Geriatri (Geros = OLD, iatria = to care)

BGS : That branch of general (internal)medicine

con cerning with promotive,preventive,
curative , rehabilitative and psychosocial
aspects of illness in the elderly .

WHY ?:

HEALTH CONCEPT OF THE ELDERLY DIFFER FROM THAT OF

FROM OTHER POPULATION

Geriatric patients:
-are peoples who are chronologically
age (≥ 60 years old) , with multiple
diseases consist of physical, psycho-
logical and socio-economic factors

-elderly  chronological

IMPORTANT: biological age

PERGEMI
 60 years CONCENSUS
+ > 2 diseases 1996))
with psychological and/or sociological component
HEALTH CONCEPTS IN DIFFERENT
POPULATION:
Social-
Geriatric Population: environment

implicate altogetherphysical/biological,psychological
and socio-environment Psychological

Disease

Physical Geriatric
syndromes
Physical
Stat.Functi
Social-environment Psychological onal

also known as BIO-PSYCHO-SOCIAL CONCEPT

Non Geriatric Population: PHYSICAL

or Psychological

implicate either physical or psychological

CONCEPT OF HEALTH IN THE ELDERLY (cont’d)

a.HEALTH IN THE ELDERLY= FUNCTIONAL CAPACITY

*ELDERLY FUNCTIONAL STATUS/
CAPACITY

 YOUNG

PHYSIC. PSYCHOL. SOCIO-

Environment.
FUNCTIONAL-ASESSMENT:
Basic ADL:-BATHING
-DRESSING
-TOILETTING
-TRANSFERRING
-CONTINENCE
-FEEDING
INSTRUMENTAL ADL :-WRITING/READING
- CLOTHING LAUNDRY
-SHOPPING
-MANAGING MONEY
-JOURNEY (with public transport)
-use TELEPHONE etc
B) THE DIFFERENCE OF DISEASES CHARACTERISTICS OF
THE ELDERLY AND YOUNG PATIENTS
Parameter(s) Young patients Elderly

Etiologiy Exogenic Endogenic

Obvious Occult

Spesific, single Multiple,cCuummulative

Recent Long lastinChrocic

Onset of symptoms Florid Insidious, chronic

Progression of disease Sel – limiting Chronic , progresif producing

dissability long before death finally
occur

Give raise to immunity

More vulnerable to other disease

Individual variation Small Great, many variations

DIAGNOSIS/diseases IN THE ELDERLY
IN THE COMMUNITY:
Tahun Penelitian 1990 1991
Peneliti Budhi-Darmojo,Hadi-Martono dkk Budhi Darmojo,Hadi Martono dkk
Tempat Penelitian Kodya Semarang(2ds),Bndngn(2ds) Kdy.Semarang(2ds)Ungaran(2ds)
Metodologi Subyektif Obyektif
Urutan Penyakit Rematisme Katark mata
Hipertensi Rematisme
Peny.Paru Hipertensi
DM/Kencing Manis PJ Hipertensif
Peny.Jantung P.J.Lain
Gang.Mata DM
Stroke/CVD Stroke/CVD
Penyakit/penderita ---- 3,9/pdrt
Kemandirian 75-82% 84,7-94,8%
GG.Depresi Pr:2,0% Wnt:2,08% Kt:3,3% Ds:3,4%

In the HOSPITAL:
ThnPenelitian 1987 1988 1989 1993-1994
Peneliti Boedhi-Darmojo Sunaryo Hadi-Martono Hadi-Martono
Hadi-Martono
Tpt.Penelitian RSDK-St.Elizabeth Smg RSDK Smg RSDK-TlgRedjo Bag.GeriatriRSDK
Usia Pdrt >60thn >60thn >80thn >60thn
Urutan Penyakit Kard-vaskuler Infeksi Hi-tensi PJ Isk Infeksi
Infeksi Kar-vask Fr-Os-por Hi-tensi PJ Iskem
Ser-vask Neoplasma Keganasan PPOM PPOM
Neoplasmata End-Metab P.J.Isk. Stroke Stroke
End-Metab PPOM Infeksi Gg.Mata
Peny.tlng&sendi
Jml.Pnykt/pdrt ----------- 2,9 3,4 7,2
c.GERIATRIC SYNDROMES:an array of symptoms
and signs perceived by an elderly patient about his/her
health
 CAPE, et al : The “O” Complex : - Fall
- Incontinence
- Impaired Homeostasis
- Confusion
- Iatrogenic Disorders
 CONI, DAVISON & WEBER : “The Big Three”
- Intelectual Failure
- Instability /immobility
- Incontinence
 SOLOMON et al : the 13 I
Imobility Isolation Impaction
Instability Impotence Iatrogenic
Intelectual Impairment Imuno-deficiency Insomnia
Incontinence Infection Impairment of vision
Inanition Impecunity hearing,smell etc
 GERIATRIC GIANTS
Cerebral-syndromes
Autonomic disorders
Confusion – dementia
Falls
Incontinence
Bone diseases and fractures
Pressure sores/Decubitus
 GERIATRIC ASSESSMENT:
 IS A MULTI DIMENSIONAL ANALYSES DONE BY GERIATRIST AND/OR
GERIATRIC (INTERDISCIPLINARY) ASSESSMENT TEAM IN ORDER TO
REVEAL THE MEDICAL CAPABILITY,FUNCTIONAL AND PSYCHO-
SOCIAL ASPECTS OF AN ELDERLY PATIENT SO THAT AN OVERALL
AND CONTINUOUS MANAGEMENT OF THE PATIENT CAN BE DONE
…………… ……………………………………………. (Shaw et al 1984
Mykita 1992)

