Comprehensive Geriatric Assessment (CGA)
Physical health.
Mental health
Functional status
Social functioning
Environment.
Comprehensive Geriatric Assessment
focuses on elderly individuals with complex problems
functional status and quality of life
interdisciplinary team of providers
Teams: Physician geriatrician (internal medicine or
family practice)
Nursing professional
Social worker
Can be enriched by collegues from:
- Geriatric psychiatry, neurology, podiatry, pharmacy,
palliative care, sleep disorders, rehabilitation, dentistry,
continence, and/or spiritual counselors.
Benefits of CGA
Decreased nursing facility admission
Decreased medication use
Decreased mortality
Decreased annual medical care costs
Increase diagnostic accuracy
Improved independence
"Five I's of Geriatrics" intellectual impairment
immobility
Instability
incontinence
iatrogenic disorders
nutrition vulnerable to inadequate nutrition limited dentition ill-fitting dentures loneliness, depression. Drugs prevalent medical conditions including
constipation,congestive heart failure, cancer and dementia.
Conversely, an elder is at increased risk of obesity by inactivity.
Social
Living arrangements financial security transportation crime access to medical services risk factors for injury social networks death of a spouse or detachment
Components of Basic ADL Assessment
Components of Instrumental ADL
Environmental
Identify SAFETY RISKS (home visit) – lighting, loose mats, handrails, stairs, showers/bath, kitchen storage
Communication – telephone, alarms Good Surveillance system – frequent visits
from Dr, Community nurses, social workers etc
Nutrition PREVENTIVE REHABILITATION – for all
illness
Medical history Patient profile: current residence (house,
apartment, nursing facility) Medication review Family history Social history Past history (prosthetic valves, artificial joints,
metal plates or screws) Review of systems (special attention to
alterations in memory, weight change, falls, sleep problems, sensory losses, urinary incontinence, information about bowel habits, dietary history)
habits
Review of systemsvision
Loss of near vision (presbyopia)
Loss of central vision
Loss of peripheral vision
Glare from lights at night
Eye pain
common with age
macular degeneration
glaucoma, stroke
cataracts glaucoma,
temporal arteritis
auditory
Hearing loss
Loss of high-frequency range
(presbycussis)
acoustic neuroma, wax,Paget's disease,
drug-induced ototoxicity/common with age
GIT
Constipation
Fecal incontinence
hypothyroidism, dehydration,hypokalemia, colorectal cancer,inadequate fiber, inactivity.
drugs ,fecal impaction, rectal carcinoma
Laboratory tests
Serum cholesterol Blood glucose – glucose intolerance increases
with aging. Heamoglobin. Vitamin B12 Thyroid function tests
Effect of medical & nursing care
HOSPITALISATION
Clinical Iatrogenesis Functional Iatrogenesis
Side effects of:
Medicalintervention
Diagnostic intervention
Therapeuticintervention
Side effects of:
The process ofThese Interventions
>50% of patients over 70 years experience a decline in Physical and/or Cognitive function Unrelated to the admitting diagnosis
Hospitalization
Excess Bed restImmobilityFallsIncontinenceDeliriumAnorexia
Additional Interventions Restraints
PsychotropicsNG feedsCatheters
Additional ComplicationsPressure sores
DeliriumAgitation
DVT & PEAspiration Pneumonia
UTI’sBacteraemiaDepression
Disruptive behaviourFUNCTIONAL LOSS
Remember the caregiver!
80% of care of elderly is informal & unpaid Education & support of caregiver may be critical
part of keeping your patient at home and safe
Abuse and Neglect: Caregiver Risk Factors and Clues Caregiver does not come to appointments Is concerned about medical costs History of substance abuse, mental health
problems, conflicts with patient Dominates interview, won’t leave, won’t let
patient talk Defensive, hostile, or indifferent Dependence on patient for income/housing
Advance directive
Instructions given by patients for their future treatment should they become incompetent to consent to, or refuse, such treatment
Advance directives
Living will
Enduring power of attorney
Suggested Reading: McQuoid-Mason, D. Advance Directives and the National Health
Act. SAMJ 2006, 96, 12: 1236-1238
Prevention
Prevention Works for Older Adults
Longer life Reduced disability
Later onset Fewer years of disability
prior to death Fewer falls
Improved mental health Positive effect on depressive symptoms Possible delays in loss of cognitive
function Lower health care costs
www.healthyagingprograms.org/content.asp?sectionid=85&ElementID=304
Preventive Interventions
Screening Immunizations counseling.
screening
Alcohol misuse Blood pressure Breast Cervical Colorectal Depression
Obesity Osteoporosis Smoking Diabetes dyslipideamia
Immunizations
Influenza Influenza infections cause substantial
morbidity and mortality among older persons: Annual influenza vaccination for all those aged
65 and older is widely recommended Pneumococcal
chemoprophylaxis
Aspirin- patients at increased cardiovascular risk
“Honest doc--if I had known I was gonna to live this long, I’d have taken better care of myself.”