GERIATRIC

Bag IKM
FK UNRAM
 Sweet 18

Sweet 81
 Sejarah

 Gerontologi : geront (Yunani) = orang usia

lanjut - Elie Metchnikoff (1903)

 Geriatri
- Ignatz Nascher (1909)
- Dr. Marjorie Warren (Inggris, 1935)
Definisi
 Gerontologi :
ilmu yang mempelajari proses menua & semua
aspek biologi, sosiologi yang terkait dg proses
penuaan

 Geriatri :
cabang ilmu kedokteran yang menitikberatkan
pada pencegahan, diagnosis, pengobatan dan
pelayanan kesehatan pada usia lanjut
 Usia Lanjut
 Para peneliti lansia mengelompokkan lansia
dlm 3 kelompok :
 young old  65-74 tahun,
 old old  75-84 tahun, dan
 oldest old  85 tahun ke atas.
 Klasifikasi yg lebih be rmakna  functional
age : seberapa baik seseorang berfungsi dlm
fisik dan lingkungan sosial dibandingkan dgn
orang lain pada kronologi usia yg sama.
Bina Nusantara
 Populasi usia lanjut  : 41,4% (thn 2025)
 Masalah - masalah fisik, psikoekonomi,
dan sosial usia lanjut 
 KURVA VITALITAS
Persentase
100%
D
D
E
E M
75% V G Optimum Health
V O
I E
E R
T N
L B
50% A E Sub-optimum Health
O I
L R
P D
I A
M I
25% T T Undiagnosed Conditions
E T
Y I
N Y
O
T
0% N
0 10 20 30 40 50 60 70 80 90 100 110 120
Usia (thn)

Dr. Ron Rothernberg A4M Dec 2002, Las Vegas NY

 Indonesia 414
Co lo mb ia 349
Kenya 347
Sing ap o re 340
Thailanda 337
Co st a Rica 327
321
Lib eria 303
295
M exico 290
279
Zimb ab we 271
257
B razil 255
254
M o ro cco 250
247
Ind ia 242
242
Sri Lanka 238
238
China 220
219
M alawi 194
146
Canad a 141
137
Cub a 130
129
Jamaica 126
121
Israel 120 Projected percentage increase
101
New Zealand 100 in the elderly population, 1990-2025
97
Luxemb urg 96
82
Greece 66
66
France 65
63
Developing country
Hung ary 63
59
B elg ium 54
Developed country
50
Denmark 47
45
No rway 40
35
(Kinsella K & Taeuber, 1993)
Swed en 33

0 50 100 150 200 250 300 350 400 450

 USIA LANJUT Vs GERIATRI

 Serupa tapi tidak sama

 Pasien geriatri adalah usia lanjut

dengan :
- Beberapa penyakit
- Masalah biopsikososial
 Usia Lanjut

 Usia kronologis
 Usia biologis (fisiologis) --- penting
 Kematangan mental
 KARAKTERISTIK
PASIEN GERIATRI

1. Usia > 60 tahun

2. Multipatologi
3. Tampilan klinis tidak
khas
4. Polifarmasi
5. Fungsi organ menurun
6. Gangguan status
fungsional
7. Gangguan nutrisi
 Masalah Usia Lanjut

 Fisik (jasmani)
 Mental (jiwa)
 Sosial dan lingkungan
 Iatrogenik (salah obat/rawat)
 FISIK

FUNGSIONAL

SOSIO -
PSIKO EKONOMIK
- LOGIK

FAKTOR-FAKTOR BERINTERAKSI SECARA KOMPLEKS

 SINDROM GERIATRI

Kumpulan gejala dan atau tanda klinis,

dari satu atau lebih penyakit, yang
sering dijumpai pada pasien geriatri.

