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Date of Birth : Solo, 28 April 1941 QUALIFICATIONS:

Curriculum Vitae. Wasilah Rochmah. Date of Birth : Solo, 28 April 1941 QUALIFICATIONS: 1968 Sarjana Kedokteran Fakultas Kedokteran UGM Yogyakarta 1971 Dokter Umum , Fakultas Kedokteran UGM Yogyakarta 1975 Ahli (Brevet) Ilmu Faal , Fakultas kedokteran UGM Yogyakarta

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Date of Birth : Solo, 28 April 1941 QUALIFICATIONS:

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  1. Curriculum Vitae Wasilah Rochmah Date of Birth : Solo, 28 April 1941 QUALIFICATIONS: 1968SarjanaKedokteranFakultasKedokteran UGM Yogyakarta 1971 DokterUmum, FakultasKedokteran UGM Yogyakarta 1975 Ahli (Brevet) IlmuFaal, Fakultaskedokteran UGM Yogyakarta 1985 SpesialisPenyakitDalam, FakultasKedokteran UGM Yogyakarta 1995 SpPD-KonsultanGeriatri, FakultasKedokteran UGM Yogyakarta 2002 DoktordalamBidangEndokrinologi-Geriatri, FK UGM Yogyakarta CURRENT POSITION: 2009–2014Guru Besar Emeritus (SK MENDIKNAS)

  2. COMPREHENSIVE APPROACH IN MANAGEMENT OF GERIATRIC PATIENT Wasilah Rochmah Geriatric Sub-Division, Department of Internal Medicine School of Medicine, Gadjah Mada University Yogyakarta YARSI, FIMA SEPT 16-17, 2011

  3. PERCENT INCREASE ELDERLY POPULATION 357 Guatemala Singapore Mexico Philippine Indonesia Brazil India China Hongkong Bangladesh Canada Australia Poland Japan Israel United States New Zealand France Bulgaria Luxemborg Hungary Italy Belgium Greece Uruguay Denmark Germany Austria Noorway United Kingdom Sweden 348 324 310 301 292 264 PERCENT INCREASE ELDERLY POPULATION 1985-2025 236 219 201 136 125 122 121 116 105 99 67 65 56 51 51 49 48 47 38 38 36 36 (WHO –TSR 779, 1989) 23 21

  4. IN UNITED KINGDOM • Makes geriatrics demands • on medical services • 30% of consultation to • general practitioner • 40% OF HOSPITAL BEDS • (2000 ) OLD AGE the last period of life 2025 ?

  5. Adult 30 20 40 Adolescence Midle age 12 50 Child 5 60 Old/elderly Birth Dead LIFE CYCLE Growth (Aging)

  6. SOLID CELLS BONE MINERAL FAT H2O BODY COMPOSITION CHANGES IN AGING 25 YEARS OLD 70 YEARS OLD 14% 30% 6% 53% 19% 61% 5% 12% (Merriman, 1989)

  7. clinical aspect AGING isa process that convert healthy adults into frail ones, with diminished reserve in most physiologycal systems and exponentially increasing vulnerability to most diseases and to death.

  8. biomedical aspect AGING process • occures lifelong, and more apparent inpost-reproductive period • decreases functional capacity of the cell, organ and organism. • resultsin degradationmostof the body structures • decreases response effectivity ofthe organism to internal & exsternal factors. All of the above processes increase the probability of dead. (Hall, 1984)

  9. INTERNAL FACTORSGENETICBIOLOGIC AN ELDERLY PERSON with DIMINISHED RESERVE in most PHYSIOLOGICAL SYSTEM ENVIRONMENT   LIFE STYLE SOCIO-CULTURAL ECONOMIC AGING PROCESS EKSTERNAL FACTORS PROBLEMS (Aswin, 2002 modified Miller, 1994; Boedi-Darmojo, 1994)

