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KORELASI ANTARA OBESITAS SENTRAL DENGAN ADIPONEKTIN PADA LANSIA DENGAN PENYAKIT JANTUNG KORONER Aryana, IGPS; Kuswardhani, RA Tuty; Suastika, K; Santoso, A
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

Obesity is rapidly becoming a global problem not only in developed countries but also in developing countries such asIndonesia. Visceral obesity (central obesity) is an importance risk for cardiovascular disease and recognition that adipose tissuecan be regarded as a large endocrine organ that secreted inflammatory and anti inflammatory molecules (adiponectin). This studyaims to know the correlation between central obesity and adiponectin in geriatric Coronary Heart Disease (CHD) patients.Thisstudy was cross sectional analytic study of geriatric CHD at out and in patients in Sanglah Hospital. Data are presented as groupmean ± SD and analyzed by t-test, chi-square, and Pearson correlation with SPSS 12 software.Forty five patients (35 males and 10 females), 23 patient unstable angina pectoris, 14 patient acute myocardial infarction,and 8 patient stable angina pectoris were recruited and examined. There was high prevalence of central obesity 51.1% (23patients). Mean of log adiponectin were significantly difference between central obese and non central obese (1.80 ± 0.61 vs 1.09± 0.41 with p). Central obesity increased risk of hypoadiponectinemia 5 times than non central obesity (p = 0.011, CI 95% 1.4- 17.8). Waist circumference has negative correlation with log plasma adiponectin (R = -0.663, p < 0.001).There was high prevalence of central obesity in geriatric coronary heart disease patients. Central obesity increased risk ofhypoadiponectinemia 5 times than non central obesity. Waist circumference has negative correlation with plasma adiponectin.Increased of waist circumference will decrease of adiponectin (cardioprotective protein) and will increase risk of Acute CoronarySyndrome in geriatric patients.
Perbandingankomposisitubuhpadakelompok lanjut usiasebelum dan setelah pelaksanaansenam tera diPanti Sosial Tresna WerdhaWana Seraya Denpasar Semadi, I Made Siswadi; Kuswardhani, RA Tuty
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Abstract

Perubahan komposisi tubuh merupakan tanda penting proses penuaan. Salah satu upaya mempertahankan danmeningkatkan kesehatan padalanjut usia (lansia) adalah olahraga yang bersifat low impact, misalnyasenamtera.Tujuan penelitian ini adalahmengetahui perbandingankomposisi tubuh (berat badan, komposisi lemakdanototskeletal) kelompok lansia sebelumdan setelah pelaksanaan senamtera. Penelitian ini merupakan penelitianeksperimental dengan desainone grouppretestandpostest. Penelitiandiikutioleh 16 orang, dilakukan di Panti SosialTresna WerdhaWana Seraya Denpasar pada bulan Januari-Maret 2013. Subjekdiberikan latihan senam tera selama 8minggu dengan frekuensi 3 kali perminggu. Pemeriksaankomposisitubuhdilakukansebelumdansetelah perlakuan.Uji normalitas menggunakan uji Shapiro-Wilk, sedangkan uji komparasi menggunakan uji t berpasangan danWilcoxon rank test. Hasil analisis menunjukkanterdapat penurunanberat badan (51,37 vs 50,38 kg; P=0,007),persentase lemak tubuh total (36,37vs29,47%; P=0,005), persentase lemak viseral (10,19%vs7,12%; P=0,008),persentase lemak subkutan (24,57 vs 22,94%; P=0,138) dan otot skeletal (23,73 vs 23,68%; P=0,899), sertapeningkatan kekuatanotot(14,44vs15,53kg; P=0,358)setelah pelaksanaan senam tera. Disimpulkanbahwa terdapatpenurunan berat badan, persentaselemak total danviseral secarabermakna, namuntidakterdapat perubahan yangbermakna pada persentase lemak subkutan, otot skeletal serta kekuatan otot setelah pelaksanaan senam tera.[MEDICINA.2016;47(3):38- 41]Changing in body composition is important sign of aging process. Low impact exercise for example tera exercise isone effort to increase health status in elderly. The aim of this study was to compare the body composition (bodyweight, fat and skeletal muscle) in elderly before and after tera exercise. Thiswasaexperimental study withone grouppretest andpostest design.There was 16 subjects in WanaSraya Nursing Home Denpasar who participated in thisstudy. They did tera exercise for 8 weeks, 3 times a week. Body weight, fat, skeletal muscle composition and musclestrength were measured before and after intervention. Data normality was analysed using Shapiro-Wilk test,comparison of body compositions were analysed using pairedt-test andWilcoxon rank test. There were decrease ofbody weight (51.37 vs50.38 kg; P=0,007), total body fat percentage (36.37vs 29.47%; P=0.005), visceral fatpercentage (10.19%vs 7.12%; P=0.008), subcutaneous fat percentage (24.57 vs 22.94%; P=0.138) and skeletalmuscle(23.73 vs 23.68%; P=0.899) after tera exercise, while muscle strength was increase (14.44vs 15.53kg;P=0.358). It was concluded that tera exercise could significantly decrease body weight, total dan visceral fatpercentage, but no significant change in subcutaneus fat, skeletal muscle percentage, and muscle strength inelderly.[MEDICINA.2016;47(3):38-41]
RISKS FOR PERIPHERAL ARTERIAL DISEASE IN THE ELDERLY WITH TYPE 2 DIABETES MELLITUS : Their Correlation with High Sensitivity C-reactive Protein and Ankle-Brachial Index Ayu Tuty Kuswardhani, Raden; Wita, Wayan; Bakta, Made; Santosa, Anwar
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 2 Juli 2009
Publisher : Udayana University

