CHAPTER IINTRODUCTION
A. BackgroundSexual life is a part of human life, so the quality of sexual life in determining quality of life. A healthy sexual relationship is sexually desired, can be enjoyed as a couple husband and wife and no bad consequences both physically and psychologically included in this elderly couple.Older adults (Late adult hood) or better known as the elderly is a period in which a person has reached the age of 45 years. In this period of sexual problems still bring heterodox views, especially in women who were married, including socio-economic aspects. In older men the biggest problem is the psychological and physical problems, whereas in elderly women are dominated by feelings of old age or feel old.On research in western countries, the obvious bias view. Kinsey study that takes a sample of thousands of people, it only took 31 women and 48 men aged over 65 years. Masters-Jonhson research also took samples mainly those aged between 50-70 years, with 1066 being Hite study sample including only 6 women aged over 70 years (Alexander and Allison, 1995).
CHAPTER IIDISCUSSION
I. Anatomic changes in the system genetalia in elderlyA. WomanWith the cessation of estrogen production, internal and external genitalia gradually atrophy.1. Vagina· Vagina have contractures, length and width of the vagina experiencing downsizing.· Fornises be shallow, so are no longer cervix protrudes into the vagina. Since the climacteric, the vagina gradually undergo atrophy, although the woman has never given birth. Sex glands shrink and stop functioning ¬. Genital mucosal thinning as well as sub-mucosal tissue no longer maintain its elasticity due to fibrosis ¬.· These changes are to some extent influenced by sustainability ¬ langsungan coitus, meaning that the longer they are carried out less sedimentation rate or diminution of the external genitalia.2. UterusAfter klimaterium uterine atrophy, penile length and wall thinning, myometrium and become a little more fibrotic tissue. Cervical shrink not prominent, even after a long time will be evenly distributed to the network wall.
3. OvaryAfter menopause, the egg size decreases and the surface becomes "wrinkles" as a result of atrophy of the medulla, is not a result of previous repeated ovulation, the ovarian surface becomes flat again like a child because there is no follicle. In general, physical changes in the internal and external genetalia affected by ovarian function. When the ovaries stop functioning, generally occurs atrophy and inactivity organ growth occurs by the hormones estrogen and progesterone.4. Breast (mammary glands)Breasts will shrink and become flat, except in women who are obese, which remains great and hanging breasts. This situation is caused by the atrophy only affects the mammary gland only.Affecting the anterior pituitary gland histologically and functionally, as well as the thyroid and adrenal glands become "hard" and similar body shape mengkibatkan mild acromegaly. Shoulders become fat and waist line disappears. Sometimes arises hair growth on the face. Armpit hair, pubic subtraction, because its growth is influenced by the adrenal glands and ovaries not gland. Head hair became sparse. Weight gain often occurs during the climacteric.B. Man1. ProstateProstate enlargement is a frequent occurrence in older men, the symptoms are due to enlargement of the mechanical effect of medial lobe which then, as if acting as a ball-shaped valve (Ball Valve Effect). Besides, there is a dynamic effect on the smooth muscle which is 40% of the components of the gland, capsule and bladder neck, under the influence of the smooth muscle alpha-adrenergic system. Incidence of microscopic nodules ¬ kopik've seen at the age of 25-30 years and present in 60% of men aged 60 years, 90% in men aged 85 years, but only 50% are being BPH Macroscopic and of that only 50% developed into clinical BPH cause medical problems.Dehidrosteron levels in the elderly increased due to increased enzyme 5 alpha reductase that mengkonfersi tetosteron be dehidro steron. It is considered to be the driving gland hyperplasia, muscle and prostate stroma. Actually, other than the aging process contributes onset of androgen stimulation is proved BPH in men who in castration before puberty will not suffer from BPH in the elderly.2. TestisAging in men does not cause a reduction in the size and weight of the testes, but the cells that produce and nourish (Leydic cells) reduced the number of sperm and sperm activity that is reduced to 50% and also decreased testosterone. This causes the drop in libido and sexual activity decline is obvious and multiple ejaculatory refractory period extension. But many elderly group still running sexsual activity until advanced age.
