Senile age of the disease. Senile mental illnesses. Physical activity and mental work
Ministry of Education of the Russian Federation
St. Petersburg State Pedagogical
University named after A.I. Herzen
Faculty of Law
Department of Criminal Procedure
Forensic psychiatry Lecture No. 12
Diseases of old age.
Alzheimer's disease.
Pick's disease.
Senile sclerosis.
Forensic psychiatric examination.
PhD M.T.Chernukhin
Saint Petersburg
Among patients with mental disorders caused by organic brain damage and pathology of other body systems, patients of senile (76 years or more) and presenile age (55-75 years) make up the majority.
The aging of the body is accompanied by changes in all its functions - both biological and mental. However, the nature of these changes and the time of their manifestation have individual characteristics and vary widely: mental age-related changes do not always correlate with the somatic manifestations of aging of the body.
Changes in mental functioning due to age can manifest themselves selectively and at different age periods. Thus, a person’s ability to imagine—its brightness, imagery—begins to weaken relatively early; the mobility of mental processes and the ability to quickly switch attention also deteriorate. Somewhat later, the assimilation of new knowledge deteriorates.
Emotional manifestations also change with age. Emotional instability and anxiety develop. There is a tendency to get stuck on unpleasant experiences, an anxious - depressive mood. The time of manifestation of age-related changes in the psyche is relatively individual.
The age that is usually considered the beginning of the onset of mental changes associated with involution is 50-60 years. Mental disorders in elderly and senile people can manifest themselves both in the form of borderline mental disorders and in the form of severe mental disorders - severe memory disorders, dementia, delirium, etc.
Among people over 65 years of age, mental disorders of varying degrees account for 30-35%, of which psychosis with severe disorders accounts for 3-5%. Borderline disorders include neurosis-like disorders, mood disorders, and personality changes.
Neurosis-like disorders manifest themselves in the form of sleep disturbances, various unpleasant sensations in the body, emotionally unstable mood, irritability, unaccountable anxiety and fears for the well-being of loved ones, one’s health, etc.
The ongoing changes in the patient's personality affect both his characterological and intellectual properties. In characterological features, there is a kind of sharpening and exaggeration of individual personality traits that were previously characteristic of the patient. Thus, distrust turns into suspicion, frugality into stinginess, perseverance into stubbornness, etc. Intellectual processes lose their brightness, associations become poor, the quality and level of generalization of concepts decreases. Understanding new events and phenomena requires a lot of effort and time. New information is either not assimilated at all or is assimilated with great difficulty. First of all, memory for current events is impaired. For example, it is difficult to remember the events of the past day. There is also a decrease in criticism - the ability to correctly assess one’s mental state and the changes taking place.
The leading changes in the clinical picture of elderly and senile people are: weakening of memory, from mild disorders to amnestic (Korsakoff) syndrome, deterioration of intellectual abilities up to dementia, disturbance of emotions - weakness, tearfulness, apathy, etc.
Severe mental disorders, which occur in a number of elderly and senile patients, are associated with degenerative and atrophic changes in the brain and changes in the functioning of other body systems.
All these changes are accompanied by typical mental disorders, called Alzheimer's disease, Pick's disease (named after the psychiatrists who first described them), senile dementia, etc.
Old age is a natural process that occurs in the body of any person. But at the same time, some people in old age retain their sanity of mind and are in good physical condition, while others early turn into old people with all the ensuing consequences.
Why is this happening? It's all about heredity and, most importantly, a person's lifestyle. What age-related diseases are most common and how to delay their occurrence? This is discussed in this article.
Major age-related diseases
The most common age-related diseases are listed below:
1. Damage to joints. Every elderly person suffers from joint diseases to one degree or another. Typically, the primary lesion occurs at a young age, and over the years the problem begins to worsen. The joints most often affected are the spine, arms, knees and neck. The main symptoms of joint diseases are pain and stiffness.
In order to reduce these manifestations to a minimum, you need to take care of your health from a young age. It is necessary to engage in sports and therapeutic exercises, lead an active lifestyle, fight foci of chronic infection in the body, and prevent the development of obesity.
2. Osteoporosis. It is known that as the body ages, bones begin to lose their elasticity and strength, and the level of essential microelements (especially calcium, magnesium and fluoride) decreases. All this leads to bones becoming too fragile and osteoporosis developing.
The disease can affect any bones in the body, but the most dangerous is the damage to the bones of the spine and hip bones. As a result, any fall can cause a fracture, which will turn a person into a disabled person for the rest of his life.
This pathology can be classified as an age-related disease of women. This is due to the fact that it is the fairer sex who suffer from osteoporosis most often.
According to statistics, every fourth woman aged 60 years and older shows signs of osteoporosis. This is explained by hormonal changes in the body that occur after menopause.
To prevent the development of osteoporosis, it is necessary to eat properly and regularly take complexes that contain B vitamins, as well as microelements such as calcium and magnesium.
3. Diseases of the cardiovascular system. Of all cardiovascular diseases in older people, atherosclerosis is the most common. It is this pathology that over time can cause the development of ischemic heart disease and heart attack, as well as thrombosis of cerebral vessels.
4. Mental disorders. Decreased memory or even its complete loss is one of the main symptoms of Alzheimer's disease and some other types of senile dementia.
If a person aged 60 years or older has memory lapses or complete loss, then an examination and treatment should be started immediately, as this symptom progresses quickly.
5. Metabolic diseases. Most often, older people develop diabetes mellitus, which is dangerous due to its complications.
6. Age-related eye diseases.
Most people over the age of 45 have some form of age-related eye disease. Most often, vision loss goes in two directions, myopia and hyperopia.
In the risk group for myopia, first of all, there are people whose activities are associated with a long stay at the computer.
Age-related eye diseases such as farsightedness develop in old age in almost all people, including those who previously suffered from myopia.
7. Age-related skin diseases. It is known that in youth, metabolic processes in the human body occur faster and cells (including skin cells) are constantly updated.
In older people, this process slows down, the keratinized layers of the skin linger on the surface of the body, giving the skin a matte look.
Age-related skin diseases are also associated with fluid loss, which leads to dryness of the epidermis. The skin of older people loses elasticity and firmness, the volume of subcutaneous fat decreases, which leads to the appearance of wrinkles and sagging skin. Disruption of the process of cell division can lead to the development of neoplasms.
Causes of age-related diseases
In old age, metabolic processes in the body slow down, vitality begins to deplete, which leads to the development of age-related diseases.
The ailments of old age are a natural phenomenon that depends little on external influences. Environmental factors can only become an impetus and lead to an earlier or later onset of old age.
Diseases of old age have an anatomical basis. It is known that age-related diseases in women and men arise due to structural changes in tissues. It is age-related changes that become the main provoking factor for the occurrence of a number of pathological changes in the body.
Symptoms of age-related diseases
Clinical manifestations of diseases in old age have a number of features.
Since the aging process affects the entire body, it is possible for several diseases to develop simultaneously. In older people, 3-5 pathologies can simultaneously develop, most often chronic (atherosclerosis, cancer, ischemic heart disease, stomach ulcers, emphysema, obesity, etc.), and the cause of death is some acute infection (for example, pneumonia).
Another feature of age-related diseases is a less pronounced clinical picture, despite the fact that the processes occurring in the body are quite serious and dangerous to human health and life. The body temperature rises slightly, remaining at a low-grade level, the pain is not severe, and so on.
This makes it difficult to diagnose and often does not allow timely diagnosis of such dangerous conditions of the body as peritonitis, pleurisy, pneumonia, senile cholecystitis.
A decrease in symptoms can also be caused by depletion of the body due to hypovitaminosis, cancer, wounds and injuries. Also, asymptomatic may be associated with a decrease in the overall level of reactivity of the body, which causes a sluggish, atypical and prolonged course of illness in the elderly.
The most important factor that complicates the course of most diseases is the weakening of the body's immune defenses caused by the aging process. For example, it is known that older people are several times more likely than young people to get tuberculosis and cancer, and 7 times more likely to die from pneumonia.
Treatment of age-related diseases
Due to the fact that older people usually develop several diseases at the same time, doctors prescribe a large number of drugs that may not be combined with each other.
This is coupled with a particularly weakened state of the body, which often leads to the development of side effects. This fact must be taken into account by the doctor when drawing up a treatment regimen.
In addition, when treating age-related diseases, the doctor must keep in mind that in old age there is a decrease in tolerance to many drugs. In this regard, you should avoid prescribing drugs that cause dry mucous membranes, atony of the sphincters, bladder, intestines, and impaired coordination of movements (hypnotics, tranquilizers, anticholinergics and a number of others).
