Jurnal Widya Medika Surabaya Vol.1 No.

2 Oktober 2013

THE NEED FOR GERIATRIC PALLIATIVE CARE IN INDONESIA

Presented in :
INTERNATIONAL SEMINAR
BIOLOGY MEDICINE IN RELATION TO ADDICTION AND ELDERLY
THE SCHOOL OF MEDICINE ATMAJAYA CATHOLIC UNIVERSITY
JAKARTA.
September 19-21, 2013.

R. Sunaryadi Tejawinata*

Abstract

As the result of the progress of various aspect of medical sciences and medical services in
Indonesia, the life expectancy of Indonesian people become longer. The number of the elderly
in Indonesia is dramatically increased.

As we know there will be bio-molecular changes which will cause the changes of the
physiology of the organs and follow by the degeneration of the organs and of the system in
elderly. All of these will bring the elderly to frailty, which obviously need various supports.

Palliative Care, while appropriate for all ages groups, will thus take on an increased
importance with the elderly. In the Decree of the Minister of Health of the Republic o Indonesia,
clearly mentioned that palliative care is not only for cancer patients, but also for patients with
nonmalignant diseases, such as patients suffering from degenerative diseases. Pope Benedict
XVI said, “often today society, which is dominated by the logic of efficiency and profit, doesn’t
welcome it as such. The quality of a society or civilization can be judged by how it treats the
elderly”.

Keywords : Geriatric, palliative care

Abstrak

Sebagai hasil kemajuan dari berbagai aspek pengetahuan medis dan pelayanan medis di
Indonesia, usia harapan hidup penduduk Indonesia menjadi lebih panjang. Jumlah lansia di
Indonesia bertambah secara dramatis.

Sebagaimana kita ketahui bahwa pada lansia akan terjadi perubahan-perubahan bio-
molekuler yang menyebabkan terjadinya perubahan fisiologi yang diikuti oleh degenerasi dari
organ-organ dan sistem pada lansia. Semua ini akan membawa lansia kepada suatu keadaan
“frailty”, yang jelas menyebabkan lansia itu membutuhkan berbagai dukungan.

Perawatan Paliatif, selain dapat diberikan kepada semua umur, dan menjadi lebih penting
bagi lansia. Di dalam Surat Keputusan Menteri Keehatan Republik Indonesia, jelas dikatakan

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R. Sunaryadi Tejawinata

bahwa perawatan paliatif tidak hanya untuk penderita-penderita penyakit kanker, tetapi juga
bagi mereka yang menderita karena penyakit non-kanker seperti penyakit-penyakit degeneratif.
Sedangkan Paus Benedictus XVI mengatakan: “dewasa ini masyarakat yang didominasi oleh
logika efisiensi dan keuntungan, sering tidak menerima apa adanya lansia. Kualitas masyarakat
atau peradaban dapat dinilai dari bagaimana masyarakat itu memperlakukan lansia”.

Kata kunci : Geriatric, palliative care:

___________________________________________________________________________
*Dr. Soetomo Hospita – Medical Faculty Airlangga University
Surabaya – Indonesia, Indonesian Palliative Society

