CHAPTER 16 FEATURES OF CARE FOR ELDERLY AND SENILE AGE PATIENTS

Age-related human development consists of the interaction of two main processes: aging and vitality. Aging is a universal endogenous destructive process, manifested in an increased likelihood of death. Vitaukt (lat. vita- life, auctum - increase) is a process that stabilizes vitality and increases life expectancy. Although not a disease, aging creates the prerequisites for the development of age-related pathology. The aging process is a continuous gradual transition from stage to stage: optimal state of health - the presence of risk factors for the development of diseases - the appearance of signs of pathology - loss of ability to work - death.

The rate of aging can be expressed quantitatively using indicators that reflect a decrease in vitality and an increase in the damageability of the organism. One of these parameters is age.

Age is the duration of existence of an organism from birth to the present moment. The current modern age standards were adopted by the WHO Regional Office for Europe in 1963 (Table 16-1).

Table 16-1. Age classification (WHO, 1963)

Age - terminology

Age - years

Young age

Mature age

Average age

Elderly age

Senile age

Centenarians

90 and older

Currently, there are more than 380 million people in the world who are over 65 years old. In Russia, one fifth of the total population are elderly and old age. In the next 10 years, the number of older citizens is expected to approximately double, i.e. Already 40% of the population will be in the elderly and senile age category. The incidence rate in older people compared to people more young 2 times higher, in old age - 6 times.

The processes of human aging are studied by gerontology (Greek. gerontos - old man, logos - teaching, science). Gerontology is a border area of ​​biology and medicine that studies not so much old age as the process of human aging. Gerontology includes such large main sections as geriatrics, gerohygiene, geropsychology, social gerontology, etc.

Geriatrics (Greek) gerontos - old man, iatreia - treatment) is a borderline section of gerontology and internal diseases that studies the characteristics of diseases of elderly and senile people and develops methods for their treatment and prevention.

MAIN FEATURES OF ELDERLY PATIENTS

AND OLDER AGE

Pathological changes characteristic of elderly and senile people begin to appear from the age of 40-50.

1. Involutional (associated with reverse development) functional and morphological changes on the part of various organs and systems. For example, with age, indicators of the vital capacity of the lungs, bronchial patency, the value of glomerular filtration in the kidneys decrease, the mass of adipose tissue increases and muscle mass (including the diaphragm) decreases.

2. The presence of two or more diseases in one patient. On average, when examining an elderly or senile patient, at least five diseases are detected. In this regard, the clinical picture of diseases is “blurred”, and the diagnostic value of various symptoms is reduced. On the other hand, concomitant diseases can reinforce each other. For example, anemia in a patient with coronary artery disease can cause clinical manifestations of heart failure.

3. Predominantly chronic course of diseases. The progression of most chronic diseases is facilitated by age-related unfavorable endocrine-metabolic and immune changes.

4. Atypical clinical course of diseases. Often a slower and more masked course of the disease is detected (pneumonia, myocardial infarction, pulmonary tuberculosis, neoplastic processes, diabetes mellitus, etc.). For example, fever in elderly patients can be one of the main, if not the only, manifestation of tuberculosis or infective endocarditis, abdominal abscesses.

5. The presence of “senile” diseases (osteoporosis, benign prostatic hyperplasia, Alzheimer’s disease, senile amyloidosis, etc.).

6. Changes in protective, primarily immune, reactions.

7. Change in socio-psychological status. The main causes of social maladjustment are

retirement, loss of loved ones and friends due to their death, loneliness and limited communication opportunities, difficulties in self-care, worsening economic situation, psychological perception of the age limit over 75 years, regardless of health status. Against this background, disorders such as anxiety, depression, and hypochondriacal syndrome (pathologically exaggerated fear for one’s health, belief in the presence of a particular disease when it is actually absent) often develop.

Rational management of an elderly patient presupposes the mandatory achievement of mutual understanding and agreement in the triad “patient - nurse - doctor”. The degree of patient compliance with medical recommendations is designated in the medical literature by the term “compliance” (English). wmpliance- agreement). Old age in itself is not a cause of insufficient compliance, since the right approach fully ensures the achievement of the latter - the use of verbal and written instructions, reducing the number of prescribed medications, preference for long-acting dosage forms and combination drugs, etc.

NUTRITION RULES FOR ELDERLY AND SENILE PATIENTS

Currently, a hypocaloric and volume-restricted diet is considered as one of the effective methods combating the process of premature aging. In the diet of an elderly person, the recommended ratio between proteins, fats and carbohydrates is 1:0.9:3.5, i.e. you need to reduce the dose of consumed fats and carbohydrates (for young men and women engaged in mental work, the recommended ratio is 1: 1.1: 4.1). You should limit the consumption of foods containing purine bases, oxalic acid and cholesterol, ensuring a sufficient amount of vegetables and fruits containing potassium, magnesium, iron salts, trace elements, vitamins and organic acids. For elderly and senile people, four meals a day are the most rational. The recommended calorie content of food is 1900-2000 kcal for women over 60 years of age and 2000-3000 kcal for men of the same age. The calorie content of the first breakfast should be 25% of the daily diet, the second - 15%, lunch - 40-45% and dinner (no later than 2 hours before bedtime) - 15-20%.

Laxative effect. It should be recommended to drink 1 hour before meals in the morning 1 glass of juice, rosehip decoction or just boiled water at room temperature, and 1 glass of kefir at night. The caloric content of the diet should be limited by reducing the consumption of high-calorie foods: sugar and other sweet foods, salt, fat and fatty foods are subject to unconditional limitation. It is advisable to replace refined sugar with honey, which is quickly absorbed into the gastrointestinal tract, has a mild sedative effect, has a laxative effect and prevents constipation.

Antiatherosclerotic orientation nutrition can be achieved by reducing the total calorie content of food and including products that normalize lipid metabolism. It is recommended to increase the proportion of vegetable fats (up to 2 tablespoons of sunflower, olive or corn oil per day). The biologically active substances they contain (polyunsaturated fatty acids, phosphatides and phytosterols) together have a beneficial effect

beneficial effect on cholesterol metabolism (it is acceptable to consume cholesterol with food in amounts up to 300 mg/day). In addition, vegetable oils have a good choleretic effect and a laxative effect.

The inclusion of seaweed in the diet is recommended as a source of vitamins, microelements and an active anti-atherosclerotic agent. Patients can be recommended to purchase seaweed powder (kelp saccharide) in pharmacies. Residents of Japan, Primorye, and the White Sea coast eat fresh kelp (seaweed), and they have a significantly lower incidence of heart and vascular diseases.

Plant fiber. The total amount of plant fiber for elderly people should be 25-30 g/day. Fibrous substances in food (complex carbohydrates containing fiber, pectin, etc.) have the ability to adsorb food and toxic substances and improve the bacterial contents of the intestine. Activation of intestinal motor activity and normalization of stool under the influence of dietary fiber are a real measure for the prevention of diverticulosis* and malignant tumors.

Vitamins. Vitamins are of particular importance in maintaining the homeostasis of an aging body. Latent hypovitaminosis, which develops as a result of metabolic disorders characteristic of age, usually manifests itself in older people with diabetes mellitus, polyuria, frequent loose stools, and during infectious diseases. A complete diet, including fresh grains and fruits, allows you to enrich your diet with vitamins. But even in the summer and autumn seasons, older people need to take additional vitamin supplements.

Minerals. With age, the body accumulates some minerals while others decrease. For example, a change in the ratio of potassium and sodium in favor of increasing the latter contributes to fluid retention, a negative effect on the functions of the cardiovascular and urinary systems. Elderly people are especially sensitive to salt deficiency

* Diverticulosis (lat. diverticulum- road to the side, branch) - a protrusion of the wall of a hollow organ (intestine, esophagus, ureter, etc.), communicating with its cavity.

potassium, and they quickly develop hypokalemia, especially during therapy with diuretics. Clinical manifestations of hypokalemia include rhythm disturbances, weakened muscle tone, increased sensitivity to cold, muscle cramps (especially leg muscles at night), decreased concentrating ability of the kidneys and decreased urine acidity. Ideal products that combine a low sodium content with a high potassium content are vegetables (potatoes, etc.), fruits (bananas, oranges, etc.), and dried fruits (prunes, apricots, raisins, dried apricots).

With age, people often experience an increased deposition of salts in some tissues against the background of a decrease in the content of minerals and the intensity of their metabolism in others - for example, an aging body is able to accumulate calcium in the walls of blood vessels, although calcium deficiency is one of the causes of senile osteoporosis. The normative intake of calcium in the body for older people is similar to that in middle age (800-1000 mg/day). Sources of easily digestible calcium are milk, fermented milk products, cheese.

