ABSTRAK PASIEN USIA LANJUT DI RUANG RAWAT INTENSIF RUMAH SAKIT IMMANUEL BANDUNG PERIODE 1 AGUSTUS 2009 - 31 JANUARI 2010 Yuvens, 2010.
Pembimbing I : Vera, dr.,Sp.PD. Pembimbing II : dra. Endang Evacuasiany, Apt., MS., AFK.
Peningkatan jumlah penduduk berusia lanjut sudah menjadi fenomena global di seluruh dunia. Usia lanjut diperkirakan berhubungan dengan peningkatan angka mortalitas pada pasien dengan kondisi kritis. Tentu saja, faktor-faktor yang yang berhubungan dengan outcome penting untuk diidentifikasi. Penelitian ini bertujuan untuk mengidentifikasikan faktor-faktor yang mungkin berhubungan dengan outcome pasien. Metode penelitian ini adalah menggunakan desain potong lintang yang dilakukan di ruang rawat intensif (ICU) Rumah Sakit Immanuel, Bandung. Selama periode 1 Agustus 2009 - 31 Januari 2010, setiap pasien usia lanjut (60 tahun atau lebih) yang masuk ruang rawat intensif karena indikasi non bedah termasuk ke dalam kriteria inklusi penelitian ini. Keluarga pasien diwawancara berdasarkan kuesioner. Beberapa data diambil dari rekam medis pasien. Status fungsional dinilai dengan Instrumental Activities of Daily Livings (IADL) menurut Lawton-Brody dan Activities of Daily Livings (ADL) menurut Barthel. Outcome dinilai selama pasien berada di ICU. Pengolahan data menggunakan Microsoft Excel dan SPSS. Hasil penelitian ini menunjukkan bahwa dari 132 pasien, pasien dengan lama rawat 0-1 hari atau >7 hari yang memiliki hasil rawat memburuk ternyata lebih banyak daripada hasil rawat membaik yakni 26 pasien atau 48,14% dari keseluruhan pasien dengan hasil rawat memburuk dibanding 16 pasien atau 20,5% dari pasien dengan hasil rawat membaik (19,7% dibanding 12,1% dari 132 pasien). Pasien dengan status fungsional Activities of Daily Living (ADL) < 10 memiliki hasil rawat memburuk yang lebih banyak dibanding hasil rawat membaik (53,3% dibanding 46,7% dari keseluruhan pasien dengan ADL <10). Pasien dengan usia ≥80 tahun kemungkinan memiliki hasil rawat memburuk dibanding membaik (60,9% dibanding 39,1%) dari keseluruhan pasien yang berusia ≥80 tahun). Pasien yang memerlukan terapi suportif kehidupan ventilator dan vasopresor lebih banyak yang memiliki hasil rawat memburuk (15,2%) dibanding hasil rawat membaik (6,1%). Penelitian ini memperoleh kesimpulan bahwa faktor-faktor yang mungkin mempengaruhi outcome pasien usia lanjut di ICU adalah usia ≥80 tahun, status fungsional ADL ≤ 10, lama rawat 0-1 hari atau >7 hari. Pasien yang memerlukan ventilator dan vasopresor lebih banyak yang memiliki hasil rawat memburuk daripada membaik. Kata Kunci : pasien usia lanjut, ruang rawat intensif, hasil rawat
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ABSTRACT CHARACTERISTICS OF ELDERLY PATIENTS IN MEDICAL INTENSIVE CARE UNIT OF IMMANUEL TEACHING HOSPITAL BANDUNG 1ST AUGUST 2009 - 31ST JANUARY 2010 Yuvens, 2010.
1st Supervisor : Vera, dr.,Sp.PD. 2 Supervisor: dra. Endang Evacuasiany, Apt.,MS., AFK. nd
The increasing number of elderly population has been a global phenomenon Advanced age is thought to be associated with increased mortality in critically ill patients. Surely, factors that may predict outcome of patient should be identified. The objectives of this study is to identify possible factors that may predict outcome of patients. Cross-sectional survey method was conducted in Intensive Care Unit (ICU) of Immanuel Teaching Hospital, Bandung. In the period of 1 August 2009 to 31 January 2010, each elderly patient (60 years or older) admitted to Medical Intensive Care Unit were included in this study. The patient’s family were interviewed using a structured questionnaire. Some clinical data were taken from the medical record of the patients. Functional status were assessed using IADL (Instrumental Activities of Daily Livings) of Lawton-Brody and ADL Activities of Daily Livings of Barthel. The outcomes were only observed when the patients period on ICU. Data was analyzed using Microsoft Excel and SPSS. The result showed among 132 patients, patients who hospitalized for 0-1 day or > 7 days who had worse outcome were more than those who had better outcome 26 patients or 48,14% of all worse outcome compare to 16 patients or 20,5% of all bettter outcome (19,7% vs. 12,1% of all 132 patients). Patients with functional status Activities of Daily Living (ADL) <10 who had worse outcome were more than better outcome (53,3% vs. 46,7% of patients with ADL score <10). Patients ≥80 years old were more frequently had worse outcome (60,9% vs. 39,1% of all patients ≥80 years old). Patients who needed both ventilator and vasopressor were more frequently to have worse outcome (15,2%) rather than better outcome (6,1%). The conclusion of this study is patients who had length of stay 0-1 day or more than 7 days, patients who had functional status Activities of Daily Living (ADL) < 10, patients who were ≥80 years old of age might had worse outcome. Patients who needed both ventilator and vasopressor were more frequently to have worse outcome. Keywords: elderly patient, intensive care unit, outcome
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DAFTAR ISI JUDUL .............................................................................................................. i LEMBAR PERSETUJUAN ........................................................................... ii SURAT PERNYATAAN ............................................................................... iii ABSTRAK ...................................................................................................... iv ABSTRACT ...................................................................................................... v KATA PENGANTAR .................................................................................... vi DAFTAR ISI .................................................................................................. vii DAFTAR TABEL .......................................................................................... ix DAFTAR GAMBAR ....................................................................................... x DAFTAR LAMPIRAN .................................................................................. xi
BAB I. PENDAHULUAN 1.1 Latar Belakang ................................................................................... 1 1.2 Identifikasi Masalah ........................................................................... 3 1.3 Maksud dan Tujuan ............................................................................ 3 1.4 Manfaat Karya Tulis Ilmiah ............................................................... 3 1.5 Kerangka Pemikiran ........................................................................... 3 1.6 Metodologi ......................................................................................... 5
