PROCEEDING UDAYANA UNIVERSITY INTERNATIONAL SYMPOSIUM
HOSPITAL BASED GERIATRIC SERVICE
Contents
Nutrition In Elderly : The Role Of Vit D Suplementation In The Healthy Aging 1 R A Tuty Kuswardhani
Hazzard’sInfectionIn Elderly 8
R A Tuty Kuswardhani
Vaccination TravelIn Elderly 15
R A Tuty Kuswardhani
Introduction Of Plant Based Diet Therapy for Hospital Based Geriatric Service 23 Naemi Kajiwara
Elderly Care In Netherlands Hospital 29
Maddy Stienstra Liem
Hospital Accreditation For Quality Improvement Hospital Based Geriatric Service 36 N P Arysta Kusuma Dewi
Research Article
Correlation Between Depression And Cognitive Impairment At Elderly People In Denpasar City 42 Ib Aditya Nugraha, R ATutyKuswardhani ,IgpSuka Aryana
Association Between Sleep Quality And Frailty Syndrome Among Geriatric Patients 48 At Geriatric Polyclinic Sanglah General Hospital
Adrian Tri Sutjahjo, TutyKuswardhani, I.G.P.Suka AryanaNyomanAstika, I.B.Putrawan,RaiPurnami
Correlation Of Visceral Fat Level And Poor Cognitive Function Among Elderly Population 55 In Denpasar
Erick Lios, R A TutyKuswardhani, IgpSuka Aryana
Correlation Between Hypertension And Cognitive Impairment In Elderly People In Denpasar 61 Made Arie Dwi Winarka, R.ATuty Kuswardhani ,Igp Suka Aryana
Albumin Level And Charlson Comorbidity Index Score In Predicting Length Of Hospitalization 67 In Geriatric Patients
Nutrition of Elderly in Healthy Aging
RA Tuty Kuswardhani
Geriatric Division of Internal Medicine of Udayana University / Sanglah General Hospital /
Udayana University Teaching Hospital
Introduction
Data from Central Bureau of Statistics stated that in 2011, 49% of human being population in the
world are more than 65 years old and be predicted increase to 59% in 2025.
Old people experience decrease of physical, psychological, social - environment adaptation
Frail reserves of physiologis , frailty increase disease and exponential death correlate with
impairments /14 ( inanition,vision,isolation)
In 2015, demography of elderly population in the world is istimated 7 billion, In Indonesia: 36
million Metropolitan City: Surabaya > 10 % of 4 million Bali island: 10,6% from 3,6 million
Population India: 17.5 % of 290 million USA :≥ 13,5% of 322,583,006 people (World Health
Organization, 2005; Kuswardhani, 2015).
WHO Paradigma, 2005, Healthy Aging, Physical, Psychology and Social – Spiritual, no
Handicap, no Disabillity (World Health Organization, 2005; Kuswardhani, 2015).
Aging definition is a changes in physical & cognitive abilities including, age related to Changes
Physical including: declining stress tolerance,reduced physical endurance, increased risk of
injury especially musculoskeletal & Bone disorders (Osteoarthritis, Osteoporosis) eyes (Cataract,
Glaucoma) (Law of Republic Indonesia, 1998).
Elderly population certainly experiences changes in their: health, decrease visual, auditory
abilities & changes in their abilities to move from place to place (Darmodjo, 2009)
Environment for Elderly
The meaning of environment expects elderly to be independent and some elderly have to be
aware of their environment if it is not suitable with them. Disease is worse condition of elderly,
therefore they need safe environment. Environment designer have to notice all aspects to make
elderly feel comfort when they do their activity such as: providing enough lightning to make
their vision clearer, design toilet in order to make it safe for elderly, etc. (Darmodjo, 2006; Elo,
et al, 2014).
14 Impairments (14 I) in Elderly
Although elderly are not ill but they experience impairment. This impairments are often become
a burden to the elderly. Immobility, instability, incontinence, impairments of cognitive.
Impaction, impairments of vision, hearing, skin integrity, taste. Infection, isolation, inanition,
impecunity, iatrogenesis, insomnia, impotence, immunodeficiency (Darmodjo, 2009)
.
There are many studies of aging process which are related to impairments of elderly, the
examples of aging process can be seen below:
Theory of Aging
The Theory of Aging are many, below are some examples of those theories (Darmodjo, 2009) :
1. Theory of genetic clock
Species in human has a clock genetic: nuclei replication stop clock death
2.Telomere Theory of Aging
Telomeres are specialized DNA sequences at the end of chromosomes, they shorten with each
cell division, when the telomeres become too short, the cell enters the senoscence stage. Adding
the enzyme telomerase lengthens the telomeres will be too long. The process of DNA replication
become well
3. The Free Radical Theory
The free radical attacks the membrane it can release another type free radical and attacks the
DNA releasing another free radical.
