Pengaruh Penggunaan Proton Pump Inhibitor Jangka Panjang terhadap Sindrom Frailty pada Pasien Usia Lanjut
Authors: Dewi Stephanie , Laksmi Purwita W , Syam Ari Fahrial , Dewiasty Esthika , Seto Euphemia 
Published: March 2018

Pendahuluan. Sindrom frailty berkaitan dengan angka morbiditas dan kematian yang lebih tinggi, sehingga dipakai sebagai prediktor kesehatan pada orang usia lanjut (usila). Polifarmasi sebagai salah satu faktor risiko sindrom frailty dapat berkaitan dengan obat Proton Pump Inhibitor (PPI) yang sering diberikan pada usila atas indikasi adanya keluhan gangguan saluran cerna bagian atas. Sampai saat ini belum ada penelitian yang mempelajari hubungan PPI jangka panjang dan sindrom frailty pada usila.Metode. Studi kasus kontrol pada pasien usila di Rumah Sakit dr. Cipto Mangunkusumo (RSCM), Jakarta. Kelompok kasus adalah usila terdiagnosis Frailty menurut FI-40 item dan kontrol adalah usila yang tidak frail berdasarkan instrumen yang sama. Data yang digunakan pada penelitian ini berasal dari data sekunder status frailty berdasarkan penelitian sebelumnya dan data rekam medis poliklinik Geriatri dan poliklinik diabetes RSCM.Hasil. Didapatkan 225 subjek (75 kasus: 150 kontrol), 59,6% berjenis kelamin perempuan (rerata usia 72,14 tahun; simpang baku ± 6,4 tathun) dan 47,1% berpendidikan tinggi. Subjek yang berpendidikan rendah, berstatus cerai mati, berstatus nutrisi lebih buruk, tidak mandiri, memerlukan caregiver, hidup tidak berkecukupan dan kondisi kesehatan yang lebih buruk lebih banyak didapatkan pada kelompok frail dibandingkan kelompok yang tidak frail. Proporsi pengguna PPI Jangka Panjang sebesar 40,9%. Penggunaan PPI jangka panjang meningkatkan risiko sindrom frailty (Crude OR 2,15; IK 95% 1,22- 3,78; p<0,007) dengan adjusted OR 1,83 (IK 1,0-3,36) terhadap variabel nutrisi dan merokok.Simpulan. Penggunaan PPI jangka panjang (≥ 6 bulan) secara independen meningkatkan salah satu risiko sindrom frailty pada usila.Kata Kunci: frailty, geriatri, proton pump inhibitor jangka panjang, usia lanjutThe Effect of Long-Term Proton Pump Inhibitor Use on Frailty Syndrome in Elderly PatientsIntroduction. Frailty syndrome, the newest elderly health predictor, associated with higher morbidity and mortality. PPI are often used in elderly due to presence of upper gastrointestinal complaints, and relates with polypharmacy as one of the risk factor for frailty syndrome. There is no study of the relationship between long term PPI use and frailty syndrome in elderly.Methods. A case control study included subjects 60 years and above with good cognitive status. All subjects with history of hypersensitivity of PPI were excluded. Elderly who were frail based on FI-40 item were defined as cases, while individuals that were not frail were classified as control. Primary data (included frailty status) was collected on March-June 2013 by Seto E and Sumantri S, et al. Secondary data used in this current study were gathered from the primary data of previous research and from the medical record taken from geriatric and diabetic outpatient clinics Cipto Mangunkusumo Hospital.Results. There were 225 subjects collected (75 cases: 150 controls), 59,6% were female (mean age 72,14 years old, SD ± 6,4 years) and 47,1% with higher education. Lower education, divorced, poor nutrition, dependent, needed caregiver, economically insufficient, more comorbidity and poor health condition were seen in frail group. The proportion of long term PPI use were 40,9%. Long term PPI medication increased the risk of frailty syndrome (Crude OR 2,154; CI 95% 1,225-3,778; p<0,007) with adjusted OR 1,83 (CI 95% 1,02-3,37) after adjusting with nutrition and smoking variables.Conclusions. Long term use of PPI significantly increase the risk of frailty syndrome compared to the non-users.