isi proposal sisanya 2003

Keterangan:

1. Termasuk kelompok polifarmasi bila mendapat terapi > 5 obat dalam sehari. Vitamin dan suplemen tidak termasuk dalam perhitungan obat.

2. Termasuk kelompok bukan polifarmasi bila mendapat terapi 5 obat dalam sehari

4.7 Rencana Pengolahan Data

1. Editing

Memeriksa kelengkapan data yang diperoleh dari hasil kriteria START dan STOPP, kriteria Naranjo, indeks Barthel dan MMSE serta wawancara, pemeriksaan fisik dan penunjang lainnya.

2. Koding

Memberi kode pada masing-masing jawaban untuk dilakukan pengolahan data.

3. Data entry

Pemindahan data ke dalam komputer agar diperoleh data masukan yang siap diolah.

4.8 Analisis Data

1. Analisis Univariat

Analisis ini dilakukan pada masing-masing variabel. Hasil ini berupa distribusi dan persentase pada variabel-variabel yang diteliti.

2. Analisis Bivariat

Analisis yang dilakukan untuk melihat ada tidaknya hubungan antara variabel bebas dengan variabel tergantung.

4.9 Penyajian Data

Data yang telah terkumpul dan diolah akan disajikan dalam bentuk, yaitu :

1. Tekstular

Penyajian data hasil penelitian dengan menggunakan kalimat.

2. Tabular

Penyajian data hasil penelitian dengan menggunakan tabel.

DAFTAR PUSTAKA

1. World Health Organization. Active Ageing A Policy Framework. Madrid, Spain;April 2002. Available at: http://www.who.int/ageing/publications/active/en.html. Accesed on: 27 January 2015

2. Soejono CH, Setiati S, Nasrun MWS, Silaswati S. Pedoman Pengelolaan Kesehatan Pasien Geriatri Untuk Dokter dan Perawat. Edisi Pertama. Jakarta: Pusat Informasi dan Penerbit Bagian Ilmu Penyakit Dalam FKUI; 2004.

3. Badan Pusat Statistik. Penduduk Menurut Kelompok Umur dan Jenis Kelamin 2010. Available at: http://www.bps.go.id/aboutus.php?sp=1. Accesed on: 27 January 2015.

4. Hamilton HJ. Gallagher PF. Mahony DO. Inappropriate prescribing and adverse drug events in older people. In: BMC Geriatrics. 2009; 9: 5. Available at: www.bmcgeriatrics.com Accessed on: 27 January 2015.

5. Page R, Linnebur S, Bryant L, et al. Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clin Interv Aging 2010; 5: 75-87.

6. Mariyono HH, Suryana K. Adverse Drug Reactions. In: J Peny Dalam. 2008; vol 9(2) Available at http://ojs.unud.ac.id/index.php/jim/article/viewFile/3862/2857Accesed January 22, 2015.

7. Departemen Sosial RI. Penduduk lanjut usia di Indonesia dan masalah kesejahteraannya. Diposkan tanggal 23 Oktober 2007. Available at: http://www.depsos.go.id. Accesed on: 27 January 2015

8. Kane RL, Ouslander JG, Abrass I. Essentials of Clinical Geriatrics. 6th ed. New York : McGraw Hill; 2008. P.1 548.

9. Waney AT. Latihan stimulasi kognitif pada kelompok usia lanjut. Jurnal Ilmiah LEMDIMAS 2005; 4 (suppl 2): 77-82

10. Sadock BJ, Sadock VA. Delirium, dementia, amnestic and cognitive disorders. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 8th Edition. Lippincott Williams & Wilkins; 2005. P. 150-180

11. Waney AT. Latihan stimulasi kognitif : senam otak pada kelompok lansia di Kamal-Kalideres, Jakarta Barat. Jurnal Ilmiah LEMDIMAS 2007; 7 (suppl 1): 6-13

12. Folstein MF, Folstein SE, McHugh PR. ""Mini-mental state". A practical method for grading the cognitive state of patients for the clinician". Journal of psychiatric research .1975. 12 (3): 18998.

