Aspek Geriatri Pada Radiologi

Dr. Fanani, Sp.Rad

Pengaruh Penuaan
Fisik
Kognitif
Psikososial

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 2

Perubahan Fisik Akibat Penuaan

Keluhan kesehatan yang paling sering pada lansia :

Penambahan berat badan
Fatigue
Massa tulang berkurang
Kekakuan sendi
Kesepian
Latihan adalah kunci untuk mengurangi empat
keluhan pertama pada daftar
Keseimbangan, koordinasi, kekuatan dan kecepatan
reaksi menurun bersama dengan penambahan usia
Mosby items and derived items 2007, 2003,
1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 3

Perubahan Fisik Akibat Penuaan

Penglihatan, pendengaran, penciuman
dan indra perasa juga menurun dengan
bertambahnya usia
Bantuan yang dapat diberikan :

Berikan

instruksi satu per satu

Kurangi kebisingan di sekitarnya
Bicaralah dengan pelan, jelas dan langsung
pada pasien
Sesuaikan volume suara dengan
pendengaran pasien
Mosby items and derived items 2007, 2003,
1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 4

Efek Kognitif
Penyakit Alzheimer adalah bentuk
dementia yang paling sering didapatkan
pada lansia
Dementia = gangguan kognitif yang
progresif yang pada akhirnya akan
mempengaruhi fungsi sehari-hari

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 5

Efek Psikososial
1 dari 5 orang berusia >65 tahun
menunjukkan tanda-tanda depresi klinis
each elderly person is unique and
deserves respect

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 6

Top 10 Chronic Conditions of 65+

Arthritis
Hypertension
Hearing impairment
Heart disease
Cataracts

Deformity or
orthopedic impairment
Chronic sinusitis
Diabetes
Visual impairment
Varicose veins

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 7

Aging of Organ Systems

Integumentary system disorders
Nervous system disorders
Sensory system disorders
Musculoskeletal system disorders
Cardiovascular system disorders
Gastrointestinal system disorders

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 8

When an examination of the geriatric

patient is complete, you must assist the
patient with returning to the dressing
room, caretaker, or waiting room.
The elderly patient must not be left
alone in the radiographic imaging room,
because he or she may become
confused and may be in danger of
falling from the radiographic table.

Changes Associated with Aging

Older adults may have nonspecific

symptoms such as:
Dizziness
Falls

for no apparent reason

Infections without fevers
Urinary Incontinence

As a radiographer, you must be able to

differentiate what is a normal from what
is pathological.

Integumentary System

Normal Changes
The

skin wrinkles, becomes lax, and loses

turgor
The vascularity of the dermis decreases,
and the skin of white people begins to look
paler and more opaque
Brown macules called Lentigines appear
on the back of the hands, on the forearms,
and face
Seborrheic keratoses and Actinic

Implications for the Radiographer

The skin of the geriatric is fragile and
thus more easily traumatized.
You must ensure that the skin of the
elderly patient is not damaged during
the exam.
Lying on a hard radiographic table may
be especially painful for the geriatric
patient; place a full table pad for
comfort.

Changes in the Head and Neck

Normal Changes of Aging

There

is mild loss of visual acuity,

particularly Presbyopia
Tear production is either reduced or
increased
Sensory, neural, and conductive changes
occur in the ear
Hearing loss is common
There is loss of muscle mass in the neck
Kyphosis

Implications for the Radiographer

Assist the patient at all times. Sudden
change in lighting may cause
momentary blindness.
You must ascertain that the patient is
able to hear your directions and speak
loudly enough for the patient to
understand.
Be especially careful to clearly state
instructions and check for

Pulmonary System

Normal Changes of Aging

Lung

capacity diminishes
The cough reflex becomes less effective
The normal respiratory defense mechanism
lose effectiveness

Implications for the Radiographer

Patients with chronic pulmonary disease
cannot be expected to lie flat for more
than brief periods of time, since this
position increases dyspnea.
During chest radiographic examination,
when possible, ask the patient to hold
his or her breath on the second full
inhalation to ensure full lung expansion.
During an UGI, position the patient in an

The Gastrointestinal System

Normal Changes of Aging

Gastric

secretion, absorption and motility

decreases
The abdominal muscles weaken
Many patients are edentulous (without
teeth), have dentures or partial plates
Esophageal motility declines

Implications for the Radiographer

Due to patient fasting, schedule the
exam early in the morning so that the
patient can have breakfast close to
usual time.
You must instruct the patient to drink
slowly to avoid choking.
Position the patient in an upright
position to prevent aspiration.

The Patient Who Has Had

Arthroplastic Surgery
Total joint replacement has become a
common procedure in hospitals throughout
the United States
Arthroplasty is indicated for patients for the
following reasons:

Severe

degenerative joint disease

Joint deformities
Trauma

Cont.
Most common Arthroplasty in geriatrics:
Hip and Knees
Take extra care when doing portable
radiography on patients with post
surgical Arthroplasty
The most common complication after
hip replacement is dislocation of the
prosthesis
You must understand the needs of the

Cultural Considerations and

Aging
One must take culture differences when
imaging patients.
Some elderly patients are accepting of
whatever treatment is offered, whereas
others require a detailed explanation
from the family members.
Whatever the culture of the patient, you
must take these differences into
consideration with sensitivity.