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Abstract

The Indonesian elderly population has been projected to increase up to about four-fold inthree decades (1990-2020). As a consequence of this population trend, the increased prevalence ofdegenerative diseases would be inevitable; this would include the prevalence of peripheral arterialdisease.This study aims to identify the correlation of diverse risk factors, either traditional or nontraditional,with the ankle-brachial index scores, and the correlation of novel non-traditional riskfactor, e.i. high sensitive C-reactive protein with the prevalence of perioheral arterial disease in theelderly, age 60-80 years old, with type 2 diabetes mellitus.Among the 146 elderly patients with type 2 diabetes mellitus, and based on measurement ofthe ABI score, approximately 30.9% of them had PAD. Some traditional and non-traditional riskfactors having a significant correlation with the ankle-brachial index score, were age (r = -0.396, p <0.001 for right ABI; r = -0.509, p < 0.001 for left ABI), supine systolic blood pressure (r= -0.268, p =0.012 for right ABI; r = -0.267, p = 0.013 for left ABI), 2-hour post-prandial blood glucose (r= -0.252, p = 0.018 for right ABI), and hsCRP (r = -0.280, p = 0.011 for right ABI; r = -0.402, p <0.001 for left ABI); whereas other risk factors like obesity based on waist circumference and BMI,non-supine systolic blood pressure, fasting blood glucose, HbA1C, duration of diabetes, plasma lipidsdid not show statistically significant different odd ratios. After linear regression test for risk factorshaving significant correlations with ABI, age and hsCRP were found to influence the ABI scores.Based on a case-control study, risk factors which, to some extent, had statistically significant valuesas risk factors, include older age (? 70 years old; OR = 7.737 [CI = 2.515-23.805]; p < 0.001),relatively high supine diastolic blood pressure (? 90 mmHg; OR = 6.882 [CI = 0.789-60.060]; p =0.048), and high concentration of hsCRP (> 3 mg/L; OR = 4.420 [CI = 1.287-15.181]; p = 0.013).Among these statistically significant risk factors, after logistic regression test analysis, only the age ofthe patient appeared to have significant influence on the prevalence of PAD.In conclusion, this study demonstrates a negative correlation between hsCRP and ABI score;and high levels of hsCRP appeared to be a risk factor for PAD. The age of the patient, however,appeared to be the strongest risk factor for PAD.
PELAYANAN KESEHATAN LANJUT USIA DI WILAYAH KERJA PUSKESMAS I DENPASAR SELATAN I.G P.S. Aryana; R. A.T. Kuswardhani; I. N. Astika; I. B.P. Putrawan; N. K.R. Purnami; A. A.M.P. Triningrat; I.D. G.A.E. Putra; N. K.S. Diniari; K. Widyastuti
Buletin Udayana Mengabdi Vol 21 No 1 (2022): Buletin Udayana Mengabdi
Publisher : Lembaga Penelitian dan Pengabdian kepada Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (424.952 KB) | DOI: 10.24843/BUM.2022.v21.i01.p07

