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"Latar Belakang : lnstabilitas postural I jatuh adalah ketidakmampuan untuk mempertahankan pusat kekuatan anti gravitasi pada dasar penyanggah tubuh (misalnya, kaki saat berdiri), atau memberi respon secara cepat pada setiap perpindahan posisi atan keadaan staffs. Prevalensi instabilitas postural di AS 30% dari penduduk usia lebih 60 tahun pernah jatuh, di RSCM tahun 2003 sebesar 23,3%. Faktor risiko yang melatar belakangi terjadinya jatuh adalah faktor ekstrinsik an faktor intrinsik. Faktor intrinsik terbagi dua sistemik (pneumonia, hipatensi ortostatik, hiponatremi, gagal jantung, infeksi saluran kemih) dan lokal (OA servikal, OA gem, Benign paroxiysmalpositional vertigo (BPPV), gangguan penglihatan, gangguan pendengaran, kelemahan otot tungkai bawah). Jatuh memiliki penyulit yang cukup serius, mulai dari cedera ringan sampai fraktur femur. Dengan mengetahui faktor risiko jatuh sedini mungkin, maka kita dapat mencegah terjadinya jatuh dan penyulitnya.Tujuan : mengetahui sebaran faktor intrinsik lokal serta hubungannya dengan instabilitas postural I jatuh.Metodologi : Studi potong lintang dengan basal-sampel 97 orang usia Lanjut yang memenuhi kriteria inklusi. Waktu : Januari-Juni 2005 di Divisi Geriatri RSCM. Tingkat instabilitas diukur dengan posturografri.Hasil : Dari penelitian ini didapat hasil prevalensi instabilitas postural sebesar 64.9%. Prevalensi perempuan 52,3% dan laki-laki 47,7%. Menurut kelompok umur prevalensi tertinggi pada umur > 80 taken sebesar 75,0%. Pada analisa bivariat osteoariritis servikal merupakan faktor intrinsik lokal yang mempunyai hubungan bermakna terhadap kejadian instabilitas postural dengan OR 3,28 (1K 95% 1,25-8,63) p= 0,02 dan pada analisa multivariat dengan inetode backward regresi logistitik didapatkan nilai OR 3,22 (1K 95% 1,18-89,74) p = 0,02. Gangguan pendengaran merupalcan faktor intrinsik lokal yang mernpunyai hubungan bermalma terhadap instabilitas postural pada analisa bivariat dengan nilai OR : 3,95 (1,29-12,11) p= 0,02 dan pads analisa multivariat dengan ailai OR 3,22 (1,18-89,74) pr= 0,02. Osteoartritis genii, BPPV, gangguan penglffiatan dan kelemaban otot tungkai bawah hell m dapat dibuktilcan mempunyai hubungan bermakna dengan instabilitas postural pada penelitian ini.Simpulan : Prevalensi instabilitas postural pada penelitian ini sebesar 64,9%. Ganggaan pendengaran dan OA servikal menrpakan faktor instrinsik lokal yang mempunyai hubungan yang bermakna terhadap instabilitas postural. OA genii, BPPV, gangguan penglihatan dan kelemahan otot tungkai bawah belum dapat dibuktikan mempunyai hubungan bermakna dengan instabilitas postural pada penelitian ini.

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Backgrounds : Instability/falls is inability to maintain central anti gravity strength of supporting structures of the body (e.g. feet while standing) or to give adequate response to positional changes or static condition Prevalence of postural instability in US reached > 30% in population aged > 60 years old A Study conducted in RSCM by Handayani (2003) found the prevalence as high as 23.3%. -Risk factors that responsible for falls are intrinsic and extrinsic factors. Intrinsic factors consist of systemic (pneumonia, orthostatic hypotension, hyponatresmia, heart failure, urinary tract infection) and local factors (cervical OA, knee OA, BPPV, visual impairment, hearing impairment, lower lambs weakness). Falls may have mild complication like mild trauma to serious complications such as femoral fracture. By identifying risk factors of instability/falls earlier, we may prevent falls and its complications.

