5 April 2014, Senior Club , PIK, Jakarta

Menjaga Imunitas dengan

Berlatih Teratur

TRAINING OF TRAINERS TAICHI

Martina WS Nasrun

Imunitas vs Aktivitas

Daya Tahan Tubuh Manusia Menurun disebabkan

oleh aktivitas Virus, Kuman, Jamur, polutan, sinar
radiasi, perubahan metabolik, perubahan genetik,
dsb
Balance

Imunitas

Aktivitas
Man

Tujuan Pelatihan: TOT

Tujuan Umum:
1. Mampu menerangkan konsep
perilaku hidup bersih sehat
2. Mampu menjelaskan konsep
Rumah Sehat ?
3. Mampu melakukan Taichi untuk
Kesehatan secara rutin
4. Mampu mengajarkan Taichi untuk
Kesehatan
5. Mampu melakukan Kebaikan !

Caranya:
1. Belajar
2. Belajar,
membacamendengarmelihatberpikirBerbicara
3. Berlatih 30
tiap Hari 3 bl
4. Implementasi
5. Pasti Bisa !

Act
Now

Tujuan Sesi 5 April14

1.

2.

3.

4.

5.

Mampu menerangkan
Imunitas / Daya Tahan
Mampu menjelaskan Aktivitas
Bermanfaat dan Teratur
Mampu merancang Program
Aktivitas untuk Lanjut Usia
Mampu mengevaluasi
kemajuan/kemunduran dari
fungsi Kognitif & Perasaan
Mampu menolong orang !

Belajar
Berlatih
Berani Coba
Bergerak Maju
Berputar
Berbalik
Berjalan
Berbicara
Berperasaan
Berbuat Baik

Aset / Modal Perawat OS di Indonesia

Sabar
Senyum
Syukur
TIR (Tulus-Ikhlas-Rela)
TLC (tender-love-care)
RP (Ramah dan Peduli)
RKS (Rawat as Keluarga Sendiri)

. 3S2T2R

Aset Lokal, Jawab Tantangan Global

Merawat ODD (orang dengan demensia)

Rawatan Paliatif
Pendampingan Lansia
Pendampingan OMM (orang menjelang meninggal)
orang dengan Hendaya Fisik-Psikik-Sosial
(disabilitas)
Merawat anak berkebutuhan khusus
Merawat lansia dengan penyakit akut, penyakit
kkronis, penyakit jiwa, penyakit terminal, dll.

Dementia worldwide - Indonesia

3
million
2
million
1
million

mws_gp_pergemi_14

3/29/2014

Global Challenge of Dementia

8

1.
2.
3.

Diagnostic Strategy
Management Strategy
Prevention Strategy

1. Advocacy
2. Raising awareness
3. Training care-workers
mws_gp_pergemi_14

3/29/2014

Caregiving Need great Demand

National
Regional

The Quality of Care?

Act Now by TOT

Advocation All Stakeholders

Analisis Kesehatan Lansia

(> 60 th)

Cause of Death (COD)

penyebab kematian usia lanjut

Tabel 13.
Proporsi Penyebab Kematian Kelompok Umur 55-64 Tahun dan 65 tahun+
di 12 Kabupaten/Kota, Tahun 2012
No

Penyebab kematian

55-64 tahun Penyebab Kematian

(n=4523)

65 tahun +
(n=10809)

Cerebrovascular diseases

20.6

Cerebrovascular diseases

22.4

Ischaemic heart diseases

10.4

Ischaemic heart diseases

8.9

Diabetes mellitus

9.1

Other heart diseases

7.7

Other heart diseases

7.6

Respiratory tuberculosis

6.9

Chronic lower respiratory

diseases
Hypertensive diseases

Hypertensive diseases

4.5

Respiratory tuberculosis

5.3

Chronic lower respiratory diseases

4.1

Diabetes mellitus

5.0

Kronic kidney disease

3.6

Remainder of diseases of the

nervous system

4.6

Remainder of diseases of the

digestive system

2.9

Remainder of diseases of the

digestive system

3.3

10

Sirosis Hepatis

1.8

Diarrhoea and gastroenteritis of

presumed infectious origin

2.9

7.5
5.9

Tabel 13.
Proporsi Penyebab Kematian Kelompok Umur 55-64 Tahun dan 65 tahun+
di 12 Kabupaten/Kota, Tahun 2012
No

Penyebab kematian

55-64 tahun Penyebab Kematian

(n=4523)

65 tahun +
(n=10809)

