Mental disorders in old age. Severe mental illness of late age

Psychoses are not characterized by severe mental disorders; they increase gradually as the disease progresses.

Treatment

Treatment of senile psychoses combines medicinal and psychotherapeutic methods. The choice depends on the severity of the condition, the type of disorder, and the presence of somatic diseases. Patients are prescribed the following groups of drugs:

The doctor selects a combination of drugs according to the type of psychosis.

It is also necessary to treat a somatic disease in parallel, if it appears cause of the disorder.

Psychotherapy

Psychotherapeutic sessions are an excellent means for correcting psychosis in the elderly. In combination with drug therapy, they provide positive results.

Doctors mainly use group classes. Old people, studying in groups, acquire a new circle of friends with common interests. A person can begin to talk openly about his problems and fears, thereby getting rid of them.

Most effective methods of psychotherapy:

Senile psychoses- this is a problem not only for the patient himself, but also for his relatives. With timely and correct treatment, the prognosis for senile psychosis is favorable. Even with severe symptoms, stable remission can be achieved. Chronic psychoses, especially those associated with depression, are less responsive to treatment.

The patient's relatives need to be patient, show care and attention. Mental disorder is a consequence of the aging of the body, so no person is immune from it.

*Published by:
Petryuk P. T. Mental disorders in old age // Age-related neuropsychology and neuropsychiatry: Proceedings of a scientific and practical conference with international participation. - Kyiv, 2007. - pp. 77–78.

The most common and important mental disorders in old age include various forms of dementia (primarily dementia due to Alzheimer's disease and vascular dementia), depression, anxiety and somatization disorders (A. Kruse, 2002).

Dementias (F00–03) are divided into: a) dementia due to Alzheimer's disease (F00); b) vascular dementia (F01); c) mixed forms of the two previous dementias (F00.2); d) dementia due to causes other than Alzheimer's disease or cerebral vascular disease (F02); e) metabolic dementia, dementia as a consequence of vitamin deficiency, dementia as a consequence of chronic intoxication (F02.8).

Alzheimer's dementia is the most common form of dementia and in most cases does not occur until after age 65, although it can appear in middle age. This type of dementia is a constantly progressive and irreversible disease that begins with learning disorders, memory and thinking disorders, as well as mild personality changes (primarily in the affective sphere). Then cognitive impairment gradually increases, allo- and autopsychic disorientation appears, motivation is lost, passivity appears and a lack of interest is revealed. The patient gradually loses his independence (the time from the onset of the disease to death is approximately 7 to 9 years).

Vascular dementia is characterized by a fluctuating course and cognitive impairment, which, depending on the affected area of ​​the brain, is lacunar in nature. And in this form of dementia, the main symptoms are impairments in memory, judgment, abstract thinking, decision-making, and personality disorder. It is necessary to distinguish various forms of dementia from pseudodementia, which can occur with severe, chronic depression and are characterized by a decrease in intellectual abilities, lack of motivation, and independence, which allows one to suspect the onset of dementia. States of confusion lasting several hours to days can occur due to insufficient oxygen supply to the brain or as a result of severe mental stress.

Depressive disorders (F32–33), along with dementia, are the most common mental disorders in old age. It has been proven that depressive episodes appear after the loss of a spouse, a loved one, with a chronic illness, as well as when there is a need for help and care. Depression in old age varies significantly in intensity - from mild to very severe episodes. Patients with dementia suffer from depressive disorders in 30% of cases, which must be taken into account in differential diagnosis (K. Osterreich, 1993).

Anxiety disorders (F40–41) also often co-occur with depression in older people, but specific phobias and social phobias occur more frequently than generalized anxiety disorders. Anxiety disorders - primarily phobias - mainly occur in those older people who are socially isolated. In patients with dementia, awareness of the disease and its consequences often leads to panic disorders.

Somatization disorders (F45.0) are more common in those older people who demonstrate a negative attitude towards their own aging and are convinced that they no longer have goals in life and are not needed by anyone, or face the accumulation of stress, not being able to cope with them (the likelihood especially increases in old age) (A. Kruse, 1989; H. Radebold, 1992).