Culinary processing. IN In old age, changes in the chewing apparatus may occur, hence special requirements arise for the choice of products and methods of culinary processing. Minced meat, fish, and cottage cheese are more easily exposed to digestive enzymes. Preferable vegetables include beets, carrots, zucchini, pumpkin, cauliflower, tomatoes, potatoes (mashed). Cabbage should be limited in the diet, since its excessive consumption increases the fermentation processes in the intestines. Food should not be too hot or cold. Among spices and seasonings, they recommend mainly Not a large number of garlic and horseradish.

GENERAL PRINCIPLES OF NURSE CARE

ELDERLY AND SENILE AGE

Medical ethics. When caring for elderly and senile patients, compliance with the norms of medical ethics and deontology is of particular importance. Often a nurse becomes the only close person for a patient, especially a lonely one. Each patient requires an individual approach, taking into account

personal characteristics of the patient and his attitude to the disease. To establish contact, the nurse must speak in a calm, friendly voice and be sure to greet the patients. If the patient is blind, you should introduce yourself every day when entering the room in the morning. Patients must be addressed with respect, by name and patronymic. It is unacceptable to call the patient familiarly “grandmother”, “grandfather”, etc.

Geriatric patients often “withdraw into themselves,” “listen” to their condition, and they develop irritability and tearfulness. Preparing the patient for various medical procedures, the ability to listen, empathize and give advice are important factors in successful treatment. However, the nurse alone, in addition to the doctor, should not give the patient or his relatives information about the nature and possible outcome of his disease, or discuss the results of the study and treatment methods.

The problem of insomnia. Elderly patients often complain of insomnia, their sleep patterns change - they often sleep more during the day, and at night they lead more active image life (eating, walking around the ward, reading). Sleeping pills, often used by patients in this case, can quickly become addictive. In addition, while taking sleeping pills, weakness, headaches, a feeling of morning “weakness,” and constipation may appear. If necessary, the doctor prescribes sleeping pills. The nurse can recommend an appointment for the patient medicinal herbs(for example, a decoction of motherwort 10-15 ml 40 minutes before going to bed), 10-20 drops of Valocordin, a glass of warm milk with honey dissolved in it (1 tbsp), etc.

Providing personal hygiene measures. It is often difficult for elderly and senile patients to care for themselves. He should be assisted in changing bed and underwear, and if necessary, take care of hair, nails, etc. It is necessary to monitor the condition of the patient's oral cavity. The nurse should give the patient boiled water after each meal so that he can rinse his mouth thoroughly. For a seriously ill patient, the nurse is required to wipe the mouth with a swab moistened with a 1% hydrogen peroxide solution or sodium bicarbonate solution. When caring for a patient who has been on bed rest for a long time, it is necessary to

Take careful skin care and prevent bedsores. The nurse should help the patient change position in bed, periodically, if his condition allows, sit him down on the bed, propping him up on all sides with pillows for stability, and lightly massage his back, feet and hands.

It is necessary to monitor the physiological functions of patients and, if necessary, regulate intestinal function with diet (including dried fruits, lactic acid products, etc. in the diet), using laxatives as prescribed by a doctor, or administering enemas.

The nurse should immediately inform the doctor about any deterioration in the patient’s well-being or the appearance of new symptoms. Before he arrives, you need to lay the patient down or help him take the appropriate position (for example, in case of suffocation, the patient should take a sitting or half-sitting position), ensure rest, and, if necessary, provide first aid.

Prevention of injuries. Particular attention should be paid to preventing possible injuries. Bruises and fractures (especially of the femoral neck) immobilize patients and are accompanied by the development of complications such as pneumonia, pulmonary embolism, which can be fatal. When washing a patient in the bath, you need to support him, help him get in and out of the bath, and there should be a rubber mat on the floor to prevent the patient from slipping. The nurse is obliged to monitor the condition of hospital premises and their sufficient lighting. There should be no foreign objects on the floor; spilled liquids are unacceptable, as the patient may not notice them and fall. The corridors of the geriatric department should be spacious, not cluttered with furniture; railings should be fixed along the walls of the corridor so that patients can hold on to them.

Monitoring medication intake. The nurse should monitor the patient's intake of prescribed medications. With memory loss and the development of dementia (lat. dementia - dementia) patients may forget to take the medicine or, conversely, take it again. Therefore, elderly and senile patients should be provided with clear instructions given by the doctor not only orally, but also in writing. Need to follow

monitor the water balance, since insufficient fluid intake can contribute to an increase in the concentration of prescribed drugs in the body, the appearance of side effects and the development of drug intoxication.

CARE AND MONITORING OF PATIENTS

ELDERLY AND SENILE AGE

WITH ORGAN DISEASES

The uniqueness of the clinical course of respiratory diseases in elderly and senile age is largely due to involutive processes in the aging body.

The elasticity of the pulmonary parenchyma decreases, and its atrophy develops.

As a result of an increase in the size of the alveoli, the respiratory surface of the lungs decreases by 40-45%.

Changed blood vessels (pulmonary capillaries become denser and become “brittle”) do not provide completely adequate nutrition to the lung tissue, and gas exchange becomes difficult.

The compaction of the membranes impedes gas exchange between alveolar air and capillary blood.

Alveolar ventilation becomes uneven.

Due to a decrease in the activity of the ciliated epithelium and the sensitivity of mucosal receptors, the gradual atrophy of epithelial cells, the mechanism of self-cleaning of the bronchi is disrupted.

Atrophy of the glandular epithelium and cartilaginous tissue of the bronchi leads to the formation of clearly shaped swellings of the bronchi and uneven narrowing of their lumen.

The cough reflex decreases.

Dystrophic changes in the muscular system chest and back, the formation of a barrel-shaped chest, sclerotic changes reduce the mobility of the ribs, limit the volume of excursion of the chest.

The sensitivity of the respiratory center to carbon dioxide and hypoxia increases.

In elderly and senile patients, frequent exacerbations of chronic bronchitis are observed, which is caused by age-related changes in the chest, limiting respiratory movements, reducing drainage function due to the low efficiency of the cough impulse and atrophy of the ciliated epithelium, stagnation in the pulmonary circulation, and a decrease in anti-infective protection. Treatment of patients with chronic bronchitis in old and senile age must be carried out taking into account the characteristics of the pathological process, the presence of concomitant diseases, and the individual characteristics of the patient.

The increased incidence of chronic bronchitis in geriatric patients determines the frequent use of antibacterial agents. It must be remembered that elderly patients are much more likely to develop possible side effects of antibacterial drugs, for example, hearing loss (streptomycin, gentamicin, etc.), toxic effects on the kidneys (kanamycin), candidiasis, dysbiosis and atrophic glossitis (tetracycline, combined antibiotics) etc. Therefore, the nurse must teach patients certain principles of taking medications, which can to some extent reduce the toxicity of medications. The patient must take the prescribed drug at the prescribed time of day, comply with the recommended behavior and conditions of administration (for example, when taking cotrimoxazole, you need to drink plenty of alkaline drinks - Borjomi or 7 g of sodium bicarbonate per glass of water), dietary rules (for example, when treating tetracycline, it is necessary to exclude sausage, smoked meats and vegetables grown using nitro fertilizers from the patient’s diet).

Oxygen therapy should be used very carefully in the treatment of elderly and senile patients. Excessive active oxygen therapy in old age can also lead to negative results - dizziness, nausea, suffocation, and Cheyne-Stokes breathing may occur. Moreover, hypercapnic inhibition of the respiratory center may occur, leading to a coma.

It must be remembered that when monitoring a patient with pneumonia, the period of critical decrease in body temperature, when acute vascular disease may develop, is especially dangerous for the patient.

distant insufficiency. This period of the disease is especially difficult in patients of geriatric age, since vascular insufficiency in them is manifested not by classic collapse, but by exacerbation of coronary artery disease, the development of stroke, increasing the degree of renal failure, etc.

CARE AND MONITORING OF PATIENTS

ELDERLY AND SENILE AGE

WITH CARDIOVASCULAR DISEASES

The features of cardiovascular diseases in elderly and senile age are determined, like diseases of other organs and systems, by involutive processes in the body, but primarily by sclerotic damage to both blood vessels and the heart.

When the aorta, coronary, cerebral and renal arteries become sclerotic, their elasticity decreases; compaction of the vascular wall leads to a constant increase in peripheral resistance.

Tortuosity and aneurysmal dilatation of capillaries and arterioles occur, their fibrosis and hyaline degeneration develop, which leads to obliteration of the vessels of the capillary network, worsening transmembrane exchange.

The blood supply to the main organs becomes not entirely adequate.

As a result of coronary circulatory failure, muscle fiber dystrophy, atrophy and replacement with connective tissue develop. Atherosclerotic cardiosclerosis is formed, leading to heart failure and heart rhythm disturbances.

Due to sclerosis of the myocardium, its contractility decreases, and dilatation of the heart cavities develops.

“Senile heart” (age-related changes in the heart muscle) is one of the main factors in the development of heart failure due to changes in neurohumoral regulation and prolonged myocardial hypoxia.

