Comprehensive Geriatric Assessment

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Comprehensive Geriatric Assessment

• Dr Miranda Tay
• Department of Elderly Medicine
• James Cook University Hospital

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Outline

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

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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.
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Marjory Warren

• Physician at the West Middlesex Hospital

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Aim of CGA

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

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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

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• 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

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Components of CGA

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

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Routes to CGA

• In-patient - Acute Geriatric Assessment
  Peri-acute Geriatric Asessment
• Rehabilitation
• Out-patient- Day Hospital

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Community Matron/District Nurse
Patient
GP
Geriatric outpatients
AE
AMAU
Elderly care Day Hospital
Geriatric ward
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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

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Who benefits?

• Functionally impaired
• i.e. Difficulty with ADLs
• Impaired mobility
• Multiple co-morbidities

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Who doesnt benefit ?

• Functionally independent
• Advanced dementia
• Terminally ill

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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

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• 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)

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• 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

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

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Applications of CGA

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

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Benefits of CGA?

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

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Summary

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

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