13. Hamilton H, Gallagher P, Ryan C, Byrne S, OMahony D. Potentially Inappropriate Medications Defined by STOPP Criteria and the Risk of Adverse DrugEvents in Older Hospitalized Patients. In: Arch Intern Med.2011; vol. 171(11): p. 1013-1019. Available at http://archinte.jamanetwork.com/article.aspx?articleid=227481Accesed January 22, 2015

14. Crum RM, Anthony JC, Bassett SS, Folstein MF. "Population-based norms for the Mini-Mental State Examination by age and educational level". JAMA. 1993. 269 (18): 238691

15. Darmojo R. Boedhi H. Martono H. Buku Ajar Geriatri (Ilmu Kesehatan Usia Lanjut) Ed. 3. Jakarta : FKUI; 2004.p. 145-8

16. Rahmawati F, Pramantara ID, Rohmah W, Sulaiman SA. Polypharmacy and Unnecessary Drug Therapy on Geriatric Hospitalized Patients in Yogyakarta Hospitals, Indonesia. In: International Journal of Pharmacy and Pharmaceutical Sciences. 2009; vol.1(1): p.1-11 Available at http://www.ijppsjournal.com/Vol1Suppl1/195.pdf. Accesed on: January 26, 2015

17. Kebijakan Obat Rasional. Dalam: Keputusan Menteri Kesehatan Republik Indonesia NOMOR189/MENKES/SK/III/2006. Available at: binfar.kemkes.go.id/?wpdmact=process&did. Accessed on: 27 January 2015.

18. WHO. Rational Use of Medicines. 2012.Available at : http://www.who.int/medicines/areas/rational_use/en/Accessed January 23, 2015

19. Akkawi FT. Prevalence and Risk Factors affecting polypharmacy among elderly patients in teh North of West Bank. In:Thesis on An-Najah National University Faculty of Draduate Studies. 2008. Available at: www.researchgate.net/.../237109653. Accessed on: 28 January 2015.

20. Kirsten K. Hege S. Tron A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. In: British Journal of Clinical Pharmacology. 2006; Vol 63(187). Availabe at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2006.02744.x/full. Accessed on: 28 January 2015.

21. Maryann M. Fulton RN. Polypharmacy in the elderly: A literature review. In: Journal of the American Academy of Nurse Practitioners. 2005; vol 17(123). Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1041-2972.2005.0020.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false. Accessed on: 28 January 2015.

22. Green JL. Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population?. In: The American Journal of Geriatric Pharmacotherapy. 2007; Vol 5(31). Available at: http://www.sciencedirect.com/science/article/pii/S1543594607000050. Accessed on: 28 January 2015.

23. Gallagher P. Ryan C. Byrne S. Kennedy J. O'Mahony D. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. International Journal of Clinical Pharmacology and Therapeutics. 2008; 46(2):72-83]. Available at: http://europepmc.org/abstract/med/18218287. Accessed on: 27 January 2015.

24. STARTing and STOPPing Medications in the Elderly. In: PHARMACISTS LETTER / PRESCRIBERS Letter. Available at: file:///C:/Users/hi/Downloads/STARTandSTOPP%20in%20elderly.pdf. Updated: September 2011. Accessed on: 27 January 2015.

25. GillespieU, Alassaad A, Udenaes MA, Mrlin C, Henrohn D, Bertilsson M, Melhus H. Effects of Pharmacists' Interventions on Appropriateness of Prescribing and Evaluation of the Instruments' (MAI, STOPP and STARTs') Ability to Predict HospitalizationAnalyses from a Randomized Controlled Trial. In: PLOS. 2013. Available at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0062401#pone-0062401 - g001. Accessed on: 27 January 2015.

26. Franceschi M, Scarcelli C, Niro V, Seripa D, Pazienza AM, Pepe G, et al. Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: a prospective study of 1756 patients. In: Pub Med. 2008;vol.31(6): p.545-56Available at http://www.ncbi.nlm.nih.gov/pubmed/18484788AccesedJanuary 26, 2015

27. OMahony D, OSullivan D, Byrne S, OConnor MN, Ryan C. STOPP/START Criteria for Potentially Inappropriate Prescribing in Older People : Version 2. In: Age and Ageing. 2014; 0: p. 16. Available at : http://ageing.oxfordjournals.org/content/early/2014/11/18/ageing.afu145.long Accesed January 22, 2015

28. Hines LE, Murphy JE. Potentially harmful drug-drug interactions in the elderly: a review. In: American Journal of Geriatric Pharmacotherapy. 2011; 9(6): 1.Available at http://www.ncbi.nlm.nih.gov/pubmed/22078863Accesed January 24, 2015)

29. Patrcia M. Leopoldo L. Diagnosis and control of polypharmacy in the elderly. Available at: http://www.scielo.br/scielo.php. Accessed on: 28 January 2015.

