REFRESHING

GERIATRIC PROBLEM

ARRANGED BY:

Name : Siti Halimah Intan

NIM : 2013730101
PRECEPTOR: dr. Hj. Ihsanil Husna, Sp.PD

Department of Internist
Jakarta Islamic Hospital of Cempaka Putih
Medical Faculty of Muhammadiyah Jakarta University
2017
 DEFINITION

Geriatric syndrome is a set of clinical conditions in the

elderly that can affect the patient's quality of life and is associated
with disability. Uncommon clinical appearance often makes geriatric
syndrome undiagnosed.
 EPIDEMIOLOGY

The number of elderly people in Indonesia reaches the top

five in the world, which is 18.1 million in 2010 and will double to 36
million by 2025. The life expectancy of Indonesians is 67.8 years in
2000-2005 and became 73.6 years in 2020-2025. The proportion of
elderly increased 6% in 1950-1990 and to 8% today. The estimated
proportion rise to 13% by 2025 and 25% by 2050. By 2050 a quarter
of Indonesia's population is elderly population, compared to the
current one-twelveth of Indonesia's population
Classification Intellectual
Impairment Impairment
Impairment
of Hearing of Visual

Inanition
Isolation

Instability Impaction
and Falls

Geriatric
Syndromes
Impotence Incontinence

Immuno
Iatrogenesis deficiency

Immobilization Infection
Insomnia
 Immobility
• Mobility limitation is common in older adults
and is associated with increased rates of
morbidity, hospitalization, disability, and
mortality
• Immobility is reduced ability of motion or
inability to move for 3 days or more,
accompanied by anatomical motion lost due
to changes in physiological function.
 Immobility
• Physical activity should be encouraged for all
elders, particularly sedentary elders. Protocols
for hospitalized elders that promote walking
two to three times daily and sitting upright for
much of the day can minimize unnecessary
immobility
 Instability (Falls)
• About one-third of people over age 65 fall
each year, and the frequency of falls increases
markedly with advancing age.
• About 10% of falls result in serious injuries,
such as fractures, soft-tissue injuries, and
traumatic brain injuries.
 Instability (Falls)
• With age, balance mechanisms can become
compromised and postural sway increases.
These changes predispose the older person to
a fall when challenged by an additional insult
to any of these systems.
• Patients who are unable to get up from a fall
are at risk for dehydration, electrolyte
imbalance, pressure sores, rhabdomyolysis,
and hypothermia.
Instability (Falls)
 Incontinence
• Incontinence is unconscious expenditure of
urine (or feces), in sufficient quantities and
frequencies causing health or social problems.
• Urinary incontinence is defined as
uncontrolled release of urine at an
undesirable time regardless of frequency and
number, resulting in social and hygienic
problems.
 Incontinence
The causes of incontinence are derived
from:
• urological disorders (inflammation, stones,
tumors),
• neurologic disorders (stroke, spinal cord injury,
dementia),
• or other (immobilization, environment).
 Incontinence
The causes of incontinence are derived
from:
• urological disorders (inflammation, stones,
tumors),
• neurologic disorders (stroke, spinal cord injury,
dementia),
• or other (immobilization, environment).
 Incontinence
Acute Urinary
Incontinence
Reversible

Urinary incontinence stress

Urinary
Incontinence Urgency urinary incontinence
Persistent
Urinary Increased urinary incontinence /
incontinence overflow
Functional urinary incontinence

Incontinence Reflex

Total incontinence
 Impecunity
• Impecunity (poverty), the age of the elderly
where a person becomes less productive (not
unproductive) due to decreased physical
ability to move.
• The retirement age in which some elderly
people only rely on life from their old age
benefits.
 Infection
• Infection is closely related to decreased
immune system function in elderly. Common
infections are urinary tract infections,
pneumonia, sepsis, and meningitis.
• Infection in the elderly is the cause of
morbidity and death no 2 after cardiovascular
disease in the world.
 Infection
Clinical symptoms of infection in the elderly :
• Fever
• Symptoms are not specific:
- Anorexia
- Fatigue
- Weight
- Incontinence (acute)
- Fall down
- Mental confusion
• Symptoms due to comorbidities
 Isolation
• Major depressive disorder occurs in up to 5% of
community-dwelling older adults, whereas
clinically significant depressive symptoms-often
related to loss, disease, and life changes-are
present in up to 16% of older adults.
• Older patients with depression are more likely to
have somatic complaints, less likely to report
depressed mood, and more likely to experience
psychotic features than younger patients. In
addition, depression may be an early symptom of
dementia.
 Isolation
• Treatment may involve psychosocial
interventions, increased physical activity,
problem-solving therapy, cognitive-behavioral
therapy, reduction of alcohol or medication
intake, antidepressant medications, or a
combination approach.
 Intelectual Impairment
Dementia is an acquired, persistent, and progressive
impairment in intellectual function, with compromise of
memory and at least one other cognitive domain,
• most commonly aphasia (typically, word-finding
difficulty),
• apraxia (inability to perform motor tasks, such as
cutting a loaf of bread, despite intact motor function),
• agnosia (inability to recognize objects), and
• impaired executive function (poor abstraction, mental
flexibility, planning, and judgment).
 Intelectual Impairment
The principle of dementia management is the
optimization of patient function, recognizing
and addressing complications, ongoing care,
family information, and family advice.
 Impairment of Vision and Hearing

