GERIATRIC GIANT

Pembimbing :
Dr. Med. Sc. Irma Ruslina Defi,dr., SpKFR(K)
 Geriatric Giants
• “Geriatric Giants” is a term coined by Bernard Isaacs, and the
expression refers to the principal chronic disabilities of old age
that impact on physical, mental and social domains of older adults.
• Many of these conditions, commonly misperceived to be an
unavoidable part of old age, can in fact be improved. These
“Giants” include:
• • Immobility
• • Incontinence
• • Postural Instability and Falls
• • Iatrogenesis & “Polypharmacy”
• • Inanition (malnutrition)
• Over the subsequent fifty years, geriatrics has evolved, and
today, the understanding of the modern “geriatric giants” has
evolved to encompass the four new syndromes :

– Frailty
– Sarcopenia
– the anorexia of aging
– Cognitive Impairments (i.e. 2’ to dementia, delirium or depression)

– these syndromes are the harbingers of falls, hip fractures, affective

disorders and delirium with their associated increase in morbidity and
mortality
 Intellectual Impairment
• Intellectual impairment : is a change in how a person thinks, react
to emotion, and behaves. 50% to 80% of those older than age 65
years have some degree of intellectual impairment.

• Disorders causing confusion in the geriatric population can be

broadly categorized into three groups:
• Acute disorders usually associated with acute illness, drugs, and
environmen- tal factors (ie, delirium)
• More slowly progressive impairment of cognitive function as seen
in most dementia syndromes
• Impaired cognitive function associated with affective disorders and
psychoses (depression)
• The differential diagnosis in an older patient who
presents with confusion includes disorders of :
• brain (eg, stroke, dementia)
• a systemic illness presenting atypically (eg,
infection, metabolic disturbance, myocardial
infarction, congestive heart failure)
• sensory impairment (eg, hearing loss), and
adverse effects of a variety of drugs or alcohol.
• Three questions are helpful in making an accurate
diagnosis of the underlying cause(s) of confusion:
• Has the onset of abnormalities been acute (ie, over a
few hours or a few days)?
• Are there physical factors (eg, medical illness, sensory
deprivation, drugs) that may contribute to the
abnormalities?
• Are psychological factors (ie, depression and/or
psychosis) contributing to or complicating the
impairments in cognitive function?
• Mental status examination has several basic
components that are essential in diagnosing
dementia, delirium, or other syndromes .
 Dementia
• Dementia is a clinical syndrome involving a sustained loss of intellectual
functions and memory of sufficient severity to cause dysfunction in daily living.
• Prevalence of dementia as high as 47% among those 85 years of age and older.
• Loss of functional ability due to impaired cognition is the key feature that
distinguishes dementia from Mild Cognitive Impairment. Its key features
include:
• • A gradually progressing course (usually over months to years)
• • No disturbance of consciousness

• Dementia in the geriatric population can be grouped into two broad

categories:
• 1. Reversible or partially reversible dementias
• 2. Non reversible dementias
 Reversible Dementias
• finding a reversible cause does not
guarantee that the dementia will improve
after the putative cause has been treated.
• “Depressive pseudodementia” is a term that
has been used to refer to patients who have
reversible or partially reversible impairments
of cognitive function caused by depression.
Non reversible Dementias
Dementia
Dementia
Alzheimer
Dementia
 Vascular Dementias
• Vascular dementias predominately caused
by multiple infarcts (multi-infarct
dementia) are common in the geriatric
population
 Diagnosis
• Patients exhibiting one or more of these symptoms should be
considered for the following evaluation:
• Focused history and physical examination, including assessment
for delirium and depression and identification of comorbid
conditions (eg, sensory impairment)
• A general physical examination and functional status assessment
• A mental status examination
• Selected laboratory studies to rule out reversible dementia and
delirium
• The Mini-Cog assessment is a useful screening tool in identifying
patients
Symptom :
Management OF Dementia
 Pharmacological Treatment Of Dementia
• There are four basic approaches to the pharmacological treatment
of dementia:
• Avoid drugs that can worsen cognitive function, mainly those with
strong anticholinergic activity
• Agents that enhance cognition and function
• Drug treatment of coexisting depression
• Pharmacological treatment of complications such as paranoia,
delusions, psychosis, and behavioral symptoms such as agitation
(verbal and physical)
• The primary pharmacological approach to the treatment of
Alzheimer Dementia has been the use of cholinesterase inhibitors.
 Delirium
• Delirium is an acute or subacute alteration in mental
status especially common in the geriatric population.
• Delirium may persist for days or weeks
• Many factors predispose geriatric patients to the
development of delirium, including :
– impaired sensory functioning and sensory deprivation
– sleep deprivation
– Immobilization
– transfer to an unfamiliar environment.
The Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR)
Delirium
• Delirium has long been thought to be a reversible, transient
condition.

