LO7 Comprehensive geriatric assessment Flashcards
What are the 4 components of the CGA assessment?
Physical assessment
Functional, social and environmental assessment
Psychological assessment
Medication review
When should CGA be performed?
When an older person presents to the GP with a Frailty syndrome e.g. falls, confusion, incontinence, reduced mobility. When the GP is made aware of a patient presenting to healthcare with a frailty defining condition. Individuals admitted to care homes.
What are the components of the physical assessment?
Sensory loss, Feet and footwear, Gait and balance, Lying and standing blood pressure, Cognition and mood, Pain/joints, Weight and nutrition, PR and genitalia, Normal age related conditions
What two questions are key to the functional assessment?
What can and what does the person actually do? How recently has it changed? This is very important to establish a timescale of deterioration in function.
What are the 3 recommended tests for establishing function in the geriatric patient?
- Barthel index for activities of daily living (not very good). -Nottingham Extended Activities of Daily Living Scale (slightly more interest in social activity).
- Timed Up and Go Test. Also a good indicator of overall function, combining an assessment of physical ability – being able to indeed ‘get up and go’ . This is also a test of cognition relating specifically to following instructions and carrying them out successfully.
What is the percentage of over 65s with depression?
Depression in older people has a prevalence of 5-10 per cent in those aged over 65, but is frequently under-recognised.
Name 5 good screening questions for depression in the geriatric patient.
During the last month, have you often been bothered by feeling down, depressed or hopeless? • Do you ever sit and cry for no reason? • Do you worry about the future and what it might hold? • During the last month, have you often been bothered by having little interest or pleasure in doing things? • Do you feel lonely?
What special score can be used to assess depression in the elderly patient? Why is it special?
The geriatric depression score. This makes allowances for those with mild, moderate, and severe intellectual impairment.
What scores can be used to measure cognitive capabilities in the elderly? What are the considerations for each?
-The GP-Cog test takes about 5 minutes to complete and includes an informant interview. -Although the Hodkinson Abbreviated Mental Test Score (AMTS) is a useful and fast screening test, it was developed in hospital-based care and can miss executive dysfunction. It has never been validated for use in primary care. -A more detailed assessment of cognition can be done with either the Mini Mental State Assessment (Folstein); however its use is subject to copyright. It also does not examine executive function in detail.
What comprises the MMS examination?
Orientation, registration, attention and calculation, recall, language
What 6 pieces of information are essential to a thorough medication history?
a Primary care prescription
b Pharmacy dispensation history
c Prescribed medications from other providers (e.g. private healthcare, from abroad)
d Other medications taken (e.g. leftover tablets, medicines prescribed for others)
e Herbal supplements, vitamins, etc.
f Illicit drugs.
What is the STOPP/START toolkit?
Screening tool of older people potenitally inappropriate prescriptions/screen tool to alert doctors to right treatments
What are the 5 components of the frailty phenotype? How many are required to diagnose frailty syndrome?
Weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss. 3.
