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Abstrak :
Latar Belakang. Kemoterapi merupakan salah satu modalitas terapi kanker pada pasien usia lanjut yang dapat menyebabkan risiko berat, terutama pada pasien usia lanjut dengan sindrom frailty. Hingga saat ini belum ada model prediksi kemotoksisitas dengan variabel frailty. Penelitian ini bertujuan mengembangkan model prediksi kemotoksisitas berat pada usia lanjut yang melibatkan penilaian status frailty. Metode. Penelitian kohort retrospektif menggunakan data sekunder terhadap pasien usia lanjut yang menjalani kemoterapi di RSCM tahun 2019-2021. Dilakukan pemeriksaan determinan (jenis kelamin, usia, jenis kanker, jumlah regimen kemoterapi, status nutrisi, status frailty, polifarmasi, fungsi kognitif, status fungsional dan depresi) sebelum kemoterapi. Pasien diikuti hingga 21 hari pasca kemoterapi siklus pertama untuk dinilai apakah mengalami luaran kemotoksisitas berat berdasarkan kriteria CTCAE grade 3-5. Dilakukan analisis untuk pengembangan model prediksi dengan regresi Cox dan perhitungan performa prognostiknya menggunakan perangkat SPSS. Hasil. Dari 193 subyek yang menjalani kemoterapi, sebagian besar laki-laki dengan median usia 65,6 (RIK 60-82). Toksisitas berat terjadi pada 36% subyek. Model prediksi yang dikembangkan terdiri dari 4 determinan yaitu polifarmasi, penggunaan regimen kemoterapi lebih dari satu obat, status frailty dan jenis kanker saluran cerna. Model ini memiliki AUC 0,79 (IK95% 0,70-0,88) dengan p=0,01. Kesimpulan. Model prediksi dengan variabel polifarmasi, regimen kemoterapi lebih dari satu, status frailty dan jenis kanker saluran cerna dapat memprediksi kejadian toksisitas berat kemoterapi pada usia lanjut dengan performa baik ......Background. Chemotherapy is a therapeutic modality for elderly with cancer which can pose elderly, especially frail patients, to fatal side effect. To date, there is no prediction model incorporating frailty in clincal practice. This study aims to develop prediction model which includes frailty state evaluation in predicting severe chemotoxicity in elderly. Methods. A retrospective cohort study using secondary data of elderly underwent chemotherapy during 2019-2021 was conducted in Cipto Mangunkusumo Hospital. Data of determinants ( sex, age, polypharmacy, frailty status, nutritional status, depression, cognitive status, cancer type, polychemotherapy, and functional status) and the incidence severe chemotherapy side effect according to grade 3-5 CTCAE were collected. Data was analyzed to develop prediction model with Cox regression using SPSS Results. Of 193 subjects, most of them are male, with median age of 65.6 (IQR 60-82) years old. Severe chemotoxicity was found in 36% of the subjects. Prediction model consists of polypharmacy, number of chemotherapy drugs, cancer type and frailty status was developed. The model has AUC of 0.79 (95% CI 0.70-0.88), p value 0,01 Conclusion. A prognostic Model consists of polypharmacy, number of chemotherapy drugs, cancer type and frailty status can predict incidence of severe chemotoxicity in elderly with AUC 0.79 (95%CI 0.70-0.88)

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Tujuan. Penelitian ini bertujuan untuk melakukan uji validitas dan reliabilitas pada KCL-ENG versi Bahas Indonesia agar dapat digunakan sebagai alat ukur frailty pada lansia di Indonesia. Metode. Studi ini dilakukan secara potong-lintang pada pasien berusia ≥ 60 tahun yang mampu berkomunikasi dengan bahasa Indonesia. Pasien yang tidak mampu berkomunikasi dieksklusikan. Luaran dari penelitian ini adalah validitas dan reliabilitas alat skrining KCL-ID. Penilaian validitas dilakukan dengan uji t-test, sementara reliabilitas (konsistensi internal) dinilai dengan Cronbach’s alpha. Hasil. Dari 100 lansia dengan rerata usia 67,53±5,57 tahun yang diikutsertakan dalam penelitian ini, dan ditemukan 55 subjek dengan risiko frail berdasarkan KCL-ID. Hasil uji