Comprehensive Geriatric assessment Flashcards
What is the definition of ‘Comprehansive Geriatric Assessment’?
A MDT diagnostic process focused on determining a frail elderly person’s medical, psychological and functional capability in order to develop a co-ordinated and integrated plan for treatment and long term follow up
What does ‘ageing’ really mean?
Progressive accumulation of damage/disease to a complex system resulting in aggregate loss of system redundancy
- Loss of system redundancy leads to decreased resilience to overcome environmental stress (as the system becomes stressed then it is less able to overcome the problem - increased risk in system failure)
What are the overall effects of Ageing on humans?
Age related decline leads to:
- Impairment of individual organ function
- Breakdown of the complex interplay between organ systems (dyshomeostasis)
This leads to:
- Increased susceptibility to environmental stress that they cannot overcome (i.e being hit by a vehicle, pneumonia etc that a young, fit individual could overcome)
And ultimately FRAILTY
Define frailty
Frailty is a state of susceptibility to:
- Acquiring disease
- Functional decline in the context of disease i.e not overcoming it
How can you identify someone as ‘frail’?
Clinical frailty scale - used nowadays
Frailty index - not very useful in clinical practice
Fried frailty index - 3 of 5 criteria - unintentional weight loss, exhaustion, weak grip strength, slow walking speed or low physical activity
Clinical frailty scale
What are the ‘frailty syndromes’ that frail patients tend to present?
- Falls
- Immobility
- Delirium
- Functional decline
These are system failure presentations - environmental stress leading to breakdown of the whole system
Look
‘System failure’ is much bigger than just the failure of one system in the body. In life you need multiple systems in your body to work together in order to do basic things tasks/movements like:
- Get up and move around
- Problem/system failure - fall
- Understand, process and react to the environment
- Problem/system failure - delirium
- Being able to look after yourself
- Problem/system failure - functional decline
All of these are linked together. Can have more than one failure.
What do you want to find out from taking a functional history from your patient? i.e how they are able to manage on a day to day basis?
The Activities of Daily Living
- Transfers
- Mobility
- Toileting
- Washing
- Dressing
- Meal preparation
- Feeding
What is the MUST screening tool?
‘MUST’ is a 5-step screening tool to identify adults, who are malnourished, at risk of malnutrition, or obese.
- Work out BMI score
- Note % unplanned weight loss and score
- Establish acute disease effect and score
- Add scores from steps 1, 2 and 3 together to obtain overall risk of malnutrition.
- Use management guidelines and/or local policy to develop care plan.
Environmental factors that affect the elderly and their health (4)
- Housing
- Heating
- Sanitation
- Adaptation
Care for the elderly: how is it approached?
- MDT approach
- Holistic - treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease.
- ‘Goal centeredness’
- Doing what the patient wants and not what the doctor wants
- Working towards improving the patient’s QOL and not focusing too much on the problem i.e the disease
So how does the Comprehensive Geriatric assessment work as an inpatient / what happens when the patient is referred to the ward?
A patient presents with a decompensated frailty syndrome and is admitted onto the ward e.g Fall, Delirium, Immobility or Functional decline
MDT initial assessment of that patient:
- Doctors - look at medical contributors to disruption to their health and take a broad overview/responsibility for the patient’s management
- Physiotherapists - assess mobility
- OT’s - assess functions (ADLs - activites of daily living)
- Nurses - provide care needs and assessment over longer period of time
- Also see pharmacists, social work, speech and language therapists, dieticians etc
MDT meetings to come up with management plan
The MDT will meet to come up with a plan for their patients after the initial assessments.
What are the goals/aims for the majority and minority of geriatric patients once in hospital?
- For the majority, the goal is to enable them to live their life - a plan is put in place to do all that is necessary to get that patient functioning at a level they can go home
- Second to that - plan to maintain future health
- For the minority, they recognise that the patient’s life is coming to an end - palliative care
What are the ‘Geriatric giants’?
The major categories of impairment that appear in elderly people, especially as they begin to fail.
- Intellectual impairment
- Immobility
- Instability (falls)
- Incontinence
- Iatrogenic disease (mainly drug induced)