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Meningkatnya jumlah lansia menjadi tantangan bagi kita semua. Jumlah lansia yang mencapai 6146 lansia (23.44% dari total penduduk) di kecamatan Denpasar Selatan. Rumitnya permasalahan kesehatan yang dialami oleh lansia serta karakter khusus yang dimiliki oleh lansia, maka diperlukan cara dan pendekatan yang berbeda dengan melakukan pemeriksaan kesehatan dari komprehensif (aspek bio-psiko-sosial) sehingga dapat meningkatkan kesadaran pada lansia untuk memelihara kesehatan sendiri dan meningkatkan kemampuan dan peran serta keluarga dan masyarakat dalam mengatasi kesehatan lansia. Kegiatan yang akan dilakukan yaitu pelayanan kesehatan lansia dengan pemeriksaan kesehatan secara komprehensif meliputi pengkajian paripurna pasien geriatri (P3G), pemeriksaan fisik, Mata, THT, kesehatan jiwa dan saraf). Pengabdian masyarakat dilakukan pada lansia di Desa Sesetan, Denpasar Selatan. Lansia yang ikut serta dalam pengabdian ini berjumalah 130 orang. Lansia dengan kelompok usia 60-69 tahun berjumlah 72 orang (55,4%) paling banyak hadir pada pelayanan kesehatan. Laki-laki sebanyak 44 orang (33,8%) dan 86 orang (66,2%) berjenis kelamin perempuan. Hasil dari pemeriksaan didapatkan 75 orang (57,7%) sedang menderita penyakit infeksi, 8 orang (6,2%) mengalami malnutrisi, 49 orang (37,7%) mengalami obesitas, dan 25 orang (19,2%) mengalami sarkopenia (kehilangan massa otot). Berdasarkan dari hasil pemeriksaan kesehatan lansia, kegiatan pelayanan kesehatan lansia ini diharapkan memberikan manfaat kepada lansia dan keluarganya.
FAKTOR-FAKTOR YANG MENENTUKAN KEKUATAN GENGGAMAN TANGAN PADA PASIEN LANJUT USIA DI PANTI WREDHA TANGTU DAN POLIKLINIK GERIATRI RSUP SANGLAH - DENPASAR Putrawan, IB Putu; Kuswardhani, RA Tuty
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Handgrip strength is necessary for performing activities of daily living, which, in turn, are required to maintain functionalactivity. The purpose of this study was to determine anthropometric and personal factors that affect handgrip strength in groupsof nursing home and out patients of Sanglah Teaching Hospital Denpasar-Bali. Body weight and height, Waist Circumference(WC), Mid-Upper-Arm Circumference (MUAC) and triceps skinfold, scapula skinfold and supra iliaca skinfold were obtainedusing standard techniques. Body height was estimated from kneeheight. Handgrip was measured using a mechanical handgripdynamometer. A total of 38 male and 53 female aged 60 ? 82 years participated in the study. Both groups were statistically similarregarding all factors studied. Bivariate analyses showed that handgrip strength was associated with sex, age, WC, hemoglobin,albumin and body mass index in both of groups. Multiple linear regression analysis identified sex and WC (r = 0.39; p = 0.00),sex and age (r = 0.71; p = 0.00), as independent determinants of handgrip strength in both of groups. We conclude that womenhave a smaller handgrip strength than men. In addition, handgrip strength decreases with increasing age and decreasing WC.
KORELASI ANTARA GERIATRIC NUTRITIONAL RISK INDEX DENGAN LAMA RAWAT PASIEN GERIATRI DI RUMAH SAKIT SANGLAH, DENPASAR Andriyasa, K; Kuswardhani, RA Tuty; Aryana, IGP Suka; Astika, N; Putrawan, IB
journal of internal medicine Vol. 12, No. 2 Mei 2011
Publisher : journal of internal medicine

