OP: CGA, death certs Flashcards
What is CGA?
Comprehensive geriatric assessment
What is CGA used for?
multidimensional, interdisciplinary diagnostic process to determine the medical, psychological, and functional capabilities of a frail older person in order to develop a coordinated and integrated plan for treatment and long-term follow-up
What is the emphasis of CGA?
quality of life
functional status
prognosis
outcomes
Why is CGA important?
better outcomes, including reduced readmissions reduced long-term care
greater patient satisfaction
lower costs
Who is in a CGA team?
geriatrician
nurse specialist
occupational therapist
physiotherapist
pharmacist
others as needed (speech and language therapist, dietician)
What are the domains of CGA?
Problem list – current and past
Medication review
Nutritional status
Mental health – cognition, mood and anxiety, fears
Functional capacity
Social circumstances
Environment
What is considered when assessing functional capacity in CGA?
basic activities of daily living
gait and balance,
activity/exercise status
instrumental activities of daily living
What is considered when assessing social circumstances in CGA?
informal support available from family or friends,
social network such a visitors or daytime activities, eligibility for being
offered care resources
What is considered when assessing environment in CGA?
home environment, facilities and safety within the home environment, transport facilities ,accessibility to local resources
How do you recognise the end of life or dying phase?
Patient may be:
Bed bound
Semi-comatose
Only able to take sips of fluid
Unable to take medicine orally
What are symptoms patients may have at the end of their life?
Pain
Nausea and vomiting
Dyspnoea
Agitation
Confusion
Constipation
Anorexia
Terminal secretions
What do you check for in the death certification process?
Check that the pupils are fixed and dilated
No response to pain
No breath or heart sounds after 1 min of auscultation
Who writes the death certificate?
A doctor that has cared for the patient within the last 14 days
How does the death certificate outline the cause of death?
1a- Cause of death
1b- Condition leading to cause of death
1c- Additional condition leading to 1b
2- Any contributing factors or conditions
What is the process for cremation paperwork?
Completed by 2 independent doctors.
Part 1- completed by doctor who knows the patient.
Part 2- by an independent doctor 2 years post registration, seeking confirmation of the cause of death from a variety of sources.
When should a death be reported to the coroner?
When a doctor knows or has reasonable cause to suspect that the death occurred due to:
Poisoning, use of controlled drug, medicinal product or toxic chemical
Trauma, violence or physical injury
Related to any treatment or medical procedure
Self harm
Injury or disease attributed to patients work
notifiable accident, poisoning or disease
neglect
otherwise unnatural
Aside from certain causes of death, when should the death be reported to coroner?
Occurred in custody or in state detention
No attending practitioner attended the deceased at any time in the 14 days prior to death or no attending practitioner is available within a reasonable period to prepare an MCCD
Identity of deceased is unknown
What is the coroners role?
To determine who died, where they died and how they died.
They do not comment on care but do have powers to insisit on further local investigation.
Coroners can decide to hold an inquest to ascertain the answers to the questions above.