Objective = to determine intrinsic local factors and its relationship with instability/falls.

Methods : Cross sectional study on 97 elderly patients who fullfled inclusion criteria was conducted in RSCM from January to June 2005 in outpatient clinic, Geriatric Division FKUI 1 RSCM.

Results : From this study we found the prevalence of instability was 64.9%. The prevalence in female (52.3%) was higher than male (47.7%) patience According to age group, the highest prevalence was found in age group of > 80 years (75%). After bivariat analysis, we found cervical OA was intrinsic local factor which bad significant relation with incidence of postural instability with OR 3.28 (CI 95% 1.25-8.63); Bivariat and multivariate analysis of logistic regression using backward method we found OR 3.22 (Cl 95% 1.18-89.74); p= 0.02. Hearing impairment was local intrinsic factor that had significant relation with postural instability after bivariat analysis with OR 3.95 (Cl 95% 1.29-12_ l 1); p= 0.02 and multivariate analysis with OR. 3.22 (Cl 95% 1.18$9.74); p= 0.02. BPPV, knee OA, visual impairment and lower limb weakness had not been proven yet to have significant relation with postural instability in this study.

Conclusion : Prevalence of instability in thus study is 64.9%. Hearing impairment and cervical OA were intrinsic local factors that showed statistically significant relation with postural instability. Knee OA, BPPV, visual impairment, and lower limb weakness had not been proven to have significant relation with instability in this study."

"Latar Belakang. Sindrom delirium memberikan dampak yang sangat besar yaitu dengan mengakibatkan bertambahnya lama perawatan, timbulnya komplikasi dan angka ketergantungan serta kematian yang tinggi. Beberapa penelitian di luar negeri mengenai faktor prognosis berupa retrospektif dan prospektif telah dilakukan dengan hasil yang bervariasi.Tujuan. Mengetahui hubungan antara risiko kematian pada penderita sindrom delirium pada geriatri dengan pneumonia, skor APACHE II tinggi, klasifikasi ADL ketergantungan total, hipoalbuminemia dan anemia.Metodologi. Desain penelitian prospektif kohort dari bulan Desember 2004 sampai dengan agustus 2005 di ruang rawat inap penyakit dalam RSUPNCM Jakarta. Subyek pada pasien usia >60 tahun yang memenuhi kriteria inklusi. Sindrom delirium dinilai dari anamnesis dengan menggunakan Confusion Assessment Method (CAM).Hasil. Didapatkan dari 96 sampel, 49 orang pria (51%) dan 47 orang wanita (49%), 38 meninggal di rumah sakit. Kisaran umur antara 60 hingga 89 tahun dengan rerata 70,50 tahun. Angka kematian sindrom delirium di rumah sakit adalah 39,60%, dengan variabel bebas pneumonia angka kematian 68,40%, klasifikasi ADL ketergantungan total 34,30%, hipoalbumin 65,80% dan anemia 76,30%. Berdasarkan analisis bivariat didapatkan antara pneumonia dengan risiko kematian RR 1,32 (IK 95% 0,51-3,45)p= 0,67, rerata skor APACHE II tinggi dengan risiko kematian 20,2 +SB 5, p= 0,001, ldasifikasi ADL ketergantungan total dengan risiko kematian RR 8,23 (IK 95% L60-47,88) p= 0,001, hipoalbuminemia < 2,50 g/dL dengan risiko kematian RR 2,71 (1K 95% 1,32-8,79) p= 0,001 dan anemia dengan risiko kematian RR 3,22 (1K 95% 1;19-8,87) p= 0,01. Berdasarkan regresi logistik didapatkan skor APACHE II dengan titik potong ? 16, anemia dan tingkat ketergantungan total yang berhubungan dengan risiko kematian pada sindrom delirium dengan RR masingmasing adalah 30,80 (IK 95% 7,79-122,12) p= 0.001, 4,80 (IK 95% 1,25-18,36) p-0.02 dan 1,59 (IK 95% 1,05-2,40)p= 0,03.Simpulan. Skor APACHE II > 16, anemia dan ADL ketergantungan total merupakan faktor prognosis kematian yang paling berperan pada pasien sindrom delirium pada geriatri.

