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A.

Eldery
1. Definition of Eldery
According to Ratna Suhartini of UNAIR elderly or elderly is the final stage of the
aging process. At this stage usually individuals have experienced a decline in the
physiological function of organs. Classification of elderly according to WHO
quoted from Ratna Suhartini from UNAIR (2010) are grouped into four, namely:
middle age (middle age) 45-59 years old, elderly (60 - 74 years old, old age) 75-90
years old , and very old age (very old) above 90 years (Vina Dwi W, Fitrah, 2010).

According to Law No.4 of 1965 article 1 a person can be declared as decrepit or


elderly after the age of 55 years, has no or no power to earn his own living for the
needs of his daily life and receive a living from others. Law No.13 of 1998 on the
welfare of the elderly that the elderly is someone who reached the age of 60 years
and over (Azizah, 2011).
Aging is a gradual process of gradual removal of tissue ability to repair itself or
replace and maintain its normal function so that it can not survive infection and
repair the damage (Constantinides, 1994 in Siti Bandiyah, 2009).
2. Eldery Restriction
In the opinion of various experts in Efendi (2009) age limits that include the age
limit of the elderly are as follows:
1. According to Law Number 13 Year 1998 in Chapter 1 of Article 1 paragraph
2 which reads "The elder is someone who reaches the age of 60 (sixty) years
and above".
2. According to World Health Organization (WHO), old age is divided into four
following criteria: middle age is 45-59 years old (elderly) is 60-74 years old
elderly is 75- 90 years old, very old age is over 90 years old.
3. According to Dra. Jos Masdani (Psychologist UI) there are four phases: first
(the phase of inventus) is 25-40 years, second (virilities phase) is 40-55 years,
third (presenium phase) is 55-65 years, fourth (phase of artum) is 65 to close
the age.
4. According to Prof. Dr. Koesoemato Setyonegoro the elderly (geriatric age):>
65 years or 70 years. The age of the age (getiatric age) itself is divided into
three age limits, namely young old (70-75 years), old (75-80 years), and very
old (> 80 years).

