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PERAN REHABILITASI MEDIK PADA GERIATRI

PERAN REHABILITASI MEDIK PADA GERIATRI. Afriwardi. THE GERIATRIC TEAM. PHYSICIAN / GERIATRICIAN :CLINICAL COORDINATOR / LEADER - Clinical Assessment & Treatment, rehabilitation etc. - Functional assessment. NEURORLOGIST PSYCHOLOGIST, PSYCHIATRICS NURSE : - Patients Care

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PERAN REHABILITASI MEDIK PADA GERIATRI

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  1. PERAN REHABILITASI MEDIK PADA GERIATRI Afriwardi

  2. 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

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

  4. 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

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

  6. 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

  7. 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

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

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

  10. 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

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

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

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

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

  15. 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

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

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

  18. 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

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

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

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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

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

  28. Terima Kasih

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