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"Latar belakang: Pengkajian Paripurna Pasien Geriatri (P3G) bermanfaat dalam pelayanan pasien lanjut usia. Domain yang sering dinilai adalah status fungsional, disabilitas, status nutrisi, dan kognitif. Namun, pengerjaan P3G membutuhkan waktu yang lebih lama, sehingga dikembangkan bentuk singkat P3G, di antaranya Geriatric 8 (G8). Belum ada publikasi mengenai kesahihan, keandalan, dan performa diagnosis G8 pada populasi umum lansia di Indonesia. Tujuan: mengetahui kesahihan, keandalan, dan performa diagnostik G8. Metode: Penelitian ini merupakan penelitian potong lintang yang dilakukan di Poli Geriatri RSCM. Dilakukan pemeriksaan G8 dan P3G terhadap pasien yang memenuhi kriteria seleksi subjek penelitian, kemudian dilakukan uji kesahihan dengan mencari koefisien korelasi dan analisis kappa. Pasien dengan gangguan pada satu domain P3G dikatakan gangguan P3G, yaitu ADL  19, IADL  7, MoCA-INA  25, MNA < 24, atau timed up and go  10 detik. Hasil: terdapat 80 orang subjek penelitian dengan rerata usia 73,68 tahun, Interrater dan intrarater concordance masing-masing adalah 1 dan 0,904 (p<0,005). Interclass corelation coefficient berkisar antara 0,77 (0,412 – 0,913) sampai dengan 1 (1 – 1). Didapatkan nilai Cronbach 0,697. Titik potong acuan yang digunakan 14,25 menunjukkan sensitivitas 70,27 (58,82 – 80,34), spesifisitas 83,33 (35,88 – 99,58), dengan AUC 0,846 (p<0,005), IK95% 0,667- 1,0) Simpulan: G8 cukup sahih dan memiliki keandalan yang baik sebagai instrumen penapisan pasien rawat. Titik potong G8 yang disarankan adalah 14,5 sehingga pasien dengan skor lebih rendah disarankan untuk menjalani pemeriksaan P3G lengkap.

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Background: Comprehensive geriatric assessment (CGA) has been proved to be beneficial for older adults care. Domains that usually assessed in CGA are functional status, disability, cognitive function, and nutrtion status. However, CGA takes more time to complete, hence shorter versions of CGA were developed, including Geriatric 8 (G8). G8 was developed to screen older adults with cancer who would benefit the complete CGA. There was no publication regarding validity, reliability, and diagnostic performance of G8 for general population of older adults in Indonesia. Objective: This study aimed to evaluate validity, reliability, and diagnostic performance of G8 in older adults. Methods: This is a cross-sectional study conducted in Geriatric Clinic of Cipto Mangunkusumo National Hospital. Both CGA and G8 were performed, concordance between these tests were analyzed to determine validity, reliability, and diagnostic performance of G8. Abnormal CGA is defined by at least one abnormal CGA domain is identified, i.e ADL  19, IADL  7, GDS  5, MoCA-INA  25, MNA < 24, or timed up and go  10. Commorbidities was assessed by CIRS-G. Results: We found strong inter-rater and intra-rater condordance (kappa=1 and kappa=0.904, p<0.005, respectively). Interclass Coefficient Corelation was ranged 0.77 (0.412 – 0.913) to 1 (1 – 1). We also found acceptable Cronbach of 0.697. For diagnostic performance, the sensitivity was 70.27 (58.82 – 80.34), specificity 83.33 (35.88 – 99.58), with AUC 0.846 (p<0.005), CI95% 0.667-1.0). Conclusion: G8 screening tool is valid and reliable to be used in older adults. G8 also demonstrated good diagnostic performance. We propose 14.5 as cut off point for older adults who need full form geriatric assessment."

"In this paper, fasting refers to the Muslim fast, defined as refraining from eating and drinking and all other activities that annul the fast from sunrise to sunset (approximately 14 hours). Fasting can be performed at any time in the year, but is usually performed during certain the compulsory month or recommended days.The fasting of the month of Ramadan is an activity that is health-wise quite difficult, since the person has to refrain from eating and drinking from sunset to sunrise (approximately 13 to 14 days per day) for 29-30 consecutive days."