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Backgrounds. Delirium syndrome can give very big impact such as prolonged hospitalization, complication, high number of dependence and increasing the mortality rate. Some researches on prognostic factors of delirium syndrome in the form of retrospective and prospective studies have been done with vary result.

Objectives. Knowing death risk relation between delirium syndrome patient with 'pneumonia, high score of APACHE II, ADL total dependence classification, hypo albumin and anemia.

Methods. Design of the research is prospective cohort study at the patient with delirium syndrome from December 2004 up to August 2005 which hospitalized in RSUPNCM Jakarta Subject of age patient > 60 years fulfilling criterion inclusion. Delirium syndrome is assessed from anamnesis by using Confusion Assessment Method (CAM).

Main Results. From 96 sample, 49 men (51%) and 47 women (49%), 38 are death in hospital. The age range is from 60 to 89 years of age, with mean 70.50 years. The mortality rate of syndrome delirium in hospital is 39.60%, with independent variable of pneumonia is got prevalence of death 68.40%, ADL total dependence classification 34.30%, hypo albumin 65.80% and anemia 76.30%. Based on bivariate analysis got result between pneumonia with risk of death RR 1.32 (Cl 95% 0.51-3.45) p= 0.67, between mean high score of APACHE II with risk of death 20.20 ± SD 5, p= 0.001, ADL total dependence classification with risk of death RR 8.23 (CI 95% 1.60-47.88) p= 0.001, between hypoalbumin < 2.50 gldL with risk of death RR 2.71 (CI 95% 1.32-8.79) p= 0.001, and between anemia with risk of death RR 3.22 (Cl 95% 1.19-8.87) p= 0.01. By logistics regression got score of APACHE II with cut of point 16, anemia and ADL total dependence classification which deal with death risk at delirium syndrome with RR each is 30,8 (CI 95% 7.79-122.12)p- 0.001, 4.08 (CI 95% 1.25-1836) p= 0.02 and 1.59 (CI 95% 1.05-2.40)p= 0.03.

Conclusions. APACHE II scores X16, anemia and the ADL total dependence classification represent factor of most prognosis death share at geriatric patient with delirium syndrome."

"Latar Belakang. Status fungsional merupakan komponen esensial pengkajian paripuma pasien geriatri. Sesungguhnya pada usia lanjut bukan hanya usia harapan hidup yang penting, tetapi bagaimana usia lanjut dapat menjalani sisa kehidupannya dengan baik dan optimal. Untuk itu usia lanjut harus bisa melakukan ADL secara mandiri. Untuk menilai ADL dasar diperlukan alat ukur yang andal, sahih dan Iuas dipakai. Indeks ADL Barthel merupakan alat ukur yang banyak dipakai. Suatu alat ukur yang baik untuk dapat dipalcai luas hares melalui uji keandalan dan kesahihan. Di Indonesia Indeks ADL Barthel belum pernah diuji keandalan dan kesahihannya.Tujuan. Membuktikan bahwa kuesioner Indeks ADL Barthel merupakan intrumen ukur yang andal dan sahih untuk menilai status fungsional dasar usia lanjut Indonesia.Metodologi. Dirancang suatu studi validasi. Prosedur yang dilakukan adalah pada hari pertama kunjungan semua pasien dilakukan anamnesis, pemeriksaan fisik, pengisian formulir kuesioner indeks ADL Barthel dan indeks ADL Katz serta pada hari 7 --14 kunjungan dilakukan pengisian ulangan formulir kuesioner ADL Barthel.Hasil. Telah dilakukan pengambilan data dari 100 responden, nilai ICC ADL Barthel tiap-tiap butir, dan nilai total ADL Barthel didapatkan sangat baik (> 0,75), kecuali untuk butir mengendalikan rangsang buang air besar dengan ICC 0,645 hasilnya baik (0,4 -- 0,75). Keandalan internal consistency penelitian ini diperoleh nilai Cronbach a 0,938. Uji kesahihan eksternal ADL Barthel dibandingkan ADL Katz dianalisis dengan uji Spearman correlation coefficient menunjukkan hubungan bermakna (pc0,01), yaitu antara butir dan nilai total ADL Barthel dengan butir dan nilai total ADL Katz. Hanya hubungan butir mengendalikan rangsang buang air km-II ADL Barthel dengan butir makan ADL Katz yang bermalma dengan (p<0,05). Kesahihan konstruksi ADL Barthel diuji dengan Spearman correlation coefficient dan melihat nilai rho (r) masing masing butir. Hasil yang didapatkan semua butir berhubungan bermakna dengan nilai total (p<0,001). Semua butir mempunyai nilai r > 0,3.Simpulan. Kuesioner ADL Barthel merupakan instrumen ukur yang andal dan sahih serta dapat digunakan untuk mengukur status fungsional dasar usia lanjut Indonesia.

