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
Vaccination Travelers in Elderly
RA Tuty Kuswardhani
Geriatric Division of Internal Medicine of Udayana University / Sanglah General Hospital /
Udayana University Teaching Hospital
Introduction
Modern era gives impact to high air transportation, so does to land and water transportation.
Increase of elderly population related to elderly who want to travell around.
The proportion of children and young people an increase in the proportion of people age 60 and
over As populations age, the triangular population pyramid of 2002 children and adult more than
older people will be replaced with a more cylinder-like structure in 2025 old population more
than adult population.
Aging is a process to release the ability of tissues slowly to repair or to change it self to keep the
sturcture and normal function so it can not stand toward injury and to develop the damage.
Decrease of immune system in elderly make elderly is easy attacked by disease which is related
to vacination that is probably have not been given.
The Damage of Immune System in Elderly
The repeated mutation/ the changing protein post translation is decrease the immune system
ability to recognized, it self The somatic mutation lead to antigen disorder in the cell to cause
immune system and treat the changing cell as a strange cell and destroy it. Auto immune process
make antigen antibody reaction in different tissues aging effect incontability reaction in multi
tissue and lead to auto antibody prevalence.
Immune System is divided to two those are specific immune system cellular and natural or
humoral immune system. Different ability from non specific immune system in recognizing a
strange cell The first strange cell appears in the body is soon recognized by specific immune
system It stimulate the sensctation of the cell in the immune system If again the immune system
cell is facing the same strain cell. It will be more easily to recognized it to destroy.
Specific Immune
Cellular Immunity Thymus Gland. Thymus hormone stimulates differentiation, expression &
function of lympocyte T because involution gland occurs in the early life. T lymphocyte cell
differentiation is decreasing during the aging process. Thymus involution causes immune system
dysfunction
Humoral Immune
Natural immune The lost of the body ability to prevent the antigen a. Volume of B lymphocyte
cell, volume of B cell apoptotis b. Function of B lymphocyte cell specific antibody production
c. Immunoglobulin In the elderly the increasing decrease of IgG and IgA IgM and Ig D are
decrease IgE constant except atopic patient IgE
High risk of infectious disease supposes elderly take vaccination. Elderly who aged more than 60 years
old are lack of immunity and often attacked by tetanus, pertusis and flu. Beside that, elderly is also often
attacked by chronic disease such as: diabetes, asthma, heart disease and pneumococcal disease.
Meningococcal hepatitis A, B amd Varicella are often attacked health workers, lab workers soldiers and
college students.Complication of influenza is also often infect to pregnant women.
Elderly who have bad habbit and lifestyle are also have high risk attacked by disease. Elderly
who usually smoke will be attacked by Pneumococcal infection. Elderly who use drug will be
attacked by Hepatitis B. Cervical cancer and hepatitis B infect elderly who have multiple sexual
partners. Hepatitis A and B infect homosexuality elderly. Traveller is often attacked by
influenza, meninococcal, typhoid, hepatitis A and B.
There are adult vaccination factors which can be seen in table below.
Patient Factor
Focus, underconcept
Decrease of Awarness
Untrusted
Culturallethnic race issues
Provider Factors
Competion demands
Loss of Opportunities
System Factor
Ecercise may have limited available material
Not available vaccine in physician or
specialistic practices
Environmental Factors
Difficult access
Unregular health care provider
Less of health insurance
WHO 2008
World Health Organization made guideline internationally by Vaccine for Traveller including
Elderly population.
Category 1 Regular Vaccination Items of Vaccines:
1. Diptheria,
2. Tetanus and Pertussis.
3. Hepatitis B,
4. Haemophilus Influenzae type B,
5. Human Papillomavirus,
6. Influenza,
7. Measles,
8. Mumps and Rubella,
9. Pneumococcal disease,
10. Poliomyelitis,
11. Rotavirus,
12. Tuberculosis,
13. Varicella.
Category 2 Special use for Traveller
1. Cholera,
2. Hepatitis A,
3. Japanese encephalitis,
4. Meningococcal disease,
5. Rabies,
6. Tick-borne enchephalitis,
7. Thypoid fever,
8. Yellow fever
Category 3 is Obligatory Vaccination
1. Yellow fever (Depending on Nation which are visited)
2. Meningococcal disease and polio (is obligated in Saudi Arabia to Muslim Pilgrims for
Hajj)
3. Meningitis Vaccine for Hajj / Umrah
Muslims Pilgrims going to Hajj / Umrah is obligated to have menigitis certificate of
vacination. Meningitis vaccine (1 dosage) must not more than 3 years and must not less
in 10 days before landing in Saudi Arabia.
