Professional Documents
Culture Documents
Geriatric Syndrome Workshop Tig2010
Geriatric Syndrome Workshop Tig2010
(1) Vellas, B. et al, NNWS, 1999, Volume 1; (2) Nutr Screening Initiative
Why the concern?
Malnutrition
Loss of muscle
strength
Causes of weight loss in older
persons
Causes of weight loss in older persons
• Medications
• Emotions (depression)
• Alcoholism, anorexia
• Late-life paranoia
• Swallowing problems
• Oral problems
• No money (poverty)
• Wandering (dementia)
• Hyperthyroidism, Hyperparathyroidism
• Entry problems (malabsorption)
• Eating problems
• Low-salt, low-cholesterol diet
• Shopping problems
Faktor-faktor medis (melalui anoreksia, rasa cepat kenyang,
malabsorpsi, metabolisme meningkat, pengaruh sitokin, dan gangguan
status fungsional)
• Kanker
• Alkoholism
• Gagal jantung
• PPOK
• Infeksi
• Disfagia
• Rematoid Artritis
• Parkinson
• Hipertiroid
• Sindrom malabsorpsi
• Gejala-gejala GI: dispepsia, gastritis atrofi, muntah, diare
• Konstipasi
• Gigi geligi yang buruk
Faktor-faktor psikologis
• Alkoholism
• Kehilangan
• Depresi
• Demensia
• Fobia Kolesterol
Obat-obatan
24 : normal/well-nourished
• < 17 : undernutrition
Pneumonia 3
Tuberculosis 10
Urinary tract infections 1
Bacteremia / sepsis 3
Cholecystitis 2-8
Appendicitis 15-20
Septic Arthritis 2-3
Bacterial meningitis 3
Infective endocarditis 2-3
Clinical features of infections
in elderly
• Fever
• Nonspecific symptoms :
- Anorexia
- Fatigue
- Weight loss
- Incontinence (acute)
- Falls
- Mental confusion
Sir William Osler :
37
Physio-pathology Chronic
Constipation
38
Risk Factors Constipation in Elderly
Medications
• Anticholinergic drugs
(trisyclic,antipsichotic,antihistamin,antiemetic
drug for detrusor hyperactivity) (1)
• Polypharmacy (≥ 5 medications) (1)
• Opiates, calcium supplement (2)
• NSAID, CCB (nifedipin, verapamil) (2)
• Iron suplement (2)
Impaired mobility (2)
Depression (3)
39
Risk Factors Constipation in
Elderly
Neurological conditions
• Parkinson, DM, spinal cord injury (1)
• Dementia (2), strok (3)
• Dehydration (2)
• Low dietary fiber (3)
Metabolic disturbances
• Hypothyroidism, hypercalcemia, hypokalemia
• Patients receiving renal dialysis (3)
Lack of privacy or comfort
Poor toilet acces (3)
40
Physical Examination
All patients constipation :
Rectal Touche !!
Rectal impaction ?
Rectal dilatation ?
Hemorrhoid ?
Anorectal disease ?
Perianal fecal soiling ?
41
SITI SETIATI, Geriatri IPD FKUI/RSUPN-CM, 2003
Instabilitas
Obat
Fraktur Kesadaran
Hipotermia Imobilisasi
Depresi Gangguan
Ulkus tidur
Trombosis vena
Pneumonia
ISK Dehidrasi konstipasi
Atrofi otot
Asupan cairan
Asupan makanan Malnutrisi
Summary
• Geriatric population is rising worldwide, esp. in
developing countries, including Indonesia
• Geriatric patients have special characteristics
that need to be considered
• Syndromes in geriatric geriatric giants (13 i)
• All the syndromes are inter-correlated and
should be evaluated in all geriatric patients
• The assessment and management of geriatric
patients holistic comprehensive