BAB II. TINJAUAN PUSTAKA 2.1 Dasar-dasar ilmu gerontologi ............................................................. 6 2.1.1. Definisi Menua ............................................................................... 6 2.1.2 Teori Proses Menuadan Konsep Homeostenosis ............................ 7 2.1.3 Demografi dan Epidemiologi Populasi Geriatri .............................. 9 2.1.4 Pengkajian Paripurna Pasien Geriatri dan Penilaian Holistiknya . 10 2.1.5 Aspek Farmakologi dan Polifarmasi pada Usia Lanjut................. 11 2.2 Intensive care unit (Ruang rawat intensif) ....................................... 15
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BAB III. METODE PENELITIAN 3.1 Desain Penelitian .............................................................................. 16 3.2 Tempat dan Waktu Penelitian .......................................................... 16 3.3 Subjek Penelitian ............................................................................. 16 3.4 Pemilihan Subjek Penelitian ............................................................ 16 3.5 Alur Penelitian ................................................................................. 17 3.6 Definisi Operasional ........................................................................ 17 3.7 Pengolahan Data .............................................................................. 18
BAB IV. HASIL DAN PEMBAHASAN 4.1 Karakteristik Pasien Usia Lanjut ICU RS Immanuel Bandung ....... 19 4.2 Usia .................................................................................................. 23 4.3 Penanggung Biaya ............................................................................ 26 4.4 Status Fungsional ............................................................................. 28 4.5 Diagnosis .......................................................................................... 31 4.6 Infeksi Selama di ICU ...................................................................... 32 4.7 Biaya ............................................................................................... 33 4.8 Aspek Polifarmasi ............................................................................ 35 4.9 Terapi Suportif Kehidupan ............................................................... 38 4.10 Hasil Rawat .................................................................................... 40 4.11 Lama Rawat ................................................................................... 41
BAB V. KESIMPULAN DAN SARAN 5.1 Kesimpulan ...................................................................................... 44 5.2 Saran ................................................................................................44
DAFTAR PUSTAKA ................................................................................... 45 LAMPIRAN ................................................................................................... 49 RIWAYAT HIDUP ....................................................................................... 55
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DAFTAR TABEL Tabel 4.1 Karakteristik Jenis Kelamin, Jenis Diagnosis Penyakit, Outcome, dan Penanggung Biaya Responden ................................................................. 20 Tabel 4.2 Karakteristik Jenis Kelamin, Jenis Diagnosis Penyakit, Outcome, dan Penanggung Biaya Non Responden ......................................................... 21 Tabel 4.3 Karakteristik Usia, Lama Rawat, Status Fungsional, dan Biaya yang Dikeluarkan Responden ......................................................................... 22 Tabel 4.4 Jumlah Obat yang Diberikan........................................................... 35 Tabel 4.5 Perubahan Farmakokinetik Obat Akibat Proses Menua ................. 37 Tabel 4.6 Jumlah Obat berdasarkan Penanggung Biaya ................................. 38 Tabel 4.7 Tabel Silang antara Lama Rawat dan Outcome .............................. 41
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DAFTAR GAMBAR Gambar 2.1 Skema konsep homeostenosis .................................................... 9 Gambar 2.2 Siklus Pemberian Obat pada Usia Lanjut yang Cenderung mengarah ke Polifarmasi ................................................................................. 14 Gambar 3.1 Bagan Alur Penelitian ............................................................... 17 Gambar 4.1 Grafik Klasifikasi Usia Responden .......................................... 23 Gambar 4.2 Grafik Kategori Usia dan Outcome ........................................... 24 Gambar 4.3 Grafik Penanggung Biaya ......................................................... 26 Gambar 4.4 Grafik Kategori Penanggung Biaya dan Outcome .................. 27 Gambar 4.5 Grafik Kategori IADL dan Outcome........................................ 28 Gambar 4.6 Grafik Kategori ADL dan Outcome ......................................... 29 Gambar 4.7 Grafik Jenis Diagnosis yang Dibuat Dokter ICU ...................... 31 Gambar 4.8 Grafik Infeksi selama di ICU ................................................... 32 Gambar 4.9 Grafik Jenis Infeksi dan Kultur .................................................. 33 Gambar 4.10 Grafik Persentase Biaya yang Dikeluarkan .............................. 33 Gambar 4.11 Grafik Kategori Biaya dan Outcome ....................................... 34 Gambar 4.12 Grafik Jumlah Obat yang Diberikan ...................................... 35 Gambar 4.13 Grafik Terapi Suportif Kehidupan ........................................... 38 Gambar 4.14 Grafik Terapi Suportif kehidupan dan Outcome ...................... 39 Gambar 4.15 Grafik Hasil Rawat ................................................................... 40 Gambar 4.16 Grafik Kategori lama rawat dan Outcome............................... 41 Gambar 4.17 Grafik Kategori lama rawat dan Outcome................................ 43
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DAFTAR LAMPIRAN
Lampiran : Kuesioner ...................................................................................... 48
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