Vaccine of maningitis is given to muslim pilgrims hajj and umrah 1 dosage for 2 years
Avian Influenza Virus
Avian Influenza Virus have different impact on human health. From February 2013 in South
East China, that is found severe cases avian influenza atacked people. The cause of Avian
Influenza is A(H7N9) Viruses or LPAI. Low Patogen Avian Inlfluenza (LPAI) on big outbreak
Avian Infuenza in human with highly patogen Avian Influenza (HPAI) is A(H5N1) viruses
Avian Influenza virus can be prevented by giving vaccination to healthy fowl in the infectious
region. The prevention is also can be done by increasing biosecurity, decontamination tools and
facility of farming. Selective vanished can be done to healthy fowl which are put in one cage
with fowl that have been contractetd.
Influenza Virus
In Influenza Virus that is found the data for the one who does not receive the vaccination is 2,9
times than risk of people that have received the vaccine.
Vaccine-induced antibody need at leats 2 weeks to develop. Get Flu Shot 2 weeks (at the latest)
before travelling.
Investigating Outbreak in Community or other, Settings: If there are 2 people or more with 2
until 3 days cold and breeze can be one of clinical sign and symptom compatible with infuenza
virus infection. If yes, it is presumption of avian influenza virus. After that, it is consider to exam
of Influenza virus. The last, the influenza virus describe and the test is done which is known as
RIDTS. If the sign and clinical symptom negative it is not indicate influenza virus and the test is
not done.
Adults should take vaccination of influenza every 1 year 1 times. Infulenza vaccination can be
given every years. Some population must take influenza vacination: cardiovascular disease, acute
coronary syndrome, heart failure, chronic respiratory disease, hypertension, diabetes mellitus,
imunocompremized, obisity, smoker, health worker, muslim pligrims hajj and umrah, traveller
and elderly population.
Typhoid Fever Vaccine
Thypoid Fever become highest risk in Southern Asi. The transmission by oral and fecal.
Incubation period : 1 until 3 weeks. Good hand washing and food precautions are helpful in
prevention. Shed in feces for 6 weeks to 3 months after ifection.
Thypoid Fever Vaccine
Indication: Travel to endemic area, travelling more than 3 weeks in one area, rural travel
Refference
WHO 2008
Kabat. 2003. Influence of Vaccination of Influenza on Hajj jama’ah Indonesia. Medika August
29th 2003 (8): 493-500)
Kuswardhani RAT. 2015. Aging, Nutrition and Health Care Service in Elderly.
Darmodjo Boedhi. 2009. Aging Definition: Guideline Geriatry. Textbook of Boedhi Darmojo:
Geriatrics (Elderly Health Sciences), 4th Edition, pp. 13-16.
Weinberger B, Loebenstein BG, 2012. Vaccines for the Elderly.
http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2012.03944.x/pdf. Accessed on October
27th 2015.
Boyles TH, Bamford C, Bateman K, Blumberg L, Dramowski A, Kartaedst A, Korsman S, le
Roux DM, Maartens G, Madhi S, Naidoo R, Nuttall J, Reubenson G, Taljaard J, Thomas J, van
Zyl G, Gottberg A von, Whitelaw A, Mendelson M. 2013. Guidelines for the management of
Accute Meningitis in Elderly. Accessed on October 28th 2015.
Plague F, Aviaire G. 2014. Avian Influenza.
http://www.cfsph.iastate.edu/Factsheets/pdfs/highly_pathogenic_avian_influenza.pdf. Accessed
on October 29th 2015.
Jackson BR, Iqbal S, Mahon B. 2015. Updated Recommendations for the Use of Typhoid
Vaccine — Advisory Committee on Immunization Practices, United States, 2015.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a4.htm. Accesed on October 29th 2015.