• Delirium is characterized by :
• Acute onset /fluctuations
• Attention deficit
• Confusion /disorganized thinking
• Altered level of consciousness and psychomotor activity
• Perceptual and emotional disturbances
• Sleep /wake cycle disturbances
• Memory impairment / disorientation
 DELIRIUM SUBTYPES
• Delirium can have many presentations but is
often classifed into three categories primarily
based on level of arousal and psychomotor
activity.
• There are the hyperactive, hypoactive, and
mixed subtype
 MANAGEMENT
• First and foremost is to identify and treat the
underlying condition(s).
• Second is to avoid additional insults that can prolong
or worsen the condition.
• Third, we must provide supportive and restorative
care that will allow the patient time to recover safely.
• Finally, treatment may need to be initiated to manage
harmful or dangerous behaviors that may be present
and may interfere with the frst three components of
management.
 MANAGEMENT
• Avoidance of immobility and sensory deprivation
• Provision of glasses, assistive hearing devices, appropriate orienting stimuli
(clocks, calendars, and natural lighting)
• Regular review of medications and minimization of psychoactive medications
and discontinuation of unnecessary drugs
• The use of staff or family members who can provide interpersonal contact with
use of reorientation strategies and encouragement for increasing activity and
increased oral intake
• Use of restraints as well as unneeded “tethers” such as urinary catheters or
telemetry monitors should be avoided
• Allowance for uninterrupted sleep with appropriate night-time lighting and
noise should be provided for
• Natural lighting and encouragement for activity during daytime can also be
helpful
 Isolation (Depression)

– Isolation (terisolasi) / depresi, penyebab utama depresi

pada lanjut usia adalah kehilangan seseorang yang
disayangi, pasangan hidup, anak, bahkan binatang
peliharaan.

– Selain itu kecenderungan untuk menarik diri dari

lingkungan, menyebabkan dirinya terisolasi dan menjadi
depresi. Keluarga yang mulai mengacuhkan karena merasa
direpotkan menyebabkan pasien akan merasa hidup sendiri
dan menjadi depresi. Beberapa orang dapat melakukan
usaha bunuh diri akibat depresi yang berkepajangan.
 Depression
• The prevalence of major depression among older adults actually decreases
with age, with this rate being approximately 5% to 10% of older person
• When depression is associated with other medical problems (eg, hip
fracture or osteoarthritis), there is often an exacerbation of associated
pain, poor compliance and motivation, and impaired recovery and
function.
• Persons age 65 and over account for 25% of all suicides, and as many as
75% of older adults who commit suicide suffer from depression
• Aging changes in the central nervous system, such as changes in
neurotransmitter concentrations (especially catecholaminergic
neurotransmitters), may play a role in the development of geriatric
depression. Inflammatory markers such as interleukin 6 (IL-6) have likewise
been associated with depression, as has vitamin D deficiency.
Depression
identifying depression disorders in older adults is complicated by
many factors, including:

