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"ABSTRAKLatar belakang: Perawatan-kembali 30 hari merupakan salah satu parameter penting yang berhubungan dengan biaya kesehatan tinggi dan outcome yang buruk, namun hal ini berpotensi dicegah. Usia lanjut merupakan kelompok yang rentan mengalami perawatan dengan karakteristik khusus yang dapat dinilai dengan pengkajian paripurna pasien geriatri (P3G). Beberapa penelitian menunjukkan komponen P3G merupakan faktor prognostik perawatan-kembali pada pasien usia lanjut sehingga dapat digunakan sebagai model prediksi perawatan-kembali 30 hari pada populasi ini. Belum ada penelitian prospektif yang khusus menilai komponen P3G sebagai model prediksi perawatan-kembali 30 hari. Tujuan: Mengembangkan model prediksi perawatan-kembali 30 hari pada pasien usia lanjut yang dirawat di bangsal medik RS Cipto Mangunkusumo. Metode: Penelitian adalah studi kohort prospektif pada 263 subjek usia >60 tahun yang diikuti hingga 30 hari pasca rawat. Data demografis dan komponen P3G dikumpulkan melalui wawancara dan rekam medik saat perawatan. Analisis kesintasan secara bivariat dan multivariat berjenjang dilakukan untuk mendapatkan hazard ratio. Dikembangkan suatu model prediksi dan persamaan fungsi hazard untuk memprediksi risiko perawatan-kembali 30 hari pasca rawat. Komponen P3G yang diukur adalah skor FRAIL (fatigue, resistance, ambulance, illness, loss of weight), Geriatric Depression Scale-15 (GDS-15), Mini nutrition Assessment short form (MNA-SF), Activity Daily Living (ADL)-Barthelindex, Cumulative illness rating scale-geriatric (CIRS-G), Zarits-4 item screening test, uji Mini Cog, dan polifarmasi. Hasil: Status nutrisi dan status depresi berhubungan secara signifikan dengan perawatan-kembali 30 hari dengan HR 2,368 (IK95%: 1,412-3,972, p=0,001) dan HR 1,627 (IK95%: 1,080-2,450, p=0,02), berurutan. Model prediksi menggunakan dua komponen tersebut memiliki AUC 0,663, Hosmer Lemeshow Goodness-of fit test 0,48, p<0,005. Probabilitas perawatan kembali 30 hari pada subjek dengan gangguan nutrisi dan depresi menggunakan persamaan fungsi Hazard adalah 79%. Simpulan: Status nutrisi dan status depresi memiliki hubungan signifikan dengan perawatan-kembali 30 hari. Model prediksi perawatan-kembali 30 hari yang menggunakan komponen ini memiliki tingkat diskriminasi tidak terlalu baik dengan performa yang baik, namun dapat dihitung menggunakan suatu persamaan cox proportional Hazard.

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ABSTRACTassociated with high costs and poor outcomes for hospitalized elderly patients. This population are vulnerable for hospital admission due to aging-related characteristics which can be assessed by comprehensive geriatrics assessment (CGA). Several studies have shown that CGA components were related to 30-day readmissions in elderly patients, on the contrary, only few studies consider these components as predictive score. Objective: To develop a prediction model for 30 days unplanned readmission in elderly patients who are treated in medical ward of Cipto Mangunkusumo Hospital. Methods: A prospective observational study followed 312 subjects aged >60 years old from admission to 30 days after discharge. Demographic data and CGA components were compeleted through interviews and medical records. Bivariate followed by stepwise multivariate survival analysis was used. Then, a prediction score and a hazard functional equation were developed to predict the risk of 30 days unplanned readmission. The CGA components measured were FRAIL score (fatigue, resistance, ambulance, illness, loss of weight), Geriatric Depression Scale-15 (GDS-15), Mini nutrition Assessment short form (MNA-SF), Activity Daily Living (ADL)-Barthel index, Cumulative illness rating scale-geriatric (CIRS-G), Zarits-4 item screening test, Mini Cog test, and polypharmacy. Results: Nutritional and depression status were significantly related to 30-day unplanned readmission with HR 2,368 (CI95%: 1,412-3,972, p=0,001) and HR 1,627 (CI95%: 1,080-2,450, p=0,02), respectively. Prediction model using these two components had AUC 0,663, Hosmer Lemeshow Goodness-of-fit test 0,48, p<0.005. Probability for readmission in a patient with nutritional and depression problem on the 30th days after discharge using functional hazard equation was 79%.Conclusion: Nutritional and depression status have significant relationship with 30-day unplanned readmision. The prediction model had moderate level of discrimination but good calibration. Also, a cox proportional hazard equation can be calculated as an alternative. "