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Abstract

Patients at risk of malnutrition are associated with a poor outcome. There are several tools that we can use to assess thenutritional status. European Society of Parenteral and Enteral Nutrition (ESPEN) guidelines and the French Program NationalNutrition Sante (PNNS) recommend Mini Nutritional Assessment (MNA) to detect the risk of under nutrition among elderlysubjects. The MNA which based on a Questionnaire does not use biological indicators. It is more adapted to the elderly at homeor nursing home setting than hospitalization. We want to evaluate the new tool Geriatric Nutritional Risk Index (GNRI) that moresimple than MNA to assess nutritional status and predict hospitalization outcomes in geriatric patients.This is a cohort study to evaluated correlation between GNRI score with length of stay in elderly patients. We evaluatednutritional status using Geriatric Nutritional Risk Index (GNRI) and Mini Nutritional Assessment (MNA) for elderly patientsthat admitted in Sanglah Hospital (Internal Department, class III) between February 2010 and April 2010. The patients werenutritionally assessed within 48 hours of hospital admission and studied in correlation to length of stay and in-hospital mortality.Fifty complete assessments were available for analysis. There are 32 male (62%) and 18 female (38%) with mean age are67.2 (60 ? 82) years old. GNRI score and MNA correlated inversely with length of stay in elderly patients (r = -0.67; p < 0.000)and (r = -0.44; p = 0.004) respectively. There are three fatal outcome (death) and all of cases with GNRI score grade 4 (majorrisk, GNRI score < 82) . GNRI score has a significant correlation with MNA score (r = 0.72; p < 0.000).In conclusion: Poor nutritional status as measured by GNRI was associated with a longer length of stay and increased inhospitalmortality. GNRI is a simple tool and has more significant correlation with hospitalization outcomes than MNA.
HUBUNGAN ANTARA SUDUT KELENGKUNGAN THORAK DAN SELISIH TINGGI BADAN UKUR DAN TINGGI BADAN HITUNG BERDASARKAN TINGGI LUTUT PADA PASIEN USIA LANJUT DI POLIKLINIK GERIATRI RUMAH SAKIT SANGLAH DENPASAR Wiryani, Cilik; Kuswardhani, Tuty; Aryana, Suka; Astika, Nyoman; -, Yanson; Widana, K
journal of internal medicine Vol. 11, No. 1 Januari 2010
Publisher : journal of internal medicine