• The presence of common medical conditions (eg, Parkinson disease,

congestive heart failure) that can result in the individual appearing depressed,
even when depression is not present.
• Nonspecific physical symptoms (eg, fatigue, weakness, anorexia, diffuse pain)
that are commonly associated with comorbid conditions.
• Specific physical symptoms, relating to every major organ system, can
represent depression as well as physical illness in geriatric patients.
• Depression can exacerbate symptoms of coexisting physical illnesses such as
exacerbation of memory changes or pain associated with arthritis.
• Pharmacologically induced depressive symptoms from substance use,
particularly alcohol, and abuse or prescribed or over-the-counter medications.
 Management
A, supported by one or more
high quality randomized trials;
B, supported by one or more
high-
quality nonrandomized cohort
studies or low-quality RCTs; C,
supported by one or more case
series
and/or poor quality cohort
and/or case-control studies; D,
supported by expert opinion
and/or
extrapolation from studies in
other populations or settings;
X, evidence supports the
treatment
being ineffective or harmful.
There is insufficient evidence
to support multiple herbal
remedies (with the exception
of St. John’s
wort), acupuncture, music
therapy, or vitamins.
ECT, electroconvulsive therapy;
RCT, randomized controlled
trials.
 Pharmacological Treatment
• Indication :
• When symptoms and signs of depression are of
sufficient severity and duration to meet the criteria for
major depression
• if the depression is producing marked functional
disability or interfering with recovery from other
illnesses (eg not participating in rehabilitation
services)
• when the patient is not responding to
nonpharmacological interventions alone
 Instability and Falls
• Definition of Falls :
• subject unintentionally coming to rest on the
ground as a result of major intrinsic event or
overwhelming hazard
Instability - Age associated changes & chronic
disease
• Increasing age is associated with diminished
proprioceptive input, slower righting reflexes,
diminished strength of muscles important in maintaining
posture, changes in gait and increased postural sway.

• All these changes can contribute to falling—especially

the ability to avoid a fall after encountering an
environmental hazard or an unexpected trip
 Gait disorders in adults and the elderly A clinical guide
Walter Pirker · Regina Katzenschlager

Waddlinggait
Weakness of the hip girdle and upper thigh muscles, for instance in myopathies, leads to an
instability of the pelvis on standing and walking. If the muscles extending the hip joint are
affected, the posture in that joint becomes flexed and lumbar lordosis increases.

The patients usually have difficulties standing up from a sitting position. Due to weakness in
the gluteus medius muscle, the hip on the side of the swinging
leg drops with each step (referred to as Trendelenburg sign) [10]. The gait appears waddling.
The patients frequently attempt to counteract the dropping of the
hip on the swinging side by bending the trunk towards the side which is in the stance phase
(in the German language literature this is referred to as Duchenne
sign) [26]. Similar gait patterns can be caused by orthopedic conditions when the origin and
the insertion site of the gluteus medius muscle are closer to each
other than normal, for instance due to a posttraumatic elevation of the trochanter or
pseudarthrosis of the femoral neck [10].
•
 2. Postural control
• Dependent integration visual-vestibular- proprioceptive input
• Fall risk has been linked to mediolateral instability  tested by
stand in tandem, one leg stand
• Difficulty standing balance  walk more slowly, wider base
support
• Maintaining balance during body movement  requires
reaction to restore the person’s displaced center of mass over
the base of support
• Inability to quickly detect the displacement because of 
sensory impairment, slowing CNS integration of sensory
information into a motor response, muscle weakness, joint pain
 3. Sensory input
• Vision : impaired visual acuity, contrast sensitivity and ability
to detect edges
• Hearing : affect perception of and orientation to environment
• Proprioception : Mechanoreceptor in apophyseal joint and
peripheral nerve provide proprioceptive input  affected by
age
• Degenerative joint disease  can cause pain, unstable joints,
muscle weakness, and neurological disturbances
• Peripheral neuropathy  Diminished sensory input 
diminish cues from the environment that normally contribute
to stability
 5. Musculoskeletal impairments
• Muscle mass and strength decline with age and disease  muscle
weakness  (caused by pain and/or lack of exercise / disuse) can
contribute to an unsteady gait and impair the ability to right
oneself after a loss of balance
• inactivity
• Ankle dorsiflexor weakness
• Hip abductors and adductors weakness  decrease an ability to
maintain balance while stepping to avoid fall
• Musculoskeletal disease  OA (pain), deformity, limited ROM
• Foot problem  calluses, bunions, long nails, joint deformity 
cause pain, deformities, and alterations in gait are common,
correctable causes of instability
 Step length after discrete perturbation predicts accidental falls and fall-related injury
in elderly people with a range of peripheral neuropathy ☆, ☆☆, ★
Lara Allet a,b,c,⁎, Hogene Kim d, James Ashton-Miller d,e, Trina De Mott b, James K. Richardson b

