Comprehensive Geriatric Assessment Essay

Comprehensive Geriatric Assessment Essay

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A CGA primarily focuses on identifying the needs and problems of elderly adults to manage the frailty in this population. Based on the information gathered from the client (M.G.) and her daughter during CGA, M. G is suffering from mental and emotional health issues. First, the client is struggling with Prolonged Grief Disorder (PGD). An individual meet DSM-V diagnostic criteria for PGD upon experiencing a pervasive and persistent longing for a deceased person (Eisma et al., 2020). The client meets the diagnostic criteria for PGD since he is longing for his wife. He wishes she was present during her birthday party. Additionally, his birthday party was baked using his wife’s recipe as a way of remembering her. Secondly, the client is struggling with depression. In elderly adults, depression is characterized by a lack of concentration, reduced energy, feeling hopeless, reduced appetite or overeating, lack of sleep or oversleeping, or suicidal thoughts. A person meets the DSM-V diagnostic criteria for depression upon experiencing some of the depressive symptoms listed above for a minimum of two weeks (Kennedy, 2022). The client reports reduced appetite and sleeping during the day despite having adequate sleep at night, indicating he is depressed. According to Liguori et al. (2018)Comprehensive Geriatric Assessment Essay , stress is a major cause of stress in elderly adults. Therefore, the client’s depression could be triggered by stress caused by his wife’s death and his health status. Social isolation and loneliness before moving in with his children are other significant factors contributing to the client’s depression.

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Additionally, the client has nutritional issues. Specifically, M.G. is experiencing undernutrition. According to Hung et al. (2019), undernutrition in senior adults is characterized by reduced appetite, loss of interest in food and drinks, being depressed, feeling cold, constantly tired, difficulty concentrating, and being lethargic throughout the day. The client’s caregiver reports that he doesn’t eat much food during breakfast or lunch. He only takes some fruit or a piece of toast due to a lack of appetite. The caregiver also reports that the client sleeps a lot during the day mostly after taking his 11 o’clock lunch. Furthermore, the client’s current weight is 139 lbs, which has dropped from 142 lbs during the previous home visit. Based on data collected during CGA, the client’s poor feeding habits are the most significant contributing factor to his nutrition deficiency. The last issue facing the client is medication non-adherence. He reports flushing bigger pills to the toilet so that nobody sees them.

Plan of Care

An appropriate plan of care should be developed to address issues identified during the CGA. The first intervention involves referring the client to a psychotherapist for the management of his mental and emotional health issues, including PGD and depression. Specifically, the client will be advised to enroll in a group cognitive behavioral therapy (CBT) for people with similar mental health issues. CTB is recommended due to its efficacy in improving symptoms in elderly adults with various mental health issues (Mavranezouli et al., 2020)Comprehensive Geriatric Assessment Essay . During the therapeutic session, the psychotherapist focuses on understanding the underlying problem and replacing negative thoughts with more positive ones. Additionally, group members discuss their problems giving individual members the courage to cope with their challenges. Thus, the client will develop positive thoughts and overcome depressive thoughts and grief after enrolling in a group CBT. Developing positive thoughts and behaviors will then improve his quality of life and well-being.

Another effective intervention entails developing a meal plan for this client. The plan indicates the food components that the client’s meal should contain, including their recommended proportions. Therefore, it would guide the caregiver and the family members in ensuring that the client is taking a balanced diet. The client should take three main meals daily, including breakfast, lunch, and dinner. Each of these three meals should consist of carbohydrates (whole grain), proteins, and vitamins. Carbohydrates and vitamins should occupy a quarter of the plate each, while proteins should occupy the remaining half. According to, high-protein intake is recommended for aging adults to maintain muscle mass. Keeping protein intake high can also help prevent muscle loss during weight loss (Hengeveld et al., 2020)Comprehensive Geriatric Assessment Essay . Additionally, the client should take a minimum of two snacks daily containing 12 to 15 grams each for optimal muscle health.  Lastly, medication non-adherence can be addressed by referring the client to his primary care provider for his treatment regimen to be reviewed. He claims he does not need to take all the prescribed pills and it is difficult to swallow the bigger ones. Thus, the client would adhere to the prescribed medications and dosage if the current regimen is reviewed.