validitas diskriminan pada total item KCL dengan pertanyaan umum yang mengukur derajat kesehatan pada lansia didapatkan hubungan yang signifikan dengan p value = 0,043 (p value < 0,05). Penelitian ini menunjukkan adanya hubungan yang signifikan dari hasil uji validitas diskriminan pada KCL sehingga dapat digunakan sebagai alat ukur untuk menilai status frailty. Nilai Cronbach’s alpha untuk seluruh kuesioner KCL-ID 0,742, yang menandakan bahwa kuesioner ini memiliki reliabilitas yang baik (≥0,60) (acceptable). Simpulan. Alat skrining frailty KCL-ID memiliki validitas diskriminan yang baik, serta memiliki konsistensi internal KCL-ID ditemukan yang baik (reliabel). ......This study aims to test the validity and reliability of the Indonesian version of KCL-ENG so that it can be used as a measure of frailty in the elderly in Indonesia. Method. This study was conducted cross-sectionally on patients aged ≥ 60 years who can communicate Bahasa Indonesia. Patients who were unable to communicate were excluded. The outcome of this study is the validity and reliability of the KCL-ID screening tool. Validity assessment was carried out by t-test, while reliability (internal consistency) was assessed by Cronbach's alpha. Results. Of the 100 elderly people with a mean age of 67.53±5.57 years who were included in this study, 55 subjects were found to be at risk of frail based on KCL-ID. The results of the discriminant validity test on the total KCL items with a general question which can measure health condition in elderly obtained a significant correlation with p value = 0.043 (p value < 0,05). The significant correlation based on the discriminant validity test in this study therefore suggest that Indonesian Version of KCL can be used to assess frailty in the elderly. Cronbach's alpha value for all KCL-ID questionnaires is 0,742, which indicates that this questionnaire has good reliability (≥0,60) (acceptable). Conclusion. The KCL-ID frailty screening tool has good discriminant validity, and the KCL-ID internal consistency is found to be good (reliable).

Abstrak :
Latar belakang: Frailty merupakan sindrom biologis yang dapat menyebabkan kerentanan terhadap hasil yang lebih buruk terhadap pasien. Penilaian frailty saat ini berkembang pada populasi penyakit lainnya antara lain pada populasi pasien sirosis hati. Modalitas yang dikembangkan dan sudah divalidasi untuk menilai frailty pada populasi sirosis hati adalah dengan Liver Frailty Index (LFI). Prevalensi pasien sirosis hati yang mengalami frail ternyata cukup tinggi. Dipikirkan pasien yang mengalami frail akan meningkatkan mortalitas pada pasien sirosis hati. Tujuan: Menilai apakah frailty berdasarkan Liver Frailty Index dapat menjadi prediktor mortalitas pada pasien sirosis hati Metode: Penelusuran literatur dilakukan melalui basis data daring: PubMed/ MEDLINE, EMBASE, ProQuest, dan EBSCOhost dengan menggunakan kata kunci “sirosis hati” dan “liver frailty index” dalam Bahasa Inggris dan Indonesia. Pencarian manual dilakukan melalui portal data nasional, e-library fakultas kedokteran, dan snowballing. Studi yang dimasukkan ke dalam penelitian adalah studi kohort prospektif dan retrospektif yang mengikutsertakan pasien sirosis hati tanpa keganasan hati dan melaporkan mortalitas pasien berdasarkan status frailty. Hasil: Sebanyak 7 artikel diikutsertakan dalam telaah sistematis ini, 3 diantaranya diikutkan dalam meta-analisis untuk menilai hubungan dengan mortalitas dan 2 studi menilai hubungan dengan kejadian dekompensasi. Risiko mortalitas lebih tinggi pada pasien sirosis dengan frailty (HR 1,68; IK 95% 1,36-2,08; p<0,00001). Frailty berhubungan dengan kejadian asites (OR 1,84 IK 95% 1,41-2,40; p<0,00001). Tidak didapatkan adanya hubungan antara frailty dengan kejadian EH pada pasien sirosis hati (OR 1,57 IK 95% 0,65-3,80; p=0,31). Kesimpulan: Frailty merupakan prediktor mortalitas pada pasien sirosis hati. Pasien sirosis hati dengan frailty memiliki