masalah kesehatan lansia

7/22/2019 masalah kesehatan lansia

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MASALAH KESEHATAN LANSIA

Keperawatan Komunitas II

OLEH: SOVIA, Ners, M.Kep.


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DEFINISI LANJUT USIA

Pra Lansia : Seseorang yang berusia

4560 tahun

Lansia : Seseorang yang berusia

> 60 tahun

Lansia Risiko : Seseorang yang berusiaTinggi > 70 tahun


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Definisi Sehat

UU No 36 Tahun 2009 Tentang Kesehatan

Kesehatan adalah keadaan sehat, baik

secara fisik, mental, spiritual, maupun sosial

yang memungkinkan setiap orang hidup

produktif secara sosial dan ekonomis.

Mandiri artinya dapat melakukan kegiatan/

aktivitas sehari-hari tanpa bantuan orang

lain.


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PERKEMBANGAN LANJUT USIA

DI INDONESIA

Umur harapan

hidup

Jumlah Lansia (juta)

1980 52,2 7,998 (5,45%)

1990 59,8 11.277 (6,29%)

2000 64,5 14,440 (7,18%)

2010 70,6 23,993 (9,77%)

2014 72 28,823 (11,34%)

7Sumber : BPS


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KARAKTERISTIK

LANSIA

1. Usia > 60 tahun2. Multipatologi

3. Tampilan klinis tidakkhas

4. Polifarmasi

5. Fungsi organ menurun

6. Gangguan statusfungsional

7. Gangguan nutrisi


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FISIK

SOSIO -

EKONOMIKPSIKO

- LOGIK

FUNGSIONAL

FAKTOR-FAKTOR BERINTERAKSI SECARA KOMPLEKS


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Masalah Kesehatan Fisik


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13

Jenis penyakit 55- 64 th 6574 th > 75 th

Penyakit sendi 56,4 62,9 65,4Hipertensi 53,7 63,5 67,3

Katarak 28,8 41,9 51,6

Stroke 20,2 31,9 41,7

Jantung 16,1 19,2 20,4

Gangg mental emosional 15,9 23,2 33,7

DM 3,7 3,4 3,2

MASALAH KESEHATAN LANSIA

(Riskesdas 2007)Dalam persen


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Tips Menuju Lansia Sehat Dan Mandiri

1. Hindari Pola Hidup Tidak Sehat

2. Gizi Seimbang3. Melakukan Aktifitas Fisik dan Olah

Raga

4. Istirahat dan tidur yang cukup

5. Pemeriksaan Kesehatan Secara Berkala


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GAYA HIDUP (POLA HIDUP)

PERILAKU TERTENTU YANG TELAH BERULANGKALI

DILAKSANAKAN, SEHINGGA MENJADI MENETAP

DAN RUTIN, SUKAR BERUBAH (MEMBUDAYA)

DILANDASI OLEH KEYAKINAN YANG KUAT

KARENA DORONGAN KEBUTUHAN YANG JUGA KUAT

DAN SISTEM NILAI YANG KOKOH

SEHINGGA SEOLAH-OLAH MENJADI MADAT,

TIDAK BISA HIDUP KALAU TANPA PERILAKU TERSEBUT

1. HINDARI POLA HIDUP TIDAK SEHAT


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GAYA HIDUP TIDAK SEHAT

Stress

Insomnia

Merokok

Hipertensi

Depresi

Obesitas

Serangan Asma

Angina

Pectoris

Alkoholik

TIA & Stroke

Kecemasan


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Obesitas

F KTOR UT M PENYEB B PENY KIT G Y HIDUP

Diet Tidak Sehat

(Unh ealthy Diet)

Ketidakaktifan Fisik

(Phy sic al Inact ivity )

Merokok

(Smoking)

Stress

Osteoporosis

Diabetes Mellitus

Hipertensi

Asma

Hiperlipidemia

Osteoarthritis



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Pola Makan &

Diet Tidak Sehat

(Unhealthy Diet)

Makanan Tinggi

Kalori

Makanan Tinggi

Lemak

Makanan Tinggi

Garam

Makanan Rendah

Serat

Gunakan Bahan

Perasa Pengawet,

Pewarna Buatan

Makanan KurangCalsium

DiabetesMellitus

Hiperlipidemi

Obesitas

Hipertensi

Kanker Usus

Osteoporosis

Radikal Bebas



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Age related changes

Taste & smell

Visual acuity

Loss of teeth & poor fitting denture

Gastric secretion influence in absorptionof B12, folic acid& iron.

