MATA KULIAH MANAJEMEN PELAYANAN GERIATRI TERPADU

DI RUMAH SAKIT

PROGRAM STUDI ADMINISTRASI RUMAH SAKIT PROGRAM

MAGISTER

Nama : KARTIKA ZARI ARYANI

Angkatan/Kelas : 37 D
TUGAS : SUMMARY GENERAL LECTURE 25 JUNI 2023

Geriatric Medicine is not Internal Medicine for order people. When most people think of doctors, they
usually think of general practitioners or internists. However, there are actually several different types of medical
specialists. One such specialty is geriatric medicine, which is focused on the care and health of elderly patients.
Geriatric medicine is a medical specialty that focuses on the health and care of elderly patients. The geriatrician’s
goal is to optimize their patients’ health and quality of life. Geriatrics is a branch of internal medicine, but it is its
own distinct specialty. Geriatricians are experts in the care of elderly patients, while internists may or may not
have specific training in geriatrics. Most internists will be able to treat elderly patients, but they may not be as
knowledgeable about the specific needs of this population.
Overview :
1. Some myth busted
Internist also feel Griatricians are stealing their patients because most patients lost by internist are visiting
specialist, patients that visit geriatriciants have been neglected by internist for long.
2. The confusion: Internal medicine or Geriatric medicine?
Geriatric medicine is concerned with both the physical and mental health of elderly patients. Internists
typically only deal with the physical health of adults, although some do specialize in psychiatry. Therefore, if you
are looking for a doctor who can help you with your physical and mental health, you should consider seeing a
geriatrician.
On the other hand, if you are only concerned with your physical health, then internists would be a better
choice. They are experts in diagnosing and treating adult illnesses, so they can help you get back to feeling like
yourself again! Whichever doctor you choose, make sure to do your research and ask lots of questions.and
Internal medicine is a medical specialty that deals with the diagnosis and treatment of adult internal diseases and
conditions
Internists are general practitioners who have completed a three-year residency in internal medicine. During
this residency, they learn how to diagnose and treat adult illnesses. Most internists will be able to treat elderly
patients, but they may not be as knowledgeable about the specific needs of this population. If you are looking for
a doctor who can help you with your physical and mental health, you should consider seeing a geriatrician.
Geriatricians often work in collaboration with other health professionals, while internists typically work alone.
Geriatricians are more likely to be involved in long-term care planning, while internists are more likely to
provide acute care. Geriatricians are more likely to be involved in long-term care planning. They may help their
patients set up a care plan that meets their individual needs. Geriatricians can also provide support and resources
for caregivers. Internists are more likely to provide acute care. This means that they typically focus on diagnosing
and treating serious illnesses or injuries. Internists may also provide short-term treatment for chronic conditions,
such as diabetes or high blood pressure. Some geriatricians also work in hospices or nursing homes, while others
see patients in their own offices. The focus of geriatric care is on keeping patients healthy and independent for as
long as possible, rather than just treating them when they are sick.
3. Future
 In the US, 13 % of the population > 65 years, account for 43 % of annual inpatient care spending, projected
increased to 19 % by 2030, 20-30% die within one year of discharge, and highst prevalensi of per capita
healthcar spending.
4. Problem
Older patients are mistreated, growth rate > 3 times of total population and growth of 75+ segment is
accelerating, main users of healthcare services. Projections indicate that the rate of population growth for
older age groups from now to 2050 will continue to grow more than twice as rapidly as the total population.
Future growth of the older adult population will partly result from the baby boomer generation aging.
However, this growth is also the result of an increase in life expectancy for people living in developed
countries.