risiko kematian lebih besar dibandingkan pasien sirosis hati tanpa frailty. ......Background: Frailty is a biologic syndrome that can lead to susceptibility to poorer outcomes for patients. Frailty assessment is currently developing in other disease populations, including the population of patients with liver cirrhosis. The developed and validated modality to assess frailty in the liver cirrhosis population is the Liver Frailty Index (LFI). The prevalence of liver cirrhosis patients who experience frail is quite high. It is thought that patients who experience frail will increase mortality in patients with liver cirrhosis. Objective: Assessing whether frailty based on the Liver Frailty Index can be a predictor of mortality in patients with liver cirrhosis. Methods: Literature search was conducted through online databases: PubMed/MEDLINE, EMBASE, ProQuest, and EBSCOhost using the keywords “cirrhosis of the liver” and “liver frailty index” in English and Indonesian. Manual searches were carried out through national data portals, medical faculty e-libraries, and snowballing. The studies included in the study were prospective and retrospective cohort studies that included patients with liver cirrhosis without liver malignancy and reported patient mortality based on frailty status. Results: A total of 7 articles were included in this systematic review, 3 of which were included in a meta-analysis to assess the association with mortality and 2 studies assessed the association with the incidence of decompensation. There was a higher risk of mortality in cirrhotic patients with frailty (HR 1.68; 95% CI 1.36-2.08; p<0.00001). Frailty was found to be associated with the incidence of ascites (OR 1.84 95% CI 1.41-2.40; p<0.00001). There was no association between frailty and the incidence of HE in patients with liver cirrhosis (OR 1.57 95% CI 0.65-3.80; p=0.31). Conclusion: Frailty is a predictor of mortality in patients with liver cirrhosis. Liver cirrhosis patients with frailty have a greater risk of death than patients with liver cirrhosis without frailty.

Abstrak :
ABSTRAK
Latar belakang. Sampai saat ini belum ada instrumen yang teruji yang dapat digunakan untuk menilai status kerentaan usia lanjut di komunitas di Indonesia.Tujuan. Mengetahui kesahihan dan keandalan sistem skor The Study of Osteoporotic Fracture SOF berbahasa Indonesia untuk digunakan oleh kader posbindu dalam menilai status kerentaan pada usia lanjut. Metode. Penelitian terdiri dari dua tahap : 1 . adaptasi bahasa dan budaya; dan 2 . uji kesahihan dan keandalan. Penelitian ini berlangsung di posbindu lansia di Kelurahan Pisangan Timur, Jakarta Timur, dengan melibatkan 8 kader dan 85 responden berusia ge; 60 tahun. Sebagai uji referensi digunakan skor The Cardiovascular Health Study CHS untuk menilai kesahihan eksternal. Keandalan dinilai dengan mencari intraclass coeffisient correlation ICC pada uji ulang dan konsistensi internal dengan menghitung nilai Cronbach-?. Hasil. Skor total SOF memiliki korelasi positif kuat yang bermakna dengan butir penilaian terkait status nutrisi r = 0,815, p

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ABSTRACT<>br> Background There is no proven instrument that can be used to assess frailty among the elderly in community in Indonesia. Objective to construct and validate Indonesian version of SOF used by posbindu cadres. Methods This research was consisting of two stages 1 . Culture and language adaptation 2 . validity and reliability test, conducted in posbindu in Kelurahan Pisangan Timur, by involving 8 cadres and 85 respondents 60 years or older. We used the Cardiovascular Health Study CHS frailty index as a reference test to assess the external validity. Reliability was tested by internal consistency and the test retest reliability at a 2 week interval. Results The total score of SOF score had a strong positive correlation with the nutritional status r 0.815, p

Abstrak :
ABSTRACT
