The Nursing Role in Orthogeriatric Comprehensive Geriatric Assessment (CGA)

Older people with fragility fractures are a diverse group, and their care needs are complex. Although some have comparatively few health problems, many have several interconnected illnesses alongside psychological and social problems, requiring a range of interventions. The primary focus of care is to meet these needs throughout the care pathway and ensure that they receive the same high standard of specialist care within orthopaedic services as they would within a setting specialising in the care of older people. The central philosophy is holistic care with a person-centred approach that brings the various aspects of specialist care together. ‘Geriatric syndrome’ is a term often used to refer to common health problems in older adults that do not fit into distinct organ-specific disease categories and that have multifactorial causes. This includes frailty, cognitive impairment, delirium, incontinence, malnutrition, falls, gait disorders, pressure ulcers, sleep disorders, sensory deficits, fatigue and dizziness. These are common in older adults and can have a major impact on quality of life (QoL) and disability. Identifying problems specific to ageing so that interventions can be tailored to meet the needs of patients with fragility fractures needs a detailed and comprehensive assessment that can help clinicians manage these conditions and prevent or delay their complications. This needs to be a collaboration of the whole interdisciplinary team so that the skills of each team member can contribute to building a picture of the patient’s needs. Nursing assessment is a significant part of this whole. A term often used in relation to the assessment of older people with medical needs is comprehensive geriatric assessment (CGA). The aim of this chapter is to explore the nature of comprehensive geriatric assessment (CGA) for the patient with a fragility fracture and discuss how this can be applied to nursing assessment and care.