In old age, the blood coagulation system is activated, functional insufficiency of anticoagulant mechanisms develops, and blood rheology worsens.

In old and senile age, a number of hemodynamic features are formed: mainly systolic blood pressure increases, venous pressure, cardiac output, and later cardiac output decrease, etc.

Most often, in elderly and senile people, systolic blood pressure increases (more than 140 mm Hg) and so-called isolated systolic arterial hypertension develops. With age, the walls of large vessels lose their elasticity, atherosclerotic plaques appear, and organic changes develop in small vessels. As a result, cerebral, renal and muscle blood flow decreases. To date, a system of normative blood pressure values ​​depending on age has not been developed - a number of specialists consider an increase in blood pressure in elderly and senile people as a normal compensatory phenomenon.

When caring for a patient, it is necessary to remember that deterioration of the condition in elderly and senile patients with coronary artery disease can be provoked by concomitant bronchopulmonary diseases, physical activity, overeating, psycho-emotional stress, acute infections, inflammatory processes in the urinary tract, surgical interventions, etc.

The nurse must actively work with patients, explaining to them the need to combat bad habits. It should be explained to the patient that after smoking a cigarette, the frequency and strength of heart contractions increases, blood vessels narrow, and blood pressure rises. Smokers are more likely to have a malignant course arterial hypertension*, the effect of treatment decreases, mortality from cardiovascular diseases almost doubles.

Elderly and senile patients need a little rest during the day and restful sleep at night. Targeted relaxation exercises are helpful. The patient needs a diet moderately rich in calories and vitamins. You should avoid eating animal fats, sweets, and “snacks” between main meals, as excess body weight interferes with the functioning of the heart.

* At the same time, the prevalence of arterial hypertension among smokers is lower than among non-smokers.

CARE AND MONITORING OF PATIENTS

ELDERLY AND SENILE AGE

WITH GASTROINTESTINAL DISEASES

In old and senile age, the nature of the course of diseases of the digestive system changes significantly due to age-related anatomical and physiological characteristics of the gastrointestinal tract.

Oral cavity: involution of the salivary glands develops, the chewing apparatus changes.

Esophagus: the mucous membrane atrophies, peristalsis decreases, dyskinesias develop more often.

Stomach: secretory and enzymatic activity decreases, motor activity slows down.

Liver: the number of hepatocytes decreases, their regeneration processes are suppressed, decreases functional activity liver. There is a tendency to decrease the level of bilirubin, bile acids and phospholipids and increase cholesterol. A decrease in the lipid complex of bile contributes to disruption of intestinal digestion, which is manifested by dyspeptic disorders.

Pancreas: age-related tissue atrophy leads to a decrease in exocrine function and, consequently, a slowdown in cavity and membrane digestion.

Intestines: the height of the intestinal villi decreases and the area of ​​the mucous membrane on which membrane digestion and absorption occurs decreases. Age-related changes in the hypothalamus, pituitary gland and thyroid gland entail a restructuring of the enzymatic spectrum of the small intestine. The motor activity of the small and large intestines decreases, the composition of the intestinal microflora changes, and the symptoms of intestinal dyspepsia worsen.

The blood supply and innervation of the digestive system are also subject to functional and structural involutive changes.

According to statistics, chronic gastritis affects more than 50% of the working population, and in people over 60 years of age, the frequency of this disease approaches 100%. As a rule, in elderly and senile people, chronic gastritis is not an independent disease and often accompanies other diseases of the gastroduodenal zone, chronic pancreatitis, ischemic heart disease, and diabetes mellitus.

The high prevalence of atrophic gastritis in the elderly is due to the long course of bacterial chronic gastritis, duodenogastric reflux often developing in old age and, as a result, the occurrence of irritation and damage to the gastric mucosa. Chronic gastritis can also be caused by iatrogenic causes (frequent use of various medications).

Clinical manifestations of atrophic chronic gastritis in old and senile age are nonspecific. It must be remembered that the symptoms of chronic gastritis can be masked by concomitant pathology (coronary artery disease, chronic pancreatitis, etc.).

Often, under the guise of various diseases of the gastrointestinal tract, ischemic disease of the digestive organs occurs (the terms “abdominal ischemic disease”, “chronic mesenteric insufficiency”, “abdominal ischemic disease” are used to designate it). Chronic ischemia in this pathology is caused by circulatory failure in the celiac, superior and inferior mesenteric arteries. The causes of impaired mesenteric circulation may be atherosclerotic lesions of the mesenteric arteries and other conditions that reduce blood flow:

Myocardial infarction, heart rhythm disturbances (eg, atrial fibrillation), arterial hypertension;

Compression of blood vessels from the outside (extravasal compression) due to a tumor or adhesive process;

Age-related changes in the intramural layer of the vascular wall, aggravating disturbances in the blood supply to the abdominal organs.

In caring for such patients, it is of great importance to monitor the patient’s compliance with the regimen (rest after meals is advisable) and diet (aimed at normalizing lipid metabolism with a decrease in the amount of food taken).

One of the common complaints of elderly and senile patients is constipation. Its causes may be a sedentary lifestyle, intestinal atony, poor diet, side effects of a number of medications, etc.

To normalize stool, you first need to adjust your diet. The patient should be advised to drink 1/2 cup of cold boiled water, kefir or yogurt in the morning on an empty stomach. The nurse can advise the patient to eat dishes made from beets (vinaigrette), carrots, baked apples, and replace potatoes with stewed vegetables and buckwheat porridge. The diet should contain a large amount of vegetables and fruits. The laxative effect is promoted by the consumption of dried fruits - dried apricots, prunes, figs, raisins. They should be soaked in hot water, and if it is difficult for the patient to chew, grind them using a meat grinder.

In case of prolonged constipation, as prescribed by the doctor, the nurse gives the patient an enema (cleansing, hypertonic, oil, etc.).

CARE AND MONITORING OF PATIENTS

ELDERLY AND SENILE AGE

WITH KIDNEY AND URINARY TRACT DISEASES

The following changes are characteristic of an aging kidney.

Progressive accumulation of connective tissue components in almost all structural elements of the kidney, which leads to the so-called senile atrophy of the organ.

Reduction in kidney mass and volume, more significant in men compared to women.

Thickening and compaction of the capsule, increase in the volume of perinephric tissue.

The development of hyalinosis of the capillary loops of the glomerulus (which clearly manifests itself from the age of 40), followed by the gradual death of renal nephrons.

Decrease in glomerular filtration (by approximately 7% during each subsequent decade of life after 40 years).

A decrease in the rate of physiological renewal of the tubular epithelium in the tubular part of the nephron and disruption of the activity of the tubules: the maximum reabsorption of glucose, the total excretion of acids, and the clearance of free water are reduced.

Arteriolosclerosis of renal vessels, elastic hyperplasia of the ihintima.

Changes in the hemodynamics of the senile kidney as a whole: renal blood flow decreases by almost half, and in parallel with it, effective renal plasma flow decreases.

Atrophy of the elements of the juxtaglomerular apparatus with the restructuring of its cells.

Weakening of the mechanisms of intracellular regulation of blood flow.

Atony urinary tract, contributing to the occurrence of reflux (backflow of urine) at various levels.

The most common kidney diseases in elderly and senile patients are pyelonephritis, acute renal failure and angionephrosclerosis. The most common kidney disease in geriatrics is senile pyelonephritis. The following reasons contribute to its development.

Frequent reflux due to atony of the urinary tract.

Urolithiasis and tumor processes.

Prostate diseases in men.

Fixation of bacterial flora in the kidneys due to impaired renal hemodynamics.

Age-related disorders of the body's immune response.

Increased frequency of instrumental interventions on the urinary tract with age.

It should be borne in mind that with the severity of senile general dystrophic processes and cachexia, even purulent forms of pyelonephritis can be asymptomatic. Often, only an isolated intoxication syndrome is clinically observed (patients are often admitted to the infectious diseases department), persistent severe anemia (which “diverts” the diagnosis from kidney pathology

and forces patients to be examined according to the “oncology program”).

One of the problems in caring for patients is the presence of frequent urination at night in geriatric patients (not only due to pathology of the urinary system, but also due to age-related changes in the kidneys, sleep disorders), which leads to the need for patients to get out of bed frequently at night. However, in weakened patients, when suddenly getting out of bed, a sharp decrease in blood pressure is possible, which can provoke fainting. A fall in an elderly or senile patient is often accompanied by various fractures, which further aggravates the patient's condition. Therefore, the nurse should explain to the patient that he should not drink later than 6-7 pm, so as not to experience frequent urge to urinate at night, and leave a vessel or potty by his bed at night.

Often, geriatric patients experience urinary incontinence - enuresis (with kidney disease, cystitis, prostate adenoma, cerebrovascular accident, general exhaustion of the patient, senile dementia, etc.).