BACKGROUND: Alphacalcidol, a vitamin D analog, shows immune regulatory potency as it works on the macrophage and T cell to control inflammation and T cell dysregulation in elderly. None has been known about its effect on elderly with various states of frailty syndrome, which have different level of chronic low grade inflammation. This study aimed to determine the effect of alphacalcidol on inflammatory cytokines (IL-6, IL-10, g-IFN ) and T cell subsets (CD4/CD8 ratio and CD8+ CD28-) of elderly with various stages of frailty syndrome. METHODS: from January to July 2017, a double blind randomized controlled trial (RCT) with allocation concealment, involving 110 elderly subjects from Geriatric Outpatient Clinic Cipto Mangunkusumo Hospital Jakarta, was conducted to measure the effect of 0.5 mcg alphacalcidol administration for 90 days to inflammatory cytokines (IL-6, IL-10, g-IFN) from PBMC culture supernatant, as well as CD4/CD8 and CD8+CD28- percentage using flow cytometry. Statistical analysis using SPSS version 20 was performed with t-test to measure mean difference. RESULTS: of 110 subjects involved in the RCT consisting of 27 fit, 27 pre-frail and 56 frail elderly, 25(OH)D serum level was found to be as low as 25.59 (12.2) ng/ml in alphacalcidol group and 28.27 (10.4) ng/ml in placebo group. Alphacalcidol did not decrease IL-6 (p=0.4) and g- IFN (p=0.001), but it increased IL-10 (p=0,005) and decreased IL6/IL10 ratio (p=0.008). Alphacalcidol increased CD4/CD8 ratio from 2.68 (SD 2.45) to 3.2 (SD 2.9); p=0.001 and decreased CD8+ CD28- percentage from 5.1 (SD 3.96) to 2.5 (1.5); p<0.001. Sub group analysis showed similar patterns in all frailty states. CONCLUSION: Alphacalcidol improves immune senescence by acting as anti-inflammatory agent through increased IL-10 and decreased IL6/IL-10 ratio and also improves cellular immunity through increased CD4/CD8 ratio and decreased CD8+ CD28- subset in elderly. This effect is not influenced by frailty state.

Abstrak :
Latar Belakang. Komplikasi pascabedah elektif meningkat sejalan dengan peningkatan usia. Status frailty pada pasien usia lanjut dikaitkan dengan peningkatan kejadian komplikasi pascabedah. Pengaruh status frailty terhadap komplikasi 30 hari pascabedah perlu diteliti lebih lanjut pada pasien usia lanjut di Indonesia. Tujuan. Mengetahui pengaruh status  frailty terhadap komplikasi 30 hari pascabedah elektif pada pasien usia lanjut. Metode. Studi dengan desain kohort prospektif untuk meneliti pengaruh status frailty terhadap kejadian komplikasi 30 hari pascabedah elektif pada pasien usia lanjut, dengan menggunakan pengambilan data pada pasien yang menjalani pembedahan elektif di RS Cipto Mangunkusumo pada tanggal 20 April sampai dengan 13 Juli 2018. Penilaian frailty dengan menggunakan FI 40 items. Analisis bivariat dan multivariat dengan logistik regresi dilakukan untuk menghitung crude risk ratio (RR) dan adjusted RR terjadinya komplikasi 30 hari pascabedah elektif antara kelompok frail terhadap kelompok fit, dan antara kelompok pre-frail terhadap kelompok fit dengan menggunakan SPSS. Hasil. Sebanyak 21,1% dari total 180 subjek pasien usia lanjut yang menjalani pembedahan elektif mengalami komplikasi 30 hari pascabedah. Proporsi kejadian komplikasi 30 hari pada kelompok frail lebih tinggi dibandingkan dengan kelompok pre-frail dan fit (41,7% vs 15% vs 9,4%). Pada analisis multivariat, didapatkan adjusted RR pada kelompok frail sebesar 4,579 (IK 95% 1,799-8,118), setelah memperhitungkan faktor perancu, yakni jenis pembedahan. Pada kelompok pre-frail, tidak ditemukan komplikasi yang berbeda bermakna walaupun terdapat kecenderungan komplikasi lebih tinggi dibandingkan kelompok fit. Kesimpulan. Kondisi frail meningkatkan risiko komplikasi 30 hari pascabedah elektif pada pasien usia lanjut. Sedangkan pre-frail dibandingkan fit walaupun tidak menunjukkan perbedaan yang signifikan, namun terdapat kecenderungan peningkatan komplikasi.

