Family-focused care

for older adults

Iqbal Pramukti, Ph.D.
Global aging
• Peningkatan populasi lansia
secara global
• Usia Harapan Hidup (UHH) di
negara maju + 80 tahun
• Meningkatnya UHH berkorelasi
dengan meningkatnya resiko
penyakit kanker dan jantung

(United Nations, 2020; Resnick, 2001)

Laju pertumbuhan lansia secara global
• Terdapat peningkatan laju
pertumbuhan lansia yang sangat
cepat (7%  14%)
• Setiap negara memiliki kelajuan
yang berbeda-beda

Kinsella et al, 2008

New Disease
Pattern

(United Nations, 2010)

 Prevalensi penyakit
kronis dan
disabilitas pada
lansia di Amerika,
Inggris, dan Eropa

(Avendano et al, 2009)

Populasi lansia di Indonesia

• Peningkatan jumlah lansia

(> 65 tahun)
• Tingkat ketergantungan
semakin meningkat

(Badan Pusat Statistik, 2010)

Piramida
penduduk di •(Badan Pusat Statistik, 2019)

Indonesia
Komorbiditas pada lansia di Indonesia
24% elderly with risk of malnourished,
and 2.5% malnourished

58.9% Hypertension
37.5% Diabetes Melitus
35.5% Dyslipidemia
31.7% Osteoarthritis
15.9% Chronic Kidney Disease
12.1% Coronary Heart Disease

(Setiati et al, 2019)

Lansia sebagai ”vulnerable population”

Exogenous events:
- disaster
- traumatic event
vulnerable
Endogenous events
- degenerative
process
(Galinowska, 2016; Golaz, 2011)
 Lansia sebagai ”vulnerable
population” (2)

• “Vulnerable” pada lansia 

adanya potensi ancaman pada
lansia yang dapat berdampak
negatif (Golaz, 2011)
• Vulnerable  saat mendapat
masalah sulit untuk
mengatasinya (maladaptive
coping) (Golaz, 2011)
Older adults as
the vulnerable
population
Risk factor for COVID-19 among older adult
• Eldelry are facing special risk factor for Covid-19
• Comorbidities are the main concern among 32-60% cases:
Diabetes rate: 6-20%
Hypertension rate: 15-41%
COPD & Cardiovascular rate: 14-15%
• Poor nutrition
• Dementia
• Dehydration
• Frail & bedridden
• HIV older adult  risk of osteoporosis & fracture than general population
• HCV/HIV coinfection  risk of fracture than monoinfection
(Dharma et al, 2020; Pramukti et al, 2020; Compston, 2015)
Risk of
fracture
among HIV
elderly
Overview of Covid-19
pandemic in older adults

(Dharma et al, 2020)

Issues on family-focused care for older adults
• Family nursing concern on the transformative value in family-focused care
(Anderson et al, 2019)

• The values and resources of older adults and how their families influence
them are core elements (Anderson et al, 2019)
• The increasing need of technology-assisted (Anderson et al, 2019; Croff et al, 2019)
• A holistic approach including physical, mental, emotional, and spiritual
aspects
• nutrition
• physical activity
• chronic disease management.
(Anderson et al, 2019)
Issues on family-focused care for older adults
• Family function influences aging  optimize interventions and care
plans for older adults to help them age well (Anderson et al, 2019)
• Researchers need to understand the health disparities among older
adults including racial, ethnic, and sexual/gender minority lines (Flatt et
al., 2018).

• The need to address the consequences in terms of health care

research, education, practice, and policy (Shiu, Muraco, & Fredriksen-Goldsen, 2016).
Who are family caregivers?
• Relatives, friends, partners, or neighbors who provide
assistance
• Typically, unpaid
• represent a broad and diverse group of individuals
• span all ages and are heterogeneous across multiple
dimensions
• vary in their level of competence, skill, and motivation
(Schulz et al, 2020)
Caregiver task and health effect

(Schulz et al, 2020; Schulz et al, 2010)

Family involvement in the Nursing Homes
• Families are integral to promoting social engagement (Robert et al, 2018; Kiely et al, 2000), and
bolstering the identity and dignity of relatives living in Nursing Homes (NHs) (Robert et al,
2018; Kolb, 2000; Tilse, 1997)

• A conceptual model of family involvement in residential long-term care proposed by

Gaugler (2005) illustrates how and why family involvement may be related to resident
outcomes.
families are a psychosocial resource for NH residents
their involvement is likely to improve resident QOL through reducing the negative outcomes from
stressors arising from the family caregiving context prior to or after NH admission
o caregiving stress or distance from facility
o living in the facility (e.g., policies),
o resident characteristics (e.g., functional status),
o interactions with staff (e.g., quality of staff-resident relationships).
(Robert et al, 2018)
The Gaugler model on stress process and the
institutionalization transition
(Gaugler et al, 2004)
 Indonesia is facing aging issue

Older adults is the vulnerable

population
Conclusion Risk factor for chronic disease among
older adults should be awared

Family involvement is important to

healp older adults age well
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