Prevention of age-related diseases
Prevention of age-related diseases includes:
- regular physical activity;
- compliance with the work and rest regime;
- rejection of bad habits;
- proper nutrition;
- timely rehabilitation of foci of chronic infections in the body;
- avoidance of nervous strain and stress.
One of the most important discoveries of the 20th century was the scientific proof that the aging process directly depends on the state of the body's immune system. One of the most important parts of our immune system is the thymus, where the synthesis and “training” of immune cells occurs. Unfortunately, with age, the functions of the thymus begin to fade, the number of immune cells in the body drops, and the aging mechanism begins.
Scientists around the world were tasked with creating a drug that could replace the thymus gland and take over its functions. After several years of hard work, such a drug was created. It's called Transfer Factor.
It consists of immune cells of the same name, which, when entering the body, have the following effect:
Enhance the effect of co-administered drugs;
Quickly restore the body's immune defenses and normalize metabolic processes;
- “remember” the causative agents of the disease and, when they subsequently enter the body, give a signal for their immediate destruction;
Block possible side effects from other drugs.
In addition, Transfer Factor is a 100% natural drug, so it can be taken even by pregnant women and newborn children.
As a result of regular use of Transfer Factor, a decrease in the patient’s biological age is observed, that is, the drug also has a rejuvenating effect.
I wish you health and long life!
The following diseases are more common in old age.
arterial hypertension - a stable increase in blood pressure above 140/90 mm Hg. Art. Genetic and environmental factors play a leading role in the development of arterial hypertension. External risk factors include: age over 55 years in men, age over 65 years in women, smoking, increased cholesterol levels above 6.5 mmol/l, unfavorable family history of cardiovascular diseases, microalbuminuria (with concomitant diabetes), sensitivity disorder to glucose, obesity, high fibrinogen, sedentary lifestyle, high ethnic, socioeconomic, and geographic risk.
In old age, arterial hypertension occurs more often as a result of atherosclerotic damage to blood vessels (the aorta, coronary arteries, and cerebral arteries are most often affected).
Atherosclerotic hypertension is distinguished - this is hypertension in elderly patients, in which predominantly systolic blood pressure increases, while diastolic blood pressure remains at a normal level, which leads to a large difference between systolic and diastolic pressure. An increase in systolic blood pressure with normal diastolic pressure is explained by the presence of atherosclerosis in large arteries. When the aorta and arteries are affected by atherosclerosis, they become insufficiently elastic and, to some extent, lose the ability to stretch during systole and compress during diastole. Therefore, when measuring blood pressure, we record a large difference between systolic and diastolic pressure, for example 190 and 70 mmHg. Art.
In the classification of arterial hypertension, there are 111 degrees of increased blood pressure.
I degree: blood pressure numbers 140-159/90-99 mm Hg. Art.
II degree: blood pressure numbers 160-179 / 100-109 mm Hg. Art.
III degree: blood pressure figures above 180/110 mm Hg. Art.
Clinic
When blood pressure rises, patients experience headaches, dizziness, there may be tinnitus, and “fly spots” before the eyes. However, it should be noted that intense headache, accompanied by dizziness, nausea, and tinnitus, is observed with a significant increase in blood pressure and may be a manifestation of a hypertensive crisis. Patients may also be bothered by rapid heartbeat (usually sinus tachycardia), various types of pain in the heart area.
In elderly patients with atherosclerotic hypertension, objective symptoms such as headache, dizziness are not detected. Basically, complaints arise with a significant increase in blood pressure numbers.
Often, elderly and senile patients do not experience unpleasant symptoms with a significant increase in blood pressure; patients can feel well even with blood pressure of 200 and 110 mm Hg. Art. The diagnosis of arterial hypertension in such patients is often made when high blood pressure is accidentally detected (during a medical examination, hospitalization for another disease). Many of them believe that the absence of discomfort with high blood pressure indicates a benign course of the disease. This belief is completely wrong. Such a latent (hidden) course of arterial hypertension leads to the fact that a person, without experiencing painful, painful symptoms, has no incentive to be examined and treated, as a result, antihypertensive therapy for such patients is started late or not at all. It has now been proven that the risk of developing vascular accidents (myocardial infarction, acute cerebrovascular accident, thromboembolism) in such patients is much higher than in people with normal blood pressure numbers.
Features of measuring blood pressure in elderly patients: elderly people may have a pronounced thickening of the wall of the brachial artery due to the development of an atherosclerotic process in it. Therefore, it is necessary to create a higher level of pressure in the cuff to compress the sclerotic artery. As a result, a false increase in blood pressure figures occurs, the so-called pseudohypertension.
The phenomenon of pseudohypertension is detected by the Osler maneuver; for this, blood pressure in the brachial artery is measured by palpation and auscultation. If the difference is more than 15 mm Hg. Art., which means that the phenomenon of pseudohypertension is confirmed. True blood pressure in such patients can only be measured using an invasive method.
Elderly people may also experience orthostatic hypotension, so their blood pressure should be measured while lying down.
Arterial hypertension requires constant treatment and regular use of medications. Patients with hypertension are primarily advised to have an active motor regimen, a balanced diet, adherence to a work and rest schedule, control of body weight, and abstinence from alcohol and smoking. Consumption of table salt per day is no more than 4-6 g.
Various groups of drugs are used in the treatment of arterial hypertension, mainly ACE inhibitors (captopril, enalapril, Prestarium, losinopril), diuretics (hypothiazide, furosemide, indapamide), beta blockers (atenolol, anaprilin, egilok, concor), diuretics (furosemide, hypothiazide, indapamide), sedatives (valerian, passifit, afobazole). A combination of these groups of drugs is often used. Arterial hypertension in elderly patients lasts a long time, but is more benign than hypertension at a young age.
Angina pectoris is one of the most common forms of coronary heart disease. The main symptom is the typical pain of angina pectoris - this is a pressing, squeezing pain behind the sternum that occurs with little physical activity (walking 200-1000 m, depending on the functional class), relieved with rest or with sublingual administration of nitroglycerin after 3-5 minutes. This pain can radiate under the left shoulder blade, into the shoulder, or jaw. Such coronary pain occurs when there is insufficient oxygen supply to the heart muscle, when the need for it is increased (for example, during physical exertion, emotional stress). An attack of angina may also occur when walking in cold, windy weather or when drinking a cold drink. Usually the patient knows about the load under which an angina attack occurs: how far he can walk, what floor he can climb to. Such patients should always carry nitrate-containing medications with them.
You should also remember about the so-called unstable angina, in which an attack of chest pain can dramatically change its character: the distance that the patient can walk without pain will decrease, the previously effective nitroglycerin will no longer work, or its dose will have to be increased to relieve the pain. The most dangerous thing is when pain begins to appear at night. Unstable angina is always regarded as a pre-infarction condition, and such a patient requires immediate hospitalization in a hospital. In case of severe pain syndrome, the patient should be given nitroglycerin under the tongue; you should not give the patient several tablets at once or give them continuously: you should give 1-2 tablets, wait 10-15 minutes, then another one, wait again 10-15 minutes, etc. d. Large doses of nitroglycerin can be given only by monitoring blood pressure - it should not decrease.
Prolonged course of angina pectoris, inadequate treatment or its absence can subsequently lead to the development of heart failure and myocardial infarction.
You need to know that not all pain in the heart can be of angina origin. Often, elderly patients experience widespread pain to the left of the sternum, which is constant, aching in nature, and worsens with certain movements. By palpating along the ribs or spine, painful points can be identified. Such pain is characteristic of osteochondrosis, intercostal neuralgia, and myositis. Sometimes they get worse due to colds. Such pain is well treated with non-steroidal anti-inflammatory drugs (for example, diclofenac, ibuprofen). Sometimes chest pain appears after a heavy meal, after the eater has gone to bed. Such pain may occur due to bloating (Remgelt syndrome) and associated tension in the diaphragm. Also, in the elderly, a diaphragmatic hernia occurs quite often, when the esophageal opening of the diaphragm expands and, in a horizontal position, part of the stomach moves into the chest cavity. There is pain that goes away in an upright position. Patients may sleep half-sitting due to pain.
In menopausal women, along with typical symptoms, such as a feeling of a rush of heat to the face, a feeling of goosebumps crawling in the limbs, a feeling of anxiety, unmotivated bouts of trembling, various types of pain in the heart area may also occur. Usually they are not associated with physical activity, but on the contrary, they often occur at rest, can bother you for quite a long time, and do not go away for hours. Valocordin, Corvalol, and valerian usually help relieve these pains, while taking nitroglycerin has no effect on them.
Treatment of angina pectoris mainly involves taking a group of drugs such as nitrates. Nitrates include nitroglycerin, nitrosorbide, and erinite. Taking these drugs can cause severe headaches; to reduce this unpleasant side effect, nitrates are taken together with validol. Also used for treatment are drugs that lower cholesterol levels - statins (these include Vazilip, atorvastatin), drugs that reduce blood viscosity - anticoagulants (aspirin, thromboass, cardiomagnyl).