"Tesis ini bertujuan untuk mengetahui nilai titik potong tes SPPB sebagai tes performa fisik dalam mendiagnosa sarkopenia pada pasien lanjut usia di rawat jalan. Selain itu juga untuk mengetahui nilai sensitivitas dan spesifisitas tes SPPB berdasarkan kecepatan jalan 6 meter untuk estimasi performa fisik sebagai komponen sarkopenia. Penelitian ini merupakan studi potong lintang pada pasien lanjut usia rawat jalan di RSUPN Ciptomangunkusumo. Pada penelitian ini didapatkan 100 subjek yang diminta melakukan uji SPPB, uji kecepatan jalan 6 meter, uji penilaian massa otot dengan BIA (Bio Impedance Analysis), dan penilaian kekuatan otot dengan menggunakan handgrip dynamometer. Dari hasil penilaian didapatkan nilai titik potong 7 untuk populasi total dan populasi perempuan. Sedangkan untuk populasi laki laki didapatakan nilai 8. Setelah didapatkan titik potong baru, dilakukan uji diagnostik antara nilai SPPB titik potong baru dengan status performa fisik menurun berdasarkan kecepatan jalan 6 meter. Dari penilaian didapatkan sensitivitas 81.5% dan spesifisitas 73.7% untuk populasi total. Pada populasi perempuan didapatkan sensitivitas 81.4% dan spesifisitas 66.7%. Sedangkan untuk populasi laki laki menggunakan titik potong 8 didapatkan sensitivitas 81.8% dan spesifisitas 71.4%. Kesimpulan penelitian ini adalah SPPB dengan nilai titik potong 7 untuk populasi perempuan dan 8 untuk populasi laki laki baik dipakai sebagai alat uji untuk screening dan diagnostik performa fisik sebagai komponen sarkopenia rawat jalan.

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This thesis aims to determine the cut-off point of the SPPB test as a physical performance test in diagnosing sarcopenia in elderly patients on an outpatient basis. In addition, to determine the sensitivity and specificity of the SPPB test based on a walking speed of 6 meters to estimate physical performance as a component of sarcopenia. This study is a cross-sectional study of elderly outpatients at Ciptomangunkusumo General Hospital. In this study, 100 subjects were asked to perform the SPPB test, 6 meter walking speed test, muscle mass assessment test using BIA (Bio Impedance Analysis), and muscle strength assessment using a handgrip dynamometer. From the results of the assessment, it was found that the cut-off point was 7 for the total population and the female population. As for the male population, a score of cut oof point is 8. After obtaining a new cut-off point, a diagnostic test was conducted between the SPPB value of the new cut-off point and the decreased physical performance status based on a 6-metre walking speed. From the assessment, sensitivity was 81.5% and specificity was 73.7% for the total population. In the female population, sensitivity was 81.4% and specificity was 66.7%. Meanwhile, for the male population using the 8 cut-off point, the sensitivity was 81.8% and the specificity was 71.4%.The conclusion of this study is that the SPPB with a cutoff value of 7 for the female population and 8 for the male population can be used as a test tool for screening and diagnostic of physical performance as a component of outpatient sarcopenia."

"Latar Belakang: Delirium pasca operasi merupakan salah satu komplikasi yang paling sering terjadi dan berdampak pada banyak luaran buruk. Pengkajian Paripurna Pasien Geriatri (P3G) dan stratifikasi risiko perioperatif pasien geriatri diperlukan sebagai strategi awal pencegahan serta model prediktor prognosis yang efisien dan aplikatif.Tujuan: Penelitian ini bertujuan mengetahui angka kejadian delirium pasca operasi dan mengembangkan model prediksi delirium pasca operasi elektif mayor non kardiak pada pasien lanjut usia berdasarkan faktor prediktor.Metode: Penelitian ini adalah penelitian kohort retrospektif menggunakan data sekunder dari rekam medis pasien lanjut usia rawat inap yang menjalani pembedahan mayor elektif non kardiak di RS Cipto Mangunkusumo periode Januari 2020-Juni 2023.Hasil: Didapatkan 370 subjek memenuhi kriteria dan dilakukan analisis. Kejadian delirium pasca operasi pada penelitian ini adalah 6,8% (IK 95%, 4,4%-9,8%). Faktor prediktor yang dianalisis yakni usia (HR=3,43; IK95% 1,544-7,635), status kognitif (HR=2,74; IK95% 1,156-6,492), dan status nutrisi (HR=3,35; IK95% 1,459-7,679). Model prediksi komplikasi delirium pasca operasi memiliki kalibrasi yang baik (p>0,05) dan performa skor sedang untuk memprediksi kejadian delirium pasien geriatri [AUC 0,750 (p<0,001; IK 95% 0,640-0,860)].Simpulan: Usia, status kognitif, dan status nutrisi merupakan prediktor kuat delirium pasca operasi pada pasien lanjut usia yang menjalani pembedahan elektif mayor non kardiak.