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Abstract

Anthropometric measurements are part of the nutritional assessment which is an important component of health care.Measuring the individual!s stature with accuracy is very important because it is a basis for estimating basal energy expenditureand consequent nutrient needs and to calculate indices of nutrient status. However, common methods of nutritional anthropometricassessment are not entirely satisfactory for all elderly persons. Certain measurements such as stature may be difÞ cult to obtainbecause of postural changes, thinning of the disks of the spinal column, and diminution in the height of the vertebrae, all of whichare associated with aging.This study conducted to investigate the correlation between thoracic hyperkyposis with the difference of height calculatedwith WHO formula and actual height measurements in elderly patients among geriatric outpatient clinic, Sanglah hospital. Thisis a descriptive study at August 2008. Height was calculated with WHO formula. For men 59.01 + (2.08 x knee height) and forwomen 75 + (1.91 X knee height) - (0.17 X age) and compared with actual height measurements. Data analyzed with analyticdescriptive Spearman!s correlation.There were 91 elderly patients included, male 38 (41.8%), female 53 (58.2%). Mean of age was 70.61 years ± 5.75 SD,actual height measurements was 155.30 cm ± 9.37 SD, height calculated with formula was 160.35 cm ± 8.59 SD, knee heightwas 49.60 ± 3.39 SD, thoracic hyperkiposis was -17.210 ± -11.7 SD and the difference between height formula and actual heightmeasurements was 4.99 cm ± 5.84 SD.There were no correlation between thoracic hyperkyposis and the difference of heightcalculated with WHO formula and actual height measurement with r = 0.001, p = 0.993. There were no correlations betweenbetween thoracic hyperkyposis with the difference of height calculated with speciÞ c formula and actual height measurements inelderly patients among geriatric outpatient clinic, sanglah hospital
Older Age and Worse Nutritional State Were Related with Impaired Inflammatory Response in Elderly Patients Kuswardhani, Tuty; Sukrawan, Gede; Suastika, Ketut
BALI MEDICAL JOURNAL Vol 5 No 2 (2016)
Publisher : BALI MEDICAL JOURNAL

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Abstract

Background: Ageing process is related with multisystem disorders. One of them is immune response impairment. It is imperative to evaluate the association between age and related nutritional status with inflammatory response in elderly patient. Methods: A cross sectional study to evaluate inflammatory response among elderly patients (?60 years) at Geriatric Out -patient Clinic, Sanglah Hospital was conducted. Seventy-two patients were enrolled in the study. Age, nutritional states (body mass index and mini nutritional assessment), and inflammatory markers (interleukin-2 [IL-2] and C-reactive protein [CRP]) and other anthropometric as well as laboratory parameters were measured in the study. Results: In the study it was revealed that age has a moderately negative correlation with both of plasma IL-2 and serum CRP levels (R= -0.305, p=0.009; and R= -0.413, p=0.005, respectively). Plasma IL-2 levels were positively correlated with several variables like body mass index (R=0.282, p=0.016), mini nutritional assessment (R=0.237, p=0.045), biceps skin fold (R=0.291, p=0.013), and triceps skin fold (R=0.258, p=0.028). While serum CRP levels has positive correlation with lying diastolic blood pressure (R=0.345, p=0.020) and negative correlation with calf circumference (R=-0.312, p=0.037). No significant associations were found between diabetes and hypertension with inflammatory markers. Conclusion: This study concluded that older age and worse nutritional state were related to worse inflammatory response in the elderly patients.
PERBEDAAN PENGARUH ANTARA LATIHAN GERAK TARI JAWA TENGAH MODIFIKASI DENGAN LATIHAN PROPRIOSEPTIF TERHADAP KESEIMBANGAN DINAMIS PADA LANSIA Catarina Budi P; RA Tuty Kuswardhani; S. Indra Lesmana; I Putu Gede Adiatmika; J. Alex Pangkahila; Ni Wayan Tianing
Sport and Fitness Journal Vol 8 No 3 (2020): Volume 8, No. 3, September 2020
Publisher : Program Studi Magister Fisiologi Keolahragaan, Fakultas Kedokteran, Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/spj.2020.v08.i03.p03

