Comprehensive Geriatric Assessment Flashcards
What are the 5 geriatric giants
Falls -cardiac, neuro, meds (hypovolemic, hyponatremic?) cause Confusion -delirium Immobility Incontinence Functional dependence
Often as a result of underlying problems
What is the CGA
MDT process to address the -medical -psychological -functional capabilities to develop an integrated plan for treatment and long term follow up
Identify the goals that are unique to the individual
What areas would you like to explore in a CGA
Active medical problems
Memory, mood, psychological health
Mobility, falls and bone health
Nutrition, swallow, oral health
Continence and skin care
Vision, hearing
Medication review
Advance care planning
Social care
How may you address the active medical problems
-falls?
Stop causative medications, treatments
-reassess current medical targets
Refer to hospital at home team to monitor for improvement for 48hrs
Measure postural BP, Dix Hallpike for BPPV
Memory, mood, psychological health considerations?
Social isolation?
- Red Cross social support?
- Community interventions?
Cognitive assessment
-MMSE, MOCA
Mobility considerations?
Community podiatrist referral?
OT Zimmer frame, hand rails, toilet raiser, hoist?
Issues with stairs
Anticipate for the best and worst days
Strength, balance training => improve sarcopenia, address fear of falling
Pendant alarm
VitD for bone health?
Nutrition, swallow, oral health
Community dietician referral
Meals on wheels service?
Support with meal prep
Is her swallow impaired? Risk of aspiration?
Dental care, dentures needed?
Continence and skin care considerations?
Pelvic floor exercises, info
DN referral for continence assessment
Regular turning/barrier cream for pressure areas Skin cream needed? Estrogen for vaginal atrophy?
Do they need enema, suppositories?
Medication rationalisation
-what might you consider?
All about balancing risks vs benefits and patient opinions Diuretics CCB AAch PPI Statins
Start medications to address more pressing matters
- AF stroke prevention (DOAC)
- bone protection for osteoporosis if they are mobile (Ca, bisphosphonates)
Change current medications to a form that they can take
Advance Care Planning considerations
Discuss DNACPR
-Intubation, ventilation opinions?
Plan for should they lose capacity
Vision and hearing considerations
Do they need hearing aids or glasses
-can improve delirium and confusion
