AMC Clinical Geriatric Assessment 2 — Questions and Answers
Question 1: A 76-year-old woman reports involuntary urine leakage whenever she coughs, sneezes, or exercises. Which type of urinary incontinence does this presentation describe?
- Urge incontinence
- Overflow incontinence
- Stress incontinence (Correct answer)
- Functional incontinence
Correct answer: Stress incontinence
Stress incontinence is characterised by involuntary urine leakage during activities that raise intra-abdominal pressure, such as coughing, sneezing, laughing, or physical exertion, due to urethral sphincter insufficiency.
Question 2: Using the 15-item Geriatric Depression Scale (GDS-15), which score threshold indicates probable depression requiring further clinical assessment?
- Score ≥ 3
- Score ≥ 5 (Correct answer)
- Score ≥ 8
- Score ≥ 10
Correct answer: Score ≥ 5
A GDS-15 score of 5 or more indicates probable depression warranting further assessment and clinical intervention, while a score of 0–4 is considered within the normal range for older adults.
Question 3: Which validated risk assessment tool is most widely used in Australian hospitals to determine pressure injury risk in elderly inpatients?
- Waterlow Scale
- Braden Scale (Correct answer)
- Norton Scale
- PUSH Tool
Correct answer: Braden Scale
The Braden Scale is the most widely used and validated pressure injury risk assessment tool in Australian hospitals, assessing six domains: sensory perception, moisture, activity, mobility, nutrition, and friction/shear.
Question 4: An 81-year-old woman presents with multiple unexplained bruises and appears frightened of her adult son who accompanies her. You suspect elder abuse. What is the most appropriate immediate action?
- Immediately contact police
- Interview the patient privately and assess her safety and wishes (Correct answer)
- Confront the son directly about your concerns
- Discharge with a community nurse referral
Correct answer: Interview the patient privately and assess her safety and wishes
The immediate priority is to create a safe, private environment to interview the patient alone, assessing her safety, mental capacity, and wishes before determining further action in accordance with her autonomy.
Question 5: An 85-year-old frail woman is being discharged after hip arthroplasty. Which element of the discharge plan has the strongest evidence for preventing early hospital readmission?
- Providing a written medication list at discharge
- Ensuring a GP follow-up appointment is booked
- Coordinated transitional care including medication reconciliation, timely follow-up, and carer education (Correct answer)
- Arranging outpatient physiotherapy appointments
Correct answer: Coordinated transitional care including medication reconciliation, timely follow-up, and carer education
Coordinated transitional care programmes that integrate medication reconciliation, timely follow-up, and structured patient and carer education have the strongest evidence for reducing 30-day readmission rates in frail older adults.
Question 6: What is the primary purpose of advance care planning (ACP) for older Australians?
- To legally prevent any life-sustaining treatment from being administered
- To document a person's values, goals, and preferences to guide future healthcare if they lose decision-making capacity (Correct answer)
- To appoint a medical power of attorney to manage the person's financial affairs
- To ensure all elderly patients have a 'do not resuscitate' order in place
Correct answer: To document a person's values, goals, and preferences to guide future healthcare if they lose decision-making capacity
Advance care planning enables individuals to document their healthcare values, goals, and preferences while competent, ensuring these guide treatment decisions if they later lose capacity, without automatically restricting any specific intervention.
Question 7: A family requests that their 88-year-old mother with severe dementia be resuscitated in all circumstances, contrary to her valid advance care directive requesting comfort measures only. What is the most appropriate course of action?
- Follow the family's wishes as they are the legal next of kin
- Proceed with resuscitation as family consent overrides prior directives
- Honour the patient's advance care directive as it represents her autonomous decision when competent (Correct answer)
- Refer to the hospital ethics committee before any decision is made
Correct answer: Honour the patient's advance care directive as it represents her autonomous decision when competent
A valid advance care directive represents the patient's autonomous decision-making when they had capacity and takes legal precedence over family preferences in Australian law, unless there is evidence of duress or materially changed circumstances.
AMC Clinical Geriatric Assessment 2
A 76-year-old woman reports involuntary urine leakage whenever she coughs, sneezes, or exercises.
Which type of urinary incontinence does this presentation describe?