- Perlu penatalaksanaan segera

- Identifikasi penyebab
- Comprehensive geriatric assessment
 Hormon sejalan dengan Usia
120

PEAK: Teens thru Late 20s

100
% of Maximum Secretion (Peak at 100%)

80

HGH
DHEA

60 Melatonin
Testosterone (men)
Estrogen (women)

LOW: Early 50s +

40

20

0
0 10 20 30 40 50 60 70 80
Age
 SINDROM GERIATRI
 Immobility
 Instability
 Incontinence
 Intellectual impairment --- DEMENSIA
 Infection --- PNEUMONIA
 Impairment of hearing & vision
 Isolation (depression)
 Inanition (malnutrition)
 Impecunity
 Iatrogenic
 Insomnia
 Immune deficiency
 Impotence
 Irritable colon
Demensia
Imobilisasi
Ulkus Dekubitus
INSTABILITAS -- JATUH
Malnutrisi
Depresi
 Perubahan komposisi tubuh & fisik usia lanjut
 Masalah medis
 Immobility  inanition
 instability  Iritabel colon
 intellectual impairment  immune deficience
 insomnia  infection
 Isolation / depression  impairment of vision & hearing
 Impotence  Iatrogenic
 incontinence  impecunity

Rapuh rentan thd peny  Mati

Bagaimana Proses Menjadi Tua?

Sel menjadi
GENETIK Mengkerut

Gaya hidup Jaringan menjadi

Rusak
LINGKUNGAN
Organ tubuh
Menjadi tua
 Menua

 Proses normal
 Dewasa sehat “frail”
 Cadangan sistem fisiologis berkurang
 Menurun kemampuan usila berespon terhadap
stres
 Rentan terhadap penyakit
Bagaimana pengaruh penuaan
YANG NORMAL terhadap
seseorang
AKIBAT PENUAAN
 Akibat pada bentuk fisik

 Perubahan Komposisi Tubuh

 Peningkatan Persentase Lemak
Tubuh (terutama pada daerah
PERUT)
 Peningkatan ratio pinggang /
pinggul
 Pengurangan massa otot dan
kekuatan
 Kulit Kendur dan berkerut
 Timbul selulit
 Dsb.
 Akibat pada
Jantung

 Penurunan kekuatan & massa otot jantung

 Pengurangan kapasitas maksimal pengisian beban oksigenasi
jantung
 Pengurangan ambilan oksigen maksimal
 Pengurangan denyut jantung maksimal
 Peningkatan Cholesterol LDL danTotal Cholesterol
 Penurunan HDL dan Triglyceride meningkat
 Akibat pada metabolisme
 Perubahan dalam metabolisme karbohidrat
 Perubahan dalam metabolisme lemak
 Peningkatan frekuensi hipoglikemia
 Pemulihan lambat dari reaksi hipoglikemik pada insulin
 Gangguan toleransi glukosa
 Penurunan sensitivitas insulin
 Hiperinsulemia ringan

Plak
 Akibat Terhadap Tulang
 Pengurangan densitas
tulang
 Perubahan struktur dan
geometri tulang
 Peningkatan peluang
patah tulang
 Penurunan regenerasi
tulang
 Penurunan mineralisasi
tulang
 Akibat psikis dan vitalitas

 Kelelahan
 Pengurangan kemampuan
berkonsentrasi
 Penghasilan berkurang,
motivasipun berkurang
 Meningkatnya ketakutan
munculnya penyakit
 Menarik diri dari pergaulan
sosial
 Gangguan seksual
 Sulit tidur
 Implikasi Klinik Proses Menua
ORGAN PERUBAHAN
Paru-paru Daya pegas dinding dada menurun
Kekuatan otot pernapasan menurun
Kekakuan iga meningkat
Daya pegas jaringan elastik paru menurun
Paru-paru lebih mengembang, namun kaku

Saluran nafas Refleks batuk menurun

Mudah tersedak
Gerakan bulu getar melambat
 Implikasi Klinik Proses Menua
Katup jantung kaku
Jantung- Jumlah sel pacu berkurang
pembuluh Sistem konduksi menurun
Penumpukan jar. Ikat di otot jantung kaku
darah Pembuluh darah kurang lentur TD naik
Isi sekuncup menurun; curah jantung ber<

