gangguan mental lansia
TRANSCRIPT
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Gangguan Mental pada Gangguan Mental pada LansiaLansia
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Masalah usila IndonesiaMasalah usila Indonesia
8,5 % jumlah penduduk8,5 % jumlah penduduk 19 juta (2000 – 2005)19 juta (2000 – 2005) Urutan ke 4 di duniaUrutan ke 4 di dunia
Sistim pelayanan usia lanjut?Sistim pelayanan usia lanjut? Jaminan kesehatan, akses kesehatan?Jaminan kesehatan, akses kesehatan? Kesadaran masyarakat masih kurangKesadaran masyarakat masih kurang Infrastruktur belum memadaiInfrastruktur belum memadai
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Masalah Usia lanjut:Masalah Usia lanjut:
1.1. Kesehatan (fisik & mental)Kesehatan (fisik & mental)
2.2. SosialSosial
3.3. EkonomiEkonomi
4.4. PsikologisPsikologis
5.5. Spiritualitas / religiusitasSpiritualitas / religiusitas
6.6. Hak azasi (human right)Hak azasi (human right)
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Kesehatan Usia LanjutKesehatan Usia Lanjut
MultipatologiMultipatologi80 % usila: 1 penyakit80 % usila: 1 penyakitPHBS (life style)PHBS (life style)Asuransi kesehatanAsuransi kesehatanSuccessful aging Successful aging Quality of life Quality of life
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Kesepian (loneliness)Kesepian (loneliness) PensiunPensiun Anak sibukAnak sibuk Tak punya aktivitasTak punya aktivitas Pasangan meninggalPasangan meninggal Terisolasi sosialTerisolasi sosial Tak ada teman bicaraTak ada teman bicara
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Masalah SosialMasalah Sosial
Peran sosial usia lanjut Peran sosial usia lanjut (masyarakat dan keluarga)(masyarakat dan keluarga)
Pergeseran peran (IRT, KK Pergeseran peran (IRT, KK pasif) pasif)Kesepian, frustasi, depresiKesepian, frustasi, depresiPost power syndromePost power syndromeGangguan adaptasiGangguan adaptasi
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Masalah EkonomiMasalah Ekonomi Penghasilan menurunPenghasilan menurun Masa persiapan pensiun, Masa persiapan pensiun, Tak ada pensiun / penghasilanTak ada pensiun / penghasilan
Tingkatkan aktivitas, kreativitasTingkatkan aktivitas, kreativitas Kembangkan hobi, ciptakan hobiKembangkan hobi, ciptakan hobi
Independensi keuangan?Independensi keuangan?
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Aspek PsikologisAspek Psikologis
Kepribadian masa dewasa mudaKepribadian masa dewasa muda Coping mechanism, problem solvingCoping mechanism, problem solving Kegagalan beradaptasi Kegagalan beradaptasi potensial potensial
gangguan jiwa dan fisik lainnyagangguan jiwa dan fisik lainnya Integrity vs isolationIntegrity vs isolation Dignity in old age !Dignity in old age ! Arti hidup / cara pandang kehidupanArti hidup / cara pandang kehidupan
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Spiritualisme / religiusitasSpiritualisme / religiusitas
Penghayatan keimananPenghayatan keimanan Sikap hidup / persepsi diriSikap hidup / persepsi diri Minat keagamaan meningkatMinat keagamaan meningkat Fungsi kognitif maningkat saat puasaFungsi kognitif maningkat saat puasa Penelitian Larson:Penelitian Larson:- Non religius: kurang tabah, kurang - Non religius: kurang tabah, kurang
kuat mengatasi stres, kurang tenang, kuat mengatasi stres, kurang tenang, takut mati dsb dibandingkan yang takut mati dsb dibandingkan yang usia lanjut yang “religius”usia lanjut yang “religius”
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Hak azasi usia lanjutHak azasi usia lanjut
Hindari Hindari abuseabuse dan dan neglectneglect
(mental, emosional & fisik)(mental, emosional & fisik) Hak untuk mengatur diri sendiriHak untuk mengatur diri sendiri Hak & kewajiban dalam masyarakatHak & kewajiban dalam masyarakat Hak berobat dan bertempat tinggalHak berobat dan bertempat tinggal Mendapat perlakuan yang pantasMendapat perlakuan yang pantas Human right of people with dementia Human right of people with dementia
((Kyoto, 17 Oct 2004, ADI conferenceKyoto, 17 Oct 2004, ADI conference))
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DPU dan Gangguan jiwa DPU dan Gangguan jiwa pada usia lanjut pada usia lanjut
Case finding: Case finding: temuan kasus dinitemuan kasus dini Intervensi segeraIntervensi segeraCegah disabilitasCegah disabilitasOptimalkan fungsiOptimalkan fungsi Identifikasi faktor risikoIdentifikasi faktor risikoKendalikan penyakitKendalikan penyakit
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Gangguan jiwa Gangguan jiwa pada usia lanjut:pada usia lanjut:
Gangguan DepresiGangguan DepresiGangguan CemasGangguan CemasDemensia (‘pikun’)Demensia (‘pikun’) Insomnia (gangguan tidur)Insomnia (gangguan tidur)Delirium (kebingungan akut)Delirium (kebingungan akut)
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GANGGUAN DEPRESIGANGGUAN DEPRESI
Tertekan, sedih, menetap dan tidak Tertekan, sedih, menetap dan tidak dapat berfungsi sehari-haridapat berfungsi sehari-hari
Penyebab: berbagai ‘kehilangan’Penyebab: berbagai ‘kehilangan’Sikap anggota keluargaSikap anggota keluargaPeka terhadap tanda-tanda dini !Peka terhadap tanda-tanda dini !Gejala depresi pada usia lanjut tidak Gejala depresi pada usia lanjut tidak
khas, gejala somatik menonjol !khas, gejala somatik menonjol !
