Geriatrics: Comprehensive geriatric assessment

Question 1

How is frailty phenotype diagnosed?

Answer 1

○ 3 out of 5 criteria

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

Question 2

What trend present with frailty syndromes?

Answer 2

○ Falls
○ Immobility
○ Delirium
○ Functional loss

Question 3

Why are geriatric patients challenging?

Answer 3

• Patients are increasingly
○ Multimorbid
○ Old
○ Frail
○ Complex
• Our healthcare paradigm continues to be disease/system specific
○ Research
○ Guidelines
○ Medical Education/Training
○ Secondary Care
• We need to look at the whole patient

Question 4

What is a comprehensive geriatric assessment?

Answer 4

• Process to assess and manage illness in older people with frailty
• Determine what the problems are
○ Multiple medical problems present at once
○ Multiple health domains affected
• Determine what we can reverse and what we can make better
• Produce a management plan
• It is goal centred not problem centred
○ Means we do what the patient wants (not what the doctor wants)
○ Preserves autonomy
○ Is an effective way of dealing with multimorbidity and competing clinical priorities

Question 5

What are the key proffessions involved in a comprehensive geriatric assessment?

Answer 5

• Geriatrician
• OT
• PT
• Skilled nurses

Question 6

Other than the key profesions, what other professions might get involved in a comprehensive geriatric assessment?

Answer 6

• GP
• Other doctors
• Social worker
• Home care
• Dietitian
• SALT

Question 7

What is good geriatric care?

Answer 7

○ Early identification of need
○ Early Comprehensive Geriatric Assessment
○ Early provision of appropriate level of care for needs
○ the earlier in the illness trajectory a frail person undergoes the process of CGA, the better the outcomes are likely to be

Question 8

What are the benefits of frail people staying in hospital?

Answer 8

○ Access to clinical expertise
○ Access to complex tests and interventions
○ Rapid access to supervised care support

Question 9

What are the risks of frail people staying in hospital?

Answer 9

○ Disorientation and delirium
○ Learned dependency
○ Deconditioning
○ Iatrogenic harm
○ Hospital Acquired Infection