3. Changes that Occurs in the Eldery


According to Azizah (2011), the increasing age of man, there is a degenerative
aging process that will affect the changes in human beings, not only physical
changes, but also cognitive, feel, social, and sexual.
3.1 Physical Changes
3.1.1 The Senses System
Changes in the sensory system to the elderly include the following:
3.1.1.1 Changes in vision systems in the elderly closely associated
with presbyter. Lenses lose elasticity and stiffness. Weakness
of the lobe muscles, vision acuity and accommodation power
from distance or near are reduced, good use of eyeglasses and
lighting systems can be used.
3.1.1.2 Hearing system: presbyteris (auditory disorder) due to loss of
hearing ability in the inner ear, especially to sounds or high-
pitched tones, unclear sounds, difficult to understand words,
50% occur at the age above 60 year.
3.1.1.3 Integumentary System
3.1.2 The Musculoskeletal System
Changes in the musculoskeletal system in the elderly include the
following:
3.1.2.1 Connective tissue (collagen and elastin). Collagen as the main
support on the skin, tendon, bone, cartilage and binding tissue
changes into an irregular expanse. Changes in collagen are the
cause of the turbulence of flexibility in the elderly resulting in
the impact of pain, decreased ability to increase muscle
strength, difficulty moving from sitting to standing, squatting
and walking and obstacles in performing daily activities.
3.1.2.2 Cartilage; cartilage tissue in the soft joint granulates and
eventually the joint surfaces become flat, then the ability of
cartilage for regeneration decreases and regeneration that
occurs tends towards progressive, consequently cartilage in
the joints become susceptible to friction. Changes often occur
in large weight-bearing joints. As a result of that change the
joints have inflammation, stiffness, pain, limited movement
and disruption of daily activities.
3.1.2.3 Bone; reduced bone density after observation is part of
physiological aging. The impact of reduced density will result
in pain, deformity and fracture.
3.1.2.4 Muscles; muscle structure changes in aging vary widely,
decreasing the number and size of muscle fibers, increasing
connective tissue and fatty tissue in muscles resulting in
negative effects, the effect of morphological changes in
muscle is decreased strength, decreased flexibility, increased
reaction time and decreased muscle functional ability.
3.1.2.5 Joints; in elderly, connective tissue around joints such as
tendons, ligaments and fascia decreases elasticity. Ligaments
and periarkular tissues experience decreased bending and
elasticity. Degeneration, erosion, and classification of the
cartilage and joint capsule. Joints lose their flexibility resulting
in decreased joint motion. The disorder can cause disturbance
in the form of bengkan, pain, joint stiffness, road disruption
and other daily activities.
3.1.3 Cardiovascular System
The heart period increases, the left ventricle is hypertrophied and the
ability of the heart stretch is reduced due to changes in connective
tissue and lipofusin accumulation and the SA node classification and
the ondictive tissue are transformed into connective tissue. O2
consumption at the maximum level decreases so that the lung capacity
decreases.
3.1.4 Respiration System
In aging there is a change in lung connective tissue, the total lung
capacity remains, but the volume of lung reserves increases to
compensate for the increase in pulmonary space loss, the air flowing
to the lungs is reduced. Changes in muscle, cartilage and piston joints
resulted in impaired respiratory movement and reduced thoracic
thoracic abilities. Age is not related to diaphragm muscle changes,
when diaphragm muscle changes, the thoracic muscle becomes
unbalanced and causes distortion of the thoracic wall during
respiration.
3.1.5 Digestive and Metabolism System
3.1.6 Urinal System
3.1.7 Nervous System
The nervous system undergoes progressive anatomical and atrophic
changes in elderly nerve fibers. Elderly experiencing penliman
coordination and ability in performing daily activities. Aging causes a
decrease in sensory perception and motor responsiveness in the
central nervous system and decreases in propioceptive receptors, this
is because the central nervous system in the elderly undergoes
morphological and biochemical changes, the changes resulting in
decreased cognitive function. According to Surini and Utomo (2003)
cited by Azizah (2011).
3.1.8 Reproduction System
4. Cognitive Change
4.1 Memory
In the elderly, memory is one of the cognitive functions that is often the
earliest decline. Long term memory is less likely to change, whereas short-
term memory or 0-10 minutes is deteriorating rapidly..