Heart failure- a pathological condition caused by weakness of the contractile activity of the heart and failure to ensure adequate blood circulation. Heart failure is usually a secondary condition that complicates primary damage to the heart, blood vessels, or other organs. The causes of heart failure are the following diseases: ischemic heart disease, cardiac malformations, arterial hypertension, myocarditis, dystrophic changes in the myocardium, myocardiopathy, diffuse lung diseases.
In the initial stages of heart failure, the heart's ability to relax is impaired, diastolic dysfunction occurs, the chamber of the left ventricle is less filled with blood, which leads to a decrease in the volume of blood ejected by the ventricle. However, at rest, the heart copes, the volume of blood compensates for the needs. During physical activity, when the heartbeat increases, the total output of blood decreases, and the body begins to starve of oxygen, and the patient develops weakness and shortness of breath during any physical activity. Heart failure is characterized by a decrease in the patient's tolerance to normal physical activity.
Distinguish between acute and chronic heart failure.
Acute left ventricular failure develops against the background of a load on the left ventricle (arterial hypertension, aortic defects, myocardial infarction can lead to this) and in the presence of a provoking factor, such as physical and emotional stress, infections.
Clinically, acute left ventricular failure manifests itself in the form of cardiac asthma or pulmonary edema.
Cardiac asthma develops acutely, manifested by increasing shortness of breath, feeling of lack of air, suffocation. In addition to these symptoms, a cough may appear with the discharge of first light sputum, and then streaks of blood may appear in it. On auscultation, harsh breathing is heard in the lungs, and moist fine bubbling rales are heard in the lower parts. The patient sits in bed with his legs down - this position facilitates the patient’s condition due to the unloading of the pulmonary circulation. If left untreated and the disease progresses, pulmonary edema may develop.
Pulmonary edema can develop not only with left ventricular failure, but also with pneumonia, the appearance of foreign bodies in the bronchi, and a sharp decrease in atmospheric pressure. Pulmonary edema is an acute condition that requires emergency care, since the symptoms develop so rapidly that an unfavorable outcome can occur quite quickly. Suddenly, often at night, against the background of an attack of angina pectoris, the patient experiences severe shortness of breath (even suffocation), a dry cough appears, which quickly gives way to a wet one with the release of foamy, bloody sputum. The patient takes a forced semi-sitting or sitting position, lowering his legs, resting his hands on the bed, chair, auxiliary muscles participate in breathing. General excitement sets in, a feeling of fear of death appears. The skin becomes cyanotic. In the lungs, moist rales of various sizes are heard in all fields, the frequency of respiratory movements increases to 40-45 respiratory movements per minute.
The course of pulmonary edema is always severe, the prognosis is very serious. Even with a positive result of treatment, relapse of the condition is always possible.
In the treatment of acute left ventricular failure, sublingual administration of nitroglycerin tablets 10 mg every 10 minutes is used, blood pressure monitoring, intravenous administration of narcotic painkillers (1-2 ml of 1% morphine), intravenous administration of diuretics (2.0-8.0 ml) are required. 1% solution of furosemide), intravenous administration of cardiac glycosides, it is preferable to administer strophanthin or korglykon in small doses (0.25-0.5 ml of 0.05% solution), combining them with potassium and magnesium preparations to improve metabolism in myocardium.
Chronic heart failure develops gradually, often its causes are arterial hypertension, coronary artery disease, and aortic defects.
The clinical picture of chronic heart failure has three stages.
In stage I, general symptoms predominate: weakness, fatigue, increasing shortness of breath, increased heart rate during physical activity. Acrocyanosis may occur at times. The size of the liver does not change. All these phenomena go away on their own after cessation of physical activity.
In stage II, all symptoms begin to appear with less physical activity: shortness of breath increases, tachycardia increases, and a dry cough may appear. Local symptoms (acrocyanosis) appear, swelling of the lower extremities is observed, which does not go away by the morning, in the future the swelling can increase (up to the development of anasarca - the presence of fluid in all cavities: ascites, hydrothorax, hydropericardium). The liver increases in size, becomes dense. Moist fine bubbling rales are heard in the lungs. When the condition decompensates, patients are in a forced position: sitting in bed with their legs down.
In stage III (final, dystrophic), against the background of pronounced total congestive failure, severe irreversible changes develop in the internal organs with disruption of their function and decompensation. Renal and liver failure develop.
Non-drug treatment consists of limiting physical activity and correcting water and electrolyte metabolism. Bed rest and restriction of fluid intake and sodium chloride are necessary. Daily diuresis should be taken into account; the patient should keep a diary recording the amount of fluid drunk and excreted. When determining the volume of liquid drunk per day, it is necessary to take it into account in all products taken by the patient.
With medical treatment it is necessary:
Treat the underlying disease that led to CHF (etiological therapy);
Strengthen the reduced contractile function of the left ventricle (cardiac glycosides);
Reduce the increased volume of circulating blood (diuretics, vasodilators);
Eliminate or reduce peripheral edema and congestion in internal organs (diuretics);
Reduce blood pressure (ACE inhibitors);
Reduce heart rate (beta blockers, cardiac glycosides, verapamil);
Improve metabolic processes in the myocardium, increasing its contractility (potassium, magnesium, riboxin).
Heart rhythm disturbances
Among all rhythm disorders, especially often in old age, atrial fibrillation and complete blockade of the conduction system of the heart are observed. These two rhythm disturbances are dangerous and can lead to severe complications, which in turn can lead to death. Atrial fibrillation can occur at any age, but its frequency increases with age, but complete blockade of the conduction system of the heart is exclusively a disease of old age.
Atrial fibrillation- This is frequent irregular activity of the atria. It occurs when electrical impulses emanating from the pacemaker in the right atrium begin to wander through the conduction system of the heart, add up or cancel each other out, and chaotic contractions of individual groups of atrial fibers occur with a frequency of 100-150 beats per minute. This pathology occurs more often with organic damage to the heart: cardiosclerosis, cardiomyopathy, heart defects, coronary heart disease. The occurrence of atrial fibrillation can also occur when additional conduction bundles are detected (this is a congenital defect, usually recognized at a relatively young age).
When the conduction system of the heart is completely blocked, the impulse from the atrium does not reach the ventricle. This leads to the fact that the atria contract in their own rhythm, and the ventricles - in their own, much more rare than usual. At the same time, the heart stops responding by increasing contractions in response to demand (for example, during physical activity).
Atrial fibrillation can be constant and paroxysmal.
The paroxysmal form is characterized by the fact that against the background of some provoking factor (such as physical activity, emotional stress) an attack of frequent arrhythmic heartbeat occurs. At this moment, the patient subjectively feels a feeling of interruptions in the functioning of the heart, shortness of breath, weakness, and sweating. Such an attack can pass either independently at rest or when taking medications - in this case, sinus rhythm is restored. Also, in some cases, you can try to eliminate the attack by pressing hard on the eyeballs or painfully massaging the supraclavicular area, quickly squatting the patient. Such techniques can have a positive effect on cardiac activity (up to the disappearance of arrhythmia).
The permanent form of arrhythmia is characterized by the presence of a constant arrhythmic heartbeat; sinus rhythm is not restored in this form. In this case, they ensure that the rhythm is not rapid - no more than 80-90 beats per minute. With a permanent form of atrial fibrillation, the patient always feels interruptions in the work of the heart, shortness of breath during physical exertion. When examining the pulse, pulse waves of different contents and non-rhythmic ones are determined. If you compare the pulse rate and heart rate, you can identify the difference between them in the direction of increasing the heart rate. This phenomenon is called “pulse deficiency” and determines the ineffectiveness of some of the heart contractions - the chambers of the heart do not have time to fill with blood, and an empty “pop” occurs; accordingly, not all contractions are carried out to the peripheral vessels.
A long-term course of a constant form of atrial fibrillation leads to the progression of heart failure.
In the treatment of atrial fibrillation, cardiac glycosides are used: corglycon, digoxin; beta blockers: atenolol, concor; cordarone isoptin, etacizin.
With a complete blockade of the cardiac pathways, blood pressure suddenly decreases, the heart rate decreases to 20-30 beats per minute, and symptoms of heart failure increase. Patients with newly diagnosed complete heart block require mandatory hospitalization, since in this case the development of myocardial infarction can be missed. Currently, the treatment of this pathology consists in installing an artificial pacemaker to the patient, which, by generating electrical discharges, stimulates heart contractions through a wire inserted into the heart through a vein. An artificial pacemaker is sewn into the patient for 5-8 years. Such a patient should be away from areas with high magnetic fields (industrial transformers, high-voltage power lines, use of a radiotelephone and cellular communications, etc.), he can “interfere” with the reception of radio and television broadcasts if he is close to the antenna.
