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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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