A special form of enuresis is the so-called stress urinary incontinence, which occurs in women when coughing, sneezing or laughing, and in old age due to insufficiency of the bladder sphincter. This usually happens if the patient has previously given birth a lot or during postmenopause, etc.

Complete urinary incontinence develops with complete loss of sphincter function when innervation is disrupted. Bladder due to invasion of the sacral nerve plexus by a tumor or direct invasion of the tumor into the bladder neck. In this case, the patient has a constant leakage of urine.

If there is urinary incontinence, the nurse should wash the patient and change his underwear after each urination. Relatives should be advised to purchase special diapers for adults. If urinary incontinence occurs, the patient should be advised to limit fluid intake after 3 pm. Food should be easily digestible; the patient should eat frequently in small portions throughout the day. It is necessary to remember that you need to regulate

Properly disinfect the vessel (urinal bag) and disinfect the patient’s discharge before draining it into the sewer.

In case of strict bed rest, the patient’s serious condition, the nurse must pay special attention to the patient’s condition. skin the patient, especially if he has edema, and prevent pressure ulcers (see section “Skin care and prevention of pressure ulcers” in Chapter 6).

The science of old age and the aging of living beings, including humans, is called gerontology.

According to the World Health Organization (WHO) Regional Office for Europe, ages 60 to 74 years are considered old; 75 years and older - old people; those aged 90 years and older are long-livers.

Aging is a multi-link, constantly developing, destructive process that increases over time, which leads to a reduction in the adaptive capabilities of the body and an increase in the likelihood of death.

The problem with aging is physiological changes organisms that cause various diseases.

Most people's vision deteriorates as they age. This is due to the influence of aging, various diseases, especially the weakening of the functioning of the structural elements of the eye (lens, pupil, retina, apple). Deterioration of vision is caused by cataracts - clouding of the lens, senile miosis - a decrease in the ability of the pupil of the eye to adequately respond to changes in lighting. As a result of changes in the retina, the perception of colors is weakened, sensitivity to bright light is exacerbated. Glaucoma (increased intraocular pressure) leads to a decrease in the field of vision, loss of peripheral vision or its acuity, blindness Patients with diabetic retinopathy (fragility of the blood vessels of the retina, hemorrhages) see the image blurred and distorted, it is difficult for them to read and distinguish small items. Solar retinopathy (burn of the central fovea) leads to decreased visual acuity. In general, almost 23% of people are unable to read text in regular font

As many people age, their hearing deteriorates. Depending on the causes, conductive and sensorineural hearing loss are distinguished. Conductive hearing loss is a consequence of decreased sensitivity of the structures of the auditory system that induce sound (external auditory canal, eardrum or ossicles). Sensorineural hearing loss can be caused by dysfunction or injury of the auditory nerve or other neural structures of the helix of the ear. Hearing loss negatively affects a person’s social contacts, his mental state, and can cause stress, depression and other emotional disorders.

Involutional changes in the sensory system affect the efficiency of information processing. Elderly people with significant hearing impairment (35-50 dB) have difficulty perceiving and remembering words by ear. Encoding and further storage of words is even more difficult for them.

In older people, the voice also changes, manifested in an increase in its pitch, a weakening of its spontaneous regulation, a slowdown in articulation during normal broadcasting, reading text, and an increase in the tempo of speech. These changes are caused by muscle wear, decreased lung capacity, poorly inserted dentures, and smoking. A decrease in the rate of speech is also associated with a decrease in memory capacity and a slowdown in cognitive processes.

In older people, coordination of movements of the fingers and hand is impaired, affecting handwriting and writing speed. This may be a consequence of certain diseases, increased time to become familiar with tasks

The emergence of physiological restrictions at the age stage of old age changes the behavior of old people. The physical world with which they directly interact is increasingly narrowing. Especially necessary for them are things that perform an auxiliary function: glasses, dentures, strollers for transporting goods, a stick. Due to physiological limitations, more and more dangers await them on the street, in the park of their own home. Therefore, older people behave very carefully.

However, the problem of aging is much broader, since a person’s health at any age is directly dependent on how actively he interacts with others and fulfills his social functions. If we leave aside diseases associated with the central nervous system, then this is already enough to classify the majority of elderly people into the category of “borderline patients”. It follows from this that they need observation and therapeutic correction from a psychiatrist or psychotherapist. The fact is that even one chronic disease (no matter at what age it is acquired) leads to so-called “neurosis-like conditions” and to painful character deformation, even psychopathy. In old age, not only the changes that occur to a person are important, but also the person’s attitude towards these changes.

Social situation: readiness for retirement; adaptation to a new social status; search for new forms of employment.

Leading development activities: professional activities in adapted forms; structuring and transferring life experience; a hobby appears; ancestry; gradual cessation of activity.

Memory. Mechanical memorization suffers; logical memory is best preserved. Figurative memory weakens more than semantic memory, but is preserved better than mechanical imprinting. Short-term memory is impaired; perception and memorization are not accompanied by the organizing function of speech. Emotional memory continues to function. Marked weakening of the mechanical component of memory. Relatively good preservation of the components of logical-semantic memory. Extremely sharp weakening of short-term (working memory).

This age period is characterized by the appearance of sanogenic thinking - it helps to improve the mental health, relieve internal tension in it, eliminate old grievances, complexes and much more.

Personal development. V. Henry divides old people into three groups, depending on the amount of psychic energy they have. The first group includes those who feel quite cheerful and energetic, continue to work, etc. The second group includes those who are engaged in their own business - a hobby. The third group is people with weak mental energy, not busy with anything or busy only with themselves.

Recognizing oneself as old is the strongest psychological factor of aging. The correct feeling of your own age is the correct manner of behavior and communication.

Neoplasms. K. Rogers identifies the following personal new formations: an uncontrollable desire for risk; high sensitivity to social orders addressed to him and readiness to fulfill them in the shortest possible time; high level of development of the intuitive sphere of personality. All these personal developments? the result of a person's integration activity or holistic experience of his life.

A sense of belonging to a group or groups, personal comfort in interacting with people, integration with them. A sense of community with other people, faith in others, the courage to be imperfect, optimism, acceptance of your life.

Life wisdom is the main new formation of old age (E. Erikson).

Old age of a person covers the eighth psychosocial crisis according to Erikson. This is the crisis of “completion of the previous life path.” One way or another resolution of this crisis depends on the result of summing up one’s life. If the previous stages of an elderly person’s life have taken place, then he maintains a calm and balanced view of his own future. He is not afraid of death, because he understands that this is the natural end of life. When frustrated, older people experience feelings of purposelessness own life and powerlessness, irritability, fear of death, etc.

In turn, the eighth crisis period are divided into 5 stages of human psychological aging. It should be noted that this division is conditional, since these stages are not indicative; they may be absent or of different lengths in time.

The first stage is characterized by maintaining social ties with pre-retirement activities. An elderly person can continue to work, contact former work colleagues, etc.

The second stage is a narrowing of the circle of interests due to the loss of professional attachments. Conversations on everyday topics predominate - children, grandchildren, dacha, television news, etc. In such an elderly person it is already difficult to recognize his former profession - military, doctor, engineer, scientist, etc. These older people are almost no different from each other.

The third stage is primary concern for personal health. The most authoritative figure in the life of such an elderly person is his attending physician or nurse.

Fourth stage - passionate desire preserving life itself. Interests are clearly limited only to maintaining the comfort of life, the stability of the infrastructure (family members, neighbors, peers, social worker, etc.), information about those still alive or already dead.

Fifth stage - vital interest concerns only vital needs - food, sleep. Such elderly people have no limits to everything around them; their ability to connect with the general is practically lost.