Chronical bronchitis is an inflammatory diffuse lesion of the bronchial tree. The cause of the development of bronchitis are viral and bacterial infections, exposure to toxic substances, smoking. In old age, smokers are more likely to suffer from chronic bronchitis.
Chronic bronchitis, like any chronic disease, occurs with periods of remission and exacerbation, which occurs more often in the cold season. During the period of exacerbation of the disease, the patient is bothered by a cough (dry or with sputum discharge), shortness of breath when walking, an increase in temperature to low-grade levels, weakness, and sweating. On auscultation, hard breathing and dry rales are heard throughout all fields of the lungs. The constant course of chronic bronchitis, the lack of adequate treatment, and the presence of a constant irritating factor subsequently lead to the development of emphysema, pneumosclerosis, and the development of cor pulmonale.
In treatment, first of all, irritating and provoking factors should be excluded. The patient needs bed rest. The following groups of drugs are used: antibacterial drugs, expectorants (mucaltin, bromhexine), herbal decoctions (chest collection No. 3, 4), non-steroidal anti-inflammatory drugs (aspirin, ortafen, nise).
Often, a long course of chronic bronchitis leads to the development of chronic obstructive pulmonary disease. The disease is characterized by the presence of shortness of breath, dry paroxysmal painful cough. After the sputum is discharged, the patient's condition improves and it becomes easier for him to breathe. Locally, acrocyanosis can be noted, often the color of the skin has an earthy tint, fingers in the form of drumsticks and nails in the form of watch glasses. On auscultation, such patients can hear hard breathing, dry wheezing in all fields, and prolonged exhalation.
In the treatment of such patients, antibacterial drugs, expectorants, inhalation of Berodual, salbutamol, and inhaled glucocorticosteroids are used. Often such patients are prescribed oral glucocorticosteroids.
Physical therapy, hardening, and physiotherapy play an important role in the treatment of respiratory diseases.
Elderly people should be protected from drafts, but the room in which elderly patients are located must be well ventilated and wet cleaning must be carried out regularly. Such patients should take walks more often - they need to be in the fresh air for 30-40 minutes every day.
Diabetes- a disease characterized by a violation of the absorption of blood glucose by cells, resulting in a progressive lesion of large and small vessels. Type I and II diabetes are distinguished; older people are characterized by type II diabetes mellitus. Type II diabetes mellitus occurs as a result of exposure to the body of many factors, among which are smoking, alcoholism, severe stress.
Patients with diabetes develop itching of the genital organs, thirst, they begin to consume a lot of fluids, and polydipsia also occurs (patients eat a lot), polyuria (patients excrete a lot of urine). However, in older patients, not all of these symptoms are pronounced. The exact diagnostic criteria for the development of diabetes in a patient are the detection of a high blood glucose level (above 6.0 mmol / l) in a biochemical blood test and in the study of a glycemic profile, as well as the presence of sugar in a general urinalysis.
In the treatment of diabetes mellitus, adherence to a diet that excludes sugar, foods containing carbohydrates is of great importance. Patients are recommended to use sugar substitutes - saccharin and aspartame. Regular testing of blood glucose in the clinic or at home is necessary.
Patients are prescribed glucose-lowering drugs: glibenclamide, maninil. In severe cases, when the correction of blood sugar levels with hypoglycemic drugs is not possible, insulin administration is prescribed during operations.
The presence of diabetes in an elderly patient always complicates the course of coronary heart disease, arterial hypertension. Since small and large vessels are affected in diabetes mellitus, the sensitivity in such patients is reduced, and the clinic of many diseases is not so typical, more blurred. For example, myocardial infarction in such patients may occur with a less intense pain syndrome. This can lead to delayed medical care and death of the patient.
In diabetes mellitus, a hypoglycemic state can develop, which can lead to coma, and hyperglycemic coma.
With hypoglycemia, the patient has a feeling of anxiety, trembling throughout the body, a feeling of hunger. He becomes covered in cold sweat, weakness and confusion appear. In this state, the patient must be given a piece of sugar under the tongue, this will improve his well-being. In a hyperglycemic state, the level of glycemia is corrected by the careful administration of insulin under the control of a blood sugar test.
With long-term diabetes mellitus, patients develop vascular damage to the lower extremities - diabetic angiopathy of the lower extremities. This disease initially leads to cold feet and legs, a feeling of numbness in the limbs, and pain when walking, which goes away as soon as the person stops (“intermittent claudication”). Subsequently, the sensitivity of the skin of the lower extremities decreases, pain appears at rest, ulcers and necrosis occur on the legs and feet. If left untreated, ischemic damage to the lower limb ends in leg amputation.
Damage to small vessels that supply nerve endings leads to loss of sensitivity in the skin of the legs, disturbances in its nutrition, and the development of “diabetic foot.” At the same time, the patient does not feel pain from small wounds and abrasions on the skin, which turn into long-term non-healing ulcers. In combination with or without ischemia of the lower extremities, “diabetic foot” can lead to amputation.
For the treatment of diabetic foot use plavika, vasoprostan.
Proper foot care is also essential. You should wash your feet every day with warm water and soap, wear warm cotton socks without elastic. Feet should be protected from hypothermia, wear comfortable, soft, loose shoes, carefully observe safety when cutting nails, entrust it to a partner or caregiver, and treat nail beds with iodine solution. When scuffed, you need to use various creams.
Chronic pyelonephritis- a nonspecific infectious kidney disease that affects the renal parenchyma. The occurrence of the disease in old age is facilitated by the presence of urolithiasis, prostate adenoma, diabetes mellitus, and poor genital hygiene. The disease proceeds for a long time, with periods of remission and exacerbation. During the period of exacerbation, low-grade fever, dull aching pain in the lumbar region, and frequent painful urination appear. In elderly patients, the disease may occur without severe fever, and sometimes mental changes occur - anger, irritability.
In the treatment of pyelonephritis, antibacterial drugs, uroseptics, and renal herbal preparations are used. Such patients need to avoid hypothermia and maintain personal hygiene.
Chronic renal failure occurs as a result of a long course of chronic diseases of the urinary system (pyelonephritis, glomerulonephritis, prostate adenoma), diabetes mellitus, hypertension, or as a result of aging of the body (sclerotic changes occur in the vessels of the kidneys).
This disease is characterized by the replacement of nephrons with connective tissue, as a result of which the kidneys can no longer function adequately and their functions progressively deteriorate.
At the onset of the disease, patients experience weakness, polyuria, nocturia, and anemia may be detected. For a long time, the only symptom of chronic renal failure may be a persistent increase in blood pressure.
The disease is diagnosed by a biochemical blood test, which reveals elevated levels of urea and creatinine, and by urine testing, which reveals the presence of protein and a decrease in the relative density of urine.
If patients have arterial hypertension, diabetes mellitus without adequate treatment, or an infectious process, chronic renal failure begins to progress quite quickly. Patients experience severe weakness, nausea, vomiting, unbearable skin itching, and sleep disturbances. There is a significant decrease in urine output, hyperhydration develops, anemia, azotemia, and hyperkalemia increase. Patients develop symptoms of heart failure: shortness of breath and tachycardia increase. Patients have a characteristic appearance: the skin is yellowish-pale in color, dry, with traces of scratching, and severe swelling. Further progression of the disease can lead to the development of uremic coma.
In the treatment of chronic renal failure, hemodialysis using an artificial kidney machine is used. However, this method of treatment is quite expensive; elderly patients have difficulty with hemodialysis. Therefore, at present, conservative treatment methods are most often used for elderly and senile patients. First of all, it is necessary to treat those diseases that can lead to the development of chronic renal failure: arterial hypertension, diabetes mellitus, chronic pyelonephritis, prostate adenoma. Early detection of these diseases and their adequate treatment are very important. Such patients should be observed in the clinic at their place of residence and undergo regular examinations to adjust therapy.
To reduce the progression of renal failure, ACE inhibitors (enalapril, captopril, fosinopril), antiplatelet agents (Plavika), sorbents (enterosgel, polyphepan) are used. Also used in treatment are keto analogues of amino acids (ketosteril) up to 8-12 tablets per day, activated carbon up to 10 g per day or enterodesis 5-10 g per day. It is important to follow a diet with limited salt and protein (reduced consumption of meat and fish), with sufficient fluid under mandatory control of diuresis and carbohydrates. All this allows you to improve the patient’s quality of life, and often extend the patient’s life for several years.