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Background. Status functional is essential component of comprehensive geriatric assessment. Actually in addition to longevity, the important thing for elderly is to live the rest of their life as good and as optimal as possible. To live their life as good and as optimal as possible, the elderly should do the basic ADL independently. To measure basic ADL performance of elderly, measurement tool which is valid, reliable and commonly used is needed. Barthel index is the measurement tool which commonly used. For a good instrument to become commonly used, it should be tested for reliability and validity. In Indonesia Barthel index hasn't been tested for reliability and validity.Objectives. To verify that Barthel index form is an accurate tool to measure basic functional status in elderly population Indonesia.Methods. A validation study was arranged. On the first day of visit, all patients were subjected to anamnesis and physical examination. Barthel index form and Katz index form were filled on the first visit, which were repeated on day 7 through day 14 of visits.Results. There were 100 respondents in this study. Intra class correlation coefficient (ICC) Barthel index for each dimension, total score Barthel index were found to be excellent (>0.75) with the exception of controlling bowels with ICC 0.645 (good). The internal consistency was found to have Cronbach a 0.938. Compared to Katz index, the external validity of Barthel index was found to be significant (p<0.01) using Spearman correlation coefficient. The construct validity was found to be significant (p<0.001)Conclusion. Barthel index form is an reliable and valid tool which is recommended to measure basic functional status in elderly population Indonesia."

"Latar Belakang. Kualitas hidup merupakan hal yang penting pada penyakit kronik, termasuk pada usia lanjut. Kualitas hidup yang dibahas di bidang kesehatan adalah kualitas hidup terkait kesehatan (health related quality of life). Salah satu kuesioner untuk mengukur kualitas hidup yang banyak digunakan adalah formulir European Quality of Life - 5 Dimensions (EQ-5D). Di Indonesia belum ada suatu alat mengukur kualitas hidup terkait kesehatan pada usia lanjut yang sudah diuji keandalan dan kesahihan.Tujuan. Membuktikan bahwa formulir EQ-5D merupakan alat pngukur yang andal dan sahib untuk menentukan kualitas hidup terkait kesehatan pada usia lanjut di Indonesia.Metodologi. Dirancang suatu studi validasi. Prosedur yang dilakukan adalah pada hari pertama kunjungan, semua pasien melakukan pengisian formulir European Quality of life - 5 Dimensions (EQ-5D) dan Short Form - 36 (SF-36) dan pada hari ke 7-14 kunjungan dilakukan pengisian ulang formulir EQ-5D.Hasil. Telah dilakukan pengambilan data terhadap 86 responden, nilai ICC EQ-5D masing-masing dimensi, EQ-5D indeks maupun VAS didapatkan sangat baik (>0,75), kecuali untuk rasa cemas/ depresi, dengan nilai ICC 0,611. Keandalan internal consistency penelitian ini didapatkan nilai Cronbach a 0,829. Uji kesahihan ekstemal EQ-5D-dibandingkan SF-36 dan dianalisis-dengan uji Pearson/ Spearman correlation coefficient. Terdapat hubungan bermakna (p<0,0I), yaitu antara dimensi EQ-5D, EQ-5D indeks, EQ-5D VAS dengan dimensi SF-36 maupun SF-36 nilai total, kecuali hubungan EQ-5D VAS dan kesehatan jiwa SF-36. Hasil uji kesahihan konstruksi EQ-5D, didapatkan semua dimensi berhubungan bermakna dengan EQ-5D indeks ( p<0,01).Simpulan. Fornulir EQ-5D merupakan alat pngukur yang andal dan sahih dan dianjurkan dapat digunakan untuk mengukur kualitas hidup terkait kesehatan usia lanjut di Indonesia.

