Geriatrics: Comprehensive Geriatric Assessment Flashcards
What is frailty?
- Frailty is a susceptibility state
- It is a reduced ability to withstand illness without loss of function
What is ageing and redundancy?
The progressive accumulation of damage to a complex system resulting in aggregate loss of system redundancy
What does age related decline lead to?
- Impairment of individual organ function
- Breakdown of the complex interplay between organ systems
- Increased susceptibility
How is frailty identified?
- Frailty index
- Frailty phenotype
- HIS Think frailty
- Presenting with frailty syndromes
What is the frailty phenotype?
Fried et al: 3 of 5 criteria
- Unintentional weight loss
- Exhaustion
- Weak grip strength
- Slow walking speed
- Low physical activity
What are the components of HIS think frail guidelines?
- F: functional impairment in context of significant multiple condition
- R: resident in a care home
- A: acute confusion
- I: immobility or falls in last 3 months
- L: list of 6 or more medicines
Give examples of frailty syndromes.
- Falls
- Immobility
- Delirium
- Functional loss
What are the stages of the clinical frailty scale?
- Very fit
- Well
- Managing well
- Vulnerable
- Mildly frail
- Severely frail
- Very severely frail
- Terminally ill
Define health
- A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO)
- It is a dynamic process rather than a binary state
Describe the frailty decline.
It is usually slow and progressive
What is the purpose of a CGA?
Determine what the problems are:
- Multiple medical problems may present at once
- Multiple health domains may be affected
What are the established models of CGA?
- Inpatient
- Intermediate care
- Hospital at home
What professions are involved in CGA?
Key professions -Geriatrician -OT -PT Skilled nurse
Other professions
- GP
- Other doctors
- Social worker
- Home care
- Dietician
- SALT
What is the medical domain assessed for?
- Pathological: disease
- Physiological: normal ageing
- Reversible vs non-reversible causes
- Multiple concomitant problems
- Iatrogenic harm
- Majority of modern medicine is treating/ameliorating chronic disease (or acute exacerbations of chronic disease)
- Few things in medicine are ‘curable’
- Infection
What is the spiritual domain assessed for?
- How do I fit into the bigger picture?
- What’s important to you
- How do you like to project your self-image?
- What’s the meaning of your life?
- Person-centred care
What is the psychological domain assessed for?
- Mood: low mood and anxiety
- Confidence: fear of falling syndrome
- Cognition: delirium and dementia
What is the functional domain assessed for?
- Mobility: transfers and mobilising
- Activities of daily living
- Community living skills
What is the behavioural domain assessed for?
- Behavioural determinants of ill health (unhealthy eating, smoking, drinking)
- Activities and past times
- Occupation
What is the nutritional domain assessed for.?
- Poor nutrition leads to ill health
- Ill health leads to poor nutrition
- Use of the MUST screening tool
What is the environmental domain assessed for?
- Housing
- Heating
- Sanitation
- Adaptation
What is the social domain assessed for?
Support networks
- Practical/ emotional
- Formal or informal
Potential for abuse
- Financial
- Physical
- Sexual
- Neglect
What is the societal domain assessed for?
Attitudes to ageing/ the aged
-Asset vs burden
Paternalism
Technological advance
-Enabling or disabling
Political/ regulations
- Money ( winter heating allowance/pensions)
- Accessibility (free buss passes/disabled access)
What is meant by good geriatric care?
- Early identification of need
- Early comprehensive geriatric assessment
- Early provision of appropriate level of care for needs
What are the benefits of hospital admittance?
- Access to clinical expertise
- Access to complex tests and interventions
- Rapid access to supervised care support
What are the risks of a hospital admittance?
- Disorientation and delirium
- Learned dependency
- Deconditioning
- Iatrogenic harm
- Hospital acquired infection