Chronic cholecystitis is an inflammatory disease of the gallbladder wall. This disrupts the ability of the gallbladder to contract and secrete bile necessary for normal digestion. As a result, stones can form in the lumen of the gallbladder - cholelithiasis. The causes of the development of cholecystitis can be: bacterial infections, viruses, possibly toxic or allergic in nature, and sometimes unhealthy diet.
The disease occurs with periods of remission and exacerbation, expressed by the presence of pain in the right hypochondrium after physical activity, errors in diet (eating fried, salted, smoked foods), nausea, and a feeling of bitterness in the mouth. When the bile ducts are blocked by a stone, sharp paroxysmal pain occurs in the right hypochondrium, similar to hepatic colic, and yellowness of the skin and mucous membranes may appear - in this case, surgical treatment is necessary.
In the treatment of uncomplicated cholecystitis, antibacterial drugs, antispasmodics, and anticholinergic drugs are used. You should also follow a diet excluding alcohol, fried, fatty, salty, and spicy foods.
BPH- Benign neoplasm of the prostate. Occurs in men over 50 years of age, the disease is based on age-related changes in hormonal levels, resulting in the proliferation of prostate tissue with impaired bladder emptying.
Patients complain of frequent urination in small portions, urination at night, and urinary incontinence may subsequently occur.
Previously, only surgical treatment of the disease was practiced. Currently, there are drugs that can reduce the size of the prostate without surgery. The most widely used are dalfaz and omnic - these drugs reduce spasm of the urinary tract and in this way eliminate the main signs of the disease. When used, there may be a decrease in blood pressure, so they are not recommended or taken in small doses when blood pressure is low.
Deforming osteoarthritis- a group of joint diseases. Caused by damage to the articular cartilage, its thinning, proliferation of bone tissue, pain in the affected joint. Factors contributing to the occurrence of deforming osteoarthritis in old age are obesity, occupational stress on the joint, and endocrine disorders.
The disease progresses gradually. Initially, patients experience rapid muscle fatigue and pain in the joints after exercise, a slight crunch in the joints when moving, and slight morning stiffness. As the disease progresses, the symptoms become more pronounced, limitation of movement in the joint increases, joint deformities and muscle atrophy appear. The joints of the spine, lower extremities, and interphalangeal joints are most often affected. In the area of the distal interphalangeal joints, dense formations appear that deform the joint (Heberden's nodes), the joint increases in volume and takes on a fusiform shape (Bouchard's nodes). When the spine is damaged, local pain appears with symptoms of radiculitis and stiffness.
The treatment uses therapeutic exercises, massage, and diet to correct body weight. To relieve pain, non-steroidal anti-inflammatory drugs are used: Nise, Movalis, diclofenac. Kenalog and hydrocortisone are also injected into the joint.
Physiotherapy is widely used.
Aging and disease
At each stage of ontogenesis, in connection with the specific features of the body’s adaptive capabilities, its own prerequisites are created for the development of any age-related pathology. By old age, diseases accumulate, reappear, acquire qualitative and quantitative characteristics of the course and, due to a decrease in the adaptive capabilities of the body, become the cause of death of the body.
There is a unity, an inextricable connection between aging and disease, which does not mean their identity. Outstanding Soviet pathologist I.V. Davydovsky wrote: “...old age is not a disease in the modern meaning of the word. Old age is usually painful. This “morbidity” is natural in the sense that it reflects the natural ailments of old age caused by the essence of aging (20). Aging creates the basis for the inevitable development of diseases; in this regard, we can say that old age is an interweaving of physiological and pathological.
Aging is characterized by a combination of several diseases (from 2-5 or more), which have a chronic course and are difficult to treat (multimorbidity). The most unpleasant consequence of existing diseases is the development of senile infirmity, which constantly requires outside care and assistance.
Typical for late age are diseases associated with changes in organs as a result of aging, as well as associated degenerative processes under the influence of various environmental factors.
Let's consider the most common diseases of elderly and old people.
Atherosclerosis - chronic arterial disease, gradually leading to narrowing of the lumen and dysfunction. This means that blood flow through the artery that supplies oxygen and nutrients to an intensively working organ becomes insufficient. As a result, the functions of the organ are significantly reduced. Accumulations of cholesterol are always found in the affected areas of the arterial wall. Further changes
tissue cells of the arterial wall and the biochemical processes in it are disrupted.
The disease develops slowly, sometimes throughout life. It can progress, but also undergo reverse development. Risk factors contributing to the development of atherosclerosis, especially atherosclerosis of the heart vessels:
High blood pressure (hypertension);
Smoking;
Excessive nutrition, especially high-calorie foods;
Sedentary lifestyle;
Frequent stressful conditions, nervous overstrain;
Diabetes;
Hereditary predisposition;
Excessive alcohol consumption. The occurrence and rate of development of atherosclerosis are associated with
arterial hypertension, diabetes mellitus, heredity. Usually there is a predominant damage to the vessels of the brain, heart, kidneys, but...
arterial hypertension - a condition characterized by a persistent increase in blood pressure. Blood pressure up to 140/90 mm Hg is considered normal. Art. Blood pressure is subject to fluctuations associated with physical activity, anxiety, and experiences.
Although the reasons for the development of arterial hypertension are not completely clear, it is known that physical inactivity, obesity, smoking, alcohol consumption, salt abuse, kidney disease, atherosclerosis, stress, etc. contribute to it. Symptoms: headache in the occipital region, dizziness, palpitations, shortness of breath, impaired intellectual and mnestic functions. When a hypertensive crisis occurs (sudden increase in blood pressure), nausea, vomiting, “fog” before the eyes, and trembling in the body appear.
High blood pressure increases the risk of death from vascular accidents - myocardial infarction, stroke; in such patients, heart failure develops faster and more often.
In the elderly, it is often possible to identify so-called “sclerotic hypertension”. It is known that blood pressure is maintained by the force of contraction of the heart (systole), which pushes blood into the aorta (systolic, upper pressure). At the moment, the aorta is stretching. When the heart relaxes (diastole), the valve in the aorta closes and the aorta begins to contract, thereby maintaining diastolic (lower) pressure. Moreover, the aorta contracts not just due to its elasticity, but also with the help of the muscles located in its wall; the wave of these contractions moves to the small arteries, forming an additional blood movement - the peripheral heart.
If the aorta and arteries are severely damaged by atherosclerosis, they lose their elasticity - the ability to stretch during blood filling in systole and compress, maintaining pressure in diastole. In this case, when measuring pressure, a very large spread between systolic and diastolic pressure is recorded, for example, 200\70 mmHg. It has been proven that high systolic pressure poses a danger from the point of view of the development of stroke and myocardial infarction, and contributes to the appearance and progression of heart failure. For this reason, it is extremely important to strive to reduce it.
Cardiac ischemia - heart disease caused by a decrease or cessation of blood supply to the heart muscle due to atherosclerosis of the heart vessels. Risk factors: physical inactivity, obesity, smoking, alcohol consumption, kidney disease, atherosclerosis, stress, hypertension, diabetes, etc.
Acute forms of the disease are: angina pectoris, myocardial infarction, heart failure.
Angina pectoris has a very clearly defined clinical syndrome: pain behind the sternum, usually of a squeezing, pressing nature, clearly associated with exercise or going out into the cold, lasts no more than 10-15 minutes, and when taking nitroglycerin - about 5 minutes. These pains radiate (radiate) to the left arm, to the shoulder blade - rarely, only in a third of patients. Pain occurs due to insufficient oxygen supply to the heart muscle when the need for it increases (state of oxygen starvation). “Hungry” muscle cells release factors that lead to a change in blood fluidity - blood cells begin to stick together and form a blood clot. At the moment there is pain, which disappears when the load is reduced. If you take nitroglycerin under your tongue or spray it into your mouth with nitroglycerin spray, the blood cells will stop sticking together, blood flow through the coronary arteries will improve, and the pain will go away within 2-5 minutes.
Myocardial infarction - an acute disease caused by the development of foci of necrosis in the heart muscle and causing disturbances in cardiac activity. Causes: atherosclerosis, hypertension, obesity, bad habits, diabetes, angina pectoris, etc. Symptoms: chest pain for more than 15-20 minutes, not relieved by taking nitroglycerin; “dagger” pain, bursting, burning, squeezing; sweating, nausea, abdominal pain, dizziness, short-term loss of consciousness, pale skin, cold extremities.
Heart failure - a condition associated either with senile changes in the heart muscle or with cardiovascular diseases, such as arterial hypertension, angina pectoris, cardiac arrhythmias, myocarditis, etc. Heart failure is characterized by a drop in
pine heart function. In the initial stages of the disease, the ability of the heart to relax (diastolic dysfunction) changes, the left ventricular chamber fills less with blood, and, accordingly, the volume of blood ejected by the ventricle decreases. At the same time, at rest, the heart copes with the load, the volume of blood compensates for the needs. During exercise, when the heart begins to beat faster, the total blood output decreases, and the person begins to feel a lack of oxygen - weakness appears, shortness of breath when climbing stairs, etc. But almost everyone can experience shortness of breath when climbing stairs. Heart failure begins where exercise tolerance decreases.
