Comprehensive Geriatric Assessment

Question 1

What does CGA stand for?

Answer 1

Comprehensive geriatric assessment

Question 2

What is CGA?

Answer 2

CGA = a process to assess and manage disruption to health in older people with frailty

Question 3

What is redundancy?

Answer 3

Redundancy = ability to deal with environmental stress, loss of system redundancy leads to decreased resilience to overcome environmental stress

Question 4

Age related decline leads to what?

Answer 4

Age related decline leads to:

• Impairment of organ function
• Breakdown of complex interplay between organ systems (dyshomeostasis)
  
  • Causing increases susceptibility to environmental stress (frailty)

Multi-morbidity increases with age

Question 5

What are different ways to identify someone as frail?

Answer 5

• Frailty index
  
  • 1 point for each impairment/disease on large list
• Frailty phenotype
  
  • 3 of 5 criteria – unintentional weight loss, exhaustion, weak grip strength, slow walking speed, low physical activity
• Clinical frailty scale

Question 6

What are examples of ‘frailty syndromes’?

Answer 6

• System failure presentations - falls, immobility, delirium, functional decline

Question 7

What should you ask the patient to take a ‘functional history’?

Answer 7

To take a functional history, ask the person similar things to what you did yourself to get up and go to work (known as ‘basics of living’ – activities of living ADL):

• Transfers
• Mobility
• Toileting
• Washing
• Dressing
• Meal preparation
• Feeding

Question 8

What does ADL stand for?

Answer 8

Activities of daily living

Question 9

Describe CGA in terms of:

• goal centred
• holistic
• multi-disciplinary

Answer 9

• Goal centred
  
  • Focus on goals not problems, multi-morbidity would make this conflicting
• Holistic
  
  • Lots of aspects to ‘health’
    
    • Medical – reversible or irreversible, consider iatrogenic harm
    • Spiritual – what’s important to patient, meaning of their life
    • Psychological – mood, confidence, cognition
    • Functional – mobility, activities of daily living, community living skills
    • Behavioural – eating, smoking, drinking, activities, occupation
    • Nutrition – poor nutrition leads to poor health and poor health leads to poor nutrition
    • Environmental – housing, heating, sanitation, adaption
    • Social – support networks, potential for abuse
    • Societal – attitudes to ageing, technological advance, political (money, accessibility to transport)
  • Frailty can be triggered by disruption to any of these aspects of ‘health’
• Multi-disciplinary
  
  • MDT assessment
    
    • Doctors – look at medical contributors to disruption to health
    • Physiotherapists – assess mobility
    • Occupational therapists – assist function (ADLs)
    • Nurses – provide care and assessment over longer period of time
    • Others can be involved such as pharmacists, social work, speech and language therapists, dieticians
  • MDT meetings and communication
    
    • Come up with plan to be able to get patient to stage where they can be discharged (when risks of hospital outweighs benefits or when goals have been met)
    • Recognise that 10% of geriatrics patients at any time will die in the ward

Question 10

What does goal cented mean?

Answer 10

Focus on goals not problems

Question 11

What are the different aspects of holistic care?

Answer 11

• Lots of aspects to ‘health’
  
  • Medical – reversible or irreversible, consider iatrogenic harm
  • Spiritual – what’s important to patient, meaning of their life
  • Psychological – mood, confidence, cognition
  • Functional – mobility, activities of daily living, community living skills
  • Behavioural – eating, smoking, drinking, activities, occupation
  • Nutrition – poor nutrition leads to poor health and poor health leads to poor nutrition
  • Environmental – housing, heating, sanitation, adaption
  • Social – support networks, potential for abuse
  • Societal – attitudes to ageing, technological advance, political (money, accessibility to transport)
• Frailty can be triggered by disruption to any of these aspects of ‘health’

Question 12

What are hospital risks and benefits for frail people?

Answer 12

• Benefits
  
  • Access to clinical expertise
  • Access to complex tests and interventions
  • Rapid access to supervised care support
• Risks
  
  • Disorientation and delirium
  • Learned dependency
  • Deconditioning
  • Iatrogenic harm
  • HAI