GERONTOLOGY, MEDICAL GERONTOLOGY

AND
GERIATRIC PRINCIPLES

Dr. H. Hadi Martono. SpPD, K-Ger

Dept.of Medicine Medical Faculty,Diponegoro University /Dr. KariadiHosp.

Semarang
 INTRODUCTION
Increase in Indonesian elderly pop. 414% from
year 1990 to 2025
2010 :ELDERLY POP. The Under 5 years
Characteristic of elderly diseases(Stieglitz,
1954) :
Multipatology, degenerative,inter-connective,
atypic presentation
Chronic,longstanding disability until death occurs
Polypharmacy iatrogenesis
Psychologic and social component
more vulnerable to other acute disease
Thats why urgently needed :
Knowledge and science about
elderly, aging process, problem of
the elderly:

Gerontology, Medical Gerontology,

Geriatric Medicine
Gerontology (Geros = old, logos = science) :scientific discipline
concerning with the aging process and problems of the elderly
(OConnel, MS, 1987).
Medical Gerontology : that branch of gerontology and medicine/health
concerning with/studying medical aspects of aging process and
problems in the elderly

Social

Gerontology Psychology

Biology Medical
Geront.
Clinic Ger = Geriatric
Medicine

Medicine/Health
 Parameter YOUNG ELDERLY
Etiology Exogenous Endogenous
Florid,obvious Occult
Spesific,single Cummulative / multiple
Recent Chronic
Symptoms onset Florid Insidious, chronic
Diseases course Sel limiting Chronic , progresive resulting in
long standing disability before
death finally occur
Give rise to immunity More vulnerable to other
disease(s)
Penyakit (Disease) pd usia
Individual Variation
muda vs lansia( Stieglietz,1954)
Small Great

Geriatric Medicine (Geros = old, iatria = to care)

BGS : that part of (general) internal medicine concerning with promotive,,
preventive, curative,rehabilitative,and psycho-social aspects of
disease(s) in the elderly
WHY?

ELDERLY HEALTH CONSEPT OTHER POPULATION

 HISTORY:
* At the ends of 1930-an,Dr.Marjorie Warren in West Middlesex
Hospital.London,England
* deal in with elderly patients
* Physically decrease in economic and social condition
* disease >
polipharmacy / iatrogenic
pgysician >
many episodes of Physic. / psycological diseases
disease burden death
*GERIATRIC MEDIINEstart and grew in Englandall over the
world

GERIATRIC MEDICINE(British Geriatric Society) :

... that part of general internal medicine concerning with
preventive, promotive, curative, rehabilitative and psycho
social aspects of illness in the elderly ...............................
GERIATRIC MEDICINE AS A DISCIPLINE
CONTAINS 4 SEPARATE AND UNIQUE ELEMENTS:
1.The Study of Aging:
*the theory of aging
*other aspects of gerontology

2.The Basic Clinical Problems of the elderly

The Geriatric Syndromes
3.Special features of diseases in old age
4.Organization and provision of medical,social and
voluntary services for old peoples
Brocklehurst and Allen,1987
GERONTOLOGICAL APLICATION IN
GERIATRIC MEDICINE:
THE THEORY OF AGING :
The error catastrophe Theory
Genetic clock Theory
The imunological Theory
The metabolism Theory
The free radicalls Theory
Thewear and tear Theory etc:
Endogenic aging

seluler Tissue AGING: the combination

anatomical Organ between exogenic and
endogenic factors
AGING intervension should be
directed toward these
Environment Life Style
factors

Exogenic factors
SOCIAL GERONTOLOGY :
*Fact of elderly-life in the community
*RETIREMENT AND ITS IMPACT
-SOCIAL-ECONOMIC
-POST POWER SYNDROME

PSYCHOLOGICAL GERONTOLOGY:
-disengagement theory
- psychological stereotype :
constructiveness
dependent
self hate
defensive
angry/hostility
 STEREOTYPE OF
PSYCHOLOGICAL PATTERN OF THE ELDERLY

Dependency
(Rocking chairman)

Defensiveness
(Armoured man)

Self haters
Hostility
(Angry man) Mature type
WHAT/WHO ARE THE GERIATRIC PATIENTS:
PERGEMI CONCENSUS : MORE THAN 60 YEARS OLD
HAVE 2-3 DISEASES/PATHOLOGIES
1996
USUALLY HAVE ALSO SOCIO-ECONOMIC &PSYCHOL.PROBLEMS

HEALTH CONCEPT IN THE ELDERLY

a. Health in the elderly=Functional capacity/status
Status/functional
* Elderly
capacity