Thus, when treating mental disorders in old age, it is necessary to take into account the above-mentioned clinical features of the mentioned disorders.

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Senile mental illnesses

The aging process is accompanied by changes in the human psyche. In the article we will look at senile mental illnesses and learn how to prevent the appearance of abnormalities in older people using folk methods. Let's get acquainted with preventive methods that maintain clarity of mind and sobriety of memory.

Aging of the body

This physiological process is not a disease or a death sentence. It is accompanied by changes in the human body. It makes no sense to put labels on the age at which such changes occur, because each person’s body is individual and perceives everything that happens to it in its own way. Many manage to maintain clarity of mind, good memory and physical activity until the end of their days.

Mental disorders provoke retirement, death of loved ones and acquaintances, feelings of abandonment and failure, and illness. This and much more changes life patterns and provokes chronic depression, which leads to more serious illnesses.

Deviations in old age are difficult to characterize, because a person’s mental state depends on many factors. The occurrence of the disorder is provoked by negative thoughts, constant stress and worries. Prolonged stress affects a person’s emotional and physical state. The nervous system becomes vulnerable, hence neuroses and deviations.

Diseases of old age

Common diseases of old age:

1. Damage to blood vessels leads to atherosclerosis.
2. Psychosis and depression are frequent companions of older people.
3. Alzheimer's and Parkinson's diseases.
4. Loss of calcium causes osteoporosis.
5. Epileptic seizures.
6. Unsolved problems
7. Reaction to negative events
8. Side effect from taking medications,

Women are susceptible to mental illness more often than men.

9. Bad habits.
10. Gaming addiction.

Psychosis is accompanied by unthinkable ideas. An elderly person with such a diagnosis suffers himself and unwittingly makes those around him suffer. A paranoid person is suspicious, irritable, prone to exaggeration, does not trust close people, accuses them of all mortal sins.

This is a disease of the brain, manifested by impaired coordination of movements, trembling of the hands, chin, legs, stiffness, slow actions, and a frozen gaze.

11. Aging of the body;
12. Bad ecology,
13. Vitamin D deficiency
14. Oncological diseases.

Early diagnosis allows you to remain active for a long time and remain a professionally active person. Ignoring the disease leads to its progression.

The disease is also called “quivering paralysis” and often occurs in people over 70 years of age.

Symptoms of central nervous system disease are extensive. It happens differently for everyone. Loss of short-term memory, ill-considered actions, mental disorders are alarming, and gradually a person becomes helpless.

Factors influencing the development of the disease:

1. Poor nutrition, consumption of alcoholic beverages, sausages.
2. Passion for salt, white sugar, flour products.
3. Lack of oxygen.
4. Obesity.

Treatment of the psyche with folk remedies

Traditional methods are effective only in combination with therapy prescribed by a doctor.

Time-tested recipes

5. Water – 500 ml.

Result: Calms, relieves senile neuroses, promotes sound sleep.

Recipe for senile dementia

6. Nettle – 200 g,

How to cook: Pour cognac over stinging nettle. Leave it for a day. Place in a dark place for 5 days.

How to use: Take the tincture twice a day before meals, a teaspoon.

Recipe: Prevention of mental disorders.

Aggressive Behavior Reducer

7. Motherwort,
8. Water – 700 ml.

• Asparagus,
• Red caviar,

Include fish in your diet, which improves brain activity and slows down the development of dementia.

Sport improves brain function and protects it from aging. Jogging, brisk walking, dancing, roller skating, cycling and other types of cardio training are considered effective.

Constantly develop yourself, read books every day, learn a new language. Studies have shown that memory does not fail people who read and write by hand a lot. This will preserve the functions of brain activity, but is not a panacea for developing pathologies.

It is much easier to cope with mental illnesses if you accept your age and the changes that accompany it. A real assessment of behavior and attitude will help with this. Optimism will maintain self-control and peace of mind. The wisdom accumulated over the years of life will solve any problems.