Ginjal Jumlah nefron, glomerulus <

Fungsi filtrasi menurun
Kepekaan tubulus terhadap ADH <
Reabsorbsi <
LFG menurun 7,5 mL/m/dekade

Tulang, sendi, otot Keropos, cairan <, massa otot <, cairan sendi <, tulang
rawan mulai rusak
 Implikasi Klinik Proses Menua
Saluran cerna Produksi air liur <
Osteoporosis tulang rahang, gigi tanggal
Gerakan kerongkongan & lambung melambat
Produksi enzim pencernaan <
Gerakan usus besar <

Saluran Kemih & Kelenjar prostat membesar

Kelamin Selaput mulut rahim kering
Otot dasar panggul melemah

Susunan Saraf Pusat Pengerasan pembuluh darah otak

Demensia (neurofibril tangie, amyloid)
Mengisut (atrofi)
MACROSCOPIC CHANGES OF AGING BRAIN

ADULT BRAIN

AGING BRAIN
 INTERNAL FACTORS
GENETIC
BIOLOGICAL

NORMAL
AGING

EXTERNAL FACTORS
ENVIRONMENT  LIFE STYLE
SOCIOCULTURAL
ECONOMIC
Boedhi Darmojo (modified)
 Banyak teori proses menua
 Aging by program
 Teori gen & mutasi gen
 Cross-linkage theory
 Teori autoimun, dll

Tidak ada 1 teori tunggal yang dapat

menjelaskan seluruh proses menua
 Teori Radikal Bebas
 Radikal bebas : senyawa kimia yg berisi elektron
yg tidak berpasangan
 Produk sampingan berbagai proses selular atau
metabolisme normal yg melibatkan O2
 Bersifat merusak, sangat reaktif, dapat bereaksi
dengan DNA, protein, asam lemak tak jenuh
 Contoh : superoksida (O2), hidroksil (OH),
peroksida hidrogen (H2O2)
 Teori Glikosilasi
 Proses glikosilasi nonenzimatik, yg menghasilkan
pertautan glukosa-protein — advanced glication end
products (AGEs)
 AGEs menyebabkan penumpukan protein &
makromolekul — disfungsi pada
hewan/manusia yg menua
 AGEs berakumulasi di jaringan
(kolagen,hemoglobin,lensa mata)
 Jaringan ikat kurang elastis & kaku
 Teori DNA repair

 Dikemukakan Hart & Setlow

 Ada perbedaan pola laju repair kerusakan DNA yg
diinduksi sinar UV
 Spesies yg mempunyai umur terpanjang — laju
DNA repair terbesar (mamalia & primata)
 Pemanjangan Telomer

 Setiap sel mempunyai kemampuan untuk

membelah (50 kali)
 Setiap sel membelah, telomer semakin pendek
 Akhirnya telomer tidak dapat memendek lagi —
kematian sel (proses menua)
Kromosom -- Telomere
Kematian sel/apoptosis
Patient’s Condition during the Final
Days and Hours
 Fatique
 Anorexia
 Dehydration
 Dysphagia
 “Death rattle”-noisy breathing
 Apnea, Cheyne-Stokes respiration,dyspnea
 Urynari or fecal incontinence
 Agitation or delirium
 Dry mucosal membrane
 When caring for the elderly, there are a number of
important things you have to take into
consideration. As well as the possibility of nursing
home care and long-term care, there is an increase
in the number of older people who have complex
needs. There is also an increase in the amount of
home support given to older people.
 The Care Provided For Seniors Should Be Person-
Centered
 Every senior citizen in every community is human. That is
exactly how they should be treated. They have the same
rights as every one of us.