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Background. Postoperative complication is increased in the elderly patients. Frailty in the elderly is associated with postoperative complication. The impact of frailty on 30- day complications after elevtive surgery needs to be evaluated in the elderly patients in Indonesia. Objectives. To identify the impact of frailty on 30-day complications after elective surgery in the elderly patients. Methods. A prospective cohort study was conducted to determine the impact of frailty on 30-day complications after elective surgery in the elderly patient in Cipto Mangunkusumo hospital from 20 April to 13 Juli 2018. Frailty was asessed using Frailty Index  40 items. Analysis was done using SPSS statistic for univariate, bivariate and multivariate logistic regression to obtain crude risk ratio and adjusted risk ratio of probability of 30-day complications after elective surgery in the elderly patients. Result. Out of the total 180 eldery patients who underwent elective surgery, 21,1% of those had 30-day complications. Postoperative complications were higher in those with frail than pre-frail and fit subjects(41,7% vs 15% vs 9,4%). Multivariate analysis using logistic regression analysis with type of surgery as counfounder, revelead that adjusted RR in frail group was 4.579 (95% CI 1.799-8.118). Although pre-frail subjects showed higher postoperative complications than fit subjects, but there were no differences significantly. Conclusion. Elderly patients with frail condition had higher 30-day complications after elective surgery. There were no significant differences between pre-frail compared to fit subject on 30-day complications after elective surgery, although pre-frail subject tends to showed higher complication.

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Latar belakang: Penyakit paru obstruktif kronis (PPOK) merupakan penyakit paru yang menyebabkan 60% kematian di Indonesia. Terjadi peningkatan prevalensi frailty pada pasien PPOK hingga dua kali lipat dibandingkan pada pasien tanpa PPOK. Frailty merupakan sindrom lansia terkait perubahan fisiologis dan morfologis pada berbagai sistem tubuh akibat penuaan. Pada PPOK terjadi inflamasi sistemik yang ditandai dengan penanda inflamatori. Rasio neutrofil-limfosit (RNL) merupakan penanda inflamatori yang cukup stabil, terjangkau, dan banyak digunakan. Penelitian ini bertujuan untuk menentukan hubungan RNL dengan frailty pada pasien lansia dengan PPOK. Metode: Penelitian ini merupakan studi potong lintang. Penilaian frailty dilakukan berdasarkan kuesioner FRAIL dan hitung jenis darah perifer melalui data rekam medis RSCM dari bulan Oktober 2021–Oktober 2022. Hasil: Terdapat 103 subjek dengan prevalensi yang mengalami frail sebanyak 63 orang (61,2%). Pada analisis bivariat, didapatkan hasil bahwa RNL memiliki hubungan yang signifikan dengan frailty (p = 0,017). Median RNL pada kelompok frail sebesar 2,30 (1,27 – 7,03) dan kelompok non-frail sebesar 2,01 (0,72 – 4,56). Pada analisis kelompok kuartil, didapatkan hasil yang signifikan antara RNL dengan frailty (p = 0,009). Sebanyak 33,3% pasien frail berada pada kuartil keempat (> 3,060) dan sebanyak 42,2% pasien non-frail berada pada kuartil kesatu (<1,870). Kesimpulan: Terdapat hubungan yang signifikan antara RNL dengan frailty pada pasien lansia dengan PPOK. ......Introduction: Chronic obstructive pulmonary disease (COPD) is a lung disease that causes 60% of deaths in Indonesia. There was an increase in the prevalence of frailty in COPD patients up to two times compared to patients without COPD. Frailty is an elderly syndrome related to physiological and morphological changes in various body systems due to aging. In COPD, there is systemic inflammation characterized by inflammatory markers. Neutrophil to Lymphocyte ratio (NLR) is an inflammatory marker that is relatively stable, affordable, and widely used. This study aims to determine the relationship between NLR and frailty in elderly patients with COPD. Method: This cross-sectional study was conducted on elderly patients with COPD. Subjects performed frailty assessment based on the FRAIL questionnaire and peripheral blood type count through RSCM’s patient medical record from October 2021 – October 2022. Result: There were 103 subjects with a prevalence of frailty in 63 patients (61.2%). In bivariate analysis, results found that RNL had a significant relationship with frailty (p = 0.017). The median RNL in the frail group was 2.30 (1.27 – 7.03), and the non-frail group was 2.01 (0.72 – 4.56). In the quartile group analysis, RNL and frailty obtained significant results (p = 0.009). A total of 33.3% of frail patients were in the 4th quartile (> 3.060), and 42.2% of non-frail patients were in the 1st quartile (<1.870). Conclusion: There is a significant relationship between NLR and frailty in elderly patients with COPD.

