Geriatrics: Comprehensive Geriatric Assessment Flashcards

1
Q

What is frailty?

A
  • Frailty is a susceptibility state

- It is a reduced ability to withstand illness without loss of function

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2
Q

What is ageing and redundancy?

A

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

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3
Q

What does age related decline lead to?

A
  • Impairment of individual organ function
  • Breakdown of the complex interplay between organ systems
  • Increased susceptibility
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4
Q

How is frailty identified?

A
  • Frailty index
  • Frailty phenotype
  • HIS Think frailty
  • Presenting with frailty syndromes
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5
Q

What is the frailty phenotype?

A

Fried et al: 3 of 5 criteria

  • Unintentional weight loss
  • Exhaustion
  • Weak grip strength
  • Slow walking speed
  • Low physical activity
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6
Q

What are the components of HIS think frail guidelines?

A
  • 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
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7
Q

Give examples of frailty syndromes.

A
  • Falls
  • Immobility
  • Delirium
  • Functional loss
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8
Q

What are the stages of the clinical frailty scale?

A
  • Very fit
  • Well
  • Managing well
  • Vulnerable
  • Mildly frail
  • Severely frail
  • Very severely frail
  • Terminally ill
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9
Q

Define health

A
  • 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
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10
Q

Describe the frailty decline.

A

It is usually slow and progressive

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11
Q

What is the purpose of a CGA?

A

Determine what the problems are:

  • Multiple medical problems may present at once
  • Multiple health domains may be affected
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12
Q

What are the established models of CGA?

A
  • Inpatient
  • Intermediate care
  • Hospital at home
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13
Q

What professions are involved in CGA?

A
Key professions
-Geriatrician
-OT
-PT
Skilled nurse

Other professions

  • GP
  • Other doctors
  • Social worker
  • Home care
  • Dietician
  • SALT
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14
Q

What is the medical domain assessed for?

A
  • 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
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15
Q

What is the spiritual domain assessed for?

A
  • 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
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16
Q

What is the psychological domain assessed for?

A
  • Mood: low mood and anxiety
  • Confidence: fear of falling syndrome
  • Cognition: delirium and dementia
17
Q

What is the functional domain assessed for?

A
  • Mobility: transfers and mobilising
  • Activities of daily living
  • Community living skills
18
Q

What is the behavioural domain assessed for?

A
  • Behavioural determinants of ill health (unhealthy eating, smoking, drinking)
  • Activities and past times
  • Occupation
19
Q

What is the nutritional domain assessed for.?

A
  • Poor nutrition leads to ill health
  • Ill health leads to poor nutrition
  • Use of the MUST screening tool
20
Q

What is the environmental domain assessed for?

A
  • Housing
  • Heating
  • Sanitation
  • Adaptation
21
Q

What is the social domain assessed for?

A

Support networks

  • Practical/ emotional
  • Formal or informal

Potential for abuse

  • Financial
  • Physical
  • Sexual
  • Neglect
22
Q

What is the societal domain assessed for?

A

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)
23
Q

What is meant by good geriatric care?

A
  • Early identification of need
  • Early comprehensive geriatric assessment
  • Early provision of appropriate level of care for needs
24
Q

What are the benefits of hospital admittance?

A
  • Access to clinical expertise
  • Access to complex tests and interventions
  • Rapid access to supervised care support
25
Q

What are the risks of a hospital admittance?

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