Geriatrics: Comprehensive Geriatric Assessment

Question 1

What is frailty?

Answer 1

• Frailty is a susceptibility state

- It is a reduced ability to withstand illness without loss of function

Question 2

What is ageing and redundancy?

Answer 2

The progressive accumulation of damage to a complex system resulting in aggregate loss of system redundancy

Question 3

What does age related decline lead to?

Answer 3

• Impairment of individual organ function
• Breakdown of the complex interplay between organ systems
• Increased susceptibility

Question 4

How is frailty identified?

Answer 4

• Frailty index
• Frailty phenotype
• HIS Think frailty
• Presenting with frailty syndromes

Question 5

What is the frailty phenotype?

Answer 5

Fried et al: 3 of 5 criteria

• Unintentional weight loss
• Exhaustion
• Weak grip strength
• Slow walking speed
• Low physical activity

Question 6

What are the components of HIS think frail guidelines?

Answer 6

• F: functional impairment in context of significant multiple condition
• R: resident in a care home
• A: acute confusion
• I: immobility or falls in last 3 months
• L: list of 6 or more medicines

Question 7

Give examples of frailty syndromes.

Answer 7

• Falls
• Immobility
• Delirium
• Functional loss

Question 8

What are the stages of the clinical frailty scale?

Answer 8

• Very fit
• Well
• Managing well
• Vulnerable
• Mildly frail
• Severely frail
• Very severely frail
• Terminally ill

Question 9

Define health

Answer 9

• A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO)
• It is a dynamic process rather than a binary state

Question 10

Describe the frailty decline.

Answer 10

It is usually slow and progressive

Question 11

What is the purpose of a CGA?

Answer 11

Determine what the problems are:

• Multiple medical problems may present at once
• Multiple health domains may be affected

Question 12

What are the established models of CGA?

Answer 12

• Inpatient
• Intermediate care
• Hospital at home

Question 13

What professions are involved in CGA?

Answer 13

Key professions
-Geriatrician
-OT
-PT
Skilled nurse

Other professions

• GP
• Other doctors
• Social worker
• Home care
• Dietician
• SALT

Question 14

What is the medical domain assessed for?

Answer 14

• Pathological: disease
• Physiological: normal ageing
• Reversible vs non-reversible causes
• Multiple concomitant problems
• Iatrogenic harm
• Majority of modern medicine is treating/ameliorating chronic disease (or acute exacerbations of chronic disease)
• Few things in medicine are ‘curable’
• Infection

Question 15

What is the spiritual domain assessed for?

Answer 15

• How do I fit into the bigger picture?
• What’s important to you
• How do you like to project your self-image?
• What’s the meaning of your life?
• Person-centred care

Question 16

What is the psychological domain assessed for?

Answer 16

• Mood: low mood and anxiety
• Confidence: fear of falling syndrome
• Cognition: delirium and dementia

Question 17

What is the functional domain assessed for?

Answer 17

• Mobility: transfers and mobilising
• Activities of daily living
• Community living skills

Question 18

What is the behavioural domain assessed for?

Answer 18

• Behavioural determinants of ill health (unhealthy eating, smoking, drinking)
• Activities and past times
• Occupation

Question 19

What is the nutritional domain assessed for.?

Answer 19

• Poor nutrition leads to ill health
• Ill health leads to poor nutrition
• Use of the MUST screening tool

Question 20

What is the environmental domain assessed for?

Answer 20

• Housing
• Heating
• Sanitation
• Adaptation

Question 21

What is the social domain assessed for?

Answer 21

Support networks

• Practical/ emotional
• Formal or informal

Potential for abuse

• Financial
• Physical
• Sexual
• Neglect

Question 22

What is the societal domain assessed for?

Answer 22

Attitudes to ageing/ the aged
-Asset vs burden
Paternalism

Technological advance
-Enabling or disabling

Political/ regulations

• Money ( winter heating allowance/pensions)
• Accessibility (free buss passes/disabled access)

Question 23

What is meant by good geriatric care?

Answer 23

• Early identification of need
• Early comprehensive geriatric assessment
• Early provision of appropriate level of care for needs

Question 24

What are the benefits of hospital admittance?

Answer 24

• Access to clinical expertise
• Access to complex tests and interventions
• Rapid access to supervised care support

Question 25

What are the risks of a hospital admittance?

Answer 25

- Disorientation and delirium - Learned dependency - Deconditioning - Iatrogenic harm - Hospital acquired infection