Prosiding Udayana University International Symposium, Hospital Based Geriatric Service.
PROCEEDING UDAYANA UNIVERSITY INTERNATIONAL SYMPOSIUM
HOSPITAL BASED GERIATRIC SERVICE
Contents
Nutrition In Elderly : The Role Of Vit D Suplementation In The Healthy Aging
R A Tuty Kuswardhani
1
Hazzard’sInfectionIn Elderly
R A Tuty Kuswardhani
8
Vaccination TravelIn Elderly
R A Tuty Kuswardhani
15
Introduction Of Plant Based Diet Therapy for Hospital Based Geriatric Service
Naemi Kajiwara
23
Elderly Care In Netherlands Hospital
Maddy Stienstra Liem
29
Hospital Accreditation For Quality Improvement Hospital Based Geriatric Service
N P Arysta Kusuma Dewi
36
Research Article
Correlation Between Depression And Cognitive Impairment At Elderly People In Denpasar City 42
Ib Aditya Nugraha, R ATutyKuswardhani ,IgpSuka Aryana
Association Between Sleep Quality And Frailty Syndrome Among Geriatric Patients
48
At Geriatric Polyclinic Sanglah General Hospital
Adrian Tri Sutjahjo, TutyKuswardhani, I.G.P.Suka AryanaNyomanAstika, I.B.Putrawan,RaiPurnami
Correlation Of Visceral Fat Level And Poor Cognitive Function Among Elderly Population
In Denpasar
Erick Lios, R A TutyKuswardhani, IgpSuka Aryana
55
Correlation Between Hypertension And Cognitive Impairment In Elderly People In Denpasar
Made Arie Dwi Winarka, R.ATuty Kuswardhani ,Igp Suka Aryana
61
Albumin Level And Charlson Comorbidity Index Score In Predicting Length Of Hospitalization 67
In Geriatric Patients
Ni WayanMeindraWirtayani, Ra TutyKuswardhani
INFECTION IN THE ELDERLY
Focus on Pneumonia in Elderly
RA Tuty Kuswardhani
Geriatric Division of Internal Medicine of Udayana University / Sanglah General Hospital /
Udayana University Teaching Hospital
Introduction
Generally, diseasses which are attacked elderly including infectious disease are often give
unclear symptomps. Therefore, accuracy is needed to know the diseasses. Late handling and
treatment to the infectious disseases can lead to fatal condition.
The tendency towards infection in elderly, the risk towards infection in elderly lead to multi
factorial. Risk factors consist of: comorbid, decrease of immune, aging process that lead to
complex.
Comorbid Infection in Elderly:
1. Old age and comorbid consist of diabetes, kidney failure, chronic lung disease, immobilization
and lead to decrease of innate immunity (non-specific barrier and immunity towards microbial
product). COPD, Pneumonia and old age lead to mucus clearance, alveolar disfunction, cough
reflex suppression increasing of risk of lower respiratory tract. Infections and old age lead to
poor prognosis
2. Decrease Immune System
Immune senescence lead to disregulation of the immune system
Up regulation of inflammatory response (CRP, IL-6, NFkB)
down regulation innate immunity (NK, PMN), adaptive immunity (decrease of naive T cell,
cytokines, cell surface receptor)
3. Social and Environmental Factors
Biomedical, behavioral, social, and environmental are should healthy.
1
Usually Low Income occurs in eldelry CAP towards elderly lead to poor nutrition and inadequate
vaccination.
Diagnosis and Management Infection in Elderly
Clinical manifestation of Elderly Infection:
In The Elderly the infection a typical features: decreasing of status mental, anorexia, worsening
of comorbid (CHF, diabetes mellitus).
Fever sometimes there is no response towards endogenous pyrogens such as IL-1, IL-6, TNF
lead to reduced
Old age and Frailty lead to decrease of basal temperature
Fever Criteria:
1. Persistent temperature 2 ° C (1.1 ° C) from basal temperature
2. Oral Temperature 99 ° F (37.2 ° C) or higher when the repetition
3. The rectal temperature of 99.5 ° F (37.5 ° C) or higher when the repetition
Decreasing fever response retardation in diagnosis makes poor prognosis, cognitive impairment
could not communicate well
Bacteremia and sepsis
Criteria of Bacteremia and Sepsis in elderly are:
1. 14% of the causes hospitalization
2. Systemic symptoms rarely
3. derived from GI or GU, gram-negative bacteria that cause >>
4. 35-42% mortality 28 days of age> 65 yrs
5. Nosocomial, gram negative à 37-50% mortality
6. Contamination during surgery
Pneumonia
Inflamation and Infection in Lungs like pneumonia are much suffered by elderly.
Fever more than 38 celcius degree, caugh, pain in chest, waekness and no appetite or sometime
disorientation
2
Etiology
Streptococcus pneumonia, haemophilus influenza
Management:
1. Antibiotic:
2. Pneumococcal vaccine:
Standard vaccines for age more than 65 yrs or age 5 days were treated in
hospital.
Approach to Diagnosis
Anamnesis
HAP Clinical picture is not so clear and could not be used as criteria for the diagnosis of HAP.
Can be found fever, sputum purulen.