"Latar belakang: COVID-19 menginfeksi semua kelompok umur, namun beban infeksi lebih tinggi dan lebih berbahaya pada kelompok usia lanjut. Pasien yang mengalami infeksi akut COVID-19 juga bisa mengalami gejala menetap yang disebut dengan Sindrom Pasca COVID-19, khususnya pada lansia. Belum ada data yang menunjukkan prevalensi Sindrom Pasca COVID-19 pada lansia di Indonesia dan juga faktor-faktor risiko yang berhubungan dengan kejadian Sindrom Pasca COVID-19 pada lansia.Tujuan: Penelitian ini bertujuan untuk mengetahui seberapa besar prevalensi Sindrom Pasca COVID-19 pada lansia di Indonesia serta meneliti hubungan antara faktor-faktor risiko dengan kejadian Sindrom Pasca COVID-19 dengan menggunakan definisi waktu >4 minggu, >8 minggu, dan >12 minggu.Metode: Penelitian ini merupakan penelitian kohort retrospektif yang menggunakan rekam medis dan wawancara untuk mendapatkan data terkait keberadaan faktor-faktor risiko dan gejala menetap pasca perawatan infeksi akut COVID-19.Hasil: Penelitian ini diikuti oleh 329 pasien lansia (≥60 tahun) yang sempat dirawat akibat COVID-19 di RSCM dan RS Mitra Keluarga Kalideres pada 1 Januari-31 Desember 2021. Prevalensi Sindrom Pasca COVID-19 pada lansia adalah sebesar 31%, 18,24%, dan 10,64% dengan menggunakan definisi waktu >4 minggu, >8 minggu, dan >12 minggu, secara berurutan. Clinical Frailty Scale rawat inap (OR 2,814 [IK 95% 1,172-6,758) dan imobilitas rawat inap (OR 4,767 [IK95% 2,117-10,734]) berhubungan dengan Sindrom Pasca COVID-19 >4 minggu. Selanjutnya, jumlah gejala awal (OR 2,043 [IK95% 1,005-4,153]), konstipasi rawat inap (OR 2,832 [IK95% 1,209-6,633]), imobilitas rawat inap (OR 2,515 [IK95% 1,049-6,026]), dan instabilitas rawat inap (OR 2,291 [IK95% 1,094-4,800) berhubungan dengan Sindrom Pasca COVID-19 >8 minggu. Gangguan pendengaran dan penglihatan follow-up (OR 2,926 [IK95% 1,285-6,665]) dan imobilitas rawat inap (OR 3,684 [IK95% 1,507-9,009]) berhubungan dengan Sindrom Pasca COVID-19 >12 minggu.Kesimpulan: Infeksi akut dengan ≥ 5 gejala, adanya frailty dan sindrom geriatri, khususnya imobilitas saat perawatan, berhubungan dengan Sindrom Pasca COVID-19 pada lansia.

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Background: COVID-19 infects all age groups, but the burden of infection is higher and more dangerous in the elderly. Patients with acute COVID-19 infection can also experience persistent symptoms called Post-Covid-19 Syndrome, especially elderly. No data show the prevalence of Post-Covid-19 Syndrome in the elderly in Indonesia and the risk factors associated with the occurrence of Post-Covid-19 Syndrome in the elderly

Objective: This study aims to determine the prevalence of Post-Covid-19 Syndrome in the elderly in Indonesia and examine the relationship between risk factors and the incidence of Post-Covid-19 Syndrome by using the definition of time > 4 weeks, > 8 weeks. , and >12 weeks.

Methods: This study is a retrospective cohort study that uses medical records and interviews to obtain data regarding risk factors and persistent symptoms after treatment of acute COVID-19 infection.

Results: This study is followed by 329 elderly patients (≥60 years) who had been treated because of COVID-19 at Cipto Mangunkusumo Hospital and Mitra Keluarga Kalideres Hospital from January 1st until December 31st, 2021. the prevalence of Post COVID-19 Syndrome in the elderly was 31%, 18.24%, and 10.64% using the time definition of >4 weeks, >8 weeks, and >12 weeks, respectively. Clinical Frailty Scale during hospitalization scores (OR 2.814 [95% CI 1.172-6.758]) and immobility during hospitalization (OR 4.767 [95% CI 2.117-10.734]) were associated with Post-Covid-19 Syndrome >4 weeks. Furthermore, number of initial symptoms (OR 2,043 [CI95% 1.005-4.153]), constipation during hospitalization (OR 2.832 [CI95% 1.209-6633]), immobility during hospitalization (OR 2,515 [95% CI 1,049-6.026]), and instability during hospitalization (OR 2,291 [CI 95% 1,094-4,800]) was associated with Post-Covid-19 Syndrome >8 weeks. In addition, impairment of visual and hearing during follow-up (OR 2,926 [95% CI 1,285-6,665]) and immobility during hospitalization (OR 3,684 [95% CI 1.507-9,009]) was associated with Post-Covid-19 Syndrome >12 weeks.

