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Comprehensive Geriatric Assessment

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James Cook University Hospital. Outline. What is Comprehensive Geriatric Assessment ? ... A multidimensional interdisciplinary diagnostic process focused on ... – PowerPoint PPT presentation

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Title: Comprehensive Geriatric Assessment


1
Comprehensive Geriatric Assessment
  • Dr Miranda Tay
  • Department of Elderly Medicine
  • James Cook University Hospital

2
Outline
  • What is Comprehensive Geriatric Assessment ?
  • What are the benefits ?
  • Who does it ?
  • Where is it done ?
  • Other applications ?
  • Conclusions
  • Discussion

3
Comprehensive Geriatric Assessment
A multidimensional interdisciplinary diagnostic
process focused on determining a frail
elderly persons medical, psychological and
functional capability in order to develop a
coordinated and integrated plan for treatment and
long-term follow-up.
4
Marjory Warren
  • Physician at the West Middlesex Hospital

5
Aim of CGA
  • the restoration of healthy function and
    independence, where possible, as well as the
    amelioration of disability and distress

6
Comprehensive Geriatric Assessment
  • Medical Assessment
  • Functional assessment-ADLs, Activity/Exercise
    status, Gait/Balance
  • Psychological- Cognitive, Mood/ Depression
  • Social- Informal supports/assets, care resource
    eligibility/financial assessment
  • Environmental-Home safety, assistive devices, etc

7
  • Medical review- identify problems, treat
    reversible conditions, medication review,
    initiate appropriate investigations
  • PT-assessment and tailored individualised
    rehabilitation programs
  • OT-assessment and tailored individualised
    rehabilitation program, home visits
  • Nurse- nursing assessments, continence
  • Dietician
  • Speech and Language Therapist
  • Pharmacist- medication review, compliance issues,
    appropriate formulations
  • Social worker- assessment of care needs,
    finances, social provision

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In-patient Geriatric Consultation teams vs
Geriatric Evaluation and Management Units
  • Multi-disciplinary teams
  • Implementation of recommendations for therapy
  • Continuity of care
  • ? Geriatric Wards

12
Components of CGA
  • Prevention and treatment of delirium
  • Falls prevention
  • Improving physical function
  • Discharge planning and support post-discharge
  • Nutritional support

13
Routes to CGA
  • In-patient - Acute Geriatric Assessment
    Peri-acute Geriatric Asessment
  • Rehabilitation
  • Out-patient- Day Hospital

14
Community Matron/District Nurse
Patient
GP
Geriatric outpatients
AE
AMAU
Elderly care Day Hospital
Geriatric ward
15
Multi-Disciplinary Team
  • Accredited Senior specialist physician in medical
    care of older people
  • Co-ordinating Specialist nurse with experience
  • Dedicated physiotherapist
  • Dedicated occupational physiotherapist
  • Senior social worker

16
Who benefits?
  • Functionally impaired
  • i.e. Difficulty with ADLs
  • Impaired mobility
  • Multiple co-morbidities

17
Who doesnt benefit ?
  • Functionally independent
  • Advanced dementia
  • Terminally ill

18
Mrs GW
  • 83 years old
  • Insulin treated diabetes mellitus
  • On long term steroids for polymyalgia rheumatica
  • Chronic Renal Failure
  • Developed necrotising fascitis on R groin?
    extensive surgical debridement, later followed by
    skin grafting
  • Prolonged bed rest gt1 month
  • Multiple courses of antibiotics
  • AMT8/10

19
  • Transferred for rehabilitation/ comprehensive
    geriatric assessment
  • Developed CCF ? treated
  • Became tearful, weepy, anxious?started on SSRI
  • Developed ESBL UTIs ? treated
  • Steroids reduced
  • Bones !
  • ? ADCAL D3 Alendronic acid
  • Glycaemic control improved
  • Treated for constipation (chronic problem)

20
  • Received intensive physiotherapy
  • On discharge, managing 20m with Wheeled Zimmer
    Frame
  • Received intensive Occupational therapy
  • Partially sighted
  • Previously lived alone in a bungalow,
    independently mobile about home.
  • Daughter helped with shopping and housework
  • ?Washing/dressing practice
  • ?transfer practice
  • ?kitchen practice

21
  • Nutritional support
  • Initially poor oral intake?supplements
  • Later ?maintain weight (obese)
  • Eventually,
  • ? Home with package of care
  • Seen in clinic in August ? Doing well!

22
Applications of CGA
  • Stroke Unit
  • Peri-operative care of the older patient with
    multiple co-morbidity

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29
Benefits of CGA?
  • decreased nursing-home placement
  • improved survival short term
  • improved functional status
  • improved mental status ?
  • fewer discharge medications

30
Summary
  • Comprehensive Geriatric Assessment works !
  • Functionally impaired
  • Cognitively impaired
  • Not advanced dementia
  • Not terminally ill
  • Improve mortality, functioning, maintain
    independence

31
  • Dont forget to call your friendly neighbourhood
    Geriatrician next time you have a frail older
    person who has not had a Comprehensive Geriatric
    Assessment !
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