4.2 IQ (Intellegent Quocient)


Elderly does not change with mathematical information (analysis, linear,
sequential) and verbal words. But the perception and imagining power
(fantasy) decreases. Despite the controversy, intelligence tests pay little
attention to the decrease of intelligence in the elderly (Cockburn & Smith,
1991 quoted by Lumbantobing, 2006).
4.3 Ability to Learning
According to Brocklehurst and Allen (1987) on Darmojo and Martono.
(2006), healthy elderly and not dementia still have good learning ability, even
in developed industrial country University of the third age.
4.4 Ability to Understand (Compherension).
The ability to understand or grasp the understanding of the elderly has
decreased. This is influenced by the hearing concentration and hearing
function of the elderly who decreased.
4.5 Problem Solving.
In the elderly the problems faced certainly more and more. Many things that
were once easily unbreakable become inhibited because of the decline in
sensory function in the elderly.
4.6 Decission Making
Decision-making in the elderly is often slow or as if delays.
4.7 Wisdom
Wise (Wisdom) is the aspect of personality (personality) and a combination
of cognitive aspects. Wisdom illustrates the nature and attitude of the
individual who is able to consider between good and bad and the advantages
and disadvantages that can act fairly or wisely..
4.8 Performance
In the elderly it will be seen a decrease in performance both quantitatively
and qualitatively. Changes in performance that require speed and time
decrease (Lumbantobing, 2006).
4.9 Motivation
In the elderly, both cognitive and affective motivation to achieve / obtain
something large enough, but the motivation is often lacked support physical
and psychological strength, so that things are desirable many stop in the
middle of the road.
5. Spiritual Changes
Religion or elderly beliefs are increasingly integrated in life. The elderly gets
more organized in her religious life. It can be seen in thinking and acting day-to-
day. At the stage of development of the elderly feel or conscious of death (Sense
of Awareness of Mortality).
6. Psychosocial Changes
6.1 Pension/Retirement
Retirement is often wrongly associated with passivity and seclusion. In
reality, retirement is a life stage characterized by transition and role change,
which can cause psychosocial stress.
6.2 Changes in aspects of personality
In general after people enter the elderly then he experienced a decrease in
cognitive and psychomotor function. With the decline of both functions, the
elderly personality changes. elderly personality is divided into 5 personality
types: constructive personality type, independent, dependent personality type,
hostile, defensive personality type, and personality type self-criticism (Self-
Hate personal).
7. Changes in social roles in ociety
Due to the reduced function of the sense of hearing, sight, physical movement
and so it appears functional disorders or even defects in the elderly, such as the
body becomes hunched, hearing is greatly reduced, the vision is more blurred and
so on so often cause alienation.
8. Changes in sexual function and potential
Decreased function and sexual potency in the elderly are often associated with
various physical disorders. Psychological factors that accompany the elderly
associated with sexuality, such as a sense of taboo or shame when maintaining a
sexual life in the elderly.
9. Nutritional Problem
Less nutrition is lack of nutrients both micro and macro
9.1 Causes
a. Decrease or loss of taste and smell sensitivity
b. Periodoental disease (occurring in 80% of elderly) or tooth loss
c. Decreased gastric acid secretion and digestive enzymes
d. Decreased mobility of the food digestive tract
e. Use of long-term medicines
f. Impaired motor ability
g. Less social, lonely
h. Decreased revenues (retirement)
i. Chronic infectious disease
j. Disease of ferocity

B. Nursing Care Gerontik

1. Physiological / physical

a. Nutritional status

IMT = Kg Weight Male = 18 -25


(Heigt)2 Female = 17 – 23
b. fluid intake in 24 hours

c. Skin condition

d. Lip condition, mouth mucosa, teeth

e. Medical history, alcohol, other addictive substances

f. Evaluation of vision, hearing and mobility

g. Nutritional-related complaints: digestive system disorders, appetite,


preferred and disliked foods, flavor and aroma
h. Behavior or habit while eat ( 2 –3 x/day, snack, etc)

2. Psychosocial / affective

a. Behavior while eat(eat alone, while watching TV, etc)

b. environmental situation (capacity of food supply, processing and


storage of food)
c. sociocultural effect that affects the pattern of nutrition and elimination
d. Depression conditions that can interfere with the fulfillment of nutrients
3. Supporting Examintaion/Laboraotium
a. Blood Analysis:
Creatinin : Index of muscle mass
Serum proteins especially for the synthesis of antibodies and lymphocytes,
in cellular immunity, enzymes, hormones, broad cell structure, tissue
structure.
C. Nursing Diagnosis
1. Inbalance nutition less than body related to Inadequate nutrition intake due to
anorexia
2. Risk for infectiona related to decreased intake of calories and protein
3. Damage for physical mobility related to skeletal deformity, pain, activity
intolerance
4. Pain related to inflamasi process, joint destruction
5. Risk for injury (joint dislocation) in muscle loss of strength, joint pain

