Geriatri (Specialis Lanjut Usia) Dr Davin Prasetyo Bestdokter.com

Geriatri (Specialis Lanjut Usia) Dr Davin Prasetyo Bestdokter.com

• • • •

Garis Besar Pembicaraan

Apa itu Geriatri Proses pelayanan di RS Australia (Pemerintah) Pelayanan Lansia di Komunitas Demensia/ Pikun/ Ling-lung

• Dokter:

Apa itu Geriatri

– Dokter Umum (GP) – Dokter Spesialis (Physician) – Dokter Bedah (Surgeon) – DLL: anesthetist, O&G, paediatric, ENT, Opthalmologist

Apa itu Geriatri

• Spesialis Lanjut Usia • Kenapa?

– Physiology tubuh orang lanjut usia berbeda – Penyakit ‘khusus’ lansia: • • • •

Dementia Jatuh (Fall) Masalah kencing (urinary incontinence) Banyak memerlukan obat2an (Poly-pharmacy)

– Lansia punya banyak penyakit – Holistic

Apa itu Geriatri (Perubahan di waktu Lansia)

• Jantung  mekar, detak berkurang, pembuluh darah mengeras (tekanan darah tinggi) • Paru2  susah batuk, kurang efisien untuk penukaran oksigen • Sendi2, tulang dan otot  sendi2 perkapuran (osteoarthritis), tulang melemah (osteoporosis) dan otot melemah dan tidak flexible • Perut dan usus (gastrointestinal) berkurang lendir, kontraksi perut dan usus melambat dan susah BAB • Saluran kencing  ginjal mengecil (25-30%, 30-80yo), susah kontrol kencing • Ingatan berkurang • Kulit  kurang elastis, gampang terluka, kering dan berkerut • Metabolism berkurang

Proses pelayanan di RS Australia (Pemerintah)

• Ranking dokter:

– Intern  Resident  Registrar  Spesialis

JMO

• Emergency Department - Triage (Level 1-5) •  Emergency Doctors (JMO + Registrar + Spesialis) •  Tim Medis (JMO + Registrar + Spesialis) •  Allied Health (Physiotherapist, Occupational Therapist, Social Worker, Nurses)

Proses pelayanan di RS Australia (Pemerintah)- Allied Health

• physiotherapy (exercise, mobility, strength and balance) • speech pathology (helps with difficulties in communicating, swallowing and eating) • occupational therapy (help to recover, or maintain your physical ability) • podiatry (foot care) • dietitian (nutrition assessment, food and nutrition advice, dietary changes) • Social worker (practical support, counselling, information and emotional support, find government housing, help them obtain Centrelink entitlements)

Proses pelayanan di RS Australia (Pemerintah)- Resuscitation

• NFR (Not For Resuscitation) • Advance Care Directive/ Planning • •

(health.qld.gov.au & heart.org)

Proses pelayanan di RS Australia (Pemerintah)- Resuscitation

• Kualitas Hidup VS Panjang Hidup (Quality VS Quantity)

Pelayanan Lansia di Komunitas

• myagedcare.gov.au: – Help at home

• Assessment/ ACAT (free) • Basic $ and income tested $ • Domestic help (cleaning, shopping, ironing, washing), personal care (bathing, toileting, dressing, grooming), meals (Meals on Wheels or cooking), fitness, nursing, equipment, allied health • Home care package (low level or high level) • Mesti cari provider di area


• myagedcare.gov.au: – Nursing home:

ACAT Find Apply Fee (basic fee, mean tested care fee, extra service fee, accommodation fee) • Boleh ‘liburan (52 days)’, minta pindah kamar/ tempat • • • •


• myagedcare.gov.au: – Carer:

• Counselling (emotional and psychological) • Respite (liburan)- beberapa jam  beberapa hari – – – – –

In home respite Centre based respite Overnight/ weekend respite Short stay in nursing home Carer’s payment (income tested) and carer’s allowance (not income tested, tapi ada eligibility criteria untuk penerima)

