Comprehensive Geriatric Assessment

Question 1

How are geriatric patients processed initially?

Answer 1

Comprehensive geriatric assessment, creation of problem list, agree objectives of care, develop individual management plan, regular review

Question 2

What is a comprehensive geriatric assessment (CGA)?

Answer 2

Multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s capability

Question 3

What is the purpose of CGA?

Answer 3

Allows development of a co-ordinated and integrated plan for treatment

Question 4

What are the components of a CGA?

Answer 4

Medical, psychological, functional, social/environment

Question 5

What makes up the medical component of the CGA?

Answer 5

Problem list, co-morbid conditions and disease severity, medication review, nutritional status

Question 6

What make up the psychological and functional components of the CGA?

Answer 6

Psychological = mental status/cognitive function, mood/depression testing
Functioning = basic and extended ADLs, activity/exercise status, gait and balance

Question 7

What are some frailty syndromes?

Answer 7

Poor mobility, falls, confusion, continence issues, polypharmacy

Question 8

What are some features of problem lists?

Answer 8

Patient centred = seek diagnosis, multiple causes/risk factors should be sought and treated, include non-medical issues

Question 9

What are the benefits of doing a CGA in a dedicated assessment unit?

Answer 9

Reduces mortality at 6 months
Improves function and cognition
Reduces need for nursing home care and subsequent hospital admission

Question 10

How should CGA be delivered?

Answer 10

MDT assessment used and some have weekly MDT meetings = specific care plans developed that incorporate rehabilitation
50% use specific assessment tools and half set patient centred goals

Question 11

Is community or unit CGA better?

Answer 11

Benefits only seen in assessment units = roving teams less effective

Question 12

How can the presentation of acute illness vary in older people?

Answer 12

Atypical or masked presentation may delay diagnosis
Pathophysiological response varies
Immune response may vary with disease, drugs and nutrition

Question 13

How should acute illness be managed in older people?

Answer 13

Investigations and management need to be tailored to individual, and medication should always be reviewed

Question 14

How does the presentation of an MI vary in older patients?

Answer 14

No chest pain in 1/3 = collapse, delirium, dizziness, SOB

Question 15

What investigations will be done for an MI in an older person?

Answer 15

Blood tests, ECG, CXR, may not be able to tolerate angiogram, echo may be abnormal

Question 16

What should be considered in the management of an MI in an older person?

Answer 16

More likely to suffer from side effects from antiplatelets and statins

Question 17

How does sepsis present differently in older people?

Answer 17

BP may drop early and temperature often low
Tachycardia may be absent and delirium prominent
CRP and WCC may not rise

Question 18

How is sepsis management different in older people?

Answer 18

Fluid balance may be hard

Antibiotics should be targeted as higher risk of C.diff

Question 19

Why can healthcare intervention often cause harm in older people?

Answer 19

Older people are often delicately balanced because they have little homeostatic reserve

Question 20

What are the outcomes of acute illness in older people?

Answer 20

Carries much higher mortality rate = tend to decompensate much faster
Even minor acute illness can cause major deterioration in function
Each illness predisposes to further illness

Question 21

What are some features of acute admissions for older people?

Answer 21

Older people need access to expert diagnosis but acute hospitals aren’t always best place = initial CGA can take place in hospital and continued in community via practice MDTs

Question 22

What must be ensured when using Prevention of admission schemes?

Answer 22

Must not deny access to expert assessment/hospital for those who need it

Question 23

What is the best practice for acute admissions of older people?

Answer 23

To recognise early decompensation and prevent getting to stage of needing admission