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Background. Quality of life is an important issue in chronic disease and elderly population. Quality of life discussed here is Health Related Quality of Life (HRQOL). HRQOL is an abstract variable. It contents two dimensions, subjective or perception and objective component. One of the HRQOL instrument most commonly used is European Quality of Life - 5 Dimensions (EQ-5D) form. So far there isn't any tool to measure HRQOL in elderly population in Indonesia, which has been validated consistently.

Objectives. To verify that EQ-5D form is a reliable and valid instrument to measure health related quality of life in elderly population in Indonesia.

Methods. A validation study was arranged. On the first day of visit, all patients filled in EQ-5D form and Short Form - 36 (SF-36), which was repeated on day 7 through day 14 of visits.

Results. There were 86 respondents in this study. Interclass Correlation Coefficient (ICC) EQ-5D for each dimension, EQ-5D index and EQ-5D VAS were found to be excellent (>0.75) with the exception of anxiety/ depression with ICC 0.611. The internal consistency was found to have Cronbach a 0.829. Compared to SF-36, the external validity of EQ-SD was found to be significant (p<0.01) using Pearson/ Spearman correlation coefficient, except the correlation of EQ-5D VAS and mental health. The construct validity was found to be significant (p<0.01).

Conclusions. EQ-5D form is a reliable and valid instrument which is recommended to measure health related of life in elderly population in Indonesia."

"Latar BelakangPerlemakan hepatitis non-alkoholik (NASH) merupakan bagian dari spektrum penyakit perlemakan hati non-alkoholik (NAFLD) yang dimulai dari perlemakan hati murni dan bisa berlanjut menjadi sirosis hati. Hipotesis terjadinya NASH hingga saat ini adalah teori Two Hit. Dikatakan bahwa sindrom resistensi insulin (obesitas, DM tipe II, dan dislipidemi) memegang peranan penting dalam terjadinya NASH. Sampai saat ini studi tentang resistensi insulin pada NASH belum pernali dilaporkan di Indonesia.Tujuan PenelitianMendapatkan gambaran klinik dan besar kejadian resistensi insulin pada penderita NASH.Desain PenelitianStudi ini merupakan studi abscrvasional yang bersifat deskriptif-analitik dengan desain potong lintang perbandingan. Pasien dan MetodeDidapatkan 30 pasien yang berobat ke poliklinik hepatologi di beberapa Rumah Sakit di Jakarta dengan perlemakan hati (dari hasil USG) yang bersedia menjalani pemeriksaan antropometrik, dan pemeriksaan darah perifer untuk kadar gula puasa, preftl lipid, fungsi hati dan insulin puasa. Penderita dengan riwayat minuet alkohol, narkoba, serologi virus hepatitis positif, dan ANA posilifdieksklusi.Gambaran NASH diperiksa oleh tiga ahli patologi anatomi (menurut criteria Brunt). Untuk analisa resistensi insulin (dengan reagen insulin ultrasensitif) diperiksa pada 30 penderita NASH yang dibandingkan dengan 30 kontrol normal dengan metode ELISA. Untuk analisa statistik digunakan program SPSS untuk Window versi 12 dengan uji statistik nonparametrik (Mann-Whitney).HasilDari 30 penderita NASH, hipertensi ditemukan pada 8 (26,7%) subyek, dispepsia pada 14 (46,7%) subyek, berat badan berlebih pada 6 (20%) subyek, obesitas pada 19 (63,3%) subyek, gangguan fungsi hati pada 20 (67%) subyek, hipertrigliseridemi pada 19 (63,3%) subyek, DM tipe II pada 5 (16,7%) subyek, dan sindroma metabolik pada 9 (30%) subyek. HOMA-IR didapatkan lebih tinggi pada kelompok subyek dengan NASH bila dibandingkan kontrol normal (p = 0,001). Resistensi insulin ditemukan pada 16 (53,3%) dari 30 penderita NASH (dengan batas HOMA-IR < 3,02).SimpulanKebanyakan penderita NASH memiliki minimal satu dari komponen metabolik. Resistensi insulin mungkin mempunyai peran pada penderita NASH. Dibutuhkan sampel lebih banyak dan penelitian lebih lanjut mengenai resistensi insulin di hati.