Summary

            The CGA reveals that the client is suffering from mental and emotional health issues, including Prolonged Grief Disorder (PGD) and depression. PGD is characterized by wishing his wife was still alive to attend his birthday party. On the other hand, his depression is characterized by increased sleep and reduced appetite. The client’s depressive symptoms might be triggered by stress caused by his wife’s death and his deteriorating health. The mental health issues can be addressed by referring the client to a group CBT. By going through therapeutic sessions, the client would develop positive thoughts, which would improve his quality of life. The second issue identified during the CGA is nutrition deficiency. This condition is characterized by poor feeding habits, reduced appetite, and weight loss. A meal plan was prepared to guide the family members and the caregiver in ensuring that the client takes a balanced diet rich in proteins to optimize his muscle health. The last problem discovered during the CGA is medication non-adherence. The client reports disposing of some medicines, especially bigger ones, claiming does not need to take all of them. This issue was addressed by referring the client to his primary care provider for the current treatment regimen to be reviewed Comprehensive Geriatric Assessment Essay

References

Eisma, M. C., Rosner, R., & Comtesse, H. (2020). ICD-11 prolonged grief disorder criteria: turning challenges into opportunities with multiverse analyses. Frontiers in Psychiatry, 11, 752.

Kennedy, S. H. (2022). Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues in clinical neuroscience, 10 (3), 271-277.

Liguori, I., Russo, G., Curcio, F., Bulli, G., Aran, L., Della-Morte, D., … & Abete, P. (2018). Oxidative stress, aging, and diseases. Clinical interventions in aging, 757-772.

Hung, Y., Wijnhoven, H. A., Visser, M., & Verbeke, W. (2019). Appetite and protein intake strata of older adults in the European Union: socio-demographic and health characteristics, diet-related and physical activity behaviours. Nutrients, 11(4), 777.

Mavranezouli, I., Megnin-Viggars, O., Grey, N., Bhutani, G., Leach, J., Daly, C., … & Pilling, S. (2020). Cost-effectiveness of psychological treatments for post-traumatic stress disorder in adults. PloS one, 15(4), e0232245.

Hengeveld, L. M., Pelgröm, A. D., Visser, M., Boer, J. M., Haveman-Nies, A., & Wijnhoven, H. A. (2019). Comparison of protein intake per eating occasion, food sources of protein and general characteristics between community-dwelling older adults with a low and high protein intake. Clinical nutrition ESPEN, 29, 165-174. Comprehensive Geriatric Assessment Essay

Week 5 Assignment 2: Comprehensive Geriatric Assessment, Visit 5

Visit with Homer

One month has passed since Homer’s fourth visit. Watch his latest visit:

CGA Fifth Visit

This Week’s Assignment

Identify what your assessment and plan of care would be for Homer at this visit. Indicate what parts of the CGA you would complete next for Homer. What questions would you ask Homer and his daughter, and what additional tasks would you perform? Provide a rationale for all decisions.

Use the Comprehensive Geriatric Assessment (CGA) Outline to prepare your assignment based on this week’s visit with Homer. Use each of the headings listed in the outline in your document. Your assignment should be written using APA 7^th edition and include references. To view the rubric for this assignment, please go to My Grades in your course menu. Locate the assignment in the list and select View Rubric.

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Comprehensive Geriatric Assessment (CGA) Outline

1. Assessment
   1. Choose which assessment from the CGA is most pertinent to the problem that the patient presents with.
2. Plan of Care
   1. Develop a brief plan of care related to the CGA assessment conducted.
   2. Prescribing medication or ordering labs is not expected; however, suggestions on what your thoughts would be can be part of the plan of care.
3. Information Gathered
   1. Gather supporting data from at least 3 references to support your plan.
4. Summary Paragraph
   1. Summarize the CGA and plan. Comprehensive Geriatric Assessment Essay

Readings

Required

Read the following articles and web resources:

