Comprehensive Geriatric Assessment, which emerged during 1980s, is a type of medical assessment that aims to uncover the multidimensional problems among elderly with the purpose of developing and implementing a well-coordinated management plan for each patient’s specific needs.
Why do I need CGA?
As we all know that Australians are living longer and it is anticipated that by 2050 the dependence ratio of older people will rise significantly.
Treating them is very challenging given aged-related physiological changes which in turn affects both the metabolism and also action of drugs, they are under-represented in clinical trails, clinical guidelines tend to focus on treatment of each disease and then drug interactions for being on a number of medications.
Then there are other issues such as impaired mobility, reduced functional capacity, presence or absence of dementia in a particular patient and level of family support or social support which is different in each patient which also significantly affects their management of medical illnesses.
A Geriatrician by using his management and clinical experience of addressing these issues on a regular basis during and after training is best suited to developing an effective, more successful and holistic management plan for these patients.
How can I have my CGA or CGA of my relative done?
Your general practitioner need to refer you or the relative to the Geriatrician and or you can also ask your GP to have CGA done for you or your relative.
Is there an evidence that CGA is effective?
There is considerable evidence for sustained benefit to patients patient function compared to no CGA and or usual general practitioner/usual care. These benefits are apparent for interventions within patient’s home and almost all the reported outpatient programs appear to be equally effective. In addition CGA may also reduce hospital presentations and admissions into residential care facilities (nursing home/hostels).
How much time it takes to perform CGA?
It takes about one hour to perform CGA because in addition to medical assessment the specialist may need to have information from family & or carer (other key stake holders such as GP & other). An input from allied health professionals, to address to mobility, functional capacity and psychosocial issues which significantly affect management of chronic & complex diseases in elderly people is also sometime needed.
How much it will cost?
At Mediclinic all bulk-billed patients are bulk-billed and also all DVA patients are charged through DVA. For all other patients please contact us on (02) 8313 9064 to discuss your situation and make a booking.
Dementia assessment is a medical assessment which focuses on assessing memory (cognition) and its effect on functional capacities of the patients such as ability to do activities of daily living (dressing, showering/bathing, toileting, personal hygiene etc.), integrated activities of daily living (shopping, cooking, banking).
How do you diagnose Dementia?
Memory problems are very common in people/patients attending any general practice. Various studies have shown that there is lag period of up to 3 years from the onset till the diagnosis is made due to large number of factors.
Dementia in the elderly needs to be very importantly differentiated from age related forgetfulness and or late life depression but also the memory problems are also associated with a number of complex & chronic medical illnesses (with their medications either contributing to or exacerbating the memory problem). This makes it very difficult to diagnose dementia particularly when there is no single screening test which itself is sufficient for its diagnosis
How can I get a Dementia assessment?
So if you have any concern about your or your relatives memory, if you have noticed an impairment in their functional capacity or are worried about their ability to live independently and safely at home please ask your general practitioner to refer to Hope Mediclinic.
For more details we encourage you to use other resources such as Alzheimer’s Australia.
The term Geriatric Syndrome is not very well defined, as this group of illnesses do not fit into a discrete category or a single organ/system/tissue disorder.
Geriatric Syndrome is a very heterogeneous group of common condition in elderly people such as delirium, fall, urinary incontinence, dizziness, syncope, frailty, malnutrition, vision/hearing problems, difficulty walking, and pressure ulcers.
How common are they?
They are very common medical conditions especially in frail elderly, which are managed by Geriatricians in outpatient clinics and acute aged care wards on a daily basis.
What is the cause?
The above clinical conditions are multi-factorial affecting multiple organ systems. For example urinary tract infection or upper/lower respiratory tract infection may present with delirium, which is altered mental function in the form of confusion and other cognitive or behavioural problems in elderly people.
What is the treatment?
The treatment of Geriatric Syndrome conditions is very challenging because multiple organs are involved, there are multiple risk factors and diagnostic strategies to identify the cause are not very effective (as difficult to ascertain the single pathology, are unpleasant, sometimes dangerous and inappropriate in a frail elderly person with dementia). The therapeutic management of the symptoms is not only needed for the patient care & also for family members but also very useful even in the absence of a firm diagnosis.
Dementia is a term that describes a group of symptoms that are caused by disorders affecting the brain. It affects thinking, behaviour and the ability to perform everyday activities. Dementia is usually progressive which means the symptoms get worse over time. It is important to note that dementia is not a normal part of aging, but rather a disease of the brain.
