Comprehensive Geriatric Assessment

Question 1

What is the focus of a comprehenisve geriatric assessment (as opposed to a standard medical one)?

Answer 1

Functional rather than medical improvement is the focus

Question 2

What are some of the “giants” of geriatric medicine?

Answer 2

• Instability and falls
  
  • Musculoskeletal problems, vestibular/cerebellar problems
• Immobility
  
  • Pain, neurodegenerative diseases
• Incontinence
• Intellectual decline (delirium +/- dementia)
• Others - iatrogenesis, functional decline, pressure ulcers, dizziness

Question 3

How is frailty defined?

Answer 3

• Unintentional weight loss
• Weakness
• Exhaustion
• Slow waking speed
• Low physical activity
• 3+ = frail, 1-2 = pre-frail

Question 4

Describe which populations most benefit from a comprehensive geriatric assessment

Answer 4

• People with low functional reserve or high levels of frailty, that aren’t too ill in a medical sense or too well to benefit
  
  • Recent onset of physical impairment/cognitive, or changing status
  • Multiple interacting treatable problems
  • Fragmented specialist care
  • Disorders requiring rehabilitation
  • Consideration of living situation change
  • Competency/capacity/medicolegal issues

Question 5

Describe the key domains of a comprehensive geriatric assessment

Answer 5

• Medical
  
  • Problem list, medication review, nutrition/dental
• Physical and functional
  
  • ADLs (pADLs and iADLs), balance, continence, gait
• Neuropsychological
  
  • Cognition and mood (CAM, MMSE, GDS)
• Social
  
  • Living arrangements and supports
• Economic
• Environmental
  
  • Home safety, transport
• Support