Cerebrovascular diseases

20.6

Cerebrovascular diseases

22.4

Ischaemic heart diseases

10.4

Ischaemic heart diseases

8.9

Diabetes mellitus

9.1

Other heart diseases

7.7

Other heart diseases

7.6

Respiratory tuberculosis

6.9

Chronic lower respiratory

diseases
Hypertensive diseases

Hypertensive diseases

4.5

Respiratory tuberculosis

5.3

Chronic lower respiratory diseases

4.1

Diabetes mellitus

5.0

Kronic kidney disease

3.6

Remainder of diseases of the

nervous system

4.6

Remainder of diseases of the

digestive system

2.9

Remainder of diseases of the

digestive system

3.3

10

Sirosis Hepatis

1.8

Diarrhoea and gastroenteritis of

presumed infectious origin

2.9

7.5
5.9

Burden of disease usia lanjut

LIFE CYCLE BOD USILA

INDONESIA DALYs PREDIKSI 2010
USIA 75 TAHUN +

LIFE CYCLE BOD USILA

Prevalensi Morbiditas dan Disabilitas Lanjut Usia di Indonesia,

2007

Tahapan Pembangunan dlm UU 17/2007 ttg

Rencana Pembangunan Jangka Panjang
Nasional (RPJPN) 2005-2025

TAHAPAN
RENCANA PEMBANGUNAN JANGKA PANJANG
KESEHATAN (RPJPK) 2005-2025
(Kepmenkes 375 thn 2009 ttg RPJP Bidang Kesehatan 2005-2025)
RPJM 4
(2020-2024)
RPJM 3
(2015-2019)

RPJM 1
(2005-2009)
Bangkes
diarahkan untuk
meningkatkan
akses dan mutu
yankes

Akses masyarakat
terhadap yankes
yang berkualitas
telah mulai
mantap

Akses masyarakat
thp yankes yang
berkualitas telah
menjangkau dan
merata di seluruh
wilayah Indonesia

Tantangan, strategi dan sasaran yg tertulis

pada Dokumen RPJPK sp 2025
No

Tantangan

Strategi

Sasaran

1.

Msh Tingginya AKI, AKB dan

pertumbuhan penduduk + miskin

1. Bangkesnas
berwawasan nas

1. Meningkatnya UHH
69 73,7

2.

Beban ganda: penyakit baru, jiwa,

kecelakaan, NCD, kecelakaan kerja,
perubahan iklim &cemarling, gaya
hidup tak sehat dan napza

2. Pemberdayaan
masy dan daerah

2.Menurunnya AKB 32.3

15,5

3.

Desentralisasi dan komitmen

pemerintah belum memadai dan
lemahnya manajemen pemb kes

3. Pengembangan
upaya dan
pembiayaan kes

3. Menurunnya AKI
262 74

4.

Pemberdayaan masy msh lemah,

PHBS masih kurang sekali

4. Pemberdayaan
& pengemb. SDM
kes

4. Menurunnya gizi
kurang balita 26 9.5

5.

Kesenjangan kualitas dan cakupan

yankes, pembiayaan kes dg SJSN,
logistik dan obat yg belum merata

5. Penenggulangan
kedaruraran kes

6.

SDM kesehatn baik kuan& kual <<<

7.

Globalisasi, bioterism, perdag

Sistem Kesehatan Nasional 2012

Ascobat Gani/June 2013

Agenda Post-2015 yang

terkait bidang kesehatan
22

3. Provide quality

3a. Increase by x% the proportion of children able to access and complete pre-primary education

education and
lifelong journey

4. Ensure
Healthy Lives

4a. End preventable infant and under-5 deaths

4b. Increase by x% the proportion of children, adolescents, at-risk adults and older people that are fully
vaccinated
4c. Decrease the maternal mortality ratio to no more than x per 100,000
4d. Ensure universal sexual and reproductive health and rights
4e. Reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and
priority non-communicable diseases

5. Ensure food
security and good
nutrition

5a. End hunger and protect the right of everyone to have access to sufficient, safe, affordable, and
nutritious food 1, 2
5b. Reduce stunting by x%, wasting by y%, and anemia by z% for all children under five
5c. Increase agricultural productivity by x%, with a focus on sustainably increasing smallholder yields and
access to irrigation
5d. Adopt sustainable agricultural, ocean and freshwater fishery practices and rebuild designated fish
stocks to sustainable levels
5e. Reduce postharvest loss and food waste by x%

6. Achieve
Universal Access
to Water and
SAnitation

6a. Provide universal access to safe drinking water at home, and in schools, health centers, and refugee camps
6b. End open defecation and ensure universal access to sanitation at school and work, and increase access to
sanitation at home by x%
6c. Bring freshwater withdrawals in line with supply and increase water efficiency in agriculture by x%, industry by
y% and urban areas by z%
6d. Recycle or treat all municipal and industrial wastewater prior to discharge