D. Dromley identifies the following types of a person’s attitude towards old age.

• 1. A person’s constructive attitude towards old age, in which elderly and old people are internally balanced and have good mood, satisfied with emotional contacts with people around them. They are moderately critical of themselves and at the same time very tolerant of others and their possible shortcomings. They do not dramatize the end of professional activity, have an optimistic attitude towards life, and interpret the possibility of death as a natural event that does not cause sadness and fear. Having not experienced too many traumas and shocks in the past, they show neither aggression nor depression, have lively interests and constant plans for the future. Thanks to their positive life balance, they confidently count on the help of others. The self-esteem of this group of older people is quite high.
• 2. Dependency relationship. A dependent personality is a person who is subordinate to someone, dependent on a marital partner or on his child, who does not have too high demands in life and thanks to this leaves the professional environment. The family environment provides him with a sense of security, helps him maintain internal harmony, emotional balance, and not experience hostility or fear.
• 3. A defensive attitude, which is characterized by exaggerated emotional restraint, some straightforwardness in one’s actions, the desire for “self-sufficiency” and reluctant acceptance of help from other people. People of this type of adaptation to old age avoid expressing their own opinions and have difficulty sharing their doubts and problems. Sometimes they take a defensive position towards their family; even if there are any claims and complaints against the family, they do not express them. The protective mechanism that they use against the feeling of fear of death and deprivation is their activity “through force”, constant “feeding” by external actions. People with a defensive attitude towards advancing old age are very reluctant and only under pressure from others to leave their professional work.
• 4. Attitude of hostility towards others. People with this attitude are aggressive, explosive and suspicious, they strive to “shift” the blame and responsibility for their own failures onto other people, and do not quite adequately assess reality. Distrust and suspicion make them withdraw into themselves and avoid contact with other people. They do their best to drive away the thought of retiring, as they use the mechanism of relieving tension through activity. Their life path, as a rule, is accompanied by numerous stresses and failures, many of which turned into nervous diseases. People related to this type old age, are prone to acute reactions of fear, they do not perceive their old age, and think with despair about the progressive loss of strength. All this is also combined with a hostile attitude towards young people, sometimes with the transfer of this attitude to the entire “new, alien world.” This kind of rebellion against their own old age is combined in these people with a strong fear of death.
• 5. The attitude of a person’s hostility towards himself. People of this type avoid memories because they have had many failures and difficulties in their lives. They are passive, do not rebel against their own old age, they only meekly accept what fate sends them. The inability to satisfy the need for love is the cause of depression, self-esteem and sadness. Associated with these conditions are feelings of loneliness and uselessness. Self-aging is assessed quite realistically; the end of life, death, is interpreted by these people as deliverance from suffering.

The described types of attitude towards old age are most likely the position that a person has adhered to all his life; in old age it only becomes somewhat sharper and is modified under the influence of new circumstances. With age, a person usually experiences a decrease in the level of social aspirations, ambitions and aspirations, and a feeling of satisfaction with the life he has lived arises. Due to the action of psychological defense mechanisms, the past and one’s role in it are rarely idealized. Views are becoming more conservative, which undoubtedly has its advantages, both for the individual and for society as a whole. Some older people have a slight exaggeration of their role in the past: they talk, for example, about close acquaintance with historical figures, initiation into state secrets, their influence on important historical decisions, etc., which is not delusional and is not a pathology .

Thus, the main achievement in mental development At this age stage, a person’s ability to adapt to the new conditions of his existence, to the changes that occur within himself is evident. Activation of compensatory mechanisms ensures the safety of the personality and its subjective comfort.

gerontology aging elderly social

From this article you will learn:

What are the characteristics of old age?

What are the psychological characteristics

How do physiological characteristics manifest themselves in elderly and senile people?

What are the special features of caring for the elderly?

Who can help care for elderly relatives

Currently, the social situation, the focus on youth and an intensive lifestyle create a certain insecurity for older people. The most acute vulnerability is observed in the social and psychological position of the elderly in society.

The concepts of “old age” and “elderly people” It is customary to assign a negative meaning and consider them synonymous with the words “obsolete” and “inferior”. This situation is reflected in the self-awareness of older people and the appeal of younger generations to them. To correct the situation, you need to understand the characteristic features of older age and take them into account according to your capabilities.

What are the characteristics of the elderly and senile age?

The age usually referred to is people 60-65 years old. Most of them are active, do not quit their jobs when they retire, contribute to the lives of their children, and often devote a lot of time to their grandchildren. Of course, after 65 years, every person’s body experiences a restructuring of the immune, genetic and hormonal systems. All tissues and systems of the body undergo changes. Often your health deteriorates. Social status changes noticeably.

At that time Human aged needs an influx of additional vital energy. Friendly communication, physical and intellectual activity, a prosperous family environment, and a positive attitude towards life give pensioners the feeling that they are an important part of society. You should definitely help your health with a diet rich in vitamins and timely accessible medical care. Often, religion gives meaning to existence, inspires and gives vitality and health.

It is noteworthy that with retirement they often make themselves felt hidden abilities , many people can finally will make your wishes come true activities for which there was no time before: fishing, going to theater performances, philharmonic concerts. They are fully invested in creating comfort on summer cottages, spend time with friends, and can finally get properly involved in their favorite pastime. This way of life pushes aside the feeling that life has already been lived. It is especially important for older people to be able to appreciate every moment of existence, enjoy the moment, be attentive to their well-being, take care of their appearance and strive for an active life.

Features of old age

Old age inevitably follows advancing years- a special stage in the development of personality. Nowadays, the average life expectancy threshold has risen and the age of 75 years or older is considered old. Centenarians are people who live more than 90 years.

With the advent of old age, age-related changes are increasingly visible: the general condition of the nervous, cardiovascular, musculoskeletal and other systems of the body changes not for the better.

Daily body cells die, blood vessels, tendons, connective tissue lose their former elasticity. The functioning of the body deteriorates. The body's reactions are no longer the same, muscles weaken, joints and bones undergo changes. The work of the heart slows down, blood circulation is less intense, and processes of degeneration of the liver, kidneys, and digestive system occur.

Such internal changes in the body invariably affect the appearance: the skin becomes covered with wrinkles, age spots appear. Hair turns gray and teeth often fall out.

Old age- This is a time of peace and contemplation. Despite the fact that physical activities quickly lead to fatigue, it is extremely useful for older people to take daily walks and meet with friends and family. Often, even after 70 years, many continue to be an example for the younger generation, remaining active and in demand, leading healthy image life, care about appearance, have rich life experience and happily share their observations. It should be remembered that the health of older people is greatly influenced by the atmosphere at home, relationships with loved ones, the care of relatives and healthy food.

Psychological characteristics of the elderly

Let's start, unfortunately, with the sad stuff. The body ages and you have to put up with it. The wise try to maintain their health from their youth; there are elderly people who are not inferior in strength and erudition to the young. And yet, the reality is inexorable: to one degree or another, the body wears out, it takes more time to recover from stress, the skin changes, and diseases occur more often. Besides everything else, over the years The psychological sphere is also undergoing changes:

in the intellectual field The perception of new knowledge and ideas, the ability to navigate in unplanned conditions may be difficult. Situations that in the early years did not raise any special questions suddenly become difficult: a change of place of residence, illness of loved ones or oneself. Particularly severe stress is caused by situations that have never happened before: the departure of a spouse, restrictions in actions caused by paralysis, deterioration of vision to varying degrees;

in the emotional area uncontrollable affective reactions (excessive nervous excitement) occur, characterized by unreasonable sadness and a tendency to tears. The most common things can cause this condition: watching a movie from years ago or accidentally breaking a cup.

Often Hidden character traits are revealed. It is significant that the sense of purpose and meaning of life is lost.

Psychologists highlight several phases of psychological aging, which is in no way determined by the person’s true age:

at the first stage there remains a relationship with the job that was the main one before retirement. Usually, this is a matter directly related to the pensioner’s previous specialization. These can be people of intellectual professions (teachers, writers, scientists, artists). The connection can manifest itself directly in the form of participation in past activities from time to time, or indirectly, through reading professional literature, writing on the topic of specialization. When the activity ends abruptly with retirement, the person immediately moves on to the second stage.

at the second stage there is a decrease in the sphere of interest due to the end of professional activity. In conversations, more space is given to conversations about everyday issues, discussions of what they saw on TV, worries about the lives of children and grandchildren, and family news. And now among pensioners it is difficult to understand who was engaged in philosophy, who treated people, and who developed complex projects.

at the third stage Concerns for personal well-being occupy first place. Discussions of medications and traditional methods treatment. Newspapers devoted to health are subscribed, and not a single program on the topic is missed on TV. The local doctor often acquires the status of the closest person.

at the fourth stage the whole meaning of life focuses on preserving this very life. The sphere of communication is extremely narrowed: the attending physician, relatives who contribute to the person’s personal comfort, neighbors living nearby. To maintain the norms of decency - congratulations on the holidays to long-time relatives and acquaintances. Mail correspondence may remain, but often there is only one interest - who else can be survived.

at the fifth stage vital needs are reduced: food, amount of sleep, need for rest. Emotionality and communication practically disappear.

Depressing scheme, but not necessary! Physical withering of the body does not determine psychological aging. In life you can often see the opposite picture: many people “die” mentally much earlier, aging body on the physical level. This happens to those who, on their own initiative, withdraw from society, which leads to a decrease in the number of personality traits and to the destruction of the personality structure.

If you look at older people aged 60-65 years, who suffer from a feeling of social uselessness, and at long-livers, who have saved and developed personal qualities, then the first ones will seem like decrepit old men. It has already begun for them stage of personality dying. The consequences of this stage are a sharp blocking of all reserves of a person’s performance and talents. The end of many years of work causes fundamental changes in the structure of a person’s personality.

We can confidently draw an optimistic conclusion: to live, increasing the actual age, but always arrive young at heart, to be alive,energetic and cheerful — Maybe! You might think that year after year it will be more difficult, but wisdom also increases, experience is gained. Motivation is important here—who is this all for?