Patients complain of weakness (the most common symptom), shortness of breath with relatively little physical exertion. In a more pronounced stage, swelling of the legs appears, later the liver enlarges, fluid appears in the abdomen and lungs, dry cough at night, which makes it extremely important to sleep high or half-sitting. In severe cases, the patient can only sit, leaning forward and resting his hands on the bed. Later, hoarse breathing appears, cough with sputum, pulmonary edema may develop with expectoration of frothy, occasionally pink sputum.
Stroke (apoplexy)- acute violation of cerebral circulation with damage to brain tissue and disorder of its functions. The main causes are hypertension and atherosclerosis of cerebral vessels.
There are hemorrhagic stroke, in which there is a hemorrhage in the brain, and ischemic stroke, which occurs due to difficulty or cessation of blood flow to a particular part of the brain and is accompanied by a softening of the brain tissue area. - cerebral infarction.
A stroke occurs suddenly. Symptoms: noise and heaviness in the head, headache and dizziness, numbness and paralysis of the arms and legs, impaired speech, convulsions, vomiting, loss of consciousness.
Diabetes - disease, the incidence of which has been growing rapidly in recent years. It can be said that, along with cardiovascular diseases and tumors, diabetes mellitus has become the most common disease of the elderly.
The essence of the disease is reduced to a progressive lesion of large and small vessels, the cause of which is not completely clear. An external manifestation of diabetes is a violation of the absorption of sugar (glucose) by cells. As a result, the blood sugar level rises, and in the absence of correction, complications associated with a high sugar content can occur - a diabetic coma.
In old age, type 2 diabetes mellitus occurs - non-insulin dependent, due to the influence of many factors, including alcohol and smoking, possibly severe stress.
For treatment at first, a diet low in sugar and carbohydrates is used, and later, with the ineffectiveness of the diet, tableted hypoglycemic drugs.
Patients with diabetes lose weight, they may develop itching (perineal itching is typical), appetite decreases, and constant thirst is felt. Unfortunately, these symptoms are usually limited to the initial signs of diabetes and they are not present in all elderly patients. The only criterion for diagnosing diabetes is an increase in blood sugar levels.
Diabetes mellitus causes the progression of angina pectoris, heart failure, especially when combined with arterial hypertension. Another significant complication of diabetes is hypoglycemic state, ĸᴏᴛᴏᴩᴏᴇ can lead to coma. Patients who do not use
I write sugar and carbohydrates, as a result of an increased load, they can utilize all the sugar in the blood. The result is a sucking feeling of hunger, discomfort in the upper abdomen, severe weakness, sweat on the forehead. A drop in blood pressure can lead to fainting. In any case, such a patient should immediately put a piece of sugar under the tongue.
With a long course of the disease, regardless of the level of sugar and the therapy used, after 5-8 years, patients develop diabetic nephropathy. It can be manifested by diabetic pyelonephritis and damage to the renal microvessels. In the latter case, protein appears in the urine, then edematous syndrome (nephrotic), chronic renal failure may develop.
Another diabetic lesion is damage to the vessels of the lower extremities. Narrowing of the large arteries leads to the development of ischemia of the lower extremities - first there is pain when walking (intermittent claudication), the legs become numb, later pain at rest, ulcers and necrosis appear on the legs and feet.
Damage to small vessels that supply nerve endings leads to loss of sensitivity of the skin of the legs, disturbances in its nutrition - to “diabetic foot syndrome”. As a result, the patient does not feel the abrasions, which turn into non-healing ulcers, and easily injures himself when cutting nails or cutting calluses. Diaper rash and infection complete the problems: ulcers and purulent lesions on the skin of the foot appear. If left untreated, ischemic lesions of the lower extremity, or “diabetic foot,” can lead to amputation.
In diabetes mellitus, as a rule, the small vessels of the retina are also damaged, and blindness gradually develops.
Often older patients develop pyelonephritis, which is facilitated by urolithiasis, prostate adenoma, other disorders of the passage of urine through the urinary tract, diabetes mellitus, insufficient sanitary treatment of the perineum (lack of daily care), etc. Pyelonephritis occurs chronically, rarely causing acute urinary infection. Even the appearance of purulent melts in the kidneys is not always accompanied by an adequate picture in the elderly. Often a sign of a severe infection is a sharp change in consciousness and psyche - sudden anger, irritability, swearing. In the elderly, severe inflammation is not always accompanied by fever. Other symptoms include lower back pain, sometimes radiating to the perineum, chills, sweating, weakness, pain when urinating, and arterial hypertension.
Chronic renal failure is the result of diseases of the kidneys and urinary tract (pyelonephritis, prostate adenoma), kidney damage due to diabetes mellitus or arterial hypertension, and should be a consequence of the aging process.
In chronic renal failure, the functioning kidney tissue (nephrons) is replaced by connective tissue - sclerosis develops. If 15-20% of the original volume of kidney tissue remains, the kidneys continue to provide a cleansing function.
The earliest sign of kidney failure is nighttime urination, which may appear many years earlier than other symptoms. Renal failure begins to rapidly progress with uncontrolled arterial hypertension and with untreated diabetes mellitus, with exacerbation of pyelonephritis, with impaired urinary emptying due to prostate adenoma. Severe weakness appears, night sleep is disturbed, and anemia can be detected. If left untreated, kidney failure progresses, nose and gum bleeding, severe dry skin, itching, scratching, and a sweetish smell from the mouth appear. Later, consciousness is impaired and the patient falls into a uremic coma.
BPH - This is a benign tumor-like growth of the prostate gland. It occurs more often in men over 50 years of age.
The disease develops slowly and gradually compresses the urethra, making it difficult to empty the bladder. The first characteristic sign is frequent urination, especially at night; Over time, these phenomena intensify: urine is released in drops with strong straining, and complete urinary retention may occur. In advanced cases, urine flows out involuntarily, slowly, without satisfying the urge and without eliminating the feeling of a full bladder. Increased pressure in the urinary tract contributes to the expansion of the renal pelvis and calyces and the development of bacterial inflammation (pyelonephritis); Stones often form. In advanced cases, kidney failure develops.
Arthrosis- chronic joint disease due to the development of severe degenerative processes in the joints. Occurs as a result of prolonged injury to joints, endocrine disorders, excess weight, and metabolic disorders in the body.
Both large (knee, hip, ankle, elbow) and small joints are affected. The cartilage covering the articular surfaces of the articulating bones, as well as the bone tissue and the inner surface of the joint (synovium) gradually collapse and become thinner. Sometimes spiky bone growths form on the surface of the joint.
The disease begins with the appearance of mild and intermittent pain in the joints after significant physical activity, which disappears with rest. Further pain occurs even with slight exertion and gradually becomes constant. The joints may swell, pain appears, and their flexion and extension are often accompanied by a crunching sound. The shape of the joints may change. The most often thickened and deformed are the interphalangeal periungual joints of the hands and the joints of the big toes.
Joint pain is very common in older people. Pain, sometimes very intense, and deformation of small joints of the hands and feet are characteristic of deforming polyarthritis. A characteristic symptom of this disease is morning stiffness - it is extremely important to stretch your joints in the morning so that they work normally. Old people with this disease become completely helpless in every detail and require care.
Severe, sudden pain in the hip joint is a consequence femoral neck fracture. This fracture is typical for the elderly; it can happen even with a slight load, from a sudden change in body position. As a rule, older people develop senile osteoporosis - bone resorption: bones lose strength and become brittle. The greatest load in the body falls on the femoral neck - this is the horizontal short part of the femur that connects it to the pelvis. The entire weight of the body presses in the transverse direction on the femoral neck. Part of the load is redistributed to the muscles of the pelvis and thigh, but with age the muscles lose their tone and cease to function as a muscular frame.
The main sign of a femoral neck fracture, in addition to pain, is an unnatural outward turn of the foot, severe pain when trying to pull or turn the leg by the foot.
Often senile infirmity must be due to mental illness. Mental disorders arise as a result of painful changes in the brain and are manifested by a disorder of higher mental functions (sensations of perception, thinking, memory, will and drives, emotions, consciousness). Let's look at the main mental illness elderly and senile age.
Mental illnesses of late age are divided into:
For involutional (presenile, presenile) functional (reversible) psychoses that do not lead to the development of dementia;
For senile organic psychoses that arise against the background of a destructive process in the brain and are accompanied by the development of severe intellectual impairment.
