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Dept. of Internal Medicine
Objectives
Geriatric Medicine
Geriatric Medicine
Definition:
Goal:
Optimize function
Multiple disciplines involved physician,
nursing, rehabilitation medicine, social work
Geriatric Medicine
Geriatric Medicine
Demography
Life expectancy:
75 years at birth
82 years at 65
Demography
Downloaded from: Cecil Essentials of Medicine (on 5 March 2005 09:38 PM)
2005 Elsevier
Aging
alterations in biochemistry,
decrease in physiologic capacity and
increased disease susceptibility
Theories of Aging
stress
Genetically regulated aging
Oxidative Stress
Oxidative Stress
Genetically Regulated
Normal Aging
Normal Aging
accompanied by typical
nonpathologic losses of physiologic
function
Successful
Physiologic
Normal Aging
Diet
Exercise
Psychosocial factors
Treatment of Disease
Treatment
Treatment of Disease
Failure to thrive
Acute change in appetite
Decline in self-care capacity
Onset of falls
Change in intellectual function
New onset of incontinence
reserve
More prone to the adverse effects of
bed rest
Physiologic Consequences
Cardiac
output declines/Pulmonary
volumes decline
Urinary concentrating ability decreases
Decrease
Prevention
Passive
Comprehensive Geriatric
Assessment
Improves function
Repetition of functional assessment may
be used to gauge impact of therapy
More appropriate medication use
May decrease number of acute care days
Functional Status
Downloaded from: Cecil Essentials of Medicine (on 5 March 2005 09:38 PM)
2005 Elsevier
2.
3.
Components of CGA
Geriatric Syndromes
1.
Cognitive Disorders
Dementia/Delirium
2.
3.
4.
5.
6.
Polypharmacy
Falls/Gait Instability
Urinary Incontinence
Depression
Malnutrition
Components of CGA
Components of CGA
of Daily Living
Instrumental Activities of Daily Living
Cognitive Impairment
Cognitive Impairment
dwelling patients
Prevalence
much greater in
institutionalized settings
Cognitive Impairment
ORIENTATION
Ask for year, season,
date, day, month
Ask for state, county,
town, place,street
REGISTRATION
Name three unrelated
objects. Ask patient to
repeat
ATTENTION/
CALCULATION
- Subtract 7 from
100,repeat 5 times
RECALL
Recall three previous
objects
LANGUAGE
Show wrist watch and
ask what it is
Ask to repeat no, ifs
ands or buts
On blank piece of paper
print Close your eyes
and ask patient to do it
Give patient a blank
piece of paper and ask
him to write a sentence
Cognitive Impairment
Depression
Depression-Screening
patients
Series of 30 YES/NO questions covering
symptoms and manifestations of
depression
Takes 10-15 minutes to administer
Score > 14 greatly increases
probability of depression
Score < 9 greatly decreases probability
YES/No
Depression- Screening
Depression
Problems
Unsteadiness
Abnormality sitting or getting up from a
chair
Turning or walking with difficulty
Step height
Screening Tests
Balance Measures
Sitting
Gait Observations
Initiation
of gait
Step length
Step height
Step continuity
Step symmetry
Walking stance
Amount of trunk sway
Path deviation
GAIT SCORE ___/12 < 9 = HIGH
FALL RISK
Malnutrition
Indicators
Historical clues
Involuntary
Physical Exam
Glossitis,
Lab
Serum
albumin
DETERMINE Checklist
Score
0-2
3-5
>6
Good
Moderate risk
High risk
Visual impairment
13%
Hearing impairment
65-74y/o
>85y/o
25%
50%
Visual Impairment
Visual Impairment
Hearing Impairment
Performed in 90 seconds
94% sensitive, 72% specific
Functional Assessment
Functional Assessment
Transferring
Continence
Feeding
Kitchen
Bathroom
Outside the home
health
Provider service
Day care
living facility
Subsidized senior apartments
Nursing home
Conclusions
Conclusions
Conclusions
Comprehensive Geriatric
Assessment has been advanced as a
means to more effectively diagnose
and manage complex medical
problems of frail elderly
Asesmen geriatri
Tujuan :
Quality of life
Health status
Physical,sosial,mental healhty
Disease status
Physiological measuress
Sign and sympioms
Prognosis
Socioeconomy status
Environment
Fungtional status
Daily activities
Achievement
Disabilities
environment
economic
medical
Fungtionsl
Status
Affective
Social support
spirituality
Dalam Pelaksanaan
Skala asesmen kuantitatif
Panduan evaluasi
Membantu diagnosa
/form
Interpretasi /
keterbatasan
Asesmen fungsional
Asesmen medis
Asesmen Kognitif
Dimensia
Asesmen Afektif
Depresi
10 - 15% R jalan
20% r inap
GDS geriatric depression scale
Asesmen sosial
Asesmen lingkungan
Asesmen Ekonomi
Asesmen spiritual
Agama !
Kesimpulan