PENILAIAN AKTIVITAS LANSIA

a. Geriatric Assesment Center Activities Of DailyLiving Physical Self-Maintenance

Scale
NO RESPONSES VALUE
1 TOILET
4 Cares for self at toilet completely, no incontinence
3 Needs to be reminded, or needs help in cleaning self,
or has rare (weekly at most) accidents
2 Soiling or wetting while asleep, more than once a 4
week
1 Soiling or wetting while awake, more than once a
week
0 No control of bowels or bladder
2 FEEDING
4 Eats without assistance
3 Eats with minor assistance at meal times, with help
preparing food or with help in cleaning up after meals
2 Feeds self with moderate assistance and is untidy 4
1 Requires extensive assistance for all meals
0 Does not feed self at all and resists efforts of others to
feed him

3 DRESSING
4 Dresses, undressed and selects clothes from own
wardrobe
3 Dresses and undresses self, with minor assistance
2 Needs moderate assistance in dressing or selection of 4
clothes
1 Needs major assistance in dressing but cooperated
with efforts of other to help
0 Completely unable to dress self and resists efforts of
 others to help
4 GROOMING (neatness, hair, nails, hands, face,
clothing)
4 Always neatly dressed and well-groomed, without
assistance
3 Grooms self adequately, with occasional minor
assistance, e.g., in shaving
4
2 Needs moderate and regular assistance or supervision
in grooming
1 Needs major assistance in dressing but cooperates
with efforts of others to help
0 Actively negates all efforts to others to maintain
grooming
5 PHYSICAL AMBULATION
4 Goes about grounds or city
3 Ambulates within residence or about one block
distant
2 Ambulates with assistance of (check one):
____another person, ____ railing, ____ cane, ____ 3
walker, or ____wheelchair: ____ gets in and out without
help ____ needs help in getting in and out
1 Sits unsupported in chair or wheelchair, but cannot
propel self without help
0 Bedridden more than half the time
6 BATHING
4 Bathes self (tub, shower, sponge bath) without help
3 Bathes self, with help in getting in and out of tub
2 Washes face and hands only, but cannot bathe rest of
4
body
1 Does not wash self but is cooperative with those who
bathes him
0 Does not travel at all
7 RESPONSIBILITY FOR OWN MEDICATION 4
 2 Is responsible for taking medication in correct
dosages at correct time
1 Takes responsibility if medication is prepared in
advance in separate dosages
0 Does not try to wash self, and resists efforts to keep
him clean
Total Score 27

Scoring ADL : Nilai >20 mandiri

Nilai 12 – 19 ketergantungan ringan

Nilai 9 – 11 ketergantungan sedang

Nilai 5 – 8 ketergantungan berat

Nilai 0 – 4 ketergantungan total

Berdasarkan hasil penilaian mengenai aktivitas hidup sehari-hari (AHS) dasar

pada Ny. D di dapatkan total skor 27, maka pasien dikatakan mandiri.

b. Geriatric Assesment Center Scale For Instrumental Activities Of Daily Living

NO RESPONSES SCORE
1. ABILITY TO USE TELEPHONE 0
3 Operates telephone on own initiative; looks up and
dials numbers, etc.
2 Dials a few well known numbers
1 Answers telephone but does not dial
0 Does not use telephone at all
2. SHOPPING 2
3 Takes care of all shopping needs independen
2 Shops independently for small purchases
1 Needs to be accompanied on any shopping trip
0 Needs to have meals prepared and served
3. FOOD PREPARATION 0
 3 Plans, prepares and serves adequate meals
independently
2 Prepares adequate meals if supplied with ingredients
1 Heats and serves prepared meals, or prepares meals but
does not maintain adequate diet
0 Needs to have meals prepared and served
4. HOUSE KEEPING 3
4 Maintains house alone or with occasional assistance
(e.g., heavy-work domestic help)
3 Performs light daily tasks such as dish-washing and
bed-making
2 Performs light daily tasks but cannot maintain
acceptable level of cleanliness
1 Needs help with all home maintenance tasks
0 Does not participate in any housekeeping tasks
5 LAUNDRY 1
2 Does personal laundry completely
1 Launders small items; rinses socks, stockings, etc.
0 All laundry must be done by others
6 MODE OF TRANSPORTATION 0
4 Travels independently on public transportation or
drives own car
3 Arranges own travel via taxi, but does not otherwise
use public transportation
2 Travels on public transportation when assisted or
accompanied by another correct dosages at correct time

1 Travel limited to taxi or automobile, with assistance of

another
0 Does not travel at all
7 RESPONSIBILITY FOR OWN MEDICATION 1
2 Is responsible for taking medication in correct dosage at
correct time
 1 Takes responsibility if medication is prepared in
advance in separate
0 Is not capable of dispensing own medication
8 ABILITY TO HANDLE FINANCES 1
2 Manages financial matters independently (budgets,
write checks, pays
rent and bills, goes to Bank) collects and keeps track of
income
1 Manages day-to-day purchases, but needs help with
banking, major purchases, etc.
0 Incapable of handling money
Total score 8

Scoring ADL instrumental :

Nilai >17 mampu melakukan sendiri

Nilai 9 – 16 sedikit bantuan

Nilai 1 – 8 mampu dengan bantuan

Nilai 0 tidak mampu apa-apa

Berdasarkan hasil penilaian mengenai aktivitas hidup sehari-hari (AHS)

instrumental pada Tn. AS di dapatkan total skor 8, maka pasien dikatakan mampu
melakukan sesuatu dengan bantuan.

c. MMSE (Mini Mental State Examination)

MINI MENTAL STATE EXAMINATION (MMSE)

Nilai
NO Tes Penilaian
Total

ORIENTASI
 Sekarang ini Tahun berapa ? 1

Bulan apa ? 1

1 Tanggal berapa ? 5 1

Hari apa ? 1

Musim apa? 1

Kita dimana Negara mana ? 1

Propinsi mana ? 1
2
Kota mana ? 1
5
Rumah? 1

Ruang apa / tingkat

1
berapa ?

PENCATATAN

3 Sebutkan 3 Objek : Apel, Meja, Koin 3 3

ATENSI DAN KALKULASI

Meminta pasien untuk mengeja balik nama

4 5 5
“WAHYU”

MENGINGAT KEMBALI

Meminta pasien untuk menyebutkan 3 objek yang

5 3 3
telah dipelajari pada pertanyaan no.3

BAHASA

Menunjuk pada sebuah pensil dan sebuah arloji

6 tangan. Meminta pasien untuk menyebutkan nama 2 2
benda yang ditunjuk : Buku, Kursi, Handphone

7 Meminta pasien untuk mengulang : “tanpa, bila, 1 1

 dan, atau, tetap”

Meminta pasien untuk mengikuti 3 tahap tugas:

“ambil lipatan kertas dengan tangan kanan anda “

8 3 3
“lipat kertas menjadi dua”

“letakkan kertas di atas lantai “

Meminta pasien membaca dan melakukan tugas

9 yang dibacanya 1 1

“mohon pejamkan mata anda”

10 Meminta pasien untuk menulis nama 1 1

Meminta pasien untuk menyalin gambar berikut

11 1 0

Total skor 30 29

Kriteria penurunan fungsi kognitif berdasar status mental mini (MMSE) adalah :

Normal : >28

Dugaan MCI (Mild Cognitif Impairment) : 24-28

Probabilitas kognitif terganggu/ dugaan demensia : 17-23

Gangguan kognitif definitive : 0-16

Pada Ny. D ini didapatkan nilai MMSE berjumlah 29 yang artinya adalah
normal.