Older Persons - Frailty Flashcards
What is a complex geriatric assessment (CGA)?
A multidimensional and holistic assessment of an older person considering their health and wellbeing, which leads to the formulation of a plan to address issues which are of concern to the older person and the family.
What are the four components of a complex geriatric assessment?
- physical assessment
- functional, social and environmental assessment
- psychological components
- medication review
Outline some features explored within a physical assessment as part of a CGA.
- posture
- feet and footwear
- gait and balance
- lying and standing blood pressure
- cognition and mood
- functional ability
- pain / joints
- weight and nutrition
- PR and genitalia
Outline some features explored within a functional assessment as part of a CGA.
- mobility
- activities of daily living
- ability to interact with technology
There are two components of a functional assessment:
- What can and what does the person actually do?
- How recently has it changed?
Outline some features explored within a social and environmental assessment as part of CGA.
- does the patient live alone?
- does the accommodation have stairs?
- are there concerns about damp?
- how often is support available?
- does the patient get out and about?
- are there any pets?
- does the patient have a will?
May warrant referral to adult social services team
https://www.bgs.org.uk/resources/bgs-social-environment-questionnaires
Outline some features explored with a psychological assessment as part of CGA.
- mood (screening for depression and suicide)
- mini mental state assessment
Outline some features explored within a medical review as part of CGA.
- obtain full medication history
- review medication use
- review full drug list for pharmacological interactions or common side effects (STOPP START)
- obtain sufficient medical history
- review each medication
- list and prioritise
What questions could you ask an older person to explore their medication use?
- are you good at remembering your medications?
- can you swallow them OK?
- do you think your medication works?
- does your medication have any side effects?
What is the STOPP START medication review?
Screening tool of older people’s potentially inappropriate prescriptions, and screening tool to alert of right treatment.
Aims to reduce the adverse drug reactions and interactions experienced in older persons medicine.
https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf
What is frailty?
A syndrome that arises often as a consequence of ageing, characterised by a loss of biological reserves and subsequently increasing vulnerability to adverse outcomes.
How is frailty assessed?
Clinical frailty score - scores people from being very fit, through to very severely frail.
What is mental capacity?
The ability for a patient to make an informed decision, being decision and time specific.
Outline how to assess mental capacity of a patient.
Start from the assumption that the patient does have capacity. Do not assume a patient lacks capacity because of their age, disability, appearance, medical condition, or because they choose an option that you consider unwise.
A person has capacity if they can do the following:
- understand information relevant to the decision in question
- retain the information
- use the information to make their decision
- communicate a decision
