Comprehensive geriatric assessment + capacity Flashcards
What is a comprehensive geriatric assessment?
A multidimensional, interdisciplinary diagnostic process to determine the medical, psychological + functional capabilities of a frail older person in order to develop a coordinated + intergrated plan for treatment + long term follow up
What does a comprehensive geriatric assessment lead to/what are the advantages?
- reduced readmissions
- reduced long term care
- greater patient satisfaction
- lower costs
Who makes up a CGA team?
- geriatrician
- nurse specialist
- OT
- PT
- pharmacist
- additional specialties if needed e.g. SALT, dietician
What are the components of a comprehensive geriatric assessment?
- problem list (current + past)
- medication review
- nutritional status
- physical assessment
- functional capacity
- mental health
- psychological, social + environment assessment
Factors involved in the mental health domain of CGA
cognition
mood + anxiety
fears
Factors involved in the functional capacity domain of CGA
- basic daily activities
- gait + balance
- activity/exercise status
Factors involved in the social circumstances domain of CGA
- informal support from friends and family
- social network
- eligibility for care resources
Factors involved in the environment domain of CGA
- home environment including facilities + safety
- transport facilities
- access to local resources
What is mental capacity?
the ability to make a decision at a specific point in time
How do you assess capacity?
Firstly, assume someone has capacity until proven otherwise
A person has capacity if they can:
- understand information relevant to the decision
- retain that information
- weigh up the information to make their decision
- communicate their decision
When is it ‘alright’ to go against a patient’s wishes even if they have capacity?
- risk of serious harm to themselves or others
- court orders
- emergency situations
- coercion
Who are three possible things you could consult if a patient lacks capacity?
advance directive
lasting power of attorney
advance care plan
What is an advanced directive?
a legal document where a person pre outlines their wishes for medical treatment/care if they lose capacity
What is a lasting power of attorney?
A legal document that allows a person to appoint someone they trust to make a decision on their behalf if they lose capacity
What is an advance care plan?
a non legally binding document where a person can express their general wishes + preferences in their medical care