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Latar Belakang. Semakin meningkatnya rerata usia harapan hidup penduduk Indonesia akan menyebabkan populasi orang usia lanjut yang frail meningkat. Sindrom frailty merupakan prediktor semua penyebab kematian pada orang usia lanjut di panti wreda. Selain itu, faktor yang berhubungan terhadap frailty antara orang usia lanjut di panti wreda dengan di komunitas juga berbeda. Sampai saat ini, belum ada penelitian mengenai faktor ini pada orang usia lanjut di panti wreda di Indonesia. Tujuan. Mengetahui faktor-faktor yang berhubungan terhadap sindrom frailty pada orang lanjut usia di panti wreda Metode. Studi ini menggunakan metode potong lintang. Menggunakan data sekunder dari penelitian besar mengenai performa fisik dan status nutrisi orang usia lanjut di panti wreda di provinsi Banten. Penelitian tersebut dilakukan di 5 panti wreda di Tangerang. Variabel independen terdiri dari usia, tingkat aktivitas fisik, status kognitif, status nutrisi, gejala depresi, komorbiditas, dan kualitas hidup terkait kesehatan. Sistem skor frailty berdasarkan CHS untuk menentukan fit, pre-frail dan frail. Hubungan variabel independen dengan frailty dianalisis secara bivariat menggunakan uji Chi-Square dan secara multivariat menggunakan regresi logistik. Hasil. Didapatkan 105 subjek dengan rerata usia 74,88 (SB 7,61) tahun, median skor PASE 170 kkal/minggu, kekuatan genggam tangan 16 kg, indeks EQ-5D 76, EQ-5D VAS 70, dan rerata kecepatan berjalan 0,66 (SB 0,34) m/s. Proporsi subjek yang tergolong fit/ robust 1%, pre-frail 52,4% dan frail 46,7%. Faktor-faktor yang berhubungan dengan sindrom frailty adalah malnutrisi OR 4,81 (IK 95% 1,93 – 12,00) dan kualitas hidup OR 4,79 (IK 95% 1,92 – 11,98). Kesimpulan. Proporsi kelompok orang usia lanjut di panti wreda, yang tergolong fit/ robust 1%, pre-frail 52,4% dan frail 46,7%. Faktor-faktor yang berhubungan dengan sindrom frailty adalah malnutrisi dan kualitas hidup terkait kesehatan.

