Comprehensive Geriatric Assessment (CGA)

Question 1

Describe the difference in approach to Medicine for the Elderly that has been developed in the last 20 years?

Answer 1

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

Question 2

What factors were traditionally assessed in elderly patients?

Answer 2

Mobility
Continence
Mental state

Question 3

What is the aim of elderly patient rehabilitation?

Answer 3

Enables patients to care for themself enough to go home/ live themself

Question 4

From what age are frail patients seen in the MFE ward?

Answer 4

Can be 65 and frail and seen on the MFE ward

More based on the body’s age rather than the patients chronological age

Question 5

What problems can you face when taking a history from an elderly patient?

Answer 5

• > 1 presenting complaint
• PCs may not be linked
• Many have comorbidities and extensive medications
• Hx may have to be taken from a 3rd party

Question 6

What are the next steps after a CGA?

Answer 6

• Make a “Problem list”
• Agree objectives of care
• Develop Individual Management Plan
• Regular Review

Question 7

What are the 4 main sections of the CGA?

Answer 7

Medical
Functioning
Psychological
Social/ Environment

Question 8

What medical factors of a patients life should be assessed in a CGA?

Answer 8

• Problem list
• Co-morbid conditions
• Medication review
• Nutritional status

Question 9

How is a patient’s function level assessed in a CGA?

Answer 9

• Basic Activities of Daily Living (ADL)
• Extended ADLs
• Activity/exercise
• Gait and balance

Question 10

What psychological aspects of a patients life should be assessed in a CGA?

Answer 10

• Mental status/cognitive function

- Mood/depression testing

Question 11

What parts of a patients social environment are considered in a CGA?

Answer 11

• Social circle - check for isolation
• Care received and eligibility for care packages
• Safety in their home and community

Question 12

What other health professionals are involved in elderly patients care?

Answer 12

• 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

Question 13

Give examples of features in a problem list that may not be medically related?

Answer 13

Social isolation
Poor Housing
Family difficulties

Question 14

What are considered to be the “Frailty” syndromes?

Answer 14

Off legs (poor mobility)
Falls
Confusion
Continence issues
Polypharmacy

Question 15

Why do a lot of elderly patients present with dehydration?

Answer 15

• 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

Question 16

Dehydrated patients often present with weight loss. TRUE/FALSE?

Answer 16

TRUE

dehydration can cause patients to lose weight rapidly

Question 17

What makes acute illness in the elderly difficult to assess?

Answer 17

• 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

Question 18

How do older people differ from younger patients in presentation of an MI?

Answer 18

Young people = Chest pain

Older people: No chest pain in 1/3
Also	- Collapse
	- Delirium
	- Dizziness
	- Breathlessness

Question 19

Why may investigations and management of an MI be different in old and young patients?

Answer 19

• 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

Question 20

How does the presentation of SEPSIS differ between older and younger patients?

Answer 20

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)

Question 21

Why is the management of SEPSIS in older patients more difficult?

Answer 21

• Fluid balance may be hard (due to comorbidities like heart failure)
• Antibiotics should be targeted as higher risk of C.diff in the elderly

Question 22

What other symptoms should you ask about when patients complain of urinary incontinence and seem rather confused?

Answer 22

Constipation - faeces in the rectum can push on the bladder causing it to be overactive and the patient to be urgent when voiding

Question 23

Why does acute illness carry a much higher mortality rate in the elderly?

Answer 23

• Impaired physiology => body doesn’t react as it should
  => they tend not to compensate for as long as young pts
• multimorbidity

Question 24

How do doctors try to combat the increasing rate of acute admissions?

Answer 24

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