Food remain longer time in stomach + gastric secretion will lead to indigestion

&feeling of fullness.


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Psychosocial factors

Depression is common ( losses, death,retirement, change of body appearance,

impaired vision &poor physical fitness)

this will lead to lack of interest in eating

& anorexia and food intake.

Living alone also will lead to lack of

incentive to cook &eat.


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Economic Factors

Low income

Limited access to food and foodchoices

Inadequate facilities to food storage

and preparation


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Cultural factors

Eating habits may miss certain foodgroup as vegetarians.


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- makanlah aneka ragam makanan- makanlah makanan sesuai kebutuhan (seimbang)

- batasi konsumsi lemak/minyak/santan kental

- dianjurkan gunakan karbohidrat komplek krn

mengandung vit dan mineral dp mengkonsumsikarbohidrat murni (gula)

- biasakan makan pagi

- minum air putih yg aman dan cukup jumlahnya

- lakukan kegiatan fisik dan olahraga secara teratur

- hindari minuman beralkohol


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4- Carbohydrates requirement

CHO is essential for maintaining normal bl.glucose level & preventing protein break

down.

50% of total calories---- CHO

Simple CHO as sugar, honey ( avoided)

Complex CHO as vegetables, grains, fruits

Complex CHO has vit, minerals, fibers whichhelp in bowel elimination& bl. cholesterol

level.


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5-Fluidintake

Elderly at high risk for dehydration due to:

1. Thirst sensation2. Inadequate fluid intake (2000-3000 cc/day) required

3. Some medications, such as for high blood pressure oranti-depressants, and diuretic

4. Some medications may cause patients to sweat more5. Frail seniors have a harder time getting up to get a

drink when theyre thirsty, or they rely on caregiverswho cant sense that they need fluids

6. As we age our bodies lose kidney function and are less

able to conserve fluid (this is progressive from aroundthe age of 50, but becomes more acute and noticeableover the age of 70)

7. Illness, especially one that causes vomiting and/ordiarrhea, also can cause elderly dehydration


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6- Vitamins & mineral requirements

Calcium:---for mineralization of bone &has a role

in blood & cardiac function.

Daily requirement 1200 mg./day if there is no

contraindications

Vitamin D :------ needed for calcium absorption&

metabolism.

Exposure 15 minutes/day to sun is enough


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Nurse Role

Assessment involves: nutritional history,

physical examination, anthropometric

measurements, biochemical evaluation,

cognitive & mood evaluation

Health history related to nutrition

Anthropometric measurement

Client and family education


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3. MELAKUKAN AKTIVITAS FISIK

DAN OLAHRAGA

Aktivitas fisik adalah setiap gerakan tubuh yang

meningkatkan pengeluaran tenaga dan energi

Olahraga adalah suatu bentuk aktifitas fisik dari

otot tubuh yag bila dilaksanakan dengan baik,

benar, terukur dan teratur akan meningkatkan

kebugaran jasmani

Kebugaran Jasmani adalah kemampuan tubuhuntuk melakukan pekerjaan sehari-hari tanpa

menimbulkan kelelahan yang berarti.


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AKTIFITAS FISIK DAN OR

Physical Social

Psychological

Benefits of

exercise

h i l b fi f i


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Physical benefits of exercise

1) Consumption of body fat

2) Improve cardio-vascular capacity( byblood flow----- keep tissue healthy

3) Control hypertension& blood sugar

4) Improve respiratory function

5) Improve joint flexibility

6) Improve pattern of sleep & rest

7) independency

8) Improve sense of well being & relaxation9) Maintain minds function

10) Promote sense of normality

11) Peristaltic movement


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Social benefits of exercise

Improve social interaction & relation with

other


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TIPS MELAKUKAN OR PADA LANSIA

Konsultasi ke dokter

Dilakukan 3 x seminggu secara teratur

Pilih olahraga yang mudah,aman sesuai dengan minat dankemampuan tubuh

Olahraga sebaiknya dilakukan 2 jam setelah selesai makandan diajurkan minum sebelum OR

Pakaian yang dikenakan terbuat dari bahan yg ringan danmudah menyerap keringat dan tidak menggangu untukbergerak

Bila OR dilakukan diluar rungan sebaiknya dilakukan pagiatau sore hari


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Role of the nurse during exercise

I- Assessment done at the beginning of exerciseprogram include:

1. History & physical examination (CVS, resp,musculoskeletal & neurological system)

2. Renal & liver function tests

3. ECG,& exercise stress test

4. Assess range of motion & use of assistive

devices.