II. Physiological changes in sexual activity due to the aging process when the review of the sexual stage in the Kaplan division is the following:1. Phase desireAffected by illness, relationship problems, cultural expectations, worries about the ability of sex. Desire in older women may decrease with increasing age continued, but the bias bervariasi.Interval to increase sexual desire in older men increased and testosterone decreased gradually since the age of 55 years will affect libido.2. Arousal phase· Elderly women: breast augmentation reduced, there is a decrease flushing, the elasticity of the vaginal wall, vaginal lubrication and stretching muscles; irritation of the urethra and bladder.· Elderly men: erection takes longer, and less so powerful; decreased sperm production since the age of 40 years due to decreased testosterone; elevation slower testicles to the perineum.
3. Orgasmic phase· Elderly women: responses orgasm less intense with less konstraksil reduced ability to get multiple orgasm.· Elderly man: improved ability to control ejaculation; strength and reduced number of muscle contraction; decreased ejaculate volume.4. Post-orgasmic phaseMaybe there is a refractory period in which the generation of passion until the onset of the next phase is more difficult to orgasm occurs. Sexual dysfunction in the elderly is not only caused by physiological changes course, there are many other causes such as:· The cause of iatrogenicBad behavior of some clinicians, doctors, nurses and others who may make inadequate counseling about the effects of the surgical procedure on sexual function.· Cause Biological and medical caseAlmost all chronic debilitating conditions that either directly or indirectly related to sex and reproduction system may spur psychogenic sexual dysfunction.
III. In addition to the factors of physical changes, psychological factors are also often lead to decreased function and sexual potency in elderly such as:
1. Sense of taboo or embarrassment when maintaining sexual life of the elderly.2. Family and community attitudes are less supportive and reinforced by tradition and culture.3. Fatigue or boredom due to lack of variety in his life.4. Spouse has died.5. Sexual dysfunction due to hormonal changes or other mental health problems such as anxiety, depression, dementia, etc..
IV. Some things that can lead to social problems such as:1. Myocardial infarctionMay have a small effect on sexual function. Many patients are reluctant to engage in sexual intercourse for fear of causing infarction.2. Post-strokeSexual problems may arise after hospitalization for patients experiencing anxiety due to changes in body image, loss of capacity, fear of loss of love or support or employment relationship as well as the guilt and shame over the situation. Sexual patterns including the quantity and quality of sexual activity before the stroke is very important to know before specific advice about sexual activities offered. Because the autonomic nervous system rarely damaged in a stroke, the sexual response may not be affected.Libido is usually not affected directly. If there hemiplegi permanent will require adjustments in sexual activity. Changes in vision may limit the introduction of people or objects, in some cases, the patient and her partner may need to learn to use the undamaged area. Motor weakness can lead to mechanical difficulties, however, can be overcome by physical or technical assistance "fuck" alternative. Lost the ability to speak may require a non-verbal system of communication.3. CancerSexual problems are not limited to cancers of the sex organs. Neither surgery nor medication rebrand themselves and can lead to sexual dysfunction (strength and libido) for a short while only, although there is no nerve damage.
4. Diabetes mellitusDiabetes causes arteriosclerosis and in many cases cause autonomic neuropathy. This may cause dysfunction erectile dysfunction and vasoconstriction that contributes to sexual dysfunction.5. ArthritisSome positions intercourse is painful and weakness or flexion contractures may interfere if adequately stimulated. Pain and stiffness may be reduced by heating, exercise, analgesics before sexual activity.6. Cigarettes and alcoholAlcohol consumption and tobacco smoking reduces sexual function, especially when there is damage to the liver which affects the metabolism of testosterone. Smoking also may reduce vasocon affect sexual response and ability to experience pleasure.7. Chronic obstructive pulmonary diseaseThere is a chronic obstructive pulmonary disease, libido may be affected due to general fatigue, respiratory requirements during sexual activity may cause dyspnoea, which may be life-threatening.8. DrugsSome medications can cause sexual dysfunction, such as some antihypertensive drugs, estrogen, anti-psychotics, sedatives, and others.
V. Efforts to overcome sexual problems in elderlyTo overcome some of the physical and psychological disorders including sexual problems need serious handling and integrated. This treatment process requires considerable time depending on the complaint and cooperation between patients with a counselor. Of the three disorders, sexual problems handling an issue that requires patience and caution, because some of the people of Indonesia, especially in rural communities talk about sexual issues is taboo issue.Management committed health workers to overcome sexual disorders in the elderly are as follows:1. Anamnesis Sex History· Use language that mutually beneficial and satisfying· Use a mixture of open questions and teutup· Getting an accurate picture of what is really wrong· Describe the length permasaIahanya· Get medical background includes a complete list of medications consumed called for by the patient.