  10. GERIATRIC PROBLEMS • Immobility (keterbatasan gerak) • Instability (tidak stabil) • Intelectual impairment (gangguan intelektual) • Impairment of vision and hearing • Isolation (depression) • Inanition (malnutrition) • Irritable colon (gangguan BAB) • Incontinence (gangguan buang air kecil) • Infection (Infeksi) • Iatrogenesis (gangguan karena obat) • Insomnia (sulit tidur) • Immune deficiency (penurunan sistem imun) • Impotence (lemah syahwat) • Impecunity (merasa miskin)

  11. PHYSICAL CAPACITY Normal hope 100% ? 50% exercise crhonic acute 0 10 20 30 40 age 60

  12. The concept of health status in the Elderly WHO defined: HEALTH IN THE ELDERLY AS A STATE OF COMPLETE PHYSICAL, PSYCHOLOGICALandSOCIALWELL – BEING and NOT MERELY THE ABSENCE OF DISEASE and INFIRMITY (Cuccione, 2001)

  13. Wa man nu’ammirhu nunakkishu fil kholqi afalaa ya’qiluun (AL QUR’AN, surah Yasiin, verse 68) SOCIO- ECONOMIC elderly An elderly person with decrease in QoL PSYCHOLOGIC PHYSIC

  14. WHO ARE INVOLVED TO REACH WELL BEING ? THE ELDERLY (acceptance) COMMUNITY (to supports) THE FAMILY (to understand) GOVERNMENT (responsibility)

  15. Risk factors and degerative disease associated with age SPIDER MODEL DEGENERATIVE DISEASES Osteoporosis Respiratory diseases Demensia Stroke Renal & Liver diseases Heart Disease Diabetes Melitus Hypertension Cancer RISK FACTORS Physical inactivity Personality / Stress Environment Tobacco Alcohol Improper food Dyslipidemia Impaired GlucoseTolerance Vascular Resistance E L D E R L Y (Boedhi-Darmojo, 2000 - modified)

  16. DISEASES IMPAIRMENTS DISABILITIES HANDICAPS SEVERE ILL ELDERLY Age-related decreased in psycho-socio-econo mical status Age-related decreased In physical capacity Factors Predisposing The Elderly Reduced in QoL Changing in Body composition (Fat , H2O ,  Muscle) Coexisting deseases (Multipathology) D R U G S (Polypharmacy) G E N E T I C Meneilly, 2001 (modified)

  17. Clinical Steps Patient Approach Anamnesis (History taking) Physical Exam. Support. Exam. Data Collection Data Analysis Data Synthesis Medical Record Doctos’s Characteristic: - Journalist - Detective - Artist - Architect Diagnosis Therapy Prognosis Follow up S, O, A, P

  18. Anamnese Physical Examinations Laboratories Supporting Examinations DIAGNOSES DISEASES Anatomy/Histology Physiology/Pathology DIAGNOSES ONLY DO NOT TELL THE WHOLE STORY IN GERIATRIC ICD of Geriatric Patient: DIAGNOSES IMPAIRMENTS DISABILITIES HANDICAPS COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) IS NEEDED

  19. COMPREHENSIVE GERIATRIC ASSESSMENT A MULTIDEMENTIONAL ANALYSIS TO MEASURE CAPABILITIES OF MEDICAL, FUCNTIONAL, PSYCHOLOGICAL, and SOCIAL INFORMATION about THE ELDERLY PERSON/PATIENT MULTIDISIPLINARY TEAM In INTERDISIPLINARY METHOD DIAGNOSIS IMPAIRMENT DISABILITY HANDICAP

  20. ANAMNESIS MEDICAL HISTORY : Current Problems Medication Use Nutritional State IMPAIRMENTS Geriatric Syndromes Health Promotion

  21. BASIC ACTIVITY :ACTIVITIES OF DAILY LIVING (ADL) INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) MINI MENTAL SCREENING EXAMINATION (MMSE) DISABILITIES HANDICAPS

