Intro/Principles

Question 1

10 principles

Answer 1

1) Ageing is not a disease
2) Chronic, multiple, multifactorial conditions
3) Reversible conditions under-Dx and under-Rx
4) Fx + QoL critical outcomes
5) Social support and pt preference important
6) MDT specialty
7) Cog/Affective disorders prevalent and under-Dx
8) Iatrogenic disease common and preventable
9) Multiple care settings
10) Ethics

Question 2

Ageing theories

Answer 2

sensecent cells, telomere shortening, oxidative stress, mitoCh, hormones, aneuploidy, free radical damage

Question 3

ICF

Answer 3

• health condition (disorder/disease)
• function and structure (impairment)
• activities (limitation)
• participation/roles (restriction)
• environmental factors
• personal factors (risk aversion, help acceptance etc.)

*participation: choice, preference, meaning; living in desired way/expected role; roles in society, contribution

Question 4

general approach

Answer 4

history and exam
problem list
management (8):
-Ix
-Rx
-MDT
-specialists
-procedures
-locations
-monitoring
-education

Question 5

Barriers (D)

Answer 5

deaf, dentition
dementia, delirium, depression
declined cognition, drowsy
dsyarthria, dysphasia, disability
drugs, denial, dual pathology
demeanour/generation gap, difficult family

Question 6

Overcoming Barriers (C)

Answer 6

consideration and comfort
consider environment (senses)
cognition
collateral Hx
CGA

Question 7

CGA components

Answer 7

medical: Dx, co-morbid, severity, polypharmacy + r/v, nutrition, problem list
psych: mental state (cog + affect)
function: ADLs, dependence, life roles, mobility and balance
social: support, informal/formal care, networks, poverty
environment: home, telehealth, transport, access

Question 8

CGA stages

Answer 8

assessment (Q’naires, tests, home visit)
stratified problem list
management plan
goal-setting

inteventions and iterations (r/v and improve)

Question 9

Geriatric giants (I)

Answer 9

incontinence
inadequate nutrition
instability/immobility/falls
iatrogenic (polypharmacy)
imapired cognition
-impaired vision/hearing
(also infection, isolation, and depression)

Question 10

ADLs

Answer 10

basic: dress, walk, toilet, feeding, wash, transfers
instrumental: transport, finance, shopping, housework, meal prep, med Mx

Question 11

History

Answer 11

collateral Hx important
nutrition important
social history important (dependence, carers, mobility, finances etc)

Question 12

Exam

Answer 12

cognitive assessment (MOCA)
joint exam
PR (consitpation)
bandages/shoes
nutrition
hearing aids
postural BP
gait assessment
pressure areas
general: age, state, nutrition, alertness, bitals

Question 13

CGA benefits

Answer 13

mortality and wellbeing: 14%
living at home: 26%
less readmission: 12%
cognitive function: 41%
physical function and independence: 0.6%
better NNT

Question 14

Non-specific presentations

Answer 14

homeostatic failure (hypothermia, BP, Na/BM, balance)
missing/masked Sx2
dependence/function reduced
infections and delirium

Question 15

Demographics

Answer 15

16% of UK population >65yo
65% of IP >65yo
LE: M 81.8y, F84.6y
LE increasing 2y/decade

Question 16

CGA - definition (stuck et al; Lancet, 1994)

Answer 16

multi-dimensional
interdisciplinary
diagnostic process
evaluation medical, psychological, and functional capabilities
coordinated, integrated management plan incl. Rx and f/u

used for all older, frail, and/or vulnerable people esp. non-specific presentation (giants)
IP, OP/home, NH/RH, intermediate care,

Question 17

CGA - assessment

Answer 17

Dx and Rx: med/psych
functions: intrinsic systems (senses, strength, balance)
activities: tasks/ADLs, self-care
participation: roles (protect/restore)
social environment: network, carers, poverty
physical environment

Question 18

CGA team

Answer 18

all team members trained to use CGA
case manager: organises
doctor: medical treatments
nurse: all domains/care aspects
OT: activities, aids, appliances
PT: functions
SW: social