Introduction The life expectancy of the people

of Indonesia is remarkably increased. The
There is nothing so ancient in medicine average life expectancy is 69,26 years: In
as the idea of palliative care. This humane male 66,84 years. In female 71,8 years.
caring for sick patients, once the hallmark of
good medicine (Callahan, D. and Topinkeva, Mean while the recent data reported on
E). But now this humanistic efforts for caring 18 September 2008:
the patient getting more and more neglected
along with the progress of modern medical In the year 1971 the elderly was 4,5%
technologies, that is believed able to solve any of the population or 5,3 millions.
problem of the sick people. Cure, not care,
In the year 2000, the elderly was 14,4
has been the predominant note. Despite with
millions, 3 (three) fold that of 1971.
all of the much-touted sophisticated medical
technology, which forces an old insight to In the year 2005, the elderly reached
sink; people still get sick and die, and old age 7% of the population of Indonesia.
with its burdens of frailty and disability is still
with us. Beritastatu.com, 30 Mei 2012: The
number of elderly people in Indonesia belong
The elderly in Indonesia
to the big five in the world. In 2010, 18,04
As the result of the progress of various millions. It was 9,6% of the total population
aspect of medical sciences and medical of Indonesia.
services in Indonesia, the life expectancy
As it is written in the Indonesia Finance
of Indonesian people become longer. The
Today, 22 July 2013: Indonesian human life
number the elderly in Indonesia dramatically
expectancy is increasing. Nafsiah Mboi,
increased.
Minister of Health, to quote from the Medium
As it is reported the percentage of Term Development Plan of the Ministry
elderly population in Indonesia (anika.com of Health, stated in 2014, life expectancy
July 2004): is expected to increase to 71 years from
70,6 years in 2010. According to Bappenas
More than 65 years old is 5,1% of the projected elderly population 60 years and
population, consist of 5.308.986 male and older will increase from 18,1 million in 2010
6.845.464 female. to two fold (36 million) in 2025.

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From these data, it could be imagined expectancy. This life expectancy continues
how the Indonesian population pyramid will to increase at a rate that outstrips all of the
change. And how big will be the number of predictions of demographers. This dramatic
the elderly population in Indonesia. increase in life expectancy is an enormous
success, attributable in large part to advances
As we know there will be bio-molecular in medical sciences and medical services,
changes which will cause the changes of the along with the advances in medical technology.
physiology of the organs and follow by the Geriatric medicine recognized the fundamental
degeneration of the organs and of the systems physiologic processes of aging and that
in elderly. All of these will bring the elderly physician caring for older people needed
to frailty, which obviously need various to move beyond the single disease, single
supports. organ system, or single specialty approach,
Palliative care and Geriatrics. to examine the interaction of multiple chronic
illnesses, multiple medications, and highly
Aging is not a disease but a natural variable physiologic status at the center of
condition of human life, marked by a gradual increasing risk.
decline of many important physiological
capacities and an increased risk of illness, Palliative care is also “new” specialty
dementia, and disability. An endlessly emerging from the recognition by some
aggressive war against death is not an clinicians that all of the wonders of modern
appropriate goal for elderly care, even though medical technology, while they have
in many cases it can and should be forestalled; managed to rescue many people from death,
and in many other cases, it is the care and cannot ultimately erradicate mortality. The
comfort of the patient that should became the early leader of palliative care recognized the
focus. important historical roots in medicine and
nursing of caring for the dying, relieving pain
Palliative care, while appropriate for and suffering, providing support, answering
all age groups, will thus take on an increased questions, and stay with family at the bedside
importance with the elderly. That is not only of a dying patient.
because of an increase in the lesser burdens of
aging, those comparatively minor aches and Palliative care originally focused on
pains and functional losses that ordinarily go the extremely important goal of improving
with the biology of aging, even for those in the quality of care for patients at the end of
good health, but also because of a gradually life. Its focus was the quality of life for the
increased risk of more serious disabilities. At few remaining days or weeks that patient
some points, the goal of a peaceful death, will might have and respecting individual dignity
become the right goal, calling for an increase and humanity, As this matured over the last
intensity of palliative care and a renewed decade, it has recognized that predicting when
emphasis on the relief of pain and suffering death will come is difficult until the very late
(Callahan, D. and Topinkova, E.). stages of certain illnesses. Palliative care has
confronted and overturned the assumption
Geriatric medicine and palliative care that this model is only morally relevant when
Geriatric medicine emerged from the “nothing else can bid one to prolong life”.
stunning observation about the increasing life Modern palliative care recognizes that there