Examination should be performed before her partner. Anamnesis should be detailed, including onset, type and intensity of perceived interference. Also the anamnesis of systemic disorders or organic felt. A study of the psychological disorders, cognitive be done. Also anamneses about drugs. The physical examination includes head to toe.Supplementary examination was conducted on the state of the heart, haati, kidneys and lungs. Endocrine status and metaboliuk include blood sugar condition, nutritional status and certain hormonal status. If complaints regarding ereks dysfunction in men, typical examination also includes al examination with snap gauge or nocturnal penile tumescence testing. (Hadi-Martono, 1996)2. Treatment given include:· Psychosexual· Hormone Therapy· Healing with drugs· Mechanical Equipment· Surgical Tubes3. Psychosocial counselingGuidance and counseling is very overlooked in the planning and management of disorders of sex combined with pharmakologi healing.4. Healing Hormones· In elderly men: The use of testosterone supplements to cure viropause / andropause in men (heating and ejaculation).· In elderly women: hormone replacement therapy (HRT) with estrogen on climacteric.5. Healing with Medicinal· Yohimbine, use of vasoactive cream· Oral phentholamin· Tablet sublingual apomorphine· Sildenafil, injecting vasoactive drugs intra-carporal· Placement of intra-urethral prostaglandin
CHAPTER IIINURSING CARE OF ELDERLY WITH SEXUAL FUNCTION PROBLEMS
Assessment
a. Client Identity1. Client Name2. Age3. Religion4. Tribe5. Education6. Address7. Job8. Religion and belief affect health9. Socioeconomic status of the family
b. Get Sexual history:· Sexual pattern usually· Satisfaction (individual, couple)· Sexual Knowledge· Problems (sexual health)· Expectations· Mood, energy level
Nursing Diagnosis
1. Sexual dysfunction associated with changes in body structure / function which is characterized by a change in achieving sexual satisfaction.Objective: Patients can receive structural changes in the body, especially on her sexual functionOutcomes:1. Expressing comfort2. Expressing confidenceIntervention:1. Help the patient to express changes in the function of the body including the sexual organs with age.2. Discuss some options in order to achieve comfort.3. Provide health education on sexual function decline.4. Client motivation to consume foods that are low fat, low cholesterol, and a vegetarian diet5. Encourage clients to use vaginal creams and gels to reduce dryness and itching of the vagina, as well as to reduces pain during intercourse2. Body image disturbance associated with changes in the form of one of the members of the body.Objective: Patients can receive one of the members change her body shape in a positiveOutcomes:1. Patients want to interact and adapt to the environment without any sense of shame and low self-esteem2. Patients confident capabilitiesIntervention:1. Assess feelings / perceptions of patients about self-image changes associated with members of the state body that is not functioning normally2. Do approach and establish a trusting relationship with patients3. Show empathy, attention and acceptance in patients4. Help the patient to make contact with other people5. Allow the patient to express feelings of loss6. Encourage patients to participate in self-care and appreciate constructive problem solving from the patient.3. Changing patterns of sexuality associated with the effects of acute and chronic diseasesObjective: Patients can receive sexuality pattern changes caused health problems.Criteria results:1. Identify limitations on sexual activity due to health problems2. Identify modifications of sexual activity is appropriate in response to the limitationsInterversi:1. Assess the factors causing and supporting, which includes· Fatigue· Pain· Shortness of breath· The limited supply of oxygen· Immobilization· Damage to the nervous innervation· Changes in hormone· Depression· Lack of proper information2. Eliminate or reduce the factors causing when possible. Teach the importance of obeying rules are made to control medical symptoms3. Provide limited information and specific advice· Provide appropriate information to patients and their partners about sexual functioning limitations due to ill health· Teach modifications are possible in the sexual activity to help comply with the limitations caused by illness (specific advice)
REFERENCEShttp://abhique.blogspot.com/2009/10/konsep-keperawatan on lnjut age (elderly). htmlhttp://abhique.blogspot.com/2009/10/rencana nursing care to lansia.htmlCarpenito, Lynda Juall.2000.Diagnosa Keperawatan.EGC.JakartaReny Aspiani Yuli, S.Kep.Ns.Buku Festive Nursing Gerontik.2008.
