Tesis

Peran Terapi Medik Gizi pada Perbaikan Severitas Stroke dan Kapasitas Fungsional Pasien Geriatri dengan Stroke Iskemik = The Role of Medical Nutrition Therapy on Severity and Functional Capacity Improvement in Geriatric Patient with Ischemic Stroke.

Stroke iskemik pada pasien geriatri meningkatkan risiko malnutrisi yang dipengaruhi oleh beberapa faktor yaitu disfagia, tipe stroke, masalah gastrointestinal, disabilitas fisik, penyakit komorbid dan psikologis. Tujuan utama intervensi nutrisi adalah membantu pemulihan fungsi neurokognitif dan mencegah defisit energi dan protein. Pasien pada serial kasus ini adalah pasien geriatri berusia di atas 65 tahun dengan diagnosis stroke iskemik yang dirawat di RSCM pada bulan Agustus-September 2019. Terapi medik gizi diberikan pada keempat pasien sesuai dengan kondisi klinis masing-masing pasien melalui jalur enteral. Satu pasien dapat makan melalui jalur oral di akhir perawatan. Suplementasi mikronutrien yang diberikan adalah vitamin B6, vitamin B12, vitamin C, asam folat dan seng. Hasil yang didapatkan selama perawatan sebanyak tiga pasien mencapai kebutuhan energi total (KET)dan satu pasien mencapai kebutuhan 83% KET. Asupan protein mencapai target 1,2 g/kg BB atau lebih pada tiga orang pasien. Suplementasi mikronutrien mencapai nilai AKG bagi usia di atas 65 tahun. Mikronutrien belum mencapai AKG yaitu vitamin E, vitamin D, kalium, magnesium. Nutrien spesifik omega-3 dan kolin yang diperoleh dari asupan makan pada sebagian pasien belum memenuhi AKG. Lama perawatan pasien di rumah sakit 10 hingga 33 hari. Nilai severitas stroke dengan NIHSS dan kapasitas fungsional dengan FIM di akhir perawatan menunjukkan perbaikan. Keempat pasien pulang ke rumah dengan keadaan klinis perbaikan. Kesimpulan yang didapatkan yaitu terapi medik gizi yang adekuat berperan memperbaiki derajat keparahan dan kapasitas fungsional pasien geriatri dengan stroke iskemik.
Kata Kunci: kapasitas fungsional, geriatri, stroke iskemik, terapi medik gizi, severitas


The geriatric patient with ischemic stroke increased risk of malnutrition, which because various causes including dysphagia, type of stroke, gastrointestinal problems, physical disability, comorbid disease and psychological problem. The main purpose of nutrition intervention is to help restore neurocognitive function and prevent energy/protein deficits. Patients in this case series were geriatric patients aged over 65 years with a diagnosis of ischemic stroke who were treated at the Cipto Mangunkusumo General Hospital in August-September 2019. Medical nutrition therapy was given to all four patients, according to the clinical condition of each patient through the enteral route. One patient could eat by oral route at the end of treatment. Patients have given oral micronutrient supplementation consisting of vitamin B6, Vitamin B12, vitamin C, folic acid and zinc. The results obtained as many as three patients achieved total energy requirements and one patient reached 83% energy requirements. Protein intake reached the target of 1,2 g/kg body weight just in three patients. Supplementation micronutrients oral reached RDA values for people over 65 years. Micronutrients that have not yet reached the RDA were vitamin E, vitamin D, potassium, magnesium. Omega-3 and choline obtained from food intake in some patients do not meet the RDA. The length of stay in the hospital was around 10-33 days. The value of stroke severity with NIHSS and functional capacity with FIM at the end of treatment showed improvement. All four patients returned home with improvement. The conclusion obtained is that adequate nutritional medical therapy plays a role in improving the severity and functional capacity of geriatric patients with ischemic stroke.
Keywords: functional capacity, geriatric, ischemic stroke, medical nutrition therapy, stroke severity