Comprehensive Geriatric Assessment (CGA) Flashcards
Describe the difference in approach to Medicine for the Elderly that has been developed in the last 20 years?
1990s - pts referred to MFE from other specialities
2000s - MFE and other specialities coordinating early intervention and rehab
2010s - Acute frailty team take on patients from AMU who are seen as frail and require MFE intervention
What factors were traditionally assessed in elderly patients?
Mobility
Continence
Mental state
What is the aim of elderly patient rehabilitation?
Enables patients to care for themself enough to go home/ live themself
From what age are frail patients seen in the MFE ward?
Can be 65 and frail and seen on the MFE ward
More based on the body’s age rather than the patients chronological age
What problems can you face when taking a history from an elderly patient?
- > 1 presenting complaint
- PCs may not be linked
- Many have comorbidities and extensive medications
- Hx may have to be taken from a 3rd party
What are the next steps after a CGA?
- Make a “Problem list”
- Agree objectives of care
- Develop Individual Management Plan
- Regular Review
What are the 4 main sections of the CGA?
Medical
Functioning
Psychological
Social/ Environment
What medical factors of a patients life should be assessed in a CGA?
- Problem list
- Co-morbid conditions
- Medication review
- Nutritional status
How is a patient’s function level assessed in a CGA?
- Basic Activities of Daily Living (ADL)
- Extended ADLs
- Activity/exercise
- Gait and balance
What psychological aspects of a patients life should be assessed in a CGA?
- Mental status/cognitive function
- Mood/depression testing
What parts of a patients social environment are considered in a CGA?
- Social circle - check for isolation
- Care received and eligibility for care packages
- Safety in their home and community
What other health professionals are involved in elderly patients care?
- Occupational therapist - assess tasks in the home
- Dietitian - assess nutritional status and can#
aid with dietary supplements - Pharmacist - medication review
- Physiotherapist - rehabilitation and mobility
- Nurse - getting to know the patient most
Give examples of features in a problem list that may not be medically related?
Social isolation
Poor Housing
Family difficulties
What are considered to be the “Frailty” syndromes?
Off legs (poor mobility) Falls Confusion Continence issues Polypharmacy
Why do a lot of elderly patients present with dehydration?
- If patient is confused then they may forget to drink an adequate amount of water during the day
- Limited mobility prevents patients going to get a drink
Dehydrated patients often present with weight loss. TRUE/FALSE?
TRUE
dehydration can cause patients to lose weight rapidly
What makes acute illness in the elderly difficult to assess?
- Atypical / masked presentations (NOT TEXTBOOK)
- At their age, the body’s physiological response varies
- Immune response varies with disease/drugs/nutrition
- They have Co-morbid conditions
How do older people differ from younger patients in presentation of an MI?
Young people = Chest pain
Older people: No chest pain in 1/3 Also - Collapse - Delirium - Dizziness - Breathlessness
Why may investigations and management of an MI be different in old and young patients?
- Older pts may not tolerate angiogram or stenting
- Younger pts are given dual antiplatelet therapy but this may interact with other drugs taken by the older pts
- dual antiplatelets increase the elderly patient’s risk of haemorrhages, bleeds and bruising
How does the presentation of SEPSIS differ between older and younger patients?
IN OLDER PATIENTS
- BP may drop early (esp in those on vasodilating antihypertensives)
- Temperature often LOW, not high (HYPOthermia)
- Tachycardia less likely
- Delirium
- CRP and WCC may not rise (or not as much - due to poor liver and bone marrow function)
Why is the management of SEPSIS in older patients more difficult?
- Fluid balance may be hard (due to comorbidities like heart failure)
- Antibiotics should be targeted as higher risk of C.diff in the elderly
What other symptoms should you ask about when patients complain of urinary incontinence and seem rather confused?
Constipation - faeces in the rectum can push on the bladder causing it to be overactive and the patient to be urgent when voiding
Why does acute illness carry a much higher mortality rate in the elderly?
- Impaired physiology => body doesn’t react as it should
=> they tend not to compensate for as long as young pts - multimorbidity
How do doctors try to combat the increasing rate of acute admissions?
Try to recognise signs of de-compensation earlier than the patients need for admission to hospital
Prevention of admission schemes are used for patients who can be assessed and managed outwith a hospital setting
