comprehensive geriatrics assessment Flashcards
define comprehensive geriatric assessment
‘A multidimensional interdisciplinary diagnostic process focused on determining a frail elderly person’s medical, psychological and functional capability in order to develop a coordinated and integrated plan for treatment and long-term follow-up
- a multidimensional holistic assessment
of an older person considers health and wellbeing - formulation of a plan to address
issues which are of concern to the older person
(and their family and carers when relevant).
Interventions are then arranged in support of
the plan. Progress is reviewed and the original
plan reassessed at appropriate intervals with the
interventions reconsidered accordingly.
what are the multiple domains of assessment in CGA
Medical assessment
- problem list
- comorbidities
- medications
- nutritional assessment
functional assessment
- basic ADLs
- instrumental activities of daily living
- gait and balance assessment
- exercise/activity assessment
Psychological assessment
- cognitive status
- assessment of mood
social assessment
- informal social support
environmental assessment
- care resource eligibilityt/financial assessment
- home safety
- access to transport facilities
Physical Symptoms: Pain, continence, Sensory impairment, Musculoskeletal problems, nutritional and skin assessment
Mental Health symptoms: Mood, cognitive impairment
Functional abilities and living environment
Social support networks
what is included in advance care planning
advanced statements - values religion/family, views about treatment, place of treatment
DNACPR - if they want to
power of attorney
Advance statement. What do you want? Statements of wishes and preferences – should be considered when acting in a person’s best interests but will not be legally binding.
o Personal preferences – where they wish to live, having a shower rather than a bath.
o Values – the welfare of their spouse/children is taken into account when decisions are
made about their care.
o Views about treatments they do not wish to receive but they do not want to formalise
these views as a specific advance decision.
• Advance decision to Refuse Treatment. What don’t you want? Living will (advance decision) to
refuse treatment. DNACPR. This is legally binding.
• LPA. Who will speak for you? Lasting power of attorney can make decisions on behalf of the
person in question regarding personal welfare, property and financial affairs. This is legally binding.
what is advanced care planning
Advance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual’S preferences and values concerning future treatment and care, including end-of-life care.
Essentially a process of planning for the future, so that the patient gets what they want for their healthcare as they age, it’s a process over time and not a one off thing.
ethical issues arising from end of life decisions
May not be part of their culture or against their cultural beliefs as it does not ‘exist’ in the countries they have come from (South Asia communities)
They may believe in treatment ‘till the end’ (Middle Eastern and South Asian communities)
Palliative care and DNACPR is seen as withdrawal of treatment so is viewed as unethical and unkind
In certain cultures, there are community leaders, religious figures, family elders and other key family members whose presence in such meetings can be beneficial. Ask early if this is the case
when can someone not make a decision in terms of MCA
understand the information relevant to the decision
retain that information
use or weigh up that information as part of the process of making the decision
how to assess if something is in someones best interest
can they reagin
optimise involving them in the decision process
religious or spiritual views
advantages of CGA
- NNT 17 to avoid one death at 6 month
- more likely to be alove
- less likely to have physically deteriorated
- lower level of dependency
disadvantages of CGA
only seems to be effective when the whole multidisciplinary team are involved
