Elderly- Comprehensive Geriatric Assessment

Question 1

What is the function of a comprehensive geriatric assessment?

Answer 1

A process to assess and manage disruption to health in older people with frailty

Question 2

What is ageing?

Answer 2

Progressive accumulation of damage to a complex system resulting in aggregate loss of system redundancy

Question 3

What does a loss of system redundancy lead to?

Answer 3

Decreased resilience to overcome environmental stress

Resulting in an increased risk of system failure

Question 4

What is frailty?

Answer 4

State of susceptibility

Question 5

How can you identify someone as fail?

Answer 5

Frailty index
Frailty phenomenon
They tend to present with decompensated frailty syndrome

Question 6

What is decompensated frailty syndrome?

Answer 6

System failure presentations 
•	Falls 
•	Incontinence 
•	Delirium 
•	Functional decline

Question 7

What is a Comprehensive Geriatric Assessment?

Answer 7

A multidimensional interdisciplinary diagnostic process focused on determining a frail elderly person’s medical, psychological and functional capability in order to develop a co-ordinated and integrated plan for treatment and long term follow up

Question 8

What does a comprehensive geriatric assessment include?

Answer 8

• Goal centred
• Holistic
• Multidisciplinary

Question 9

What is goal centred vs problem centred?

Answer 9

The goal and focus is the life, not the disease

It is about what the person wants, not what the doctor wants

Question 10

What is a holistic approach?

Answer 10

Broad approach to health

Health is a dynamic process rather than a binary state

Question 11

What are the health domains?

Answer 11

Medical, psychological, nutritional, spiritual, environmental, social etc.

Illness in frail people leads to disruption in multiple health domains

Question 12

What happens to the health domains in an ill, frail person?

Answer 12

There is disruption in multiple health domains

Question 13

How is the psychological heath domain disrupted?

Answer 13

• Mood- Low mood, Anxiety
• Confidence- Fear of falling
• Cognition- Delirium, Dementia

Question 14

How is the nutritional health domain disrupted?

Answer 14

• Poor nutrition leads to ill health
• Ill health leads to poor nutrition
• MUST screening tool

Question 15

What does environmental health domain encompass?

Answer 15

• Housing
• Heating
• Sanitation
• Adaptation

Question 16

What does the social health domain encompass?

Answer 16

• Support networks- Practical/emotional, Formal/informal

* Potential for abuse- Financial, Physical, Sexual, Neglect

Question 17

Who is involved in the multidisciplinary team that carries out the multidisciplinary assessment?

Answer 17

• Doctors
• Physiotherapists
• Occupational therapist
• Nurses

Question 18

What do the doctors look at?

Answer 18

The medical contributors to disruption to health

Question 19

What do the physiotherapists assess?

Answer 19

Mobility

Question 20

What do the occupational therapists assess?

Answer 20

Function

Question 21

What does the nurse do?

Answer 21

Provide care and assessment over long period of time

Question 22

When is the optimal discharge of patients?

Answer 22

When the benefits outweigh the risks or when the goals are met

Question 23

What are the benefits to a patient being in hospital?

Answer 23

• Access to clinical expertise
• Access to complex tests and interventions
• Rapid access to supervised care support

Question 24

What are the risks of a patient being in hospital?

Answer 24

• Disorientation and delirium
• Learned dependency
• Deconditioning
• Iatrogenic harm
• Hospital Acquired Infection