Sarcopenia is common in hemodialysis patients, especially in the elderly patients undergoing hemodialysis. Various factors may contribute to the occurrence of sarcopenia, such as anabolic and catabolic imbalance. This study aims to investigate the correlation of insulin-like growth factor-1 (IGF-1) levels as an anabolic factor, myostatin levels, and insulin resistance as catabolic factors with sarcopenia in the pathogenesis of sarcopenia in elderly patients undergoing hemodialysis. A total of 40 subjects aged 60 years or more who undergoing hemodialysis in Dr. Soetomo Hospital Surabaya were included in this cross-sectional study. Sarcopenia was diagnosed according to Asian Working Group Sarcopenia 2019 criteria. IGF-1, myostatin, and insulin resistance levels were measured once before hemodialysis. Subjects with sarcopenia diagnosis were 33 (82.5%), that is, 19 (47.5%) men and 14 (35%) women. There were 28 (70%) of the subjects diagnosed with severe sarcopenia. Furthermore, there were significant differences in the characteristics and geriatric parameters between the sarcopenia and nonsarcopenia groups. There were differences between the two groups in hemoglobin levels, IGF-1 levels, myostatin levels, homeostasis model assessment-insulin resistance (HOMA-IR) levels, muscle mass, handgrip strength, body mass index status, mini nutritional assessment status, and physical activity scale for elderly status (all p  < 0.05). Correlation analyses showed that IGF-1 levels negatively correlated with sarcopenia status in elderly patients undergoing hemodialysis ( p  < 0.05). On the contrary, myostatin and HOMA-IR levels were positively correlated with sarcopenia status in elderly patients undergoing hemodialysis (all p  < 0.05). Based on this recent study, IGF-1, myostatin, and insulin resistance were significantly correlated with sarcopenia in elderly patients undergoing hemodialysis.

Pendahuluan. Kalsidiol adalah metabolit vitamin D yang digunakan untuk menentukan status vitamin D. Kalsidiol adalah bentuk utama yang ada di sirkulasi dengan half life 2 hingga 3 minggu. Sarkopenia merupakan sindrom geriatrik baru terkait dengan mortalitas dan peningkatan beban biaya kesehatan pada usia lanjut (usila). Di Indonesia, belum didapatkan data penelitian tentang hubungan kadar serum kalsidiol dengan derajat keparahan sarkopenia. Tujuan dari penelitian ini adalah untuk menganalisis hubungan antara defisiensi kalsidiol serum dengan derajat sarkopenia pada komunitas usia lanjut di Surabaya.Metode. Penelitian komunitas ini bersifat analitik observasional menggunakan rancangan cross-sectional. Subjek penelitian adalah usila yang hadir ke salah satu dari lima posyandu terpilih selama Maret -April 2019 yang memenuhi kriteria inklusi dan eksklusi. Sarkopenia didiagnosis menggunakan pengukuran massa otot dievaluasi menggunakan bio-impedance analysis (BIA), kekuatan genggaman tangan diukur dengan handgrip dynamometer, dan performa fisik dinilai dari gait speed. Kadar serum kalsidiol diukur menggunakan electrochemiluminescence immunoassay (ECLIA). Uji komparasi dilakukan menggunakan uji chi square dengan penggabungan sel antara kelompok sufisiensi dan insufisiensi.Hasil. Dari 104 subjek, didominasi usila perempuan sebanyak 52,9%. Median usia subjek adalah 66,4 (60-82) tahun. Dari 104 subjek, 53 orang diantaranya merupakan kelompok sarkopenia (19 orang dengan sarkopenia berat), 22 orang presarkopenia, dan 29 orang normal (tidak sarkopenia). Jumlah subjek penelitian yang mengalami defisiensi kalsidiol serum sebanyak 55,8% dan yang tidak defisiensi sebanyak 44,2%. Hasil uji analisis menunjukkan adanya perbedaan kadar serum kalsidol yang signifikan pada berbagai derajat sarkopenia (p=0,03).Simpulan. Terdapat perbedaan yang signifikan antara kadar serum kalsidiol dengan derajat keparahan sarkopenia pada komunitas lansia.

