MEDICAL ASPECT OF

AGING
DSC GERODONTOLOGI
(Aline&Marlin)
Kenapa qta harus belajar ini??
Understanding :
1. Vulnerability of older person
2. Alteration assessment & parameter that occur
in disease presentation and response to
therapy
3. Capasities of older person & the lack of
significant change in many function
4. Which aging function might partially modified


CATATAN...
Penyakit di rongga mulut bisa muncul sebagai
penyakit primer maupun penyakit sekunder.
Baik penyakit sistemik maupun konsumsi
obat2an ttt bisa memunculkan manifestasi
patologis di rongga mulut
Sebagai drg harus bisa membedakan
perubahan kondisi rongga mulut yang terjadi
pada lansia itu, apakah akibat dari perubahan
fisiologis ataukah patologis.
PHYSIOLOGIC CHANGES DUE TO
IMMUNE SYSTEM
DECREASE :
Thymus mass
Lymphocyte circulation
Cell mediated immune system
Suppressor cell function
INCREASE :
Natural antibody challenge
Autoantibody

ORAL IMPACT ON IMMUNE SYSTEM
CHANGES
Penyakit autoimun yang bermanifestasi di oral
meningkat
Kebutuhan perawatan untuk meminimalisir
kerusakan jaringan meningkat
Pemakaian antibiotik , efek samping
infeksi oportunistik naiknya insidensi infeksi
rongga mulut
Efek dari penggunaan steroid jangka panjang
CHANGES IN SKELETAL SYSTEM
Slow & unsteady movement
Complaint joint pain
Joint swelling, redness

Ex. Penyakit arthritis/rheumatoid arthritis
gerakan ekstremitas dan jari2 menurun
CHANGES IN MUSCULAR SYSTEM
Sulit mengangkat / membawa objek
Kemampuan untuk menggerakan anggota
gerak badan terbatas kemampuan untuk
menjaga OH

CHANGES IN CARDIOVASCULAR
SYSTEM
Sebagai penyakit sistemik, manifestasi di oral
tidak nyata perlu modifikasi perawatan ex.
Jadwal & lama kunjungan, posisi duduk
Obat2 yg dikonsumsi manifestasi di oral
bersifat nyata, antara lain:
Menimbulkan ulserasicdi mulut
Dry mouth
Gingival hyperplasia
Lichenoid rachitis
Altered taste (-blocker)
Burning mouth


OBSERVATIONS OF THE RESPIRATORY
SYSTEM
Color of sputum
Complaint of pain in chest, back, sides
Shortness of breath
Noisy respirations
Sneezing
Gasping for breathing
Axiety

CHANGES OF THE DIGESTIVE SYSTEM
DUE TO AGING
Atrophy of mucosa throughout
Decreased number of taste buds
Slowing of peristaltis causing constipation
Slower absorption of nutrients
Difficulty chewing and swallowing

Catatan tmbhn : sputum berwarna kekuningan
bisa tanda infeksi TB bisa fisiologis bisa
tanda infeksi lain
Catatan tambahan...
Saliva mulut << bisa krn perub fisiologis, bisa jg
patologis
Saliva berkurang sulit mengunyah & menelan disfagia
nafu makan berkurang
Klo nafsu makan bekurang intake makanan <<
defisiensi nutrisi
Defisiensi vit B12 angular chelitis
Tapi diperhatikan jg, angular cheilitis itu bisa disebabkan
oleh infeksi jamur candida, bisa juga karena vertikal
dimensinya berkurang (pasien edentulous
Intinya teman2 sebisa mungkin menganamnesis pasien yg
lengkap ya, supaya faktor etiologi sebenarnya bisa
diketahui....
CHANGES OF THE URINARY SYSTEM
DUE TO AGING
Decreased kidney size
Decreased elasticity of ureters, bladder, and
urethra
Decreased muscle tone
Diminished blood flow to kidneys
Decreased ability of kidneys to concentrate urine
Difficulty emptying urinary bladder
Enlarged prostate in males which presses on
urethra
ORAL IMPLICATION OF THE
GENITOURINARY CHANGES
Impaired excretion of meds
Tendency to dehydration because of reduced
intake
Stress inkongenital
OBSERVATIONS OF THE URINARY
SYSTEM
Evaluated temperature
Sugar and/or acetone in urine
Urine color other than clear, pale yellow
Complaint of burning on urination
Incontinence
Polyuria

CHANGES OF THE ENDOCRINE SYSTEM
DUE TO AGING
Decrease in thyroid, parathyroid, adrenal, and
sex hormone secretions
Decreased glucose tolerance (Diabetes)
Multiple physical changes due to decreas of
sex hormone

OBSERVATION OF THE ENDOCRINE
SYSTEM
Irritability & restlessness
Nervousness
Confusion
Weight loss
Diaphoresis
Edema
Excessive thirst
Sweet, friuty odor to breath

