Episode 1.1 – Comprehensive Geriatric Assessment

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SERIES 1

MDTea Episode 1: Comprehensive Geriatric Assessment 

Presented by: Jo Preston & Iain Wilkinson, Geriatricians at Surrey and Sussex Healthcare NHS Trust.
Posted on 19th January 2016

The first MDTea podcast explains what the Comprehensive Geriatric Assessment, or CGA, is about and why it matters for older people. Specifically, it explores the role each member of the MDT in the process to create a person centred plan. 

 

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Episode 1 Show Notes

Comprehensive Geriatric Assessment

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Presented & Written by: Dr Jo Preston & Dr Iain Wilkinson

Broadcast Date: 19th January 2016

 

Learning Objectives

Knowledge:

•         To understand and be able to define the a comprehensive geriatric assessment as a patient centred multidisciplinary process
•         To recall the components of a CGA
•         To understand and explain the role of CGA and the evidence for it in managing older patients

Skills:

•         To identify settings where the CGA is appropriate

Attitudes:

•         To treat older patients with respect and identify the need for a CGA to others
•         To understand the role of each member of the MDT in delivering CGA

 

Definitions:

Formal / Scientific Definition:

‘A multidimensional interdisciplinary diagnostic process focused on determining a frail elderly person’s medical, psychological and functional capability in order to develop a coordinated and integrated plan for treatment and long-term follow-up’

Comprehensive Geriatric Assessment for Older Hospital Patients:

 

Practical Definition:

A process of good, holistic care delivered within a geriatric medicine focused multi-disciplinary team, which goes above and beyond simply managing the acute problem that the person has presented with.

 

Key Points from Discussion

 

CGA comprises multiple domains of assessment including

• Physical Symptoms: Pain, continence, Sensory impairment, Musculoskeletal problems, nutritional and skin assessment
• Mental Health symptoms: Mood, cognitive impairment
• Functional abilities and living environment
• Social support networks

 

When this approach is compared to ‘usual medical care’ it leads to better outcomes. Usual medical care would be, for example, addressing just the problem the person presented with, e.g. pneumonia, in isolation.

 

Those who underwent a CGA were more likely to be alive, less likely to have physically deteriorated and more likely to be living with a lower level of dependency than those who did not. The effect was seen at both 6 and 12 months later.

• At 6 months, this equates to a number needed to treat of 17 (95% CI 50 to 10) to avoid one unnecessary death or deterioration or 20 for institutionalisation.
• NNT 25 at 12 months

Comprehensive geriatric assessment for older adults admitted to hospital’ – Cochrane review 2014: 

The benefit for delivery of CGA seems to only be present in the context of a whole team approach. When multidisciplinary teams did not take responsibility for the patient, for example, a one off review, then the effect was not seen. In the majority of studies, this meant patients being transferred to a ward for older adults.

Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 2011 

The success of CGA as a model of care has been so successful that moves are being made to provide it to more people who may benefit. There is growing evidence for delivery of CGA outside of the traditional older person’s ward. For example in the Emergency Department.

A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‘Emergency Frailty Unit’ Age and Ageing 2013; 0: 1–6:

Also, in the community. The DEED study showed that using only the trigger ‘older than 65 and attending ED for any reason’, to prompt community CGA was successful.

A Randomized, Controlled Trial of Comprehensive Geriatric Assessment and Multidisciplinary Intervention After Discharge of Elderly from the Emergency Department. The DEED II Study. DEED study – J Am Geriatr Soc 52:1417–1423, 2004.

 

More recently, the British Geriatrics Society have advocated the identification of frailty pro-actively in the community through publishing guidance called ‘Fit for Frailty’. The current link can be found here but note that the website changes often.

 

Feedback

Request for reference to Communities of Practice:

Lave and Wenger: Situated Learning: Legitimate Peripheral Participation. 1991  and Communities of Practice: Learning, Meaning and Identity. Wenger 2000

 

 

Curriculum Mapping:

This episode covers the following areas (n.b not all areas are covered in detail in this single episode):

Curriculum	Area
NHS Knowledge Skills Framework	Suitable to support staff at the following levels: Personal and People Development: Levels 1-3 Service Improvement: Level 1 – 2
Foundation Programme Curriculum 2012	Section 1.3 1.4 2.1 7.9 10.1 10.3 10.4	Title Continuity of care Team working Patient as centre of care Interactions with different specialties and other professions Long-term conditions Nutrition Discharge planning
Foundation Programme Curriculum 2016	2. Patient centred care 6. Interface with other healthcare professionals 7. Interaction with colleagues 10. The frail patient 16. Demonstrates understanding of the principles of health promotion and illness prevention
Core Medical Training	Team working and patient safety Management of long term conditions and promoting self-care Communication with colleagues and cooperation Evidence and guidelines Geriatric Medicine
GPVTS program	Section 2.03 The GP in the Wider Professional Environment Core Competence: Managing medical complexity Section 3.05 – Managing older adults Core Competence: Managing medical complexity Core Competence: Working with colleagues and in teams Core Competence: Practising holistically and promoting health
ANP (Draws from KSF)	Section 4.  History taking KSF Core 1 Level 4 Section 6. Clinical examination KSF HWB4 Level 4 Section 9. CGA process KSF Core 2 Level 4 Section 7 Section 10. CGA process KSF HWB7 level 4 Section 22. Teamworking and patient safety KSF Core 2 Level 1.