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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
Geriatric Giant
Immobility
Instability
Incontinence (urinary & alvi)
Intellectual impairment (MCI, Dementia)
Infection (Pneumonia, etc)
Impairment of hearing & vision
Impaction (constipation)
Isolation (depression)
Inanition (malnutrition)
Impecunity (poverty)
Iatrogenesis
Insomnia
Kane, Ouslander Abrass. (from
Immune deficiency
Solomon 1988), Essentials of
Impotence
Clinical Geriatrics.2004 . p.13-14.
Impairment
of Hearing
Intellectual
Impairment
Impairment
of Visual
Inanition
Isolation
Instability
and Falls
Impaction
Geriatric
Syndromes
Impotence
Incontinence
Immuno
deficiency
Iatrogenesis
Infection
Immobilization
Insomnia
Immobilization
The Bed
Look at a patient lying long in bed. What a
pathetic picture he makes! The blood clotting in
his veins, the lime draining from his bones, the
scybala stacking up in his colon, the flesh rotting
from his seat, the urine leaking from his
distended bladder, and the spirit evaporating
from his soul.
(R Asher: The Dangers of Going to Bed: BMJ 1947)
Imobilization
Keadaan tidak bergerak atau tirah
baring selama 3 hari atau lebih dengan
gerak anatomik yang hilang akibat
perubahan fungsi.
Pasien Imobilisasi
Apathy, depression
Poor concentration
Reduced mobility
Loss of muscle
strength
Poor Appetite
Kanker
Alkoholism
Gagal jantung
PPOK
Infeksi
Disfagia
Rematoid Artritis
Parkinson
Hipertiroid
Sindrom malabsorpsi
Gejala-gejala GI: dispepsia, gastritis atrofi, muntah, diare
Konstipasi
Gigi geligi yang buruk
Faktor-faktor psikologis
Alkoholism
Kehilangan
Depresi
Demensia
Fobia Kolesterol
Obat-obatan
Consequences of malnutrition
Validation of MNA
Nursing home, hospitalized & free living
elderly
Sensitivity 96%
Specificity 98%
Predictive value 97%
Inter-observer MNA- Kappa 0.51
normal/well-nourished
< 17 :
undernutrition
Guigoz et al., Facts & Res. Gerontol. 1994 (suppl.2):15-70
Intellectual Impairment:
Dementia & Delirium
ALZHEIMER'S DISEASE
Depression
Infection
Infection
Morbidity and mortality no.2 after CV
diseases:
Comorbid of chronic diseases
Decrease of immunity
Communication difficulties
Environment
Predisposition: intrinsic, virulence,
environment
Pneumonia
Tuberculosis
Urinary tract infections
Bacteremia / sepsis
Cholecystitis
Appendicitis
Septic Arthritis
Bacterial meningitis
Infective endocarditis
3
10
1
3
2-8
15-20
2-3
3
2-3
Iatrogenesis: A Definition
Any illness that results from a
diagnostic/therapeutic intervention
or the omission of such intervention
that is not a natural consequence of
the patients disease
Contributors to Polypharmacy
Patient
Doctor
Failing to review the patients medications
Prescribing medications for common and non-life
threatening symptoms
Treating multiple symptoms or illnesses with several
drugs
IMPACTION
(CONSTIPATION)
Constipation in older people > 60 y
Regular use of laxatives
Associated : anxiety, depression
poor health perception
Complication : fecal impaction (1)
fecal incontinence (1)
urinary retention (2)
sigmoid volvulus (2)
morbidity : intestinal obstruction,
36
Definition
37
Physio-pathology Chronic
Constipation
38
Neurological conditions
Parkinson, DM, spinal cord injury (1)
Dementia (2), strok (3)
Dehydration (2)
Low dietary fiber (3)
Metabolic disturbances
Hypothyroidism, hypercalcemia, hypokalemia
Patients receiving renal dialysis (3)
Lack of privacy or comfort
Poor toilet acces (3)
40
Physical Examination
All patients constipation :
Rectal Touche !!
Rectal impaction ?
Rectal dilatation ?
Hemorrhoid ?
Anorectal disease ?
Perianal fecal soiling ?
41
Instabilitas
Jatuh
Obat
Inkontinensia urin
Fraktur
Hipotermia
Infeksi
Kesadaran
Imobilisasi
Ulkus
Trombosis vena
Pneumonia
ISK
Atrofi otot
Asupan makanan
Asupan cairan
Depresi
Gangguan
tidur
Dehidrasi
konstipasi
Malnutrisi
Summary
Geriatric population is rising worldwide, esp. in
developing countries, including Indonesia
Geriatric patients have special characteristics
that need to be considered
Syndromes in geriatric geriatric giants (13 i)
All the syndromes are inter-correlated and
should be evaluated in all geriatric patients
The assessment and management of geriatric
patients holistic comprehensive