability)

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16
Q

People with physical frailty are often frail in what domains?

A

Multiple health domains

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17
Q

Why can health not be viewed as a binary state?

A

It is a dynamic process - changes from hour-to-hour, day-to-day, complete physical, social and mental well-being is almost always not achievable

18
Q

What are the health domains?

A
Medical 
Psychological
Functional 
Behavioural
Nutritional 
Spiritual 
Environmental 
Social 
Societal
19
Q

What does illness in frail people lead to?

A

Disruption in multiple health domains, which can be triggered by disruption in any health domain

20
Q

How have illness trajectories changed?

A

Fewer sudden deaths e.g. due to MI, stroke

Increasing frailty and organ failure

21
Q

Why does our healthcare paradigm present challenges for comprehensive geriatric assessment?

A

It continues to be disease/system specific in research, guidelines, medical education and training, and secondary care

22
Q

What are the problems for the medical health domain?

A
Pathological 
Physiological 
Reversible or irreversible 
Multiple concomitant problems 
Iatrogenic harm 
Majority of modern medicine treats/ameliorates chronic disease or acute exacerbations of chronic disease 
Few things in medicine are truly curable
23
Q

How is spiritual care person-centred?

A

It focuses on what is important to that individual and takes into account what their wishes are for their care

24
Q

What are the factors affecting the psychological health domain?

A

Mood
Confidence
Cognition

25
What are the factors affecting the functional health domain?
Mobility Activities of daily living Community living skills
26
What are the factors affecting the behavioural health domain?
Behavioural determinants of ill-health e.g. smoking, unhealthy eating Activities/pastimes Occupation
27
What are the factors affecting the environmental health domain?
Housing Heating Sanitation Adaptation
28
What are the factors affecting the social health domain?
Support networks | Potential for abuse
29
What are the factors affecting the societal health domain?
Attitudes to the ageing and elderly Technological advances Political Regulations
30
What is comprehensive geriatric assessment?
The process used to assess and manage illness in older people with frailty
31
What is comprehensive geriatric assessment used for?
To; Determine what the problem are - where multiple medical problems present at once and where multiple health domains are affected Determine what can be reversed and what can be made better Produce a management plan
32
What is the approach of comprehensive geriatric assessment? What are the benefits of this approach?
Goal-centred rather than problem-centred Preserves autonomy Means we do what the patient wants, not what the doctor wants Effective way of dealing with multi-morbidity and competing clinical priorities
33
What are the key professions involved in comprehensive geriatric assessment?
Geriatrician Occupational therapist Physiotherapist Skilled nurses
34
What other professions are involved in comprehensive geriatric assessment?
``` GP Other doctors Social worker Home care Dietician ```
35
What are the established models of comprehensive geriatric assessment?
Inpatient Intermediate care Hospital at home
36
What does good geriatric care allow?
Early identification of need Early comprehensive geriatric assessment Early provision of appropriate level of care for need
37
What evidence is there supporting the benefit of comprehensive geriatric assessment?
Ellis et al Comprehensive Geriatric Assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials More likely to be alive and living at home at: • 6 months OR 1.25, p < 0.001, NNT 17 • 12 months OR 1.16, p = 0.003, NNT 33 Less likely to be living in residential care • OR 0.78, p < 0.001 CGA is proven to improve health outcomes in frail older people. The earlier in an illness trajectory a frail person undergoes CGA, the better the outcomes are likely to be
38
What are the benefits of hospitalisation?
Access to clinical expertise Access to complex tests and interventions Rapid access to supervised care support
39
What are the risks of hospitalisation?
``` Disorientation and delirium Learned dependency Deconditioning Iatrogenic harm Hospital Acquired Infection ```
40
When should patients be discharged from hospital?
When goals are met, or when risk of staying in hospital outweighs the benefits