Professional Documents
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PROCEEDING UDAYANA UNIVERSITY HOSPITAL
INTERNATIONAL SYMPOSIUM GERIATRIC HEALTH SERVICE
Contents
Determination Of Factors Influence Pain Reduction And Adverse Drug Reaction Between 61
Amitripthyline Versus Gabapentin On Neuropatic Pain Therapy In Geriatric With Type II
Diabetes Mellitus
Md Krisna Adi Jaya, R A Tuty Kuswardhani
Depression In Elderly 69
Made Wedastra, R A Tuty Kuswardhani
Research Article
Correlation Of Sepsis And Albumin Serum Among Elderly Patients In RSUP Sanglah Bali 77
Ni Made Darma Patni Sri Rejeki, R A Tuty Kuswardhani
Correlation Between Depression And Falls Among Elderly Patient Hospitalized At Geriatric 87
Ward In Sanglah Hospital
IDG Teguh Krisna Murti, Tuty Kuswardhani
Correlation Between Immobilitation With Albumin Serum Among Elderly In Sanglah Hospital 97
Putu Dhenny Wahyu Wiguna, R A Tuty Kuswardhani
Correlation Nutrition With Mini Nutritional Assesment (MNA) And Functional Status At 105
Elderly People In Sanglah Hospital
Kadek Dwi Wulandari, R A Tuty Kuswardhani
Immobilization in Elderly Patient
RA Tuty Kuswardhani
Introduction
Physical Examination1
1. Cardiopulmonary status
2. Skin
3. Musculoskeletal: muscle tone and power, range of motion of joints, deformity
and lesions of the feet
4. Neurologic: focal weakness, perception and sensory evaluation
5. Gastrointestinal
6. Genitourinary
7. Functional status: Barthel’s Activity of Daily Living Index
8. Mental Status: screening using geriatric depression scale (GDS)
9. Cognitive status: screening using mini-mental state examination (MMSE),
abbreviated mental test (AMT)
10. Grade of mobility: Mobility on bed, transfer ability, mobility on wheelchair, gait,
pain while moving.
Work Ups1
Assessment of the severity of immobilization’s underlying medical causes (knee x-
ray, echocardiography, etc) and immobilization’s complications (albumin, electrolyte,
blood glucose, and hemostasis workups, etc).
Treatment
General Treatment
1. Multidiscipline medical team and active participation from patient, family, and
social service/retirement house
2. Informing the family about the fee of bed rest, the importance of gradual
exercise and early ambulation, and preparing patient to be independent in
doing daily routines based on patient’s ability
3. Complete geriatric assessment, functional target formulation, and treatment
plan which estimates time needed to achieve therapy’s goals.
4. Identify and treat infection, malnutrition, anemia, fluid and electrolyte
imbalance, and other comorbid conditions which might be related to
immobilization
5. Evaluate all consumed drugs, all fatigue or weakness-causing drugs should be
adjusted accordingly or totally stopped
6. Supply adequate nutrition, enough fluids and high-fiber foods, vitamin, and
minerals.
7. Commence exercise and remobilization program once medical condition’s
stability is achieved. The program includes mobility on bed, joints’ range of
motions (passive, active, and active with assistance), muscles’ strength
restoration, coordination/balance exercise (ie, walking in a straightline),
transfer with assistance, and ambulation on limited extent.
8. Assist the patient to use mobilization aid device and ambulation
9. Urination and defecation training and management, including using a toilet
Specific Treatment
1. Treatment of immobilization’s risk factors
2. Treatment of immobilization’s complications
3. Consult certain medical condition to a specialist when needed
4. Remobilize early and gradually to avoid further immobilization in a hospital
or social service/retirement house setting
5. Provide environmental and social support and mobilization aid device for
elderly with permanent disability
6. Low dose heparin (LDH) and Low molecular weight heparin (LMWH),
contracture prevention, and pneumonia prevention (what movements should
be exercised, and how to prevent decubitus ulcer).
Non Pharmacological
The effort that can be done is by doing some regular physical therapy and
physical exercise. For patients who undergo complete bed rest, changing positions
regularly and exercising in bed. Besides, early mobilization in the form of getting out
of bed, moving from bed to chair and functional exercises can be done gradually.
To prevent decubitus, one thing to be performed is eliminating cause of ulcers
which is the pressure on the skin. So, changing position in the lateral 300 can be done,
with the use of anti-decubitus mattress or a hollow pillow. Patients with a wheelchair
can do repositioning every hour or rested from sitting. Training the movement by
tilting the patient to the left and to the right and preventable friction can also prevent
decubitus. Giving oil after a bath or wetting can be done to prevent maceration.
Regular blood pressure control and review the use of drugs that can causes a
decrease in blood pressure and early mobilization need to be done to prevent
hypotension.
Monitoring the intake of fluid and foods that containing fiber needs to be done
to prevent constipation. It also needs an evaluation and assessment of the patient's
bowel habits. The provision of adequate nutrition needs to be noticed to prevent
malnutrition of a immobilization patient.
Pharmacological
Pharmacological management that primarily can be given is prevention of
thrombosis occurrence. Provision of low-dose anticoagulation heparin (LDH) and low
molecular weightheparin (LMWH) is a safe and effective prophylaxis for geriatric
immobilization patients but it is a must to consider the function of the liver, kidney
and interactions with other drugs.
Prognosis
Prognosis depends on underlying disease of immobilization and its
complication. It is to be highlighted that the underlying disease will be worsened by
immobilization if not treated early, and might even cause death.
References:
1. Anderson LC, Cutter NC.Immobility. In: Hazzard WR, Blass JP, Ettinger WH,
Halter JB, Ouslander JG. Principles of geriatric medicine and gerontology. 4thed.
New York: McGraw-Hill; 1999.p.1565-75.
2. Govinda A. Setiati S. Immobilization in the Elderly. In: Alwi I, Setiati S,
Simadibrata M, eds. Textbook of Medicine. Jakarta: PIP. 2009.
3. Kane RL, Ouslander JG, Abras IB. Immobility. In: Kane RL. Editors.Essential of
clinical Geriatrics. New York: McGraw Hill; 2004.p. 245-77.
4. Setiati S. Guidelines for the management of immobilization in geriatric patients.
In: Soejono CH, Setiati S, Wiwie M, Silaswati S. Editor. Guidelines for the
management of patient health geriatrics for doctors and nurses. Jakarta: Center for
Information and Publishing Disease In - Faculty of Medicine; 2000.p. 115-22.
Preface
This book reports the proceeding of Udayana University International Symposium Hospital Based
Geriatric Service. The purpose of this symposium was to Improving knowledge about health
services based integrated geriatric hospital, especially at Udayana University Hospital. At
Udayana University Hospital are public health services, comprehensive specialist and sub-
specialist, one of which is an integrated geriatric health care. Integrated geriatric health services
at Udayana University Hospital is also supported by human resources, as well as adequate
infrastructure, qualified line with the rules of government and national or international
accreditation commission. Based on that then held a symposium and workshop activities related
to international health services based integrated geriatric hospital, health workers and medical
students at the Udayana University. End of the word, we hope this book is useful for readers.
Best Regards
Chairwoman Of Committee
R A Tuty Kuswardhani