Kerangka Teori:
Continuum of Care

ha
0
100

a
m
a
t
er
ri p

an
p
u
id
keh

Persalinan,
nifas&
Pemeriksaan neonatal
Kehamilan

Lansia

Pelayananbagi
anakSMP/A&
remaja
Pelayanan
bagianak
SD
Pelayanan
bagibalita

Pelayanan
bagibayi

Pelayanan
PUS&WUS

Konseling
PelayananKB
PKRT

P4K
Buku KIA
ANC terpadu
Kelas Ibu Hamil
Fe & asam folat
PMT ibu hamil
TT ibu hamil

Inisiasi Menyusu Dini

Vit K 1 inj
Imunisasi Hep B
Rumah Tunggu
Kemitraan Bidan Dukun
KB pasca persalinan
PONED-PONEK

Kualitas
Degenerasi

Kesproremaja
Konseling:
GiziHIV/AIDS,
NAPZAdll
Fe
Penjaringan
BlnImunisasiAnak
Sekolah
UpayaKesSklh
PMT
Pemantauan
pertumbuhan&
perkembangan
ASIeksklusif PMT
Imunisasidasar
lengkap
Pemberianmakan
Penimbangan
VitA
MTBS

Kerangka Konsep
Lifecycle approach

7. Lansia

1. Bayi
2. Balita

6. Ibu hamil

3. Usia sekolah
4. Remaja

5. Usia produktif

Apakah IMUNITAS ?

Daya tahan tubuh terhadap Penyakit

Host, Agent and Environment

Agent

Lingkungan

Host

Imunitas Tubuh
Humoral

Antibodi ? Antigen?
Imunoglobulin:
G
A
E
M
D

Seluler

Sel T
Sel B

Autoimun
.

Limfosit

Sel NK
..

Sifat Biologik Imunoglobulin pada Manusia

Sifat utama

Ig G

Ig A

Ig M

Ig D

Ig E

Cairan tubuh
ekstra
vaskuler, u/
melawan
jasad renik
dan toksin

Sekresi
selaput
lendirdarah, u/
melindungi
permukaaan
tubuh

Aglutinator
yg sangat
efektif,
dihasilkan
pada awal
respons
imun
pertahanan
garis depan
efektif
terhadap
bakteremia

Terdapat
pada
permukaan
limfosit

Terbentuk
pada infeksi
parasit,
penyebab
gejala
alergi
atopik

Menembus
plasenta

Ikatan
sitofilik pd
makkrofag
& polimorf

Adakah hub Aktivitas dg Imunitas?

Sholat Tahajud meningkatkan imunitas

Exercise memperbaiki imunitas
Berkesenian membuat semangat hidup
Bersosialisasi membuat diri lebih mantap
Berbagi pengalaman (Sharing) meringankan stres
Reminiscence memperbaiki Mood

Rutin, Terstruktur &

Teratur

Tai Chi dan Imunitas

Medical-dictionary.thefreedictionary.com/tai+chi
CachedTai Chi Definition. T'ai chi is a Chinese exercise
system that uses slow, smooth body movements to
achieve a state of relaxation of both body and mind.
Boost Your Immune System Naturally with Tai Chi Prevention.com
www.prevention.com/...your-immune-system-naturallytai-chi CachedA Tai Chi workout is a natural health
remedy for boosting immunity and avoiding common
colds. Try this 20-minute no-sweat routine from
Prevention Magazine.

..about TaiChi

www.peacerivertaichi.com/taichi.html CachedDefi
nition. Tai chi is a ... can be helpful in achieving a
state of physical and mental relaxation while also
strengthening the cardiovascular and immune ...
www.opposingviews.com/i/studies-yoga-and-taichi...immunity CachedWikipedia--a resource I use
only very carefully and with a critical eye--has a
fairly good definition of the ... We know Tai Chi
has ... twice the level of immunity.

www.taichiforeveryone.net/main/taichi.htm Cach
edDEFINITION OF TAI CHI . Tai Chi falls easily
into at least four major categories: martial arts,
meditation, medicine, and exercise. Much like the
art form itself, Tai ...
en.wikipedia.org/wiki/Tai_chi_chih CachedTai chi
chih is a series of 19 movements and 1 pose that
together make up a meditative form of exercise to
which practitioners attribute physical and spiritual
health ...

Imunitas Psikologis ?

Coping Mechanism: R, P, I, S, PA, dsb

Cara Pikir: Positif vs Negativ
Cara Pandang: Persepi Diri dan Lingkungan
Cara Bersikap: . ?
Cara Mendengar .. KATANYA ???

