PEMENUHAN KEBUTUHAN

AKTIVITAS PADA LANSIA

Emmelia Astika Fitri Damayanti,S.Kep,Ns
Program Studi Ilmu Keperawatan
Fakultas Kedokteran UNLAM
 TUJUAN INSTRUKSIONAL KHUSUS
 Mahasiswa mampu memahami aktivitas pada
lansia
 Mahasiswa mampu memahami aktivitas pada
lansia dengan demensia
 Mahasiswa mampu memahami kejadian jatuh
pada lansia
 Mahasiswa mampu memahami managemen
keperawatan pada kejadian jatuh pada lansia
 ACTIVITY OF DAILY LIVING
 Include the things that most adults do
everyday, often without special attention or
effort.
 Older adults  modification and the use of
assistive device that help maintain
independence.
 Basic activities of daily living include the
everyday personal care tasks related to
hygiene, nutrition, and elimination.
 PHYSICAL EXERCISE ACTIVITIES
 Maintain health, preserve the ability to perform
ADLs, and improve the general quality of life
 Benefit of physical activity  prevention of
heart disease, reduced risk of osteoporosis,
promotion of appropriate weight, promotion of
more restful sleep, promoting muscle strength,
joint flexibility, and reduce the risk of falling
by increasing agility.
 EXERCISE
 Walking
 30 mnts or more everyday
 Starting with only 5 mnts each day and
gradually working up to 20 – 30 mnts per day
 Drinking water before and after exercise
 Clothing worn for exercising  allow for easy
movement and perspiration
 Athletic shoes  support and protection
 Nurses should advice older adults to stop
exercising and seek help if they experience
chest pain or tightness, shortness of breath,
dizziness or lightheadedness, or palpitations
during exercise.
 ACTIVITY AS AFFECTED BY
LIFESTYLE CHANGES
A. RETIREMENT
 Replacement of work with meaningfull

activities
 Activity in retirement  socialization needs
 Past interest or develop new areas of interest
 Volunteer in community organization, start

second career
B. RELOCATION
 From their homes to the homes of their children or

grandchildren or a long term care facility

 The usual pattern of activity are disrupted.
 Long term care facility will have different option

for activities
 Nurse role  support effort to become accustomed

to new situation and opportunities, monitor the

effect of the stress of relocation on health
Activity programming in long term care facility:
 Individual (one on one activities)
 Small group
 Large group
 ACTIVITIES IN LONG TERM CARE
FACILITIES
 EXERCISE
 Walking programs
 Dancing

 SPECTATOR ACTIVITIES
 Television (selected programming)
 Videotaped movies
 Live performances at the facility
 PARTICIPATIVE ACTIVITIES
 Games
 Adaptations of TV game shows
 Field trips to museums, sports event
 Picnics
 Fishing

 CREATIVE ACTIVITIES
 Art projects (painting)
 Crafts (woodworking)
 Gardening
 Cooking
 Music (vocal or instrumental performances by residents)
 INTERGENERATIONAL ACTIVITIES
 Visits from children’s groups

 PETS OR OTHER ANIMALS

- Domestic animal kept at the facility
C. LOSS OF SPOUSE
o The loss of spouse disrupt both joint activities and

those activities where one spouse supported the

other
o Part of the process of grief and recovery from grief

is the adoption of a new pattern of life  new

pattern includes new activities or resumption of
former activities, making new friends
o Stress experienced by the older adult may lead to

alterations in health
ACTIVITIES FOR OLDER ADULTS WITH
DEMENTIA
 At the heart of planning activities for an older
adult with dementia is the desire to preserve
the remaining physical and cognitive abilities
and to promote independence
 MEANINGFUL ACTIVITIES FOR
OLDER ADULTS WITH DEMENTIA
 Meaningful activities have an obvious purpose
 Meaningful activities are voluntary
 Meaningful activities support a sense of well-
being
 Meaningful activities are consistent with social
status
 Meaningful activities positively reflect the
perception of self
FALLS IN THE ELDERLY
 Prevalence
 30% of those over 65 fall annually
 Half are repeat fallers
 Falls go up with each decade of life
 Over half of those in nursing homes and
hospitals will fall each year
 6% of falls results in hip fracture
 Prevalence
 In the first year following fracture
• 25% patiend die
• At least 50% will not recover to their
pre-fracture functional level
• 25% - 50% will be admitted for
institutional care
Tren kejadian jatuh pada lansia
Kejadian kematian akibat jatuh
Perbandingan lama rawat inap akibat jatuh
dan non jatuh pada lansia
 Impact of Hip Fractures
 25% die within 6 months
 60% have restricted mobility
 25% remain functionally more dependent
 Falls Cause Morbidity and Mortality
 Fractures: 6% of falls
 Soft tissue injury, head injury, subdural hematoma
 Fear of falling can result in decreased activity and
isolation
 Nursing home placement and loss of independence
 Falls are Multifactorial
Intrinsic Factors Extrinsic Factors

