geriatrics: comprehensive geriatric assessment Flashcards
What does CGA stand for?
Comprehensive geriatric assessment
What is CGA?
CGA = a process to assess and manage disruption to health in older people with frailty
what is redundancy?
ability to deal with environmental stress
loss of system redundancy leads to decreased resilience to overcome environmental stress
age related decline leads to what?
- impairment of organ function
- breakdown of complex interplay between organ systems (dyshomeostasis)
- causing increases susceptibility to environmental stress (frailty)
multi-morbidity increases with age
what are different ways to identify someone as frail?
- frailty index
- 1 point for each impairment/disease on large list
- frailty phenotype
- 3 of 5 criteria – unintentional weight loss, exhaustion, weak grip strength, slow walking speed, low physical activity
- clinical frailty scale
what are examples of ‘frailty syndromes’?
system failure presentations
falls, immobility, delirium, functional decline
what should you ask the patient to take a ‘functional history’?
similar things to what you did yourself to get up and go to work (known as ‘basics of living’ – activities of living ADL):
- transfers
- mobility
- toileting
- washing
- dressing
- meal preparation
- feeding
What does ADL stand for?
Activities of daily living
Describe CGA in terms of:
- goal centred
- holistic
- multi-disciplinary
goal centred: focus on goals not problems
holistic: lots of aspects to ‘health’
- medical – reversible or irreversible, consider iatrogenic harm
- spiritual – what’s important to patient, meaning of their life
- psychological – mood, confidence, cognition
- functional – mobility, activities of daily living, community living skills
- behavioural – eating, smoking, drinking, activities, occupation
- nutrition – poor nutrition leads to poor health and poor health leads to poor nutrition
- environmental – housing, heating, sanitation, adaption
- social – support networks, potential for abuse
- societal – attitudes to ageing, technological advance, political (money, accessibility to transport)
- frailty can be triggered by disruption to any of these aspects of ‘health’
- multi-disciplinary
MDT assessment
- doctors – look at medical contributors to disruption to health
- physiotherapists – assess mobility
- occupational therapists – assist function (ADLs)
- nurses – provide care and assessment over longer period of time
- others: pharmacists, social work, speech and language therapists, dieticians
- MDT meetings and communication
- plan for patient discharge (when risks of hospital outweighs benefits or when goals have been met)
- recognise that 10% of geriatrics patients at any time will die in the ward
What does goal cented mean?
Focus on goals not problems
What are the different aspects of holistic care?
- Lots of aspects to ‘health’
- Medical – reversible or irreversible, consider iatrogenic harm
- Spiritual – what’s important to patient, meaning of their life
- Psychological – mood, confidence, cognition
- Functional – mobility, activities of daily living, community living skills
- Behavioural – eating, smoking, drinking, activities, occupation
- Nutrition – poor nutrition leads to poor health and poor health leads to poor nutrition
- Environmental – housing, heating, sanitation, adaption
- Social – support networks, potential for abuse
- Societal – attitudes to ageing, technological advance, political (money, accessibility to transport)
- Frailty can be triggered by disruption to any of these aspects of ‘health’
What are hospital risks and benefits for frail people?
- Benefits
- Access to clinical expertise
- Access to complex tests and interventions
- Rapid access to supervised care support
- Risks
- Disorientation and delirium
- Learned dependency
- Deconditioning
- Iatrogenic harm
- HAI