Could I develop dementia?
Anyone can develop dementia, however the risks may be increased by:
Family history (this is very rare)
Certain health and lifestyle factors
Untreated vascular conditions
People who are less physically and mentally active
Signs to look out for:
Personality, mood or behaviour changes
Withdrawal and depression
Problems with spatial skills
Disorientation to time and place
Loss of initiative
Problems with language
There is no available cure for dementia, however there are treatments that can help improve the symptoms and improve quality of life for both the patient and their families.
Speak to us today if you or someone you know is showing early signs of dementia.
What is Behavioural and Psychological Symptom Dementia?
Behavioural and psychological symptoms of dementia frequently occur in patients with dementia. It is a very well recognised potential complication throughout the course of dementia. These are very distressing symptoms to the patients, family members and also the health care providers in nursing homes. These symptoms have a significant effect on care provision because of their unpredictability and aggression towards others.
At HOPE Mediclinic we understand and recognise this very difficult issue. So we focus on developing a mutually agreed plan by working with family members, cares, general practitioners and care providing nursing home staff. This plan is based on the principle to trial non pharmacological measures and using medication as the last resort.
Signs to look out for:
Social and sexual inappropriate behaviour
The characteristics of the behaviour or symptoms together with the frequency, severity and impact on the patient and caregiver must be identified before we can tailor a treatment plan, which will likely involve medications and non-medication interventions.
It is interesting that it is common in clinical care of elderly patients in hospitals or clinics that there is disagreement about whether a patient had or not had a fall. So in clinical practice Fall is defined as coming to rest on a lower level without your intention.
How common it is?
It is very common and research studies have shown that approximately one third of the people aged 65 years or above living in the community will experience a fall each year. Falls in elderly people are a leading cause for not only injury related deaths but also a common cause for hospital admissions.
What are the causes?
In any given patient the increased risk of fall is multi-factorial and only some of these factors are reversible.
Are there any interventions which can reduce the risk of fall and if so is there any evidence and what are they?
In a Cochrane Review published in September 2009 multi-component home based exercises carried out either in groups or by individuals done significantly reduce the rate of falls and also reduced an individual’s risk of falling.
Some of other effective strategies include:
cataract removal on first affected eye, gradual;
withdrawal of anti-psychotic medications, sedatives/hypnotics and also patient-specific modification of medications;
safety modifications & behavioural changes at home;
At Mediclinic, by providing holistic and personalised care with particular focus on addressing poly-pharmacy we are more likely to be successful in this area.
Poly-pharmacy is defined as the use of five or more medications. Australians are living longer and unfortunately approximately half of them have three or more chronic diseases. A typical Australian aged 65 years or above takes four or more different medications each day.
Poly-pharmacy is present in 20-40% of elderly population. Although there are benefits of appropriately prescribed (more so on evidence based guidelines) medications, 20% of hospital admissions in older people are medications related and medication injuries are the main source of all treatment injuries among the elderly.
What can be done to address Poly-pharmacy?
Treating elderly people is very challenging as with age there are age-related physiological changes in the body which significantly affect the absorption, metabolism, excretion and also the effect a particular drug has on various organs/tissues of the body. So a Geriatrician is much better placed to address to this issue.
Further Dr Sidhu at Mediclinic is a post-graduate in Pharmacology and has a sound knowledge base in pharmaco-kinetics (what body does to the drug/medications), pharmaco-dynamics (what drug/medications do the body) and drug interactions. So at Mediclinic medication review in each patient is an essential component of the management.
What are potentially inappropriate medications?
PIMS-which is defined as a medication where the risk of adverse event outweighs the clinical benefit, particularly if there is evidence of a safer and more effective alternative) among elderly.
Diagnosing Dementia is very complex and according to National Institute of Health and Care Excellence (NICE) guidelines recommendations is made by specialist services.
According to Diagnostic and Statistical Manual Fifth Edition, Dementia is defined as a significant cognitive decline from a previous level of performance in one or more domains and is sufficient enough to undermine independence in everyday activities.
So dementia assessment consist of history (including very importantly information from family or carer or other key stake holder), physical examination, cognitive testing (MMSE, RUDAS, MOCHA, etc.)and investigations including imaging to rule out the secondary causes & more support for your clinical diagnosis.
RECENT ARTICLES OF INTEREST Comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults:a network meta-analysis.
Thorlund K, Druyts, E, Wu P, Balijepalli C, Keohane D, Mills E: J. Am Geriatric Society 2015; 63: 1002-1009