The nature and scope of medical and social assistance to the elderly are determined by the program adopted by the UN World Assembly on Aging and approved by the 37th UN General Session. Care for the elderly must go beyond what is directly related to disease. It involves ensuring their general well-being, taking into account the whole complex of physical, mental and social factors. Health care efforts should be aimed at allowing the aging to lead an adequate (possibly independent) lifestyle in the family and society for as long as possible, instead of being excluded from real life and society. It should be assumed that the attitude towards the elderly is one of the criteria for social well-being.

Outpatient, inpatient and sanatorium-resort stages
When organizing medical and preventive care for the elderly and senile, attention should be paid to improving out-of-hospital forms of treatment, i.e.

e. Strengthening the geriatric focus, first of all, outpatient services. This is due to two reasons. The first is the real need for outpatient care for these patients, the second is the desire of the majority of elderly patients to be treated together with relatives, friends, without changing the conditions of stay at home.

In this regard, the question really arises of the need to improve the efficiency of outpatient care, in particular, through the use of such a form as a “hospital at home” with a visit to a doctor, medical diagnostic procedures, combined with an expansion of the motor regimen and exercise therapy. Of particular importance is the deployment of a "hospital at home" for patients with chronic diseases who cannot visit the polyclinic. Their state of health, the frequency of exacerbations, as well as the need for emergency care and emergency hospitalization.

From those observed at home, a group of patients at increased risk in terms of health status and fatal outcomes should be distinguished.

In addition to those in a somatically serious condition, they should include persons over the age of 80, living alone, just discharged from the hospital, and recently changed their place of residence.

When managing patients at home, it is necessary to provide social and household assistance and assistance in the implementation of personal hygiene elements. So-called social sisters can actively participate in solving these issues. This new category of medical and social workers has already gained recognition in a number of countries. In the absence of social nurses, these issues should largely be taken over by the district nurse.

The main figure in the management of geriatric patients is now a district physician, in the near future - a general practitioner (family doctor). With an increase in the age of the patient, the role of these participants, the amount of work both in home care and at the reception in the clinic increases. In addition to conducting a thorough questioning, examination and analysis of clinical data, they carry out a “psychological unloading” of the patient. The latter is achieved in the course of a confidential conversation, when the patient tells the doctor not only purely medical, but also social aspects of his life. The local general practitioner and general practitioner must have sufficient knowledge in various areas of pathology from the side internal organs, be well oriented in neurology, cardiology, arthrology, endocrinology, oncology and angiology. They must have the skills of a physical examination of an elderly and senile patient, know and be able to put into practice an arsenal of non-pharmacological means, including means to combat accelerated aging.

The creation of the Gerontological Society, which received the status of an institution under the Russian Academy of Sciences and which in 1997 was admitted to the International Association of Gerontology, contributed to the increase in the level of knowledge and professionalism of doctors in matters of gerontology and geriatrics. The recognition of the achievements of Russian gerontology was the decision of the European Branch of the International Classification of Gerontology, which instructed the Gerontological Society to hold the II European Congress on Biogerontology and the VI European Congress of Gerontologists and Geriatricians in St. Petersburg.

An obligatory feature of a doctor should be a sensitive, encouraging attitude towards patients. This requirement applies not only to district physicians, but also to doctors of other specialties, primarily cardiologists, neuropathologists, surgeons, ophthalmologists, to whom geriatric patients turn most often.

When developing the best option the organization of inpatient treatment should take into account complex changes in the neuropsychic status of patients. Due to progressive sclerosis of cerebral vessels, arterial hypertension, pulmonary emphysema and pneumosclerosis, impaired carbohydrate metabolism and decreased function of the endocrine glands, most of these patients develop tissue and cerebral hypoxia, leading to changes in their behavior. Thus, in a significant number of these patients, during hospitalization, even under favorable conditions, an unaccountable feeling of tension and even fear appears, most often caused by the fear of increasing their dependence on strangers, increasing the degree of isolation from relatives and friends, as well as the fear of identifying an incurable disease and the possibility of death.

In this regard, it seems appropriate to allocate wards or beds for geriatric patients within the general therapeutic departments of the hospital, in which there are also recovering younger patients. At the same time, the efforts of doctors and paramedical personnel should be directed to the behavioral characteristics of senile patients. Knowledge of these features would help medical workers actively form the patient's attitude to his condition from an optimistic position, especially the feeling of "satisfaction with life" necessary to improve physical and mental health.

The seriousness of this aspect obliges to pay attention to the issues of psychotherapy in the provision of medical care to patients both in a hospital and at home. climatic zone of Russia. In this case, as a rule, large volumes of physical activity, training modes of walking or swimming, loading physiotherapy or balneological procedures, direct solar insolation should be excluded. An indispensable condition for successful treatment should be the provision of functional control over the change in the patient's condition during his stay in the sanatorium.

Thus, each of the stages of medical care for the elderly and senile (outpatient, inpatient, sanatorium) has its own characteristics that should be taken into account.

Principles of palliative care for the elderly
One of the most important features of medical and social assistance to the elderly is the need to provide them various kinds palliative care.

Palliative care, by definition World Organization health care, suggests “... an approach that improves the quality of life of patients and their families facing the problem of a fatal disease, by preventing and alleviating suffering through early detection and accurate assessment of emerging problems and conducting adequate therapeutic interventions (for pain and other disorders activities), as well as the provision of psychosocial and moral support.

Palliative Care - The Hard Facts and Improving Palliative Care for the Elderly, published by the World Health Organization Regional Office for Europe, emphasize that the development and implementation of innovative programs for the elderly are aimed primarily at "alleviating the suffering of a sick aging person, preserving his human dignity, identifying his needs and maintaining the quality of life in its final period.

Palliative care is based on “respect for the unique individual characteristics of each person with their unique history, relationships and culture”, which is manifested in the provision of adequate medical and social care “using the achievements of recent decades to give people the best chances for a fulfilling life.” In addition, Palliative care includes providing support to the family and loved ones of the patient. The system of support for relatives and friends of the patient is designed to help them cope with the tragic situation of loss. loved one which may require the provision of psychological assistance to them even after the death of the patient.

Thus, the main tasks of palliative care implemented in the context of geriatric practice are “control” over the manifestations of diseases and senile suffering, determining the needs of patients and their loved ones for support and assistance, as well as carrying out “adequate actions designed to help adapt and cope with severe situation."

Palliative care is primarily aimed at relieving pain and other painful symptoms and disorders observed during the last year of life, palliative care can have a positive impact both in slowing down the senile decrepitude of the body and in the course of diseases associated with aging. In this regard, it seems appropriate to use the principles of palliative care as early as possible, along with other types of treatment (for example, chemotherapy or radiation therapy), as the need arises, even before the clinical manifestations of senile ailments and complications of diseases that bring suffering become uncontrollable.

Compliance with these principles requires the full implementation of diagnostic measures, which makes it possible to timely correct the ailments of old age and treat complications of diseases that occur in old age. In addition, psychological and moral support helps a seriously ill person to keep life as active as possible until the last day. Palliative care affirms the value of life and strengthens the ability of a dying person to treat death as a natural phenomenon. Experts from the European Regional Office of the World Health Organization, based on the experience of Europe and North America, highlight a number of practically significant scientific and methodological aspects of palliative care.

The most important of them, in relation to clinical geriatrics, are:
the most complete assessment of the state of health and determination of the needs of older people at the final stage of life;
usage various forms organization of palliative care for the elderly;
meeting the needs of an old sick person, depending on the characteristics of the disease;
discussing issues related to death.

