Profile of Geriatric Care in RSST compared to RSCM

Azzaky Amrizal, Sp.PD, Frida Nurrochman, Rizki Oktasari

ABSTRACT
Background :
Recently, there is some evidence that geriatric population tend to increase.
Geriatric is defined as people who is older than 60 years. . It’s expected that the
population of geriatric will increase from 605 billion in 2000 to 1,2 billion in 2025.
In the meantime, United Nations and Central Bureau of Statistics of Indonesia
found that number of life expectancy is also increased. In Indonesia, it is
increased from 64,5 years in 2000 to 69,43 years in 2011. Therefore, we need to
know the ideal characteristic of health care facility for geriatric by comparing the
profile of geriatric care in different settings. The ultimate goal is to improve the
quality of geriatric care by these findings.
Objectives :
To compare the profile between geriatric care of dr. Soeradji Tirtonegoro Central
General Hospital (RSST) with geriatric care of dr. Cipto Mangunkusumo National
General Hospital (RSCM).
Methods :
This study was conducted by searching from each hospital website to obtain data
about the profile of geriatric care and the most common disease in each settings.
Results :
RSST has been established since 2016 which has a vision to became a geriatric
friendly National Referral General Hospital in 2019. The geriatric integrated team
consists of 14 different disciplines, 11 types of services, and has 3 diagnostic
modalities. By 2016, there are 4,173 outpatient visits coming from different
regions.
RSCM has been established since 1996, has a vision to respond the demographic
transitions, epidemiological transitions and the globalization of health services in
the field of geriatric. Geriatric integrated team consists of 20 different disciplines,
23 service types, and has 6 diagnostic modalities. By 2016, there are 13,412
outpatient visits coming from different regions.
The 5 most common diseases according to national data are hypertension,
arthritis, stroke, COPD, and DM. In RSST, 5 most common disease are Type II DM,
DM II Neuropathy, Primary Hypertension, HHD without CHF, and CHF. In RSCM, 5
most common disease are Hypertension, Diabetes Mellitus, Osteoarthritis,
Dyslipidemia, and Chronic Kidney Disease.
Conclusions :
RSCM has stood longer than RSST. Of the total number of medical personnel,
types of services, and experts, and the number of outpatients in 2016, RSCM is
superior to RSST. However, the number of patients and the patient's home area
of RSST needs to be considered, considering that this achievement is achieved in
less than 1 year. Chronic diseases associated with degeneration of body functions
are ranked at the top of most common diseases in geriatric clinics. Broadly
speaking, hypertension is the most common disease in the national as well as in
geriatric clinics in RSST and RSCM. However, to know the impact of this search
result on the quality of service received with certainty, further research is needed

Background
In the last few decades, there is a rapid increase in geriatric population in
both developing and developed countries, and is predicted that this will last for
the next two or three decades. Geriatric is defined as people who is older than 60
years. It’s expected that the population of geriatric will increase from 605 billion
in 2000 to 1,2 billion in 2025. Currently there is about 60% geriatric living in the
developing countries and is expected to increase to 75% (843 million) in 2025.
According to the United Nations in 2011 reports, life expectancy in 2000-
2005 was 66.4 years (with the percentage of the geriartric population in 2000 is
7.74%), this number will increase in the year of 2045-2050 with estimated life
expectancy is 77.6 years (With the percentage of the geriatric population in 2045
is 28.68%). Similarly, the Central Bureau of Statistics (BPS) reported an increasing
number of life expectancy. In 2000 the life expectancy in Indonesia was 64.5
years (with the percentage of the geriatric population was 7.18%). This number
increased to 69.43 years in 2010 (with the percentage of the geriatric population
is 7.56%) and in 2011 to 69.65 years (with the percentage of the geriatric
population is 7.58%).
That’s why it is very important to understand the management of geriatric
people especially in developing country like Indonesia and to know the
comparison and the profile of geriatric care in different settings so that in the
future we can improve the quality of geriatric care.
Source :

Objectives
To compare the profile of geriatric care in RSST with geriatric care in other
settings in Indonesia and to know the most common diseases in elderly patients.

Methods
This study was conducted by collecting data from the internet to obtain data
about the profile of geriatric care in different settings and data about the most
common diseases in elderly in Indonesia.

