Comprehensive Geriatric Assessment Flashcards
How are geriatric patients processed initially?
Comprehensive geriatric assessment, creation of problem list, agree objectives of care, develop individual management plan, regular review
What is a comprehensive geriatric assessment (CGA)?
Multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s capability
What is the purpose of CGA?
Allows development of a co-ordinated and integrated plan for treatment
What are the components of a CGA?
Medical, psychological, functional, social/environment
What makes up the medical component of the CGA?
Problem list, co-morbid conditions and disease severity, medication review, nutritional status
What make up the psychological and functional components of the CGA?
Psychological = mental status/cognitive function, mood/depression testing Functioning = basic and extended ADLs, activity/exercise status, gait and balance
What are some frailty syndromes?
Poor mobility, falls, confusion, continence issues, polypharmacy
What are some features of problem lists?
Patient centred = seek diagnosis, multiple causes/risk factors should be sought and treated, include non-medical issues
What are the benefits of doing a CGA in a dedicated assessment unit?
Reduces mortality at 6 months
Improves function and cognition
Reduces need for nursing home care and subsequent hospital admission
How should CGA be delivered?
MDT assessment used and some have weekly MDT meetings = specific care plans developed that incorporate rehabilitation
50% use specific assessment tools and half set patient centred goals
Is community or unit CGA better?
Benefits only seen in assessment units = roving teams less effective
How can the presentation of acute illness vary in older people?
Atypical or masked presentation may delay diagnosis
Pathophysiological response varies
Immune response may vary with disease, drugs and nutrition
How should acute illness be managed in older people?
Investigations and management need to be tailored to individual, and medication should always be reviewed
How does the presentation of an MI vary in older patients?
No chest pain in 1/3 = collapse, delirium, dizziness, SOB
What investigations will be done for an MI in an older person?
Blood tests, ECG, CXR, may not be able to tolerate angiogram, echo may be abnormal
What should be considered in the management of an MI in an older person?
More likely to suffer from side effects from antiplatelets and statins
How does sepsis present differently in older people?
BP may drop early and temperature often low
Tachycardia may be absent and delirium prominent
CRP and WCC may not rise
How is sepsis management different in older people?
Fluid balance may be hard
Antibiotics should be targeted as higher risk of C.diff
Why can healthcare intervention often cause harm in older people?
Older people are often delicately balanced because they have little homeostatic reserve
What are the outcomes of acute illness in older people?
Carries much higher mortality rate = tend to decompensate much faster
Even minor acute illness can cause major deterioration in function
Each illness predisposes to further illness
What are some features of acute admissions for older people?
Older people need access to expert diagnosis but acute hospitals aren’t always best place = initial CGA can take place in hospital and continued in community via practice MDTs
What must be ensured when using Prevention of admission schemes?
Must not deny access to expert assessment/hospital for those who need it
What is the best practice for acute admissions of older people?
To recognise early decompensation and prevent getting to stage of needing admission
