Lecture 2- Comprehensive Geriatric Assessment (CGA)

Question 1

What is the value of CGA

Answer 1

• Improves function
• Improves Health Quality of Life
• Decrease Hospitalizations

Question 2

How to conduct office-based assessment (what should you do?)

Answer 2

• Functional assessment by observation
• Directed medical history and physical examination
• Assessment instruments/tools
• Psychological assessment

Question 3

Functional assessment by observation

Answer 3

• Did the patient fill out the questionnaire?
• Observe the patient walk and getting on exam table
• What kind of detail does the pt. give you in a history?

Question 4

What to include in Directed medical history and physical exam

Answer 4

• IADL (instrumental activities of daily living)
• Vision
• Hearing
• Weight/Nutrition
• Gait and balance/feet

Question 5

What are the IADL’s, and when do you start asking about them?

Answer 5

• Community dwelling, and 65 and older- begin asking
• Follow up at 1,3,5 yr….

The four IADLS

• Telephone
• Transportation
• Medications
• Finances

Question 6

What percentage of the elderly have a nutritional disorder?

Answer 6

20-30%!

Question 7

Serum _______ and _______, although nonspecific, are prognostic factors for mortality

Answer 7

Albumin, cholesterol

Question 8

Weight loss of more than _______ total body weight in the past 6 months is a RED FLAG

Answer 8

10%

Question 9

How do you test gait, balance, feet in the CGA?

Answer 9

• The get up and go test!
• walk 10 ft and return to chair
• Fail if it takes more than 20 seconds.

Question 10

How should you do psychosocial assessment in a CGA?

Answer 10

• Cognitive Testing
• Mood/Depression testing
• be familiar with the risk factors for depression- esp. social isolation.—- does this patient apply to any of those?

Question 11

2 geriatric screeners for depression

Answer 11

• Geriatric Depression Scale (GDS)

- Patient Health Questionnaire (PHQ-9)

Question 12

What can you use for Cognitive Function assessment?

Answer 12

• Folstein mini-mental state examination (MMSE)
• Montreal cognitive assessment (MOCA)
• Clock draw test (CDT)
• Verbal fluency (VF) or animal naming
• Mini-Cog (3 item recall test and clock draw)

Question 13

What can you use for palliative/performance status assessment?

Answer 13

• Karnofsky scale (0-100 scale, with normal being 80 and above)
• Palliative Performance scale, version 2 (PPSv2)

Question 14

CGA Definition

Answer 14

• A multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional capabilities of an older adult in order to develop a coordinated plan to maximize overall health with aging

Question 15

IADL’s as a predictor of dementia

Answer 15

• the odds ratio for getting dementia goes up as you have more issues with IADL’s

1 IADL lost- OR- 1.00
2 IADL lost- OR- 2.34
3 IADL lost- OR - 4.54