TREN ISUE KEP GERONTIK DI KOMUNITAS.pdf

7/27/2019 TREN ISUE KEP GERONTIK DI KOMUNITAS.pdf

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CARING OLDER ADULTSIN COMMUNITY

By:Ns. Tantut Susanto, M.Kep.,Sp.Kep.Kom

Community Health Nursing Department

School of Nursing, Jember UniversityEmail: [email protected]

Pendahuluan (1)

Angka harapan hidup penduduk Indonesia berdasarkandata Biro Pusat Statistik pada tahun 1968 adalah 45,7tahun, pada tahun 1980 adalah 55,30 tahun, pada tahun1985 adalah 58,19 tahun, pada tahun 1990 adalah 61,12

tahun, tahun 1995 adalah 60,05 tahun, tahun 2000 adalah66,2 tahun, serta tahun 2010 adalah 70,6 (BPS 2005).

Diperkirakan pada tahun 2005-2010 jumlah penduduk usialanjut akan sama dengan jumlah Balita yaitu 8,5% darijumlah penduduk atau sekitar 19 juta jiwa (PusatKomunikasi Publik,2007).

Populasi lanjut usia menuntut perhatian karena rentannyaterhadap berbagai penyakit dan berkurangnya daya tahantubuh dalam menghadapi pengaruh dari luar.


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Pendahuluan (2)

Usia lanjut bukan suatu penyakit, namun bersamaandengan proses penuaan, insiden penyakit kronik , karenaberkurangnya daya tahan tubuh dalam menghadapipengaruh dari luar dan hendaya (disabilitas) akan semakin

meningkat.

Angka kesakitan pada lanjut usia adalah penyakit kronis

persendian termasuk arthritis 49 %, hipertensi 36 %,gangguan pendengaran 30 %, penyakit jantung 27 %,gangguan orthopedik 18 %, katarak 17 %, sinusitis 12 %,dan diabetes 10 % (USDHHS,1999, 2000; dalam Clemen-Stone, McGuire dan Eigsti, 2002).

Pendahuluan (3)

Berdasarkan SKRT tahun 2004 untuk usia 55 tahun ke atas,dilaporkan bahwa penyakit kardiovaskular menempatiperingkat pertama yaitu 15,7 per 100 pasien, kemudiandiikuti oleh penyakit muskuloskeletal 14,5 , TB paru 13,6 dan

Bronkitis Asma 12,1.

Sedangkan 6 penyebab utama kematian pada lanjut usiaadalah penyakit jantung, kanker, stroke, penyakit paruobstruksi menahun, pneumonia, dan influenza.

Berbagai penyakit tersebut memiliki prevalensi tinggi padalanjut usia yang berkontribusi terhadap tingginya angkakematian lanjut usia.


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Pendahuluan (4)

Setelah mengidentifikasi populasi lanjut usia sebagaipopulasi at risk, maka seorang community healthprofessionalsbertanggung jawab untuk mengidentifikasimasalah kesehatan dan pelayanan kesehatan yang

dibutuhkan, termasuk promosi, proteksi dan prevensikesehatan.

Anderson & McFarlane (2004) pelayanan kesehatan harus

diupayakan menjadi strategi pelayanan kesehatan primer(primary health care) yang berfokus pada kebutuhankomunitas, memaksimalkan keterlibatan komunitas, meliputiseluruh sektor terkait, dan menggunakan teknologikesehatan yang dapat diakses (accessible), dapat diterima

(acceptable), terjangkau (affordable), dan sesuai(appropriate).

Components of A ComprehensiveHealth Assessment

Physical

SosioeconomicsPsychological Function

Kanes conceptualization of central function. (from Kane RL, Ouslander JG,Abrass IB: Essentials of clinical geriatrics, ed 4, New York, 1999, McGraw-Hill


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Chronic Health Concern of OlderAdults in The Community (1)

Chronic illness occur over a long period with occasionalacute exacerbations and remissions

They can affect multiple systems and can be expensive anddiscouraging

The prevalence of chronic disease rises with the lengtheningof the life span and the increasing availability of highly

technical medical care Health care in general is oriented toward acute illness

In chronic illness, cure is not expected, so nursing activities

need to be more holistic, addressing function, wellness, andpsychosocial issues

Chronic Health Concern of Older Adults in TheCommunity (2) With chronic illness, the focus is on healing(a unique

process resulting in a shift in the body-mind-spirit system)rather than curing(elimination of the signs and symptoms ofdisease)