• Finally, Otten (1999) analyzed younger subjects balancing on one foot

on a thin beam, thereby effectively removing or minimizing ankle
control, and found that hip adductor/abductor-generated moments
varied the horizontal ground-reaction force so as to allow the
maintenance of equilibrium. Frontal plane hip strength is critical to
maintenance of unipedal balance given the sensorimotor impairments at the ankle
in older people with diabetic neuropathy. Prior
work found this to be the case during static unipedal balance. In that
paper we showed that Hip abductor/adductor maximum
strength was the dominant predictor of unipedal stance time (Allet et al.,
2012a).The data reported here substitute hip abductor/adductor
RTG for maximum strength, as might be expected given the more
dynamic and time-contingent nature of the rejection of a perturbation
while walking
7. Medication
• Medication effect or adverse effect on cognitive functioning, fluid
and electrolyte imbalance, blood pressure, fatique, somnolence,
dizziness
• Medication include diuretics (hypovolemia), antihypertensives
(hypotension), antidepressants (postural hypotension), sedatives
(excessive sedation), antipsychotics (sedation, muscle rigidity,
postural hypotension), hypoglycemics (acute hypoglycemia), and
alcohol (intoxication). 
• Combinations of these drug types may greatly increase the risk of a
fall.
8. Acute illness and hospital discharge
• Pneumonia, exacerbation CHF  altered mental status, postural
hypotension, weakness
• Deconditioning
• Healed fractures of the hip and femur can cause an abnormal and less
steady gait
 Hazard geriatric
• Acute Illness and Hospital Discharge
Time-related or situational factors also may result in impaired balance by
augmenting already presentrisk factors for falls. Acute illness,
such as pneumonia or exacerbation of congestive heart failure, may
present as a fall in a frail older person because of altered mental status,
postural hypotension, or weakness. Older persons are also vulnerable
after treatment in the emergency department or after hospitalization
because of the illness that caused their admission, deconditioning,
or medication effects.
• The risk of a fall in older persons recently
discharged from the hospital and receiving home care is about fourfold higher
than that for others in the community during the first
2 weeks after discharge.
•
9. Extrinsic risk factor  environmental
hazards
 Evaluating
The Elderly Patient Who Falls
 Management
• Exercise and training to improve deficit in balance
mobility and strength
• Correction of sensory deficit  vision, hearing,
vestibular, proprioception
• Evaluation and treatment of postural
hypotension
• Reduction of medication
• Use adaptive equipment ( environmental
modification)
 Incontinence
• Incontinence is a common, bothersome, and potentially
disabling condition in the geriatric population.

• It is defined as the involuntary loss of urine or stool in

sufficient amount or frequency to constitute a social
and/or health problem

• Approximately one in three women and 15% to 20% of

men older than age 65 years have some degree of
urinary incontinence.
 incontinence can always be managed in a manner that keeps people comfortable,
makes
life easier for caregivers, and minimizes the costs of caring for the condition and its
complications.
Continence requires effective functioning of the lower
urinary tract, adequate cognitive and physical
functioning, motivation, and an appropriate
environment
Etiology incontinence
It is important to distinguish between urological and neurological
disorders that cause incontinence and other problems (such as
diminished mobility and/or mental function, inaccessible toilets, and
psychological problems)