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Background : Postoperative delirium is one the most common complications and will impact many adverse outcomes. Comprehensive Geriatric Assessment (CGA) and perioperative risk stratification of geriatric patients are needed as an initial prevention strategy as well as an efficient and applicable prognosis predictor model.

Objective: This study aims to determine the incidence of post-operative delirium and develop a prediction model for delirium in elderly patients after major non-cardiac elective surgery based on predictor factors.

Methods: This research is a retrospective cohort study using secondary data from medical records of elderly inpatients who underwent major elective non-cardiac surgery at Cipto Mangunkusumo Hospital between January 2020-March 2023.

Result: Total of 370 subjects that met the criteria were analyzed. The incidence of post-operative delirium was 6.8% ( 95% CI, 4,4% - 9,8%). The predictor factors analyzed were age (HR=3.43; 95%CI 1.544-7.635), cognitive status (HR=2.74; 95%CI 1.156-6.492), and nutritional status (HR=3.35; 95%CI 1.459- 7,679). The postoperative delirium complication prediction model had good calibration (p>0.05) and moderate score performance for predicting the incidence of delirium in geriatric patients [AUC 0.750 (p<0.001; 95%CI 0.640-0.860)].

Conclusion: Age, cognitive status, and nutritional status are strong predictors of postoperative delirium in elderly patients undergoing major non-cardiac elective surgery."

"Persentase penduduk usia lanjut di Indonesia meningkat sekitar dua kali lipat dalam lima dekade terakhir. Pasien usia lanjut yang akan menjalani pembedahan mempunyai risiko mengalami komplikasi pascabedah. Pengkajian Paripurna Pasien Geriatri (P3G) dan klasifikasi ASA dapat digunakan untuk mengevaluasi kesehatan pasien geriatri. Program prehabilitasi yang direkomendasikan oleh berbagai guideline perioperatif untuk memperbaiki kesehatan fisik dan status fungsional preoperatif dapat meningkatkan pemulihan pascabedah dan luaran klinis. Penelitian ini bertujuan untuk mengetahui hubungan komponen P3G, status ASA dan prehabilitasi preoperatif terhadap komplikasi pascabedah 30 hari pasien usia lanjut yang menjalani pembedahan artroplasti panggul dan lutut elektif dan untuk mengembangkan model prediksi komplikasi pascabedah 30 hari berdasarkan faktor prediktor tersebut. Penelitian ini adalah penelitian kohort retrospektif yang menggunakan data sekunder dari rekam medis pasien usia lanjut yang menjalani pembedahan artroplasti panggul dan lutut elektif di RSUPN Dr. Cipto Mangunkusumo periode Januari 2017 – Oktober 2022. Performa pengembangan model prediksi komplikasi pascabedah 30 hari dilakukan dengan menentukan nilai kalibrasi (uji Hosmer-Lemeshow) dan diskriminasi (Area Under the Curve [AUC]). Didapatkan 144 pasien yang telah memenuhi kriteria dan dapat dianalisis. Angka komplikasi pascabedah 30 hari sebesar 29,2%. Faktor yang dianalisis sebagai prediktor komplikasi di antaranya status depresi (HR=5,11; IK95% 2,549-10,244), status frailty (HR=2,44; IK95% 1,329-4,473), komorbiditas (HR=1,53; IK95% 0,786-2,982) serta prehabilitasi preoperatif (HR=1,77; IK95% 0,906-3,459). Model prediksi komplikasi pascabedah 30 hari memiliki kualitas kalibrasi dan diskriminasi yang baik dan cukup kuat [AUC 0,690 (p<0,001; IK 95% 0,586-0,794)]. Status depresi, status frailty, komorbiditas dan prehabilitasi preoperatif berhubungan dengan komplikasi pascabedah 30 hari  pada pasien usia lanjut yang menjalani pembedahan artroplasti panggul dan lutut elektif. Model prediksi komplikasi pascabedah 30 hari memiliki kualitas kalibrasi dan diskriminasi yang baik dan cukup kuat.