Conclusions: Acute infection with ≥ 5 symptoms, frailty, and geriatric syndrome, especially immobility during hospitalization, were associated with Post-Covid-19 Syndrome in the elderly."

"Latar Belakang. Pneumonia nosokomial adalah infeksi paru yang terjadi setelah pasien dirawat di rumah sakit setelah lebih dari 48 jam, tanpa adanya tanda dari infeksi paru pada saat perawatan. Jika dibandingkan dengan individu usia muda, pada individu usia lanjut lebih sering didapatkan adanya penyakit infeksi yang bersumber dari komunitas dan nosokomial dengan hasil akhir yang lebih buruk. Penilaian domain Pengkajian Paripurna Pasien Geriatri (P3G) diharapkan dapat menjelaskan faktor yang berperan terhadap pneumonia nosokomial pada pasien usia lanjut. Tujuan. Mengetahui proporsi pasien usia lanjut yang dirawat di RSUPN Dr. Cipto Mangunkusumo dan mengalami pneumonia nosokomial dan apakah domain P3G merupakan faktor yang berpengaruh terhadap kejadian pneumonia nosokomial. Metode. Kohort retrospektif dengan melihat rekam medis pasien usia ≥ 60 tahun yang menjalani rawat inap dalam rentang waktu Januari-September 2019 di ruang rawat medis Ilmu Penyakit Dalam Geriatri RSUPN Dr. Cipto Mangunkusumo dan mengambil data sekunder dari penelitian divisi geriatri. Sampel yang diambil adalah pasien yang dirawat inap dengan usia ≥ 60 tahun yang mengalami pneumonia nosokomial. Pengolahan data menggunakan aplikasi Statistical Product and Service Solutions (SPSS) 16.0. Hasil. Dari 228 subjek, proporsi pneumonia nosokomial pada pasien usia lanjut yang menjalani rawat inap adalah 31,14%. Rerata usia adalah 69 tahun dengan rentang usia subjek antara 60-89 tahun. Status nutrisi (RO 2,226, IK95% 1,027-4,827) dan status fungsional (RO 3,578, IK95% 1,398-9,161) merupakan faktor yang berpengaruh terhadap kejadian pneumonia nosokomial pada pasien usia lanjut yang menjalani rawat inap di RSUPN Dr. Cipto Mangunkusumo. Simpulan. Proporsi pasien usia lanjut yang mengalami pneumonia nosokomial adalah 31,14%. Status nutrisi dan status fungsional merupakan faktor yang berpengaruh terhadap kejadian pneumonia nosokomial pada pasien usia lanjut yang dirawat di RSUPN Dr. Cipto Mangunkusumo.

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Background. Nosocomial pneumonia is a lung infection that occurs after the patient is hospitalized for more than 48 hours, without any signs of pulmonary infection at the time of treatment. When compared with young individuals, elderly individuals are more likely to have community-sourced and nosocomial infections with worse outcomes. Comprehensive Geriatric Assessment (CGA) domains are expected to explain the factors that contribute to nosocomial pneumonia in elderly patients.

Objective. To determine the proportion of elderly treated at Dr. Cipto Mangunkusumo National Central General Hospital and experienced nosocomial pneumonia and whether the CGA domains influence nosocomial pneumonia.

Methods. A retrospective cohort by looking at the medical records of patients aged 60 years or older who were hospitalized in the medical ward of Geriatric Internal Medicine at Dr. Cipto Mangunkusomo National Central General Hospital in January-September 2019 and taking secondary data from the geriatric division research. The samples were taken from hospitalized patients aged 60 years or older who had nosocomial pneumonia. Data processing using the application of Statistical Product and Service Solutions (SPSS) 16.

Result. From 228 subjects, the proportion of nosocomial pneumonia in elderly patients who were hospitalized was 31,14%. The mean age was 69 years with the subject's age range between 60-89 years. Nutritional status (OR 2.226, CI 95% 1.027-4.827) and functional status (OR 3.578, 95% CI 1.398-9.161) are factors that influence the incidence of nosocomial pneumonia in elderly patients who are hospitalized at Dr. Cipto Mangunkusumo National Central General Hospital.

Conclusion. The proportion of elderly patients with nosocomial pneumonia was 31.14%. Nutritional status and functional status are factors that influence the incidence of nosocomial pneumonia in elderly patients who are hospitalized at Dr. Cipto Mangunkusumo National Central General Hospital."