Elderly - comprehensive geriatric assessment Flashcards
what are the main implications of an ageing world
multimorbidity
frailty
disability
what is frailty
a reduced ability to withstand illness without a loss of function
increased susceptibility state - not an illness itself
what does age related decline lead to
impairment of individual organ function
breakdown of the complex interplay between organ systems (dyshomeostasis)
= leads to frailty
what is considered to be included in the “frailty phenotype”
Unintentional weight loss Exhaustion Weak grip strength Slow walking speed Low physical activity
what are “frailty syndromes’
falls
immobility
delirium
functional loss
what is health
a dynamic process rather than a binary state
ie not just what WHO says it is
what are the different health domains
medical psychological functional behavioural nutritional spiritual environmental social societal
what does illness in frail people lead to
a disruption in multiple health domains
what is the illness trajectory in frailty
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
what is a comprehensive geriatric assessment (CGA)
a process to assess and manage illness in older people with frailty
what can a CGA determine
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
What sort of management plan is used in the elderly
person-centrered/goal-centered approach
- do what the patient wants
- preserve autonomy
- effective in dealing with multimoridity/competing clinical priorities
what components are there to the medical health domain
pathological - disease physiological - normal ageing reversible vs non-reversible multiple naturally occurring problems iatrogenic harm infection
what components are there to the spiritual health domain
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?
what components are there to the psychological health domain
Mood - Low mood - Anxiety Confidence - 'fear of falling syndrome' Cognition - Delirium - Dementia
what components are there to the functional health domain
Mobility - Transfers - Mobilising Activities of Daily Living Community Living Skills
what components are there to the behavioural health domain
Behavioural determinants of ill health
- Unhealthy eating/smoking/drinking
Activities/Pastimes
Occupation
what components are there to the nutritional health domain
Poor nutrition leads to ill health
Ill health leads to poor nutrition
MUST screening tool
what components are there to the environmental health domain
Housing
Heating
Sanitation
Adaptation
what components are there to the social health domain
Support networks - Practical/emotional - Formal/informal Potential for abuse - Financial - Physical - Sexual - Neglect
what components are there to the societal health domain
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)
what are the key professions involved in patient care
Geriatrician
OT
PT
Skilled nurses
what are other professions involved in patient care
GP Other doctors Social worker Home care Dietitian SALT (speech and language therapist)
where can geriatric care take place
inpatient
intermediate care
hospital at home