Elderly people have a higher risk of deep vein thrombosis (DVT) than younger adults. The causes of this are considered multifactorial, including changes in age-related hemostatic factors, greater comorbid conditions, and the frequency of hospitalizations, although they are not fully understood. Besides, DVT in the elderly can be difficult to recognize because the symptoms can appear atypically. The diagnostic approach of DVT remains the same for all age groups, including pre-test probability, D-dimer measurement, and imaging, although these can be less specific in older age. Antithrombotic agents are the main treatment of DVT. Direct oral anticoagulation (DOAC) provides clinicians with more choices for DVT therapy. However, the anticoagulation of DVT in the elderly must always be done carefully, because old age is also a risk factor for the occurrence of bleeding complications. Identifying bleeding risk factors that can be modified and balancing the risk of thrombosis with bleeding, including the selection and adjustment of anticoagulant doses, are important in considerations of using anticoagulants in the elderly. This narrative review summarizes the literature on the management of DVT in the elderly

Introduction: Skin diseases in elderly are often not recorded and are not complained of by elderly patients, but the more we let it become a problem in decreasing the quality of life of elderly patients, it can be seen in the current global situation that the biggest problem in elderly is degenerative diseases, with increasing age the function Physiological human and health changes will decrease due to degenerative processes (aging) which will have an impact on changes in humans, not only physical changes, but also cognitive, emotional, social and sexual changes and it is predicted that by 2050 around (75%) elderly who suffer from this degenerative disease will not suffer from this disease can work and have to stay at home. Objective To know the profile of skin disease in the elderly population who visited the Dermatology and Venereology Outpatient clinic Dr. Soetomo General Academic Surabaya period of 2019-2020. Methods This study is a retrospective descriptive study based on medical records at the Dermatology and Venereology Outpatient clinic Dr. Soetomo General Academic Surabaya, data collection was carried out in July 2021 -November 2021. In this study an evaluation of the profile of elderly patients with outpatient status was carried out by noting gender, age, domicile, chief complaint, comorbidities, fluorescence, diagnosis, examination of vital signs, therapy, and response to therapy. Results Based on the incidence in elderly patients at the Dermatology and Venereology Outpatient clinic Dr. Soetomo General Academic Surabaya for the 2019-2020 period. 299 patients were found the most were men (51.51%), the age group 66-74 years (58.86%), the most domiciled in Surabaya (82.27%), the most common chiefcomplaint was itching (60.87%) , the most frequent diagnosis was xerosis cutis (29.10%) and the most common lesion was erythematous macules (46.25%). Conclusion :The most common disease on the elderly's skin is in the form of xerosis cutis which requires special management to prevent a decreases in the quality of life of individuals.

Asian working group for sarcopenia (AWGS) recently introduced “possible sarcopenia” diagnosis for early identification of sarcopenia in the primary healthcare. For initial screening, 3 modalities, i.e. calf circumference (CC) measurement, strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire, and a combination of both (SARC-CalF), are recommended. However, no validation study has been done until now. Therefore, this study aims to evaluate the diagnostic performance of the recommended screening modalities using data from Indonesia. This cross-sectional study included subjects aged ≥ 60 years old who visited primary healthcare in Surabaya, Indonesia. The diagnosis of possible sarcopenia was confirmed with hand-grip strength and repeated chair stand test. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance. Among 266 subjects, 186 (70%) were diagnosed with possible sarcopenia. Using the recommended cut-off, the area under the curve, sensitivity, and specificity were 0.511, 48.39% and 53.75% for CC, 0.543, 8.60% and 100% for SARC-F, and 0.572, 19.35% and 95% for SACRC-CalF. Our findings indicate that the diagnostic performance of the recommended screening modalities is poor. Multicenter studies from different areas in Indonesia should be done to confirm these findings.

