SALAH PERLAKUAN,
DEPRESI, DAN BUNUH DIRI
PADA LANJUT USIA
Oleh:
Tim Keperawatan Keluarga, Komunitas, dan
Gerontik
Fakultas Keperawatan
Universitas Jember
GOALS Tradition of Exce
• Improve quality of life for people with abuse, neglect,
depression, and suicide conditions
• Increase community awareness that abuse, neglect,
depression, and suicide is a preventable public health
problem
• Change public perception about the stigma of mental
illness, especially about abuse, neglect, depression, and
suicide
• Increase the ability of the public to recognize and
intervene when someone they know is abuse, neglect,
depression, and suicide
• Advance understanding and treatment through research,
prevention, and education
• Support for increased research funding
Types of Abuse
Physical Tradition of Exce
Sexual
Neglect
Emotional/Psychologic
al
Financial Exploitation
Definitions
•ABUSE – The causing or allowing to be caused theTradition of Exce
infliction of physical pain, injury or mental anguish.
Abuse includes unreasonable restraint or confinement,
verbal abuse and sexual abuse. OKLA.STAT.tit.43A § 10-
103(A)(8)(2001)
• Bedsores
• Dehydration and malnutrition
• Unsafe or Unsanitary living conditions
• Allowing an Alzheimer’s patient to
wander unsupervised
• Increased medical complications due to
lack of/improper medication or care
Crimes range
from: Tradition of Exce
• Avoid isolation
• Stay social/active – volunteer, see friends
• Avoid living with a person with a history of abuse or
violence
• Beware of family members with financial motivations or
with substance abuse issues
• Consider respite services to relieve caregivers
• Have friends and relatives remain involved and
observant
• Consider Counseling
• Communicate
• Have relatives and friends visit at various times of the
day – unannounced
Warning
Signs Tradition of Exce
Fear of repercussions
Fear of loss of independence
Embarrassment for not being able to
protect themselves or being duped
Doesn’t want to get the perpetrator
in trouble
Incapacitated or unable to report
Elder doesn’t recognize abuse is
happening
Indicators of Abuse from the Tradition of Exce
Caregiver
• Elder not given opportunity to speak for
him/herself or see others without the
presence of the caregiver
• Attitudes of indifference or anger toward
the dependent person, or the obvious
absence of assistance
• Family member or caregiver blames the
elder (e.g. accusation that incontinence
is a deliberate act)
• Aggressive behavior by caregiver
toward the elder
Tradition of Exce
• Previous history of abuse to others
• Problems with alcohol or drugs
• Inappropriate displays of affection by caregiver
• Flirtations, coyness, etc as possible indications of
inappropriate sexual relationship
• Social isolation of family or isolation or restriction of
activity of the older adult within the family unit by the
caregiver
• Conflicting accounts of incidents by family, supporters or
victim
• Unwillingness or reluctance by the caregiver to comply
with service providers in planning for care and
implementation
• Inappropriate or unwarranted defensiveness by
Depression Tradition of Exce
• Affects some 10% of people aged 65 and above
• Depression in older people sometimes a continuation of
depression from earlier periods of life and sometimes a
new development
• Appears to have multiple origins
• Can be connected with the personality factor of
neuroticism
• Possible structural changes in the brain
• Possible genetic predisposition to imbalances of the
neurotransmitter noradrenaline; may be link
between depression and physical illnesses such as
Alzheimer’s disease, heart disease, stroke,
Parkinson’s disease, cancer
Depression Tradition of Exce
(cont’d)
suicide
• Weary of life
• Life isn’t worth living
• “I’d be better off dead.”
• “You’d be better off if I weren’t here.”
• Passive suicide
• Refuse to eat
• Refuse medications
Tradition of Exce
Causes of Tradition of Exce
Depression
• Interaction of biological and psychosocial
factors
• Possible genetic contribution
• Reaction in response to losses
• Unresolved grief
• Physical illnesses may lead to depression
• Medications may cause symptoms of
depression
Risk Factors Of Elderly
Depression Tradition of Exce
1. Female gender
2. Being widowed or divorced
3. Medical illness, e.g. stroke, neurological disorders
4. Functional disability
5. Family and personal history of depression
6. Social isolation
7. Life events
8. Medications, e.g. antihypertensives, steroids and
antiparkinsonian drugs
9. Caregiving, e.g. carers of people with dementia
Etiology (1) Tradition of Exce
• Social: reduced social networks, loneliness,
bereavement, poverty, physical ill health
• Psychological: low self-esteem, lack of capacity for
intimacy, physical ill health
• Biological: neuronal loss/neurotransmitter loss,
genetic risk, physical ill health
• Disease:
• Direct: CVA, Parkinson's disease, thyroid disease,
Cushing's disease, Hungtington's disease
• Indirect: pain, disability, chronicity, poor diet,
decreased activity
Etiology Tradition of Exce
(3)
• Drugs:
• Digoxin, L-dopa, steroid
• Beta-blockers, methyldopa
• Chronic benzodiazepine use
• Phenobarbitone
• Neuroleptics in chronic use
The research evidence is overwhelming - depression is
far more than a sad mood. It includes: Tradition of Exce
1. Weight gain/loss
2. Sleep problems
3. Sense of tiredness, exhaustion
4. Sad or angry mood
5. Loss of interest in pleasurable things,
lack of motivation
6. Irritability
7. Confusion, loss of concentration, poor
memory
8. Negative thinking (Self, World, Future)
9. Withdrawal from friends and family
10.Sometimes, suicidal thoughts 39
Warning Signs : Tradition of Exce
Depression
Physical Changes in Thoughts and
• Aches, pains, or other physical complaints Feelings
• Marked changes in appetite • Feelings of hopelessness and
helplessness
• Change in sleep patterns
• Feelings of worthlessness
• Fatigue • Impaired concentration
• Problems with memory
Emotional • Indecisiveness
• Pervasive sadness • Recurrent thoughts of death and
• Apathy suicide
• Decreased pleasure
Changes in Behavior
• Crying for no apparent reason
• Loss of interest in previously
• Indifference to others enjoyed activities
• Neglect of personal appearance
• Withdrawal from people
• Increased use of alcohol
• Increased agitation
• Talking about the "end"
Verbal
Expressions Tradition of Exce
• Common statements
• I shouldn't be here
• I'm going to run away
• I wish I were dead
• I'm going to kill myself
• I wish I could disappear forever
• If a person did this or that…
., would
he/she die
• Maybe if I died, people would
love me more
Some Behavioral Tradition of Exce
Warning Signs
• Common signs
• Previous suicidal thoughts or attempts
• Expressing feelings of hopelessness or guilt
• (Increased) substance abuse
• Becoming less responsible and motivated
• Talking or joking about suicide
• Giving away possessions
• Having several accidents resulting in injury;
"close calls" or "brushes with death"