A. BackgroundSexual life is a part of human life, so the quality of sexual life in determining quality of life. A healthy sexual relationship is sexually desired, can be enjoyed as a couple husband and wife and no bad consequences both physically and psychologically included in this elderly couple.Older adults (Late adult hood) or better known as the elderly is a period in which a person has reached the age of 45 years. In this period of sexual problems still bring heterodox views, especially in women who were married, including socio-economic aspects. In older men the biggest problem is the psychological and physical problems, whereas in elderly women are dominated by feelings of old age or feel old.On research in western countries, the obvious bias view. Kinsey study that takes a sample of thousands of people, it only took 31 women and 48 men aged over 65 years. Masters-Jonhson research also took samples mainly those aged between 50-70 years, with 1066 being Hite study sample including only 6 women aged over 70 years (Alexander and Allison, 1995).
CHAPTER IIDISCUSSION
I. Anatomic changes in the system genetalia in elderlyA. WomanWith the cessation of estrogen production, internal and external genitalia gradually atrophy.1. Vagina· Vagina have contractures, length and width of the vagina experiencing downsizing.· Fornises be shallow, so are no longer cervix protrudes into the vagina. Since the climacteric, the vagina gradually undergo atrophy, although the woman has never given birth. Sex glands shrink and stop functioning ¬. Genital mucosal thinning as well as sub-mucosal tissue no longer maintain its elasticity due to fibrosis ¬.· These changes are to some extent influenced by sustainability ¬ langsungan coitus, meaning that the longer they are carried out less sedimentation rate or diminution of the external genitalia.2. UterusAfter klimaterium uterine atrophy, penile length and wall thinning, myometrium and become a little more fibrotic tissue. Cervical shrink not prominent, even after a long time will be evenly distributed to the network wall.
3. OvaryAfter menopause, the egg size decreases and the surface becomes "wrinkles" as a result of atrophy of the medulla, is not a result of previous repeated ovulation, the ovarian surface becomes flat again like a child because there is no follicle. In general, physical changes in the internal and external genetalia affected by ovarian function. When the ovaries stop functioning, generally occurs atrophy and inactivity organ growth occurs by the hormones estrogen and progesterone.4. Breast (mammary glands)Breasts will shrink and become flat, except in women who are obese, which remains great and hanging breasts. This situation is caused by the atrophy only affects the mammary gland only.Affecting the anterior pituitary gland histologically and functionally, as well as the thyroid and adrenal glands become "hard" and similar body shape mengkibatkan mild acromegaly. Shoulders become fat and waist line disappears. Sometimes arises hair growth on the face. Armpit hair, pubic subtraction, because its growth is influenced by the adrenal glands and ovaries not gland. Head hair became sparse. Weight gain often occurs during the climacteric.B. Man1. ProstateProstate enlargement is a frequent occurrence in older men, the symptoms are due to enlargement of the mechanical effect of medial lobe which then, as if acting as a ball-shaped valve (Ball Valve Effect). Besides, there is a dynamic effect on the smooth muscle which is 40% of the components of the gland, capsule and bladder neck, under the influence of the smooth muscle alpha-adrenergic system. Incidence of microscopic nodules ¬ kopik've seen at the age of 25-30 years and present in 60% of men aged 60 years, 90% in men aged 85 years, but only 50% are being BPH Macroscopic and of that only 50% developed into clinical BPH cause medical problems.Dehidrosteron levels in the elderly increased due to increased enzyme 5 alpha reductase that mengkonfersi tetosteron be dehidro steron. It is considered to be the driving gland hyperplasia, muscle and prostate stroma. Actually, other than the aging process contributes onset of androgen stimulation is proved BPH in men who in castration before puberty will not suffer from BPH in the elderly.2. TestisAging in men does not cause a reduction in the size and weight of the testes, but the cells that produce and nourish (Leydic cells) reduced the number of sperm and sperm activity that is reduced to 50% and also decreased testosterone. This causes the drop in libido and sexual activity decline is obvious and multiple ejaculatory refractory period extension. But many elderly group still running sexsual activity until advanced age.
