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AGPCNP > Comprehensive Geriatric Assessment > Flashcards

Comprehensive Geriatric Assessment Flashcards

1
Q

What is comprehensive geriatric assessment?

A

Multidisciplinary evaluation in which the multiple problems of older persons are uncovered, described and explained, if possible, and in which the resources and strengths of the person are catalogued, need for services assessed and a coordinated care plan developed to focus interventions on the person’s problems.
Comprehensive Geriatric Assessment advised for older adults with high risk of adverse events to guide treatment

Multidisciplinary diagnostic and treatment process aimed at maximizing overall health
Medical
Psychosocial
Functional

Increased focus on sub-specialties
Oncology, cardiology, trauma

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2
Q

Discuss function as it related to CGA?

A

Number and severity of medical illnesses does not necessarily correlate with level of functional impairment

Decreased functional status is linked with increased risks for falls, institutionalization, and loss of independence

While screening tests for both cognitive and motor function elicit useful information, daily life involves significant DUAL TASKING

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3
Q

Describe interdisciplinary team

A

Social work, gerontologic nurse practitioner and/or a geriatrician
Patient accompanied by their support team
“Virtual Team”
Specialist teams as needed to assess condition and make recommendations for specific issue

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4
Q

Who is part of the virtual team?

A 
Neurology                  
Psychiatry
Physiatry
Pharmacy       
Dietary
Podiatry
Dentistry
Audiology
ENT
Physical Therapy
Occupational Therapy
Speech-Language Pathology
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5
Q

Discuss special considerations related to cardiology

A

Risk of mortality doubles in individuals with CVD and frailty
Functional assessments such as gait speed useful across stable disease processes and pre-operatively
Pre-operative planning of treatment course

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6
Q

Describe special considerations related to trauma/emergency

A

No single risk factor or tool accurately predicts risk for adverse outcomes in older ED patients

Risk stratification for improved resource allocation

Triage Risk Screening Tool (TRST)
Predicts risk of repeat ED/hospital visits
Not recommended to be used alone in risk stratification

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7
Q

Describe special considerations related to oncology

A 
Assisting with treatment decisions
Treatment is associated with significant toxicity
Timing
Addressing ageism
Prehab

Treatment Choice Specific Tools

https: //www.moffitt.org/eforms/crashscoreform/
http: //www.mycarg.org/Chemo_Toxicity_Calculator

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8
Q

How do you structure a Comprehensive Geriatric Assessment?

A 
Setting
Goals of provider
Goals of patient
Goals of patient support team
Time
Incorporates Flexibility, compassion, patience, cultural dexterity, follow up
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9
Q

Structuring a Geriatric Assessment

A

Stratify risk (fit, vulnerable, or frail)

Foster well-being throughout selected treatment by identifying geriatric syndromes

Create an individualized care plan that addresses treatment, prevention, and management of identified syndromes

Plan for outcomes of treatment (optimizing survivorship and/or end-of-life planning)

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10
Q

What is important in structuring post acute care?

A

Where is new baseline? Matching needs to available supports within the context of individual priorities

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11
Q

What is important in structuring inpatient trauma care?

A

minimizing iatrogenesis and supporting holistic care
CAM (confusion assessment method)
Minicog
Triage Risk Screening Tool (TRST)

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12
Q

What is important in structuring outpatient consults care?

A

referred by specialists, typically related to concerns for cognitive impairment
MoCA, SLUMS, MMSE, GDS (geriatric depression scale)

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13
Q

What are benefits of assessment tools?

A

Provides a framework for assessment

Standardizes assessment across clinicians

Tracks condition over time for a single patient

Risk stratification

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14
Q

What precautions should you be aware of with assessment tools?

A

Assessment tools DO NOT replace clinical judgement

Is the scale validated and reliable?

What population was this tool designed for?

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15
Q

What is the Fulmer SPICES tool?

A

Sleep Disorders

Problems with Eating or Feeding

Incontinence

Confusion

Evidence for Falls

Skin Breakdown

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16
Q

How do you assess frailty?