Elder Abuse
It is estimated one out of every 20
seniors experience elder abuse.
Elder abuse is: The neglect,
mistreatment or exploitation of anyone
age 65 or older (or any disabled
dependent adult).
There are 3 categories of elder abuse:

1. Domestic elder abuse

2. Institutional elder abuse
3. Self-neglect or Self-abuse

Recognizing the Warning Signs

of Abuse
Physical abuse
Sexual abuse
Emotional or Psychological abuse
Neglect
Financial abuse

Avoiding Elder Abuse or Neglect

During Imaging Procedures
Avoid pinching patients skin when moving
or transferring the patient from gurney or
wheelchair onto the radiographic table.
When immobilizing elderly patients, utilize
the standards of care for immobilizing the
geriatric patient as prescribed by your
institution during radiographic procedures.
Assist the geriatric patient when they ask for
help.

Patient Care of Elderly: Quick Tips

Edukasi pasien dan keluarga

Mengurangi

stress dan kegelisahan pasien

Meningkatkan kepatuhan dan kepuasan

Bicara lebih pelan dan lebih dekat

Treat patient with respect and dignity

Komunikasi

dengan hangat, empati, dan

sikap positif
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1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 25

Patient Care of Elderly: Quick Tips

Sediakan waktu istirahat antar

pengambilan gambar dan prosedur
tindakan
Mengurangi

Hindari penggunaan pita perekat

Mudah

vertigo dan resiko jatuh

menyebabkan kerusakan kulit

Gunakan alas meja pengambilan

gambar dan tempat pegangan tangan
Mosby items and derived items 2007, 2003,
Meningkatkan
kepatuhan dan
1999 by Mosby, Inc., an affiliate of Elsevier Inc.

kenyamanan
Slide 26

Patient Care of Elderly: Quick Tips

Sediakan selimut, spons dan alat bantu
lainnya untuk pengaturan posisi
Meningkatkan kenyamanan dan
mengurangi resiko injury

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 27

Patient Care of Elderly: Quick Tips

Carefully check patient history before

contrast administration
Mengurangi

efek samping, seperti

dehidrasi, gagal ginjal
Adakah kesulitan menelan
Berikan cairan dengan posisi tegak untuk
mengurangi resiko aspirasi

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 28

JCAHO Criteria
Age-specific competency for all health
care professionals required
Age-related care specifics include
assessment of

Visual

or hearing impairments
Digestive and esophageal problems
Grief concerns
Provision of warmth and safety aids
Mosby items and derived items 2007, 2003,
1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 29

JCAHO Criteria
Appropriate age-specific communication
skills are required
Knowledge of age-related changes and
disease processes assist radiographers
in providing needed care to elderly

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 30

Radiographers Role
Adapt procedures to accommodate
disability and disease
Understanding of physiology and
pathology of aging
Awareness of social, psychological,
cognitive, and economics of aging

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 31

Radiographic Positioning for Geriatric

Patients

Chest
For

PA, wrap arms around upright device to

increase support and security
Provide support and stability in moving
arms up and forward for lateral
Perform examination in wheelchair and
note projection change for radiologist
Hyperkyphosis changes positioning
landmarks
Mosby items and derived items 2007, 2003,
1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 32

Radiographic Positioning for Geriatric

Patients

Spine
Use

sponges and table pad

Upright more comfortable for those who are
able
Seated position may be used for
examinations that require upright position

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 33

Radiographic Positioning for Geriatric

Patients

Pelvis/Hip
Fractures

common = do not rotate limb until

fracture has been ruled out
Cross-table lateral often more comfortable
In nontrauma patients, sandbags useful to
support rotation of limbs

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 34

Radiographic Positioning for Geriatric

Patients

Upper extremity
Limited

flexibility and mobility present

positioning challenge
Contracture of limbs caused by stroke must
not be forced into position
Sponges, sandbags, and use of cross-table
projections useful

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 35

Radiographic Positioning for Geriatric

Patients

Lower extremity
Limited

flexibility and mobility present

positioning challenge
Cross-table projections useful
Feet and ankle examinations can be
performed while patient in wheelchair
Reduces need for transfer

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 36

Radiographic Positioning for Geriatric

Patients
Technical factors have to be adjusted to
accommodate disease and normal agerelated changes
To make correct technique adjustment
for diseases and age-related changes,
radiographers must know whether
disease/change is additive or
destructive

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 37

Radiographic Positioning for Geriatric

Patients

Exposure time critical

Shorter

times reduce risk of imaging

involuntary and voluntary motion
Elderly may have difficulty maintaining
required position
Breathing instructions must be carefully
communicated and practiced

Mosby items and derived items 2007, 2003,

1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 38