Comprehensive Geriatric Assessment Flashcards
What are the implications of an ageing world on the healthcare system ?
Multimorbidity - many chronic diseases in the one patinet. Frailty - susceptible to disease, and functional decline within the context of disease
What is the link between ageing and redundancy?
Progressive accumulation of damage to a complex system resulting in aggregate loss of system redundancy.
- Humans are highly redundant - as we get older the systems handling this damage break down, diminishing redundancy.
What is the effect of ageing?
Age-related decline, leading to:
- Impaired organ function.
- Dyshomeostasis - breakdown of complex interplay between organ systems.
Leading to:
- An increased susceptibility to environmental stress AKA frailty.
What is frailty?
A reduced ability to withstand illness without loss of function. Think of it as a spectrum, rather than a timeline. Repeated environmental insults make people frailer.
What is the Frailty phenotype?
3 of 5 criteria:
- Unintentional weight loss
- Exhaustion
- Weak grip strength
- Slow walking speed
- Low physical activity
What are the “frailty syndromes”?
- Falls
- Immobility
- Delirium
- Functional loss
These occur due to a breakdown in the system, and its associated impact.
What are “health domains”?
Medical, Psychological, Functional, Behavioural, Nutritional, Spiritual, Environmental, Social, Societal
Disruption of these factors can lead to frailty. Disruption to one factor can lead to the disruption to another factor.
What is “Comprehensive Geriatric Assessment”?
Process to assess and manage illness in older people with frailty
- Determine what the problems are
- Multiple medical problems present at once
- Multiple health domains affected
- Determine what we can reverse and what we can make better
- Produce a management plan: Goal centred, not problem centred.
What is a goal centred approach?
Means we do what the patient wants (not what the doctor wants), beneficial because it preserves autonomy. Is an effective way of dealing with multimorbidity and competing clinical priorities. “how does the patient want to live their life?”
Generally outline the “medical” health domain
- Patholoigcal - “disease”
- Physiological - “normal ageing”
- Reversible
- Non-reversible
- Multiple concomitant problems
- Iatrogenic harm
- Majority of modern medicine is treating chronic disease Few things are curable.
What are the spiritual health domain?
- Self-image
- Self’important
- Meaning of the patients life etc.
- Spiritual care = Person-centred care
Generally outline the psycological health domain.
Deals with mood, confidence and cognition
- Mood
- Low mood
- Anxiety
- Confidence - ‘fear of falling syndrome’
- Cognition
- Delirium
- Dementia
What are the aspects of functional health domains?
- Mobility
- Transfers
- Mobilising
- Activities of Daily Living
- Community Living Skills
What are the behavioural aspects of health?
- Behavioural determinants of ill health
- Unhealthy eating/smoking/drinking
- Activities/Pastimes
- Occupation
What are the nutritionall aspects of health?
- Poor nutrition leads to ill health
- Ill health leads to poor nutrition
- MUST screening tool