  22. MULTIDISIPLINARY TEAM in INTERDISIPLINARY METHODE of CGA • PHYCISIAN • NUTRITIONIST • NURSE • MEDICAL REHABILITATION • PSYCHOLOGIST • SOCIAL WORKER SPECIALISTS EXPERTS OTHER DISIPLINES

  23. THE RESULT OF CGA COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) DIAGNOSES IMPAIRMENTS DISABILITIES HANDICAPS RECOMMENDATIONS: 1). MEDICAL TREATMENTS Non Pharmacologic Pharmacologic 2). CONSULT TO …..

  24. AGED DISEASES IMPAIRMENTS DISABILITIES HANDICAPS RECOMMANDATIONS IMPROVEMENT NOT ACHIEVED WHAT WILL WE DO?

  25. THE AIM of TREATMENT SELECT PRIORITY • diseases improvement • defens quality of life • reach life expectancy ALLAH SWT does not create diseasewithout it’s drugs, except aged. (Al Hadist)

  26. MEDICINE IS THE SCIENCE and ART of HEALING It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. CONVENTIONAL COMPLEMENTARY ALTERNATIVE

  27. COMPLEMENTARY MEDICINEComplementary means “in addition to”Treatment in complementary medicine is used in addition to doctor’s standard care.Standard treatment in one culture may not be standard in another. CONVENTIONAL MEDICINEin clinical practice:Doctors personally assess patients in order to diagnose, treat, and prevent disease using clinical judgment http://wikipedia.org/wiki/Medicine

  28. ALTERNATIVE MEDICINE • Alternative means a choice between two possibilities • “Alternative medicine” refers to use alternative treatment in replace ofconventional medicine

  29. Compementary Medicine CLASSIFICATIONS • Whole medical systems • Mind-body intervention • Biologically based therapies • Manipulative therapies • Energy therapies http://en.wikipedia.org/wiki/Alternative_medicine

  30. WHOLE MEDICAL SYSTEM • Cut across than one of the other groups; examples include Traditional Chinese Medicine and Ayurveda http://en.wikipedia.org/wiki/Traditional Chinese_medicine Hhtp:/www.indiaoz.com.au/health/ayurveda/food_power.shtml

  31. Mind-body intervention • Take a holistic approach to health that explores the interconnection between the mind, body and spirit. • It works under the premise that the mind can affect “bodily functions and symptoms”. • The techniques are cognitive-behavioral therapy, mental healing, prayer, read Al Qur’an, dhikrulloh, and therapies that use creative outlets such as art, music, or dance.

  32. Biologically based practices • Use substances found in nature such as herbs, foods, vitamins, and other natural substances.

  33. Manipulative and body-based practices • Feature manipulation or movement of body parts, such as is done in chiropractic and osteopathic manipulation (massage).

  34. Energy medicine • Biofield terapies are intended to influence energy fields that purportedly surround and penetrate the body. No emperical evidence has been found to support the existence of the putative energy fields on which these therapies are predicated (Taichi, Reiki). • Bioelectromagnetic-based therapies use verifiable electromagnetic fields, such as pulsed fields, alternating-current or direct-current fields in an unconventional manner.

  35. CONVENTIONAL MED. for disease COMPLEMENTARY MED. for impairments & disabilities/handicaps MEDICAL TREATMENT

  36. CONCLUSION The elderly people AGE RELATED Physical capacity, psychology, diseases and socio-economical status COMPR. GERIATRIC ASS. impairments disabilities handicaps diseases Conventional medicine therapy Complementary therapy ? ALTERNATIVE THERAPY

  37. Thank you for your attention Assalamu’alaikum warohmatullahi wabarokatuh Wasilah Rochmah Geriatris Subdivision, Department of Internal Medicine, School of Medicine, Gadjah Mada University/ Dr Sardjito Hospital Yogyakarta

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