• Andy, U. U., Vaughan, C. P, Burgio, K. L, Alli, F. M., Goode, P. S., & Markland, A. D. (2016). Shared risk factors for constipation, fecal incontinence, and combined symptoms in older U.S. adults. Journal of the American Geriatrics Society, 64(11), e183-e.
• Consult Geri. TryThis:® Series:
  • Dowling-Castronovo, A., & Spiro, E. (n.d.). Urinary incontinence assessment in older adults: Part I—transient urinary incontinence.
  • Dowling-Castronovo, A., & Spiro, E. (n.d.). Urinary incontinence assessment in older adults: Part II—established urinary incontinence.
• Davis, N. J., Wyman, J. F., Gubitosa, S., & Pretty, L. (2020). Urinary incontinence assessment in older adults: Part I—transient urinary incontinence (PDF). The American Journal of Nursing, 120(1), 57–62.
• Kim, J., & Parish, A. L. (2017, September). Polypharmacy and medication management in older adults. Nursing Clinics of North America, 52(3), 457–468.
• National Institute on Aging. (2019). Urinary incontinence in older adults.
• (2012). Beers revised: Drugs not to use in older adults. American Pharmacist Association.
• Cojuc-Konigsberg, G., Schoo, C. (2022). Inappropriate Medication In The Geriatric Population.National Library of Medicine.
• Sergi, G., De Rui, M., Sarti, S., Manzato, E. (2011). Polypharmacy in the elderly: Can CGA reduce inappropriate medication use?Drugs & Aging, 28(7), 509–518.
• Shaw, Tansey, R., Jackson, C., Hyde, C., & Allan, R. (2001). Barriers to help seeking in people with urinary symptoms. Family Practice, 18(1), 48–52.
• Stinson, M. J., Guervitz, S., & Carrigan, A. (2019). Deprescribing at the end of life in older patients. Journal of the American Academy of Physician Assistants, 32(7), 20–24.

Nurse: Hi, Mr. Grant. I’m glad to see you again. Are you feeling any better from your fall since the last time you were here?

80. GRANT: I had a birthday. I turned 80. The kids had a party for me. And some of my friends came. Although, I don’t have too many friends left. I just wish my wife had been there with me. Comprehensive Geriatric Assessment Essay

Nurse: Happy birthday, Mr. Grant. 80, wow, that’s great.

1. GRANT: Thank you.

Julie: We had a great time, didn’t we, dad?

1. GRANT: Oh, yes. It was nice.

Julie: My sister-in-law is such a good baker. And she used my mom’s cake recipe to make dad’s birthday cake. That was special. Dad loved that and had a great day.

Nurse: That does sound like a great celebration.

Julie: Yeah, it was. Even though dad didn’t hardly eat any cake.

Nurse: Julie, how is your father’s health been since you two were last here?

Julie: Well, since we were last here, my brothers and I decided to have dad come move in with me. Our office became his bedroom. Since we’re all out of the house during the day, I have someone come to be with him while we’re away. She shared that he doesn’t eat much breakfast or lunch. Maybe a piece of toast or some fruit. She said he’s also sleeping a lot more during the day. He usually takes a nap after his 11 o’clock lunch.

1. GRANT: I get sick to my stomach from all the pills. And I just don’t have much of an appetite.

Nurse: Mr. Grant, you mentioned that you feel sick to your stomach with all of your pills, can you tell me what matters the most to you right now?

1. GRANT: I would like to take less of these pills. I don’t think an 80-year-old needs to be taking all these pills. I can hardly swallow some of the bigger ones. So I just flushed them in the toilet so no one sees them. Comprehensive Geriatric Assessment Essay

Nurse: OK, Mr. Grant, let’s proceed with your examination.

Review the information gathered from Homer’s Physical

Weight 139 lbs. (BMI), Previous visit: 142 lbs

Follow-up

I’d like to see you again in one month for a follow up.

Comprehensive Geriatric Assessment (CGA) Outline

1. Assessment
   1. Choose which assessment from the CGA is most pertinent to the problem that the patient presents with.
2. Plan of Care
   1. Develop a brief plan of care related to the CGA assessment conducted.
   2. Prescribing medication or ordering labs is not expected; however, suggestions on what your thoughts would be can be part of the plan of care.
3. Information Gathered
   1. Gather supporting data from at least 3 references to support your plan.
4. Summary Paragraph
   1. Summarize the CGA and plan.  Comprehensive Geriatric Assessment Essay

Name: CGA Rubric Weeks 2 – 6

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Name:CGA Rubric Weeks 2 – 6 Comprehensive Geriatric Assessment Essay