Geriatrics: comprehensive geriatric assessment Flashcards
What are the main implications of an ageing world?
Multimorbidity
Frailty
What is frailty as opposed to an illness?
Susceptibility state
What is ageing and redundancy?
Progressive accumulation of damage to a complex system resulting in aggregate loss of system redundancy
What are the physiological effects of ageing?
Impairment of individual organ function + breakdown of the complex interplay between organ systems (dyshomeostgasis) = increased susceptibility to environmental stress (FRAILTY)
How do we identify someone as frail?
CSHA Frailty Index
What is the frailty phenotype?
The frailty phenotype defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria
What are the 5 criteria of the frailty phenotype?
Unintentional weight loss Exhaustion Weak grip strength Slow walking speed Low physical activity
What are the frailty syndromes?
Falls
Immobility
Delirium
Functional loss
What are the criteria for a person benefitting from a Comprehensive Geriatric Assessment (CGA)?
Functional impairment in context of significant multiple conditions Resident in care home Acute confusion Immobility/falls in last 3mo 6+ medicines
What is the clinical frailty scale?
1-9
1 = very fit
9 = terminally ill
What are examples of health domains?
Medical Psychological Functional Behavioural Nutritional Spiritual Environmental Social Societal
What happens when frail people are ill?
Leads to disruption in multiple health domains
Can be triggered by disruption in any health domain
What is the illness trajectory usually in frailty?
Triggering event Decline Crisis Admission Reablement
What is the Comprehensive Geriatric Assessment (CGA)?
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
Is CGA goal or problem centred?
Goal-centred
What does a goal-centred approach mean?
Do what patient wants
Preserves autonomy
Effective way of dealing with multi morbidity and competing clinical priorities
How can you ask about spiritual domain?
What’s important to you?
What’s the meaning of your life?
What are things to consider in psychological domain?
Mood: low/anxiety
Confidence
Cognition: delirium/dementia
What are things to consider in functional domain?
Mobility: transfers/mobility
Activities of daily living
Community living skills
What are things to consider in behavioural domain?
Unhealthy eating/smoking/drinking
Activities
Occupation
What are things to consider in nutritional domain?
Poor nutrition leads to ill health
Ill health leads to poor nutrition
MUST screening tool
What is the MUST screening tool?
Malnutrition Universal Screening Tool
What are things to consider in environmental domain?
Housing
Heating
Sanitation
Adaption
What are things to consider in social domain?
Support networks: practical/emotional
Potential for abuse: financial, physical, sexual, neglect
What are things to consider in societal domain?
Attitudes to ageing
Technological advance: enabling/disabling
Political/regulations: money (pensions), accessibility (bus passes/disabled access)
What are things to consider in medical domain?
Pathological/physiological Reversible/non-reversible Multiple problems Iatrogenic harm Infection
Who is involved in CGA?
Geriatrician OT PT Nurses GP Other doctors Social worked Home care Dietician SALT
Where can CGA be done?
Inpatient
Intermediate care
Hospital at home
What are the outcomes for doing a CGA?
Earlier in illness trajectory a frail person undergoes CGA, the better the outcomes are likely to be
What are the risks of hospital care?
Disorientation and delirium Learned dependency Deconditioning Iatrogenic harm HAI
When is the optimal time for discharge?
Goals met
Or when risk starts to outweigh benefits
