1. What are the main components of the comprehensive geriatric assessment (CGA) and why is it important

for older adults in acute care settings? (10 points)

Answer: The CGA is a multidimensional, interdisciplinary, and individualized evaluation of an older adult's

physical, mental, functional, and social status. It aims to identify the patient's strengths, needs, preferences,

and goals of care, and to develop a comprehensive and personalized plan of care. The CGA is important for

older adults in acute care settings because it can improve outcomes such as survival, functional status,

quality of life, satisfaction, and discharge destination. It can also reduce complications, hospital length of

stay, readmissions, and costs.

Rationale: The CGA is a key component of geriatric medicine and gerontological nursing practice. It is

based on the biopsychosocial model of aging and the recognition that older adults are heterogeneous and

have complex and interrelated needs. The CGA can help optimize the care of older adults in acute care

settings by addressing their physical, mental, functional, and social needs holistically and collaboratively.

2. What are some common causes and risk factors of delirium in older adults in acute care settings? How

can delirium be prevented, detected, and managed? (10 points)

Answer: Delirium is an acute and fluctuating disturbance of cognition, attention, awareness, and behavior. It

is caused by multiple factors that disrupt the brain's homeostasis, such as infections, medications, metabolic

disturbances, dehydration, pain, hypoxia, surgery, trauma, or environmental stressors. Risk factors for

delirium include advanced age, dementia, sensory impairment, frailty, comorbidity, polypharmacy,

malnutrition, immobilization, or previous delirium. Delirium can be prevented by identifying and addressing

the predisposing and precipitating factors, providing adequate hydration and nutrition, avoiding

inappropriate medications or polypharmacy, managing pain and discomfort, maintaining oxygenation and

perfusion, promoting sleep hygiene and circadian rhythm, ensuring sensory aids and orientation cues,

minimizing restraints and invasive devices, engaging in cognitive stimulation and social interaction, and

mobilizing early and often. Delirium can be detected by using validated screening tools such as the

Confusion Assessment Method (CAM) or the 4AT. Delirium can be managed by treating the underlying

causes or contributing factors, optimizing the environment (e.g., lighting, noise), providing reassurance and

support to the patient and family/caregivers, using non-pharmacological interventions (e.g., music therapy),

or using pharmacological interventions (e.g., antipsychotics) judiciously and cautiously.

Rationale: Delirium is a common and serious condition that affects up to 50% of older adults in acute care

settings. It is associated with increased morbidity, mortality,

functional decline, cognitive impairment,

dementia,

hospital-acquired complications,

length of stay,

readmissions,

and costs.

It is often underrecognized,

underdiagnosed,

and undertreated.

Therefore,

it is essential to prevent,

detect,

and manage delirium effectively