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Background. Along with the increasing average life expectancy of the Indonesian population, the elderly population who are frail will increase too. Frailty syndrome is a predictor of the all caused mortality in the elderly in nursing homes. In addition, there are also differences in factors related to frailty between the elderly in nursing homes and the elderly in the community. Until now, there has been no research on the factors associated with frailty syndrome in the elderly in nursing homes in Indonesia. Objective. Knowing the factors associated with frailty syndrome in the elderly in nursing homes. Methods. This study uses a cross-sectional method. Using secondary data from large studies of the physical performance and nutritional status of the elderly in nursing homes in Banten province. The study was conducted at 5 nursing homes in Tangerang. Independent variables consist of age, physical activity level, cognitive status, nutritional status, depressive symptoms, comorbidities, and health-related quality of life. The frailty score system is based on the CHS to determine fit, pre-frail and frail. The relationship between independent variables with frailty was analyzed bivariately using the Chi-Square test and multivariately using logistic regression. Results. There were 105 subjects with a mean age of 74.88 (SD 7.61) years, median score of PASE 170 kcal/week, handgrip strength 16 kg, EQ-5D 76, EQ-5D VAS 70, and average walking speed 0,66 (SD 0,34) m/s. Proportion of subjects classified as fit/ robust 1%, pre-frail 52.4 % and 46.7% frail. Factors associated with frailty syndrome are malnutrition OR 4.81 (95% CI 1.93 - 12,00) and health-related quality of life OR 4.79 (95% CI 1,92 - 11,98). Conclusion. Proportion of elderly groups in nursing homes, which are classified as fit/robust 1%, pre-frail 52.4% and frail 46.7%. Factors associated with frailty syndrome are malnutrition and health-related quality of life.

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Latar Belakang: Meningkatnya populasi geriatri membuat sindrom frailty akan banyak ditemui di praktik klinik sehari-hari. Fenotip frailty dikaitkan dengan rendahnya massa otot secara teori, namun masih terdapat perbedaan hasil di antara penelitian yang ada. Tujuan: Mengetahui rerata indeks massa otot pada populasi geriatri di rawat jalan dan hubungannya dengan status frailty. Metode: Penelitian menggunakan desain potong lintang terhadap pasien berusia ≥60 tahun di poliklinik Geriatri Rumah Sakit Cipto Mangunkusumo, periode waktu April-Juni 2018. Dilakukan pengambilan data antropometri, pengisian kuesioner Cardiovascular Health Study (CHS) dan pengukuran indeks massa otot dengan dual energy X-ray absoprtiometry (DXA). Parameter indeks massa otot diukur berdasarkan appendicular lean mass (ALM) yang disesuaikan dengan tinggi badan (ALM/TB2) dan indeks massa tubuh (ALM/IMT). Hasil: Didapatkan proporsi subjek frail, pre-frail dan robust berdasarkan skor CHS berturut-turut adalah 29,17%, 58,33% dan 12,5%. Terdapat perbedaan rerata indeks massa otot dengan parameter ALM/TB2 antara pasien yang frail dan yang tidak (6,54 (1,01) Kg/m2 vs 7,03 (0,91) Kg/m2; p=0,01), namun tidak halnya dengan ALM/IMT (p=0,72). Tidak terdapat hubungan yang bermakna baik antara kejadian sindrom frailty dengan indeks massa otot ALM/TB2 (PR 2,03; 95% IK 0,80-5,15; p=0,13) maupun ALM/IMT (PR 5,09; 95% IK 0,45-58,06; p=0,2). Dari analisis multivariat faktor perancu didapatkan hubungan bermakna antara nutrisi (PR 3,67; 95% IK 1,59-8,49; p=0,02) dan status fungsional (PR 4,94; 95% IK 2,01-11,75; p=0,00) dengan kejadian sindrom frailty. Simpulan: Indeks massa otot yang rendah saja tidak dapat dijadikan faktor prediktif terjadinya sindrom frailty, melainkan perlu digabungkan dengan parameter lain seperti kualitas atau fungsi otot, status fungsional dan nutrisi. Penggunaan indeks massa otot dengan parameter ALM/TB2 lebih disarankan.