Young

PSYCHOL. SOCIO
PHYSIC.
ECONOMIC
FUNCTIONAL STATUS:
ACTIVITY OF DAILY LIVINGKATZ INDEX
Basic ADL: A-independence in feeding,continence,transfer-
ing,toiletting,dressing and bathing
B-independence in all but one of these func.
C-but two of these func.
D-but three of these func.
E-but four of these func.
F-but five of these func./
G- dependence in all of these functions.
Instrumental ADL:-writing -using telephone
-reading -managing medication
-cooking -managing money
-cleaning -ability to perform paid
-shopping employment duties or
-doing laundry outsides work
-climbing stairs -ability to travel
b.Diseases/diagnosis of elderly
In the community
Year of the study 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
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 hearing,smell etc
GERIATRIC GIANTS
Confusion dementia
Cerebral syndromes
Falls
Inkontinentia (urine et alvie)
Bone diseases and fracture
Autonomic nervous system disorders
Decubitus/Pressure sores
 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 PSYCHOSO-
CIAL 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 physiological decr.due to aging
Disease(s) -- pathological process
Geriatric syndrome Psychol-cognitive abnormality
 WHY GERIATRIC ASSESSMENT ?:

Schematic illustration of diseases in the eklderly vs in the other population

Medical model Geriatric model (bio-psycho-

(Law of Parsimony) social)

Social-economic/environ.

Symptoms/signs
Legend
Functional / anatomic decr.due to aging
Disease(s)

Diagnosis: Geriatric assessment Physiological proc.

Patological proc.
Resources
Social envir.
 Comprehensive assessment
Anamnesis : systematic.(from hair to toe )
cognitive/medic./bad habit to health
perceived health problems(geriatric synd)
Physical :from top to bottom(systematically as above)
* vital sign * abdomen
* head * extremity
* thorax (incl.nerv.system etc)
Psycho-cognitive : - Depression / Bereavement/Anxiety
- Mini-mental test/SPMTQ)
Environment
Social - economic
 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
1. Instrumental ADL function by asking the patients if he/she can do shopping or preserving meals
by them self or with helps
2. About continence,politely asking the patient if he/she continence or not,or if he/she sometimes
soils the bed
3. The nutritional status of patients is obtained by measuring weight and height of the patient
4. The possibility of depression is sought by asking the patient if he or she sometimes feel sad or
depressed
5. 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
6. Cognitive status is examined by asking the patient to mention 3 object and asked to repeat again
after 3 minutes time
7. 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
 Assessment

Probl Identific. Resource(s) Identif.

Short period
Problem Solving Objective
Plan setting
Longer period

Program.
Task-spreading Programme Program.
Implement. Monitor. Evaluat.

Program.
Plan
Review
Hosp.disch.
TEAM IN GERIATRIC SERVICES:
COORDINATION IN CONCEPT AND ACTION
COORDINATION IN ACTION
CORE : Medical Doctor
Nurse
Medical-social worker
(family !!!)
+ others depend on situation

Multi-disciplin. Inter-&multi disciplin.

HOLISTIC ASPECTS OF GERIATRIC SERVICES
DIAGNOSIS AN ELDERLY IS HUMAN AS A WHOLE
VERTICALLY : COMM.SERVICE SUBSPESIALISTIC
HOSPITAL
HORIZONTALLY : HEALTH = A PART OF WELFARE
SERVICE
PREVENTATIVE , PROMOTIVE , CURATIVE and
REHABILITATIVE
(WHO : DISEASE , IMPAIRMENT , DISABILITY ,
HANDICAP)
Layanan Geriatri berbasis RS
BAGIAN GERIATRI
RS POLIKLINIK
-Asesmen/konsultasi
-Kuratif(sederhana)
BANGSAL AKUT:
-Asesmen/konsultasi
-Kuratif/akut
-Rehab.jalur cepat
DAY-HOSPITAL:
-Terapi terrencana/terpadu
-Ambulat/non ambulatoir
REHAB.JLR LAMBAT(Care>cure)
PENDIDIKAN/LATIHAN
PENELITIAN
LAYANAN MASYARAKAT BERBASIS RS.:
Asesmen Geriatrik
Bimbingan
Pembinaan(transfer of knowledge)
(Placement)
Rujukan
LAYANAN MASYARAKAT:
Dokter Praktek Swasta
Mental
POSYANDU LANSIA
P O P U LA S I
LAYANAN GERIATRI PARIPURNA
UNIT PSIKOGERIATRI
POLIKLINIK/Bangsal/
DAY-HOSPITAL dll
Berbagai Penyakit psik.:
-Depresi berat
CON-JOINT -Demensia(SDAT)
CARE -Paraphrenia dll
Oleh:
-Geriatris/Psikogeriatris
-Terapis
-Perawat kes.masy
-Pekerja sosio-medik
Puskesmas Dinas(sosial dll)
Fisik Sosial
Day-club-sport-rekreasi-hobby-religi dll
U SIA LA N J U T
THANK YOU