30. Wiffen P. Edwards J. Moore A. Adverse drug reactions in hospital patients (A systematic review of the prospective and retrospective studies). In: Bandolier. 2005. Available at: www.ebandilier.com. Accessed on: 27 January 2015.

31. David R Paula R. Emma C. Christopher F. Adverse Drug Reactions in Hospital In-Patients: A Prospective Analysis of 3695 Patient-Episodes. In: PLOS. 2009. Available at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0004439#pone-0004439-t007. Accessed on: 28 January 2015

32. Evans SR. Risk Factors for Adverse Drug Events: a 10-year analysis. Ann. Pharmacother., 42 (1) (2005), pp. 5361

33. Clavenna, Bonati M. Adverse Drug Reactions in Childhood: a Review of Prospective Studies and Safety Alerts. Arch. Dis. Child., 94 (2008), pp. 724728.

34. Budnitz DS, Shehab N, Kegler SR, Richards CL. Medication Use Leading to Emergency Department Visits for Adverse Drug Events in Older Adults. Ann. Intern. Med., 147 (2007), pp. 755765.

35. Jimmy J, Padma GM. Pattern of Adverse Drug Reactions Notified by Spontaneous Reporting in an Indian Tertiary Care Teaching Hospital. Pharmacol. Res., 54 (2006), pp. 226233.

36. Klotz U. Pharmacokinetics and Drug Metabolism in The Elderly. Drug Metab. Rev., 41 (2) (2009), pp. 6776

37. Ofotokun I, Pomeroy C. Sex Differences in Adverse Reactions to Antiretroviral Drugs. Top. HIV Med., 11 (2) (2003), pp. 5559

38. Sun H, Frassetto L, Benet LZ. Effects of Renal Failure on Drug Transport and Metabolism. Pharmacol. Ther., 109 (12) (2006), pp. 111

39. Colloca G, Tosato M, Vetrano DL, Topinkova E, Fialova D, et al. (2012) Inappropriate Drugs in Elderly Patients with Severe Cognitive Impairment: Results from the Shelter Study. PLoS ONE 7(10): e46669. doi:10.1371/journal.pone.0046669

40. Hartati S, Widayanti CG. Clock Drawing: Asesmen untuk Geriatri (Studi Deskriptif pada Orang Lanjut Usia Di Kota Semarang). In: Jurnal Psikologi Undip. 2010; vol. 7 (1) : p. 1-9. Available at http://ejournal.undip.ac.id/index.php/psikologi/article/download/2940/2627 Accesed February 2, 2015

41. Carulla LS, Gasca VI. Defining Disability, Functioning, Autonomy and Dependency in Person-Centered Medicine and Integrated Care. In: International Journal of Integrated Care. 2010; vol 10 p. 69-72 Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834916/pdf/ijic2010-2010025.pdf Accesed February 4, 2015

42. Bruce, Altice FL, Fried GH. Pharmacokinetic Drug Interactions Between Drugs of Abuse and Antiretroviral Medications: Implications and Management for Clinical Practice. Exp. Rev. Clin. Pharmacol., 1 (1) (2008), pp. 115127

43. Kroon LA. Drug Interactions with Smoking. Am. J. Health Syst. Pharm., 64 (18) (2007), pp. 19171921

44. Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN. Polypharmacy: Misleading but Manageable. Clin. Interv. Aging, 3 (2) (2008), pp. 383389

45. Rambhade S, Chakarborty A, Shrivastava A, Patil UK, Rambhade A. A Survey on Polypharmacy and Use of Inappropriate Medications. Toxicol. Int., 19 (1) (2012), pp. 6873

46. Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen J, Kaboli J. Polypharmacy and Precsribing Quality in Older People. J. Am. Geriatr. Soc., 54 (10) (2006), pp. 15161523

47. Pranarka K. Penerapan Geriatrik Kedokteran Menuju Usia Lanjut yang Sehat. In: Jurnal Universa Medicina. 2006; vol. 25 (4) : p. 187-197. Available at http://www.univmed.org/wp-content/uploads/2011/02/kRISPRANAKA.pdf Accesed February 2, 2015

48. Yenni, Herwana E. Prevalensi Penyakit Kronis dan Kualitas Hidup pada Lanjut Usia di Jakarta Selatan. In: Jurnal Universa Medicina. 2006; vol 25 (4) p. 164-171 Available at http://www.univmed.org/wp-content/uploads/2012/04/Yenny.pdf Accesed February 4, 2015