II. Physiological changes in sexual activity due to the aging process when the review of the sexual stage in the Kaplan division is the following:1. Phase desireAffected by illness, relationship problems, cultural expectations, worries about the ability of sex. Desire in older women may decrease with increasing age continued, but the bias bervariasi.Interval to increase sexual desire in older men increased and testosterone decreased gradually since the age of 55 years will affect libido.2. Arousal phase· Elderly women: breast augmentation reduced, there is a decrease flushing, the elasticity of the vaginal wall, vaginal lubrication and stretching muscles; irritation of the urethra and bladder.· Elderly men: erection takes longer, and less so powerful; decreased sperm production since the age of 40 years due to decreased testosterone; elevation slower testicles to the perineum.
3. Orgasmic phase· Elderly women: responses orgasm less intense with less konstraksil reduced ability to get multiple orgasm.· Elderly man: improved ability to control ejaculation; strength and reduced number of muscle contraction; decreased ejaculate volume.4. Post-orgasmic phaseMaybe there is a refractory period in which the generation of passion until the onset of the next phase is more difficult to orgasm occurs. Sexual dysfunction in the elderly is not only caused by physiological changes course, there are many other causes such as:· The cause of iatrogenicBad behavior of some clinicians, doctors, nurses and others who may make inadequate counseling about the effects of the surgical procedure on sexual function.· Cause Biological and medical caseAlmost all chronic debilitating conditions that either directly or indirectly related to sex and reproduction system may spur psychogenic sexual dysfunction.
III. In addition to the factors of physical changes, psychological factors are also often lead to decreased function and sexual potency in elderly such as:
1. Sense of taboo or embarrassment when maintaining sexual life of the elderly.2. Family and community attitudes are less supportive and reinforced by tradition and culture.3. Fatigue or boredom due to lack of variety in his life.4. Spouse has died.5. Sexual dysfunction due to hormonal changes or other mental health problems such as anxiety, depression, dementia, etc..
IV. Some things that can lead to social problems such as:1. Myocardial infarctionMay have a small effect on sexual function. Many patients are reluctant to engage in sexual intercourse for fear of causing infarction.2. Post-strokeSexual problems may arise after hospitalization for patients experiencing anxiety due to changes in body image, loss of capacity, fear of loss of love or support or employment relationship as well as the guilt and shame over the situation. Sexual patterns including the quantity and quality of sexual activity before the stroke is very important to know before specific advice about sexual activities offered. Because the autonomic nervous system rarely damaged in a stroke, the sexual response may not be affected.Libido is usually not affected directly. If there hemiplegi permanent will require adjustments in sexual activity. Changes in vision may limit the introduction of people or objects, in some cases, the patient and her partner may need to learn to use the undamaged area. Motor weakness can lead to mechanical difficulties, however, can be overcome by physical or technical assistance "fuck" alternative. Lost the ability to speak may require a non-verbal system of communication.3. CancerSexual problems are not limited to cancers of the sex organs. Neither surgery nor medication rebrand themselves and can lead to sexual dysfunction (strength and libido) for a short while only, although there is no nerve damage.
4. Diabetes mellitusDiabetes causes arteriosclerosis and in many cases cause autonomic neuropathy. This may cause dysfunction erectile dysfunction and vasoconstriction that contributes to sexual dysfunction.5. ArthritisSome positions intercourse is painful and weakness or flexion contractures may interfere if adequately stimulated. Pain and stiffness may be reduced by heating, exercise, analgesics before sexual activity.6. Cigarettes and alcoholAlcohol consumption and tobacco smoking reduces sexual function, especially when there is damage to the liver which affects the metabolism of testosterone. Smoking also may reduce vasocon affect sexual response and ability to experience pleasure.7. Chronic obstructive pulmonary diseaseThere is a chronic obstructive pulmonary disease, libido may be affected due to general fatigue, respiratory requirements during sexual activity may cause dyspnoea, which may be life-threatening.8. DrugsSome medications can cause sexual dysfunction, such as some antihypertensive drugs, estrogen, anti-psychotics, sedatives, and others.
V. Efforts to overcome sexual problems in elderlyTo overcome some of the physical and psychological disorders including sexual problems need serious handling and integrated. This treatment process requires considerable time depending on the complaint and cooperation between patients with a counselor. Of the three disorders, sexual problems handling an issue that requires patience and caution, because some of the people of Indonesia, especially in rural communities talk about sexual issues is taboo issue.Management committed health workers to overcome sexual disorders in the elderly are as follows:1. Anamnesis Sex History· Use language that mutually beneficial and satisfying· Use a mixture of open questions and teutup· Getting an accurate picture of what is really wrong· Describe the length permasaIahanya· Get medical background includes a complete list of medications consumed called for by the patient.