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BackgroundsNon-Alcoholic Steatohepatitis (NASH) is a spectrum of Non-Alcoholic Fatty Liver Disease (NAFLD) which is starting from pure fatty liver (steatosis) to hepatic cirrhosis. Most of studies about prevalence of NASH come from Western countries. The recent hypothesis of NASD which is accepted until now is the Two Hit Theory. It was noted that insulin resistance syndrome (obesity, diabetes, dyslipidemia) has an important sole in NAFLD especially in progression to become NASH. In Indonesia, study about insulin resistance in NASH has not been reported.Aims of the studyTo know the clinical pictures and the prevalence of insulin resistance in subjects with NASH.Study DesignThis study was a descriptive-analytic with a comparative cross-sectional design. Patients and MethodsThere were 30 outpatients who come to liver clinic in several hospitals in Jakarta, with a diagnosis of fatty liver (ultrasound examination) underwent examination of anthropometric measurement, and blood tests for fasting glucose, lipid profile, liver function and fasting insulin level. Subjects with a history of alcohol intake, drug abuser, HBsAg positive, anti I-ICV positive and ANA positive were excluded. A liver biopsy proven NASH was confirmed from every subject (according to Brunt criteria), which has been examined by three experienced pathologists. The insulin resistance measured (with ELISA method) in 30 subjects with NASH by 1-IOMA-IR was compared with 30 normal controls. All analyses were performed with SPSS for Windows version 12 A significance level of 5% was used with non-parametric test (Mann-Whitney).ResultsFrom 30 subjects with NASH, hypertension was found in 8 (26.7%) subjects, dyspepsia was found in 14 (46.7%) subjects, overweight was found in 6 (20%) subjects, obesity was found in 19 (63.3%) subjects, abnormal liver function tests was found in 20 (67%) subjects, hypertrigliseridemia was found in 19 (63.3%) subjects, DM type II was found in 6 (16.7%) subjects, and metabolic syndrome was found in 9(30%) subjects. HOMA-IR was found higher in 30 subjects with NASH compared to 30 normal controls (p= 0.001). Insulin resistance was defined when HOMA-IR was more than 3.02. Insulin resistance was found in 16 (53.3%) from 30 subjects with NASH.ConclusionsMost subjects with NASH have at least one component of the metabolic syndrome. Insulin resistance might have a role in subjects with NASH. A larger sample was needed to support this study. Further study about hepatic insulin resistance is needed."