Assessing the health status and identifying the needs of older people at the end of life
In old age, people most often die from chronic diseases characterized by a variety of somatic and mental disorders, often carrying with them a whole range of psychological and social problems.

Palliative care, dating back to the 60s of the last century, has traditionally been focused primarily on helping patients dying of cancer and supporting their loved ones. However, the growing needs of older people with other severe chronic illnesses, as well as evidence for the effectiveness of palliative support measures, point to the need for this type of care to be applied to a wider cohort of people. Little is known about the needs of older people for palliative care. It is only clear that old people suffering from incurable diseases have special needs that differ significantly from those of young and middle-aged patients. At the end of life in the elderly, according to WHO forecasts for 2002, the main causes of death will be coronary heart disease, cerebrovascular accidents, chronic obstructive pulmonary disease, infectious diseases, in particular respiratory infections, malignant neoplasms, and primarily lung cancer, as well as dementia, liver and kidney failure in the final stages of progression.

Due to polymorbidity in chronic elderly patients at the final stage of life, combined health disorders of varying severity often occur. Despite the specifics of the symptoms of individual diseases, many clinical manifestations and functional disorders characteristic of the last years of the life of an old sick person are almost the same in various diseases in their terminal stage. Most often, according to E. Davies, I.J. Higginson, such disorders are: confusion, insomnia, depression, pain, loss of appetite, shortness of breath, constipation, vomiting, anxiety in the patient and those assisting him.

At the same time, the cumulative effect of several diseases, as a rule, significantly exceeds the severity of functional disorders caused by one or another individual disease. This results in more pronounced disturbances in the condition of patients, and, consequently, their greater need for palliative care.

Disorders caused by acute illness in the elderly usually develop against the background of chronic diseases, senile ailments and mental disorders, which are also often combined with material difficulties, social isolation and loneliness.

In addition, older people are at higher risk of drug side effects and iatrogenic effects.

All this determines the complex nature of health disorders and disorders of the functions of the body of an old sick person. The likelihood of developing a syndrome of multiple organ failure increases, in which the provision of palliative care to patients becomes simply necessary. The results of epidemiological studies indicate that with age, the severity of disorders such as disorientation, urination disorders, stool retention, visual and hearing impairments, dizziness, etc. sharply increases.

As the number of older people continues to grow, and as the risk of developing irreversible chronic diseases increases with age, the need for care and palliative care at the end of life of an aging person inevitably increases. Due to the fact that the course of most chronic diseases in the elderly is difficult to predict, the provision of palliative care is based more on the needs of the patient and his family than on the prognosis of certain diseases.

Organizational options for palliative care for the elderly
One of the main principles of organizing palliative care is to provide old people with a real choice various options its provision. A study by WHO experts of the question of what kind of palliative care option the elderly would like to have at the final stage of their lives led to the following conclusions. About 75% of the respondents were in favor of spending the final segment of their lives at home and dying at home. Among the respondents who shortly before the survey suffered the loss of a loved one, the percentage of people who preferred inpatient conditions was higher. Among those suffering from malignant tumors and other serious diseases, from 50 to 70% of people also preferred to end their lives at home, although as the condition worsened and death approached, a significant part of them began to lean in favor of a hospital or hospice.

WHO experts emphasize that the prevalence in various countries of certain organizational forms and options for providing palliative care to the elderly largely depends on historical traditions, the economic development of the country, the characteristics of the healthcare system, the volume and nature of financing of medical and social care.

In most European countries, the majority of palliative care is provided by primary health care workers. The main goal of palliative care at the same time is to create the conditions necessary for an old sick person, if he wishes, to remain at home until the end of his life, while receiving everything necessary: ​​the cordial attitude of relatives and caring staff, material support, good nutrition, appropriate living conditions, necessary treatment, daily care, etc.

It is very important that in a home environment, the natural need for each person to influence the changing conditions of one’s own life with age can be realized to the greatest extent, which largely determines the possibility and success of a person’s psychological adaptation to the negative manifestations of unhealthy old age.

At the same time, one cannot ignore the moral and domestic difficulties and difficulties that fall to the lot of family members and close relatives living with patients. Driven by the desire to help and support the fading life of a loved one, those caring for the sick do their best to help them create optimal living conditions. Their functions are diverse: from maintaining personal hygiene (washing, changing clothes, changing bed linen, helping with the administration of natural needs), feeding, monitoring medication intake to daily moral and psychological support for a patient whose personal characteristics and characteristics may change as the death approaches. behavior.

The often heavy burden of such care, which is carried out mainly by women in the home, over time can lead to negative emotional reactions that both patients and caregivers begin to suffer.

In this regard, with all the positive aspects of the most common option for organizing palliative care, one cannot underestimate the fact that the stay of an old sick person in the family may not be as cloudless as it seems. Thus, according to the World Health Organization review “Violence and its impact on health. Report on the situation in the world, cruel treatment with the elderly, their relatives or caregivers is now recognized as a serious social problem. The report presents the results of those few selective international studies, such as those in England, Canada, which show that 4 to 6% of older people experience some form of abuse in the family. Intra-family tensions can most often worsen dramatically once an older person becomes completely dependent on family members or caregivers. Another source of intra-family conflict may be the dependence of the caregiver on the elderly for living space or financial support. Does not mistreatment of the elderly demonstrate how such representatives of a younger and more vigorous generation, as it were, deny the real possibility of their own old age and death.

In such unfavorable conditions, providing palliative care to an old sick person at home becomes very difficult, which should be taken into account by doctors and social workers.

Shrinking families, the territorial and moral disunity of family members, the growing level of population migration, the increasing number of divorces and the need to devote most of the time to work or study make it increasingly difficult for the younger and middle generation to find time to show care and provide the necessary assistance. elderly family members. Therefore, the responsibility for implementing palliative care measures is likely to increasingly become the subject of activity and tutelage on the part of institutions providing care for the elderly.

In some countries, special attention is paid to the development of inpatient palliative care services and hospices. The use of these forms of organization of palliative care is most justified in the event of acute diseases or the development of complications of chronic diseases that can lead to death. At the same time, the need to maintain the vital functions of the body, control the development of critical conditions, effective pain relief for a long time, etc., are of particular relevance.

Quite often, palliative care for old sick people is provided in the conditions of boarding schools, when moving to which the issues of care, social and psychological support are quite effectively resolved, in particular, by removing the situation of psychological and material uncertainty and the possibility of building a new "living world" for old man.

But even with this form of medical and social care for the elderly, there may be difficulties and difficult to resolve issues, the possibility of which should be borne in mind by the doctor, medical staff and social workers. In particular, according to the data presented in a review by experts from the World Health Organization, poor and often cruel treatment of the elderly in specialized institutions in a number of developed countries in Europe and North America has a much higher big sizes than is usually thought. This may consist, for example, in a forced and strictly regulated daily routine for all residents of a nursing home, in insufficient care for patients, when sufficient attention is not paid to their requests, grief and resentment, infringement of the rights, dignity, and even in the physical isolation of old patients. of people.

Violations of interaction between nursing home staff and patients most often occur, according to WHO experts, in those institutions where staff is poorly trained to help the elderly or is overworked, where there are not enough funds to maintain normal living conditions, where the administration of institutions cares more about the interests of staff, not patients, which is observed mainly in those countries where the health care system itself does not consider caring for the elderly as a priority.

