Gangguan Mental pada Lansia

Arni Nur Rahmawati Keperawatan Gerontik 2013

1.

2.
3. 4.

5.
6.

Kesehatan (fisik & mental) Sosial Ekonomi Psikologis Spiritualitas / religiusitas Hak azasi (human right)

Masalah Usia lanjut:

Kesehatan Usia Lanjut

Multipatologi 80 % usila: 1 penyakit PHBS (life style) Asuransi kesehatan Successful aging Quality of life

Kesepian (loneliness)

Pensiun Anak sibuk Tak punya aktivitas Pasangan meninggal Terisolasi sosial, jarang bertemu org byk Tak ada teman bicara

Masalah Sosial

Peran sosial usia lanjut (masyarakat dan keluarga) Pergeseran peran (IRT, KK pasif) Kesepian, frustasi, depresi Post power syndrome Gangguan adaptasi

Masalah Ekonomi

Penghasilan menurun Masa persiapan pensiun, Tak ada pensiun / penghasilan Tingkatkan aktivitas, kreativitas Kembangkan hobi, ciptakan hobi Independensi keuangan?

Aspek Psikologis

Kepribadian masa dewasa muda Coping mechanism, problem solving Kegagalan beradaptasi potensial gangguan jiwa dan fisik lainnya Integrity vs isolation Dignity (harga diri) in old age ! Arti hidup / cara pandang kehidupan

Spiritualisme / religiusitas

Penghayatan keimanan Sikap hidup / persepsi diri Minat keagamaan meningkat Fungsi kognitif meningkat saat puasa Penelitian Larson: - Non religius: kurang tabah, kurang kuat mengatasi stres, kurang tenang, takut mati dsb dibandingkan yang usia lanjut yang religius

Hindari abuse dan neglect (mental, emosional & fisik) Hak untuk mengatur diri sendiri Hak & kewajiban dalam masyarakat Hak berobat dan bertempat tinggal Mendapat perlakuan yang pantas Human right of people with dementia (Kyoto, 17 Oct 2004, ADI (Alzheimer's Disease International)conference)

Hak azasi usia lanjut

Gangguan jiwa pada usia lanjut

Case finding: temuan kasus dini Intervensi segera Cegah disabilitas Optimalkan fungsi Identifikasi faktor risiko Kendalikan penyakit

Next Gangguan jiwa pada usia lanjut:

Gangguan Depresi Gangguan Cemas Demensia (pikun) Insomnia (gangguan tidur) Delirium (kebingungan akut)

Tertekan, sedih, menetap dan tidak dapat berfungsi sehari-hari Penyebab: berbagai kehilangan Sikap anggota keluarga : Peka terhadap tanda-tanda dini ! Gejala depresi pada usia lanjut tidak khas, gejala somatik menonjol ! Ex : susah tidur, kelelahan yang kronis, berat badan yang turun dengan drastis

GANGGUAN DEPRESI

4 Tanda pengenal gangguan depresi:

Ada

perasaan kosong / hampa Pesimis, kuatir masa depan Tak ada kepuasan hidup Merasa hidupnya tidak bahagia

Gejala fisik muncul dahulu Cemas & kuatir berlebih Ketegangan fisik dan mental Gejala otonom (keringat, debardebar, sakit perut, pusing dll) Berlangsung kronis, hilang timbul PTSD (Post Traumatic Stress Disorder): pada usila lebih berat

Gangguan Cemas

Kemunduran mental progresif Defisit berbagai fungsi kognitif Sindrom ABC (Activity, Behavior, Cognitive) Penyebab: AD, Stroke, Parkinson, dll Tanda tanda dini demensia! BPSD (behavior & psychological symptoms of dementia)

Demensia

AD prognosis Optimal case

Mini Mental State Examination score 25 ---------------------| Symptoms 20 |----------------------| Diagnosis

15
10

|-----------------------| Loss of functional independence

|--------------------------------| Behavioral problems
Nursing home placement

5
0 1

|-------------------------------------------|
Death |------------------------------------------

5 Years

Feidman and Gracon, 1996

Demensia: kumpulan gejalagejala

dis - eksekutif

Aspek neuropsikologis (kognitif) Amnesia Aphasia Agnosia Apraxia

Gejala neuropsikiatrik (non-kognitif: BPSD)

Gangguan Perilaku Aktivitas sehari-hari (ADL & IADL)
BPSD, behavioral and psychological symptoms of dementia
17

Gejala Psikiatrik / Psikologis

A: activity decline B: behavior disturbances C: cognitive impairment

Sebab: gangguan fungsi otak! --- > kemunduran mental (De - Ment)

What is Dementia?

