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Okay, Thanks. Give a short talking corporate securities assessment. Really assessment. I'm in advance. Nurse Practitioner. I'm currently working in white. I'll be Nightingale Hospital Onda. Uh, basically, the the White House be not guilty is a and you had better unit where patients are given intensive rehab. So if you think of any patients need intensive rehab you can send us because we're a regional unity night. The EMS of this short talk is to have not astounding off the demeans of comprehensive geriatric assessment on Teo. Sure, the usefulness of CG a on freely assessment and various care settings. So a CD a focus is an older adults with complex needs It soliciting person standard involves family on this multi dimensional. It collects out on capabilities and imitations places emphasis on the functional status and quality of life on the assessment involves all members of thumb of the disciplinary team. So the demands include the physical demand which includes a kid medical problems. Comorbidity is P n medication of the hydration, nutrition and end of life issues. The social demand, for example, may involved in formal care, network, social activities, financial circumstances, eligibility for care, resources, care, stress and safeguarding issues which leads has just touched on the functional to be includes mobility, balance falls, sensory loss. Victoza is a daily living and comments on psychological Dominica walls, cognation delirium, boot fears and worries on the environment, which includes home environment facilities transporting access to local resources. Night. You can see where each part of the M D T fits into this, so the benefits of CG A it improves diagnostic accuracy. It optimizes medical and rehabilitation treatment that enhances health and social and functional. It comes and forms development of individualized care plants on assists and avoiding potential complications of most realization on facilitates Effect of discharge Planning on the evidence is right there. There are many papers published to demonstrate it's effectiveness after c g, a old Robison hospital of less are less likely to die. Experience. Functional deterioration there would be admitted to the institution under more likely to be alive and in their own homes or 12 months Follow up. It improves. It comes for free. Older adults resisting and resulting if you're on this. Sir Hospital admissions. Andrea. Just admission rates of free little the rattles from emergency departments on identification off more needs and community dwelling old rattles with even slight cognitive decline on can help decrease polypharmacy potentially an appropriate medications and potential prescribing emissions. Oh, older people requiring perioperative care good. Also benefit from C G and really assessment Proactive identification assessment on optimization of physical of your physiological status, multi morbidity, geriatric syndromes and predictors of of our side comes on and dissipation and prevention of potential postoperative complications help reduce incidents in severity. So after having Procedure eight, we would Diane need to do a free of the assessment. Feel. Assessment has become a useful tool to help finish in screen. Patients to identify function, decline on risk of ability and severity. Free older people. So why is this really acute hospitalization of older patients have increased substantially? Well, the people's really represent a large proportion of acute admissions really increases readmission. It's meant a false will stay on mortality rates. Many aspects of really can't be reversed on identifying patients with really early on can help improve patient outcomes. Really, a serious on muscle is we should with mortality. I knew that Doctor Macintoshes going to give you some information later on on Really, so I'm just touching on a slightly. This graph represents the freely truck, the reentry. It's represents the development of a dependence level off a patient with fielding. Why the blue represents out of a patient without really so following the onset of a seemingly minor Ellis. The health of the patient with really deteriorates to the point where they lose their independence. They also take longer to bind back from the illness if they are in fact, people today. So at all, assessing field is a particular importance meant considering the difference in recovery between patients with, um without really and a response to a stressor. A patient who's really is likely to experience more pronounced irriation in response to even a minor illness, which will in turn require more recovery time. And this decreased resistance to a stress free can result in loss of independence, either temporarily or permanently. So it end If I feel the the British Geriatric Society recommends it all and kind of between health and switch your car stuff on older people should include a free of the assessment. Older people with real dick may need supported South management, and older people with moderate really may benefit from structured interventions from healthcare professions on older people with severe feel. They may require anticipatory care. Planning an end of life, maybe approve it. So what do we do this? Why do you say it's really there? Are a few? Validate A tools we can use the Augmentin for. The skill takes a bite 20 to 30 minutes to do on involves questioning regarding mobility, cognitive impairment, incontinence and balance. The get speed test, which is used more and evaluation of frailty. Associative mobility. The Prisoners seven Questionnaire takes approximately five minutes and are seven questions a score of three or more as a part of three of our positive answers. And the kids really. And all of these tests are excellent of measuring aspects of building over the British geriatric society. Evaluated all of them and find the prisoners. Seven. It was very good, but only moderate specificity because there are many for older patients who have a positive result because he walk slow. This was similar with the gets be test on the BG s study showed one and three people with a slow walking speed had freely, so the evidence scale is also excellent. But in the dining site. It did not take into kind of free, all terminal patient on. But for us, we use the rocket on because we feel it's a Goldilocks of all the skills, because just right, Okay, but there are clinical for this heel. Is it clinically orientated, freely skill that was created by Kenneth Rockwood. Hey, is a professor. Um, he's a geriatrician. Canadian still have health in aging, Really. Index is where he was using on following assessment. Off patient train stuff can then agreed the degree of realty um, using the pictographs. In addition to want to have a certain and from their overall assessment, the clinical freely scale is a nine point really scale based on clinical evaluation, which can see in front of you on in the demands of about mobility, energy, physical activity and function. It is quick and easy way to assess a person's level of really on this. It's last time consuming. It's easier TV's compared to all. They're more complex tools while providing similar predictive information and takes it a kind of real terminal patient that the Rockwood appears to be popular with clinicians and over there