Comprehensive Geriatric Assessment

Question 1

what does age related decline lead to?

Answer 1

• Impairment of individual organ function
• Breakdown of the complex interplay between organ systems (dyshomeostasis)
This leads to an increased susceptibility to environmental stress. This is frailty.

Question 2

define the frailty phenotype by Fried et al

Answer 2

3 of 5:

1. Unintentional weight loss
2. Exhaustion
3. Weak grip strength
4. Slow walking speed
5. Low physical activity

Question 3

list some frailty sydromes

Answer 3

• Falls
• Immobility
• Delirium
• Functional loss

Question 4

WHO definition of health

Answer 4

“A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”.

Question 5

list the health domains

Answer 5

• Medical
• Psychological
• Functional
• Behavioural
• Nutritional
• Spiritual
• Environmental
• Social
• Societal

Question 6

what is a CGA?

Answer 6

This is the process to assess and manage illness in older people with frailty.
• Determine what the problems are:
o Multiple medical problems present at once
o Multiple health domains affected
• Determine what we can reverse and what we can make better
• Produce a management plan
The CGA is GOAL CENTRED NOT PROBLEM CENTRED
The person/goal centred approach:
• Means we do what the patients wants (not what the doctor wants)
• Preserves autonomy
• Is an effective way of dealing with multimorbidity and competing clinical priorities?

Question 7

CGA domains: medical

Answer 7

o Pathological vs physiological
§ If you can’t walk you don’t care if its disease or normal ageing
o Reversible vs non-reversible
o Multiple concomitant problems
o Iatrogenic harm
o Majority of modern medicine is treating/ameliorating chronic disease (or acute
exacerbations of chronic disease)
o Few things in medicine are curable
o Infection
o Iatrogenic harm

Question 8

CGA domains: spiritual

Answer 8

o How do I fit in to the bigger picture?
o What’s important to you?
o How do you like to project your self-image?
o What’s the meaning of your life?

Question 9

CGA domains: psychological

Answer 9

o Mood
§ Low mood, anxiety
o Confidence
§ Fear of falling syndrome
o Cognition
§ Delirium, dementia

Question 10

CGA domains: functional

Answer 10

o Mobility
§ Transfers, mobilising
o ADL
o Community living skills

Question 11

CGA domains: behavioural

Answer 11

o Behavioural determinants of ill health
§ Unhealthy eating/smoking/drinking
o Activities/pastimes
o Occupation

Question 12

CGA domains: nutritional

Answer 12

o Poor nutrition leads to ill health
o Ill health leads to poor nutrition
o MUST screening tool

Question 13

CGA domains: environmental

Answer 13

o Housing
o Heating
o Sanitation
o Adaption

Question 14

CGA domains: social

Answer 14

o Support networks
§ Practical/emotional, formal/informal
o Potential for abuse
§ Financial, physical, sexual, neglect

Question 15

CGA domains: societal

Answer 15

o Attitudes to ageing/the aged
§ Asset vs burden
§ Paternalism
o Technological advance
§ Enabling vs disabling
o Political/regulations
§ Money e.g. winter heating allowance/pensions
§ Accessibility e.g. free bus passes/disabled access

Question 16

professions involved in inpatient care of a geriatrics patient

Answer 16

Key professions involved:
o Geriatrician
o OT
o PT
o Skilled nurses
• Other professions involved
o GP
o Other doctors
o Social work
o Home care
o Dietician
o SALT

Question 17

components of good geriatric care

Answer 17

• Early identification of need
• Early CGA
• Early provision of appropriate level of care needs

Question 18

geriatrics: hospital benefits

Answer 18

• Access to clinical expertise
• Access to complex tests and interventions
• Rapid access to supervised care support

Question 19

geriatrics: hospital risks

Answer 19

• Disorientation and delirium
• Learned dependency
• Deconditioning
• Iatrogenic harm
• HAI

Question 20

when should you aim to discharge a geriatrics patient?

Answer 20

when goals are met or when risk outweighs harm