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The percentage of the geriatric population in Indonesia has roughly doubled in the last five decades. Elderly patients who will undergo surgery are at risk of experiencing postoperative complications. The Comprehensive Geriatric Assessment (CGA) and ASA Classification can be used to evaluate the health of geriatric patients. Prehabilitation programs that various preoperative guidelines suggest to improve physical health and preoperative functional status may increase the rate of postoperative recovery and clinical outcomes. This study aims at determining the relationship between the CGA components, ASA status, and preoperative prehabilitation on complications within 30 days after the surgery in elderly patients undergoing elective hip and knee arthroplasty, as well as developing a prediction model for 30-day postoperative complications. This research is a retrospective cohort study using secondary data from medical records and interviews with elderly patients who underwent elective hip and knee arthroplasty at Cipto Mangunkusumo Hospital between January 2017 and October 2022. The performance of the 30-day postoperative complication predictor model was measured by determining the calibration (Hosmer-Lemeshow test) and discrimination (Area Under the Curve [AUCC]) value. 144 patients who met the criteria were analyzed. The 30-day postoperative complication rate was 29.9%. The factors analyzed as complication predictors including depression status (HR=5.11; 95%CI 2.549-10.244), frailty status (HR=2.44; 95%CI 1.329-4.473), comorbidity (HR=1.53; 95%CI 0.786-2.982) and preoperative prehabilitation (HR=1.77; 95%CI 0.906-3.459). The 30-day postoperative complication prediction model has good and strong enough calibration and discrimination qualities [AUC 0.690 (p<0.001; 95% CI 0.586-0.794)]. Depressive status, frailty status, comorbidity, and preoperative prehabilitation were significantly associated with 30-day postoperative complications in elderly patients undergoing elective hip and knee arthroplasty surgery. The 30-day postoperative complication prediction model has good and strong enough calibration and discrimination qualities."

"Pasien geriatri rentan mengidap berbagai penyakit (multipatologi) sehingga memungkinkan terjadi polifarmasi. Saat ini, trend penggunaan statin di beberapa negara mengalami peningkatan. Statin digunakan sebagai pencegahan primer dan sekunder penyakit jantung koroner yang prevalensinya terbanyak pada pasien geriatri. Di RSCM belum ada kajian kuantitatif penggunaan statin, sehingga perlu dilakukan kajian penggunaan statin pada pasien geriatri guna mengetahui besar penggunaan statin di RSCM. Studi ini adalah penelitian cross sectional menggunakan kajian defined daily dose (DDD) pada pasien geriatri (>60 tahun) rawat inap di RSCM pada periode Januari-Juni 2015. Hasil yang didapatkan adalah 24 pasien menggunakan statin; 22 pasien (91.6%) menggunakan simvastatin dan 2 pasien (8.4%) menggunakan atorvastatin. Diperoleh hasil DDD total statin 4.12 DDD/100 bed-days, dengan DDD simvastatin dan atorvastatin berrturut-turut 3.68 dan 0.28 DDD/100 bed-days. Profil penggunaan obat statin pada pasien geriatri rawat inap di RSCM tergolong rendah dibandingkan dengan negara lain, seperti India dengan DDD total statin 55.6 DDD/100 bed-days dan 4.32 DDD/100 bed-days