Physical Examination
Body temperature> 38,3oC, lung examination can be found signs of consolidation as percussion
dullness
Support Examination
Blood: leukocytosis> 10,000 / mm3, or leukopenia
HOSPITAL BASED GERIATRIC SERVICE
Contents
Nutrition In Elderly : The Role Of Vit D Suplementation In The Healthy Aging
R A Tuty Kuswardhani
1
Hazzard’sInfectionIn Elderly
R A Tuty Kuswardhani
8
Vaccination TravelIn Elderly
R A Tuty Kuswardhani
15
Introduction Of Plant Based Diet Therapy for Hospital Based Geriatric Service
Naemi Kajiwara
23
Elderly Care In Netherlands Hospital
Maddy Stienstra Liem
29
Hospital Accreditation For Quality Improvement Hospital Based Geriatric Service
N P Arysta Kusuma Dewi
36
Research Article
Correlation Between Depression And Cognitive Impairment At Elderly People In Denpasar City 42
Ib Aditya Nugraha, R ATutyKuswardhani ,IgpSuka Aryana
Association Between Sleep Quality And Frailty Syndrome Among Geriatric Patients
48
At Geriatric Polyclinic Sanglah General Hospital
Adrian Tri Sutjahjo, TutyKuswardhani, I.G.P.Suka AryanaNyomanAstika, I.B.Putrawan,RaiPurnami
Correlation Of Visceral Fat Level And Poor Cognitive Function Among Elderly Population
In Denpasar
Erick Lios, R A TutyKuswardhani, IgpSuka Aryana
55
Correlation Between Hypertension And Cognitive Impairment In Elderly People In Denpasar
Made Arie Dwi Winarka, R.ATuty Kuswardhani ,Igp Suka Aryana
61
Albumin Level And Charlson Comorbidity Index Score In Predicting Length Of Hospitalization 67
In Geriatric Patients
Ni WayanMeindraWirtayani, Ra TutyKuswardhani
INFECTION IN THE ELDERLY
Focus on Pneumonia in Elderly
RA Tuty Kuswardhani
Geriatric Division of Internal Medicine of Udayana University / Sanglah General Hospital /
Udayana University Teaching Hospital
Introduction
Generally, diseasses which are attacked elderly including infectious disease are often give
unclear symptomps. Therefore, accuracy is needed to know the diseasses. Late handling and
treatment to the infectious disseases can lead to fatal condition.
The tendency towards infection in elderly, the risk towards infection in elderly lead to multi
factorial. Risk factors consist of: comorbid, decrease of immune, aging process that lead to
complex.
Comorbid Infection in Elderly:
1. Old age and comorbid consist of diabetes, kidney failure, chronic lung disease, immobilization
and lead to decrease of innate immunity (non-specific barrier and immunity towards microbial
product). COPD, Pneumonia and old age lead to mucus clearance, alveolar disfunction, cough
reflex suppression increasing of risk of lower respiratory tract. Infections and old age lead to
poor prognosis
2. Decrease Immune System
Immune senescence lead to disregulation of the immune system
Up regulation of inflammatory response (CRP, IL-6, NFkB)
down regulation innate immunity (NK, PMN), adaptive immunity (decrease of naive T cell,
cytokines, cell surface receptor)
3. Social and Environmental Factors
Biomedical, behavioral, social, and environmental are should healthy.
1
Usually Low Income occurs in eldelry CAP towards elderly lead to poor nutrition and inadequate
vaccination.
Diagnosis and Management Infection in Elderly
Clinical manifestation of Elderly Infection:
In The Elderly the infection a typical features: decreasing of status mental, anorexia, worsening
of comorbid (CHF, diabetes mellitus).
Fever sometimes there is no response towards endogenous pyrogens such as IL-1, IL-6, TNF
lead to reduced
Old age and Frailty lead to decrease of basal temperature
Fever Criteria:
1. Persistent temperature 2 ° C (1.1 ° C) from basal temperature
2. Oral Temperature 99 ° F (37.2 ° C) or higher when the repetition
3. The rectal temperature of 99.5 ° F (37.5 ° C) or higher when the repetition
Decreasing fever response retardation in diagnosis makes poor prognosis, cognitive impairment
could not communicate well
Bacteremia and sepsis
Criteria of Bacteremia and Sepsis in elderly are:
1. 14% of the causes hospitalization
2. Systemic symptoms rarely
3. derived from GI or GU, gram-negative bacteria that cause >>
4. 35-42% mortality 28 days of age> 65 yrs
5. Nosocomial, gram negative à 37-50% mortality
6. Contamination during surgery
Pneumonia
Inflamation and Infection in Lungs like pneumonia are much suffered by elderly.
Fever more than 38 celcius degree, caugh, pain in chest, waekness and no appetite or sometime
disorientation
2
Etiology
Streptococcus pneumonia, haemophilus influenza
Management:
1. Antibiotic:
2. Pneumococcal vaccine:
Standard vaccines for age more than 65 yrs or age 5 days were treated in
hospital.
Approach to Diagnosis
Anamnesis
HAP Clinical picture is not so clear and could not be used as criteria for the diagnosis of HAP.
Can be found fever, sputum purulen.
Physical Examination
Body temperature> 38,3oC, lung examination can be found signs of consolidation as percussion
dullness
Support Examination
Blood: leukocytosis> 10,000 / mm3, or leukopenia