Living only for oneself cannot preserve the insatiable desire for existence. When a person is surrounded by children, grandchildren, friends, feels that he is needed by his colleagues and is useful to society, and has a unique experience that he is happy to share, then such a pensioner will not lose his vitality and youth.

Physiological characteristics of old age

Over the years the skin becomes thinner, mainly on the hands, feet, in the area of ​​large joints and bone protrusions. The skin becomes dry and wrinkled due to less sweat and sebum production. The amount of subcutaneous fat also decreases noticeably, and the skin becomes flabby. The skin is easily injured, cracks, tears, ulcers occur, and healing occurs much more slowly.

Throughout life hair undergoes various changes under the influence of immune, genetic, hormonal influences and exogenous factors such as frost, heat, chemicals, mechanical trauma, etc. Atrophic and dystrophic changes are observed in the hair follicles and bulbs, hair pigment disappears, and fragility appears.

Over the years the total number of bone tissue is reduced. Articular cartilage becomes thinner, as do intervertebral discs, as a result of which it develops pain syndrome, posture changes, and the spinal column is often curved.

Amount of muscle tissue Also is declining Over time, this reduces the ability to work and overall activity. Fatigue does not allow you to do things at your usual rhythm or complete the activity you started at once.

Gait becomes slow, unsteady, the step shortens, a characteristic shuffling appears. The time spent on both legs increases. It is no longer so easy for an older person to turn around; this happens clumsily and with varying speed in individual parts of the body.

Loss of elasticity is also observed in lung tissue. The diaphragm and chest lose their former mobility. When inhaling, the lungs do not have the opportunity to expand completely. Shortness of breath appears. Bronchial patency decreases, drainage “cleansing” the properties of the bronchi decrease. Insufficient ventilation of the lungs contributes to the development of congestive pneumonia.

The activity of the heart muscle becomes worse with age. First of all, this affects the contractility of the heart muscle, with the help of which the heart pumps blood throughout the body. During physical activity, the heart does not provide enough blood to the body, the tissues do not receive the proper amount of oxygen, this significantly reduces physical abilities, a person gets tired quickly.

Features of nutrition of elderly people

Elderly people should strictly observe moderation in diet and exercise regularly. These rules will help you avoid excess weight and slow down the formation of sclerotic processes in the body. You should maintain a balanced diet, eat 4-5 times a day, and avoid overeating.

The menu should contain meat and lean fish(mostly sea), preferably boiled. It is better to exclude broths. Monitor the amount of fat and do not exceed the recommended amount. Animal fats, consumed in unlimited quantities, cause the development of atherosclerotic process and interfere with the quality digestion of food. It is best to completely exclude refractory fats, such as lard and beef fat, from your diet. An excellent alternative to butter is sour cream.

Carbohydrates should primarily come from a complex, slowly absorbed polysaccharide - starch, which is found in cereals and potatoes. Cellulose has special value in the menu of an elderly person. Vegetables and fruits help separate bile and are an excellent prevention of constipation.

Bread useful only from wholemeal flour. The healthiest cereals are buckwheat and oatmeal.

Vitamins best absorbed from natural products. When the need for vitamins cannot be met with food alone, it is advisable to take a course of multivitamins.

Milk and dairy are the main source of calcium in the diet. Phosphorus is also found in dairy products and in meat, fish, and legumes. Plant foods are rich in magnesium: cereals, legumes, nuts, vegetables, etc. Zucchini, pumpkin, prunes, potatoes, berries, fruits, cabbage are rich in potassium. You should consume table salt as little as possible, limiting it to less than 15 g per day.

Features of caring for elderly and senile patients: 4 valuable tips

Monitor an elderly person's sleep

The duration of sleep for an elderly person is 7-8 hours a day, and more in case of illness or exhaustion. Nervous system elderly people very vulnerable, and sleep is the best way to restore it. This should always be kept in mind. One night without sleep is enough to subsequently feel exhausted and in a bad mood.

Unfortunately, many older people suffer from sleep disorders in the form of insomnia. Often, older people like to take naps during the day, but this is not reflected in the overall amount of sleep due to the fact that they hardly sleep at night. To solve sleep problems, your doctor may prescribe sleeping pills. Unfortunately, this method gives only short-term results. The tablets are addictive and stop working with the proper strength; increasing the dose leads to physical inactivity and apathy.

For these reasons, caring for older people is imperative takes into account the creation of comfortable conditions for proper rest. To achieve this, you need the following:

orthopedic not too soft bed;

must be observed during sleep silence;

suitable temperature indoor temperature is about 18-22 C. To access fresh air, it is necessary to ventilate the room;

take care of lung,but a warm blanket;

eat 4 hours before bedtime, it is better not to drink tea or coffee before bed, and not to overindulge in sweets;

before bedtime very favorable take a little walk, get some fresh air;

try to choose leisure and interesting activities for an elderly person so that reduce, and even better put away day dream.

Elderly people often suffer from nocturnal diuresis, which is a consequence of age-related kidney problems. Reduce nighttime trips to the toilet simple ones will help adviсe:

do not drink anything before going to bed;

wear diapers if required;

Take diuretics with caution and, if possible, stop taking them.

Monitor the personal hygiene of an elderly person

Caring for an elderly person, of course, includes maintaining personal hygiene. Particular attention should be paid to dry skin and use gentle moisturizers, apply restorative creams to avoid discomfort tightness or itching.

Be prepared for accidents

The frequency of accidents increases with age, this is due to the general decline in the level of health of older people. The consequences of an accident in the form of a fracture, bruise or dislocation, etc., are experienced much more difficult at this age. If possible, try to avoid dangerous situations.

Do not move furniture in your home without the elderly person's knowledge. It is better to remove unnecessary furniture altogether;

Carpeting will help reduce the risk of injury from falling;

install comfortable handrails in the bathtub, use anti-slip coating on the bathroom floor and in the bathtub itself.

Create comfortable conditions for an elderly person

older people need a quiet, private environment from time to time, try to allocate a separate room and be understanding of this need;

there should be enough light in the room, ventilate the room regularly;

the height of the sleeping place must be at least 60 cm, but such that when sitting on it, the legs reach the floor;

It can be difficult to get up from a deep chair on your own, so it’s better to do without it.

What services are currently offered to care for the elderly?

Social worker

Every city, even with a small population, has a social service. Social workers on state initiative offer the following services for caring for the elderly:

• taking medications, monitoring the time and frequency of taking them;

  performing certain medical procedures or accompanying an elderly person to a medical center;

  purchase of food and medicine at the expense of the ward or his relatives;

  cooking;

  assistance with eating;

  airing the room and cleaning;

  accompaniment during walks;

  washing and ironing clothes and bed linen.

Let's consider positive and negative sides social service services:

this assistance is provided by the state for free To old people;

Usually, the social worker has medical education and knows how to act in critical situations;

assistance is provided once or around the clock;

to get help social worker, you will first have to submit an application to the commission of the district comprehensive center or social service center. Social service assistance is provided solely based on medical opinion. This service is called admission to non-stationary social services. Registration of all necessary papers takes quite a lot of time and effort;

can count on the help of a social worker not all categories of elderly people;

in case old man does not correspond to the category that is entitled to social service assistance; it is provided only when a close relative of the pensioner is ill for a long time, has a disability, has reached retirement age, has a place of residence remote from the person in need of care, or often travels on business trips.

Nurse

Nurse is a qualified medical worker who has undergone special training and understands all the features of caring for the elderly. This is a difficult job, in which only those who have not only education, but also certain personality traits - patience, hard work, cheerfulness, openness and the ability to empathize - take root. Such character traits are rare, so finding a really good caregiver is not easy.

Depending on the situation, you can invite a visiting nurse with an hourly rate or a live-in nurse, where you pay a certain amount for an agreed period of time.

In what pros and cons of using babysitting services:

You pay only behind That time work nurses, which you need.

a nurse comes to your home, therefore, an elderly person you won't have to move anywhere. Older people are often categorically against leaving their home, so this can be defined as the main positive quality in nursing services.

nurse will needs to be carried out in your house a large number of hours. The presence of a stranger may cause some discomfort.

It may happen that even after carefully selecting a caregiver, the relationship with the patient may not work out or with one of your relatives.

the nurse will be there a lot of time one on one with an elderly person those in need of help. You need to completely trust the professionalism, experience, and personal qualities of the employee in order to be calm.

Specialized boarding house (elderly care with accommodation)

Exist specialized boarding houses for caring for elderly people. Currently, boarding houses resemble cozy sanatoriums that provide the necessary medical services. They try to build such boarding houses in a quiet place with picturesque nature, not too far from the city, so that loved ones can freely visit at any time.

In addition to providing accommodation and necessary care, private boarding houses are equipped with consideration for elderly people with disabilities. These boarding houses offer a wide variety of services.. A developed system for rehabilitation recovery will be relevant to people who have received any injuries, undergone operations or serious illnesses. In boarding houses, special emphasis is placed on organizing the leisure time of the wards.

