Comprehensive geriatric assessment + capacity + STOPP-START Flashcards
(24 cards)
What is a comprehensive geriatric assessment?
A multidimensional, interdisciplinary diagnostic process to determine the medical, psychological + functional capabilities of a frail older person in order to develop a coordinated + intergrated plan for treatment + long term follow up
What does a comprehensive geriatric assessment lead to/what are the advantages?
- reduced readmissions
- reduced long term care
- greater patient satisfaction
- lower costs
Who makes up a CGA team?
- geriatrician
- nurse specialist
- OT
- PT
- pharmacist
- additional specialties if needed e.g. SALT, dietician
What are the components of a comprehensive geriatric assessment?
- problem list (current + past)
- medication review
- nutritional status
- physical assessment
- functional capacity
- mental health
- psychological, social + environment assessment
Factors involved in the mental health domain of CGA
cognition
mood + anxiety
fears
Factors involved in the functional capacity domain of CGA
- basic daily activities
- gait + balance
- activity/exercise status
Factors involved in the social circumstances domain of CGA
- informal support from friends and family
- social network
- eligibility for care resources
Factors involved in the environment domain of CGA
- home environment including facilities + safety
- transport facilities
- access to local resources
What is mental capacity?
the ability to make a decision at a specific point in time
How do you assess capacity?
Firstly, assume someone has capacity until proven otherwise
A person has capacity if they can:
- understand information relevant to the decision
- retain that information
- weigh up the information to make their decision
- communicate their decision
What are the 5 key principles of the mental capacity act?
- person must be assumed to have capacity unless it is established that they lack it
- a person is not to be treated unable to make a decision unless all practical steps to help them to do so have been taken without success
- a person is not to be treatment as unable to make a decision just because it is unwise
- a decision made on behalf of person who lacks capacity is done in their best interest
- before a best interest act is done…
When is it ‘alright’ to go against a patient’s wishes even if they have capacity?
- risk of serious harm to themselves or others
- court orders
- emergency situations
- coercion
Who are four possible things you could consult if a patient lacks capacity?
advance directive
lasting power of attorney
advance care plan
Independent mental capacity advocate
What is an advanced directive?
a legal document where a person pre outlines their wishes for medical treatment/care if they lose capacity
What is a lasting power of attorney?
A legal document that allows a person to appoint someone they trust to make a decision on their behalf if they lose capacity
Does a lasting power of attorney or an advanced directive have more power? (the final say)
lasting power of attorney
What is an advance care plan?
a non legally binding document where a person can express their general wishes + preferences in their medical care
What is used if a person has no lasting power of attorney + no advanced directives but lacks capacity?
independent mental capacity advocate
What is multimorbidity?
Presence of two or more long term health conditions
Incl physical or mental health conditions, learning difficulties, sensory impairments, substance misuse
What does STOPP START stand for?
STOPP - Screening Tool of Older Persons’ Prescriptoins
START - Screening Tool to Alert to Right Treatment
what is the aim of STOPP-START
highlight + prevent inappropriate prescribing > reduction in DDIs + ADRs
what patient group is STOPP-START validated on?
patients 65 and over
when might it be appropriate to remove/replace a drug on a patient’s prescription
- no clear benefit
- bleeding risk
- toxicity risk
- side effects
- DDIs/safety concerns
- condition has improved or stabilised
What pharmacokinetic + dynamic changes should be considered in older people?
- body composition - increased fat, decreased lean mass + water
- reduced renal mass + function
- hepatic function + blood flow
- GI absorption + bleed risk
- reduced first pass metabolism