5. Uniqueness
Geriatrics is the branch of healthcare that focuses on our unique needs as we age. Just as pediatricians
specialize in the health needs of children, geriatricians and fellow geriatrics health professionals
specialize in the health needs of older people. Focus on quality of life, multidisciplinary teams, provides
a comprehensiveness, attention to disability and discharge planning, knowlwdge of therapeutic
intervention at multiple levels
6. The way forward :
1. Collaboration : combination resources and educators
2. Inovative care and delivery system: improve acces, quality and utilitzation outcomes
3. Communication tech tool: empower patients (caregivers) to actively manage their disease
4. Health Information Technology : improved efficiency,reduce shortage, care delivery remotely or
asynchronously.
7. Geriatric syndrome: Clinical conditions that don’t fit into defined disease conditions. Common
characteristics: complex, multifactorial, often in older person, many organ system.The 9 most common
health conditions in older adults:
1.Confusion
Many of these older patients present to primary care providers with complaints of memory
problems. Early detection of such conditions can help determine the reversible causes, initiate
appropriate pharmacological interventions early and help patients and caregivers plan for the future.
2.Vision problem
Visual impairment affects older patients' functional status, especially functions such as driving,
preparing meals, managing money, etc. are significantly affected. It is also associated with falls,
cognitive decline, and depression in the elderly. Older patients are at increased risk of visual impairment
due to age-related decline as well as co-morbid conditions. Common causes of visual impairment in the
elderly are cataracts, glaucoma, presbyopia, macular degeneration, diabetic retinopathy, and
hypertensive retinopathy.
3.Imbalance and falls
Besides obvious health hazards such as hip fractures and trauma, falls also cause limitations in
physical and social activities directly and due to fear of falling indirectly, further leading to functional
decline
4.Nutritional problems
Up to 15% of the community-dwelling elderly population is affected by malnutrition, which is
associated with a decline in physical health, such as poor wound healing, anemia, immune dysfunction,
etc. Poor cognition, functional decline, and an overall increase in mortality
5.Hearing loss
Hearing loss is, in fact, the third most common condition in older patients. Like visual
impairment, hearing loss is associated with functional decline, poor cognition, and dementia, social
isolation, and depression
6. Dizzines
7.Sleep disorder
Insomnia is one of the common presenting problems of older patients. Poor sleep is associated
with increased fatigue, falls, nursing home placement, poor quality of life, and overall mortality. Quality
of sleep decreases with aging. Sleep disorders could be primary such as insomnia, restless leg
syndrome, obstructive sleep apnea, or secondary to comorbid medical, psychiatric, behavioral,
environmental, or medication side effects
8. Urinary incontinensia
Most studies show the prevalence of urinary incontinence (UI) in the range of 25-45% and rise
further with aging. However, UI is not a normal or inevitable consequence of aging. Older patients
suffering from UI cannot participate in social activities leading to isolation, increased risk of depression,
and functional disability. It can also increase the risk of falls, fractures, affects sexual health, and causes
an overall reduction in quality of life. UI can be classified into 5 types - stress, urge, overflow, mixed
and functional. Stress incontinence is leakage of urine due to activities that increase abdominal pressure.
Urge incontinence is characterized by leakage of urine after a sudden urge to void. Overflow
incontinence manifests as frequent small volume leaks, usually due to bladder outlet obstruction or
neurological disorders. Functional incontinence refers to incontinence resulting from an inability to use
the toilet independently due to functional disability such as cognitive impairment or limited mobility.
Mixed incontinence is the combination of 2 or more types of incontinence.
9. Osteoporosis
The Osteoporosis and osteopenia are common in the elderly and can lead to fractures even
with mild trauma. Increased bone loss due to aging and menopause in women puts older patients and
post-menopausal women at high risk of osteoporosis.
The new four :
 Frailty,
frieds models most widely used: weekness, slowness, exhaustion, phisycal activity, weight loss
non frail (0), pre frail (1-2),frail (>2)
Management: education, behavior therapy, physiotherapy, vit D supplementation,
 Osteosarcopenia,
Decrease in bone density+progressive generalized loss skeletal muscle mass. Clinical presentation:
multiple falls, frequent fractures, weakness, decrease in height due to vertebral collaps and
kyphosis
 Oropharyngeal dysphagia,
Any difficulty in forming, propelling or moving the food from oral cavity to esophagus,
aspiration, chocking, and pharyngeal food residu. Screening methode : EAT10/SSQ,
diagnosis : videofluoroscophy. Management : fluid adaptation-fluid thicknerersincrease
viscosity, make bolus more swallowable
 Sleep disorders
Education and sleep hygiene, reduce stimulant, comfortable stimulants, comfortable sleep
environment, regular exercise, hypnotic, melatonin, benzodiazepine