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Background: Population ageing worldwide is rapidly accelerating along with development of frailty syndrome. A theoretical link between frailty and low lean mass has been established, and low lean mass as frailty predictor, but studies conducted show inconclusive result. Objectives: To obtain appendicular lean mass values among geriatric outpatients and its association with frailty status. Methods. Cross-sectional study conducted to elderly patients (≥60 years old) in the Geriatric Outpatient Clinic of Cipto Mangunkusumo National Referral Hospital in April-June 2018. Each subject underwent anthropometric measurement, frailty evaluation using Cardiovascular Health Study (CHS) questionnaire dan lean mass measurement using dual energy X-ray absoprtiometry (DXA). Appendicular lean mass (ALM) measured was adjusted by height squared (ALM/ht2) and BMI (ALM/BMI) Results: The proportion of frail, pre-frail and robust according to CHS were 29,17%, 58,33% and 12,5% respectively. We found significant difference in ALM/ht2 between frail dan non-frail subjects (6.54 (1.01) Kg/m2 vs. 7.03 (0,91) Kg/m2; p=0.01) but nonsignificant result for ALM/BMI (p=0.72). No association was found between frailty and muscle mass index of ALM/ht2 (PR 2.03; 95%CI 0.80-5.15; p=0.13) or ALM/BMI (PR 5.09; 95% CI 0.45-58.06; p=0.2). From multivariate analysis, there was significant association between nutritional status (PR 3,67; 95% CI 1,59-8,49; p=0,02), functional status (PR 4,94; 95% CI 2,01-11,75; p=0,00) and frailty. Conclusion: Low lean mass alone cannot be used as predictive factor for frailty syndrome, further analysis using another parameter such muscle's quality or function, nutritional status and functional status are needed. This study supports ALM/ht2 as chosen muscle index.

Abstrak :
Latar belakang: Diabetes tipe 2 ditandai dengan resistensi dan defisiensi insulin, selain itu seiring dengan penuaan kejadian resistensi insulin juga semakin meningkat. Pada studi-studi klinis, resistensi insulin dan diabetes tipe 2 terbukti meningkatkan kejadian sindrom frailty pada usila. Obat antidiabetik oral metformin telah dikaitkan dengan penghambatan proses penuaan. Namun demikian, sampai saat ini belum ada data yang menunjukkan manfaat terapi metformin terhadap kejadian sindrom frailty. Penelitian ini bertujuan untuk melihat apakah ada efek protektif metformin terhadap sindrom frailty. Metodologi: Studi ini dilakukan secara kasus kontrol pada subyek berusia ≥60 tahun yang berobat di poliklinik Geriatri dan Diabetes FKUI-RSCM, bulan Maret-Juni 2013. Diagnosis frailty dilakukan dengan menggunakan indeks frailty-40 item (FI-40). Analisis statistik dilakukan dengan metode chi-square untuk analisis bivariat dan regresi logistik untuk analisis multivariat, semua data disertai dengan interval kepercayaan 95%. Hasil: Sindrom frailty didapatkan pada 25% (n=59) subyek penelitian, sedangkan pre-frail pada 72% (n=170) subyek dan sisanya fit. Metformin ditemukan mempunyai hubungan dengan sindrom frailty pada usila dengan diabetes mellitus tipe 2, yang tetap bermakna setelah dilakukan analisis multivariat (adjusted OR 0,043; IK 95% 0,019 – 0,099; p<0,001). ...... Background: Type 2 diabetes (T2DM) was characterised with insulin resistance and deficiency, furthermore with advancing age the was also an increase in insulin resistance. Clinical studies has proven that insulin resistance and T2DM increase the incidence of frailty syndrome in the elderly. Oral antidiabetics metformin was associated with the inhibition of aging process. Eventhough, there was no data that showed the relationship of metformin therapy to frailty syndrome. This study aimed to explore the possibility of metformin protective effect on frailty syndrome. Methodology: This was a case control study conducted in subjects ≥60 years old who visited the Geriatrics and Diabetes outpatient clinic of Cipto Mangunkusumo National Referral Hospital between March and June 2013. Diagnosis of frailty was established using the FI-40 item criteria. Statistical analysis was done with chi-square method for bivariate and logistic regression method in multivariate analysis, all data was accompanied with 95% confidence interval. Results: Frailty syndrome was found in 25% of subjects (n=59), with median age of 72 years old (SD 6.27) and median of FI-40 item score was 0.18 (SD 0.085). Metformin was found to have a significant relationship with frailty syndrome in the elderly diabetics, which retained significant value after multivariate analysis (adjusted OR 0.043; 95% CI 0.019-0.099; p<0.001). Conclusion: Metformin was shown to have protective effect against frailty syndrome in elderly diabetics.