"ABSTRAKLatar Belakang. Dengan meningkatnya jumlah populasi usia lanjut, masalah kesehatan yang dialami juga semakin banyak, salah satunya malnutrisi. Studi di luar negeri menunjukkan malnutrisi pada pasien geriatri yang dirawat di rumah sakit menurunkan kesintasan. Pasien usia lanjut di Indonesia mempunyai karakteristik yang berbeda dengan pasien usia lanjut di luar negeri. Di Indonesia belum ada studi tentang status nutrisi pasien usia lanjut yang dirawat di rumah sakit dan pengaruhnya terhadap kesintasan.Tujuan. Mengetahui pengaruh status nutrisi terhadap kesintasan 30 hari pasien usia lanjut yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam rumah sakit.Metodologi. Penelitian kohort retrospektif, dengan pendekatan analisis kesintasan, dilakukan terhadap 177 pasien geriatri yang dirawat di ruang rawat akut geriatri dan ruang rawat penyakit dalam Rumah Sakit Cipto Mangunkusumo selama bulan April–September 2011. Data demografis, diagnosis medis, kadar albumin, indeks ADL Barthel, geriatric depression scale, status nutrisi dengan mini nutritional assessment (MNA) dikumpulkan, dan diamati selama 30 hari sejak mulai dirawat untuk melihat ada tidaknya mortalitas. Perbedaan kesintasan kelompok pasien dengan status nutrisi baik, berisiko malnutrisi dan malnutrisi ditampilkan dalam kurva Kaplan-Meier, diuji dengan uji Log-rank, serta analisis multivariat dengan Cox proportional hazard regression model untuk menghitung adjusted Hazard Ratio dan interval kepercayaan 95% terjadinya mortalitas 30 hari dengan memasukkan variabel-variabel perancu sebagai kovariat.Hasil. Kesintasan antara subyek yang status nutrisinya baik, berisiko malnutrisi dan malnutrisi ialah 94,7% dengan 89,0% dan 80,7%, namun perbedaan kesintasan 30 hari tak bermakna dengan uji Log-rank (p=0,106). Pada analisis multivariat didapatkan adjusted HR setelah penambahan variabel perancu sebesar 1,49 (IK 95% 0,29 – 7,77) untuk kelompok berisiko malnutrisi dan 2,65 (IK 95% 0,47 – 14,99) untuk kelompok malnutrisi dibandingkan dengan pasien nutrisi baikSimpulan. Perbedaan kesintasan 30 hari pasien geriatri yang dirawat di rumah sakit yang menderita malnutrisi dan berisiko malnutrisi dibandingkan dengan status nutrisi baik pada awal perawatan belum dapat dibuktikan.

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ABSTRACTBackground. Increasing number of older population will also increased its health problems. Studies in foreign countries shown that poor nutrition worsen survival of geriatrics admitted to hospitals. Geriatric patients in Indonesia have different physical, psychological, social economic and cultural characteristics. There has been no study in Indonesia on role of nutritional status on survival in hospitalized geriatric patients.Objective. Investigating the impact of nutritional status on 30 days survival of geriatric patients hospitalized in geriatric and internal medicine wardMethods. Retrospective cohort study and survival analysis approach was conducted to 177 geriatric patients hospitalized in geriatric and internal medicine ward of Cipto Mangunkusumo from April – September 2011. Demographic data, albumin level, ADL Barthel, geriatric depression scale, nutritional status according to mini nutritional assessment (MNA) were collected. Patients were observed during 30 days since hospitalized. Difference in survival is shown in Kaplan-meier curve dan difference in survival between groups were tested with Log-rank test, and multivariate analysis with Cox proportional hazard regression to calculate adjusted HR of mortality and confounding variables as covariates.Results. The survival of well nourished, in risk of malnutrition and malnourished group was 94,7%, 89,0% and 80,7%, but non significant with Log-rank test (p=0,106). After multivariate analysis (Cox proportional hazard regression model), the adjusted HR was 1.49 (CI 95% 0.29 – 7.77) for group in risk of malnutrition and 2.65 (CI 95% 0.47 – 14.99) for malnourished group compared to well-nourished groupConclusion. Thirty days survival difference of hospitalized geriatrics with malnutrition and in risk of malnutrition compared to well-nourished have not been proved."

