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SPECIALITIES > Elderly - comprehensive geriatric assessment > Flashcards

Elderly - comprehensive geriatric assessment Flashcards

1
Q

what are the main implications of an ageing world

A

multimorbidity
frailty
disability

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2
Q

what is frailty

A

a reduced ability to withstand illness without a loss of function

increased susceptibility state - not an illness itself

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3
Q

what does age related decline lead to

A

impairment of individual organ function
breakdown of the complex interplay between organ systems (dyshomeostasis)

= leads to frailty

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4
Q

what is considered to be included in the “frailty phenotype”

A 
Unintentional weight loss
Exhaustion
Weak grip strength
Slow walking speed
Low physical activity
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5
Q

what are “frailty syndromes’

A

falls
immobility
delirium
functional loss

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6
Q

what is health

A

a dynamic process rather than a binary state

ie not just what WHO says it is

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7
Q

what are the different health domains

A 
medical
psychological
functional
behavioural
nutritional
spiritual
environmental 
social
societal
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8
Q

what does illness in frail people lead to

A

a disruption in multiple health domains

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9
Q

what is the illness trajectory in frailty

A

normal decline in functional ability from age
trigering event (sudden decline)
rapid decline in functional ability
crisis (further decline)
admission (slight increase in functional ability)
Reablement (further increase but still below the expected line of functional ability)
further slow decline over time

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10
Q

what is a comprehensive geriatric assessment (CGA)

A

a process to assess and manage illness in older people with frailty

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11
Q

what can a CGA determine

A

what the problems are

  • ie mutliple medical problems present at once
  • multiple health domains affected

what we can reverse and what we can make better

a management plan going forward

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12
Q

What sort of management plan is used in the elderly

A

person-centrered/goal-centered approach

  • do what the patient wants
  • preserve autonomy
  • effective in dealing with multimoridity/competing clinical priorities
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13
Q

what components are there to the medical health domain

A 
pathological - disease
physiological - normal ageing 
reversible vs non-reversible
multiple naturally occurring problems
iatrogenic harm
infection
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14
Q

what components are there to the spiritual health domain

A

How do I fit in to the bigger picture?

What’s important to you?

How do you like to project your self-image?

What’s the meaning of your life?

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15
Q

what components are there to the psychological health domain

A 
Mood
- Low mood
- Anxiety
Confidence
- 'fear of falling syndrome'
Cognition
- Delirium
- Dementia
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16
Q

what components are there to the functional health domain

A 
Mobility
- Transfers
- Mobilising
Activities of Daily Living
Community Living Skills
17
Q

what components are there to the behavioural health domain

A

Behavioural determinants of ill health
- Unhealthy eating/smoking/drinking

Activities/Pastimes

Occupation

18
Q

what components are there to the nutritional health domain

A

Poor nutrition leads to ill health

Ill health leads to poor nutrition

MUST screening tool

19
Q

what components are there to the environmental health domain

A

Housing
Heating
Sanitation
Adaptation

20
Q

what components are there to the social health domain

A 
Support networks
- Practical/emotional
- Formal/informal
Potential for abuse
- Financial
- Physical
- Sexual
- Neglect
21
Q

what components are there to the societal health domain

A 
Attitudes to ageing/the aged
- Asset vs. burden
- Paternalism
Technological advance
- Enabling vs. disabling
Political/Regulations
- Money (eg. Winter heating allowance/pensions)
- Accessibility (eg. Free bus passes/Disabled access)
22
Q

what are the key professions involved in patient care

A

Geriatrician
OT
PT
Skilled nurses

23
Q

what are other professions involved in patient care

A 
GP
Other doctors
Social worker
Home care
Dietitian
SALT (speech and language therapist)
24
Q

where can geriatric care take place

A

inpatient
intermediate care
hospital at home

25
Q

what is involved in good geriatric care

A

early identification of need
early CGA
early provision of appropriate level of care for needs

26
Q

what does early intervention with a CGA mean for illness trajectory in a frail person

A

early intervention leads to better outcome

27
Q

what are the benefits of caring for a patient in hospital

A

access to clinical expertise
access to complex tests and interventions
rapid access to supervised care support

28
Q

what are the risks of caring for patient in hospital

A 
Disorientation and delirium
Learned dependency
Deconditioning
Iatrogenic harm
Hospital Acquired Infection
29
Q

when is the best time to discharge a patient from hospital

A

when goals are met

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