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Specialites Summary > Comprehensive Geriatric Assessment > Flashcards

Comprehensive Geriatric Assessment Flashcards

1
Q

Implications of an ageing world

A

Multimorbidity

Frailty

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2
Q

Definition of redundancy

A

Functional ability to cope

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3
Q

What is the word used to describe the effects of ageing?

A

Senescence

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4
Q

What does age related decline lead to?

A

Impairment of individual organ function
Breakdown of complex interplay between organ systems (dyshomeostasis)

Both leading to increased susceptibility to environmental stress = frailty

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5
Q

What kind of state is frailty?

A

A susceptibility state

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6
Q

Effects of frailty

A

Increased risk of death or debility following exposure to an environmental stressor
A reduced ability to withstand illness without a loss of function

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7
Q

Patients are increasingly….

A

Multimorbid
Old
Frail
Complex

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8
Q

How to tell if someone is frail?

A

Frailty index
Frailty phenotype (freid criteria)
Tend to present with frailty syndromes

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9
Q

Freid criteria for frailty phenotype, need to have 3 of 5 of …..

A 
unintentional weight loss
exhaustion 
weak grip strength 
slow walking speed 
low physical activity
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10
Q

Frailty syndromes

A

Immobility
Falls
Delerium
Functional loss

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11
Q

What does dyshomeostasis lead to?

A

Multiple body systems being involved in ‘one illness’

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12
Q

Clinical frailty scale

A
  1. VERY FIT
    - robust, active, energetic, motivated
    - exercise regularly
    - fittest for age
  2. WELL
    - no active disease symptoms but less fit than 1
    - exercise or active occasionally e.g. seasonally
  3. MANAGEING WELL
    - medical problems well controlled, but not regardly active beyond routine walking
  4. VULNERABLE
    - not dependent on others, often symptoms limit activities
    - “slowed up”/tired in the day
  5. MIDLY FRAIL
    - may need help In higher order IADLs (finance, heavy housework, medications)
  6. MODERATELY FRAIL
    - help with all outside activities
    - inside problems with stairs, dressing etc
  7. SEVERELY FRAIL
    - completely dependent for personal care, for whatever cause
    - stable and not risk of dying within 6 months
  8. VERY SEVERELY FRAIL
    - completely dependent, approaching the end of life
    - could not recover even from minor illness
  9. TERMINALLY ILL
    - approaching the end of life
    - life expectancy < 6 months
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13
Q

In dementia, what does the degree of dementia correspond to?

A

the degree of frailty

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14
Q

Symptoms of mild dementia

A

Forgetting details of a recent event
still remembering the event itself
repeating some question/story
social withdrawal

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15
Q

Symptoms of moderate dementia

A

recent memory is very impaired
Can remember past life events well
can do personal care without prompting

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16
Q

Frailty and severe dementia

A

Cannot do personal care without help

17
Q

What is decompensated frailty?

A

When exposed to an environmental insult e.g. a fall, get ill etc then another insult knocks them back more, then another insult, then another, and this goes on

18
Q

Health domains

A 
medical 
psychological 
functional
behavioural 
nutritional 
spiritual 
environmental 
social 
societal
19
Q

What screening tool is used for nutrition?

A

MUST screening tool

20
Q

Relation between time someone goes through GCA and outcomes

A

The earlier in the illness trajectory a frail person undergoes the process of CGA, the better the outcomes are likely to be

21
Q

What can an illness trajectory pinpoint?

A

Potential sites for intervention

22
Q

What does CGA stand for?

A

Comprehensive Geriatric Assessment

23
Q

What is CGA for?

A

To assess and manage illness in older people with frailty

24
Q

Stages of CGA

A
  1. Determine what the problems are
    - multiple medical problems
    - multiple health domains
  2. Determine what is reversible and what can be made better
  3. Produce a management plan
25
Q

Established models of GCA

A

Inpatient
immediate care
hospital at home

26
Q

Risks of the hospital

A 
deterioration and delirium 
learned dependency 
Deconditioning 
Iatrogenic harm 
HAI
27
Q

When to discharge from hospital?

A

When the benefits = risk
or
Simply when the goals are met

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