Elderly people receive opportunity again plunge into social life, which has no less successful therapeutic effect than qualified medical care. In boarding houses there is an opportunity for communication, concerts are held here, picnics are organized, and people are regularly introduced to various types arts at master classes, life-affirming films are shown.

Of course, it is impossible to avoid a negative assessment of state boarding houses in our country, the only advantage of which is their low price. But if you think wisely, the cost of a private boarding house is not much higher, especially taking into account the quantity and quality of services provided, professionalism medical care. A private boarding house, of course, will cost more expensive, but this is the price of the health of a loved one.

Let's consider positive and negative aspects of staying in a private boarding house for caring for elderly people:

the staff of a private boarding house is able to provide more qualified and professional assistance, than a visiting nurse. Boarding houses have all the necessary sophisticated equipment that is simply not possible to have at home. The residents of the boarding house are monitored not only by highly qualified nurses, but also by a staff of doctors of various competencies. A nurse can only provide support for vital functions and basic comfort, while in boarding houses a lot of attention is devoted to increasing the quality of life itself.

rehabilitation programs successfully restore health, animators don’t let you get bored, cooks come up with useful and delicious menu, and a circle of peers gives older people the joy of feeling like a full-fledged person again.

boarding houses provide flexible terms oriented to any needs and capabilities of clients.

an elderly person can live only a few days in a boarding house, maybe several weeks or months. Permanent stay is also provided. Rehabilitation courses of various durations are also conducted.

in the boarding house it is possible to choose for each guest from a large staff of caregivers, with whom a friendly, trusting relationship will develop.

Over the past decade, private boarding houses have become very popular, and new ones are constantly starting to operate. To select the ideal boarding house it will take time. You should not make a choice based only on the information provided by the site; you always need to come, see with your own eyes, talk with the staff and guests;

very elderly people painfully perceive separation from home. Moving is further complicated by the fact that boarding houses are perceived as gloomy and sad nursing homes. It will take a lot of personal tact and patience to show the boarding house exactly what it is - a comfortable country hotel, with cozy living conditions and a wide range of communication and interesting activities.

In our boarding houses we are ready to offer only the best:

24/7 care elderly people professional nurses (all staff are citizens of the Russian Federation).

5 full and dietary meals a day.

1-2-3-bed occupancy (specialized comfortable beds for bedridden people).

Daily leisure (games, books, crosswords, walks).

Individual work of psychologists: art therapy, music lessons, modeling.

Weekly examination by specialized doctors.

Comfortable and safe conditions (well-equipped country houses, beautiful nature, clean air).

At any time of the day or night, elderly people will always be helped, no matter what problem worries them. Everyone in this house is family and friends. There is an atmosphere of love and friendship here.

The number of older people in the world is constantly growing. According to the World Health Organization, from 1980 to the end of this century, the number of people over 65 years of age will increase by 100 MILLION people in developed countries, and by 38 million people in developing countries. This is especially relevant for St. Petersburg as one of the oldest cities in Russia. In old age and old age, the incidence of cardiovascular diseases is extremely high. They affect 50-60 % persons of this age period. A third of all visits to doctors by older people are related to diseases of the cardiovascular system. There are SO many peculiarities of the course of diseases of internal organs in old and senile age that at present there is even a separate science - gerontology and a medical specialty - geriatrics.

First, let's figure out who is classified as elderly and old. In most Western countries, and in Russia too, the age of 45-59 years is considered average. Seniors include people aged 60 to 74 years. Ages from 75 to 90 years are considered senile. Persons over 90 years of age are considered to be long-livers. In some countries elderly age starts at the age of 65, but given that the average life expectancy of men in our country is about 60 years, this classification

tion is not very suitable for us. Cardiologists predict that over the next 20 years, diseases of the cardiovascular system will account for half of all deaths in elderly and old people. Medicine is mainly focused on diseases of middle age. Of course, the origins of many diseases of the cardiovascular system lie in adolescence and early adulthood, however, there are a number of disorders in the activity of the cardiovascular system that are inherent specifically in old age.

If you try to define in one phrase the essence of changes in cardiovascular system, occurring in old age and old age, then it can be formulated as follows: Old age is a decrease in the adaptive capabilities of the cardiovascular system, which is accompanied by a decrease in resistance to the action of vitopathogenic factors. Occurring in old and senile age! changes in all components of the cardiovascular system. In the vascular bed of a person, calcium deposition begins around the age of 40. At the same time, atherosclerotic changes in large vessels progress. As a result of these harsh processes, the aorta and other large vessels become less elastic and distensible, or, in other words, the rigidity of the vessels increases. At the same time, the vessels dilate and lengthen. Changes in small vessels lead to a decrease in their permeability and deterioration in the nutrition of body tissues. Vascular changes lead to an increase in blood pressure. This trend appears from the age of 35. However, after reaching 75-80 years of age, the increase in blood pressure stops in most people. In many elderly and long-lived lindens, blood pressure approaches normal values ​​for middle-aged lindens. However, this does not indicate that their vascular bed has been restored. I [impaired permeability of small vessels (capillaries) persist, and tissue nutrition remains reduced.

Significant changes in old age occur in the heart itself. Volumes of scientific books have been written about the uniqueness of the heart as an organ. 1 Jo, we will give only one figure illustrating the tireless work of the heart. Over the course of 70 years of human life, the heart pumps 165 million LITOS OF BLOOD. Its contractility depends primarily on the condition of the heart muscle cells (myocardium). Such cells (MIO-pts) in mature and elderly people do not divide, therefore the number of MP-otspts decreases with age, since when they die, they are mixed with connective tissue. However, the body tries to compensate for the loss of myocardial cells by increasing the MAC (and therefore the strength) of each myocyte. Naturally, such a process is not unlimited, and gradually the contractile capacity of the myocardium decreases. As noted ■ in the chapter devoted to cardiac arrhythmias, rhythmic and consistent contractions of the heart provide

They are made up of special cells of the conduction system of the heart. They are also called pacemakers, i.e. cells capable of generating impulses that create the heart rhythm. The number of cells conducting this theme begins to decrease from the age of 20, and in old age their number is only 10 % from the original one. This process, of course, eliminates the prerequisites for the development of heart rhythm disturbances in old age. In general, the resting heart rate does not increase significantly in old age, BUT its normal variability decreases. As age-related changes in the heart progress, in response to moderate physical activity or other stress (for example, acute infectious disease, psychological stress), a pronounced increase in heart function (tachycardia) occurs. With age, the valvular apparatus of the heart also suffers, and changes in the bicuspid (mitral) valve and aortic valve are more pronounced than in the valves of the right chambers of the heart. Valve leaflets in old age lose their elasticity, calcium can be deposited in them. As a result, the mitral valve is not able to completely close the transition of the left atrium to the left ventricle. Mitral insufficiency develops, which we talk about in the section Heart defects. I would like to emphasize that this defect, which formed in old age, is not associated with the rheumatic inflammatory process. Changes in the aortic valve often lead to a narrowing of the outlet of the left ventricle, which must overcome greater resistance during contraction (systole). The described disorders are accompanied by overload of the left-handed chambers of the heart and create conditions for the development of heart failure and deterioration in the nutrition of the heart muscle itself through the coronary, or coronary, arteries.

There are many problems associated with diseases of the cardiovascular system in the elderly and senile, but we will focus on the most important of them. These are hypertension, coronary heart disease, cardiac arrhythmias and heart failure. Special! The problem of elderly and senile age is a combined lesion of the cardiovascular system. One patient may have two, three, or four of the above disorders in various combinations. 1 [o First, let's look at individual violations. 11other than with hypertension.

This age covers periods of a woman’s life from 55 to 75 years, and men from 60 to 75 years. In general, it is characterized by an increase in signs of aging and an acceleration of the aging process itself. If, in terms of external signs, an elderly person of the first 5-6 years and a person of mature age (the last 5-6 years) in most cases still differ slightly, and the age boundary itself is practically indistinguishable, then by the end of the period of old age it is difficult to confuse people of these ages.

Aging is a natural manifestation of many diverse life processes of the body that occur with different signs.

Elderly people bear the visible imprint of the years they have lived. First of all, this concerns appearance- characteristic changes in hair, skin, general outline of the figure, gait, etc. Age-related graying usually begins from the head, sometimes from the beard, and a little later appears in the hair of the armpits and eyebrows. Graying of chest hair does not occur until age 40. There are, however, known cases of premature graying, which may be hereditarily determined in the family.

Characteristic changes in the skin. By the age of 50, the skin color of the face acquires an earthy-pale hue, which intensifies as age increases. The skin loses its elasticity, pigment spots of varying degrees of severity appear, and signs of keratinization appear. At the age of 50-60, wrinkles are found on the earlobes, bridge of the nose, chin and upper lip. Later, wrinkles begin to cover the skin of the cheeks, forehead, and neck, becoming deeper and more noticeable every year. It should be borne in mind that wrinkles may appear on the skin of the face and neck earlier, especially in people who spend a lot of time on fresh air, under scorching sun and the wind.