And yet, this is not the main thing, but a number of other unfavorable factors that domestic psychologists pay attention to. The most deeply studied problems of domestic gerontopsychology, the relocation of old people to nursing homes, especially if they are unwilling, can become one of the predictors of the imminent death of old people. From positions modern psychology this is associated with a decrease in the degree of freedom of the individual, the lack of stimulation of social activity, the loss of a sense of independence and the appearance of a feeling of uselessness to others. In the conditions of a nursing home or boarding school, old people often find themselves isolated from the constantly renewing stream of social life.

In addition, in nursing homes there is no such important socio-psychological factor as communication between generations, during which old people are able to analyze and revise their entire life path, professional and everyday experience, evaluate the past and, in particular, what has been done. were them in accordance with the development of society in the aspects of modern times. The absence of these forms of familiarization with a continuously ongoing life plays a significant role in the development of age-related situational depression among the residents of boarding schools. It is manifested by a sharp decrease in self-esteem, the appearance of a feeling of uselessness, worthlessness, an aggravation of feelings of loneliness and a loss of interest in the environment. Along with this, anxiety and anxiety are growing, fears appear, first of all, of impending helplessness, decrepitude, loss of memory and dementia.

Of the other forms of organizing palliative care, in addition to those considered, in a number of countries experience is being accumulated in its provision by mobile specialized teams, bringing together specialists of various profiles working on the basis of hospitals. The specialists of these teams are able to adequately assess the patient's existing disorders and functional disorders at home, conduct syndromic diagnostics, develop and apply appropriate treatment tactics, and provide psychological support to the patient and relatives and friends caring for him.

As a person approaches the end of his life path, the manifestations of the disease and the general condition of the patient can rapidly deteriorate (for example, with relapse of myocardial infarction, stroke, pneumonia, tumor metastases to vital organs, rapid progression of renal or liver failure, etc.) which most often requires a change in the type and methods of providing palliative care. Nevertheless, regardless of the characteristics of the clinical situation, the basis of palliative care is the nature of the communication of medical and social workers with a seriously ill old person and his relatives.

Confidential communication between a doctor and a patient has a positive effect not only on psychological condition sick. It significantly increases the effectiveness, in particular, of the analgesic effect of analgesics, improves control of blood pressure and blood sugar levels, etc. Familiarization of patients with the results of medical research is most often beneficial, increases the patient's level of awareness of his condition and the need to provide him with or other form of assistance.

However, with the nearest unfavorable prognosis, the doctor must be especially careful and provide information of interest to the patient, taking into account whether the patient really wants to know the full truth about his condition and whether obtaining this information will cause additional mental trauma to the patient. Constructive communication with the patient's family members and their active involvement in the decision-making process can become an important prerequisite for a positive assessment by relatives of the effectiveness of providing care to the patient in the terminal period, and as a result, improve the quality of life of those caring for the dying patient.

Meeting the needs of an old sick person, depending on the characteristics of the disease
Malignant neoplasms. Palliative care is most often provided to patients with malignant neoplasms, whose age exceeds 60-65 years. This is partly due to the more predictable nature of the course of oncological diseases, which makes it possible to plan the necessary care for patients and their families. The individual prognosis of cancer patients depends on the location of the tumor. In older men, the tumor is more often localized in the lungs, prostate and colon, and in older women - in mammary gland, lungs and large intestine.

Compared with cancer of the lungs and intestines, breast cancer and especially prostate cancer are characterized by a longer course and, consequently, a more favorable immediate prognosis. An important role is played by the stage of the oncological process and how much the tumor can be treated. A feature of the course of cancer in the majority of elderly patients is a relatively satisfactory level of survival of the organism for a long time. This continues until a rather abrupt and relatively short period of apparent and irreversible deterioration of the condition, when treatment (surgical, radiation and / or chemotherapy, including symptomatic) ceases to have an effect.

However, cancer patients usually need psychological support already in the very early stages of the disease, more often from the moment a cancer diagnosis is established, which in itself is already psychologically difficult to overcome stress. At the same time, cancer patients are characterized by an interest and desire to be involved in the process of obtaining and interpreting diagnostically significant information. Such a position in life characterizes a rather high level of psychological adaptation of cancer patients to their condition. Most of them expressed a desire to actively participate in the decision-making process, not only of a diagnostic, but also of a therapeutic nature.

At the same time, anxiety is expressed in most cancer patients, and depression may also develop due to a disappointing prognosis. In this regard, the provision of psychological assistance to an oncological patient should be considered as the most important component of the joint activities of the doctor and the patient, who have a common goal and common tasks. At the same time, the dialogue between the doctor and the patient is assumed not only in verbal form, but also through emotional manifestations, facial expressions, gestures and other forms of empathy. An important content of such a dialogue is its focus on the implementation of the necessary medical and diagnostic measures and maintaining the quality of life of a sick person.

Palliative care for cancer patients has its own characteristics depending on the severity of the clinical manifestations of cancer. If, in the absence of clinical manifestations, psychological support factors are of paramount importance, which is usually more fully realized when the patient is informed about the results of diagnostic studies and discussing the effectiveness with him possible ways treatment, then at the final stage of the disease, the forms of palliative care become different. Relief of pain and overcoming disorders of body functions, which largely depend on the location, size and growth rate of the tumor, are of decisive and paramount importance. Of great importance is the fight against intoxication, inflammatory and neurotrophic complications accompanying the cancer process, curbing the rapid progression of cachexia and correcting severe anxiety and depressive disorders.

Chronic heart failure and chronic obstructive pulmonary disease. The need to provide palliative care to elderly patients suffering from chronic heart failure and chronic obstructive pulmonary disease is dictated by the high prevalence and high mortality from these diseases. According to various statistics, more than 6-10% of people over 65 and about 50% of the elderly aged 80-89 suffer from chronic heart failure. About half of them die within 4-5 years from the moment of diagnosis, and with a high functional class of chronic heart failure during the first year. The high five-year mortality from chronic heart failure is comparable to the mortality from the most malignant forms of cancer (eg stage III lung cancer), which is not always recognized by the attending physicians.

The same unfavorable situation is with chronic obstructive pulmonary disease. About 40% of older men and about 20% of older women suffer from chronic obstructive pulmonary disease. Mortality from chronic obstructive pulmonary disease ranks 4th-5th among the causes of death in people over 45 years old, amounting to 65.6 per 100,000 for men aged 40-60, which is 3.0-3.5 times higher than the level mortality of women of the corresponding age. For men over the age of 75, the mortality rate exceeds 600 per 100,000. Almost a quarter of autopsies of people over the age of 80 show signs of obstructive pulmonary emphysema.

Thus, the individual prognosis for chronic heart failure and COPD is just as unfavorable, and often worse, than for many types of malignant neoplasms. A distinctive feature of the final stage of life in patients with chronic heart failure and COPD is that a long period of persistent and progressive disorders of the cardiovascular and respiratory systems is interspersed with episodes of even more significant deterioration.

Debilitating episodes of decompensated heart and respiratory failure become more and more pronounced and clinically more severe over time, manifested mainly by increasing shortness of breath, suffocation, edematous syndrome and neurotrophic disorders. Moreover, in the management of patients with chronic heart failure and chronic obstructive pulmonary disease, unlike cancer patients, the doctor most often faces the complexity and uncertainty of predicting the course of the disease due to the high probability of sudden death or a sharp deterioration in the condition, which significantly complicates treatment and palliative care.

