Comprehensive Geriatric Assessment

Question 1

What is meant by frailty?

Answer 1

Increased susceptibility (death or disability) to environmental stress

A reduced ability to withstand illness without loss of function

Question 2

The decline in health related to ageing leads to what?

Answer 2

• Impairement of individual organ function
• Breakdown of the complex interplay between organ systems

Question 3

How might the functional abilities of someone with frailty vary over time after an environmental stressor?

Answer 3

Question 4

What are the most common ‘syndromes of presentation’ in the geriatric population?

Answer 4

1 - Falls

2 - Immobility (‘off legs’)

3 - Functional decline (‘not coping’)

4 - Delirium

Question 5

Do geriatric patients present with problems in individual body systems, or issues in multiple ‘health domains?

Answer 5

Problems in multiple health domains

Question 6

In which health domains can geriatric patients present with problems?

Answer 6

Medical

Psychological

Functional

Behavioural

Nutritional

Social

Environmental

Question 7

What is a comprehensive geriatric assessment and what does the process involve?

Answer 7

1 - What the problems are

2 - What problems can be reversed and what can be made better

3 - Produce a management plan

Question 8

What useful ways can doctors categorise the problems of geriatric patients?

Answer 8

1) Pathological - ‘disease’
2) Physiological - ‘normal ageing’
1) Reversible
2) Non-reversible
1) Multiple concomitant problems
2) Iatrogenic harm

Question 9

What psychological factors can play a part in geriatric patient presentations?

Answer 9

1 - Mood

2 - Confidence (fear of falling syndrome)

3 - Cognition (delirium, dementia)

Question 10

What functional problems can geriatric patients present with?

Answer 10

1 - Mobility (transfers, mobilising)

2 - Activities of Daily Living

3 - Community Living Skills

Question 11

What behavioural problems can geriatric patients present with?

Answer 11

1 - Unhealthy eating/smoking/excess alcohol

2 - Activities/pastimes

3 - Occupation

Question 12

In what ways can nutrition affect the health of the elderly population?

Answer 12

1 - Poor nutrition leads to poor health

2 - Poor health leads to poor nutrition

3 - MUST screening tool

Question 13

What environmental issues can impact the health of the elderly population?

Answer 13

1 - Housing

2 - Heating

3 - Sanitation

4 - Adaptation

Question 14

What social problems can geriatric patients present with?

Answer 14

1 - Lack of support networks

2 - Potential for abuse (physical, sexual, financial, neglect)

Question 15

What are the key professions involved in the care of geriatric patients?

Answer 15

1 - Geriatrician

2 - Occupational Therapist

3 - Physiotherapist

4 - Skilled nurses

5 - Social worker

6 - GP

7 - Dietician

Question 16

What are the keys to good geriatric care?

Answer 16

• Early identification and intervention
• Early CGA

Question 17

What are the benefits of CGA?

Answer 17

1 - More likely to be alive

2 - More likely to be living home

3 - Less likely to be living in residential care

Question 18

What is the name of the scale used to assess frailty in elderly people?

Answer 18

Rockwood frailty scale

Question 19

What are some of the tools used by geriatricians to identify someone as frail?

Answer 19

1 - Frailty Index

2 - Frailty phenotype criteria:

• Unintentional weight loss
• Weak grip strength
• Slow walking speed
• Low physical activity

3 - HIS ‘Think Frailty’ assessment

Question 20

At which point should a geriatric patient be discharged from hospital?

Answer 20

Ideally:

• When the risks of staying in hospital longer start to outweigh the benefits of staying in hospital

OR:

• Discharge when goals have been met