• Visual impairment due to age-related

refractive error ("presbyopia"), macular
degeneration, cataracts, glaucoma, and
diabetic retinopathy is associated with
significant physical and mental health
comorbidities, falls, mobility impairment, and
reduced quality of life.
 Impairment of Vision and Hearing

• Hearing loss is very common in geriatrics

• The prevalence of moderate or severe hearing
loss increased from 21% in the age group 70
years to 39% in the 85-year-old age group
• Hearing loss due to noise caused by excessive
acoustic energy that causes permanent
trauma to the hair cells.
 Impairment of Vision and Hearing

• Sensory presbycusis often found in geriatrics is

caused by degeneration of the cortic organ,
and is characterized by high frequency hearing
loss
• Management for hearing loss in geriatrics is by
pairing hearing aids or by surgical action in the
form of cochlear implantation.
 Inanition

• Anorexia in the elderly is a physiological

decrease of appetite and dietary intake that
causes unwanted weight loss.
• Nutritional deficiency is caused by patient’s
condition with swallowing disorder, thus
decreasing the patient’s appetite
 Inanition
• Useful laboratory and radiologic studies for
the patient with weight loss include complete
blood count, serum chemistries (including
glucose, TSH, creatinine, calcium, and in men,
testosterone), urinalysis, and chest
radiograph.
• Oral nutritional supplements of 200- 1000
kcal/day can increase weight and improve
outcomes in malnourished hospitalized elders.
 Iatrogenics

• There are several reasons for the greater

incidence of iatrogenic drug reactions in the
elderly population, the most important of
which is the large number of medications that
elders take
• Drug metabolism is often impaired in elders
due to a decrease in glomerular filtration rate
as well as reduced hepatic clearance.
 Immunodefficiency

Immunodefficiency affects much of the immune

system's decline in old age, such as thymus
atrophy (a gland that produces T lymphocytes),
although not very significant (appears to be
significant in T lymphocytes CD8) because T
lymphocytes persist in other lymphoid tissues.
 Insomnia

• Insomnia, can occur because of problems in

life that causes an elderly person to become
depressed.
• In addition, some diseases can also cause
insomnia such as diabetes mellitus and
thyroid gland hyperactivity, neurotransmitter
disorders in the brain can also cause insomnia.
• Changed sleep hours can also be the cause
 Impotence

Impotency (Impotence), inability to engage in

sexual activity at an advanced age mainly caused
by organic disorders such as hormonal disorders,
nerves, and blood vessels.
 Irritable Bowel
• Irritable bowel (sensitive colon-easily
stimulated) to cause diarrhea or constipation /
impaction (constipation).
• The cause is unclear, but in some cases there
are disorders of the intestinal smooth muscle,
other possible disorders are intestinal sensory
nerve disorders, central nervous system
disorders, psychological disorders, stress,
nerve-stimulating gas fermentation, colitis.
 TREATMENT
• The geriatric patient's plenary approach differs from
standard medical review in three ways, focusing on
elderly patients with complex problems; including
functional status and quality of life; requires an
interdisciplinary team.
 TREATMENT

Adequate dietary intake

Regular exercise Prevention of infection
of protein, vitamin C, D,
arrangements. with vaccine
E, & minerals.

Treatment therapy in
elderly patients is
Anticipate events that
significantly different
can cause stress
from patients at a young
age
 REFERENCE
• Maxine A, Stephen J M. 2017. Current Medical Diagnosis and Treatment:Geriatric Disorders.
New York, NY:McGraw-Hill.
• Kane RL, Ouslander JG, Abrass IB, Resnick B. 2008. Essentials of clinical geriatris. 6th ed. New
York, NY:McGraw-Hill.
• Setiati S, Harimurti K, Dewiasty E, Istanti R, Sari W, Verdinawati T. Prevalensi geriatric giant
dan kualitas hidup pada pasien usia lanjut yang dirawat di Indonesia: penelitian multisenter.
In Rizka A (editor). Comprehensive prevention & management for the elderly:
interprofessional geriatric care. Jakarta: Perhimpunan Gerontologi Medik Indonesia;
2013:183.
• Setiati S, Harimurti K, Roosheroe AG. 2006. Buku ajar ilmu penyakit dalam. Jilid III.
• Stanley M, Patricia GB.2006. Buku Ajar Keperawatan Gerontik. Edisi 2. Jakarta: EGC
• Hadi M, Kris P. 2014. Buku Ajar Boedhi-Darmojo Geriatri Ilmu Kesehatan Usia Lanjut. Jakarta:
Badan Penerbit FK UI.