What to remember


• Aging affects the human psyche.
• Mental illnesses in old age are treated with medications and traditional methods.

Mental illnesses in old age

Forms of strangulation disorders



Age-related disorders include a number of mental disorders that develop in people over 65 years of age.

The causes of senile disorders at the moment are:

• vascular diseases (arteriosclerotic dementia, multi-infarct dementia, subcortical vascular dementia, etc.);
• death of neurons and degenerative-atrophic changes in the cerebral cortex (dementia in Alzheimer's disease, dementia in Pick's disease);

Despite the wide range of mental illnesses in older people, the most common syndromes are the following clinical groups:

• impairment of cognitive functions (memory, intelligence and learning ability) and awareness of the environment (disorder of consciousness and attention);
• disorders of perception (hallucinations), content of thoughts (delusions);
• mood and emotional disorders (depression, emotional agitation, anxiety), personality and behavior changes.

At the Bekhterev Center you can receive qualified medical care for all the most common types of mental disorders in the elderly.

Patients with senile dementia require hospitalization if psychosis or behavioral disorders occur.

Senile dementia (senile dementia)



Senile, or more simply put, senile disorders include a number of mental disorders that develop in people over 65 years of age.

Dementia syndrome (dementia) most often occurs in the structure of diseases such as Alzheimer's disease and vascular lesions of the brain. Briefly, this syndrome can be characterized as chronic progressive disorders of the higher functions of the cerebral cortex:

1. memory;
2. thinking;
3. orientation in place and time;
4. speech understanding;
5. check;
6. ability to learn;
7. ability to judge.

Developing senile dementia is accompanied by external manifestations. Patients have difficulty caring for themselves. It is difficult for them to wash and get dressed, they lose skills in eating, lose the ability to do arithmetic (pay utilities, count change), cannot be trained, and cannot cope with physiological functions on their own.

In addition, in the everyday life of such patients, phenomena of “mental confusion” can be observed. As a rule, such conditions occur in the afternoon and are characterized by psychomotor agitation. Patients suddenly begin to get ready somewhere, get dressed (or, conversely, strip naked) and leave the house. At the same time, they can leave the doors open or the gas on. The greatest danger comes from domestic injuries.

Elderly people do not recognize their closest relatives and do not understand where they are. The described condition can end on its own after a few hours, or last for a long period of time.

Patients are prescribed an individual treatment regimen to relieve states of agitation and eliminate fussy behavior

That is why timely diagnosis and prescription of drug therapy at the earliest stages of the disease are extremely necessary.

Hallucinatory and delusional syndromes



In some cases, patients with senile dementia experience psychosis (a psychotic form of senile dementia). They tend to accuse relatives of intentionally harming them, stalking, theft, poisoning, causing damage, etc. Delusional judgments reach the point of absurdity.

Often, in the clinical picture, together with delusional syndrome, there is also a hallucinatory syndrome. At the peak of anxiety and tension, the patient may claim that he hears voices, sounds, knocking, steps, complain about unusual smells, and a changed taste of food.

With the experiences described above, older people look suffering and anxious. They speak with pressure, irritation and resentment in their voices, and try to take restrictive or protective measures. They may urgently ask their relatives to install security cameras in the apartment, on the landing (to catch the attacker and dispel the doubts of others); For fear of poisoning, they refuse to eat, as a result of which their condition worsens.

We offer outpatient treatment options, day hospital or 24-hour hospital

It is impossible to reassure patients in such a state; it is impossible to prove to them the falsity of their fears using logical arguments. Only after the cessation of anxiety and a decrease in the severity of delusional experiences does the patient resume his previous lifestyle, sleep and appetite are restored, and family relationships improve.

Treatment of aging disorders



Patients with senile dementia require constant monitoring and care. In our clinic we offer several treatment options: outpatient, day or 24-hour hospital.

An individual treatment regimen is selected for the patient to relieve states of agitation and eliminate fussy behavior, taking into account concomitant pathology (persistent high blood pressure, diabetes mellitus, previous strokes).