Abstract

Pendahuluan: Proses penuaan dialami semua manusia secara alamiah. Penuaan ditandai perubahan yang terjadi pada sistem-sistem tubuh manusia. Sistem muskuloskeletal, sistem persyarafan, sistem kardiovaskuler, dan pancaindera mengalami perubahan-perubahan yang berdampak pada timbulnya gangguan pada lansia seperti gangguan keseimbangan, gangguan koordinasi, serta ganggua kognitif. Hal-hal tersebut menimbulkan berbagai permasalahan pada lansia, terutama masalah keseimbangan yang berdampak meninggiya resiko jatuh, penurunan performa akifitas hingga berkurangnya produkifitas lansia bahkan kematian. Latihan yang baik untuk meningkatkan keseimbangan lansia adalah latihan aktifitas dinamis (dynamic activities) antara lain latihan tari Jawa Tengah modifikasi dan latihan proprioseptif. Tujuan: (1) untuk membuktikan bahwa latihan tari Jawa Tengah modifikasi meningkatkan keseimbangan dinamis pada lansia, (2) membuktikan bahwa latihan proprioseptif dapat meningkatan keseimbangan dinamis pada lansia, dan (3) Antara latihan tari Jawa Tengah modifikasi dan latihan proprioseptif manakah yang lebih meningkatkan keseimbangan dinamis pada lansia. Metode: dilakukan penelitian terhadap komunitas lansia pada paguyuban Simeon-Hanna di Gereja Maria Assumpa Klaten. Penelitian melibatkan dua kelompok perlakuan yaitu kelompok dengan intervensi latihan tari Jawa Tengah modifikasi dan kelompok latihan .proprioseptif. Penelitian dilakukan selama 8 minggu dengan frekwensi 2 kali perminggu dan durasi 55 menit dalam satu sesi latihan. Alat ukur untuk keseimbangan diamis dan resiko jatuh menggunakan Time Up and Go (TUG) test. Hasil penelitian didapatkan: (1) Terdapat peningkatan keseimbangan dinamis pada kelompok latihan tari jawa tengah modifikasi dengan nilai p=0,000 (p?0,05) (2) terdapat peningkatan keseimbangan dinamis pada kelompok latihan propriosetif dengan nilai p= 0,012 (p?0,05). (3)Tidak ditemukan perbeda signifikan pada perubahan keseimbangan dinamis baik pada kelompok latihan tari maupun kelompok latihan proprioseptif yang ditunjukkan dengan nilai p=0,069 (p?0,05). Simpulan: latihan tari Jawa Tengah modifikasi dan latihan proprioseptif sama-sama baik untuk meningkatkan keseimbangan dinamis lansia Kata kunci: keseimbangan dinamis, tari Jawa Tengah modifikasi, latihan propriosepif
Dampakanemiapadafungsikognitifpasiengeriatri yangdirawatdiRumah Sakit Umum Pusat Sanglah Denpasar Laksono, Baskoro Tri; Kuswardhani, RA Tuty
Medicina Vol 47 No 3 (2016): September 2016
Publisher : Medicina