Medical Medications
conditions
Impaired vision Improper use of
and hearing assistive devices
FALLS

Age related Environment

changes
 Falls in the Community
 Accidents/environment 37%
 Weakness, balance, gait 12%
 Drop attack 11%
 Dizziness or vertigo 8%
 Orthostatic hypotension 5%
 Acute illness, confusion, drugs,

decreased vision 18%

 Unknown 8%
NURSING MANAGEMENT
OF FALLING IN ELDERLY
 Evaluation of Falls: History
 Location & circumstances of fall
 Associated symptoms
 Medications (including nonprescription)
and alcohol
 Injury & ability to get up
 Evaluation of Falls: Physical Examination
 Supine and standing - always
 Routine physical examination
• Focus on cardiovascular, musculo,
neuro, feet
 Vision and hearing evaluation
 Consider acute medical illness
 Formal gait and balance assessment
 Evaluation of Falls: Home Evaluation
 Stairs
 Lighting
 Clutter/berantakan
 Bathroom
 Specific hazards: cords/tali, throw
rugs/karpet
 SPECIAL TESTING
 STATIC BALANCE (sternal nudge)
 This is a test of the righting reflex and can be
done with two persons and the client. One
examiner stands in front of the client and one
behind;the examiner in front pushes on the
client’s sternum to displace the client. If the
test is positive, the client will begin to fall. A
negative test result when the client is able to
maintain standing balance despite the nudge.
 DYNAMIC BALANCE
 Observance of the client walking and during
changes in position
 Assessment tool:
1. Tinetti Balance and Gait Evaluation
2. The Timed Up and Go Test (TUG)
 Tinetti Balance and Gait Evaluation

 Instruction: client is seated in a hard, armless chair.

The following maneuver are tested:
1. Sitting balance
0 = leans or slides in chair
1 = steady and safe

2. Arise
0 = unable without help
1 = able, but use arm to help
2 = able without use of arm
3. Attempts to arise
0 = unable without help
1 = able, but requires more than one attempt
2 = able to arise in one attempt

4. Immediate standing balance (first 5 second)

0 = unsteady (e.g., staggers, moves feet)
1 = steady but uses walker or cane or grabs another object for
support
2 = steady without walker, cane, or other support

5. Standing balance
0 = unsteady
1 = steady, but has a wide stance or uses a cane, walker, or
other support
2 = narrow stand without support
6. Nudge (with subject at maximum position with
feet as close together as possible. Examiner pushes
lightly on client’s sternum three times with palm of
the hand)
0 = begins to fall
1 = staggers, grabs, but catches self
2 = steady

7. Eyes closed (with subject at maximum position as

in number 6)
0 = unsteady
1 = steady
8. Turn 360⁰
0 = discontinuous steps
1 = continuous steps
0 = unsteady (e.g. grabs staggers)
1 = steady

9. Sit down
0 = unsafe (e.g. misjudges distance, falls into chair)
1 = uses arms or does not use a smooth motion
2 = safe, smooth motion
 The Timed Up and Go Test (TUG)

 Quickness in getting up from a seated position,

walking, and sitting down.

 The test is timed and result are corelated with

prognosis
 The Timed Up and Go Test (TUG)

≤ 10 detik Normal

11 - 20 detik mobilitas baik, boleh berjalan sendiri, tdk

perlu alat bantu jalan
21 - 30 detik bermasalah, tdk boleh berjalan sendiri,
perlu alat bantu jalan
≥ 30 detik mobilitas terganggu /
Standard Arm Chair risiko tinggi roboh

3 meter

• Dapat digunakan alat bantu jalan tetapi tidak dibantu orang lain

• Tidak terdapat batasan waktu

• Dapat berhenti / istirahat (tidak duduk) atas kemauan sendiri

• Dapat diberikan latihan dulu sebelum tes dilakukan

(Podsiadlo and Richardson, 1991)