Kuesioner Faktor Gangguan Tidur Lansia

KUESIONER 

FAKTOR-FAKTOR PENYEBAB GANGGUAN TIDUR PADA LANJUT USIA DI UNIT PELAYANAN TERPADU

Tujuan Kuesioner: 1 Kuesioner Kuesioner ini !er"ujua !er"ujuann un"u# un"u# $en%e"a&ui $en%e"a&ui 'a#"or-'a 'a#"or-'a#"or #"or %an%%ua %an%%uann "i(ur )a(a )a(a *anju" usia +an% a(a (i UPT Pe*a+anan Sosia* Tuna Run%u ,iara ,iara (an Lanju" Usia (i Ja*an Sisin%a$an%araja Pe$a"an%sian"ar . Pene*i"i Pene*i"i $en%&ara)# $en%&ara)#an an #erjasa$a #erjasa$a res)on( res)on(en en un"u# un"u# $enja/a! $enja/a! )er"an+a )er"an+aan an (en%an sejujur-jujurn+a $en(a)a"#an &asi* +an% !ai# (an se!enarn+a

Pe"unju#: 1 Pi*i&*a& Pi*i&*a& sa*a& sa*a& sa"u ja/a!an ja/a!an +an% +an% "erse(ia "erse(ia (en%an (en%an $e$!eri#a $e$!eri#ann "an(a 02 02 )a(a #o*o$ +an% an(a rasa !enar . Ji#a in%in in%in $e$)er!ai $e$)er!ai#i #i ja/a!an3 ja/a!an3 ore"*a& ore"*a& +an% +an% sa*a& sa*a& (en%an (en%an $e$!eri#an $e$!eri#an 4 "an(a 0523 #e$u(ian #e$u(ian !eri "an(a "an(a 02 )a(a )a(a ja/a!an ja/a!an an(a an(a +an% +an% !enar !enar 6 Se"ia) Se"ia) ja/a! ja/a!an an (ija$i (ija$inn #era&a #era&asiaa siaann+ nn+a a

Fa#"or

No

Per"an+aan Gan%%uan Ti(ur 

Dia*a$i Ya 012

Fisi Fisio* o*o% o%is is

1

Sa+a Sa+a serin serin%% su*i" su*i" "i(u "i(urr )a(a )a(a $a*a $a*a$ $ &ari &ari #arena #a#i sa+a n+eri 86

Ti(a#  072

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89 . 4 6 9 8  ;

Psi# Psi#o* o*o% o%is is

Sa+a serin% !an%un "er*a*u e)a" (i )a%i &ari #arena n+eri )a(a *a$!un% Pa(a Pa(a $a*a$ a*a$ &ari &ari sa+ sa+a ser serin in%% "er "er!!an% an%un #arena #ra$ a"au #e!as )a(a #a#i Sa+ Sa+a ser serin in%% "er "er!a !an% n%uun )a( )a(aa $a* $a*a$ a$ &ari ari #arena su*i" !erna)as Sa+ Sa+a serin erin%% "er! "er!an an%%un )a( )a(a $a*a $a*a$ $ &ari ari #arena rasa %a"a* (i !a(an N+er N+erii (a( (a(aa $e$ $e$!u !ua" a" sa+ sa+a ser serin in%% "er "er!a !an% n%un un  )a(a $a*a$ &ari Sa+ Sa+a ser serin in%% "er "er!a !an% n%uun )a( )a(aa $a* $a*a$ a$ &ari ari #arena &arus !uan% air #ei* 0BAK2 Ba"u Ba"u## $e$ $e$!u !ua" a" sa+ sa+a ser serin in%% "er "er!a !an% n%un un )a(a )a(a $a*a$ &ari

<

Sa+a Sa+a $era $erasa sa #ese #ese)i )ian an (an (an i"u i"u $e$! $e$!ua ua"" sa+a sa+a

17

su*i" un"u# $e$u*ai "i(ur (i $a*a$ &ari =u!un%an #e#era!a"an (en%an #e*uar%a +an% ren%%an% serin% $e$!ua" sa+a su*i" "i(ur

 )a(a $a*a$ &ari 11 Ke"i# Ke"i#aa $e$i $e$i*i# *i#ii $asa $asa*a& *a& sa+a sa+a seri serin% n% su* su*i" i" 1. 1.

un"u# $e$u*ai "i(ur Ke"i# Ke"i#aa $e$ $e$i* i*i# i#ii $as $asa*a a*a&& sa+a sa+a ser serin in%%