Despite the progress made in recent years in the treatment of heart and respiratory failure, the poor adherence to treatment has an adverse effect on the course of the disease and its prognosis. According to various statistics, in 18-64% of cases or more, patients after discharge from the hospital do not follow the recommendations of doctors on taking medications, maintaining a healthy lifestyle and eliminating pathological behaviors (smoking, alcohol abuse, overeating, excessive consumption of salt, water etc.).

In this regard, in the process of providing palliative care to patients, it is of particular importance to inform patients and their caregivers about the disease, the causes, signs and symptoms of a possible exacerbation of the process, rational nutrition, and acceptable physical activity. Particular attention should be paid to the issues of drug therapy: the mechanism of action of drugs, the required doses and regularity of taking drugs, the expected positive and possible side effects of ongoing pharmacotherapy.

It is justified for patients or their relatives to keep diaries containing information about the appearance or intensification of shortness of breath, asthma attacks or pain behind the sternum, changes in body weight, the amount of fluid drunk and urine excreted, stool regularity, the appearance or increase in edema, etc.

Patients with chronic obstructive pulmonary disease, as part of their palliative care, it is advisable to teach breathing methods aimed at activating the lower parts of the lungs (abdominal breathing) and breathing with exhalation resistance. In order to reduce hypoxemia and tissue hypoxia, long-term oxygen therapy is indicated. It is necessary to promptly identify and correct extrapulmonary pathology that can aggravate respiratory failure. In order to prevent exacerbations of chronic obstructive pulmonary disease against the background of viral infections (flu), it is advisable to timely conduct influenza vaccination. It is necessary to control bowel activity and the use of laxatives and enemas, since excessive straining associated with constipation contributes to a significant increase in intrathoracic pressure and insufficiency.

Correction of the trophological status and malnutrition leading to protein-energy malnutrition, a decrease in muscle mass, the development of cachexia and the occurrence of trophic disorders is mandatory.

Dementia. Chronic and gradually progressive deterioration of intellectual-mnestic functions, weakening, and subsequently inadequacy of emotional response to the environment takes the form of dementia, according to various statistics, in 4-5% of people over 70 years old and in 13-15% of people over 80 years old. summer border.

The manifestations of dementia are varied. First of all, this is memory impairment, loss of the ability to abstract thinking, violation of concepts, judgments, loss of criticism, impoverishment of vocabulary, disorders of cortical functions (aphasia, apraxia, agnosia, etc.). Over time, behavioral and personality changes increase, apathy and indifference to the environment progress, sometimes irritability and aggressiveness, insomnia and anorexia. Gait is disturbed, prolonged constipation, urinary and fecal incontinence occur. Mental disorientation is manifested primarily in the loss of the ability to purposeful actions. Patients become indifferent and gradually cease to come into contact with others, the ability to self-service and existence without outside help is lost.

When managing patients with dementia, it should be borne in mind that in about 15% of cases the development of dementia can be reversible and provoked by somatic pathology, as well as chronic alcoholism, addiction to sleeping pills, tranquilizers and other psychotropic drugs. Elderly patients with cerebrovascular insufficiency and poorly controlled arterial hypertension may develop multi-infarct dementia, which closely resembles Alzheimer's disease.

Significant difficulties in assessing the condition of patients arise when confusion appears against the background of advanced dementia, when it becomes difficult to identify the predominance and severity of signs of intellectual-mnestic and psychopathological disorders.

Patients with mnestic and intellectual manifestations of dementia without impairment of consciousness can live a long time. The deterioration of their condition and the decrease in the level of functions occurs gradually, steadily or stepwise, over a long period of time. Their average life expectancy from diagnosis to death is about 8 years. During all this time, the need for palliative care and the dependence of patients on others is growing, although the patients themselves do not realize this, which is very traumatic for the people caring for them.

If the correction of reversible dementia involves, first of all, the treatment of somatic diseases that provoked or aggravated its development, then patients with irreversible dementia need mainly palliative forms of social care and psychological support. It is very important to maintain the usual daily routine for the patient and the environment of everyday life. One should strive to maintain physical activity and the work of thought of an aging person. This is facilitated by communication with well-known and long-term faces of the patient, the motivation for accessible mental and mental activity. The patient should be in a calm, stimulus-free environment, in a room that is adequately lit during the day and at night.

Patients should be periodically reminded of the current time and place of their stay, helped to use corrective vision and hearing devices (glasses, hearing aids), which can be very effective in controlling the behavior of dementia patients with confusion. for a long time to self-service, at least partial, which helps to maintain the viability of the body of a decrepit person. It is important to control the intake of medicines and exclude the possibility of their uncontrolled use. Old dementia patients, especially those with elements of confusion and severe visual and hearing impairments, should not be placed in an unfamiliar environment or hospitalized. If the need for this arises, then hospitalization should be preceded by thorough psychotherapeutic preparation.

As dementia progresses and dementia increases, daily care, feeding a helpless, and often subsequently immobile person, monitoring the performance of natural physiological functions, skin cleanliness, preventing the occurrence of somatic pathology (for example, aspiration pneumonia or ascending uroinfection), fight against manifestations of neurotrophic disorders (pressure sores, contractures, etc.) that join at the final stage of old age diseases.

In order to maintain vital functions within the framework of palliative care, symptomatic therapy is carried out.

Discussing issues related to death
According to the experts of the European Regional Office of the World Health Organization, in connection with the development of civilization and healthcare, an increased standard of living and an increase in its duration, people living in developed countries are becoming more and more "alienated" from the phenomena of death and dying. In past centuries, this trend was observed to a lesser extent, which is associated with greater religiosity and spirituality of previous generations. In the age of technization and widespread computerization, it is becoming increasingly difficult for people to openly discuss issues related to death. This topic turns out to be far from everyday reality and people stop perceiving it as a reality. In this regard, dying people often find themselves in an extremely vulnerable position, being absolutely unprepared for the inevitable departure from life for everyone.

A steady trend towards an increase in the proportion of the elderly and the elderly in the structure of the population, patients with chronic diseases and long-term ill people, the disabled, the characteristics of their lifestyle with the ensuing socio-economic problems reflect important aspects in the organization of gerontological care.

The "demographic revolution" has contributed to an increase in the category of the population that has the greatest risk of deterioration in health, economic and social conditions, and will ultimately need social protection. These are the so-called risk groups, which can include:

The elderly living alone

elderly women, singles and widows;

elderly living in isolation

childless elderly;

• the elderly, suffering from serious illnesses or physical disabilities;

• the elderly who are forced to live on the minimum state or social allowance or even on even more insignificant means;

Persons aged 80-90 years and older.

Older people are more exposed to the environment, more sensitive to psychological influences, often live in poor housing conditions, receive poor quality medical and social care. With age, the need for services of various kinds increases, while the ability of people to be active in daily life and independence decreases. Organizing care for the elderly creates the problem of rising spending on government programs social security and places an unbearable burden on society.

Features of diseases in the elderly, which are important for the provision of social and medical care, are manifested in a variety of pathogenetic disorders, in the specificity of the manifestation of the disease, the rapid deterioration of the general condition in the absence of treatment, the high incidence of complications, the need for supportive care for a long time. This highlights the need to integrate medical and social services.

The existing state system of social protection of the elderly and old people remains for the most part at the level of social services, limited to the provision of urgent social support of a one-time nature, the provision of places for permanent residence to those in need of constant care in

boarding houses, boarding houses, departments of night or day stay organization of funeral services.

The WHO Regional Committee for Europe, discussing the need to change the policy of social services and health authorities in connection with the aging of the population, notes that one of the most important areas of activity related to the care of the elderly is rehabilitation.

