Presentation on theme: "Dr. Rose Dinda Martini, SpPD"— Presentation transcript:
1Dr. Rose Dinda Martini, SpPD Geriatric SyndromeDr. Rose Dinda Martini, SpPD
2The Guinness Book of World Records the fastest 100-year-old to run 100 meters.
3Identifikasi penyebab Comprehensive geriatric assessment SINDROM GERIATRIKumpulan gejala dan atau tanda klinis, dari satu atau lebih penyakit, yang sering dijumpai pada pasien geriatri.- Perlu penatalaksanaan segeraIdentifikasi penyebabComprehensive geriatric assessment
5Intellectual Impairment Geriatric SyndromesIntellectual ImpairmentImpairment of VisualInanitionImpactionIncontinenceImmuno deficiencyInfectionInsomniaImmobilizationIatrogenesisImpotenceInstability and FallsIsolationImpairment of Hearing
7The BedLook 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)
8ImobilizationKeadaan tidak bergerak atau tirah baring selama 3 hari atau lebih dengan gerak anatomik yang hilang akibat perubahan fungsi.
12Malnutrition in the Elderly: More common than you would think 2 - 10% free-living elderly populations 1% institutionalized elderly 1% nursing home residents 2% home care patients 2(1) Vellas, B. et al, NNWS, 1999, Volume 1; (2) Nutr Screening Initiative
13Why the concern? Malnourished elderly are: 2 times more likely to visit the doctor3 times more likely to be hospitalizedInfection is the most common disordertimes more likely to die if malnourishedDiminished muscle strengthPoor healingMalnutrition is a greater threat than obesitystay 2 times longer in the hospital13
14Malnutrition : A vicious circle Apathy, depressionPoor concentrationReduced feedingcapabilitiesReduced mobilityPoor AppetiteLoss of musclestrength
15Causes of weight loss in older persons • Medications• Emotions (depression)• Alcoholism, anorexia• Late-life paranoia• Swallowing problems• Oral problems• No money (poverty)• Wandering (dementia)• Hyperthyroidism, Hyperparathyroidism• Entry problems (malabsorption)• Eating problems• Low-salt, low-cholesterol diet• Shopping problems
16Faktor-faktor medis (melalui anoreksia, rasa cepat kenyang, malabsorpsi, metabolisme meningkat, pengaruh sitokin, dan gangguan status fungsional)KankerAlkoholismGagal jantungPPOKInfeksiDisfagiaRematoid ArtritisParkinsonHipertiroidSindrom malabsorpsiGejala-gejala GI: dispepsia, gastritis atrofi, muntah, diareKonstipasiGigi geligi yang buruk
24ALZHEIMER'S DISEASEA progressive neurologic disorder that results in memory loss, personality changes, global cognitive dysfunction, and functional impairments. Loss of short-term memory is most prominent early. In the late stages of disease, patients are totally dependent upon others for basic activities of daily living such as feeding and toileting
26Frail Elderly Characteristics: Poor mental and physical health Low socioeconomic statusPredominantly femalePossibly isolated living conditionsMore and longer hospital stays, andMore money spent on health care and drugs
28Infection Morbidity and mortality no.2 after CV diseases: Comorbid of chronic diseasesDecrease of immunityCommunication difficultiesEnvironmentPredisposition: intrinsic, virulence, environment
29Comparative mortality rates of infections in elderly and young adults Ratio mortality rates : elderly vs youngPneumoniaTuberculosisUrinary tract infectionsBacteremia / sepsisCholecystitisAppendicitisSeptic ArthritisBacterial meningitisInfective endocarditis31012-815-202-3
30Clinical features of infections in elderly FeverNonspecific symptoms :- Anorexia- Fatigue- Weight loss- Incontinence (acute)- Falls- Mental confusion
31Sir William Osler :“In old age, pneumonia may be latent, coming on without chill, the cough and expectoration are slight, and the physical sign changeable.”
32Geriatric assessment is needed to: Identify geriatric syndromes/functional declineEvaluate and manage these geriatric syndromes/functional decline- address reversible causes- apply general measuresDetermine the type/extent of follow-up needed to sustain gains achieved
33Iatrogenesis: 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 patient’s disease
34Contributors to Polypharmacy PatientBorrowing or sharing medicationsFailing to understand instructionsSaving medication for later useCombining Rx’s with OTC’s and HerbalsVisiting more than one physicianDoctorFailing to review the patient’s medicationsPrescribing medications for common and non-life threatening symptomsTreating multiple symptoms or illnesses with several drugs
35A stepwise approach to prescribing Discontinue unnecessary therapyConsider adverse drug events for any new symptomsConsider non-pharmacologic approachesSubstitute with safer alternativesReduce the dosePrescribe beneficial therapyLadden MD. Brief Guide to Geriatric Assessment.
36IMPACTION (CONSTIPATION) Constipation ↟ in older people > 60 yRegular use of laxativesAssociated : anxiety, depressionpoor health perceptionComplication : fecal impaction (1)fecal incontinence (1)urinary retention (2)sigmoid volvulus (2)↑ morbidity : intestinal obstruction, ulceration
43SummaryGeriatric population is rising worldwide, esp. in developing countries, including IndonesiaGeriatric patients have special characteristics that need to be consideredSyndromes in geriatric geriatric giants (13 i)All the syndromes are inter-correlated andshould be evaluated in all geriatric patientsThe assessment and management of geriatricpatients holistic comprehensive