EMOTIONAL COGNITIVE AND BEHAVIOUR CHANGES IN ELDERLY

1. EMOTIONAL COGNITIVE AND BEHAVIOUR CHANGES IN ELDERLY ADAPTASI MATERI MUTRARSI FIRNGADI dan Pedoman pembinaan keswa usila DepKes RI 2001 1

2. Multi Dimensional BIOLOGICAL PSYCHOLOGICAL emotional CHANGES IN ELDERLY cognitive behavior SOCIOCULTURAL PSYCHOSOCIAL Objective: Understand the psychology social factor in elderly Aware the psychology social factor in elderly Emphatic to the elderly the psychology social factor in elderly 2

3. REGRESSION AGING INVOLUTION ADULT PROGRESSIVE DEVELOPT ELDERLY • Social activity • Ageism • Counter transference • Socio economic • Retirement • Sexual activity • Long tem care INFANT 3

4. World Health Report 2001 Mental health is a state of wellbeing in which the individual realizes his or her own abilities, can cope with normal stress of life, can work productively and fruitfully, and is able to make contribution to his or her community 4

5. Old age brings in varying degree the decline of our powers, both mental and physical. But this does not mean that life is over, that the individual is fit only for the scrapheap 5

6. What Kinds Of Changes Learn slowly To adapt with difficulty to new situations To persevere with old habit of thought fail to remember recent event 6

7. Old People Suffer From Nutritive deficiencies that result chiefly from economic – psychological or physical problems 7

8. A Man Is As Old As His Artieries As old as his skin His adrenalglads His nervous system Others ? 8

9. Integration Of The Five Dimension Of The Person 9

10. What – reversible - irreversible How - to manage - to prevent many kind of elderly • Why • Biological • Sociocultur • Physiological • Psychosocial Emotional Cognitive behavior change in elderly Who aware the condition doctor family Where -they must seeking 10

11. Belajar perlu banyak waktu & makin sulit mempelajari hal baru Kecakapan bernalar induksi & deduktif berkurang Kemampuan / minat kreatif berkurang Fungsi mengingat berkurang Mengingat masa lalu bertambah Daya tampung kosa kata menurun Kekakuan mental bertambah PERUBAHAN MENTAL

12. PERUBAHAN DALAM MINAT • Minat terhadap diri sendiri bertambah (self - centered) • Minat terhadap penampilan berkurang • Minat terhadap uang meningkat ( ? ) • Minat terhadap rekreasi tetap, cenderung menyempit

13. PERUBAHAN PSIKIS / MENTAL EMOSIONAL LAINNYA • MAKIN EGOSENTRIK • MUDAH CURIGA • DEPRESI • TAMBAH PELIT / TAMAK ( ? )

14. MASALAH DEPRESI • Gejala Depresi klasik (perasaan sedih, kurang semangat, hilang minat/hobi atau aktifitas menurun) sering tidak nampak • Sering dgn gejala hilang energi, rasa senang hlg, tidur kurang, rasa sakit dan nyeri, mencelah diri, cemas, preokupasi gejala fisik, pikiran bunuh diri, menarik diri dari kegiatan dan interaksi sosial

15. PERUBAHAN KOGNITIF “LUPA” • Fisiologis: forgetfulness, AAMI (Age associated memory impairment) • Patologis: Demensia, MCI (Mild Cognitive impairment, Amnesia tdk sesuai usia terutama amnesia jangka pendek) • Reversibel: drug induced, metabolik, gegar otak, trauma kepala, depresi • Irreversibel dan progresif: Demensia Alzheimer, Vaskular, Fronto-Temporal, Pick dll

16. Jenis memori • Episodik: peristiwa & fakta Dlm hidup • Semantik: pengetahuan umum, pelajaran disekolah. Semantik lbh diingat ketimbang episodik • Prosedural: ketrampilan tentang bagaimana melakukan kegiatan sehari-hari • segera • jangka pendek • jangka panjang