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4 Tanda pengenal 4 Tanda pengenal gangguan depresi:gangguan depresi:
Ada perasaan kosong / hampaAda perasaan kosong / hampaPesimis, kuatir masa depanPesimis, kuatir masa depanTak ada kepuasan hidupTak ada kepuasan hidupMerasa hidupnya tidak bahagiaMerasa hidupnya tidak bahagia
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Gangguan CemasGangguan Cemas
Gejala fisik muncul dahuluGejala fisik muncul dahuluCemas & kuatir berlebihCemas & kuatir berlebihKetegangan fisik dan mentalKetegangan fisik dan mentalGejala otonom (keringat, debar-debar, Gejala otonom (keringat, debar-debar,
sakit perut, pusing dll)sakit perut, pusing dll)Berlangsung kronis, hilang timbulBerlangsung kronis, hilang timbulPTSD: pada usila lebih beratPTSD: pada usila lebih berat
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DemensiaDemensia Kemunduran mental progresif Kemunduran mental progresif Defisit berbagai fungsi kognitifDefisit berbagai fungsi kognitifSindrom ABC Sindrom ABC
(Activity, Behavior, Cognitive)(Activity, Behavior, Cognitive)Penyebab: AD, Stroke, Parkinson, dllPenyebab: AD, Stroke, Parkinson, dllTanda – tanda dini demensia!Tanda – tanda dini demensia!BPSD (behavior & psychological BPSD (behavior & psychological
symptoms of dementia) symptoms of dementia)
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AD prognosisAD prognosisOptimal caseOptimal case
Min
i Men
tal S
tate
Exa
min
atio
n s
core
1 2 3 4 5 6 7 8 9
25 ---------------------| Symptoms
20 |----------------------| Diagnosis
15 |-----------------------| Loss of functional independence
10 |--------------------------------| Behavioral problems
5 |-------------------------------------------|
0 Death |------------------------------------------
Nursing home placement
Feidman and Gracon, 1996Years
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1818
DemensiaDemensia: kumpulan gejala-gejala : kumpulan gejala-gejala dis -dis - eksekutif eksekutif
Aktivitas sehari-hari (ADL & IADL)
Amnesia ApraxiaAgnosiaAphasia
Aspek Aspek neuropsikologisneuropsikologis
(kognitif)(kognitif)
Gejala Psikiatrik /Psikologis
Gangguan Perilaku
Gejala neuropsikiatrik (non-kognitif: BPSD)
BPSD, behavioral and psychological symptoms of dementia
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What is Dementia?What is Dementia?
A: activity declineA: activity declineB: behavior disturbancesB: behavior disturbancesC: cognitive impairmentC: cognitive impairment
Sebab: gangguan fungsi otak! --- > Sebab: gangguan fungsi otak! --- > kemunduran mental (De - Ment) kemunduran mental (De - Ment)
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Activity declineActivity decline Instrumental ADLInstrumental ADL::- BerkendaraanBerkendaraan- Bepergian sendiriBepergian sendiri- BerbelanjaBerbelanja- MemasakMemasak- Menggunakan teleponMenggunakan telepon- Mengelola keuanganMengelola keuangan
Basic ADLBasic ADL::- Makan Makan - MandiMandi- Naik turun tanggaNaik turun tangga- Buang air besar / Buang air besar /
kecilkecil- Berpakaian Berpakaian
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Behavior disturbancesBehavior disturbances
ApatisApatis PencurigaPencuriga
Mudah Mudah tersinggungtersinggung
Mudah marahMudah marah HiperaktifHiperaktif InsomniaInsomnia
Murung / sedihMurung / sedih
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Cognitive impairmentCognitive impairment:: Kelemahan memori (mudah lupa)Kelemahan memori (mudah lupa) Kesulitan berbahasa (afasia)Kesulitan berbahasa (afasia) Kesulitan mengeksekusi (rencana, urutan Kesulitan mengeksekusi (rencana, urutan
kegiatan, mengorganisasi)kegiatan, mengorganisasi) Pengenalan benda, wajah, bentuk, ruang dllPengenalan benda, wajah, bentuk, ruang dll Kemerosotan daya nilai, abstraksi, Kemerosotan daya nilai, abstraksi,
judgment, dan fungsi-fungsi otak lainnyajudgment, dan fungsi-fungsi otak lainnya
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Aggressive resistancePhysical aggressionVerbal aggression
‘Aggression’
HallucinationsDelusions
Misidentifications ‘Psychosis’
WithdrawnLack of interest
Amotivation
‘Apathy’
Adapted from McShane R. Int Psychogeriatr 2000; 12(Suppl 1): 147–54Finkel SI et al. Am J Geriatr Psychiatry 1998; 6: 97–100
Alessi C et al. J Am Geriatr Soc 1999; 47: 784–91
Kelompok Gejala BPSD
SadTearful
HopelessLow self-esteem
AnxietyGuilt
‘Depression’
‘Agitation’
Walking aimlesslyPacing Trailing
RestlessnessRepetitive actions
Dressing/undressingSleep disturbance
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InsomniaInsomniaSulit masuk tidur dan atau Sulit masuk tidur dan atau