Aging is also associated with

◦ a decline in bladder outlet and urethral resistance pressure in women.
◦ This decline is related to diminished estrogen influence and laxity of pelvic floor
structures associated with prior childbirths, surgeries, and deconditioned
muscles, which predisposes to the development of stress incontinence
◦ Decreased estrogen can also cause atrophic vaginitis and urethritis  cause
symptoms of dysuria and urgency and predispose to the development of
urinary infection and urgency incontinence.
◦ In men, prostatic enlargement is associated with decreased urine flow rates
and involuntary bladder contractions and can lead to urgency and/or overflow
types of incontinence
◦ associated with abnormalities of arginine vasopressin (AVP) and atrial
natriuretic peptide (ANP) levels  nocturnal polyuria and predispose many
older people to nighttime incontinence.
Persistent Incontinence
 Muscles of the trunk and pelvis are
responsive to testosterone
administration: data from
testosterone dose–response study in
young healthy men
1J. Tapper, 2S. Arver, 3K. M. Pencina, 1A. Martling, 4L. Blomqvist, 1C. Buchli,
3Z. Li, 3T. Gagliano-Juc a , 5T. G. Travison, 3G. Huang, 3T. W. Storer,
3S. Bhasin and 3S. Basaria

• Another important group of muscles that have relevance to

aging is the muscles of the pelvic floor. The muscles of the pelvic
floor subserve an important role in erectile function and in
maintaining urinary and fecal continence (Dorey, 2005). The
levator ani muscle forms the bulk of the pelvic floor and is
important in maintaining continence and support for pelvic
organs, while the ischiocavernosus muscle contributes to penile
rigidity (Clement & Giuliano, 2015). Indeed, physical exercises
directed toward strengthening pelvic floor muscles improve
erectile function and intercourse satisfaction (Meldrum et al.,
2014). Similarly, it has been suggested that use of anabolic
agents in conjunction with pelvic floor exercises might be useful
in the treatment of pelvic floor disorders (Omar & Alexander,
2013)
 Diagnosa
• Anamnesa :
• 1. Open-ended and pharesed, easily understood
• a. Tell me about any problems you are having with your
bladder
• b. Tell me about any trouble you are having holding your
urine
• 2. If the respond is negative, next question :
• a. How often do you lose urine when you don’t want to
• b. How often do you wear a pad or other protective device
to
• prevent urinary accidents
• physical examination  focus on abdominal,
rectal, and genital examinations
• postvoid residual determination
• basic laboratory studies (urinalysis, culture,
and serum glucose).
Management
 Catheters and Catheter Care
• Catheters should be avoided in managing
incontinence, unless specific indications are
present.

• Three basic types of catheters :

• external catheters
• intermittent straight
• Catheterization chronic indwelling catheterization.
 Fecal incontinence
• Fecal incontinence is less common than urinary incontinence.
• 30-50% of elderly patients in institutional settings with frequent
urinary incontinence, however, also have episodes of fecal
incontinence.
• Defecation, like urination, is a physiological process that involves
smooth and striated muscles, central and peripheral innervation,
coordination of reflex responses, mental awareness, and physical
ability to get to a toilet  Disruption of any of these factors can lead
to fecal incontinence.
• the most common causes of fecal incontinence are problems with
constipation and laxative use, unrecognized lactose intolerance,
neurological disorders, and colorectal disorders. Laxative drugs can
also contribute to fecal incontinence.
 Impaction

