Exam (elaborations)
Comprehensive geriatric ASSESSMENT PA 540
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Comprehensive geriatric ASSESSMENT PA 540
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1 of 46Definition
Approach depends on goals and setting
•More supervision in hospital, inpatient rehab, or LTACH (Long term
acute care hospitals)
•Less supervision at home, assisted living, or nursing home
•Resources and staff may be limited outside acute care
Ensure safety
•Team has to communicate effectively
•Avoid errors of overtreatment and omission
,Bill appropriately
•Avoid upcharging
•Follow Medicare Conditions of Participation
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Develop Plan
Who Benefits Most from CGA?
Implement Plan
Your patient is a 75 year-old man with Parkinson's disease, coronary artery
disease, atrial fibrillation, type 2 diabetes mellitus, and depression. He is
dependent on all ADL's and IADL's. He takes 10 medications per day, including
carbidopa-levodopa (Sinemet), pramipexole (Mirapex), warfarin, aspirin,
lisinopril, amlodipine, atorvastatin, glipizide, glucophage, and sertraline. He lives
at home with his 45 year-old daughter, who is divorced and has 3 children (ages
15, 17, and 20). Although your patient receives a monthly payment from social
security and a teacher's pension, his daughter is only able to work part-time; their
combined annual income is $48,500. The patient's daughter confides in you that
they barely have enough money to make ends meet, and she worries about her
father constantly. She has come home from work several times and found him
lying on the floor, and she cannot afford to pay anyone to watch him while she is
at work. During your conversation, she becomes very tearful and expresses guilt,
anger, resentment, and hopelessness. She is worried that her children are angry
with her for spending so much time with her father, but she doesn't know what
else to do.
Using a CGA approach, how would you help this patient and his caregiver?
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2 of 46
,Definition
◦Fecal immunochemical testing (FIT) every year
◦High-sensitivity fecal occult blood testing (FOBT) x3 every year
◦Flexible sigmoidoscopy every 5 years
◦Colonoscopy every 10 years
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Interpretation (DEXA) based on Choose one of the following
patient's BMD compared to national for screening colorectal
mean cancer
What is a Comprehensive Geriatric Recommended Preventative Care
Assessment (CGA)? (Cardiovascular)
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3 of 46
Definition
Have you fallen two or more times in the past year?"
"Have you fallen and hurt yourself since your last doctor's visit?"
"Have you been afraid of falling because of your balance or walking
problems?"
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(CGA topic) Visual Impairment
(CGA topic) Depression (screening)
(screening)
The CGA Framework (starting Gait, Balance, and Falls
points?) (screening)
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4 of 46
Definition
Home safety checklist
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(CGA topic) Environmental
(CGA topic) Malnutrition (screening)
Problems (screening)
(CGA topic) Visual Impairment (CGA topic) Hearing Impairment
(screening) (screening)
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5 of 46
Definition
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