Introduction
Geriatrics are people aged 60 years and over who have multiple diseases
(multipatology) due to impaired physical and spiritual function, and/or social
conditions that are problematic. Geriatric patients have special characteristics,
which generally have various chronic diseases, decreased organ function, and
decreased functional status. As a result, geriatric patients often get over
medications from many doctors. This actually endangers their bodies because of
declining organ functions. Unlike common adult patients, relatively mild physical
or psychosocial stressors can lead to acute illness in geriatric patients. Therefore,
the quality of good care is necessary in the management of these patients.
Geriatric Medicine is defined as a branch of medical science that focused
on diseases and health problems in the elderly regarding the aspects of
preventive, diagnosis, and management. In Indonesia, Geriatrics is a branch (sub
specialist) of internal medicine. Works in an interdisciplinary manner, whether in
education, research, or health services. It is consists of physical and rehabilitation
medicine specialist, psychiatrist, neurologist, ophtamologist, ENT specialist,
dermatologist, surgeon, and dentist.
In 2015, hospitals in Indonesia which have integrated geriatric services are
10 hospitals that are spread in 8 provinces. They are RSUPN Cipto
Mangunkusumo - Jakarta, RSUP Karyadi - Semarang, RSUP Sardjito -Yogyakarta,
Sanglah Hospital - Denpasar, RSUP Hasan Sadikin - Bandung, RSUP Wahidin -
Makassar , RSUD Soetomo - Surabaya, RSUD Moewardi - Solo, RSUP Adam Malik -
Medan, Syaiful Anwar Hospital - Malang. And in 2016, RSUP Soeradji Tirtonegoro
Klaten also has geriatric service.
It is predicted globally that the geriatric population continues to increase
as shown in the picture below. The geriatric population in Indonesia is predicted
to rise higher than the geriatric population in the Asian and global regions after
2050.

Based on sex, the geriatric population is dominated by women, as shown

in the picture below. This also shows that the highest life expectancy is in
women.
 Based on the type of the region, geriatrics live mostly in rural areas than
in urban areas which can be seen in the figure below.

The geriatric population morbidity rate in 2012 is 26.93%, it means that

out of every 100 geriatrics there are 27 people who experience illness. As we can
see in 2005-2012, there was improvement of the health status of geriatric that is
marked by decreased morbidity rate as shown in the picture below.
Results
1. Comparison of the profile of geriatric service in RSST and RSCM
No Aspect RSST RSCM
.
1 Year 2016 1996
estabilished
2 Vision/goal To became a geriatric To respond the
friendly National Referral demographic transitions,
General Hospital in 2019 epidemiological transitions
and the globalization of
health services in the field
of geriatric
3 Interdiciplina Internist (2) Internist (11)
ry team Physical and rehabilitation Physical and rehabilitation
medicine specialist (2) medicine specialist (2)
Psychiatrist (1) Psychiatrist (4)
Nutritionist (3) Nutritionist (5)
Pharmacist (2) Pharmacist (3)
 Nurse (10) Nurse (1)
Physiotherapist (2) Physiotherapist (3)
Neurologist (3) Neurologist (1)
ENT Specialist (1) ENT Specialist (1)
Dermatologist (2) Dermatologist (1)
Opthalmologist (3) Ophtalmologist (1)
Surgeon (2) Surgeon (2)
Orthopedist (1) Ortopedist (1)
Psychologist (1) Acupuncture therapist (1)
Obstretricians (1)
Dentist (1)
Speech Therapist (1)
Occupational Therapist (1)
Social Workers (1)
Clinical Nutrition Specialist
(1)
4 Services 1. Internal medicine care 1. Geriatric
2. Psychiatry care Assessment clinic
3. Neurology care
2. Preventive and
4. Physical and
Promotion Clinic
rehabilitation care 3. Internal Medicine
5. Dental and oral care
6. Nutrition care Care
7. Physiotherapy care 4. Physical and
8. Bioelectrical rehabilitation care
Impedance Analysis 5. Cardiology Care
Assessment 6. Dental care
9. Bone Mass 7. Acupuncture Clinic
Densitometry Assessment
10. Laboratory
8. Eye care
11. Pharmacy 9. Integrated sensory /
neurology care
10. Cognitive /
psychiatrist care
11. Continence care
12. Swallowing
disorders care
13. Posturography care
14. ENT care
15. Audiometry room
16. Dermatology care
17. Orthopedic and
podiatric care
18. Diet and nutrition
care
19. Aroma/Music
Therapy Clinic
 20. Paliative care
21. Procedure room
22. Laboratory

23. Pharmacy
5 Diagnostic 1. Electrocardiography 1. Electrocardiography
2. BMD Echocardiography
Tools 2.
3. BIA
3. BMD
4. BIA
5. USG
6. Radiology
6 Data of 4.173 13.412
outpatient
visits in 2016
7 Patient's 1. D.I. Yogyakarta 1. DKI Jakarta
home region 2. Central Java 2. Banten
3. DKI Jakarta
4. North Sumatera
5. West Java
6. West Sumatera

2. The most common diseases in RSST and RSCM

a. Global Data in Indonesia (2013)
In Indonesia, we can view the figure below that the most common
disease in Indonesia is hypertension, followed by arthritis, stroke, COPD,
and DM as the 5 most common diseases in elderly patient.

Health Problems in geriatric in Indonesia.

Prevalention
No. Health Problems 55-64 65-74 >75
years years years
1 Hypertension 45.9 57.6 63.8
2 Arthritis 45 51.9 54.8
3 Stroke 33 46.1 67
4 COPD 5.6 8.6 9.4
5 DM 5.5 48 3.5
6 Cancer 3.2 3.9 5
7 Coronary Heart Diseases 2.8 3.6 3.2
8 Kidney stone 1.3 1.2 1.1
 9 Heart Failure 0.7 0.9 1.1
10 Kidney Failure 0.5 0.5 0.6
Source: Riskesdas 2013 by National Health Ministry of Indonesia.
b. RSST (outpatient in 2016)
In RSST, we can view the figure below that the order of the 5 most
common diseases in elderly patient in 2016 is relatively different from
the national data in 2013. Here, we can conclude that DM without
complication is the most common disease followed by DM II neuropathy,
primary hypertension, HHD without CHF, and CHF as the top 5 common
diseases in geriatric patient.