Instrumental ADL: Berkendaraan Bepergian sendiri Berbelanja Memasak Menggunakan telepon Mengelola keuangan

Activity decline
-

Basic ADL: Makan Mandi Naik turun tangga Buang air besar / kecil Berpakaian

Behavior disturbances
Apatis Pencuriga Mudah tersinggung Mudah marah Hiperaktif Insomnia Murung / sedih

Cognitive impairment:

Kelemahan memori (mudah lupa) Kesulitan berbahasa (afasia) Kesulitan mengeksekusi (rencana, urutan kegiatan, mengorganisasi) Pengenalan benda, wajah, bentuk, ruang dll Kemerosotan daya nilai, abstraksi, judgment, dan fungsi-fungsi otak lainnya

Kelompok Gejala BPSD

Aggression Agitation
Walking aimlessly Pacing Trailing Restlessness Repetitive actions Dressing/undressing Sleep disturbance

Apathy
Withdrawn Lack of interest Amotivation

Aggressive resistance Physical aggression Verbal aggression

Depression

Sad Tearful Hopeless Low self-esteem Anxiety Guilt

Hallucinations Delusions Misidentifications

Psychosis

Adapted from McShane R. Int Psychogeriatr 2000; 12(Suppl 1): 147 54 Finkel SI et al. Am J Geriatr Psychiatry 1998; 6: 97100 Alessi C et al. J Am Geriatr Soc 1999; 47: 78491

Insomnia

Sulit masuk tidur dan atau mempertahankan tidur, atau sulit tertidur lagi setelah terbangun Kurang tidur atau berlebihan tidur Dampak kurang tidur, distress Cari underlying disease insomnia ! Hygiene tidur & variasi individu

Delirium
Kebingungan akut, disorientasi, melantur, halusinasi dll Penyebab: infeksi, ggn elektrolit dll Tanda: hiperaktif / hipoaktif Kondisi medik emergensi

Interdisiplin Psikiater, Internist, Rehabilitasi Medik, Gizi, Neurolog, dan ahli lainnya khusus geriatri Acute Ward Inpatient Ward Homecare Daycare / Day hospital

Tim Terpadu Geriatri

They have feeling, will, sensibility and moral being It is here that you may touch them And see a profound change

People do not consist of memory alone

Cognitive training

Cognitive stimulation

The role of the primary care physician in mild to moderate AD

* Define all contributory factors and other illnesses * Discuss the diagnosis, and differentiate other types of dementia * Withdraw non-essential drugs that may interfere with cognition * Treat or manage concomitant illness (e.g. depression, hearing loss)

Gauthier, Burns and Pettit, 1997

The role of the primary care physician in mild to moderate AD

(continued)

* Discuss the use of symptomatic therapies * Monitor functional ability e.g. driving, safety * Referral to specialist if appropriate * Advise on will-making and advance directives * Refer to local AD association for support * Managing caregivers

Gauthier, Burns and Pettit, 1997

The role of the primary care in severe AD

* Help caregivers discover and optimize the patient's preserved function * Monitor and treat complications * Facilitate caregiver support (respite and day care programs) * Be aware of caregiver burden and stress * Plan institutionalization, if needed * Assist with end-of-life decisions

Gauthier, Burns and Pettit, 1997

Diagnosing AD in primary care A systematic approach summary

CASE-FINDING Symptoms YES suggesting cognitive impairment CLINICAL ASSESSMENT *Clinical history *Physical examination *Laboratory tests *Functional assessment *Cognitive assessment

Functional decline and cognitive

impairment MANAGEMENT OF AD *Follow-up *Patient and caregiver counseling *Management and symptomatic treatment *Specialist referral if indicated

DIFFERENTIAL DIAGNOSIS *Exclude AD diagnosis delirium depression other causes of dementia *Evaluate evidence for AD (neuroimaging)

Primary care management of AD follow-up

* Cognitive ability

* Functional ability * Behavior * General health * Routine health checks

Primary care management of AD specialist referral

* Inconclusive diagnosis

* Atypical presentation * Behavioral/psychiatric symptoms * Second opinion * Family dispute * Caregiver support

Terima kasih
Better Mental Health for the elderly!