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Geriatric patients are susceptible to multipathologic condition and susceptible to polypharmacy. Nowadays, trend of statin utilization in some countries has been raising. Statin is used for primary and secondary prevention of coronary heart disease, which has the highest prevalence in elderly. There is no quantitative study about statin utilization in RSCM, so a study of statin utilization in geriatric patient in RSCM is needed. This is a cross sectional study evaluating the quantitative use of statin in geriatric patients (>60 years old) admitted in medicine ward of RSCM from January-June 2015 using the defined daily dose (DDD) system. The results shows that 24 patients used statin: 22 patients (91.6%) were prescribed simvastatin and 2 patients (8.4%) were prescribed atorvastatin. The total statin DDD is 4.12 DDD/100 bed-days with the DDD of simvastatin and atorvastatin is 3.68 and 0.28 DDD/100 bed-days, respectively. The statin utilization in hospitalized geriatric patients in RSCM was lower compared to other country, such as India with total satin DDD is 55.6 DDD/100 bed-days and 4.32 DDD/100 bed-days."

"Antiemetik pada pasien geriatri digunakan sebagai terapi untuk mengatasi mual dan muntah yang disebabkan beberapa penyakit, seperti gangguan pencernaan, gangguan keseimbangan, dan kanker. Berdasarkan kriteria Beers, terdapat beberapa antiemetik yang berpotensi tidak tepat pada pasien geriatri sehingga tidak direkomendasikan. Penelitian ini bertujuan untuk mengevaluasi penggunaan antiemetik di unit rawat inap geriatri Rumah Sakit Cipto Mangunkusumo (RSCM) yang diukur menggunakan metode Defined Daily Dose (DDD). Penelitian ini merupakan penelitian retrospektif observational dengan desain cross sectional dan menggunakan sampel pasien geriatri yang mendapatkan terapi antiemetik selama periode Januari-Juni 2015. Hasil penelitian ini menunjukkan bahwa besar penggunaan antiemetik di RSCM adalah 6,08 DDD/100 bed-days, dengan besar penggunaan ondansetron adalah 4,26 DDD/100 bed-days dan besar penggunaan domperidon adalah 1,82 DDD/100 bed-days. Persentase penggunaan antiemetik ondansetron adalah 79,3% dan antiemetik domperidon adalah 20,7%. Rute pemberian antiemetik lebih sering diberikan secara parenteral daripada oral. Penelitian lebih lanjut diperlukan untuk mengevaluasi ketepatan indikasi dan dosis penggunaan antiemetik.

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Antiemetics in geriatric patients is used as a therapy to treat nausea and vomiting caused by diseases such as gastrointestinal disorders, balance disorders, and cancer. Based on the Beers criteria, there are several antiemetics which potentially improper in geriatric patients so it is not recommended. This study aimed to evaluate the use of antiemetics in inpatient geriatric unit of Cipto Mangunkusumo Hospital (RSCM) as measured using Defined Daily Dose (DDD). This study was a retrospective observational study with cross sectional design and the samples were geriatric patients who received antiemetic therapy during the period of January to June 2015. The results of this study showed that the total use of antiemetic in RSCM was 6,08 DDD/100 bed-days, with the use of ondansetron was 4.26 DDD/100 bed-days and the use of domperidone was 1.82 DDD/100 bed-days. The percentage of the use of ondansetron and domperidone was 79.3% and 20.7% respectively. Route of administration of antiemetic through parenteral was more frequent than oral. Further research is needed to evaluate the accuracy of indications and dosage use of antiemetics."

"The risk of cancer increases with age, and the number of older adults seeking treatment is increasing dramatically in line with the aging population. The care of older patients differs from that of younger adults because of differences in the biology of the tumor, age-related differences in host physiology, comorbidity burden and psychosocial issues, which might impact the efficacy and side effects of cancer therapy. Practical Geriatric Oncology is a comprehensive, evidence-based text that synthesizes the growing literature in this field and provides practical guidelines to the care of older adults with cancer. Coverage includes patient assessment, management of solid tumors and hematologic malignancies, the impact of age on the pharmacology of cancer therapy, surgical oncology and radiation oncology in the older adult, symptom management and supportive care. In addition to serving as core reading for oncologists and hematologists, the book will also be a useful work for other healthcare professionals who provide oncology care, including surgeons, radiation oncologists, palliative care doctors, primary care providers, geriatricians and nurses."