D. Intervention

1. Inbalance nutition less than body related to Inadequate nutrition intake

due to anorexia

GOAL CRITERIA INTERVENTION RATIONAL

Nutritional - Increase a. Create an ideal a. Adequate


oral input
needs are weight destination nutrition avoids
met - Shows and Adequate daily malnutrition
increased
adequately BB nutritional needs

b. Weigh daily, b. Early detection

monitor the results of BB changes

of laboratory tests and nutritional


input

c. Explain the
c. With the correct
importance of
adequate nutrition Understanding

will motivate the

client to input

nutrition
d. each individuals d. The delicious

to use flavorings aroma will

(such as spices) arouse the


appetite

e. Encourage e. By eating

individuals to eat together

with others psychologically

increases your
appetite

f. Maintain good f. With a clean

oral hygiene mouth situation

(toothbrush) increases

before and after comfort


chewing food

g. Suggest eating g. Reduce feelings

with small of tension in the

portions but often stomach

h. Instruct h. Increase food


intake
individuals who

have decreased

appetite for:

- Dry-eat dry
when waking up

- Avoid foods
that are too sweet,
greasy

- Drink a little
through a straw

-Eating anytime if

tolerance

-Eat in small

portions low in
fat and eat often
2. Risk for infectiona related to decreased intake of calories and protein

GOAL CRITERIA INTERVENTION RATIONAL

Signs of
The client will inflammation a. Review common a. Early detection to
not found: signs of prevent
show the inflammation inflammation
heat, swelling,
pain, red, regularly
ability to
malfunction b. Teach about the b. Prevent the
avoid signs of
need to maintain occurrence of
infection personal hygiene infection due to the
and environment environment and
personal hygiene

c. Increase your c. increase protein


levels in the body
nutritional intake thereby increasing
the ability of
immunity in the
body

d. Note the long- d. Reduce the risk of


infection
term use of

drugs that can

cause
immunosuppress

ion
3. Damage for physical mobility related to skeletal deformity, pain, activity
intolerance

INTERVENTION
GOAL CRITERIA RATIONAL
a. Evaluation of a. The level of
clients can Demonstrate inflammatory / activity depends
mobilize techniques / illness monitoring on the
development /
adequately behaviors that resolution of the
inflammatory
enable process
activities b. aids with active / b. Maintaining joint
passive range of function, muscle
motion strength

c. change c. Eliminates
position pressure on the
frequently tissues and
with enough improves
personal circulation
d. Provide a d. Avoid injury
comfortable

environment

eg tools
4. Pain related to inflamasi process, joint destruction

GOAL CRITERIA INTERVENTION RATIONAL


a. Assess the pain a. Help in
Indicates pain Looks complaint, note the
location of pain and determining pain
decreases / relaxed, able
intensity. Record the
management
disappears to sleep and factors that speed up
the pain signs
participate in
b. Let the client take a b. In severe disease
activities comfortable position bed rest is
at rest or sleep
necessary to limit
the pain
c. Instruct the client to c. Heat increases
warm bath, provide a muscle relaxation
washcloth to and mobility,
compress the joints
decreasing pain
and joint
stiffness.
d. Give gentle massage d. Increases
relaxation /
reduces muscle
tension
e. Collaborative e. As an anti-
administration of inflammatory and
drugs such as aspirin, mild analgesic
ibuprofen, naproksin, effect in reducing
piroxicam, stiffness.
phenoprofen
REFERENCE

Azizah, Lilik Ma’rifatul. (2011). Keperawatan Lanjut Usia. Yogyakarta: Graha Ilmu.
Efendi, Ferry. (2009) Keperawatan Kesehatan Komunitas: Teori dan Praktik dalam
Keperawatan. Jakarta: Salemba Medika
Nugroho, Wahjudi. (2012). Keperawatan Gerontik dan Geriatrik . Edisi 3. Jakarta: EGC.
Setiadi. 2007. Anatomi dan Fisiologi Manusia. Cet. 1. Yogyakarta : Graha Ilmu.
Psychologymania. 2012. Pengertian-lansia-lanjut-usia. Diakses pada hari Minggu, 07
Desember 2014. http://www.psychologymania.com/2012/07/pengertian-lansia-lanjut-
usia.html

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