Geriatrics - comprehensive geriatric assessment Flashcards
1
Q
Comprehensive Geriatric Assessment (CGA)
A
- Process of assessment and management of illness in older people with frailty
- Goal-centred, holistic and multidisciplinary
2
Q
Ageing
A
- Progressive accumulation of damage to processes in the body
- Loss of redundancy
3
Q
Effects of ageing (senescence)
A
- Impaired individual organ function
- Breakdown of communication between systems (dyshomeostgasis)
- All leads to increased susceptibility to environmental stress → frailty
4
Q
Frailty
A
- A state of susceptibility
5
Q
How are frail people identified
A
- Fried criteria (3 of 5 required)
- Unintential weight loss
- Exhaustion
- Weak grip strength
- Slow walking speeding
- Low physical activity
- Frailty index
6
Q
Decompensated frailty syndrome
A
- Falls
- Immobility
- Delirium
- Functional decline
- System failure presentations
7
Q
Common system failures
A
- Getting up and moving around → musculoskeletal, nervous, cardiovascular etc
- Understanding, processing and reacting to environment → nervous system
- Being able to look after yourself → almost all
8
Q
Principles of a geriatric history
A
- Think of the processes that allows you to get up and go into work?
- E.g moving body to get out of bed, feeding yourself, driving/ walking into work
- Activities of Daily Living (ADL)
9
Q
Activities of Daily living (ADL)
A
- Transfers
- Mobility
- Toileting
- Washing
- Dressing
- Meal preparation
- Feeding
10
Q
Goal centred vs problem centred
A
- Goal centred → central focus on the patients life story
- Problem centred → central focus on the individual diseases of the patient
11
Q
Why is goal-centred care important in geriatrics
A
- Its what the patient wants, not the doctor nwants
- Easier management fo multimorbiditites
- No singular disease has higher priority
- Prevention of polypharmacy
12
Q
Medical aspect of geriatric care
A
- Pathological → ‘disease’
- Physiology → ‘normal ageing’
- Reversible vs non-reversible
- Multifactorial problems
- Iatrogenic harm
- Management of chronic condition vs cure
13
Q
Spiritual aspects of geriatric care
A
- How do you fit into the bigger picture
- Whats important to them
- How they project their self-image
- Whats their purpose to life
14
Q
Psychological aspects of care
A
- Mood → low mood and anxiety
- Confidence → ‘fear of falling syndrome’
- Cognition → delirium and dementia
15
Q
Function aspects of geriatric care
A
- Mobility → transfers and mobilising
- Activities of Daily Living
- Community Living Skills
16
Q
Behaviours aspects of geriatric care
A
- Lifestyle determinants of ill health → bad nutrition/ smoking/ alcohol
- Activities and hobbies
- Occupation
17
Q
Nutritional aspects of geriatric health
A
- Poor nutrition → ill health
- Ill health → poor nutrition
- Must use screening tools
18
Q
Environmental aspects of geriatric care
A
- Housing
- Heating
- Sanitation
- Adaptation
19
Q
Social aspects of geriatric care
A
- Support networks → practical/ emotions
- Potential for abuse → financial, physical, sexual, neglect
20
Q
Societal aspects of geriatric care
A
- Attitudes to ageing/ the aged → burden vs asset
- Technological advances → enabling vs disabling
- Political/ regulation → finances and accessibility
21
Q
The multidisciplinary team in CGA
A
- Doctors → looks at medical contributors to disrupted health + overall responsibility
- Physiotherapist → assessment of mobility
- Occupational therapist → assessment of ADL
- Nurses → provide care needs and assessment over longer period of time
- Other → pharmacy, social work, SALT, dietetics
22
Q
How to make a treatment plan
A
- Majority
- Enable patient to live their life
- In hospital = ability to regain function to live at home
- Considerations to maintain future good health
- Minority (10%)
- Recognise someones life is coming to an end
- Palliation
23
Q
If we can never make anyone better, when can we discharge them from hospital?
A
- Must weigh up the pros/cons of hospital vs community care for the individual
24
Q
Pros and cons of hospital care
A
- Pros
- Access to specialised clinical expertise
- Access to complex tests and assessments
- Rapid access to supervised care
- Cons
- Disorientation and delirium
- Learned