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
Vaccination Travelers in Elderly
RA Tuty Kuswardhani
Geriatric Division of Internal Medicine of Udayana University / Sanglah General Hospital /
Udayana University Teaching Hospital
Introduction
Modern era gives impact to high air transportation, so does to land and water transportation.
Increase of elderly population related to elderly who want to travell around.
The proportion of children and young people an increase in the proportion of people age 60 and
over As populations age, the triangular population pyramid of 2002 children and adult more than
older people will be replaced with a more cylinder-like structure in 2025 old population more
than adult population.
Aging is a process to release the ability of tissues slowly to repair or to change it self to keep the
sturcture and normal function so it can not stand toward injury and to develop the damage.
Decrease of immune system in elderly make elderly is easy attacked by disease which is related
to vacination that is probably have not been given.
The Damage of Immune System in Elderly
The repeated mutation/ the changing protein post translation is decrease the immune system
ability to recognized, it self The somatic mutation lead to antigen disorder in the cell to cause
immune system and treat the changing cell as a strange cell and destroy it. Auto immune process
make antigen antibody reaction in different tissues aging effect incontability reaction in multi
tissue and lead to auto antibody prevalence.
Immune System is divided to two those are specific immune system cellular and natural or
humoral immune system. Different ability from non specific immune system in recognizing a
strange cell The first strange cell appears in the body is soon recognized by specific immune
system It stimulate the sensctation of the cell in the immune system If again the immune system
cell is facing the same strain cell. It will be more easily to recognized it to destroy.
Specific Immune
Cellular Immunity Thymus Gland. Thymus hormone stimulates differentiation, expression &
function of lympocyte T because involution gland occurs in the early life. T lymphocyte cell
differentiation is decreasing during the aging process. Thymus involution causes immune system
dysfunction
Humoral Immune
Natural immune The lost of the body ability to prevent the antigen a. Volume of B lymphocyte
cell, volume of B cell apoptotis b. Function of B lymphocyte cell specific antibody production
c. Immunoglobulin In the elderly the increasing decrease of IgG and IgA IgM and Ig D are
decrease IgE constant except atopic patient IgE
High risk of infectious disease supposes elderly take vaccination. Elderly who aged more than 60 years
old are lack of immunity and often attacked by tetanus, pertusis and flu. Beside that, elderly is also often
attacked by chronic disease such as: diabetes, asthma, heart disease and pneumococcal disease.
Meningococcal hepatitis A, B amd Varicella are often attacked health workers, lab workers soldiers and
college students.Complication of influenza is also often infect to pregnant women.
Elderly who have bad habbit and lifestyle are also have high risk attacked by disease. Elderly
who usually smoke will be attacked by Pneumococcal infection. Elderly who use drug will be
attacked by Hepatitis B. Cervical cancer and hepatitis B infect elderly who have multiple sexual
partners. Hepatitis A and B infect homosexuality elderly. Traveller is often attacked by
influenza, meninococcal, typhoid, hepatitis A and B.
There are adult vaccination factors which can be seen in table below.
Patient Factor
Focus, underconcept
Decrease of Awarness
Untrusted
Culturallethnic race issues
Provider Factors
Competion demands
Loss of Opportunities
System Factor
Ecercise may have limited available material
Not available vaccine in physician or
specialistic practices
Environmental Factors
Difficult access
Unregular health care provider
Less of health insurance
WHO 2008
World Health Organization made guideline internationally by Vaccine for Traveller including
Elderly population.
Category 1 Regular Vaccination Items of Vaccines:
1. Diptheria,
2. Tetanus and Pertussis.
3. Hepatitis B,
4. Haemophilus Influenzae type B,
5. Human Papillomavirus,
6. Influenza,
7. Measles,
8. Mumps and Rubella,
9. Pneumococcal disease,
10. Poliomyelitis,
11. Rotavirus,
12. Tuberculosis,
13. Varicella.
Category 2 Special use for Traveller
1. Cholera,
2. Hepatitis A,
3. Japanese encephalitis,
4. Meningococcal disease,
5. Rabies,
6. Tick-borne enchephalitis,
7. Thypoid fever,
8. Yellow fever
Category 3 is Obligatory Vaccination
1. Yellow fever (Depending on Nation which are visited)
2. Meningococcal disease and polio (is obligated in Saudi Arabia to Muslim Pilgrims for
Hajj)
3. Meningitis Vaccine for Hajj / Umrah
Muslims Pilgrims going to Hajj / Umrah is obligated to have menigitis certificate of
vacination. Meningitis vaccine (1 dosage) must not more than 3 years and must not less
in 10 days before landing in Saudi Arabia.