 Dignity Is Important
 You are there to help them retain their dignity by giving them
ultimate respect. Your little show of respect and proper care
can make all the difference for an older person.
 Make It A Point To Understand Them
This is not only good for the senior you are taking
care of it is also good for you in the long run. Even
the best caregivers know that senior people can
sometimes become a little grumpy or can easily
forget things. It is your job to know these things.
Older people may also seem to act like babies, but
this kind of behavior is never intentional.
They are merely a display of the decline in the
cognitive abilities. They may say things you don’t
agree with or things that infuriate you—but you
have to remain calm and understand it. Be Patient.
Understand elderly people and see how happy you
both will be together.
 Be A Confidant, But Privacy Is Key

It is vital to be like a friend with the person you are

caring for. It helps you to understand each other better
and ensures a good relationship.
Being a confidant means you and the older person can
talk about things and laugh. You both can open up to
how daunting it is to raise children if you have one.
However, do not cross the line. It is vital to be like a
friend with the person you are caring for. It helps you to
understand each other better and ensures a good
relationship.
However, sharing things that need to be kept private
means you are going over the top. For example, the
relatives of the senior might be having a dispute about
their health.
Inasmuch as this topic has something to do with you, it
doesn’t concern you in any way. Stay clear of family
disputes and don’t share your own private life that you
don’t want to be shared with anyone else.
 Report All Forms Of Abuse Accordingly

Elderly people can be a little grumpy and it might lead

them to become a little abusive toward the individual
caring for them.
You are not expected to take your turn and it is not even
advisable to gossip about such an occurrence.
The best you should do is to report such form of abuse
to the appropriate person.
The refusal to take this gentle approach might lead to
severe repercussions that you wouldn’t like.
 Be Reliable And Dependable

Elderly people can easily lose trust in a caregiver if they

arrive late or do not keep to agreed deadlines.
Unlike young men and women, many older people do
not have the patience to keep trusting someone who
keeps failing on his promises.
You have to present yourself as someone they can rely
on, someone they can depend on.
Most of the elderly people have lived independent lives
for years. This makes it almost impossible for them to
rely on someone who has seemingly made herself
unreliable.
There are cases where an older person would take the
chance to care for herself when the caregiver doesn’t
arrive on time.
This could lead to dangerous consequences. The falling
of a staircase is one of the possibilities of an older
person giving care to herself.
The point is not to present a scary scene; you just have
to know that your reliability counts.
 Explore Ways To Understand Communication
Disabilities
Some elderly people who are experiencing some forms
of communication disabilities do not find it easy
communicating with others. For example, a stroke may
affect someone’s speech. Many older people also
struggle to hear what people are saying.

Sometimes, you have to speak up a little and expand

your mouth to show your expression of the words you
pronounce. You only have to explore different methods
which you can use to communicate with them. Their
will to communicate will make it easier for you to
understand them too.
 People Desire A Good Quality Of Life
 You might see in-home care as a way to make money,
but senior citizens see it in a different way. To them, it is
a way to improve their quality of living. It is the time to
get their living space organized to meet their social and
emotional needs. They see you as someone who will help
them achieve all that.
 They are putting all of their trust and ability to you. They
want to move even if they have mobility issues. They
want to visit the world outside their door. It is now your
job to help them achieve all that. You might think they
are old, but they want to make new friends. They want
to follow the interesting TV series that you follow.
 They want to enjoy their lives as much as possible. You
 They are putting all of their trust and ability to you.
They want to move even if they have mobility issues.
They want to visit the world outside their door. It is
now your job to help them achieve all that. You might
think they are old, but they want to make new friends.
They want to follow the interesting TV series that you
follow.
 They want to enjoy their lives as much as possible. You
can be that number one friend they seek. Loneliness is a
constant problem for elders. You can help them avoid
depression. You are right in the mix of improving
someone’s quality of life. That is probably the most
important thing you should remember when giving care
to an older person at their home.
 Cardinal sign of death
Cessation of cardiac function and respiration

 Pupils become fixed

 Body becomes cool
 Ashen white and waxy
 Muscle relax
 Incontinence
Terima Kasih