Involutional psychoses include involutional depression (melancholia), involutional paranoid. The emergence and development of involutional psychoses is facilitated by a unique personality type with traits of rigidity (inflexibility, inflexibility), anxiety, suspiciousness, various traumatic situations, and previous somatic diseases. In women, involutional psychoses develop, as a rule, after menopause (menopause), ᴛ.ᴇ. after a period of hormonal changes in the body.
Involutionary melancholy - prolonged anxious or anxious-delusional depression, which first appeared at involutionary age. It is more common in women aged 50-65 years.
There is a depressed mood, accompanied by anxiety, fear, and confusion. Patients are in a state of motor restlessness, fussiness, which at times turns into anxious and melancholy excitement. They rush around, cannot find a place for themselves, lament, repeat the same words. In this state, suicide attempts are possible.
The condition can deepen due to the emergence of auditory illusions (condemnation, reproaches, accusations are heard in the conversation of others), delusional ideas of self-accusation, condemnation, ruin, impoverishment or hypochondriacal content. Hypochondriacal ideas consist in the belief of patients in their
line they have a severe somatic disease (cancer, heart disease, gastrointestinal tract), which is not confirmed by objective research. In some cases, painful fears take extreme forms of denial of the functioning of individual organs and entire systems.
Involutional melancholia has a long course. It lasts from several months to several years. Disease outcomes vary. Full recovery is possible, especially with timely and correct treatment. Cases of a malignant course with increasing symptoms of general exhaustion are currently extremely rare. Sometimes, for many years, there is monotonous anxiety, fixation on one’s state of health, and a decrease in activity in terms of maintaining one’s appearance and everyday life, communicating with others. After recovery from psychosis, unstable sleep, headache, slight anxiety and mild “internal agitation” persist for a certain time. In this case, in any case, the ability to work is maintained, although many by this time are at retirement age. Usually they serve themselves and their loved ones, run the household, raise their grandchildren, communicate with neighbors and relatives, etc. lead a full life.
Involutionary paranoid - psychosis, which first appears in old age and is characterized by delusions of a small scale, or of everyday relationships.
The disease is characterized by the gradual development of persistent delirium against the background of clear consciousness and outwardly relatively orderly behavior. The delusional concept involves people from the immediate environment (family members, neighbors, acquaintances) who are suspected of deliberately causing all sorts of troubles: sabotage, harassment, poisoning, damage.
The delusional concept usually does not extend beyond the boundaries of narrow everyday relationships, and therefore it is customary to call it delusions of small scope, or ordinary relationships. Patients are convinced that their neighbors are ruining their things, sneaking into the apartment, picking up keys and master keys, adding salt to their food, poisonous substances, letting gas under the door, etc. Suspicious persons who are in conspiracy with them visit their neighbors. Everything is done with the specific goal of “surviving” the patient from the apartment, causing material damage or harm to health.
At the same time, patients may misinterpret their bodily sensations. For example, coughing and palpitations are regarded as a result of gas poisoning, and stomach upsets and diarrhea are considered as poisoning from poisons added to food.
Patients are distinguished by great activity and persistence in defending their delusional beliefs and fighting imaginary enemies. They arrange surveillance, put numerous locks and seals on the doors, and write complaints to various authorities. Depressed mood, unlike melancholy, does not exist.
It is possible to develop delusions in terms of ideas of jealousy, more often in men. They are jealous of their neighbors in their apartment, their dacha, and their co-workers. The most ordinary facts are interpreted distortedly. For example, a wife talked to a neighbor through the fence - that means she made an appointment, met an acquaintance by chance on the street - a pre-planned meeting. A delusional system is created with an inadequate assessment of past events (retrospective assessment). Patients with delusions of jealousy are socially dangerous, as they may try to deal with an imaginary lover or mistress, as well as with the object of jealousy (wife, husband). Outside the realm of delirium, patients maintain social connections, navigate everyday issues, and in some cases continue to work.
A distinctive feature of this disease is its late onset (after 50 years). The disease usually develops in a person prone to suspicion and punctuality, which later develop into conflict, hostility, and vindictiveness. Even with a long course of the disease, there is no tendency to complicate delusional disorders, as is the case with schizophrenia, and dementia does not occur, unlike senile psychoses. Difficulties in determining the disease usually occur in its initial stages, when the delusional statements of patients are mistaken for ordinary everyday quarrels and conflicts. It can be especially difficult to understand the situation in communal apartments, when real facts are intertwined with fictitious ones.
Senile (senile) psychoses - diseases that occur in late age due to degenerative-atrophic disorders of the brain. Common to all diseases is a slow, gradual, but progressive course, leading to a deep disintegration of mental activity, ᴛ.ᴇ. to total dementia. There are senile dementias (Pick's disease, Alzheimer's disease, Parkinson's disease, etc.) and senile dementia itself, as well as mental disorders of vascular origin.
Pick's disease - limited presenile brain atrophy, mainly in the frontal and temporal lobes. The disease begins at 50-55 years of age, lasts 5-10 years, leading to total dementia. Both earlier and later onset are possible.
Women get sick more often than men. The disease begins with personality changes. Lethargy, apathy appear, initiative disappears, liveliness of emotional reactions disappears. The productivity of thinking decreases, the ability to abstract, generalize and comprehend is disturbed, criticism of one's state, behavior and lifestyle disappears. Some patients experience euphoria with disinhibition of drives and loss of ethical and ethical attitudes. Speech becomes poor, with a progressive decrease in vocabulary, stereotypical repetitions of the same words and phrases. Gross violations of writing occur: handwriting, literacy, semantic expression change. The patient gradually ceases to recognize objects, understand their purpose (for example, he cannot name a pen, a knife and what they are for), and therefore cannot use them. A deep decline in intelligence leads to increased suggestibility and stereotypical imitation of others (their facial expressions, gestures, repeating words after them). If the patient is not disturbed, then he is mostly silent, or repeats the same movements or phrases.
With the development of the disease, memory impairments become more and more noticeable, especially the memorization of new information, leading to a violation of orientation in space. In the final stage, there is a total disintegration of thinking, recognition, speech, writing, and skills. Complete mental and physical helplessness (senility) sets in. The prognosis is unfavorable.
Alzheimer's disease - one of the varieties of presenile dementia that occurs as a result of brain atrophy, mainly in the temporal and parietal lobes. The disease begins at an average of 55 years of age and is much more common than Pick's disease. Women get sick 3-5 times more often than men. The disease begins with increasing memory impairment. Patients notice these disorders in themselves and the decrease in intellectual capabilities associated with them and in every possible way try to hide this from others.
With the increase in memory impairment, a feeling of confusion, misunderstanding, bewilderment appears, which in some cases makes them see a doctor. Gradually, patients cease to navigate in space and time, accumulated knowledge, experience, and skills fall out of memory.
The process of loss goes from the present to the past, ᴛ.ᴇ. events that are closest in time are forgotten first, and then more distant ones. At first, memory for abstract concepts suffers - names, dates, terms, titles. Next, memory impairments occur, due to which patients begin to confuse the chronological sequence of events, incl. and in my personal life. Patients cannot tell where they are or their home address (they can give the address of the house where they lived in their youth). Leaving the house, they do not find the way back.
Recognition of shape, color of faces, spatial arrangement is impaired. People from the immediate circle begin to be called by other people's names, for example, representatives of the younger generation - by the names of their brothers and sisters, then - by the names of long-dead relatives and acquaintances. Ultimately, patients cease to recognize their own appearance. So, looking at themselves in the mirror, they may ask: “What kind of old woman is this?” The disruption of orientation in space is reflected in the disorder and asymmetry of handwriting: letters accumulate in the center or in the corners of the page, it is usually written vertically. Speech disorders, poor vocabulary, and lack of understanding of what is heard, read, or written in one’s own hand are closely associated with this. For this reason, writing increasingly begins to look like a collection of irregular circles, curves, and then straight lines. Speech becomes increasingly incomprehensible, consisting of separate parts of words and syllables,
Patients gradually lose all the skills and habitual actions acquired during their lives: they cannot get dressed, cook food, do some basic work, for example, sew on a button, and ultimately - perform even one purposeful action. The mood is unstable: apathy alternates with gaiety, excitement, continuous and incomprehensible speech.
The final stage of the disease is characterized by gait disturbances, convulsive seizures, reflex movements of the lips and tongue (sucking, smacking, chewing). The outcome of the disease is unfavorable: a state of complete insanity. Death occurs either during a seizure or due to an associated infection.
Parkinson's disease - a chronic progressive degenerative disease of the central nervous system, clinically manifested by a violation of voluntary movements. Mean age of onset - 55 years.
The disease refers to the degenerative-atrophic disorders of the extrapyramidal system that develop in the elderly and senile age, providing smooth movements and the ability to interrupt the initiated action. Most researchers point to the hereditary nature of the disease.