Antidementia therapy is aimed at preventing further deterioration in the functions of memory, attention and consciousness.

If necessary, to correct mood and sleep, it is possible to prescribe antidepressant therapy and individual selection of anti-anxiety drugs.

Taking into account the high risk of side effects and the difficulty of selecting antidiabetic and antihypertensive therapy, inpatient monitoring and constant monitoring of blood tests, blood pressure and fasting glucose are extremely necessary.

Practice shows that monitoring such patients at home is associated with a high risk for the patient’s health (due to a possible error in treatment tactics).

Advantages of treatment at the Bekhterev center

Individual approach

Each of our patients is unique. Each treatment complex is unique. We are constantly improving our level of service, and currently offer you the following forms of treatment:

8. outpatient treatment (clinic visits for consultations, examinations and procedures);
9. inpatient treatment (staying in the clinic for 24 hours);
10. day hospital (a visit to the clinic for the whole day with the opportunity to return home in the evening);
11. home treatment (doctor consultation).

We work 24 hours a day, seven days a week

Hospitalization in our center is possible at any time of the day. Our patients receive constant care and attention throughout their stay at the center, 24 hours a day.

High professionalism of doctors

We are extremely scrupulous in selecting quality specialists to work in our center. In addition to their high professional level, all our doctors love their work.

Comfortable hospital

The rooms are equipped with shower, toilet, TV, air conditioning. Patients are offered three balanced meals a day, with various menu options, for example, dietary and vegetarian.

Flexible pricing policy and convenient payment options

Since each patient requires an individual approach to treatment, we tried to make our price list as simple and understandable as possible for you, and we also made 6 options for paying for our treatment (including on credit).

www.bechterev-psy.ru

Mental changes in old age

The aging of the human body is accompanied by changes in all its functions - both biological and mental. Statistics show that older people suffer from diseases associated with mental disorders much more often than young and middle-aged people. Mental disorders of varying degrees are observed in 30-35% of people over 65 years of age. Mental health disorders in older people manifest themselves in varying degrees: from relatively mild disorders to quite severe ones, in which patients require systematic treatment and observation by psychiatrists.

Mental disorders in old age can be expressed in a decrease in mental activity: perception becomes difficult, its volume narrows, emotional instability develops, and the ability to concentrate and switch attention deteriorates. Often there is a sharpening of characterological characteristics: a person becomes capricious, touchy, stingy, selfish, conservative in judgment, prone to moralizing, and afraid of any life changes. Lack of self-control makes him irritable, aggressive, hot-tempered, or, conversely, depressed, insecure and whiny. Mental disorders can be expressed in the form of anxiety, which easily arises over the most insignificant reasons, and then develop into fear, despondency and hopelessness. Such negative emotions reduce vitality and aggravate the manifestations of old age.

Severe mental disorders found in pre-senile and senile people include diseases characterized by organic changes in the brain - these are diseases such as Pick's disease, Alzheimer's, and senile dementia. Such forms of mental disorders are accompanied by amnesia, dementia, speech disorders, severe thinking disorders, spatial disorientation, depression, delusions, hallucinations, etc. Such patients not only need systematic treatment, they require constant care and attention from loved ones.

You should not think that old age necessarily entails a deterioration in mental health. Many diseases that occur in old age can be cured. It is important not to ignore changes in the behavior of your elderly relatives, to be attentive to them, since such changes can be symptoms of depression and psychogenic-neurotic disorders. Caring for your loved ones and proper treatment can lead to an improvement in their condition and return older people to a full life.

uhod-i-zabota.ru



Age-related changes are often accompanied by chronic diseases. Over the years, they worsen, gradually undermining health and affecting a person’s mental state. It is becoming increasingly difficult to resist external circumstances. Older people react more painfully to unexpected situations.

