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.”