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Specialties > Geriatrics - comprehensive geriatric assessment > Flashcards

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
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2
Q

Ageing

A
  • Progressive accumulation of damage to processes in the body
  • Loss of redundancy
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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
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4
Q

Frailty

A
  • A state of susceptibility
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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
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6
Q

Decompensated frailty syndrome

A
  • Falls
  • Immobility
  • Delirium
  • Functional decline
  • System failure presentations
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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
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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)
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9
Q

Activities of Daily living (ADL)

A
  • Transfers
  • Mobility
  • Toileting
  • Washing
  • Dressing
  • Meal preparation
  • Feeding
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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
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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
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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
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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
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14
Q

Psychological aspects of care

A
  • Mood → low mood and anxiety
  • Confidence → ‘fear of falling syndrome’
  • Cognition → delirium and dementia
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15
Q

Function aspects of geriatric care

A
  • Mobility → transfers and mobilising
  • Activities of Daily Living
  • Community Living Skills
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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

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