Examination should be performed before her partner. Anamnesis should be detailed, including onset, type and intensity of perceived interference. Also the anamnesis of systemic disorders or organic felt. A study of the psychological disorders, cognitive be done. Also anamneses about drugs. The physical examination includes head to toe.Supplementary examination was conducted on the state of the heart, haati, kidneys and lungs. Endocrine status and metaboliuk include blood sugar condition, nutritional status and certain hormonal status. If complaints regarding ereks dysfunction in men, typical examination also includes al examination with snap gauge or nocturnal penile tumescence testing. (Hadi-Martono, 1996)2. Treatment given include:· Psychosexual· Hormone Therapy· Healing with drugs· Mechanical Equipment· Surgical Tubes3. Psychosocial counselingGuidance and counseling is very overlooked in the planning and management of disorders of sex combined with pharmakologi healing.4. Healing Hormones· In elderly men: The use of testosterone supplements to cure viropause / andropause in men (heating and ejaculation).· In elderly women: hormone replacement therapy (HRT) with estrogen on climacteric.5. Healing with Medicinal· Yohimbine, use of vasoactive cream· Oral phentholamin· Tablet sublingual apomorphine· Sildenafil, injecting vasoactive drugs intra-carporal· Placement of intra-urethral prostaglandin
CHAPTER IIINURSING CARE OF ELDERLY WITH SEXUAL FUNCTION PROBLEMS
Assessment
a. Client Identity1. Client Name2. Age3. Religion4. Tribe5. Education6. Address7. Job8. Religion and belief affect health9. Socioeconomic status of the family
b. Get Sexual history:· Sexual pattern usually· Satisfaction (individual, couple)· Sexual Knowledge· Problems (sexual health)· Expectations· Mood, energy level
Nursing Diagnosis
1. Sexual dysfunction associated with changes in body structure / function which is characterized by a change in achieving sexual satisfaction.Objective: Patients can receive structural changes in the body, especially on her sexual functionOutcomes:1. Expressing comfort2. Expressing confidenceIntervention:1. Help the patient to express changes in the function of the body including the sexual organs with age.2. Discuss some options in order to achieve comfort.3. Provide health education on sexual function decline.4. Client motivation to consume foods that are low fat, low cholesterol, and a vegetarian diet5. Encourage clients to use vaginal creams and gels to reduce dryness and itching of the vagina, as well as to reduces pain during intercourse2. Body image disturbance associated with changes in the form of one of the members of the body.Objective: Patients can receive one of the members change her body shape in a positiveOutcomes:1. Patients want to interact and adapt to the environment without any sense of shame and low self-esteem2. Patients confident capabilitiesIntervention:1. Assess feelings / perceptions of patients about self-image changes associated with members of the state body that is not functioning normally2. Do approach and establish a trusting relationship with patients3. Show empathy, attention and acceptance in patients4. Help the patient to make contact with other people5. Allow the patient to express feelings of loss6. Encourage patients to participate in self-care and appreciate constructive problem solving from the patient.3. Changing patterns of sexuality associated with the effects of acute and chronic diseasesObjective: Patients can receive sexuality pattern changes caused health problems.Criteria results:1. Identify limitations on sexual activity due to health problems2. Identify modifications of sexual activity is appropriate in response to the limitationsInterversi:1. Assess the factors causing and supporting, which includes· Fatigue· Pain· Shortness of breath· The limited supply of oxygen· Immobilization· Damage to the nervous innervation· Changes in hormone· Depression· Lack of proper information2. Eliminate or reduce the factors causing when possible. Teach the importance of obeying rules are made to control medical symptoms3. Provide limited information and specific advice· Provide appropriate information to patients and their partners about sexual functioning limitations due to ill health· Teach modifications are possible in the sexual activity to help comply with the limitations caused by illness (specific advice)
REFERENCEShttp://abhique.blogspot.com/2009/10/konsep-keperawatan on lnjut age (elderly). htmlhttp://abhique.blogspot.com/2009/10/rencana nursing care to lansia.htmlCarpenito, Lynda Juall.2000.Diagnosa Keperawatan.EGC.JakartaReny Aspiani Yuli, S.Kep.Ns.Buku Festive Nursing Gerontik.2008.