The deepening and specialization of social work, the opening of rehabilitation centers that provide support and socio-medical assistance to the elderly, make it necessary for social work specialists to solve many issues of providing integrated care, rethinking the concept of health care in the social sphere system.

Considering the human community as a complex self-developing biosocial system, it should be recognized that social pathology is a reflection of the biological and social form of the disharmonious development of society. The anthropoecological approach to the problems of social pathology is based on the system-forming integrative principle of studying and understanding the cause-and-effect relationships in the human body and its environment.

One of the most important ways of harmonizing social development is rehabilitation, considered as a biosocial system. Persons belonging to different groups of the population, to a greater or lesser extent, need rehabilitation insofar as they have physical, mental, educational, professional, social and other deprivation.

Domestic and world science has accumulated quite extensive theoretical and practical material on rehabilitation. However, the actualization of this material in relation to social work in gerontology, which is directly related to the life of an elderly person, his lifestyle and health factors of diverse content, remains insufficient, primarily due to the lack of comprehensive research and links of scientific developments in the study of various components, stages of rehabilitation process, taking into account their biosocial unity.

Considering rehabilitation as an action to eliminate life limitations, it is necessary to highlight the main parameters of the functioning of the elderly:

daily activities;

mental and physical condition;

social and economic status.

Rehabilitation of the elderly should take into account the needs that a particular person needs, and should be based on the principle of providing assistance at the place of residence as the most appropriate, effective and supportive approach in medical and social services, in contrast to stationary forms of rehabilitation.

Rehabilitation of the elderly is a single organizational and methodological process focused on the personality and its problems, where medical, psychological, social and other factors are integral parts of an integral system. The division of the rehabilitation space and assigning it to certain departments does not ensure the achievement of the ultimate goal of rehabilitation and leads to a dispersion of forces both in the health care system and in social security.

A complex effect on the body, the use of proven methods from various natural sciences and the humanities with active learning

by the patient's own efforts, they can reduce the possibility of disability in the elderly and prolong an active life in a familiar microsocial environment.

Achieving the goals of geriatric rehabilitation (reactivation, resocialization, reintegration and spiritual renewal) provides a comprehensive impact on the elderly to resume an active daily life in their environment, get out of the state of isolation caused by a long illness, and fully participate in normal life. Rehabilitation ensures the preservation or restoration of the independence of the elderly in physical, psychological and social terms. Spiritual rehabilitation restores the ability to adequately define a life goal, rethink moral values, and makes it possible (including with the help of the church) to prepare for the end of one's life path.

In gerontology, the rehabilitation process is directly related to the individual's environment, and therefore an individual rehabilitation program will not be effective if the environment is not rehabilitated.

Rehabilitation is considered as a complex individual process, which includes:

ongoing maintenance treatment

Maintaining the functioning of the main life support systems;

Removal of an elderly person from mental depression;

Restoration of the ability to adequate work opportunities.

Rehabilitation measures are aimed at maintaining or restoring lost psychological and economic independence, improving emotional well-being and preventing the transition of health disorders into disability.

Social gerontologists distinguish the science of gerontological care, which considers three aspects: diagnosis, intervention, results.

Diagnostics in care is the acquisition of clinical information about individual, family or community responses to current or potential health and social problems of older people.

Intervention consists of five important areas:

1) informing older people about developing internal processes during aging, about sources of social support, etc.;

2) promotion of physical activity (lifestyle of the elderly): proper nutrition at a later age, overcoming a sedentary lifestyle;

3) alleviate the suffering of the elderly, improve the condition, supplement functions;

4) impact on environment, including on sociopolitical processes, to the extent possible contain the negative impact of social, economic and political factors on the functioning and well-being of the elderly;

5) improving self-help abilities by transferring the necessary knowledge in the field of self-observation for early detection of the disease and the application of self-help techniques.

results gerontological care is the successful management of changes that occur in the late period of life, emotional well-being, acquiring new skills and roles, new relationships and abilities, attitudes.

Modern rehabilitation prevents the danger of health deterioration, slows down the process of rapid aging, supports and stimulates the fading functions of the body. Rehabilitation changes the mental and physical state, revives the desire and will to live, helping the elderly to achieve independence in society. Timely and rationally carried out rehabilitation measures are able to maintain the functioning of the body at a level sufficient to achieve independence in society.

Rehabilitation is a system of state, socio-economic, medical, professional, pedagogical, psychological and other measures aimed at preventing the development of pathological processes leading to temporary or permanent disability; to the effective and early return of sick and disabled people to society and to social work. Rehabilitation is a complex process, as a result of which the victim creates an active attitude towards the violation of his health and restores a positive attitude towards life, family and society. The concept of rehabilitation includes prevention, treatment and adaptation of a person to life and work after illness based on a personal approach.

As emphasized by M.M. Kabanov, the basis of rehabilitation is the unity of biological and psychological and social influences; diversity of efforts in organizing its events; obligatory appeal to the personality of the patient using the relationship of cooperation in the process of rehabilitation;

stepping or sequence of activities, where the previous ones prepare the ground for subsequent impacts.

The very direction of rehabilitation medicine is quite young. It became possible only at a certain stage. scientific and technological progress, the achievement of which expanded medical knowledge about health so much that practical health care came close to the problems of rehabilitation. Considering the place of rehabilitation in the system of therapeutic and preventive measures, it should be noted that it is impossible to draw a clear line between treatment and rehabilitation, since many activities are both therapeutic and rehabilitation at the same time. Thus, rehabilitation is as much a part of the healing process as the healing process is a part of rehabilitation.

Basic principles of rehabilitation:

Early start of rehabilitation measures, which, being organically included in the main therapy, should supplement and enrich it.

Stages of rehabilitation.

Continuity and continuity of rehabilitation measures as one of the main and mandatory conditions for the effectiveness of treatment.

Comprehensive nature of rehabilitation.

Individual approach to the preparation of rehabilitation programs. An individual profile must be set for each patient:

risk factors, physical and mental characteristics, emotional reactions to the disease. The program and the staff implementing it must take into account the individual characteristics and specific needs of each patient, which may affect the outcome of rehabilitation.

At each stage of rehabilitation, a program is drawn up, the purpose of which is to identify the reserve capabilities of the body and help the patient achieve the highest level of able-bodied condition.

In each rehabilitation program, there are several components: psychological, socio-economic, professional, medical.

Psychological the component includes the study of psychophysiology, intellectual-mnestic, personal characteristics and the system of relations of older people with the aim of their restoration, maintenance and correction. Consultative work with relatives of patients is also provided.

The principles of psychocorrectional work include the following:

group approach;

mood improvement;

reduction of anxiety;

increased self-esteem;

the possibility of self-realization;

motivation for social activity;

improving communication skills;

adaptation in the current state.

Considering psychological features elderly and senile age, preference is given to group forms of work.

Psychological rehabilitation for any somatic diseases is aimed at different levels of the patient's mental organization and psychological components included in the etiopathogenesis of the disease.

Effects on the neurotic component of a somatic disease. Functional and dynamic changes accompany all somatic diseases. Most clearly manifested in the initial stages of the disease, the neurotic component can be aggravated in the future, primarily in patients with certain premorbid personality traits. Psychotherapeutic influence at the indicated level plays a symptomatic role.

Impact on the mental component of a complex of etiological factors. Taking into account the fact that the mental factor of IHD is an important, although not the only etiopathogenetic mechanism, psychological correction becomes essential. And in this case, it is aimed at restoring those elements of the patient's relationship system that determine the occurrence of mental stress involved in the etiopathogenesis of the disease, or the development of neurotic layers in connection with the latter. In this case, psychocorrection can be considered as an integral part of pathogenetic therapy.