Eliopoulos (2001) lists the following goals for chronic care:

Maintain or improve self care capacity

Manage the disease effectively

Boost the bodys healing abilities

Prevent complications

Delay deterioration and decline

Achieve highest possible quality of life

Die with comfort, peace, and dignity


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Assessments (1)

Tierney, McPhee, and Papadakis (2002) outlines chronicconditions that can adversely affect the aging experiences

There are intellectual impairment, immobility, instability,

incontinence, and iatrogenic drug reactions (5 Is)

Their 3 Ds of intellectual impairment are dementia

(progressive intellectual impairment), depression (mooddisorder), and delirium (acute confusion)

Immobility is most often caused by degenerative jointdisease and results pain, stiffness, loss of balance, andpsychological problems.

This is related to instability, which results in 30% of falls eachyear

Assessment (2)

Urinary incontinence often contributes to institutional care

Because it may also result in social situation, it is difficult toestimate the number of individuals affected by, and the cost

of, incontinence

It is important to address continence routinely in theassessment process, identify the type of incontinence, andintervene appropriately

Iatrogenic drug reactions result from changes in the olderindividuals absorption, metabolism, and excretion processesthat lead to altered responses to drugs

Many take numerous medicines, increasing the chance ofdrug reactions


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Assessment (3)

Older person abuse encompasses physical, psychological,financial, and social abuse or violation of an individualsrights (McKenna, 1997).

Abuse consists of the following:

The willful infliction of physical pain or injury

Infliction of debilitating mental anguish and fear

Theft or mismanagement of money or resources

Unreasonable confinement or the depriving of services

Assessment (4)

Neglect refers to the failure of a caregiver to provideservices that are necessary for the physical and mental

health of an individual

Older persons can make independent choices with whichothers may disagree

Their right to self determination can be taken from them if

they are declared incompetent Exploitation is the illegal or improper use of a person or

their resources for anothers profit or advantage


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Intervention in Community Eliopoulos (2001) TLC dalam (Stanhope & Lancaster,

2004):

T = Training in care techniques, safe medication use,

recognition of abnormalities, available resources

L = Leaving the care situation periodically to obtainrespite and relaxation and maintain the caregiversnormal living needs

C = Care for caregivers themselves through adequate

sleep, rest, exercise, nutrition, socialization, solitude,support, financial aid, and health management

Implementation (Allander, 2001)

Primary prevention

Nutrition needs

Exercise needs

Economics security needs

Psychosocial needs

Coping with multiple losses

Social interaction, companionship and purpose

Safety needs

Spirituality, advance directives, and preparing for death


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Implementation (Hitchkock, J., Schubert, P.,Thomas, S.,1999):

1. Self

Recognize and concept changes and limitations of aging

Plan living arrangements for remaining years

Practice healthy lifestyle including diet and exercise appropriate to status

Pursue activities that give a feeling of statisfaction and a sense of beingneeded

Face the inevitability of ones own death ass well as the deaths of lovedones

2. Family

Continue warm relationships with spouse and family Maintain connection with children and grandchildren

3. Society

Establish affiliation with same age group

Maintain close friendships and social connections

Incorporate civic activities to maintain social responsibilities

Evaluation (Travis, 1997; dalam Stanhope &Lancaster, 2004)Wellness:

1. Self responsibility: the core of wellness, encouraging self helpstrategies, taking control of health and life choices, and partnering withhealth care

2. Nutritional awareness: learning about the selection and preparation offood and developing eating habits that lead to more balanced,nutritionally appropriate diet

3. Physical fitness: involving aerobic capacity, body structure, bodycomposition, balance, muscle flexibility, and muscle strength

4. Stress management: developing new attitudes and ways to cope withevents in life that seem beyond control and that cause negativephysical and mental problems

5. Environmental sensitivity: influencing ones personal room/home space;physical earth issues of conservation and pollution; and socialcompnents of government, economics, and culture


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TREN ISUE KEP GERONTIK DI KOMUNITAS.pdf

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