MEDICAL ASPECT OF AGING

DSC GERODONTOLOGI(Aline&Marlin)

Kenapa qta harus belajar ini??

Understanding :1. Vulnerability of older person2. Alteration assessment & parameter that occur

in disease presentation and response to therapy

3. Capasities of older person & the lack of significant change in many function

4. Which aging function might partially modified

CATATAN...

Penyakit di rongga mulut bisa muncul sebagai penyakit primer maupun penyakit sekunder.

Baik penyakit sistemik maupun konsumsi obat2an ttt bisa memunculkan manifestasi patologis di rongga mulut

Sebagai drg harus bisa membedakan perubahan kondisi rongga mulut yang terjadi pada lansia itu, apakah akibat dari perubahan fisiologis ataukah patologis.

PHYSIOLOGIC CHANGES DUE TO IMMUNE SYSTEM

DECREASE : Thymus mass Lymphocyte circulation Cell mediated immune system Suppressor cell function

INCREASE : Natural antibody challenge Autoantibody

ORAL IMPACT ON IMMUNE SYSTEM CHANGES

• Penyakit autoimun yang bermanifestasi di oral meningkat

• Kebutuhan perawatan untuk meminimalisir kerusakan jaringan meningkat

• Pemakaian antibiotik , efek samping infeksi oportunistik naiknya insidensi infeksi rongga mulut

• Efek dari penggunaan steroid jangka panjang

CHANGES IN SKELETAL SYSTEM

• Slow & unsteady movement• Complaint joint pain• Joint swelling, redness

Ex. Penyakit arthritis/rheumatoid arthritis gerakan ekstremitas dan jari2 menurun

CHANGES IN MUSCULAR SYSTEM

• Sulit mengangkat / membawa objek • Kemampuan untuk menggerakan anggota

gerak badan terbatas kemampuan untuk menjaga OH

CHANGES IN CARDIOVASCULAR SYSTEM

Sebagai penyakit sistemik, manifestasi di oral tidak nyata perlu modifikasi perawatan ex. Jadwal & lama kunjungan, posisi duduk

Obat2 yg dikonsumsi manifestasi di oral bersifat nyata, antara lain: Menimbulkan ulserasicdi mulut Dry mouth Gingival hyperplasia Lichenoid rachitis Altered taste (β-blocker) Burning mouth

OBSERVATIONS OF THE RESPIRATORY SYSTEM

• Color of sputum• Complaint of pain in chest, back, sides• Shortness of breath• Noisy respirations• Sneezing• Gasping for breathing• Axiety

CHANGES OF THE DIGESTIVE SYSTEM DUE TO AGING

• Atrophy of mucosa throughout• Decreased number of taste buds• Slowing of peristaltis causing constipation• Slower absorption of nutrients• Difficulty chewing and swallowing

Catatan tmbhn : sputum berwarna kekuningan bisa tanda infeksi TB bisa fisiologis bisa tanda infeksi lain

Catatan tambahan...• Saliva mulut << bisa krn perub fisiologis, bisa jg patologis• Saliva berkurang sulit mengunyah & menelan disfagia

nafu makan berkurang• Klo nafsu makan bekurang intake makanan << defisiensi

nutrisi• Defisiensi vit B12 angular chelitis• Tapi diperhatikan jg, angular cheilitis itu bisa disebabkan oleh

infeksi jamur candida, bisa juga karena vertikal dimensinya berkurang (pasien edentulous

Intinya teman2 sebisa mungkin menganamnesis pasien yg lengkap ya, supaya faktor etiologi sebenarnya bisa diketahui....

CHANGES OF THE URINARY SYSTEM DUE TO AGING

• Decreased kidney size• Decreased elasticity of ureters, bladder, and urethra• Decreased muscle tone• Diminished blood flow to kidneys• Decreased ability of kidneys to concentrate urine• Difficulty emptying urinary bladder• Enlarged prostate in males which presses on

urethra

ORAL IMPLICATION OF THE GENITOURINARY CHANGES

• Impaired excretion of meds• Tendency to dehydration because of reduced

intake • Stress inkongenital

OBSERVATIONS OF THE URINARY SYSTEM

• Evaluated temperature• Sugar and/or acetone in urine• Urine color other than clear, pale yellow• Complaint of burning on urination• Incontinence• Polyuria

CHANGES OF THE ENDOCRINE SYSTEM DUE TO AGING

• Decrease in thyroid, parathyroid, adrenal, and sex hormone secretions

• Decreased glucose tolerance (Diabetes)• Multiple physical changes due to decreas of

sex hormone

OBSERVATION OF THE ENDOCRINE SYSTEM

• Irritability & restlessness• Nervousness• Confusion• Weight loss• Diaphoresis• Edema• Excessive thirst• Sweet, friuty odor to breath

