Comprehensive Geriatric Assessment (CGA)

Question 1

Domains of the Comprehensive Geriatric Assessment

Answer 1

Medical
Psychological
Functional
Social/environment

Question 2

Medical components of the CGA

Answer 2

“Problem list”
Medication
Nutrition
Co-morbid conditions

Question 3

What ensures the full benefit of CGA is achieved?

Answer 3

Dedicated CGA unit within the hospital- “roving” teams are less effective

Question 4

Benefits of CGA

Answer 4

Reduced mortality
Reduced re-admission rates
Improved cognition
Improved function
Fewer nursing home admissions (NNT=33)

Question 5

Possible causes of impaired immunity in older patients

Answer 5

Diabetes
Treatment for co-morbid conditions e.g. steroids, DMARDs
Malnourishment

Question 6

Common causes of “blunted” cardiovascular responses

Answer 6

Impaired physiology- less able to maintain blood pressure (unlike children and adults)
Beta blockers
Vasodilators e.g. GTN, amlodopine

Question 7

Differences in management of chest pain ?MI in older patients compared to younger

Answer 7

The presentation may be “masked” or unusual e.g. may not get chest pain
Older patients may not tolerate an angiogram (confused, unable to lie flat)
Older patients may have contraindications to certain drugs or have side-effects more frequently

Question 8

How might an MI present atypically in an older patient?

Answer 8

No chest pain (1/3rd of older patients)
Collapse
Dizziness
Breathlessness
Delirium

Question 9

Potential differences in an older patient with sepsis

Answer 9

Early BP drop
May be hypothermic
CRP and WCC may not rise

Question 10

Why do antibiotics in a septic older patient need to be targeted stringently?

Answer 10

Higher chance of C. diff infection in older patients