49. Petrovic M, Cammen T, Onder G. Adverse Drug Reactions in Older People Detection and Prevention. In: Drugs Aging. 2012; vol. 29 (6): p. 453-460 Available at http://gero.usc.edu/AgeWorks/fall_session2013/tdl/gero589/readings/Week12AdverseDrugResponses.pdf Accesed on: January 26, 2015

LAMPIRAN 1

PERKIRAAN BIAYA PENELITIAN

Penggandaan KuesionerRp. 200.000,-

Transportasi Rp. 100.000,-

CDRp. 15.000,-

Kertas A4Rp 35,000,-

Tinta printer Rp 150,000,-

Biaya tak terduga:Rp. 150.000,-

Rp. 650.000,-

ORGANISASI PENELITIAN

1. Pembimbing dari Kedokteran Universitas Trisakti

DR. dr. Rina K. Kusumaratna, M.Kes

2.Pembimbing Puskesmas Kecamatan Tebet

dr. Indira Puspita

3. Penyusun dan Pelaksana Penelitian

Diana Yulianti 030.06.070

Kiki Haera Rizky 030.09.131

Lina Pratiwi 030.09.136

LAMPIRAN 2

Kuisioner dan skor dari jawaban Algoritme Naranjo

No.

Adverse Drug Reaction (ADR) / Reaksi Obat yang Merugikan (ROM)

Ya

Tidak

Tidak tahu

1.

Apakah terdapat laporan yang jelas tentang ADR tersebut pada waktu lampau?

+1

0

0

2.

ADR terjadi setelah diberi obat yang dicurigai?

+2

0

0

3.

ADR berkurang ketika obat yang dicurigai dihentikan atau diberi antagonisnya?

+1

0

0

4.

ADR muncul kembali ketika obat tersebut diberikan lagi?

+2

0

0

5.

Adakah alternatif lain penyebab ADR pada pasien tersebut?

0

+2

0

6.

Apakah ADR tersebut juga timbul ketika diberikan plasebo?

0

+1

0

7.

Apakah obat berada pada konsentrasi toksis dalam darah?

+1

0

0

8.

Apakah ADR meningkat ketika dosis ditingkatkan atau berkurang ketika dosis diturunkan ?

+1

0

0

9.

Apakah pasien pernah mengalami ADR yang sama di waktu lampau ketika obat yang sama atau turunannya diberikan ?

+1

0

0

10.

Apakah diagnosis ADR tersebut didukung oleh bukti yang obyektif ?

+1

0

0

Hasil Penilaian Skor Tingkat Kejadian Adverse Drug Reaction (ADR)

1 - 3 Possible (Kemungkinan terjadi ADR) 9 - 13 Definite (Pasti terjadi ADR)

2 - 8 Probable (Kemungkinan Besar ADR)

LAMPIRAN 3

Kriteria START dan STOPP yang meliputi berbagai sistem organ

STOPP :Screening Tool of Older Peoples Potentially Inappropriate Prescriptions

The following drug prescriptions are pottentially inappropriate in person age 65 years age

Central nervous System and Psychotropic Drugs

1. Tricyclic antidepressan ( TCAs ) with dementia

2. TCAs with galucoma

3. TCAs with cardiac conductive abnormalities

4. TCAs with contispation

5. TCAs with an opiate or calcium channel blocker

6. TCAs with protastism or pror history of urinary retention

7. Long- term (i.e > 1 month ), long- acting benzodiazepines and benzodiazepines long-acting metabolite

8. Long- term (i.e > 1 month ) neuroleptics as long-term hypnotics

9. Long- term (i.e > 1 month ) in those with parkinsonism

10. Phenothiazines in patients with Epilepsi

11. Anticholinergics to treat extra-pyramidal side-effect of neuroleptic medication

12. Selective serotonin re-uptake inhibitors (SSRIs) with a history of clinnical significant hyponatraemia

13. Prolonged use (>1week) of frist generation antihistamines i.e diphenydramin, cholopheniramine, cyclizine, promethazine



Drugs that adversely affect fallers

1. Benzodiazepines

2. Neuroleptic drugs

3. First generation antihistamines

4. Vasodilator drugs with persistent postural hypotension i.e reccurent > 20 mmhg drugs in systolic pressure

5. Long term opiates in those with reccurent falls

Analgetic drugs

1. Use of long-term powerfull opiates e.g morphine or fentanyl as first line therapy form mild-moderate pain

2. Regular opiates for more than 2 weeks in those with chronic constipation without concurrent use of laxative

3. Long term opiates in those with dementia unless indicated for palliative care or management of moderate/severe chronic pain syndrome

