Comprehensive Geriatric Assessment

Question 1

Define Frailty

Answer 1

A reduced ability to withstand illness without losing of function

Question 2

explain aging & Redundancy?

Answer 2

Progressive Accumulation of damage to a complex system resulting in aggregate loss of system redundancy

Question 3

Explain the term senescence?

Answer 3

Its the effect of aging:

Age related impairment of organ function & interplay between organs (aka dyshomeostasis)
–> Increased susceptibility to stress aka frailty

Question 4

How do we determine if someone is frail?

Answer 4

There are some scoring systems and criteria such as the Fried criteria:
3+ of exhaustion, weak grip, slow walking, low activity and weightloss

It can be more helpful to think of “Frailty Syndromes”, the way frail people tend to present e.g. falls, immobility or delirium

Question 5

What is a “Comprehensive Geriatric Assessment”?

Answer 5

A process to assess and manage illness in older people with frailty

Basically we go through multiple domains of health and determine what the problems/risks are, work out which we can improve/reverse and produce a management plan

Question 6

A CGA doesn’t just cover medical problems, what other domains are of interest?

Answer 6

• Spiritual (what’s important to this patient and their identity)
• Psychological (mood, anxiety & cognition)
• Function (mobility, daily activities etc)
• Behavioral (work, hobbies etc)
• Nutrition
• Environment (house, heat & sanitation)
• Social (support networks & abuse)
• Societal

Question 7

How do approach the medical side of a CGA?

Answer 7

We sort the reversible pathologies from the irreversible physiology of aging

Important to avoid doing extra iatrogenic harm

Question 8

How do we assess a frail patient’s nutrition?

Answer 8

With the MUST screening tool

Also remember that poor nutrition can be both a result and a cause of ill health