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R. Sunaryadi Tejawinata

is a gradual transition and balancing between 604/MenKes/SK/IX/1989 concerning the

the appropriateness of attempts to prolong establishment of the National Cancer Control
life and vigorous palliative management of Committee, with its one of the subcommittees
symptoms. Both can occur at the same time. is Palliative Care and Pain Relief.
Nowhere is this true, or more important, than
in the care of patients in advanced stage of On 19 July 2007 established the Decree
illness. of the Minister of Health of the Republic of
Indonesia number 812/MenKes/SK/VII/2007
Palliative care definition concerning The Policy of Palliative Care. In
this decree clearly mentioned that palliative
There are many definition of palliative
care is not only for cancer patients, but also for
care were made by many institution in the
patients with nonmalignant diseases, such as
world. It became a long list of palliative care
patients suffering from degenerative diseases.
definition. From this long list we can see the
We know that the degenerative diseases occur
evolution of the definition. Definitely with
in elderly people
the consequences of the evolution in the
implementation of palliative care. The most What did Pope say about the care of elderly
recent palliative care definition given by and palliative care?
World Health Organization (WHO) in 2012.
Pope John Paul II, wrote a letter dated
Obviously it is most applicable now.
October 1, 1999, to the Elderly, in the occasion
Palliative Care is an approach that of International Year of the Elderly, promoted
improves the quality of life of patients and by the United Nation. In this letter Pope
their families facing the problem associated ”direct the attention of society as a whole to
with life-threatening illness, through the the situation of these, because of the burden
prevention and relief of suffering by means of of their years, often have to face a variety
early identification and impeccable assessment of difficult problems.” The Pope adds:” The
and treatment of pain and other problems, elderly are the guardians of our collective
physically, psychosocially and spiritually. memory ………To exclude the elderly is in a
sense to deny the past, in which the presents is
It is very clear in the implementation of firmly rooted. ……..Precisely because of their
palliative care, we have to consider all aspects mature experience, the elderly are able to offer
of human. Even Harvey Cushing (1869-1939) young people precious advice and guidance.
stated: ………Human frailty become summons to
the mutual dependence and indispensable
A physician is obligated to consider solidarity which link the generation”.
more than disease organ,
more than the whole man, Pope Benedict XVI in the visit
to residence run by lay Community of
he must view the man in his world.
Sant’Egicio, Nov. 12, 2012 (Cindy Wooden,
The decree of the Minister of Health of the Catholic News Service), said: “It’s wonderful
Republic of Indonesia being old”. Urging the residents to see their
age as a sign of God’s blessing and urging
The palliative care policy in Indonesia
society to value their presence and wisdom. In
was first mentioned in the Decree of Minister
the Bible a long life is considered a blessing
of Health of the Republic of Indonesia, number

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from God, but often today society, which is centers which provide integral care, offering
“dominated by the logic of efficiency and the sick the human assistance and spiritual
profit, doesn’t welcome it as such. The quality accompaniment they need. This is a right
of a society or civilization can be judged by belonging to every human being, one which
how it treats the elderly. Pope Benedict XVI we must all be comitted to defend. ………
also insisted on recognition of the dignity The Church, following the example of the
and value of all human life, even when it Good Samaritan, has always shown particular
becomes fragile in the years of old age. Life concern for the infirm.
is wonderful even at old age, despite the aches
An appeal
and pains and some limitations.
As we understand from the above
In Evangelium Vitae, Pope John Paul II
mentioned issues:
mentioned: “ In modern medicine, increased
attention is being given to what are call 1. The number of the elderly people in
methods of palliative care, which seek to Indonesia is dramatically increased.
make suffering more bearable in the final 2. Every elderly has the burden of frailty,
stages of illness and to ensure that the patient which obviously needs supports.
is supported and accompanied in his or her 3. Palliative Care Policy mentioned in
ordeal” (#65). the Decree of the Ministry of Health
of the Republic of Indonesia.
In the speech to the Pontifical Council
4. What Pope said about the care of
for Health, November 2004, Pope John Paul
elderly and palliative care.
II said: In fact, palliative care aims, especially
in the care of patients with terminal diseases, Then, we are urged to develop and implement
at alleviating a vast gamut of symptoms of the Geriatric Palliative Care in Indonesia. Let
physical, psychological and mental suffering, us be a good Samaritan
hence, it requires the intervention of a team
of specialists with medical, psychological and References
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R. Sunaryadi Tejawinata

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