Background: Aging process commonly associated with multiple comorbidities such as metabolic disorders, vascular, visual, gait, balance and psycho-social problems. Atherosclerosis is one of comorbidities that could occur as a pre-existing condition in elderly with peripheral artery disease (PAD). Elderly patients associated with complex and multi-factorial medical conditions need to be addressed in a comprehensive approach. Here we report the complexity of perioperative management of an elderly with acute limb ischemia in elderly with multiple comorbidities and underlying diseases. Case Presentation: An elderly woman, 77-year-old, was referred to emergency room due to decreased level of consciousness. There were complaints of loss appetite, inactivity, bedridden, pain, paresthesia and muscle weakness in the right lower limb. There was history of chronic hypertension and dyspepsia. Since there was a sign of right lower limb acute limb ischemia, the patient was discussed with the multi-discipline team, planned for primary amputation, and received systemic anticoagulant treatment. Due to multiple comorbidities and underlying diseases, the patient died prior to amputation surgery. Conclusion: Surgery is not contraindication to elderly; however, from this case it shed light the needs of multi-discipline approach to decide the best treatment options for patient’s needs. Utilizing a Comprehensive Geriatric Assessment (CGA) could be an alternative to non-invasive, simple, and effective approach available in any healthcare setting.

Gangguan mood rentan diderita para penderita berusia lanjut. Statistik menunjukkan, terjadi peningkatan presentasi gangguan ini terutama pada penduduk lanjut usia. Hal ini kemungkinan disebabkan oleh gejala post power syndrome yang menyebabkan para lansia menjadi stres dan depresi. Penyebab lainnya yang dapat mencetuskan adalah penyakit komorbid yang menyertai kemudian menimbulkan pergantian mood yang cepat. Penyakit diabetes, tekanan darah tinggi, dan jantung koroner misalnya, diduga menyebabkan penderita merasa hilang kekuatan, kesulitan menyesuaikan diri, hingga akhirnya depresi. Kejadian bunuh diri pada usia lanjut yang mengalami gangguan mood juga dapat terjadi hampir setiap hari. Pentingnya deteksi dan diagnosis sejak dini merupakan hal yang penting demi mendapatkan terapi lebih dini. Gangguan mood pada usia lanjut bukanlah hal yang natural terkait proses penuaan, melainkan suatu gangguan  patologis yang dapat diterapi.Kata kunci: gangguan mood, depresi, manik, usia lanjut, geriatri. ABSTRACTMood disorders are susceptible to elderly sufferers. Statistics show, there is an increase in the presentation of mood disorder, especially in the elderly population. This is probably caused by the symptoms of post power syndrome which causes the elderly to become stressed and depressed. Other causes that can trigger are comorbid diseases that accompany and then cause rapid mood changes. Diabetes, hypertension, and coronary heart disease, for example, are thought to cause lost of strength, difficulty adjusting, and depression. Suicides in the elderly with mood disorders can also occur almost every day. The importance of early detection and diagnosis is important in order to get early therapy. Mood disorders in elderly are not a natural thing related to the aging process, but a pathological disorder that can be treated.Key words: mood disorders, depression, manic, elderly, geriatrics.

Background:The emergence of the COVID-19 pandemic has caused various changes in all aspects of life in various age groups, especially in the elderly group. In addition, the elderly are included in the group at risk of being affected by COVID-19 because when someone got into old age, various changes in conditions can be occur. As a solution to this problem, the role of the family is needed in providing care for the elderly, both care for physical activity and mental health. This aims to keep the elderly both physically and mentally healthy during the pandemic. Objectives: The sample used in this study is the elderly's family who are members of BKKBN Surabaya City. This study aims to determine the relationship between the role of family on the physical activity and mental health of elderly in the COVID-19 pandemic era. Methods: This research uses a cross sectional approach. The sampling technique is cluster random sampling. The total sample in this study is 113 respondents who were determined based on inclusion and exclusion criteria. The dependent variable in this study is the role of the family, while the independent variables are the physical activity and the mental health of the elderly during COVID-19 pandemic. Analysis of the results of this study using the Chi Square test. Results: The results obtained there is no relationship between the role of the family to the physical activity of elderly (P value = 0.176) and there is a relationship between the mental health of the elderly (P value = 0.001). Conclusion: The role of the family of Bina Keluarga Lansia (BKL) Surabaya to the elderly was in the good category. Most of the elderly had light levels of physical activity and had good mental health state during COVDI-19 pandemic era.