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Specialities > Geriatrics: comprehensive geriatric assessment > Flashcards

Geriatrics: comprehensive geriatric assessment Flashcards

1
Q

What are the main implications of an ageing world?

A

Multimorbidity

Frailty

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2
Q

What is frailty as opposed to an illness?

A

Susceptibility state

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3
Q

What is ageing and redundancy?

A

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

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4
Q

What are the physiological effects of ageing?

A

Impairment of individual organ function + breakdown of the complex interplay between organ systems (dyshomeostgasis) = increased susceptibility to environmental stress (FRAILTY)

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5
Q

How do we identify someone as frail?

A

CSHA Frailty Index

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6
Q

What is the frailty phenotype?

A

The frailty phenotype defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria

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7
Q

What are the 5 criteria of the frailty phenotype?

A 
Unintentional weight loss
Exhaustion
Weak grip strength
Slow walking speed
Low physical activity
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8
Q

What are the frailty syndromes?

A

Falls
Immobility
Delirium
Functional loss

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9
Q

What are the criteria for a person benefitting from a Comprehensive Geriatric Assessment (CGA)?

A 
Functional impairment in context of significant multiple conditions
Resident in care home
Acute confusion
Immobility/falls in last 3mo
6+ medicines
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10
Q

What is the clinical frailty scale?

A

1-9
1 = very fit
9 = terminally ill

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11
Q

What are examples of health domains?

A 
Medical
Psychological
Functional
Behavioural
Nutritional
Spiritual
Environmental
Social
Societal
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12
Q

What happens when frail people are ill?

A

Leads to disruption in multiple health domains

Can be triggered by disruption in any health domain

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13
Q

What is the illness trajectory usually in frailty?

A 
Triggering event
Decline
Crisis
Admission
Reablement
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14
Q

What is the Comprehensive Geriatric Assessment (CGA)?

A

Process to assess and manage illness in older people with frailty
Determines what problems are
Determines what we can reverse and make better
Produce management plan

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15
Q

Is CGA goal or problem centred?

A

Goal-centred

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16
Q

What does a goal-centred approach mean?

A

Do what patient wants
Preserves autonomy
Effective way of dealing with multi morbidity and competing clinical priorities

17
Q

How can you ask about spiritual domain?

A

What’s important to you?

What’s the meaning of your life?

18
Q

What are things to consider in psychological domain?

A

Mood: low/anxiety
Confidence
Cognition: delirium/dementia

19
Q

What are things to consider in functional domain?

A

Mobility: transfers/mobility
Activities of daily living
Community living skills

20
Q

What are things to consider in behavioural domain?

A

Unhealthy eating/smoking/drinking
Activities
Occupation

21
Q

What are things to consider in nutritional domain?

A

Poor nutrition leads to ill health
Ill health leads to poor nutrition
MUST screening tool

22
Q

What is the MUST screening tool?

A

Malnutrition Universal Screening Tool

23
Q

What are things to consider in environmental domain?

A

Housing
Heating
Sanitation
Adaption

24
Q

What are things to consider in social domain?

A

Support networks: practical/emotional

Potential for abuse: financial, physical, sexual, neglect

25
Q

What are things to consider in societal domain?

A

Attitudes to ageing
Technological advance: enabling/disabling
Political/regulations: money (pensions), accessibility (bus passes/disabled access)

26
Q

What are things to consider in medical domain?

A 
Pathological/physiological
Reversible/non-reversible
Multiple problems
Iatrogenic harm
Infection
27
Q

Who is involved in CGA?

A 
Geriatrician
OT
PT
Nurses
GP
Other doctors
Social worked
Home care
Dietician
SALT
28
Q

Where can CGA be done?

A

Inpatient
Intermediate care
Hospital at home

29
Q

What are the outcomes for doing a CGA?

A

Earlier in illness trajectory a frail person undergoes CGA, the better the outcomes are likely to be

30
Q

What are the risks of hospital care?

A 
Disorientation and delirium
Learned dependency
Deconditioning
Iatrogenic harm
HAI
31
Q

When is the optimal time for discharge?

A

Goals met

Or when risk starts to outweigh benefits

Specialities (14 decks)

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