Impact on the patient's personality in order to change its response to the disease, correct the "scale of experiencing the disease", improve its functioning in the new conditions of a somatic disease. The specific form of psychological rehabilitation should be determined

characteristics of the patient's personality, his age, intellectual level, degree of awareness of the disease, assessment of his condition, attitude to treatment, attitudes towards the future.

Traditionally, much attention is paid to the diagnosis and correction of cognitive processes in the elderly. The group program developed by us psychological correction of cognitive processes includes classes aimed at improving the processes of memory, attention and thinking of such patients.

During the primary diagnostic study, using simple questions and experimental psychological techniques, the initial level of mental functions is revealed. Then the corrective exercises are carried out. These include:

welcome ritual,

self-assessment assessment of mood before and after class,

warm-up exercises,

building logical chains, associations,

homework check,

class discussion,

farewell ritual.

Evaluation of the effectiveness of classes is carried out with the help of repeated experimental - psychological research after the completion of the training course.

This program, in addition to stabilizing and improving cognitive functions, improves the emotional state and self-esteem of older people, as well as increases their sociability and social adaptation.

Socio-economic component affects aspects of lifestyle changes. The patient must have information about the level of possible physical activity, nutrition, exposure to risk factors, the need to eliminate bad habits, taking medication, etc.

Professional the component is aimed at restoring production skills impaired as a result of damage or illness; in case of permanent or partial loss of professional ability to work, the patient can be prepared to learn a new profession.

Medical the component of the rehabilitation program is the main one and represents a set of therapeutic measures aimed at restoring the patient's physiological functions and identifying the reserve capabilities of his body to further ensure the activity of an independent life.

Medical rehabilitation is carried out both by means of traditional medicine and alternative medicine. The latter include physiotherapy exercises; physiotherapy; occupational therapy and household rehabilitation; diet therapy; phytotherapy; reflexology; manual therapy; aromatherapy; bioresonance therapy; psychotherapy and psychocorrection.

The following features of rehabilitation in geriatrics have been identified:

The processes of readaptation in old age are slower, so rehabilitation requires more time.

Compensatory possibilities are limited, therefore rehabilitation programs should be adequate to them.

Preference in the medical rehabilitation of the elderly is given to non-drug types of rehabilitation treatment, since intoxication and allergization develop faster with age. Along with the traditional methods of physiotherapy, magnetic field treatment, thermotherapy, hydrotherapy, classical massage, physiotherapy exercises, the rehabilitation program includes: occupational therapy, group and individual forms of psychocorrection and psychotherapy.

Occupational Therapy -- an active method of restoring and compensating for impaired functions through various work aimed at creating a useful product. The favorable influence of labor in the system of rehabilitation measures is a clinically established fact. In occupational therapy, the very process of functioning of the affected system acts as a healing and restorative factor. Labor movements and operations stimulate physiological processes, cause the harmonious work of the patient's main systems, mobilize his will, discipline, improve concentration, improve mood, free from thoughts about the disease, stimulate mental activity, directing it into the mainstream of objective, meaningful, productive and satisfying activities.

According to the main tasks, means and methods, the following types of occupational therapy are distinguished.

Restorative occupational therapy. It is a means of increasing the general vitality of the patient and creates psychological prerequisites for readaptation.

Household occupational therapy. It is carried out with patients who have undergone acute cerebrovascular accident; complicated by paresis of varying severity, and with patients suffering from senile dementia. Home rehabilitation classes should be started as early as possible, since its goal is to eliminate the patient's helplessness by consistently teaching various self-care activities differentiated by complexity.

Restorative occupational therapy. The goal is to influence the damaged part of the body, organ or system to restore the function disturbed by the pathological process with the help of appropriately selected types of labor activity. The selection of labor operations is an essential task of differential restorative occupational therapy.

Recreational occupational therapy. Its goal is to reduce the severity of aggravating factors caused by forced prolonged stay in bed or in a medical institution. It has a wide variety of forms, can be both entertaining and educational in nature; is built taking into account the individual interests and inclinations of patients. Occupational therapy by employment is a transitional stage to the main types of occupational therapy or supplements it.

Occupational therapy, by right, deserves wider use in the rehabilitation of the elderly. The attractiveness of the method is in the ease of use and low material costs in the organization; availability of use at all stages of rehabilitation; diversity, which is provided by a large number of exercises as a result of a combination of different labor movements and operations; good compatibility with any direction of treatment.

Aromatherapy - the use of natural essential oils for therapeutic and prophylactic purposes. Essential oils are fragrant, volatile substances that are extracted from roots, leaves, fruits, and flowers. Penetrating into the cells of the body essential oils cause it to "remember" how it functioned when healthy, causing the cell to repair itself.

The choice of oil is determined by the spectrum of its action. When using a mixture, oils with unidirectional action are selected, potentiating each other.

Physiotherapy occupies a central place in the physical rehabilitation of the elderly as the most biologically based treatment method. Regular exercise has a positive effect on the work of all organs and systems.

Cardiovascular system - a trained heart has great reserve capacity; the risk of cardiovascular disease is reduced.

Respiratory system - more active use of oxygen by body tissues; slowing down the processes of reducing the elasticity of the lung tissue.

Metabolism - the content of cholesterol in the blood, triglycerides changes for the better; improves sugar metabolism.

Psychic sphere - activation of mental activity; beneficial effect on mood; reduction of anxiety, increased interest in the world around; formation of adaptive mechanisms.

Thanks to physical therapy, the number of typical diseases of the elderly is reduced. Maintaining independence in everyday life depends primarily on mobility, which in turn is determined by the performance of muscles, bones, and joints. The strength of the joints and bones depends on the elasticity of the ligaments and tendons, which is improved by exercise. Poor posture limits joint mobility due to loss of elasticity in muscles and ligaments. All this significantly reduces motor activity. Physical exercise will help develop strength, flexibility, endurance, which is important for a person leading an independent lifestyle.

The development of new methods that improve the functional state of various systems of the human body to prevent injuries and the development of various pathologies is an urgent problem of our time. In recent years, the biofeedback technique has been successfully used in rehabilitation. It allows you to individually program the training parameters on special devices that transmit information about the work of a particular organ and system in the form of sound, light or game signals. This enables the patient to exercise control over the quality of the work performed; actively participate in their own rehabilitation; increases his self-esteem; positively affects the emotional state. An important means of medical rehabilitation of the elderly are psychotherapy and psychological correction. They are most adequate to the goals aimed at restoring the personal and social status of patients by mediating healing and restorative effects through the personality.

Psychological correction - this is a directed psychological impact on certain psychological structures in order to ensure the full development and functioning of the individual. Psychological correction as a directed psychological impact is realized not only in medicine, but also in other areas of human activity. It is also an important psychoprophylactic tool. Psychotherapy is a type of interpersonal interaction in which the patient is provided with professional assistance by psychological means in solving his problems or difficulties of a psychological nature. Psychotherapy in gerontological practice is a set of psychotherapeutic measures aimed at restoring and activating bodily, mental and social functions, skills and capabilities, as well as addressing specific problems. problem situations with which the elderly patient cannot cope on his own. In geriatric clinics and special institutions for the elderly, group psychotherapeutic methods are used. The purpose of group psychotherapy for the elderly is to involve them in social influence, increase self-esteem, increase independence, and focus on a constantly changing reality. Various group techniques are used: group discussion, music therapy, dance therapy, psycho-gymnastics and others. Family counseling is of great importance in gerontopsychological practice.

