PERAN REHABILITASI MEDIK PADA GERIATRI

1. PERAN REHABILITASI MEDIK PADA GERIATRI Afriwardi

3. THE GERIATRIC TEAM • PHYSICIAN / GERIATRICIAN :CLINICAL COORDINATOR / LEADER - Clinical Assessment & Treatment, rehabilitation etc. - Functional assessment. • NEURORLOGIST • PSYCHOLOGIST, PSYCHIATRICS • NURSE : - Patients Care - Supporting other members of team - Functional assessment etc. • MED. SOCIAL WORKER : Social & environmental ass. • Other consultants : - Rehabilitation doctors& Physiotherapist - Nutritionist. - Pharmacyst • Other consultants in relevant Specialistic Med.care

4. ? Kelompok usia lanjut cepat atau lambat memerlukan Rehabilitasi Medis

5. FALSAFAH & TUJUAN REHABILITASI MEDIK Falsafah rehabilitasi medik ialah meningkatkan kemampuan fungsional seseorang sesuai dengan potensi yang dimiliki untuk mempertahankan dan atau meningkatkan Kualitas hidup dengan cara mencegah atau mengurangi Impairment, Disability dan handicap semaksimal mungkin

6. KATA KUNCI • Kemampuan fungsional seseorang • Potensi yang masih dimiliki • Kualitas Hidup • Diagnosis Kecacatan : • Impairment • Disability • Handicap

7. 3 STADIA FUNGSIONAL PERJALANAN PENYAKIT / CEDERA YANG DIDERITA SESEORANG : “IMPAIRMENT” (tingkat organ) : Stadia dimana penderita masih memerlukan / tergantung pada perawatan dan terapi secara aktif, sehingga tidak mampu melaksanakan kegiatan sehari-hari (ADL), “temporary disability” “DISABILITY” (tingkat manusia) : Stadia disebut juga “recovery period” dimana penderita mulai dapat melaksanakan pekerjaan sesuai keadaan kesembuhan penyakitnya “HANDICAP” (tingkat sosial) : Stadia cacat menetap, keterbatasan kemampuan dan melaksanakan tugas pekerjaan Prof. Soelarto Reksoprodjo Unit Rehabilitasi Medis Jakarta - Indonesia

8. REHABILITASI MEDIS Pendekatan medis, psikis, sosial, kultural, spiritual untuk meningkatkan kemampuan fungsional pasien atau para penyandang cacat. Rehabilitasi medis aspek yang sangat mendasar pada perawatan geriatri

9. Upaya Rehabilitasi Medik Bagian integral dari pelayanan Kedokteran/Kesehatan yang berkaitan langsung dengan terwujudnya kualitas hidup seorang pasien

10. Proses Rehabilitasi Medik adalah Proses mengembalikan Seseorang, dari perannya sebagai pasien, menjadi seorang manusia seutuhnya

11. Konsep Upaya Pencegahan dari Sudut Rehabilitasi Medis • Pencegahan Primer Sehat  cegah jangan sakit (impairment) • Pencegahan Sekunder Sakit (impairment)  cegah jangan cacat (disable) • Pencegahan Tertier Cacat (disable)  cegah jangan handicap

12. PREVENTION PREVENTION PREVENTION PATIENT TRAINING PSYCHOSOCIAL INTERVENTION PATIENT EXERCISE FOLLOW UP PREVENTION PREVENTION THE ESSENTIAL COMPONENTS OF A COMPREHENSIVE REHABILITATION PROGRAM ASSESMENT Prevention Strategies

13. EVALUASI REHABILITASI EVALUASI DIAGNOSIS FUNGSIONAL GOAL JANGKA PENDEK GOAL JANGKA PANJANG PROGRAM REHAB/ TERAPI REEVALUASI REPROGRAM

14. Rehabilitation Nusbaum NJ primary geriatric care a cased based approach 2007 Rehabilitation efforts for frail elders may be directed to avoid loss of function, to help promote return or lost function, or both. Rehabilitation of older adults can take place in an acute hospital medical or rehabilitation unit, the nursing home, an outpatient area, or at patient’s home An important preventing measure in primary care is to encourage physical activity to help patients achieve a higher level of baseline function, so that they will have more functional reserve during an illness.

15. Early Instruments Used in Rehabilitation In selecting an assessment instrument to be used in rehabilitation, choose those that are able to measure changes over a relatively short period of time, can detect small changes in function, and are based on a variety of sources of information.

16. Functional Status Functional status has been defined as “a person’s ability to perform tasks and fulfill social roles associated with daily living cross a broad range of complexity”. Measures of functional status are used for a wide variety of purposes. Clinicians apply them to establish baselines, to monitor the course of treatment, or for prognostic purposes. The assessment can also be used for screening. Gallo JJ, ADL & Instrumental ADL Assessment in andbook of Geriatric Assessment 4th ed, 2006

17. Functional Status The capacity to function independently is poorly described by the constellation of medical diseases alone. Performance on mental status testing does not necessarily predict functional status. The severity of disease as measured by standard laboratory tests does not necessarily imply disability. Functional status should be assessed directly and independently of medical and laboratory abnormalities or cognitive impairment. Gallo JJ, ADL & Instrumental ADL Assessment in andbook of Geriatric Assessment 4th ed, 2006

18. Examinations of function divided into three levels: Basic Activities of Daily Living (BADL or ADLs) Instrumental Activities of Daily Living (IADL) Advanced Activities of Daily Living (AADL). Functional Status

19. Barthel Index The Barthel Index (Mohaney & Barhel, 1965) was originally devised as a means of clearly differentiating patients who are dependent in ADL from those who are not. It is a 10 category, weighted index, which includes ambulation and stairs as well as self-care and has a perfect score of 100. At least five versions (including the original) have been used. These include zero to 20-point scoring modification (Collin, Wade, Davies, & Horne, 1988). The Index should be used as a record of what a patient does, NOT as a record of what a patient could do.