Duplicated Drugs Classes

Any duplicated drugs prescriptions e.g two current opiates, NSAIDs, SSRIs, loop diuretics, ACE inhibitors



Cariovascular system

1. Digoxine at long-term dose 125g/day with impaired renal function

2. Loop diuretic for dependent ankle oedema only i.e no clinnical sign of heart failure

3. Loop diuretic as first-line monotherapy for hypertension

4. Thiazide diuretic with a history of gout

5. Non cardoiselective Beta-Blocker with chronic obstructive Pulmonary Disease

6. Beta- Blocker in combinnation with verapil

7. Use of dilitiazem or veramil with NYHA class III or IV heart failure

8. Calcium cahnnel blockers with chronic constipation

9. Use of aspirin and warfarin in combination withouut histaine H2 reseptor antagonis

10. Diprydamole as monotherapy for cardiovaskulaar secondary prevention

11. Aspirin with a past history of peptic ulcer disease without histamnie H2 reseptor antagonist or Proton Pump Inhibitor

12. Aspirin to treat dizziness not clearly attributable to cerebrovascular disease

13. Warfarin with no history of coronary, cerebral or peripheral vascular symptom or occulsive event

14. Aspirin at dose .150mg day

15. Warfarin for first, uncomplicated deep venous therombosis for longer than 6 month duration

16. Warfarin for first, uncomplicated pulmonarry embolus for longer than 12 months duration

17. Aspirin, clopidogrel, dipyridamoe or warfarin with concurrent bledding disorder



Urogenital System

1. Bladder antimuscarinic drugs with dementia

2. Antimuscarinic drugs with chronic glaukoma

3. Antimuscarinic drugs with chronic constipation

4. Antimuscarinic drugs with chronic prostatism

5. Alpha blockers in males with frequent incontinence i.e one ormore episodes of incontinence daily

6. Alpha blocker with long term urinary catheter in situ i.e more than 2 months

Endocrine System

1. Glibenclamide or clhorporamide with type 2 diabetes melitus

2. Oesterogen with a history of breast cancer or venous thromboembolism

3. Beta- blockers in those with diabetes melitus an frequent hypoglicaemic episode i.e 1 epiosode per month

4. Oesterogen without progesteron in patient with intact uterus

START :Screening Tool to Alert doctors to Right trea

These medication should be consideed for people 65 years of age with the following condition , where are contraindication to prescription exist

1. Warfarin in the presence of chronic atrial fibrilation

2. Aspiirin in the presence of chronic atrial fibrillation, where warfarinn is contraindicated, but not aspirin

3. Asiprin or clopidogrel with a documented history of atherosclerotic coronary, cerebral or periphera vascular disease in patient with sinus rhythm

4. Antihipertensi therapy whre systolic blood pressure consistently >160 mmhg

5. Statin therapybwith a documented history of coronary, cerebral or peripheral vascular when the patient s functional status remain indepeendent for activities of daily living and life expectancy greater than 5 years

6. Angiotensin converting enzim (ACE) inhibitor with chronic heart failure

7. Ace inhibiotor following acute myocardical infarction

8. Beta- blocker with chronic stable angina

Respiratory System

1. Regular inhaled 2 agonist or anticholinergic agent for mild modertae asthma

2. Regular inhaled corticosteroid for moderate-severe asthma or COPD, where predicated FEV < 50 %

3. Home continous oxygen with documanted chronic type 2 respiratory failure or type 2 respiratory failure

Central Nervous System

1. L- DOPA in idiopatic Parkinsons disease with definate functional impaiment and resultant diasability

2. Antidepressant drug in the presece of moderate-severe depressive symtopms lasting at least three

START :Screening Tool to Alert doctors to Right Treatment

These medication should be consideed for people 65 years of age with the following condition , where are contraindication to prescription exist

Gastrointestinal system

1. Problem pump inhibitor with severe gastro-oesophageal acid refluks disease or peptic stricture requiri dilatation

2. Fibre supplemenetvfor chronic diverticular with constipation

Muskuloskeletal system

1. Diseases modifynng anti- rheumatic drug ( DMARD) with active moderate- severe rheumatoid disease lasting >12 weeks

2. Bisphosphonates in patient taking manitanennace corticosteroid theraapy

3. Calcium and vitamin D supplement in patient with known osteoporosis

Endocrine system

1. Metformin type 2 diabetes +/- metebolic syndrome

2. ACE inhibitor or angiotensij receptor blocker in diabetes with nephropaty

3. Antiplatelet therapy in diabetes melitus with co-existing major cardiovascular risk factor

4. Statin therapy in diabetes melitus if co-existing major cardiovascular risk factor

5. ACE inhibitor or angiotensin receptor blocker in diabetes with nephropaty

6. Antiplatelet therapy in diabetes melitus with co-existing major cardiovascular risk factor

7. Statin therapy in diabetes melitus if co-existing major cardiovascular risk factor

LAMPIRAN 4 MINI-MENTAL STATE EXAM (MMSE)