Vaccine of maningitis is given to muslim pilgrims hajj and umrah 1 dosage for 2 years
Avian Influenza Virus
Avian Influenza Virus have different impact on human health. From February 2013 in South
East China, that is found severe cases avian influenza atacked people. The cause of Avian
Influenza is A(H7N9) Viruses or LPAI. Low Patogen Avian Inlfluenza (LPAI) on big outbreak
Avian Infuenza in human with highly patogen Avian Influenza (HPAI) is A(H5N1) viruses
Avian Influenza virus can be prevented by giving vaccination to healthy fowl in the infectious
region. The prevention is also can be done by increasing biosecurity, decontamination tools and
facility of farming. Selective vanished can be done to healthy fowl which are put in one cage
with fowl that have been contractetd.
Influenza Virus
In Influenza Virus that is found the data for the one who does not receive the vaccination is 2,9
times than risk of people that have received the vaccine.
Vaccine-induced antibody need at leats 2 weeks to develop. Get Flu Shot 2 weeks (at the latest)
before travelling.
Investigating Outbreak in Community or other, Settings: If there are 2 people or more with 2
until 3 days cold and breeze can be one of clinical sign and symptom compatible with infuenza
virus infection. If yes, it is presumption of avian influenza virus. After that, it is consider to exam
of Influenza virus. The last, the influenza virus describe and the test is done which is known as
RIDTS. If the sign and clinical symptom negative it is not indicate influenza virus and the test is
not done.
Adults should take vaccination of influenza every 1 year 1 times. Infulenza vaccination can be
given every years. Some population must take influenza vacination: cardiovascular disease, acute
coronary syndrome, heart failure, chronic respiratory disease, hypertension, diabetes mellitus,
imunocompremized, obisity, smoker, health worker, muslim pligrims hajj and umrah, traveller
and elderly population.
Typhoid Fever Vaccine
Thypoid Fever become highest risk in Southern Asi. The transmission by oral and fecal.
Incubation period : 1 until 3 weeks. Good hand washing and food precautions are helpful in
prevention. Shed in feces for 6 weeks to 3 months after ifection.
Thypoid Fever Vaccine
Indication: Travel to endemic area, travelling more than 3 weeks in one area, rural travel
Refference
WHO 2008
Kabat. 2003. Influence of Vaccination of Influenza on Hajj jama’ah Indonesia. Medika August
29th 2003 (8): 493-500)
Kuswardhani RAT. 2015. Aging, Nutrition and Health Care Service in Elderly.
Darmodjo Boedhi. 2009. Aging Definition: Guideline Geriatry. Textbook of Boedhi Darmojo:
Geriatrics (Elderly Health Sciences), 4th Edition, pp. 13-16.
Weinberger B, Loebenstein BG, 2012. Vaccines for the Elderly.
http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2012.03944.x/pdf. Accessed on October
27th 2015.
Boyles TH, Bamford C, Bateman K, Blumberg L, Dramowski A, Kartaedst A, Korsman S, le
Roux DM, Maartens G, Madhi S, Naidoo R, Nuttall J, Reubenson G, Taljaard J, Thomas J, van
Zyl G, Gottberg A von, Whitelaw A, Mendelson M. 2013. Guidelines for the management of
Accute Meningitis in Elderly. Accessed on October 28th 2015.
Plague F, Aviaire G. 2014. Avian Influenza.
http://www.cfsph.iastate.edu/Factsheets/pdfs/highly_pathogenic_avian_influenza.pdf. Accessed
on October 29th 2015.
Jackson BR, Iqbal S, Mahon B. 2015. Updated Recommendations for the Use of Typhoid
Vaccine — Advisory Committee on Immunization Practices, United States, 2015.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a4.htm. Accesed on October 29th 2015.