17. Kriteria mudah lupa • Mudah lupa nama benda, nama orang dan sebagainya • Gangguan mengingat kembali (retrieval) • Gangguan mengambil kembali informasi (recall) • Memerlukan isyarat (cue) utk retrieval • Lbh mudah menyabarkan fungsi dan bentuk ketimbang menyebut namanya

18. Tahapan penurunan fungsi memori • Memori deklaratif episodik (berkaitan dengan wkt dan tpt) kpn dan dimana peristiwa terjadi • Penurunan memori deklaratif semantik (Pengetahuan dan pengalaman) • Penurunan memori prosedural (keterampilan psiko motor yang dipelajari)

19. Demensia (PPDGJ III) • Memori : Lupa informasi baru, peristiwa baru • Disertai > 1 kognisi lainnya terganggu: seperti daya pikir, berbahasa, judgment, orientasi dst ) • Kesadaran jernih • Perubahan perilaku (emosi, motivasi) • Aktivitas sehari-hari terganggu • Onset (perlahan, bertahap) > 6 bl Dapat disertai delusi, halusinasi, depresi Derajat demensia: ringan, sedang, berat

20. Two major factors to delay recognition of age-associated dementia in the community Low awareness in family members Low recognition in primary care physicians 20

21. Case Example: Depression and Suicide In Older Persons Age 65+: highest suicide rate of any age group Age 85+: 2X the National Average (CDC 1999) Over HALF of Older Persons who Commit Suicide Had a Visit with their Physician in the Prior Month (Caine et al., 1996 Am J Geriatric Psychiatry; Surgeon General’s Report 1999) Depression: Associated with Poorer Health Outcomes and Higher Health Care Costs (Unützer et al., 1997 JAMA) Antidepressant Medication and Psychotherapy are As Effective in Older Adults as in Younger Persons (Surgeon General’s Report 1999) 21

22. Reductions in Quality Adjusted Life associated with chronic medical disorders over 4 years Hypertension Foot Problems Cancer Arthritis * p<0.05 Heart Disease Emphysema Depression Diabetes Stroke QALYs 0 0,1 0,2 0,3 0,4 0,5 0,6 N = 2,558. Adjusted for age, gender, and chronic medical conditions. Unützer et al, Int Psychogeriatrics, 2000. 22

23. A National Survey of health and Supportive Services in the Aging Network- Summer 2001Disease Self –Management Program Physical Activities 23

24. “Falling Through the Cracks” Under Identification and Under treatment of Mental Health Problems in Older Persons Among Older Persons in Need: Up to 4/5 in Nursing Homes and 2/3 in the Community Do Not Receive Treatment (Shea et al., 1994, Health Serv Res; Rabins et al., 1996 Am J Geriatr Psychiatry; Shapiro, et al., 1986) Prevention and Treatment: A Gap Between “What We Know” AND “What We Do” A Lack of Trained Providers and A Fragmented System of Mental Health Care for Older Persons Medicare: 50% Copayment for Psychological Treatments and No Prescription Drug Benefit 24

25. Francois, Due de la Rocheloucauld “Everyone complains of his memory, and no one complains of his judgment” 25

26. To whom did you consult first, when you realized the changes in everyday life? 26

27. References Benjamin/Ames Shaddock. MD, Virginia Alcott Shaddock. MD, 2003, a. Late adult hood in human development. Through out the life cycle b. Theories of personality and psychopathology. Erik Eriksson. Synopsis of psychiatry. Behavioral sciences/clinical psychiatry, lippincott Williams b Wilkins phila delphia, pg 50-65; pg 211 – 216 Joel sadavoy, MD, Lawrence M, Lazarus, MD, Lissy F/arvik MD, PhD, 1991, psychological aspect of normal aging in comprehensive review of geriatmc, psychiatry, pg 79 – 97, 117 – 139. Morris fishbein, MD 74 age, medical and health encyclopedia pg 2499 - 2500 Martin heller the international family health encyclopedia the calescence of life, sunset pg 77 – 85, pg 249 U.S department of health, human services, promoting older – adult health, why practitioners reed information about working situ older adult internet 27

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32. Terima kasih ... 32