mempertahankan tidur, atau sulit mempertahankan tidur, atau sulit tertidur lagi setelah terbanguntertidur lagi setelah terbangun
Kurang tidur atau berlebihan tidurKurang tidur atau berlebihan tidurDampak kurang tidur, distressDampak kurang tidur, distressCari Cari underlying diseaseunderlying disease insomnia ! insomnia !Hygiene tidur & variasi individuHygiene tidur & variasi individu
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DeliriumDelirium
Kebingungan akut, disorientasi, Kebingungan akut, disorientasi, melantur, halusinasi dllmelantur, halusinasi dll
Penyebab: infeksi, ggn elektrolit dllPenyebab: infeksi, ggn elektrolit dllTanda: hiperaktif / hipoaktifTanda: hiperaktif / hipoaktifKondisi medik emergensiKondisi medik emergensi
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In patient geriatric ward in RSCMIn patient geriatric ward in RSCM
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Tim Terpadu GeriatriTim Terpadu Geriatri InterdisiplinInterdisiplinPsikiater, Internist, Rehabilitasi Psikiater, Internist, Rehabilitasi
Medik, Gizi, Neurolog, dan ahli Medik, Gizi, Neurolog, dan ahli lainnya khusus geriatri lainnya khusus geriatri
Acute WardAcute Ward Inpatient WardInpatient WardHomecareHomecareDaycare / Day hospitalDaycare / Day hospital
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People do not consist of People do not consist of memory alone … … …memory alone … … …
They have feeling, will, sensibility and They have feeling, will, sensibility and moral beingmoral being
It is here that you may touch themIt is here that you may touch themAnd see a profound changeAnd see a profound change
A. LuriaA. Luria
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Cognitive trainingCognitive training
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Cognitive stimulationCognitive stimulation
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We can make a difference!We can make a difference!
World Alzheimer Day 2005World Alzheimer Day 200521 September21 September
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* Define all contributory factors and other illnesses * Discuss the diagnosis, and differentiate other types of dementia * Withdraw non-essential drugs that may interfere with cognition * Treat or manage concomitant illness (e.g. depression, hearing loss)
The role of the primary care The role of the primary care physician in mild to moderate ADphysician in mild to moderate AD
Gauthier, Burns and Pettit, 1997
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* Discuss the use of symptomatic therapies * Monitor functional ability e.g. driving, safety * Referral to specialist if appropriate * Advise on will-making and advance directives * Refer to local AD association for support * Managing caregivers
The role of the primary care The role of the primary care physician in mild to moderate AD physician in mild to moderate AD
(continued)(continued)
Gauthier, Burns and Pettit, 1997
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* Help caregivers discover and optimize the patient's preserved function * Monitor and treat complications * Facilitate caregiver support (respite and day care programs) * Be aware of caregiver burden and stress * Plan institutionalization, if needed * Assist with end-of-life decisions
The role of the primary care in The role of the primary care in severe ADsevere AD
Gauthier, Burns and Pettit, 1997
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CASE-FINDINGSymptomssuggestingcognitive
impairment
MANAGEMENT OF AD *Follow-up *Patient and caregiver counseling *Management and symptomatic treatment *Specialist referral if indicated
CLINICAL ASSESSMENT *Clinical history
*Physical examination *Laboratory tests
*Functional assessment *Cognitive assessment
Functional decline and cognitive impairment
DIFFERENTIAL DIAGNOSIS *Exclude delirium depression other causes of dementia *Evaluate evidence for AD (neuroimaging)
YES
AD diagnosis
Diagnosing AD in primary careDiagnosing AD in primary careA systematic approach summaryA systematic approach summary
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* Cognitive ability* Functional ability * Behavior * General health * Routine health checks
Primary care management of Primary care management of ADAD
follow-upfollow-up
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* Inconclusive diagnosis * Atypical presentation * Behavioral/psychiatric symptoms * Second opinion * Family dispute * Caregiver support
Primary care management of ADPrimary care management of ADspecialist referralspecialist referral
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Terima kasihTerima kasih
Better Mental Health Better Mental Health
for the for the elderly!elderly!