5. Assess environmental hazards

II-Set a regular time to exercise each day


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III- Before starting exercise the nurse should advice the

elderly about:

1. Document baseline resting function status (ht &resprate, bl.sugar)

2. 10 minutes warms up stretching exercise

3. Drink water before and after exercise is importantas water will be lost during exercise

4. Clothes worn during exercise should allow for easy

movement and perspiration.

5. Athletic shoes provide both support and protection

6. Outdoor exercise should be avoided in extremely

hot or cold weather.


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Enclosed shopping malls are sheltered places

for walking during the extreme weather or

when there are concerns about neighborhood

safety.

Exercising with a partner provides both

encouragement to continue exercising and

safety.

Nurse should advice the older adults to stopexercising and seek help if they experiences

chest pain or tightness, shortness of breath,

dizziness, or palpitation during exercise.


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During exercise

Monitor heart & resp. rate

Stop exercise if elderly has fatigue , chest

pain or heart & resp. rateAfter exercise

10 minutes cooling up at end of exercise

Monitor pulse rate during cooling for

returning to resting ht. rate


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4. Istirahat dan tidur

Person spend 1/3 of his life in sleep

Sleep is time for cell growth& repair Elderly need 5-7 hrs at night

Importance of Rest& sleep:1) Conserve energy

2) Provide organ respite (rest)

3) Restore the mental alertness& neurologicalefficiency

4) Relieve tension

5) Emerge feeling of well being


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Factors affecting sleeping patterns

Age related changes in sleep patterns

Internal factors

External factors

Nursing measures adopted to promote


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Nursing measures adopted to promote

sleep

1. Engage in exercise program

2. Avoid exercise within 3-4 hr. of bedtime.

3. Spend time out door in the sunlight each day but avoidperiod between 12 Md to 3 PM sunshine exposure.

4. Engage in relaxing activities near bedtime.

5. Avoid tobacco at bedtime

6. Avoid drink any caffeinated beverages before midafternoon.

7. Limit fluid intake after the dinner hour if nocturia is aproblem.

8. Limit daytime naps to 30 minutes or less.

9. Avoid using the bed for watching TV, writing bills, andreading.


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Lanjutan.

Minimal pemeriksaan yang dilakukan :

Pemeriksaan fisik, Berat badan dan tekanan darah

Pemeriksaan Status Kemandirian

Pemeriksaan Status Gizi

Pemeriksaan fungsi indera penglihatan dan

pendengaran

Pemeriksaan laboratorium meliputi urin, glukosadarah

Pemeriksaan mental psikologik

Types of health screening


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Types of health screening

Health screening Period

Bl. p Each Dr. visit or 3-6 months

Ht & wt Periodically as part of

comprehensive physical examination

Dental check up Once / year( annually)

Fecal occult blood&

sigmoidoscopy

( annually)

Vision including

glaucoma test

Every 2 years


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Health screening Period

Hearing Evaluate periodically

Cholesterol level Every 5 years

Cancer screening Annually

Mammography for

women under 70 y

1-2 years

Digital rectal examination Annually


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Immunizations

Vaccination Period

Influenza (over 65y) Annually (mid October to

mid November)Tetanus & diphtheria Every 10 years

Pneumococcalvaccination

Once at age 65y,revaccination for high risk

fatal pneumonia/6 y


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Masalah KesehatanPsikososial


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MASALAH PSIKOSOSIAL

PsikisSosial

Kognitif


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Psychosocial Well-being

Psychosocial changes may alter an individual

relationship with others.

Physical wellbeing depend on:

Psychosocial wellbeing

Social structure

Personal relationships

In Later years many adjustment are necessary


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PSIKIS

Masalah yang sering ditemukan pada lansia :- Masalah kehilangan peranan, kehilangan

pekerjaan shg terjadi stres psikososial

- Masalah kehilangan finansial krn pensiun

- Maslah kehilangan status, jabatan

- Masalah kehilangan teman, kenalan, relasi,

shg menarik diri

- Banyaknya kehilangan yang dikasihi,

suami/istri, anak, teman dekat.


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Dilakukan saat berkomunikasiuntuk melihat

fungsi kognitif termasuk daya ingat, proses fikir

Perlu dikaji alam perasaan, orentasi terhadap

realitas, kemampuan dalam menyelesaikan

masalah

Perubahan yang umum terjadi:

Penurunan daya ingat

Proses pikir lambat

Adanya perasaan sedih

Merasa kurang perhatian

KOGNITIF


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SOSIAL

- Masalah cara hidup, konsep diri.