4. Theory of Wear and Tear
On human population always use the machines DNA will show its worn-out and gradually break
Implication of Aging in the Human Organ
Thymus gland decrease at age 75Ô thymosin
No alteration on killing function, chemotactic and phagocytic function of netrophyl,monocyte
and macrophag except there is a chronic disease (Diabetes Mellitus, Rheuatoid Arthritis)
NaïveT-cells”production impaired Tcell mediated lymphocyte response T-memory and although
the capacity to be active T proliferation as a response to mitogen delayed skin hypersensitivity
might decrease in aging.
Skin Aging
One of Example of Aging is increasing: Cysteine Rich Protein 61 (CCN-1) was mediated
Interleukin 1β : inhibit the production of collagen resulting aging (Kuswardhani, 2015).
Adverse Effects of Testosterone in Elderly
Hormone Replacement Therapy (TSH) (Darmodjo, 2009).
Hormones is differentiated as we get older, such as: Testosterone, DHEA, Estradiol, Growth
Hormone, Progesterone. While this is still considered the benefits and disadvantages of the TSH
in the elderly population.
Purpose of Hormone Replacement Therapy is not make ageless, not prevent wrinkles, enhance
quality of life.
Psychological changes in elderly
Common problem of late life in elderly are Anxiety and Depression, the problem can be divided
into some categories below (Darmodjo, 2009):
1. Retirement
Retirement is a change in work role comes with retirement. It changes the way time is managed
and daily activities are carried out. Retirement alters identity, status, financial problem, lack of
self-satisfaction and self-esteem and sometimes friendships.
2. Widowhood
A common event that alters family life for the aged is the death of a spouse . The role composed
of many sub roles, such as: companion, gathering, excerise, cook, house-keeping, and care
3. Loneliness
Loneliness is the feeling of emotional isolation, being locked inside oneself and unable to obtain
the warmth and comfort from others elderly people. Any loss that creates a deficit in intimacy
and inner personal relationships can lead to loneliness.
4. Role change (role reversal)
Numerous role changes occur with the aging process, but the transitions expected by most elders
are related to the work role and the role of spouse or partner.
Retirement House in The United State applies policy to improve mental health care for elderly.
They increase the number of mental health professionals, expand the research of basic and
applied of Geropsychology at: The National Institute Mental Health and The National Institute
on Aging and provides the mental health services in place where elderly frequent spend life, such
: as primary care settings, residential settings, congregate meal, senior centers or other
community sites.
Respite Care Service
Respite Care Service short is a term of accommodation in a facility outside the home with a
developmental delay with disability. These are some examples of respite care service places in
providing a positive experience for the person: in Indonesia: Gajah Mada University, Alfiana
Sophia, Jakarta. In Malaysia: Mahkota Medical Center. In India: Indian trail. (Kuswardhani,
2015).
Nursing Home
Nursing home is a place for people who do not need to be in a hospital but can not be cared for at
home. Most nursing homes have nursing aides and skilled nurses on hand 24 hours a day. Some
nursing homes are set up like a hospital. Nursing home provides a comprehensive living area,
accomodation, transportation, health care, food / nutrition, recreations, music therapy, licencse
certification. The staff consists of: medical care, physician, Speech, OT, Nutritionist. Special
Care Units in nursing ome consist of: Memory Clinic, Podiatry Unit, Massage service, Music
therapy, Aroma therapy, Nutrition therapy (Kuswardhani, 2015).
There are some support therapies for elderly, such as: jogging, meditation, yoga, aroma therapy,
massage therapy, gamelan, music therapy, gymnastic, bicycle, travelling, nutrition therapy
(Kuswardhani, 2015).
The Dosage and Kinds which are recomended
Estrogen Conjugation Estrogen is given orally 0,3-0,625mg. 17 ß estradiol is given orally 1-2
mg. Estradiol valerat is also given orally 1-2 mg. Progesteron sequential consists of progesteron
which is given 300 mg, Siproteron asetat is given 1 mg, Didrogesteron is given 10-20 mg.
Continued Progesteron consists of progesteron which is given 100 mg, siproteron asetat is given
1 mg, Didrogesteron is given 10 mg (Kuswardhani, 2015).
