Psychosocial Theory of Aging Process

Oleh
Prof. dr. Andi Jayalangkara Tanra, Ph.D, Sp.KJ(K)
Dr. Kristian Liaury, Ph.D, Sp.KJ
Bagian Psikiatri
Fakultas kedokteran
Universitas Hasanuddin
Makassar
 PENDAHULUAN
• Proses penuaan tidak dapat dihindari tetapi
dapat diantisipasi
• Segmen populasinya semakin hari
meningkat
• Di Amerika tahun 1995  12% dari
populasi, tahun 2030  17-20% dari
populasi (± 60 juta)
• Di Indonesia tahun 2000  ±16 juta, tahun
2005  ± 18.4 juta (BPS, 1995)
• Pelayanan masih sangat minim
 Definisi dan Batasan
Proses penuaan belum diketahui secara jelas.

• Strehler : perubahan pada organ saat konsepsi sampai

kematian, pertumbuhan dan penyesuaian.
• WHO : 64th-74th  elderly
75th - 90th old
90th  very old
• Indonesia : 45th-54th  menjelang usia lanjut
55th - 64th  presenescence
 65th  senescence
 Normal Effects of Aging on the Body

Copyright © 2010 Pearson Education, Inc.

 Normal Changes with Aging:
• Skeleton
– Decreased height and weight (after age 80)
– Loss of bone substance (osteopenia)
• Kidney
– Decreased creatinine, renal blood flow and
concentration ability
• Gastrointestinal Tract
– Decreased acid (Vitamin B12 related)
– Fewer taste buds
 Normal Changes with Aging:
• Eyes
– Arcus senilis
– Decreased acuity, accommodation, color sensitivity, depth
perception
– Hyperopia (far-sightedness)
• Hearing
– Degenerative changes of ossicles
– Obstruction of eustachian tube
– Atrophy of cochlear hair cells
– High frequency hearing loss and pitch discrimination
 Normal Changes with Aging:
• Nervous & mental change:
– Increased motor response time
– Slower psychomotor performance
– Slowing intellectual performance
– Decreased complex learning
– Decreased hours of sleep
 Common versus Normal
• Just because a finding is common in the elderly
doesn’t mean it’s normal
– Hypertension, osteoarthritis, and dementia are common in
the elderly but not normal
• Patients only discuss things with you that they feel
are abnormal
– If your patient considers incontinence a “normal” part of
aging, he/she won’t bring it up during a clinic visit.
• Patient expectations are often wrong
 Disability and Disease
• Geriatric disorders are usually disabilities rather than
discretely defined diseases

• ADL (Activities of Daily Living) and IADL (Instrumental

Activities of Daily Living) difficulties increase with age
– Less than 10 percent of those 65-69 need help with
IADL/ADL
– 60% of females over 85 living in the community needed
help with IADLs, and 40% required help with ADLs
 Activities of Daily Living (ADL)
• Activities of Daily Living (ADL) include
– Dressing
– Eating
– Walking
– Going to the bathroom
– Bathing
• These are severe functional disabilities and define
dependency
 Instrument Activities
of Daily Living (IADL)
• IADL include:
– Shopping
– Housekeeping
– Accounting/bill paying
– Food/meal preparation
– Travel/driving
• These are less severe than ADL, but clearly cause
dysfunction and lead to dependency
Proses Penuaan dan Konsekuensinya

Dipengaruhi :- Kultur dan etnik

- Genetik dan warisan

- Kondisi saat konsepsi dan kelahiran

- Pertumbuhan dan maturasi

- Lingkungan dan kemaknaan lainnya

Teori Bio-Psiko-Sosial  Proses Penuaan

A. Teori psikobiologi:
– Teori Wear-and-tear

– Teori Cellular

– Teori Autoimmune

– Teori Genetic mutation

B. Teori Psikososial :
1. Teori pelepasan
2. Teori aktivitas
3. Teori pengalaman masa lalu
C. Teori personaliti :
Erikson theory : Ego integrity vs Despair
 Tantangan pada usia lanjut
• Ageism
– Diskriminasi terhadap seseorang, muda atau tua, berdasarkan
usia kronologis

• Gangguan tidur meningkat dengan bertambahnya usia

– Insomnia
– Sleep apnea (berhenti bernafas)

• Medical treatment
– Lebih banyak masalah kronis dibanding dengan gangguan yang
dapat disembuhkan
– Polypharmacy (pemberian berbagai macam obat)
– Obat biasanya diujikan pada partisipan yang lebih
muda  belum tentu cocok untuk digunakan pada
orang usia tua
 Tantangan pada usia lanjut

• Physical abuse
• Sexual abuse
• Emotional atau psychological abuse
• Financial atau material explotation
• Neglect
• Self-neglect
• Dying & death
 Kübler-Ross’s Stages of Dying

Copyright © 2010 Pearson Education, Inc.

Penanganan
• Life review therapy
• Orientasi realitas
• Kognitif training
• Terapi relaksasi
• Support and counseling groups
• Penggunaan humor
• Pendidikan keluarga dan pasien
• Pembatasan keleluasan
• Psikofarmaka
Tindak lanjut

• Penanganan komprehensif
• Bukan saja petugas kesehatan organisasi
masyarakat / LSM
• Leafleat petunjuk lansia sehat
• Wadah lansia sehat : baik dari pemerintah
maupun swasta
• Studi epidemologi juga di berbagai daerah
 Penutup

• Usia lanjut
perubahan busana
dari muda menjadi
lansia.

• Usia emas