Psychocorrection and psychotherapy are important components of medical and psychological rehabilitation aimed at full or partial restoration of the patient's personal and social status.

Group forms of psychotherapy can be considered the most adequate method of psychological rehabilitation in geriatrics. Group psychotherapy, more than any other method of psychosocial influence, contributes to the restoration of the system of relations between elderly patients and the microsocial environment, bringing value orientations in line with lifestyle. There are two types of group methods of psychotherapy and sociotherapy in rehabilitation.

Therapeutic procedures aimed at the patient's social behavior, his sociability, the ability to self-realization, the resolution of psychological and overcoming social conflicts.

Optimal organization of the social structure of a group of patients, based on the so-called environmental groups: functional groups, club of patients. These social and therapeutic groups are focused on the social activation of patients and their introduction to life in society, contribute to the training of communication and instill in patients the skills of adequate behavior. They provide a corrective social climate to re-experience interpersonal relationships.

In general, the structure and features of various organizations related to medical and medical and social services for the elderly are explained by the following diagram.
1. However, it should be remembered that the formation of such organizations is just beginning and the content and forms of their work will change rapidly, which has happened in recent years, primarily in the medical and social sphere of public services. Attention should be paid to the variety of forms of assistance to the elderly and the subordination of organizations providing them: medical, social, preventive, health, etc.

When forming the structure of gerontological centers, it is taken into account that old age is a complex biological and social phenomenon that requires an integrated approach and manifests itself as:
- Restriction of working capacity,
- Restriction of physical mobility and social activity;
- Restriction of cultural and social ties, psychological isolation from society;
- The presence of a complex of chronic diseases in most people of this age.
Therefore, the practical activities of aging prevention centers should be based on a comprehensive view of aging as a complex biosocial process, and should be aimed at:
a) increasing the efficiency of all ages, and especially the older generation;
b) improving the health of the elderly,
c) increasing the physical and mental activity of the older generation;
d) disease prevention
e) slowing down the aging process,
f) increase in average and maximum life expectancy.
Traditional in Russia is the use by the state of means of passive protection of the population of a given age, which are fundamentally costly: Money(pensions), medical patronage at home, domestic services at home, etc. However, due to the changed real conditions of society and the socio-psychological orientation of the inhabitants of civilized states to active participation in society, the opposite, active the principle is to increase the level of physical and social activity of the representatives of the older generation, which allows maintaining a sense of fullness of oneself as a person until very old age. This is possible only if the emphasis is shifted to disease prevention and geroprophylaxis in general, the state protectorate of programs related to the health and social aspects of the life of the older generation, while improving the health and physical condition of the broadest masses of the population, while changing the mentality and goals and views on the value of one's own health.
For middle-aged and elderly people who remain physically active, this is optimally solved by opening specialized Centers that combine consultative and health-improving activities. For the oldest ages, as foreign experience shows, it turned out to be promising to open special boarding houses that combine the convenience of social services with qualified medical supervision and care and the widest range of cultural events with access to social activity in a variety of areas, ensuring the demand for the elderly in society in the social, cultural and psychological levels.
Gerontological Centers should actually combine therapeutic, preventive and health-improving areas of work, which should be reflected in their structure, means used and personnel. It seems clear enough that geriatric centers should not be only geriatric centers - only a place for the treatment of old people. Such an approach leads to duplication of the entire structure of medical care (since there is no fundamental difference between diseases and age), to the creation of huge, similar to modern clinical hospitals, multidisciplinary medical complexes, the difference of which is only the age of patients. Actually Gerontological Centers should direct their work primarily to:
a) prevention of aging, incl. promotion of such methods and services, primarily for middle, working and socially active age (30-60 years);
b) methods of prenosological diagnostics, prevention and promotion of health;
c) rehabilitation, preventive and health measures after illnesses.
Thus, Gerontological Centers should be rather preventive, valeological, rehabilitation, physical culture and sports and cosmetology than traditionally narrow-profile medical. Differences from the existing Health Centers are: emphasis on the prevention, containment and treatment of aging and associated diseases; good training in the biology of aging, gerontology and bioactivation agents; availability of own powerful diagnostic methods (first of all, this is the determination of the parameters of Biological Age and a complex of methods of clinical physiology and biochemistry); availability of own methods of prevention, containment and reversal of aging (actual rejuvenation), bioactivation agents, etc.; the possibility of a high level of specialized consulting; the presence of a number of additional services (cosmetology, sports and mass forms of work, etc.); fundamentally complex nature of services; implementation, along with complex programs, of individual specialized standard programs related to age (anti-climacteric, anti-osteoporosis, prevention of lens opacity, etc.); fundamental availability of recommended means, methods, devices and methodological literature (stand of funds on the territory of the Center); powerful advertising and propaganda in the Center and outside are of great importance, since the only formed LIFE STYLE with the whole range of applied methods, means, diets, etc. lies at the heart of the effects of aging prevention. and cannot be reduced only to medical or only to physical culture institutions.
The Centers themselves can be:
a) Stationary - it is optimal to deploy them on the basis of sanatoriums and dispensaries, which corresponds to the contingent, premises, and other features of the work.
Maybe:
- the formation of groups for rehabilitation, biostimulation and rejuvenation from the contingent of the sanatorium, which is optimal for the start of the deployment of work and is low-cost;
- the formation of their contingents and departure to the sanatorium;
- Deployment of full-fledged separate stationary Centers on the basis of sanatoriums and dispensaries.
b) Consultative and diagnostic - on the basis of polyclinics and private medical centers - with a bias towards the medical side of the work of the centers, on the basis of self-supporting with polyclinics, with the involvement of local consultants, with an emphasis on specialized programs of geriatric and preventive geriatric care.
c) Rehabilitation and health-improving - the most massive type of Centers, with the formation of permanent contingents of clients. On the basis of sports and recreation centers and newly formed Gerontological Centers.
The Gerontological Center being created should:
1) Operate on the basis of the highest scientific achievements and be a clinical base for work and testing of new techniques.
2) Provide full-fledged, comprehensive rapid diagnostics without pain and inconvenience, including the determination of biological age with all parameters, conclusions and recommendations.
3) Provide detailed qualified recommendations (invited consultants working in this field) on all aspects of diagnosis, treatment and rehabilitation in the direction of life extension, prevention and reversal of aging and bioactivation, incl. for middle and young ages (treatment of chronic fatigue syndrome, stress, weight correction, figures, etc.).
4) Provide a single comprehensive effect on the body based on individualized courses based on world achievements and domestic original developments.
When carrying out geroprophylactic, biocorrective, therapeutic and biostimulating measures, the following methodological approaches and techniques are primarily used: individual detailed diagnostics; individual detailed consultations of medical specialists; special diets, body cleansing regimens and curative fasting; purified bioactivated water; special health regimen (life style correction); special psychological treatment, consultations and active management by a specially trained psychologist, autopsychotechnics; correction (harmonization) of biorhythms, including the original domestic method of galvanoelectroacupuncture; massage and manual therapy, exercise therapy and exercise equipment, physiotherapy, hydrotherapy, laser therapy; special drugs - biostimulants, bioimmunocorrectors, psychostimulants, adaptogens, anti-stress drugs; special drugs that affect the deep processes of aging (geroprotectors, adaptogens, anti-stress drugs, phyto-vitamin-microelement complexes, etc.); a wide range of therapeutic and prophylactic and health-improving preparations and means of domestic and foreign production; basic lectures, video and printed information and training; other general and special medical and wellness procedures.
Gerontological consultative and preventive care at the city and regional levels is usually formed on the basis of geriatric hospitals, with predominantly curative inpatient services, and social protection services: veterans' homes and dispensaries, with a bias towards care and rehabilitation activities, as well as with broad cultural programs.
At the federal level, Gerontological Centers are actually represented by Clinical Hospitals with a gerontological specialization (inpatient hospital forms of care), which are the bases for advanced training institutes for doctors, departments of geriatrics and scientific research institutes of gerontology with powerful services of their own scientific research and various specialized forms of geriatric care. Preventive forms of work at this level are represented by the Research Institute of Rehabilitation and Balneology with a specialization in various "diseases of the elderly", as well as by the Centers for Preventive Medicine, which pay increasing attention to the problems of the elderly. In addition, there are research institutes and universities that research the biology of aging, social and legal issues of helping the elderly, etc.