• Power of Attorney (uang) and Enduring Guardianship (lifestyle and medical)

Demesia/ Ling lung / Pikun

• Otak terdiri dari area2:

– Belajar & ingatan (learning and memory) – Bahasa (language) – Executive function (seperti reasoning, problem solving, planning) – Sosial – Perhatian (Attention)

• Demensia = penurunan fungsi di ≥ 1 area tersebut + tidak dapat melakukan kegiatan sehari-hari (tidak independen)


• Gejala2:

– Susah mengingat informasi baru – Berdebat/ reasoning – Hilang – Bahasa – Tingkah laku  Pasangan/ orang dekat/saudara


• 65-70 tahun ~ 5 per 1000 • 85 tahun ke atas ~ 6-8 per 100


• Demesia:

– Alzheimer (60-80% dementia di lansia)

• Amyloid beta deposit, neurofibrillary tangles • Penyebab? Gene APOE • Keturunan 10-30% (first degree)

– Dementia with Lewy bodies

• Lewy body di otak (anterior, temporal, insula) • Penyebab?

– Frontotemporal dementia

• Sel sel otak frontal dan temporal rusak • Keturunan ? %


• Demesia:

– Vascular dementia • stroke

– Parkinson disease with dementia

Demesia/ Ling lung / Pikun Alzheimer

Gejala awal

Gejala akhir akhir

Gejala lainnya

-Ingatan (memory) -Executive function

-Bahasa -Tingkah laku

Dementia with Lewy Body

-Perhatian -Executive function -ingatan

-Halusinasi -parkinson

Frontotemporal

Vascular

-Tingkah laku -Personality -Impulsive -Makan terus Step-wise


• Diagnosa:

– Gejala2 dari sanak saudara – Obat2 yg dapat membuat pelupa (anticholinergic, psychotrophic, sedative) – Pemeriksaan (syaraf  stroke, parkinson) – Mental State Examination – Tes darah : Tiroid/ Vit B12 – CT Brain/ MRI Brain

MMSE (Mini Mental State Examination)

• Apa : – – – – – – – – – –

Tahun Musim Tanggal Hari Bulan State Negara Kota Nama bangunan ini Lantai


• Apel, jeruk, pen


• 100-7  …  …… atau • “dunia” terbalik


• Apa tiga kata yg diingat?


• Apa ini? Apa itu? • “no ifs, ands, or buts” • Kertas, lipat dan taruh di lantai


TUTUP MATA KAMU


• Tulis kalimat



• Pengobatan:

– Cholinesterase inhibitors (donepezil, rivastigmine, galantamie) – Memantine (NMDA receptor antagonist)


• Pengobatan:

– Olah raga – Tingkah laku (depresi, halusinasi, agresif, tidur ndak benar)  kenapa? Apa gara2 sakit? • Musik, pijat, interaksi, melakukan kegiatan yg menyenangkan pasien, aromatherapy, olah raga • Obat-obatan


• Survival?

– Tergantung kapan kena demesia

• AD 65 tahun ~ 9 tahun (turun 67%) • AD 90 tahun ~ 3 tahun (turun 39%)

– Infeksi paru2, jantung, dehidrasi, kelaparan, infeksi kencing


• Pencegahan:

– Mediterranean-style diet: buah-buahan, sayur, whole grains, beans, nuts, olive oil – Olah-raga – Interaksi, beraktivitas – ? Vitamin E (2000 IU daily), ? Vitamin B, ? Omega3 fatty acids, ? Ginkgo biloba, ? Statins ? Vitamin D? – ? NSAIDS (not recommended) – X (oestrogen replacement)

Geriatri (Specialis Lanjut Usia)

• References:

– Uptodate – Google image – Webmd.com – Emedicine.com – Bestdokter.com

Geriatri (Specialis Lanjut Usia) Dr Davin Prasetyo Bestdokter.com

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