PRINCIPALLY DIFFERENT FROM DIAGNOSTIC PROCEDURE TO OTHER

POPULATION SEGMENTS DUE TO DIFFERENT CHARACTERISTIC OF
BOTH PATIENTS

 THE OBJECTIVE IS TO REVEAL:

Functional status Socio-economic resources
Environment  hazards for health
Physical pathological process
Disease(s) physiological decr.due to aging
Psychol-cognitive  Depression scale/
Geriatric syndrome MMSE/PSME
WHY GERIATRIC ASSESSMENT?:
SCHEMATIC ILLUSTRATIONS OF HEALTH
IN THE ELDERLY VS IN THE YOUNG PATIENTS
Medical model Geriatric models(bio-psycho-social)))
(Law of Parsimony)
Psychological Functional status

Geriatric
syndromes
Social-economic/environment
Phsysycal/
biological
Diseases
Signs/symptoms
Legend:
Fungtional / anatomical decrease
Disease(s)

Diagnosis: geriatric Functional status

assessment Geriatric syndromes
Diseases
Comprehensive Assessment
 Anamnesis :systematic.(from top to bottom)
cognitive/drugs-medic./bad habit
to health,depression
 Physical :from top to bottom(systematic.
see above) REGARDLESS
OF
* vital sign * abdomen COMPLAINTS+/-
* head (incl.cran. nerve) * extremity
* chest
 Psycho-cognitive : - Depresi / Bereavement/Anxiety
- Mini mental testdementia
 Environment (floor,lighting,bath-room/Closets etc)
 Social - economic social life,resources
 Simple Asesment recommended by AGS - AAIM
for basic health service/ non geriatrist doctor
1. Absence or presence of defect in visions is performed by Schnellen or modified Schnellen
test to both eyes
2. Abnormality in hearing by speaking softly to each ear
3. Function of upper extremity is tested with shake hand test to both arms and by asking the
patient to raise each hand above the head (the left and right hand respectively )
4. Function of the lower extremity by asking the patient to raise from the chair and walks
5. Basic-ADL function by asking the patient if he/she can raise from the bed,eat and bathing
all by
them self without help or with little help from carers
6. Instrumental ADL function by asking the patients if he/she can do shopping or preserving
meals by them self or with helps
7. About continence,politely asking the patient if he/she continence or not,or if he/she
sometimes soils the bed
8. The nutritional status of patients is obtained by measuring weight and height of the
patient
9. The possibility of depression is sought by asking the patient if he or she sometimes feel sad
or depressed
10. Social-economic support is sought by asking if there is/are someone to support them
economic-ally if he/she is sick or in other emergency situation
11. Cognitive status is examined by asking the patient to mention 3 object and asked to repeat
again after 3 minutes time
12. Information on environment is obtained by asking the patient about hazards in his/her
home (high step ladder etc),about lighting and about cleanliness of his/her
bathroom/closets
 COMPREHENSIVE GERIATRIC CARE

Elderly patient

Geriatric Assessment

Social-Economic-Spir-environment Physical Psychological

Phys.decre Path.pro
ase due to cess
aging

Family,care-giver, Self income, Religousity, Nutrition Liver, DM, Depression,

house-contour, fam.&rel.income spirit.life kidney, stroke, bereavment
toilet,bath room, eyes,ear, IHD, delirium,
electricity,security dentistry COPD, dementia
etc. taste, arthritis,
smell Pneumo
nia,
HT,UTI,
Geriatric syndromes CKD,etc

FUNCTIONAL STATUS

Basic and instrumental ADL 56

 Functional Status
S (inside
O the
hospital
CGAPROBLEMS Geriatric syndromes L by
V geriatric
Diseases team)
(incl.nutrition) E
TIM PD PELAYANAN GERIATRI
PENYERASIAN/PELAKSANAAN KONSEP (“team of
concept”)
PENYERASIAN KONSEP+PENATALAKSANAAN (“team of CONCEPT
&WORK”)

INTI : Dokter
Perawat
Pekerja sosio- medik
+ lain2 sesuai situasi ( keluarga !!!)

Tim multi disiplin Tim inter disiplin