Sikap Orang Positif adalah: SMRT

Pemenang
Kehidupan

Tetap Sejuk di tempat yang panas

Tetap Manis di tempat sangat pahit
Tetap Rendah hati meski telah sukses
Tetap Tenang di tengah badai yang paling hebat

The Power of Mind

Mind and Body is Unity

Pikir Kata - Laku
Mindfulness, self awareness
Meditasi-Yoga
ACT (Acceptance Commitment Therapy)
CBT (Cognitive Behavior Therapy)
Psikoterapi
Hypnosis Sugesti Diri
Positive Thinking

Aset Budaya Bangsa Indonesia: BBBBB

Ber-Gotong Royong semut

Berketuhanan YME
Berperikemanusiaan belas kasih
Bersatu kita teguh, bercerai .
Ber-Musyawarah & Mufakat
Berkeadilan menyeluruh

SAP TO PREVENT DEMENTIA IN THE

AGE FRIENDLY COMMUNITY
Martina WS Nasrun
Asosiasi Psikogeriatri Indonesia (API)

Structured
Activity
Program
For WHOM ?
What Activity?
How to create? Can PWD do it?
Where do we can access this SAP?
37

Magnitude of AD problem:
Medico-Psycho-Social impact

Family Caregiver Burden

High Cost (treatment care & medicine)
High functional disability
Lost of independency
Behavior problems
Mistreatment, abuse, neglect etc
Reduce QOL (PWD & caregiver)
Long good bye ..

Indonesia demographic Profile

Indicator

1950

1980

2010

2030

2050

Population
(thousand)

79.538

151.108

239.600

279.666

296.885

0-4 (%)

14,3

14,7

8,8

6,7

5,6

5-14 (%)

24,8

25,8

17,8

13,4

11,8

15-24 (%)

20

20

17,6

14,5

12,3

24-59 (%)

30,4

30,4

40

37,2

22,9

> 60 (%)

6,2

5,4

8,9

16

24,8

> 65 (%)

3,4

6,1

10,7

18,6

> 80 (%)

0,3

0,3

0,8

1,5

Source:Populationdivisionofthedepartment
ofeconomicandsocialaffairsoftheUN 39
secretariat.WorldPopulationprospects:2006

Persentage of mental emotional disorder

(SRQ-20) di Indonesia

age

(Riskesdas 2007, litbangkes)

26.3%M
ED 65+

wanita > laki2,

tidak sekolah, tidak kerja tinggal di
desa
33.7

39.1

40

AD DEMENTIA:
A CHALLENGE OR A BURDEN? ?

What can we do ???

..

...

42

Advocating
NCD summit 2011: joint
statement 11 NGOs

ADI Global
Chapter

ADI
Kyoto

Raising Awareness
AD Global challenge
1 new case every 4 seconds

People With Dementia in Day Center

with SAP

SAP Principle:
Goal, approach, happy/interesting, voluntary, enthusiasm, stimulate, fit to
the person or group
t

Day Center

In House / Hospital

46

SAP at home

47

Structured Activity Program

Well plan for the person / group

Fit to their culture, education & background
Has a realistic & clear goal / target
Knowledge of person asset and deficit
Knowledge of client capability and disability
Activity Staff (facilitator)
Evaluation sheet
Feed back to the family / caregivers

48

Assessment of mental & physical

capacity of senior citizen

Who ? people at risk, age 55 75 +

When? if there is a decline in daily function
What? judgment, memory, psychomotor, balance, etc
Where? General Hospital, Primary Care, Specialized
Clinic, Day Center ?
How?
Regular check up
Assess by competence staff
Early Awareness ..

49

How ?
JUST DO IT
Screening: AD & Pre- AD (MCI)
Prevention: modifiable risk factor w/
whatever ACTIVITY as long as ROUTINE

ITS TIME FOR ACTION !

Strategic Plan & Collaboration
WHO ?

All stakeholders Society, NGO, SC,

Government, Experts, Family Caregiver,
PWD, private sector, etc

ADVOCAC
Y

CAPACITY
BUILDING
Standardized Module & Action Plan

TOT
Taichi untuk
Perawat &
Fisioterapis
SCI
PIK

PWD and family IN ACTION: ABG

Advokasi
Bina-suana
Gerakkan

Continuing Action - - -

Post Test Evaluation

Mampu menerangkan Imunitas / Daya Tahan
2.
Mampu menjelaskan Aktivitas Bermanfaat dan
Teratur
3.
Mampu merancang Program Aktivitas Lanjut Usia
4.
Mampu mengevaluasi kemajuan/kemunduran dari
fungsi Kognitif & Perasaan
5.
Mampu menolong orang !
1.

Terima kasih