In an elderly person, with rare exceptions, the figure, posture and gait noticeably change, which is associated with age-related changes in the joints, muscles and skeleton. The mass and strength of the muscles, elasticity and mobility of the ligamentous apparatus gradually decrease, the degree of mineralization of the bones increases, which increases their fragility and the likelihood of fracture in the event of a fall or severe bruise. The body becomes heavy, the back becomes round and stooped. Due to the flattening of the intervertebral discs, growth decreases. The gait becomes heavy, slow, but not yet “shuffling”, which is often characteristic of old age. These signs intensify in cases where a person is obese.

Changes in the activity of most internal organs and systems continue to increase. A decrease in heart mass and the elasticity of blood vessels is accompanied by a decrease in heart rate and a decrease in the volume of blood passing through the cardiovascular system per unit time. By the way, these changes occur against the background of aging of other organs and tissues and are therefore “convenient” for the heart, which no longer has to sharply speed up its work and work to the limit of its capabilities.

Significant age-related changes occur in the respiratory system. By reducing the elastic properties of the lung tissue, the vital capacity of the lungs decreases and the amount of air constantly remaining in the lungs increases. In addition, due to the progressive ossification of the costal cartilages and atrophic changes in the tendons and respiratory muscles, a decrease in the mobility of the chest occurs. As a result of these changes, breathing becomes shallow and rapid. The lungs no longer cope with their task sufficiently, especially during physical exertion - a person suffocates, he begins to feel short of breath, and begins to cough. Excess body weight, smoking, and diseases of the respiratory system only aggravate these manifestations.

Old age takes its toll on the digestive and excretory systems.

The genitourinary system is characterized by a number of manifestations, in particular in men due to the peculiarities of their anatomical structure. After 50, and more often after 60 years, 1/3 of all men begin the process of prostate hypertrophy, which, pinching and squeezing the ureter, causes difficulty urinating. Sometimes hypertrophic changes develop into a cancerous process that affects the prostate gland. In all cases of difficulty urinating, older people are strongly recommended to consult a urologist.

Atrophic changes occur in the nervous structures, their blood supply deteriorates, and individual connections with a number of other body systems (primarily the endocrine) are disrupted. On the other hand, the majority of older people clearly show disturbances in the processes of excitation and inhibition and their relationships. Memory impairment may also occur. But the nervous system and the brain have colossal reserve capabilities for timely and fairly effective compensation of disorders caused by both age-related changes and those introduced from the outside (trauma, etc.). Therefore, it would be premature to talk about “senile” changes in the nervous system. You just need to take into account possible and actually operating factors that affect the functioning of the nervous system. These include brain injuries, disruption of its blood supply, infectious diseases, in one way or another affecting the activity of the brain (not only neuroinfections), intoxication, we can now talk about radiation effects on the nervous system, brain tumors of various origins and locations, etc. Factors destructive to brain activity include “laziness of mind,” since active mental activity promotes the development of numerous new connections between nerve cells and activates their biochemical activity. Taken together, these processes determine the mobilization of that reserve of brain power that ensures its functioning in unfavorable conditions (in in this case age-related changes).

Now let's consider an elderly person from the point of view of mental changes that occur with age, as well as those social conditions in which he lives and exists. Let's remember what age interval occupies old age. At this time, most people are either planning to retire or have been receiving it for a long time. A sharp separation from a beloved and familiar job, a work collective with which one has been closely and for a long time connected, a violation of a long-term life pattern is a powerful stress factor for the nervous system and psyche, the effect of which cannot pass without leaving a trace. A person who has taken a “well-deserved rest”, or retired, seems to hang in the air: he is no longer needed by production, he does not need to rush to work in the morning; his children have grown up and are busy with their own problems, most of them have their own families and children. Material income is sharply declining. And ahead is old age with its illnesses, infirmities and the need for help. All this gives rise to pessimism and depression. It's good if a person is able to continue creative activity and find in it peace and compensation for the previous way of life. He especially needs a garden plot, a dacha, where he could spend his energy.

Elderly or retirement age can be considered decisive from the point of view of mental experiences. If a person is able to find pleasure in his grandchildren, his own gardening, dacha, fishing, home improvement, if he finally uses previously constantly missed opportunities in his creative development, going to museums, exhibitions, theaters, etc., then enough will easily and painlessly switch to a new regime of his life. IN otherwise this transition becomes extremely painful both for the person himself and for those around him and loved ones.

Old age requires a reasonable reconsideration of one’s capabilities in terms of physical activity, organization of one’s rest, habits, and diet. What was possible at 50 or 60 becomes unacceptable at 70. The intensity and duration of physical activity must be reduced, rest should be long enough and comfortable, food should be easily digestible and small in volume.

Society should not forget people of older generations who are leaving or have already retired. Moreover, personal activity, participation in professional and social life have become necessary for the majority of people who have crossed the retirement line.

Senile age- a conditionally allocated period of human life from 75 to 90 years. In general, the age periodization of the second half of a person’s life (i.e., after approximately 35 years) is quite complex. Thus, at the end of the 19th century and the beginning of the 20th, people who were barely 45-50 years old were considered old people. Later, due to the increase in human life expectancy, ideas about the time of onset of old age and old age began to shift: we can say that old age “recedes”, and the duration of young ages increases.

Considering the morphological and functional changes characteristic of old age, it should be emphasized that there are no fundamentally different changes in relation to those that are characteristic of old age in old age. There is only their deepening and more distinct manifestation. In particular, the skin, especially the hands, face and neck, becomes thin, wrinkled, and age spots appear on it. Hair turns gray, thins, and becomes brittle. Muscle atrophy and a sharp decrease in the thickness of subcutaneous fatty tissue lead to the formation of many skin folds. The eyes lose their inherent shine, become dull, and in some cases, eversion of the eyelids and ptosis occur. Height decreases, and many old people experience excessive stooping. The gait becomes uncertain and slow.

The aging process does not bypass and internal organs. These organs, in accordance with the laws of senile decline, also gradually reduce their activity.

The totality of senile changes and pathological changes caused by external factors determine the picture of senile pathology. A decrease in the body's ability to adapt to existing factors also causes the development of metabolic or functional disorders, the most common of which are atherosclerosis, accompanied by impaired blood supply to the heart, subsequent heart failure; angina pectoris (angina pectoris); myocardial infarction; disorders of the blood supply to the brain with disorders of the activity of various organs. Hypertension is very often observed, which is usually combined with manifestations of atherosclerosis. In old age, numerous diseases of the musculoskeletal system (rheumatism, osteochondrosis, radiculitis, etc.), diseases caused by functional disorders in the endocrine sphere (diabetes mellitus, etc.) are not uncommon. Disturbances at the cellular level, in the genetic apparatus of the cell, lead to the development of various tumors.

The greatest changes manifest themselves in the mental sphere of an old person: the mobility of nervous processes and memory for recent events deteriorate, and emotional instability develops. These processes are accompanied by a weakening of the intensity of perception of new impressions, as if by a “flight into the past”, into the power of memories, as well as an “obsession” with thoughts about one’s health, “sores” and ailments. Conservatism in judgments and actions, a penchant for teaching are very noticeable; Some affectations are observed, expressed in some cases by previously unusual callousness, distrust, capriciousness, and inadequate touchiness. There is a fairly widespread opinion that in old age, characterological personality traits become sharper and more clearly manifested. For many people of this age, the described changes in the psyche are not of a pronounced nature and, according to the outstanding Soviet pathologist I.V. Davydovsky, are in the nature of an “illness of old age.” However, in some cases they become painful and can serve as the first manifestations of senile dementia.

The psyche of an old person is extremely susceptible to influence external factors, which is the basis of change social status personality, role and place in society (perhaps this explains the desire for suicide that is often found in old people).

Thus, elderly people, due to the specific characteristics of their psyche and a certain helplessness, require special treatment and care from loved ones, acquaintances and simply those around them.

Previously, this role was played by religion, church, and way of life. In our time, with the rapid pace of life, when people have lost the habit of looking around and the principle of “help your neighbor” has practically ceased to apply, the need has come to stop, look around and remember that each of us will be old and will also need help.

The effect of any factors on human life and health should be considered as a whole. For example, the social environment and living conditions determine the nature of nutrition, consumption of alcohol, tobacco, drugs, etc. This, in turn, affects the state of health, the body’s resistance, and its vitality. A decrease in these indicators inevitably leads to the emergence of diseases, an increase in the mortality rate, and ultimately to a decrease in the life expectancy of the population. A targeted impact on these connections will increase the biological capabilities of the human body, delay old age, and facilitate the aging process itself.