"Latar Belakang: Pasien geriatri memiliki kompleksitas unik yang dapat meningkatkan beban dan biaya perawatan. Perbaikan status fungsional dan penurunan rehospitalisasi merupakan luaran keberhasilan pelayanan pasien geriatri yang dapat dicapai lebih baik dengan P3G (Pendekatan Paripurna Pasien Geriatri). Sejak implementasi sistem pembiayaan Jaminan Kesehatan Nasional (JKN) pada Januari 2014 belum diketahui perbandingan luaran perbaikan status fungsional, rehospitalisasi, dan efektivitas biaya pasien geriatri di RSCM dengan P3G.Tujuan: Mengetahui perbandingan perbaikan status fungsional, kejadian rehospitalisasi, dan efektivitas biaya pasien geriatri yang dirawat di RSCM pada era sebelum dan sesudah penerapan JKN.Metode: Kohort retrospektif dengan kontrol historis dilakukan pada pasien geriatri yang dirawat di RSCM pada periode Januari-Juni 2014 sebagai kelompok JKN dan Juli-Desember 2013 sebagai kelompok pra-JKN. Pengumpulan data dilakukan secara total sampling dari rekam medis. Pasien meninggal dieksklusi. Status fungsional dinilai dengan indeks ADL (activity of daily living) Barthel. Kemudian dilakukan analisis perbedaan proporsi rehospitalisasi, perbaikan status fungsional, dan perhitungan efektivitas biaya menggunakan incremental cost-effectiveness ratio (ICER).Hasil: Dari total 158 pasien, 72 subjek berada di kelompok pra-JKN dan 86 subjek di kelompok JKN dengan karakteristik yang relatif tidak berbeda. Tidak ada perbedaan median perbaikan status fungsional dan kejadian rehospitalisasi antara kelompok pra-JKN dan JKN (1 [-5 to 13] vs 2 [-2 to 15], p=0,715 dan 21,7,1% vs 18,1%, p=0,603). Telaah efektivitas biaya menunjukkan dengan menginvestasikan 3,7 juta rupiah pada implementasi JKN menyebabkan peningkatan 1 skor ADL Barthel dan penghematan 600 ribu rupiah pada implementasi JKN menyebabkan penurunan rehopitalisasi 3,6%; namun secara klinis dan statistik perbedaan tersebut tidak bermakna.Simpulan: Tidak ada perbedaan perbaikan ADL, kejadian rehospitalisasi, dan efektivitas biaya pasien geriatri yang dirawat di RSCM pada era JKN dan pra-JKN.

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Background: Geriatric patients have unique characteristics with high burden of care and cost. Functional status improvement and reduction of rehospitalization are the outcome of health care that can be achieved better by implementation of CGA (Comprehensive Geriatric Assessment). Since January 2014, National Health Insurance Program (NHIP) has been implemented and there are no data that explain the comparison of fuctional status improvement, rehospitalization, and cost-effectiveness ratio in geriatric patients receiving CGA at RSCM.

Objectives: to determine the comparison of functional status improvement, rehospitalization, and cost-effectiveness ratio in patients admitted to RSCM acute geriatric ward before and after implementation of NHIP.

Method: Retrospective cohort with historical control was done toward geriatric patients in periode of January-June 2014 as NHIP group and periode of July-December 2013 as pra-NHIP group. Data was collected from medical record and enrolled by total sampling. Death cases were excluded. Functional status was measured using activity of daily living (ADL) Barthel index. Analysis the difference of activity of daily living score, rehospitalization, and incremental cost effectiveness ratio (ICER) were done to compare both groups.

Result : From 158 patients, 72 subjects are in pra-NHIP group and 86 subject in NHIP groups. Both group have similar characteristics. There are no difference of functional status improvement and rates of rehospitalization between pra-NHIP and NHIP group (1 [-5 to 13] vs 2 [-2 to 15], p=0,715 and 21,7% vs 18,1%, p=0,603). ICER shows that by investing 3,7 million rupiah on implementation of NHIP cause 1 score improvement of ADL Barthel index and by saving 600 thousand rupiah on NHIP cause 3,6% declining rehopitalization rates. Statistically and clinically both ICER are not significant.

Conclusion: There are no difference of functional status improvement, rates of rehospitalization, and cost-effectiveness ratio in geriatric patients between NHIP and pra-NHIP groups."