Parkinson's disease is manifested by a slowdown and a decrease in the number of movements (hypokinesia). Usually, patients describe this as a feeling of weakness and fatigue, while third-party observers first of all note a significant impoverishment of facial expressions and gestures when communicating with the patient, quiet, monotonous speech. It is especially difficult for the patient to start movement, as well as the coordinated execution of a motor act. Patients move in small steps, when walking they do not have coordinated hand movements; if the patient is slightly pushed, he will move forward by inertia and will not be able to stop immediately. Rigidity is noted, manifested by an increase in muscle tone. When examining passive movements, the patient feels a characteristic resistance in the muscles of the limbs, called the “gear wheel” phenomenon. The increased tone of skeletal muscles also determines the characteristic stooped posture of patients with Parkinson's disease (the so-called “petitioner” posture). The torso is bent forward, the head is tilted to the chest, the arms are brought to the body and bent at the elbow joints.
The reflexes involved in the regulation of standing and walking are disturbed. It is difficult for patients to regulate the position of the body's center of gravity: they often fall, and are unable to prevent bruises, since the protective reaction - emphasis on the hands - does not have time to work. This explains the frequent falls of patients with parkinsonism.
Stiffness can cause pain. In later stages of the disease, patients note difficulty changing body position during sleep, which may be disturbed due to pain. When such patients wake up, it is very difficult to get out of bed without someone else's help.
Tremor does not necessarily accompany parkinsonism. The trembling is most noticeable in the hands, resembles “rolling pills” or “counting coins” and becomes less pronounced or disappears when performing a directed movement.
Often at the initial stage of the disease there is increased irritability, “stickiness”, and tearfulness. importunity, egocentrism, suspicion, constant dissatisfaction with others. There is a decrease in speech activity, slowness, and apathy against the background of preserved mnestic functions and orientation.
The most frequent depressive disorders. Usually these are superficial, psychogenically colored depressive states. At the same time, more severe depressions are also possible, incl. with suicidal tendencies.
There are delusional disorders with a content characteristic of late age (ideas of damage and small-scale persecution). Approximately 40% of cases of Parkinson's disease, mostly in the later stages, show weakness of memory, decreased judgment, and mild euphoria. Often, especially in the later stages of the disease, there is a disorder of consciousness in the form of a state of confusion, delirium. Hallucinatory disorders are noted, incl. tactile and visceral with painful coloration.
The real possibilities for the prevention of parkinsonism are limited to measures to prevent neuroinfections. intoxications, vascular diseases of the brain, the use of neuroleptic drugs only under strict indications.
Senile dementia(senile dementia) is a disease of senile age due to brain atrophy, manifested by the gradual disintegration of mental activity with the loss of individual personality traits and the outcome in total dementia. Senile dementia is the central problem of psychiatry of late age. Patients with senile dementia make up 3-5% of the population of people over 60 years of age, 20% of 80-year-olds and 15 to 25% of all mentally ill old people. The cause of senile dementia, like other atrophic processes, is still unknown. There is no doubt about the role of heredity, which is confirmed by cases of ʼʼfamilial dementiaʼʼ.
The disease begins at 65-75 years old, the average duration of the disease is 5 years, but there are cases with a slow course - for 10-20 years.
The disease develops imperceptibly, with gradual personality changes in the form of sharpening or exaggeration of previous character traits. For example, frugality turns into stinginess, perseverance into stubbornness, distrust into suspicion, and so on. At first, this resembles the usual characterological shifts in old age: conservatism in judgments and actions; rejection of the new, praise of the past; tendency to moralize, edify, intractability; narrowing of interests, selfishness and egocentrism. Along with this, the pace of mental activity decreases, attention and the ability to switch and concentrate it worsen. Thinking processes are violated: analysis, generalization, abstraction, logical conclusion and judgment.
With the coarsening of the personality, its individual properties are leveled and the so-called senile features come out more prominently: narrowing of horizons and interests, stereotyped views and statements, loss of former connections and affections, callousness and stinginess, captiousness, quarrelsomeness, spitefulness. In some patients, complacency and carelessness, a tendency to talkativeness and jokes, complacency and impatience of criticism, tactlessness and loss of moral standards of behavior prevail. In such patients, modesty and basic moral principles disappear. In the presence of sexual impotence, there is often an increase in sexual desire with a tendency to sexual perversions (public exposure of the genitals, seduction of minors).
Along with the ʼʼdeteriorationʼʼ of character, ĸᴏᴛᴏᴩᴏᴇ relatives are often regarded as a normal age phenomenon, gradual
Aging and diseases - concept and types. Classification and features of the category "Aging and Diseases" 2017, 2018.
Senile dementia (senile dementia) is a disease of old age caused by brain atrophy, manifested by the gradual disintegration of mental activity with the loss of individual personality characteristics and outcome in total dementia.
Senile dementia is a central problem in late-life psychiatry. Patients with senile dementia make up 3-5% in the population of people over 60 years old, 20% among 80-year-olds and from 15 to 25% of all mentally ill old people. The cause of senile dementia, like other atrophic processes, is still unknown. There is no doubt about the role of heredity, which is confirmed by cases of “familial dementia”.
The disease begins at 65-75 years of age, the average duration of the disease is 5 years, but there are cases with a slow progression over 10-20 years. The disease develops imperceptibly, with gradual personality changes in the form of sharpening or exaggeration of previous character traits. For example, frugality turns into stinginess, persistence into stubbornness, distrust into suspicion, etc. At first, this resembles the usual characterological shifts in old age:
- conservatism in judgments and actions;
- rejection of the new, praise of the past;
- tendency to moralize, edify, intractability;
- narrowing of interests, selfishness and egocentrism.
Along with this, the pace of mental activity decreases, attention and the ability to switch and concentrate deteriorate. Thinking processes are disrupted: analysis, generalization, abstraction, logical inference and judgment.
With the coarsening of a personality, its individual properties are leveled out and the so-called senile traits become more and more prominent: narrowing of horizons and interests, stereotyped views and statements, loss of previous connections and attachments, callousness and stinginess, pickiness, grumpiness, malice. In some patients, complacency and carelessness, a tendency to talkativeness and jokes, complacency and impatience of criticism, tactlessness and loss of moral standards of behavior predominate.
In such patients, modesty and basic moral principles disappear. In the presence of sexual impotence, there is often an increase in sexual desire with a tendency towards sexual perversion (public exposure of the genitals, seduction of minors). Along with the “deterioration” of character, which loved ones often regard as a normal age-related phenomenon, memory disorders gradually increase. Memorization is impaired and the ability to acquire new experiences is lost.
The reproduction of information in memory also suffers. First, the most recently acquired experience falls out of memory, then memory for distant events also disappears. Forgetting the present and recent past, patients remember the events of childhood and adolescence quite well. There appears to be a shift of life into the past, up to “life in the past,” when an 80-year-old woman considers herself an 18-year-old girl and behaves according to this age.
She calls her roommates and medical staff by the names of people who were in her circle at that time (long dead). In answering questions, patients report facts from long ago or talk about fictitious events. At times, patients become fussy, businesslike, collecting and tying things into bundles - “getting ready for the journey”, and then, sitting with the bundle on their knees, waiting for the trip. This occurs due to gross violations of orientation in time, the environment, and one’s own personality.
However, it should be noted that with senile dementia there is always a discrepancy between severe dementia and the preservation of certain external forms of behavior. The manner of behavior with features of facial expressions, gestures, and the use of familiar expressions is preserved for a long time. This is especially evident in streets with a certain professional style of behavior developed over many years: teachers, doctors.
Thanks to the preservation of external forms of behavior, lively facial expressions, several common speech patterns and some reserves of memory, especially for past events, such patients at first glance can create the impression of being completely healthy.
And only a randomly asked question can reveal that a person who is having a lively conversation with you and demonstrating an “excellent memory” for past events does not know how old he is, cannot determine the date, month, year, season, has no idea where he is is located, who is he talking to, etc. Physical decrepitude develops relatively slowly, compared with the increase in mental decay of the personality.
However, over time, neurological symptoms appear: constriction of the pupils, weakening of their reaction to light, decreased muscle strength, trembling of the hands (senile tremor), gait with small, mincing steps (senile gait). Patients lose weight, the skin becomes dry and wrinkled, the function of internal organs is impaired, and insanity sets in.
During the development of the disease, psychotic disorders with hallucinations and delusions may occur. Patients hear “voices” containing threats, accusations, and talk about torture and reprisals against loved ones. There may also be visual illusions of perception (they see a person who came into their apartment), tactile ones (“bugs” crawling on the skin).
Delusional ideas mainly spread to people in the immediate environment (relatives, neighbors), their content is ideas of damage, robbery, poisoning, and less often persecution.
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