Nama Pasien:..(Lk / Pr) Umur: th Pendidikan:..... Pekerjaan:.........

Riwayat Penyakit: Stroke ( ) DM ( ) Hipertensi ( ) Peny.Jantung ( ) Peny. Lain....

Tes

Maks

Nilai

ORIENTASI

Sekarang (tahun), (bulan), (tanggal), hari apa?

Kita berada dimana? (negara),(provinsi),(kota),(rumah sakit),(lantai/kamar)?

REGISTRASI

Sebutkan 3 buah nama benda (jeruk, uang, mawar), tiap benda 1 detik. pasien disuruh mengulangi ketiga benda tadi. Nilai 1 untuk tiap nama benda yang benar. Ulangi sampai pasien dapat menyebutkan dengan benar dan catat jumlah pengulangan.

ATENSI DAN KALKULASI

Kurangi 100 dengan 7. Nilai 1 untuk setiap jawaban yang benar. Hentikan setelah 5 jawaban. Atau disuruh mengeja terbalik kata WAHYU (nilai diberi pada huruf yang benar sebelum kesalahan, misal uyahw = 2)

MENGINGAT KEMBALI (RECALL)

Pasien disuruh menyebut kembali 3 benda diatas

BAHASA

Pasien diminta menyebutkan nama benda yang ditunjukkan (pensil, arloji)

Pasien diminta mengulang rangkaian kata tanpa, kalau, dan, atau, tetapi

Pasien diminta melakukan perintah: Ambil kertas ini dengan tangan kanan, lipatlah menjadi dua dan letakkan di lantai

Pasien diminta membaca & melakukan perintah angkat tangan kiri anda

Pasien diminta menulis sebuah kalimat (spontan)

Pasien diminta meniru gambar di bawah ini

5

5

3

5

3

2

1

3

1

1

1

-

-

-

-

-

-

-

-

-

-

-

Skor Total

30

-

LAMPIRAN 5 Indeks Barthel

No

Item yang dinilai

Skor

Nilai

1.

Makan

0 =Tidak mampu 1 =Butuh bantuan 2 =Mandiri

2.

Mandi

0 =Tergantung orang lain 1 =Mandiri

3.

Perawatan diri

0 =Membutuhkan bantuanorang lain

1 =Mandiridalam perawatan muka, rambut, gigi, bercukur

4.

Berpakaian

0 =Tergantung 1 =Sebagian dibantu(Ex: mengancing baju)

2 =Mandiri

5.

Buang air kecil

0 =Inkontinensiaatau pakai kateter dan tidak terkontrol

1 =Kadang Inkontinensia (maks, 1x24 jam)

2 =Kontinensia(teratur untuk lebih dari 7 hari)

6.

Buang airbesar

0 =Inkontinensia(tidak teratur atau perlu enema)

1 =Kadang Inkontensia (sekali seminggu) 2 =Kontinensia(teratur)

7.

Penggunaan toilet

0 =Tergantung bantuan orang lain

1 =Membutuhkan bantuan, tapi dapat melakukan beberapa hal sendiri

2 =Mandiri

8.

Transfer

0 =Tidak mampu 1 =Butuh bantuanuntuk duduk (2 orang)

2 =Bantuan kecil (1 orang) 3 =Mandiri

9.

Mobilitas

0 =Immobile(tidak mampu)

1 =Menggunakankursi roda

2 =Berjalan dengan bantuan satu orang

3 =Mandiri(meskipunmenggunakan alat bantuseperti,tongkat)

10.

Naik turuntangga

0 =Tidak mampu 1 =Membutuhkan bantuan (alat bantu)

2 =Mandiri

Interpretasi hasil :

20 :Mandiri

12-19 :Ketergantungan Ringan

9-11 :Ketergantungan Sedang

5-8 :Ketergantungan Berat

0-4 :Ketergantungan Total

62

isi proposal sisanya 2003

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