- Kemampuan ekonomi menurun

- Menurunnya penghargaan dan penghormatan- Memurunnya peran sosial dimasyarakat

- Ketergantunagan krn kemampuan fisik lemah

- Kebosanan krn rasa tidak diperlukan


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Masalah KesehatanSpiritual

S i it l W ll b i


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Spiritual Well- being

Spiritual well-beingis the practice and

philosophy of the integral aspects of mental,

emotional and overall wellbeing.

Spiritual well-beingis a state in which the

positive aspects of spiritualityare

experienced, incorporated and lived by theindividual and reflected into ones

environment.
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Spiritualitas lansia

Karena lansia telah mengalami kemunduran

kemampuan fisik, maka lansia mempunyai

lebih banyak waktu untuk perkembangan

spiritual yaitu : Agama/ kepercayaan semakin terintegrasi

Perkembangan spiritual pada usia 70 thn,

secara menyeluruh, pada tkt ini lansiabersyukur dan memberi contoh cara

mencintai dan keadilan.


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Signs of spiritual distress:

Doubt

Despair

Guilt

Boredom

Expression of anger toward GOD


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Spiritual

Kenyakinan agama yang dimiliki dan sejauh

mana kenyakinan tersebut dapat diterapkan

dalam

Hal-hal yang perlu dikaji:

Kegiatan ibadah setiap hari

Kegiatan keagamaan

Cara menyelesaikan masalah (Doa) Terlihat sabar dan tawakal


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Benefits

The practice and incorporation of Spiritual

Wellbeing into ones life influences andincludes benefits for ones; Emotional

Wellbeing, Physical Wellbeing, and Mental

Wellbeing.

Some of the measurable benefits that people experience
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Some of the measurable benefits that people experiencefrom spiritual wellbeing counseling and groupsinclude:

A feeling of being more contented with their lifessituation

Greater enjoyment of self time, finding an innerpeace

Greater ability to take control of and resolve theirlifes issues

A greater sense of satisfaction in their activities andlife situations

Ability to take a more active part in life rather thanstanding still and watching it pass by

Ability to build more intimate, loving and lastingrelationships

A greater feeling of purpose and meaning in their life


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Measures to increase Spiritual well being

Identify ways that believes give meaning to life Use problem solving to solve any conflict related

to spirituality

Meeting with religious man at regular intervals

Presence of religious literatures in the

immediate environment such as Quran on

beside table Reading in religious books & praying

Discuss role of spirituality in ones life


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Masalah Ekonomi


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Sosial ekonomi

Bagaimana lansia membina keakraban

dengan teman sebaya maupun dengan

lingkungannya dan bagaimana

keterlibatkan lansia dalam organisasisosial

Penghasilan yang diperoleh

Perasaan sejahtera dalam kaitannyadengan sosial ekonomi

Hal-hal yang perlu dikaji:


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y g p j

Kesibukan lansia dalam mengisi waktu luang

Sumber keuangan

Dengan siapa yang ia tinggal

Kegiatan organisasi sosial yang diikuti

Pandangan lansia terhadap lingkungannya Berapa sering lansia berhubungan dengan orang lain

diluar rumah

Siapa saja yang biasa mengunjunginya

Seberapa besar ketergantungannya

Apakah dapat menyalurkan hobi atau keinginannya

dengan fasilitas yang ada.

Role of the nurse in elders health


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Role of the nurse in elders health

promotion

Assessment to his physical health, Psychosocial

Well- being, lifestyle pattern, hobbies, high risk

behaviors, knowledge, believes & attitudes that

affect health & wellbeing.

Assess health needs

Assess social , environmental & cultural influences

on health behaviors

Lifestyle modifications is a comprehensive approach

for effective change in heath promotion behaviors


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Nurse role should directed toward helping elderly

to cope with his function level ------delay

disabilities & impairments.

Nurse identify environmental hazards & make

necessary modifications

Identify social needs & encourage participation &

social support groups.

Nurse should inform elderly & caregivers aboutaging process, common disorders & disabilities ,

different services available


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Encourage elderly to take better care to them,

avoid high risk behaviors,& hazards affecting

their health.

Regular and continuous evaluation isimportant aspect of nurses role.


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Thank you

Documents

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