Deficiency Growth Hormon in Adults
Main Outcome Target of Deficiency Growth Hormon in Adults is : Metabolism & Body
Composition. Paramedic have to know pituitary disease, physiological replacement (T4,
Cortisol). They must also monitor with IGF-I and need to adjust other hormones after starting
Growth Hormone (Darmodjo, 2009).
Management for Elderly
Taking care of Elderly can be done by avoiding falls, imobilisation and fractur complication,
active rehabilitation and medicament therapy (Kuswardhani, 2015).
Benefit of Physical Activity and Excercise
Excercise and physical activity for elderly is helpful to Accelerate blood flow, improve fitness,
strengthen muscles and improve bone density, increase body flexibility, maintain balance and
body coordination, Increases the body's resistance to disease, lowering the risk factors for certain
disease, reduce tension and anxiety (Kuswardhani, 2015).
Therapy Non Pharmacology
Therapy Non Pharmacology consists of periodic rest in 24 hours and long rest to induce athropy
joint and decrease mobility. Manual therapy is for flexibility, muscle strength and coordination
of elderly. Non Pharmacology Therapy aims to balance weight to get an ideal wieght, reducing
10 pounds / 20 kg for 10 years, improve Osteoarthritis as many as 50% (Kuswardhani, 2015).
Vitamins is a complex organic compounds that: The body can’t make — or make enough to
maintain good health, naturally occurs in common foods, deficiency condition occurs when the
vitamin is missing, good health is restored if deficiency disorder is treated early
Vitamin D is The Sunshine Vitamin
A study : correlation of falls risk and fractures in Minnesota Hospital and ↓ Vit D diet < 200 IU (
60-65 yo,163 patients: 65% ; p < 0,005)
Vitamin D and Dementia
Low levels of vitamin D are believed by many to be a potential risk factor for cardiovascular and
brain disease. Previous studies have shown associations between low levels of vitamin D and
hypertension,DM, Myocardial infarction and Stroke. Low vitamin D has been associated
Hypertension and DM which in turn have been associated with white matter hyperintensities and
cognitive impairment
Summary:
Every year, population of elderly will increase and usually is followed by disease. Taking care of
them is needed to prosper the population of elderly. All aspect have to be noticed to make elderly
feel safe and comfort. Aging is a normal process that is experienced by human being. Aging and
impairments cannot be avoided, all we can do is to prepare to deal with it in various ways. Began
with knowing what aging is, it will make people ready to deal with their late life. Learning about
theory of aging, elderly needs and psycological change will help us to overcome problems that
usually rise in late life. Managing elderly problems can be done by therapy. Health care service
is really helpful to take care and prosper elderly in their late life. Respite care service and nursing
home are two examples of health care service for elderly that provide all needs of elderly and can
be a good solution to take care of elderly in this era. However, elderly reserves the right to enjoy
their late life and we all have to take care of them until the end of elderly life. Vitamin really take
However it is not only Vitamin D that important to healthy of Elderly, but all vitamins and
minerals are needed to Elderly.
Refferences:
World Health Organization. 2005. Elderly Age.
Law of Republic Indonesia, 1998. Elderly Welfare.
Kuswardhani RAT. 2015. Proceeding Udayana University International Symposium: Hospital
Based Geriatric Service.
Kuswardhani RAT. 2015. Osteoporosis in Elderly: Diagnosis and Management. National
Congress of Internal Medicine Association of Indonesia.
Kuswardhani RAT. 2015. Aging, Nutrition and Health Care Service in Elderly.
Darmodjo Boedhi. 2009. Aging Definition: Guideline Geriatry. Textbook of Boedhi Darmojo:
Geriatrics (Elderly Health Sciences), 4th Edition, pp. 13-16.
Darmodjo Boedhi. 2006. Aging and Environment. Textbook of Boedhi Darmojo: Geriatrics
(Elderly Health Sciences), 3rd Edition, pp. 32-34.
Darmodjo Boedhi. 2009. Deficiency Hormone in Elderly. Textbook of Boedhi Darmojo:
Geriatrics (Elderly Health Sciences), 4th Edition.
Darmodjo Boedhi. 2009. Psychology in Elderly. Textbook of Boedhi Darmojo: Geriatrics
(Elderly Health Sciences), 4th Edition.
Elo Satu, Saarni Reetta, Isola Arja. The physical, social and symbolic environment supporting
the well-being of home-dwelling elderly people. 2014. http://www.circumpolarhealthjournal.net
de Oliveira WS, Moraes Niele, Santos FC. 2013. Vitamin D and Chronic Pain in the Elderly.