OBSERVATIONS OF THE ENDOCRINE SYSTEM

• Complaint of headache• Drowsiness• Rapid, weak pulse• Low blood pressure• Nausea or vomitting• Flushed, dry, hot skin biasanya pd wanita

menopause• Excessive urination

CHANGES OF THE NERVOUS SYSTEM DUE TO AGING

• Loss of nerve/brain cells• Increase in reaction time• Changes in memory• Receptors become less sensitive, so require

increased stimuli for response• Reduced sense of touch and sensitivity to pain• Reduced blood flow to brain• Forgetfulness

OBSERVATIONS OF THE NERVOUS SYSTEM

• Confusion• Complaint of loss of feeling on one side• Incontinence• Deranged thought processes• Tremor • Muscular rigidity• Complaint of visual disturbances or changes• Paralysis• Seizures

CHANGES OF THE SENSORY ORGAN DUE TO AGING

• Lense in eye becomes thick and cloudy

• Sclera becomes more yellow

• Less light reaches inner eye

• Accomodation to light and dark decreases

CHANGES OF THE SENSORY ORGAN DUE TO AGING

• Hearing structures of ear become less moveable

• Soft wax production decreases• Progressive hearing loss of

high-pitched sounds occur• Peripheral vision and night

vision decreases• Eye adjusts more slowly to

changes in distance

CHANGES OF THE SENSORY ORGAN DUE TO AGING

• Sense of smell decreases

• Of taste (sweet and salty first) decreases

• Sense of touch, heat cold, pain and pressure awareness decreases

OBSERVATIONS OF THE SENSORY ORGAN

• Drainage from ear canal• Complaint of feeling of fluid

or noise in ear• Complaint of sudden flashes

of light or loss of sight

CHANGES OF THE INTEGUMENTARY SYSTEM DUE TO AGING

• Compromised circulation • Less active glands• Drying, thinning, and saling of skin• Thickening of nails• Loss of fat and elasticity of skin• Loss of hair color and thinning of hair• Development of skin tags, moles, and warts• Folds, lines, and wrinkles in skin• Nails harden, become more brittle

OBSERVATIONS OF THE INTEGUMENTARY SYSTEM

• Breaks• Rash• Complaint of itching• Balck and blue areas• Redness• Ulcers, sores, or drainage

CANCER-OBSERVATIONS TO REPORT

• Fever• Changes in weight• Bleeding• Changes in vital signs• Complaint of pain• Behavioral changes• Constipation• Diarrhea• Nausea and vomitting• Sores of mouth

Catatan tambahan...

• Tugas drg jika menjumpai pasien lasia baik yang menderita penyakit sistemik maupun tidak adalah :– Bagaimana membantu mengembalikan fungsi

mulut menjadi normal, sehingga pasien tersebut dapat makan dan bicara dengan nyaman

– Mencegah terjadinya penurunan yang lain atau penyakit lain di rongga mulut

Catatan tambahan... Jika melihat kondisi pasien lansia yang begitu kompleks, kita sbg

drg hrs bs memprediksi kondisi pasien tsb. Bbrp faktor yg perlu diperhatikan o/ drg dalam menangani

pasien lansia : Kebutuhan perawatan lansia > pasien dewasa/muda Riwayat medik pasien bgmn Obat2an yg sdg dikonsumsi apa saja? Kapasitas fisik pasien sejauh apa Pasien impaired cognitive unable to understad a treatment

plan perlu menerangkan pada keluarga yg mengantar Neuromuscular skill maintain OH <<

Catatan tambahan...

Faktor modifikasi pasien yg perlu dipertimbangkan : Patient desire & expectation Patient dental need type & severity Patient’s dental effect problems affect

his/her quality of life Treatment alternative Patient’s life span

Catatan tambahan...

Perawatan pasien lansia sebaiknya bersifat komprehensif dengan pendekatan yg holistik

Sbg drg dalam melakukan perawatan tidak hanya bth TECHNICAL ORIENTED, tp jg perlu MEDICAL ORIENTED utk mencapai kondisi medik yg baik (GOAL)

Jika hanya mengandalkan TECHNICAL ORIENTED bs trjd OVERTREATMENT

GAYA HIDUP KONDISI UMUM

FAKTOR RISIKO

PENYAKIT ORAL

PERAWATAN ORAL

ORAL HEALTH

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