Elderly: Comprehensive Geriatric Assessment

Question 1

What is frailty?

Answer 1

• Frailty is a susceptibility state
• It is a reduced ability to withstand illness without loss of function

Question 2

What is ageing?

Answer 2

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

Question 3

What does age related decline lead to?

Answer 3

• Impairment of individual organ function
• Breakdown of the complex interplay between organ systems
• Increased susceptibility

Question 4

How is frailty identified?

Answer 4

• Frailty index
• Frailty phenotype
• HIS Think frailty
• Presenting with frailty syndromes

Question 5

What is the frailty phenotype?

Answer 5

Fried et al: 3 of 5 criteria

• Unintentional weight loss
• Exhaustion
• Weak grip strength
• Slow walking speed
• Low physical activity

Question 6

What are the components of HIS think frail guidelines?

Answer 6

• Functional impairment in context of significant multiple condition
• Resident in a care home
• Acute confusion
• Immobility or falls in last 3 months
• List of 6 or more medicines

Question 7

Give examples of frailty syndromes.

Answer 7

• Falls
• Immobility
• Delirium
• Functional loss

Question 8

What are the stages of the clinical frailty scale?

Answer 8

• Very fit
• Well
• Managing well
• Vulnerable
• Mildly frail
• Severely frail
• Very severely frail
• Terminally ill

Question 9

Define health

Answer 9

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO).

Question 10

Describe the frailty decline.

Answer 10

It is usually slow and progressive

Question 11

What professions are involved in CGA (comprehensive geriatric assessment)?

Answer 11

Key professions

• Geriatrician
• OT
• PT
• Skilled nurse

Other professions

• GP
• Other doctors
• Social worker
• Home care
• Dietician
• SALT

Question 12

What is the medical domain assessed for?

Answer 12

• Pathological: disease
• Physiological: normal ageing

Question 13

What is the spiritual domain assessed for?

Answer 13

• What’s important to you?
• What’s the meaning of your life?
• Person-centred care

Question 14

What is the psychological domain assessed for?

Answer 14

• Mood: low mood and anxiety
• Confidence: fear of falling syndrome
• Cognition: delirium and dementia

Question 15

What is the functional domain assessed for?

Answer 15

• Mobility
• Activities of daily living
• Community living skills

Question 16

What is the behavioural domain assessed for?

Answer 16

• Behavioural determinants of ill health (unhealthy eating, smoking, drinking)
• Activities and past times
• Occupation

Question 17

What is the environmental domain assessed for?

Answer 17

• Housing
• Heating
• Sanitation
• Adaptation

Question 18

What is the social domain assessed for?

Answer 18

• Support networks
  
  • Practical/ emotional
  • Formal or informal
• Potential for abuse
  
  • Financial
  • Physical
  • Sexual
  • Neglect

Question 19

What is meant by good geriatric care?

Answer 19

• Early identification of need
• Early comprehensive geriatric assessment
• Early provision of appropriate level of care for needs

Question 20

What are the benefits of hospital admittance?

Answer 20

• Access to clinical expertise
• Access to complex tests and interventions

Question 21

What are the risks of a hospital admittance?

Answer 21

• Disorientation and delirium
• Learned dependency
• Deconditioning
• Iatrogenic harm
• Hospital acquired infection