OBSERVATIONS OF THE ENDOCRINE
SYSTEM
Complaint of headache
Drowsiness
Rapid, weak pulse
Low blood pressure
Nausea or vomitting
Flushed, dry, hot skin biasanya pd wanita
menopause
Excessive urination


CHANGES OF THE NERVOUS SYSTEM
DUE TO AGING
Loss of nerve/brain cells
Increase in reaction time
Changes in memory
Receptors become less sensitive, so require
increased stimuli for response
Reduced sense of touch and sensitivity to pain
Reduced blood flow to brain
Forgetfulness
OBSERVATIONS OF THE NERVOUS
SYSTEM
Confusion
Complaint of loss of feeling on one side
Incontinence
Deranged thought processes
Tremor
Muscular rigidity
Complaint of visual disturbances or changes
Paralysis
Seizures
CHANGES OF THE SENSORY ORGAN
DUE TO AGING
Lense in eye becomes
thick and cloudy
Sclera becomes more
yellow
Less light reaches inner
eye
Accomodation to light
and dark decreases


CHANGES OF THE SENSORY ORGAN
DUE TO AGING
Hearing structures of ear
become less moveable
Soft wax production
decreases
Progressive hearing loss of
high-pitched sounds occur
Peripheral vision and night
vision decreases
Eye adjusts more slowly to
changes in distance
CHANGES OF THE SENSORY ORGAN
DUE TO AGING
Sense of smell
decreases
Of taste (sweet and
salty first) decreases
Sense of touch, heat
cold, pain and
pressure awareness
decreases
OBSERVATIONS OF THE SENSORY
ORGAN
Drainage from ear canal
Complaint of feeling of fluid
or noise in ear
Complaint of sudden flashes
of light or loss of sight
CHANGES OF THE INTEGUMENTARY
SYSTEM DUE TO AGING
Compromised circulation
Less active glands
Drying, thinning, and saling of skin
Thickening of nails
Loss of fat and elasticity of skin
Loss of hair color and thinning of hair
Development of skin tags, moles, and warts
Folds, lines, and wrinkles in skin
Nails harden, become more brittle

OBSERVATIONS OF THE
INTEGUMENTARY SYSTEM
Breaks
Rash
Complaint of itching
Balck and blue areas
Redness
Ulcers, sores, or drainage

CANCER-OBSERVATIONS TO REPORT
Fever
Changes in weight
Bleeding
Changes in vital signs
Complaint of pain
Behavioral changes
Constipation
Diarrhea
Nausea and vomitting
Sores of mouth

Catatan tambahan...
Tugas drg jika menjumpai pasien lasia baik
yang menderita penyakit sistemik maupun
tidak adalah :
Bagaimana membantu mengembalikan fungsi
mulut menjadi normal, sehingga pasien tersebut
dapat makan dan bicara dengan nyaman
Mencegah terjadinya penurunan yang lain atau
penyakit lain di rongga mulut
Catatan tambahan...
Jika melihat kondisi pasien lansia yang begitu kompleks,
kita sbg drg hrs bs memprediksi kondisi pasien tsb.
Bbrp faktor yg perlu diperhatikan o/ drg dalam menangani
pasien lansia :
Kebutuhan perawatan lansia > pasien dewasa/muda
Riwayat medik pasien bgmn
Obat2an yg sdg dikonsumsi apa saja?
Kapasitas fisik pasien sejauh apa
Pasien impaired cognitive unable to understad a
treatment plan perlu menerangkan pada keluarga yg
mengantar
Neuromuscular skill maintain OH <<


Catatan tambahan...
Faktor modifikasi pasien yg perlu
dipertimbangkan :
Patient desire & expectation
Patient dental need type & severity
Patients dental effect problems affect
his/her quality of life
Treatment alternative
Patients life span

Catatan tambahan...
Perawatan pasien lansia sebaiknya bersifat
komprehensif dengan pendekatan yg holistik
Sbg drg dalam melakukan perawatan tidak
hanya bth TECHNICAL ORIENTED, tp jg perlu
MEDICAL ORIENTED utk mencapai kondisi
medik yg baik (GOAL)
Jika hanya mengandalkan TECHNICAL
ORIENTED bs trjd OVERTREATMENT

GAYA HIDUP
KONDISI UMUM
FAKTOR RISIKO
PENYAKIT ORAL
PERAWATAN ORAL
ORAL HEALTH
Pesan dr DSC...
Berhubung dosen ngga ngasi slide kuliah, tim
DSC hanya bs buat kerangka pembelajaran...
Jadi sebaiknya cr informasi tambahan dan
sedikit belajar makul OM brdsrkn kerangka
materi yg ada yaa...