• Definition : the inability to evacuate large hard inspissated

concreted stool or bezoar lodged in the lower GI tract
• Constipation is extremely common in the geriatric population
and, when chronic, can lead to fecal impaction and incontinence.
• Constipation technically indicates less than three bowel
movements per week, although many patients use the term to
describe difficult passage of hard stools or a feeling of incomplete
• Poor dietary and toilet habits, immobility, and chronic laxative
abuse are the most common causes of constipation in geriatric
patient
 Management
• Proper diet, including adequate fluid intake and bulk
• Crude fiber in amounts of 4 to 6 g/day
• Improving mobility
• positioning of body during toileting
• the timing and setting of toileting are all important
in managing constipation
• Defecation should optimally take place in a private,
unrushed atmosphere and should take advantage of
the gastrocolic reflex
 Iatrogenic
• Any pathologic alteration caused to a patient by the
inappropriate practice of health professionals, which
results in harmful consequences for the patient’s health
• WHO  iatrogenic disease may be defined as adverse drug
reactions or complications induced by nondrug medical
interventions.
• Iatrogenic disease defined as a disease induced by a drug
prescribed by a physician, after a medical or surgical
procedure (excluding intentional overdose, nonmedical
intervention) unauthorized prescription, and
environmental events (eg, falls, defective equipment)
• the more aggressive the treatment, the greater is the chance that it will
produce adverse effects.
• As the response to therapy decreases, the susceptibility to toxic side
effects increases. These changes are attributable to many factors,
including the ability to metabolize drugs, changes in receptor behavior,
and an altered chemical environment produced by other simultaneous
drugs.
Prevention
1. Identification of the elderly who are at high risk
2. Minimization of medication  While such a
reevaluation is prudent, the decision to discontinue
should be made carefully.
3. Early recognition and treatment
4. Close management chronic illness

Management
- Geriatric interdisciplinary team
- Pharmacist consultation
 SLEEP DISORDER IN ELDERLY
• SLEEP-DISORDERED BREATHING
• PERIODIC LIMB MOVEMENTS IN
SLEEP/RESTLESS LEGS SYNDROME
• CIRCADIAN RHYTHMS SLEEP DISORDERS
• RAPID EYE MOVEMENT SLEEP BEHAVIOR
DISORDER
• INSOMNIA
Sleep Complaints of Older Adults
 Spend too much time in bed
 Spend less time asleep
 Increase in number of awakenings
 Increase in time to fall asleep
 Less satisfied with sleep
 Significant increase in daytime sleepiness
 Napping more often and longer
 INSOMNIA
• Definition : complaint of low quantity and / or poor quality
sleep, resulting in a sense of nonrestorative sleep

• Type of insomnia :
• 1. Sleep onset insomnia (an inability to initiate sleep)
• 2. Sleep maintain insomnia ( an inability to maintain sleep
throughout the night)
• 3. Early morning insomnia (awakening early in the morning,
inability to return to sleep)
• 4. Pathophysiologic insomnia (behaviorally associated with
maladaptive behaviors)
 Management
• Sleep restriction therapy entails limiting time in
bed to consolidate actual time sleeping.
• stimulus control and practicing good sleep hygiene
• relaxation therapy  to guide individuals to a
calm, steady state when they wish to go to sleep.
• Medication  drugs have been approved by the
FDA for the treatment of insomnia, including
benzodiazepines, nonbenzodiazepines, and a
melatonin receptor agonis
 Immobility
• Immobility refers to the state in which an individual
has a limitation in independent, purposeful physical
movement of the body or of one or more lower
extremities
• Causes of immobility  intrapersonal factors
including psychological factors (eg, depression, fear
of falling or getting hurt, motivation), physical
changes (cardiovascular, neurological, and
musculoskeletal disorders, and associated pain), and
environmental causes.
 Management of immobility
• The goal in the management of any older
adult is to optimize function and mobility to
the individual’s highest level.

• Medical management is central to assuring

this goal because optimal management of
underlying acute and chronic disease must be
addressed to assure success
 Inanition (malnutrition)
•  Age related changes that affect nutrition