The Most Common Diseases in geriatric in RSST in 2016.

NO. NO. Number of
DIAGNOSIS
CODE New Cases
NON-INSULIN-DEPENDENT DIABETES MELLITUS
1 E11.9
WITHOUT COMPLICATIONS / NIDDM / DM II
145

2 E11.4+G63.2* DM II NEUROPATHY 95

3 I10 ESSENTIAL (PRIMARY) HYPERTENSION 83

HYPERTENSIVE HEART DISEASE WITHOUT
4 I11.9
(CONGESTIVE) HEART FAILURE/HHD
51

5 I50.0 CONGESTIVE HEART FAILURE 48

HYPERTENSIVE RENAL DISEASE WITH RENAL
6 I12.0
FAILURE
26

7 K30 DYSPEPSIA 25
CHRONIC RENAL FAILURE, UNSPECIFIED / GAGAL
8 N18.9
GINJAL CHRONIC
23

CHRONIC OBSTRUCTIVE PULMONARY DISEASE,

9 J44.9
UNSPECIFIED/PPOK/PPOM
23

10 K29.7 GASTRITIS, UNSPECIFIED 22

Others diseases 555

Source: internal data from the department of medical records of RSST.
c. RSCM (outpatient in 2014)
From the figure below, we can see that the order of the most common
diseases is also different from the national data. But the exact data of
each health problems is still unknown because if we want to obtain the
complete data, we have to directly analyize from the complete data of
Department of Medical Record of RSCM.

The Most Common Diseases in Geriatrics in RSCM in 2014.

No. Health Problems
1 Hypertension
2 Diabetes Mellitus
3 Osteoarthritis
4 Dyslipidemia
 5 Chronic Kidney Disease
6 Coronary Heart Disease
7 Heart Failure
8 Benign Prostate Hyperplasia
9 Osteoporosis
10 Cataract
Source: the Geriatric research from faculty of medicine, Universitas Indonesia,
2015.

d. Comparison of the Most Common Diseases in Geriatric

No. Health Problems

National RSST RSCM
1 Hypertension Type II DM Hypertension
2 Arthritis DM II Neuropathy Diabetes Mellitus
3 Stroke Primary Hypertension Osteoarthritis
4 COPD HHD without CHF Dyslipidemia
5 DM CHF Chronic Kidney Disease
6 Cancer Hypertensive Renal Coronary Heart Disease
Diseases with Renal Failure
7 Coronary Heart Dyspepsia Heart Failure
Disease
8 Kidney stone Chronic Renal Failure Benign Prostate
Hyperplasia
9 Heart Failure COPD Osteoporosis
10 Renal Failure Gastritis Cataract

Discussion
Geriatric care of RSCM has been established 20 years before the geriatric
care of RSST. In terms of medical personnel, RSCM clinic outlines have more
number and there are experts who do not exist in RSST. The advantages of RSST
are having a greater number of nurses, neurologist, dermatologist, and
ophthalmologist. In terms of service and diagnostic tools, geriatric care of RSCM
is also superior. The number of outpatient visits in 2016 includes 31% of total
RSCM visits. This is quite large considering geriatric clinic of RSST has not run
even 1 year compared to RSCM which has stood 20 years at that time. The
geriatric patients at RSST are from Java and Sumatera, while RSCM is from Java
Island.

Conclusion
 RSCM has stood longer than RSST. Of the total number of medical
personnel, types of services, and experts, and the number of outpatients in 2016,
RSCM is superior to RSST. However, the number of patients and the patient's
home area of RSST needs to be considered, considering that this achievement is
achieved in less than 1 year. Chronic diseases associated with degeneration of
body functions are ranked at the top of most common diseases in geriatric clinics.
Broadly speaking, hypertension is the most common disease in the national as
well as in geriatric clinics in RSST and RSCM. However, to know the impact of this
search result on the quality of service received with certainty, further research is
needed

References
Kementrian Kesehatan RI. 2013. Topik Utama Gambaran Kesehatan Lanjut Usia di
Indonesia. Jakarta: Jendela Datinkes
Kementrian Kesehatan RI. 2016. Situasi Lanjut Usia di Indonesia. Jakarta: Jendela
Datinkes
Keller, I., Makipaa, A., Kalenscher, T., Kalache, A. 2002. Global Survey on Geriatrics
in the Medical Curriculum. Geneva: World Health Organization.
Divisi Geriatri Departemen Penyakit Dalam RSCM. 2015. Penelitian Usia Lanjut
Fakultas Kedokteran Universitas Indonesia. Jakarta: FK UI. Disampaikan
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Depok, 27 Mei 2015. Diunduh dari http://cas.ui.ac.id/wp-
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http://www.rscm.co.id/index.php?
XP_webviewrujukan_menu=0&pageid=5&title=Pelayanan%20Geriatri
%20Terpadu