20. The Barthel Index was used to document improvement. Patients who did not improve their score during rehabilitation were believed to have poor potential for recovery. Barthel Index

21. INDEKS ADL BARTHEL (BAI)

22. INDEKS ADL BARTHEL (BAI) (lanjutan) Skor BAI 5-8 : Ketergantungan berat • : Mandiri 12-19 : Ketergantungan ringan 0-4 : Ketergantungan total 9-11 : Ketergantungan sedang

23. Lawton IADL Scale

24. A HIERARCHICAL MODEL OF PHYSICAL FUNCTION When selecting a performance-based measure of function, rules that are used to choose any functional status measure apply

25. Role function Task or goal-oriented function (e.g., ADL, IADL) Specific physical Movements (e.g., 8-foot walk) Coordination Line motor Balance Strength Flexibility Endurance Hierarchy of physical function Integration level III Integration level II Integration level I Basic component

26. Hierarchy of Physical Function and Disability ADL = activities of daily living BADL = basic ADL Physically elite • Sports competition, • Senior Olympics • High-risk and power • sports (e.g., hang- • gliding, weight • lifting Physically fit Physically independent • Moderate physical • work • All endurance • sports and games • Most hobbies Physically frail • Very light physical • work • Hobbies (e.g., walking, • and games • Low physical demand • activities (e.g., golf, • social dance, hand • crafts, traveling, auto- • mobile driving) • Can pass all IADLs Physical function Physically dependent • Ligtht housekeeping • Food preparation • Grocery shopping • Can pass some • IADLs, all BADLs • May be homebound • Cannot pass some • or all BADLs : • waling • bathing • dressing • eating • transferring • Needs home or • institutional care Disability Adapted from Spicduso WW. Physical Dimensions of Aging. Champaign, IL; Human Kinetics; 1995

27. PROSES REHABILITASI Langkah 1 • Atasi masalah medis utama • Kondisi stabil, menjadi landasan untuk mengawali program Rehabilitasi Medis

28. PROSES REHABILITASI Langkah 2 Cegah Komplikasi Sekunder Malnutrisi Inkontinensia Gangguan kognisi Pneumonia Kontraktur Dekubitus Sindroma dekondisi Ketergantungan Psikologis Depresi Trombosis Vena

29. PROSES REHABILITASI Langkah 3 Mengembalikan fungsi yang hilang • Nilai kemampuan fungsional yang masih tersisa, dan maksimalkan • Bila perlu, gunakan alat bantu agar mandiri, bersosialisasi Walau penyebab gangguan fungsi tak dapat dihilangkan, pasien tetap mampu beraktifitas

30. PROSES REHABILITASI Langkah 4 Ciptakan kemampuan adaptasi bagi pasien Adaptasi Fisik Adaptasi Psikis Adaptasi Sosial

31. PROSES REHABILITASI Langkah 5 Adaptasi Lingkungan Ciptakan lingkungan yang bersahabat, baik dirumah sakit, dirumah, dilingkungan, untuk kemudahan pasien beraktifitas

32. PROSES REHABILITASI Langkah 6 Adaptasi Keluarga • 85% aktifitas usia lanjut, dirumah • Para usia lanjut butuh waktu untuk ‘menerima’ kondisinya • Keluarga, makna hidup bagi para usia lanjut • Keluarga, mitra kerja tenaga medis/paramedis

33. PENGAWASAN & EVALUASI • Lakukan Reevaluasi dan Reprogram • Setiap kali, tentukan target baru, agar motivasi terjaga • Target pencapaian merupakan kesepakatan dokter dan pasien

34. PEMILIHAN PROGRAMTERAPI REHABILITASI MEDIK • Tujuan Rasional • Dosis latihan tepat & jelas • Latihan bertahap • Jenis latihan mudah dan aman

35. Basic Consideration If we are to rehabilitate our elderly patient successfully we need: • Timing of treatment • The team • Techniques

36. Basic Consideration Timing of treatment • When does rehabilitation begin • Frequency and intensity of therapy • When to stop The team • Involvement of patient and family • Team coordinator • Involvement of nurse in rehabilitation (enablement) • Focusing on goals • Concern with the well-being of the team

37. Basic Consideration Techniques • Accurate assessment and recognition of all problems • Prevention of complications • Physical agents • Physical techniques • Compensating for disability • Rating scales • Morale and motivation

38. Age-related factors that may affect rehabilitation Biologic Muscle strength Cardiac function Pulmonary function Aerobic capacity Vital capacity Minute volume Orthostatic changes Peripheral resistance Psychologic Slow learning pace More repetitions Belief about rehab Belief about recovery Belief about self Social Negative views of aging Less frequent referrals Self-ageism Financial barriers

39. Disease-related factors that may affect rehabilitation Biologic Multiple diseases Deconditioning Contractures Disease-disease interactions Polypharmacy Subclinical organ dyfunction Psychologic Cognitive deficits Depression Atypical presentations motivation Social Societal prejudice (“Disabilityism”) Lack of services Inaccessible buildings Reimbursement regulations

40. Rehabilitation Problem List Primary rehabilitation diagnosis or anatomic injury Other associated diagnoses with severity measures Impairments (e.g., neurogenic, bladder, bowel, sexual function) Activity limitations (e.g., mobility, ADLs, communication) Education Participation barriers Psychological adaptation Social role function Architectural accessibility Community reintegration Vocational adaptation Spiritual practice

41. Quality of Life Paradigm has meaning for both patient and physician

42. Terima Kasih