• Changes in appetite  loss of taste, smell

• Dental
• Slowly swallowing  presbyphagia
• Gastrointestinal tract and post absorptive effect
• Pyschological  depression, cognitive impairment, drugs
(sedation effect)
• Socioeconomic  income, reduced access to food, poor
knowledge of nutrition
• Limited mobility
 Management
• Postural adjustment  upright posture  vertical phase
oropharyngeal on gravitation forces
• Safe & efficient swallow
• Eat slowly & allow enough time
• Do not eat or drink when rushed or tired
• Take small amounts  use a teaspoon
• Concentrate on swallowing  eliminate distraction (TV)
• Avoid mixing food & liquid
• Adaptive equipment
 Adaptive equipment
• 1. Straw  prevent backward head tilt (neck
extension) more likely to be misdirected into
airways
• 2. Spoon narrow, shallow bowls
• 3. Diet modification
• a.Liquid  thickened  honey b.Pureed diet /
soft food
• 4. Education caregiver sign of choking & Heimlich
maneuver
 Impairment Visual and Hearing
• Normal age related changes in vision
• Loss of accommodation  crystalline lenses lose flexibility,
ciliary muscle lose tone
• Loss of low contrast acuity  << transmission of ocular media, <<
pupil size
• Difficulty with dark adaptation  losses in ocular transmittance
and papillary miosis
• Loss of color discrimination  smaller pupil diameter, << light
transmission through the lens
• Loss of attentional visual field  << higher order visual processes
>> difficulty with visual reading ability  low contrast acuity
Magemenet
Age related hearing impairment (ARHI)

• Many changes in the peripheral and central

auditory system during aging have effects on
the hearing mechanism
 Management
• In the severely impaired, in addition to a hearing aid, aural
rehabilitation with speech reading may be necessary.
• Patients may initially be resistant to using a hearing aid. Patient and
family counseling may overcome this resistance and improve use of
and satisfaction with a hearing aid.
 Infection
– Pada lanjut usia terdapat  beberapa penyakit sekaligus, menurunnya
daya tahan/imunitas terhadap infeksi, menurunnya daya
komunikasipada lanjut usia sehingga sulit/jarang mengeluh, sulitnya
mengenal tanda infeksi secara dini.

– Ciri utama pada semua penyakit infeksi biasanya ditandai dengan

meningkatnya temperatur badan, dan hal ini sering tidak dijumpai pada
usia lanjut, malah suhu badan yang rendah lebih sering dijumpai.

– Keluhan dan gejala infeksi semakin tidak khas antara lain berupa
konfusi/delirium sampai koma, adanya penurunan nafsu makan tiba-
tiba, badan menjadi lemas, dan adanya perubahan tingkah laku sering
terjadi pada pasien usia lanjut.
 Immunodefficiency
(penurunan sistem kekebalan tubuh).

• Daya tahan tubuh menurun bisa disebabkan

oleh proses menua seperti fungsi fagositik,
cell-mediated immunity dan humoral
immunity disertai penurunan fungsi organ
tubuh,  juga disebabkan penyakit yang
diderita, penggunaan obat-obatan, keadaan
gizi yang menurun.
 Infection
• Although it is proposed that alterations in host defense
mechanisms predispose older adults to certain infections,
there is little evidence to support this hypothesis. It may
well be that environmental factors, physiological changes
other than in the immune system, and specific diseases are
the major elements in the increased frequency of certain
infections in older adults

• Physiological alterations in the lungs, bladder function, and

the skin—and glucose homeostasis may also predispose
older adults to infections
 Impecunity (Tidak punya penghasilan)
• Dengan semakin bertambahnya usia maka kemampuan
fisik dan mental akan berkurang secara berlahan-lahan,
yang menyebabkan ketidakmampuan tubuh dalam
mengerjakan atau menyelesaikan pekerjaan sehingga
tidak dapat memberikan penghasilan
• Usia pensiun dimana sebagian dari lansia hanya
mengandalkan hidup dari tunjangan hari tuanya
• Selain masalah finansial, pensiun juga berarti kehilangan
teman sejawat, berarti interaksi sosial pun berkurang
memudahkan seorang lansia mengalami depresi
 Impotence (Gangguan seksual)
Impotensi/ ketidakmampuan melakukan
aktivitas seksual pada usia lanjut terutama
disebabkan oleh gangguan organik seperti
gangguan hormon, syaraf, dan pembuluh darah
dan juga depresi
DAFTAR PUSTAKA

Essentials of Clinical Geriatrics, 8e

Robert L. Kane, Joseph G. Ouslander, Barbara Resnick,
Michael L. Malone

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