and on this widely used in hospital elder care wards after a comprehensive geriatric assessment by the multidisciplinary team. Okay, so what do you want to consider when using the Rockwood skill? So you want a local irritations, overall level of fitness, their presence or absence of any active disease symptoms, their level of dependency and other people for the activities of daily living on the cognitive status, for example, anyone who needs assistance with personal care, for example of some spit in their level said they're gonna say it's really anybody. Any health care professional was training and really assessment on. This could kind for party or training, but I'll give you a little website, not the end of the talk, and that you can do a little training online. And there's also cc watches that you could do training on this well, so when it comes to feel the I always keep in mind that looks competed. Sieving, for example, in using probably questions can help gather more information. If the person is still working, find out what their workday looks like are the only feet all day, or are they out of desk? If the person says the exercise know we gave business. Are they walking leisurely pace or doing more regular sected? Bitty? The more knowledge, huh, for example, has it'll help to score for anything were accurately, incorrectly to response buys. To avoid responsible aspirin, using the rock would focus on the current state of health and emotional and cognitive skills. Don't ask the patient reflect too far back from the present, as this is more likely to result in accuracy. Months is so. There has been a lot of focus of Africa. The scores and interpreting for for the scores at the West suffer freely. Project 2017 Lane suggested actions, so patients who have a score of 1 to 4 should be referred to a local wellbeing services. Patients with a fairly score 5 to 6 should have clinical assessment. For example, under take a medication of you Start, and a new medication of the low dose was very gradual increments. Consider me for calcium vitamin D of high spine. Avoid over treating hypertension and diabetes. Screen for falls tax reposting. Hypertension on Regis medications Accordingly. This ask you tractional status is gonna integrity. Long letter for consider referral to geriatric medicine. Significantly complex on maybe even hold a psychiatry after it's cognitive or behavior problems. Patients with a friendly score of 7 to 9 should have a risk assessment on care planning. Use advance care plan when applying disease based. Get the guidelines. For example, diabetes, hypertension and chronic kidney disease. Dementia, cetera, letting treatment goals and supporting anticipatory care plans. And consider the patient's preference for end of life and complete a DNA CPR form if it is appropriate. So got a little study. Had the see. He's been paying attention. Mrs. Smith is a 74 year old lady. She is scheduled time to go elective surgery for abdominal hernia repair. She lives by herself in a multi story home that her husband on her one shared. She has a cleaning person that comes in a weekly to do chores. Such a vacuuming pants leaning the bathtubs, etcetera. She's finding it more more difficult to do it on her own, and she has arthritis. It closes. Her discomfort, protected in the colder months, should previously enjoy gardening at her yard. Whatever she has had her son look after her garden, she had pain in her knees when needed. She requests that her daughter monitors her finances, but she's noticed she's becoming slightly forgetful and fear she may miss a bill. Mrs. Smith is an excellent cook and continues to enjoy making large probably means for their Children and grandchildren to enjoy their Sunday evenings. Does anybody want a shot in where they think this lady falls into? Okay, so she's a five year you should. That's a key points to consider an assassin. Mrs. Smith really scored physical fitness. She wants enjoyed activities such as gardening. She's no longer able to do this stupid. The pain. She feels that her knees, uh, presence of disease symptoms, for example. And she has arthritis, too, to symptoms of her disease. And it will unable to do things you previously enjoyed. She's also beginning to know his memory loss on dependency and others for activities of daily living. She has a cleaning person from and week to do chores. Daughter monitors her plain ounces on. She's beginning our cognitive status, and she's been getting to you. Notice some memory. Does you still need to watch out for you asses? Mister Jones. He's a 77 year old guy. He is scheduled to have a thoracic surgery for a sulfa Jill counter. He recently stopped smoking at times, if it is depressed. He recently moved into his sons full, says Son wanted to be there with her. Help him through his counselor journey. Mister Jones has been experienced. Some difficulty eating do this cancer, and this reason is not staying very interest her. He has recently started getting creative with smoothies. He's he is noticing a difference in his energy levels. He still plays an active role in Look After His. Two years ago, eight grandchildren on walks into him from the bus every day. Throughout the day, he's able to himself busy the tightening up around his son's home move, moving along on preparing dinner, etcetera. With this comes to need for Mister Jones to rest more frequently, which he has started to make a point of doing it. It's anybody. Wonder should probably look there. Which one do you think Mr Jones falls into? Okay, so Mister Jones is a four. He's vulnerable on again. Keep Oint to consider physical fitness. He's able to walk, his grandchildren turn from the bus every day, and so he still physically fit. But he's noticed that physically tough It's such a morning alone. He gets tired and can't cope on throughout the rest of day. Is he getting too tired? Vesicle, um, in the presence of disease symptoms, for example. He struggles with eating to this cancer on he's not I, dependency and others. He's able to go buy this activities of daily living because he's able to rest in between on cognitive status. He hasn't got any, so he falls into forward there. So guys that complete that little short talk on freely there's a website. But I promise you, if you have low going to that, if you want to take a photograph of that or need complete, pass it around on, that opens up a whole frailty teaching session what you can and get a little certificate to save done some really training on again. Look up on the CDC website. You'll find some, uh, is a multi layer on treating for freely as well. Thanks so much. Just, um, that's, uh, super helpful. So if he if you said without really think, and I, um, I make sure the guys all access to so guys, um, I think probably just put me back on tax office. We have our freely service a hey, which is about my with Emily and her MDT in cause I, um, as any really any other questions? Nothing coming up. Just my Are you able to get by for a while or you? I'm heading to coast way. No, I actually started being being because we had a blood in our That's right on. But any other questions come through, then we can beat them back to you, but yeah, absolutely. What's helpful? Justice? It's and says up today. So I think, you know, problem. Thank you very much for inviting. Thanks again.