Comprehensive Geriatric Assessment

Question 1

Effects of ageing (senescence)

Answer 1

Age related decline leads to = impairment of individual organ function + breakdown of complex interaction bwtn organ systems (dyshomeostasis)

This leads to increased susceptibility to environmental stress (frailty)

Question 2

Frailty Phenotype

Answer 2

3 of 5 criteria:

Unintentional wgt. loss
Exhaustion
Weak grip strength
Slow walking speed
Low physical activity

Question 3

Frailty Syndromes

Answer 3

Falls, immobility, falls, delirium, incontinence, functional loss/decline

Question 4

Think FRAILTY

Answer 4

F = FUNCTIONAL IMPAIRMENT in context of sig. multiple conditions (new/pre-existing)

R = RESIDENT in CARE HOME

A = ACUTE CONFUSION (think delirium) - 4AT, is there a diagnosis of dementia/hx of chronic confusion

I = IMMOBILITY/FALLS in last 3 months

L = LIST of ≥ 6 medicines

also FRAILTY INDEX + CLINICAL FRAILTY (1. very fit - 9. terminally ill)

Question 5

Health domains (expand)

Answer 5

Frail pt. are often frail in multiple domains

Medical - pathological vs. physiological; reversible vs. non-reversible; multiple concomitant problems; iatrogenic, infection; few things are curable - mostly trying to treat chronic disease

Psychological - mood, cognition, confidence

Functional - decline is aggressive self-perpetuating problem; mobility, activities of daily living, community living skills

Behavioural - behavioural determinants of ill health, activities/past-times, occupation

Nutritional - poor nutrition leads to ill health + ill health leads to poor nutrition; MUST screening tool

Spiritual - holistic; how do i fit into bigger picture, what is important to me, how do i like to project my self-image, what in meaning of my life

Environmental - housing, heating, sanitation, adaptation

Social - support networks, potential for abuse

Societal - attitudes to ageing, technological advance, political/regulations

Question 6

Illness & Frailty

Answer 6

Illness can LEAD TO disruption in multiple health domains or illness can be TRIGGERED BY disruption in any health domain

Question 7

Patients in geriatrics are increasingly?

Answer 7

Multimorbid
Old
Frail
Complex

Challenging as current healthcare system is disease/system focused whereas pt. require more holistic approach

Question 8

Comprehensive Geriatric Assessment

Answer 8

Process to assess + manage illness in older people w/ frailty

1. Determine what the problems are - multiple health problems present at once + multiple health domains affected
2. Determine what is reversible + what we can make better
3. Produce management plan - GOAL-CENTRED not problem-centred

Can be applied in any setting: inpatient, intermediate care, hospital at home - the earlier CGA is applied to a frail individual - the better their outcomes

Question 9

What is a person-centred/goal-centred approach?

Answer 9

Do what the patient wants

Preserves autonomy

Effective way of dealing with multimorbidity + competing clinical priorities

Question 10

Geriatrics MDT

Answer 10

Key professions: geriatrician, OT, physiotherapy, skilled nurses

Others: GP, other doctors, social worker, home care, dietician, SALT

Question 11

Good geriatric care

Answer 11

Early identification of need

Early Comprehensive Geriatric Assessment

Early provision of appropriate level of care for needs

Question 12

Discharge planning

Answer 12

When goals are met or when risks outweigh benefits

Hospital benefits: access to clinical expertise, complex tests, interventions; rapid accesses to supervised care support

Hospital risks: disorientation + delirium, learned dependency, deconditioning, iatrogenic harm, HAI

Question 13

Ageing & Redundancy

Answer 13

Progressive accumulation of damage to a complex system - resulting in aggregate loss of system redundancy