Comprehensive Geriatric Assessment

Question 1

Define Frailty

Answer 1

A reduced ability to withstand illness without losing of function

Question 2

Explain ageing & 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

It’s the effect of ageing:

Age related impairment of organ function & interplay between organs (aka dyshomeostasis)

Increased susceptibility to stresses (a.k.a. frailty)

Question 4

How do we determine if someone is frail?

Answer 4

Scoring systems such as

Fried criteria:
3+ of: 
Exhaustion
Weak grip
Slow walking 
Low activity
Weight loss

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.

We go through multiple domains of health

and determine what the problems/risks are, work out where 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)
• Behavioural (work, hobbies etc)
• Nutrition
• Environment (house, heat & sanitation)
• Social (support networks & abuse)
• Societal

Question 7

How do we approach the medical side of a CGA?

Answer 7

We sort the reversible pathologies from the irreversible physiology of ageing.

Important to avoid doing extra iatrogenic harm

Question 8

How do we assess a frail patient’s nutrition?

Answer 8

With the M.U.S.T. screening tool

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