One of the special types of stationary social service institutions are gerontological (gerontopsychiatric) centers, created in our country to serve older people. The average age of clients in most geriatric centers is 81-82 years old.¹

Taking into account the aging of the Russian population, the emerging trend towards an increase in the number of elderly people and centenarians, the creation of the most comfortable living conditions for older citizens, the provision of comprehensive rehabilitation of the elderly and disabled living in geriatric centers and maintaining rehabilitation potential, is an urgent and important practical task.

Stationary social service institutions of the gerontological profile began to be created in the 90s. the last century. The first such institution was the geriatric psychiatric center "Mercy" of the Committee for Social Protection of the Population of Moscow, established in 1993 on the basis of one of the neuropsychiatric boarding schools. ²

However, the organizational and legal status, tasks, structure and activities of such centers were fixed after the approval by the Decree of the Ministry of Labor and Social Development of the Russian Federation dated November 14, 2003 No. 76 of the Guidelines for organizing the activities of state and municipal institutions of social services for the population "Gerontological Center" . In these recommendations, it is noted that it is recommended to create a state or municipal institution of social services for the population "Gerontological Center" in order to provide social services to elderly citizens and the disabled (men over 60 years old, women over 55 years old), who have partially or completely lost

the ability to self-service and those in need of outside care and supervision for health reasons

themselves centers can be:

1. Stationary - the best is to deploy them on
base of sanatoriums and dispensaries, which corresponds to the contingent, premises and other features of the work. Maybe:

Formation of groups for rehabilitation, biostimulation and rejuvenation from the contingent of the sanatorium, which is optimal for the start of the deployment of work and is low-cost;

Formation of their contingents and departure to sanatoriums and nursing homes;

Deployment of full-fledged separate stationary centers on
bases of sanatoriums and dispensaries.

2. Consultative and diagnostic - on the basis of polyclinics and private medical centers with a bias towards the medical side of work, on a self-supporting basis with polyclinics, with the involvement of local consultants,
with an emphasis on specialized programs for geriatric and preventive geriatric care.

3. Rehabilitation and health - on the basis of sports and health centers and newly formed geriatric centers with the formation of permanent contingents of clients (the most massive type of centers).

Gerontological centers that provide inpatient social services are currently represented by two profiles: gerontological centers for older people with somato-neurological pathology and geriatric psychiatric centers for older people with personality changes and intellectual disorders.

Main tasks activities of the gerontological center are:

Providing social services to citizens of older age groups (care, catering, assistance in obtaining medical, legal, socio-psychological and natural types of assistance, assistance in vocational training, employment, leisure activities, funeral services, etc.), including additional ones, at home, in stationary and semi-stationary conditions;

Monitoring the social status of citizens of older age groups living in the service area of ​​the Gerontological Center, their age structure, health status, functional
abilities and income level in order to timely forecast and further plan the organization and improve the effectiveness of social services for citizens of older age groups;

Implementation of the results of scientific research in the field of social gerontology and geriatrics in the practice of the Gerontological Center;

Interaction with bodies and organizations, including research organizations, institutions of social services for the population, on the organization of social services
citizens of older age groups, including issues of practical application of social gerontology and geriatrics in social services for citizens of older age groups.¹

Taking into account that in the elderly there is a tendency to growing painful pathological processes, in some cases becoming chronic and difficult to treat, as well as to a significant decrease in mobility, socio-medical departments are provided in the structure of almost all geriatric centers.

Clinical aspects of the health of the elderly and disabled living in the institution determined the direction of social and medical activities in two main areas: social and medical work of a preventive type and socio-medical work of a pathogenetic type.

Social work preventive focus includes the implementation of measures to prevent socially dependent disorders of somatic and mental health, the formation of an attitude to

a healthy lifestyle, ensuring social protection of the rights of citizens in matters of health protection.

Social work pathogenetic focus includes activities for the organization of social and medical care; assistance in conducting medical and social expertise; implementation of medical, social and professional rehabilitation of the elderly and disabled; correcting the mental status of the client and especially the elderly, ensuring continuity in the interaction of medical specialists in related professions.

The contingent of geriatric centers greatly increases staffing requirements, carrying out work on the provision of services to citizens of the listed categories, who are especially dependent people who require outside help and constant monitoring.

In the gerontological center, in addition to providing social services, including additional ones, the monitoring of the social status of citizens of older age groups living in the service area of ​​the gerontological center is carried out; implementation of the results of scientific research in the field of social gerontology and geriatrics in the practice of the geriatric center; interaction with bodies and organizations on the organization of social services for citizens of older age groups, including practical use social gerontology and geriatrics in social services for elderly Russians.

In 2008, there were 34 geriatric centers operating in Russia located in 26 regions of the Russian Federation. The capacity of individual institutions varies from 60 (Republic of Tatarstan) to 650 places (Smolensk region).¹

Actually gerontological centers should direct their work, first of all, to:

a) prevention of aging, including the promotion of methods and services,
first of all, for people of average, able-bodied and socially active age (35-55 years);

b) prenosological diagnostics, prevention, rehabilitation and health promotion;

c) rehabilitation, preventive and health-improving methods
after illnesses.

Consequently, gerontological centers should be rather valeological, rehabilitation, physical culture and sports and cosmetology than traditionally narrow-profile medical ones. Their difference from the existing health centers are:

a) emphasis on prevention, containment and reversal of aging;

b) good training in the field of biology of aging, gerontology and means of bioactivation;

c) the presence of its own powerful diagnostic methods (the whole complex of methods, first of all, this is the determination of the parameters of biological age and a complex of methods of clinical physiology and biochemistry);

d) availability of own methods of prevention, containment and reversal of aging (actual rejuvenation), means of bioactivation, etc.;

e) the possibility of a high level of specialized consulting;

f) the possibility of a high level of cosmetology services used in combination with other methods;

g) the fundamentally complex nature of the methods used,
focus on long-term use, the formation of a permanent
contingent;

h) implementation, along with complex programs, of individual specialized standard programs related to age (anti-climacteric, anti-osteoporotic, prevention of lens opacity, etc.);

j) powerful advertising and propaganda in the gerontological center and in society is the basis of the work, since the basis of the effects can only be formed life style with the whole range of applied methods.

It seems that it is gerontological centers that should solve not only current, but also promising (taking into account the demographic forecast) regional problems associated with population aging. Along with practical activities the centers should be engaged in scientific developments in the field of social gerontology and carry out scientific and methodological activities. One of the mandatory functions is organizational and methodological work with all institutions of social service for the elderly and disabled in the region.