14 14

"er!an%un )a(a $a*a$ &ari Sa+a Sa+a su*i" su*i" un" un"u# u# $e$ $e$u* u*ai ai "i(u "i(urr #are #arena na ser serin in%% $e$i#ir#an )asan%an &i(u) sa+a +an% "e*a& "ia(a

Fa#"or O!a"-

No

Gan%%uan Ti(ur

16 16

Sa+ Sa+a $en $en(e (eri ri"a "a sa#i sa#i"" (an (an &aru &aruss

19 19

$en%#onsu$si o!a" (ari (o#"er O!a" O!a" +an% +an% sa+a sa+a $a#a $a#ann $e$! $e$!ua ua"" sa+a sa+a seri serin% n%

o!a"an

 !uan% air #ei* )a(a $a*a$ &ari

Ya

Ti(a# 

012

072

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88 1 1

&ari O!a" O!a" +an% +an% sa+a sa+a $a#a $a#ann seri serin% n% $en+ $en+e! e!a! a!#a #ann

1; 1;

#an"u# !era" )a(a sian% &ari Sa+a Sa+a "i(a "i(a## sa#i sa#i"3"3 "e"a "e"a)i )i sa+ sa+aa $e$i $e$inu nu$ $ o!a" o!a"

Ga+ Ga+a &i( &i(uu) 1<

a%ar (a)a" "i(ur 0o!a" "i(ur2 Sa+ Sa+a a(a* a(a*a& a& seo seoran ran% )ero ero#o# o# >ero >ero##o#

.7 .7

se!e*u$ "i(ur $e$!ua" sa+a susa& "i(ur Sa+a Sa+a $inu $inu$ $ "e& "e& a"au a"au #o) #o)ii se!e se!e*u *u$ $ "i(u "i(ur3 r3 i"u i"u

.1 .1

$e$!ua" sa+a susa& "i(ur (i $a*a$ &ari Sa+a Sa+a $inu $inu$ $ "e& "e& a"au a"au #o) #o)ii se!e se!e*u *u$ $ "i(u "i(ur3 r3 i"u i"u

.. ..

$e$!ua" sa+a serin% "er!an%un $a*a$ &ari A#"i A#"i?i ?i"a "ass (i sian sian%% &ari &ari serin serin%% $e$! $e$!ua" ua" sa+a sa+a

.4 .4

susa& "i(ur (i$a*a$ &ari Sa+a Sa+a serin serin%% "i(a "i(a## (a)a (a)a"" $e$u $e$u*ai *ai "i(ur "i(ur #are #arena na

.6 .6

$erasa *a)ar Ke#e Ke#en+ n+an an%a %ann seri serin% n% $e$! $e$!ua ua"" sa+a sa+a susa susa&& un"u# $e$u*ai "i(ur )a(a $a*a$ &ari

Fa#"or Lin%#un%a

No

Gan%%uan Ti(ur

.9 .9

Sa+a Sa+a serin serin%% "i(a "i(a## (a)a (a)a"" $e$u $e$u*ai *ai "i(ur "i(ur #are #arena na

.8 .8

suara !isin% (ari *uar a"au (a*a$ #a$ar Sa+a Sa+a ser serin in%% su* su*i" i" $e$ $e$u* u*ai ai "i( "i(ur ur ji# ji#aa su&u su&u

. .

ruan%an )anas Sa+a Sa+a serin serin%% "i(a "i(a## (a)a (a)a"" $e$u $e$u*ai *ai "i(ur "i(ur #are #arena na

.; .;

su&u ruan%an +an% (in%in Te$)a" e$)a" "i(ur "i(ur +an% +an% #ei* #ei* $e$ $e$!u !ua" a" sa+ sa+aa serin serin%%

.<

"er!an%un )a(a $a*a$ &ari Ruan Ruan%a %ann +an% +an% )en% )en%a) a) seri serin% n% $e$ $e$!u !ua" a" sa+ sa+aa

n

Ya

Ti(a# 

012

072

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8 47 47

Se)r Se)rai ai +an% +an% #o"o #o"orr seri serin% n% $e$! $e$!ua" ua" sa+a sa+a susa susa&&

41 41

"i(ur N+a$ N+a$u# u# seri serin% n% $e$! $e$!ua ua"" sa+a sa+a seri serin% n%

4. 4.

"er!an%un (i $a*a$ &ari Sa+a Sa+a serin serin%% "i(a "i(a## (a)a (a)a"" "i(u "i(urr #are #arena na ruan ruan%a %ann "eran%