A

Accumulation of deficits versus a biologic reduction in physiologic reserve

Scales often geared toward a specific population

Physical Frailty Phenotype (PFP) most widely researched

Examples: Palliative Performance Scale, Vulnerable Elderly Survey – 13 (VES-13), Groningen Frailty Index (GFI)
Weight loss of 10 pounds or more
Weakness measured by grip strength
Self reported exhaustion
Gait Speed
Physical activity

Frail: more than 3 positive flags

Variable cut offs based on weight and gender

17
Q

Describe the vulnerable elderly score

A

13-item self report tool

Can be done in person or over the phone and is not setting specific

Age, self-reported health, ADLs and IADLs

Cut off score 3 or more points

Individuals scoring greater than 3 had 4-fold increased risk of death or functional decline

18
Q

How can you assess fall risk?

A

Validated in specific populations

The yellow sock problem

Community: Fall Risk Assessment Screening Tool (FRAST), Timed Up and Go

Home Care: Missouri Alliance for Home Care (MAHC-10) Fall Risk Assessment

Inpatient: Morse Fall Scale Model and Heindrich II Fall Risk Model

19
Q

Describe the mini nutritional assessment and what other considerations?

A

Used across settings

Also to consider:
Where and how food obtained
Chewing and swallowing
Companionship
1. food intake decline in past 3 months
2. weight loss
3. what is mobility?
4. suffered psych distress or acute disease?
5. neuropsych problems?
6. BMI
7. calf circumference
20
Q

MMSE

A 
69-91% sensitive
87-99% specific
15 items out of 30 points
cut off >/=25
measures severity of dementia
21
Q

MOCA

A 
100% sensitive
87% specific
12 items, 30 points
cutoff >/= 26
detects MCI
22
Q

SLUMS

A 
Sensitive 92-95%
Specificity 76-81%
11 items, 30 points
>/= 27
not copyrighted
23
Q

Mini cog

A

Mini Cog screens executive, visual perception, construction, language, attention, and memory domains of cognition in 3 minutes
1: State 3 unrelated words and ask individual to remember them. Repeat up to 3 times to register the words

2: Clock Draw Test (2 points)
3: Repeat 3 word (3 points)

Score of 2 or less screens positive for dementia

24
Q

How can you screen for delirium?

A

Confusion Assessment Method (CAM)

1: Acute or Fluctuating Course
2: Inattention

3: Disorganized Thinking
and/or
4: Altered Level of Consciousness
Is there evidence of an acute change in mental status from the patient’s baseline? Did the (abnormal) behavior fluctuate during the day, that is, tend to come and go, or increase and decrease in severity?

Did the patient have difficulty focusing attention, for example, being easily distractible, or having difficulty keeping track of what was being said?

Was the patient’s thinking disorganized or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?

Overall, how would you rate this patient’s level of consciousness? (alert [normal]), vigilant [hyperalert], lethargic [drowsy, easily aroused], stupor [difficult to arouse], or coma [unarousable])

25
Q

Describe the geriatric assessment scale

A

a score > 5 suggests depression

describe how you felt over past week

26
Q

Describe gait speed

A 
”6th Vital Sign”
Walkway of 5-10 meters
Acceleration phase (3 meters)
Straight path
Instruct individual to walk a safe speed without running
Ideal 1 meter/second or faster
27
Q

Describe interventions to improve function

A

MULTIPLE interventions and resources available to maximize patient function

Plan must be individualized for each patient

Goal to achieve and maintain HEALTH, HAPPINESS, and SAFETY!
Personalized care planning
Take away before you add interventions
Guiding expectations
Advance Care Planning
Appropriate Referrals
Follow Up
28
Q

What is included in ROS

A 
HPI
sleep
nutrition
continence/bowels
sensory impairment
ADLs/functional status
falls/mobility
cognition
mood
goals of care/medical decision-making
29
Q

PE

A 
VS
general
Skin
HEENT
neck/lymph
REsp
CV/PV
GI
GU
MS
N
Cogn
Psych
Capacity {ACE}
30
Q

Objective labs

A

Labs
CMP, magnesium, Calcium, phosphate, CBC (should already be done recently)

pre-albumin, albumin, TSH, B12, Vitamin D, Folate, (LDL), RPR, (if concern), urinalysis (if concern)

AGPCNP (30 decks)

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