Transcript comprehensive_geriatric_assessment_cga.pptx

Comprehensive geriatric
assessment (CGA)
Dr. Rehab F. Gwada
Comprehensive geriatric assessment
(CGA)
• is a multidimensional, interdisciplinary
diagnostic process to determine the medical,
psychological, and functional capabilities of a
frail elderly person in order to develop a
coordinated and integrated plan for treatment
and long-term follow-up.
• to optimize quality of life
• frail elderly person = at risk of loss of
homeostasis and incident disability
Comprehensive geriatric assessment
 the hallmarks of CGA are the employment of
interdisciplinary teams and the use of any number of
standardized instruments to evaluate aspects of patient
functioning, impairments, and social supports.
 Geriatric assessment is complex and time consuming
 It is important to ensure that patient is not exhausted
 Sample geriatric screening instruments have been used
for simple, quicker and efficient assessment
the objectives of CGA
• Improve diagnostic accuracy.
• Optimize medical treatment and health
outcomes.
• Improve function and quality of life.
• Reduce the use of unnecessary formal
services.
• Improve long-term care management.
The team for CGA
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physicians,
Physical therapists
Occupational therapists
Speech therapists
Psychologist
Dentist
Audiologist
nurses
social workers
Dietician
that assess and plan care addressing the multiple needs of older adults.
Components of Comprehensive
Geriatric Assessment
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medical, psychological, social, and environmental
components, as well as functional components (at
the level of activities of daily living [ADLs] and
instrumental activities of daily living [IADLs]).
. Components of Comprehensive Geriatric Assessment
Component
Medical assessment
Elements
History taking
Problem list
Co morbid conditions and disease severity
Medication review
Nutritional status
Physical examination
Assessment of functioning
Basic activities of daily living
Instrumental activities of daily living
Gait and balance
Psychological assessment
Mental status (cognitive) testing
Mood/depression testing
Social assessment
Informal support needs
Care resource eligibility/financial assessment
Environmental assessment
Home safety
Transportation
Rationale
• Early detection of risk factors for functional
decline when linked to specific interventions
may help reduce the incidence of functional
disability and dependency for older patients
Palmer RM, Med Clin North Am, 1999
Components of Comprehensive
Geriatric Assessment
• History taking: include
Subjective &personal history , chief complain,
present &previous physical illness, medication,
nutritional& family history
Guidelines regarding history taking
 Remember, the elderly have age related changes
 Keep the pace slow
 Introduce yourself at the beginning
 Address each individual with his or her preference
 (adopt effective way of communication)Eye contact ,
loud voice
 Ensure that pt. can hear what is said
 Provide glasses if needed
 Speak at eye level, facing the elderly
 Never treat the elderly as a child
 Respect the elderly as an individual.
Components of Comprehensive
Geriatric Assessment
Physical examination may include :
• Height , weight,
• orthostatic hypotension, pulse ,
• edema, skin integrity, pallor
• ROM, Muscle strength , sensory status,
coordination,
• vision ,hearing,
• oral cavity(no or lose of teeth)
Components of Comprehensive
Geriatric Assessment
Function status: This is vital component
• Information collect from it can be used as baseline to
measure the future decline in function & to plane
treatment strategy to improve QoL. including
1. ADLs{including bathing, dressing, toileting, eating,
ambulating, and continence}
2. Instrumental activities of daily living (IADLs) are the more
complex tasks people need for independent living. include
being able to shop, cook, manage finances, manage
transportation, do housework and manage medications.
3. Balance
4. Gait
Components of Comprehensive
Geriatric Assessment
Mental status:
• Because altered cognitive status is one of the
more commonly occurring symptoms of disease
among older adults, cognitive assessment is an
essential skill to be acquired by physiotherapist
for the older population.
• One screening tool that has been used
successfully to screen for the development of
changes in cognitive function symptomatic of
dementia is the Mini-Cog assessment instrument
The Mini-Cog
• Components
– 3 item recall test: give 3 unrelated words, ask to repeat, divert
and recall after CDT
– Clock Drawing Test (CDT)
• Normal (0): all numbers present in correct sequence and
position and hands readably displayed the represented
time
• Its advantages: less time consuming, needs no special
equipment, useful for poorly educated people.
• Abnormal Mini-Cog scoring
– Recall =0, or
– Recall ≤2 AND CDT abnormal
Borson S. et al Int J Geriatr Psychiatry 2000;15:1021-1027
Clock Drawing Test Instructions
– Subjects told to
• Draw a large circle
• Fill in the numbers on a
clock face
• Set the hands at 8:20
– No time limit given
– Scoring (subjective):
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0 (normal)
1 (mildly abnormal)
2 (moderately abnormal)
3 (severely abnormal)
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2
10
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Borson S. et al Int J Geriatr Psychiatry 2000;15:1021-1027
Components of Comprehensive
Geriatric Assessment
• Emotional status:
 Depression is the most common psychological
problem among elderly
 10% of >65 y/o with depressive symptoms
 1% with major depressive disorder
 Associated with physical decline of communitydwelling adults and hospitalized patients
 Geriatric depression scale (GDS) is used to assess
depression in elderly.
Q
Ture or false:
1- Comprehensive geriatric assessment is a
diagnostic process to determine the medical,
psychological, functional, social domains.
2- Information collect from emotional status can be
used as baseline to measure the future decline in
function & to plane treatment strategy
3- Depression Associated with physical decline.
4- Clock Drawing Test composed of 3 item recall
test and The Mini-Cog test.
Any Q?