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Abstract

Anemiamerupakanmasalahyang seringdijumpai padagolongan geriatrikdengankonsekuensi yangserius. Belumbanyak penelitian yang meneliti pengaruh anemia terhadap fungsi kognitif. Penelitianinibertujuanuntukmengetahuihubungan antaraanemiadangangguan kognitif pada pasiengeriatrik yang dirawat di RSUP Sanglah Denpasar.Penelitianinimerupakan studianalisispotong-lintang. Penelitiandilakukanpadapasiengeriatri (usia?60tahun)yangdirawat di BagianPenyakit Dalam RSUP Sanglah Denpasar. Sebanyak121pasien terdaftar dalampenelitian ini.Status anemia dan fungsi kognitif didefinisikan dengan menggunakan kriteria WHOdan mini-mental stateexamination(MMSE). Uji Chi-square atauFisher-exact digunakanuntuk menguji signifikansi antara keduanya.Risikodiperkirakan menggunakanrasioodds (RO) dan interval kepercayaan(IK) 95%. Prevalens anemia dangangguan kognitifpada pasiengeriatrikyangdirawat diRSUPSanglahadalah62,8%dan47,2%. Gangguan kognitiflebih umumterjadi di kalangan perempuan dibanding lelaki (50,88%vs 49,12%) dan pasien usia ?70 tahundibandingkan<70 tahun(63,15%vs 36,84%). Tidakditemukanhubunganyang signifikan antara anemia dangangguan kognitifpadapasiengeriatri (P=0,32).Disimpulkan bahwa tidak adahubungan antaraanemiadangangguankognitifpada pasiengeriatriyang dirawatdiRSUP Sanglah Denpasar.[MEDICINA.2016;50(3):6-9].Anemia isa common problem with serious consequences ingeriatricpatients but the impact of anemia on cognitivefunction has not been extensivelystudied.The aimof this study wasto evaluate the association between anemia andcognitive impairment in hospitalizedgeriatric patients at Sanglah Hospital Denpasar. This was a hospital-basedanalytic cross-sectional study. The data were derived from the medical records ofgeriatricpatients (age?60 years)admitted toDepartment ofInternal Medicine SanglahHospitalDenpsar. A total of 121elderly patients were enrolled.Anemic status and cognitivefunction were defined using WHO-criteria andmini-mental state examination(MMSE)questionnaires, respectively. Chi-square or Fisher-exact test wasused to test thesignificance between 2 proportions.The risk was estimated by usingoddsratio(OR) and 95%confidence interval(CI). The overall-prevalence of anemiaand cognitive impairment among hospitalized elderly patients was 62.8% and 47.2%, respectively. Cognitiveimpairment was more prevalent infemalethan male (50.88% vs. 49.12%) and inpatientswith the age>70 vs<70years(63.15% vs. 36.84%). We found no significantassociationbetween anemia and cognitive impairment ingeriatricpatient (P=0.32). It was concluded that there is no association between anemia and cognitive impairment inhospitalizedgeriatricpatientsatSanglah hospital.[MEDICINA.2016;50(3):6-9].
Co-Authors A Santoso Anak Agung Ayu Ratih Hapsari Anak Agung Gede Angga Puspa Negara Anak Agung Mas Putrawati Triningrat Anak Agung Wiradewi Lestari Anwar Santosa Anwar Santoso Baskoro Tri Laksono Budiana, I Nyoman Catarina Budi P Cilik Wiryani Cok I. I. Purwaningsih Cokorda Agung Wahyu Purnamasidhi Dewianti Dewianti Dewianti, Dewianti Diah Pradnya Paramita Dian Pritasari Jeger Dyah Pradnyaparmita Duarsa Gede Sukrawan I Gusti Agung Wilaja Putra I Gusti Putu Suka Aryana I Ketut Suastika I Made Ady Wirawan I Made Bakta I Made Jawi I Made Jawi I Made Siswadi Semadi I Nyoman Adi Putra I Nyoman Astika I Nyoman Wande I Nyoman Wande I Putu Gede Adiatmika I Putu Gede Adiatmika I Wayan Mustika I Wayan Mustika I Wayan Mustika I Wayan Wita I. N. Astika I.D. G.A.E. Putra Ida Bagus N Maharjana Ida Bagus Putu Putrawan IGP Adiatmika IN Astika Iswara, Ni Putu Ayu Astri Prana IW Yuna Ariawan J. A. Pangkahila K Andriyasa K Widana K. Widyastuti Kadek Tresna Adhi Ketut Tirtayasa Lanawati Lanawati, Lanawati M. Ali Imron Made Nopriantha Made Nopy Diah Sundari Muhammad Irfan N Astika N. Adiputra N. K.S. Diniari Ngakan Ketut Wira Suastika, Ngakan Ketut Wira Ni Ketut Rai Purnami Ni Putu Ayu Astri Prana Iswara Ni Wayan Tianing Paramita, Diah Pradnya Purwaningsih, Cok I. I. Putra, I Komang Wisuda Dwija Putu Ayu Indrayathi Putu Ayu Sani Utami Putu Mulya Kharismawan Putu Shely Prihastuti Rudy Rina Listyowati Rina Listyowati, Rina S. Indra Lesmana Saktivi Harkitasari, Saktivi Sawitri, Anak Agung Sagung Semaradana, Wayan Giri Putra Shelvy Florence Gousario Siti Nadhir Ollin Norlinta Sundari, Made Nopy Diah Surya Rini, Sandra Susy Purnawati Trisna Yuliharti Tersinanda Wahyuddin, Wahyuddin Wayan Giri Putra Wimpie I Pangkahila Wira Gotera Wirawan, I Made Budi Wisnu Wardhana Yanson - Yosef Samon Sugi