4 - Comprehensive Geriatric Assessment Flashcards
Who should undergo a CGA?
Generally over 65s with a frailty syndrome
What are the frailty syndromes?
Falls
Immobility
Delirium and dementia
Polypharmacy
Incontinence
When should you conduct a CGA in (1) the hospital and (2) in the community?
(1) On all frail patients regardless of which speciality they are under
(2) When a frailty syndrome is identified
What are CGA associated with?
Reduced morality, reduced admissions and readmissions, increased independence
When taking a geriatric Hx - what is it important to cover in terms of systems review?
Bladder & bowel function
Why do older age Ps tend to experience more side effects and drug interactions?
Due to altered pharmacokinetics and pharmacodynamics
Also they often have polypharmacy => more drug interactions
Which tool can be useful for medication review?
STOPP/START tool
Which drugs are most commonly associated with ADR requiring admission?
NSAIDs and aspirin
Diuretics
Warfarin
What are the common side effects of
- NSAIDs and aspirin
- Diuretics
- Warfarin
NSAIDs & Aspirin = AKI, upper GI bleeds
Diuretics = Electrolyte derangement, dehydration
Warfarin = bleeding
What scores can be used to assess cognition in the CGA?
AMTS - Abbreviated Mental Test Score
MMSE - Mini-mental state exam
MOCA - Montreal Cognitive Assessment
Which scale can be used to measure depression, anxiety and loneliness in a CGA?
Geriatric Depression Scale
What score on AMTS is considered abnormal?
What does AMTS measure?
<8
Cognitive impairment - but cannot differentiate between short or long term - therefore cannot diagnose dementia or MCI by itself
Which test is superior to AMTS as detecting MCI?
MOCA
What score on a MOCA is considered abnormal?
<26
What score on a Geriatric Depression Scale indicates probable depression?
> 5
What should always be included in the management plan?
Advanced Care Planning - i.e. whether they have CPR and their feelings about future admissions to hospital