12. Dementia or senile dementia.
13. Diuresis is a disease that causes urinary incontinence and frequent urge.

Changes in the older person's brain

According to scientists, old age is a disease that can be treated. Most diseases appear in the human body at a young age. Brain aging provokes the awakening of chronic diseases and the emergence of new ailments.

Senile depression

Causes of depression in old age:

14. Genetic predisposition,
15. Changes in neurological and hormonal areas,

Symptoms are: depression, bad mood, accompanied by tears and negative thoughts, loss of appetite, sleep disturbance, etc. In some cases, depression causes dementia, accompanied by apathy, poor memory, confusion of thoughts, and disruption of physiological processes.

Dementia refers to the destruction of the psyche by age. Elderly people deny the presence of mental disorders. Even relatives are in no hurry to recognize the problem, justifying the illogical behavior of a loved one with old age. People are mistaken when they say that insanity is a manifestation of character.

Causes of dementia:

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From this article you will learn:

Where do mental disorders come from in older people?

What types of mental disorders can occur in older people?

What are the symptoms of mental disorders

What treatment is used for reversible and irreversible mental disorders

How can you prevent mental changes?

How to care for an elderly person with mental disorders

A favorite of family, friends and colleagues, the 60-year-old elegant lady was congratulated on her anniversary. To the phrase “We wish you everything that life is rich in...”, she reacted like this: “I don’t expect anything, because what else can you find after 60, except Alzheimer’s and Parkinson’s?” This approach is very wrong. Of course, older people are much more likely to be diagnosed with mental illness than older or younger people. Unfortunately, immunity to mental disorders does not exist. It is impossible to say with certainty who will be affected by this problem and who will avoid it. All you have to do is treat your elderly relatives and yourself with special attention, know the general signs of mental disorders in older people and seek medical attention in a timely manner.

Where do mental disorders come from in older people?

There are people for whom old age suits them: their hair may be gray, but their eyes glow with peace and wisdom. Yes, the body of older people loses strength, bones become thinner, blood vessels become thin, slow blood circulation does not nourish the skin, it becomes dull and withers, muscles are not strong, and vision is not pleasing. But these people find strength in themselves and adapt to the changes that have occurred. Some do exercises to maintain muscle tone, others make it a rule to take daily walks in the fresh air and saturate the body with oxygen. There are many vitamin complexes for the health of older people. All the measures used are often aimed only at maintaining physical strength; we not only forget that the psyche requires increased support, but we don’t even realize.

In old age, there is a process of decline in vital functions not only of the physical body, but also of mental strength. There are a few optimists among older people from whom we need to take an example. They maintain fortitude, control their will, are not afraid to change something in their lives, and encourage others. The majority resign themselves to the fading of their strength, their gaze is directed only back to the past, they do not want to see the future, pessimism evokes thoughts of death, of life without them, the strength of older people simply melts away with such thoughts. Constant anxiety provokes the emergence of mental disorders and mental health problems in general.

Mental illnesses of late age are divided into:

Reversible, which do not lead to dementia (they are also called involutional functional);

Irreversible, these are organic psychoses, they arise from a destructive process in the brain and can be accompanied by severe intellectual impairment.

How will involutional (reversible) mental disorders manifest in older people?

1) Neuroses. Widely known neuroses. What happens to an elderly person? He complains of heaviness, noise in the head, in the ears, ringing is disturbing, and due to dizziness, staggering is possible when standing up suddenly or walking. An elderly person gets tired quickly, so he needs periodic, unscheduled sleep. Night sleep is disturbed, impatience, irritability, and resentment increase. Irritated by bright light and loud sound. Mental health treatment is required, but it is done on an outpatient basis.

2) Depression. No one is immune from a bad mood; in old age you need to learn to avoid it. If a depressed, melancholy state lasts for weeks, you need to sound the alarm, most likely it’s depression. Anxiety gives way to emptiness, sadness and sadness manifest themselves in apathy, the meaning of life is lost. An elderly man feels sorry for himself in his own uselessness to anyone. Eating, walking, everything is done through strength. Unpleasant pain and sensations aggravate the mental state. Our old people are brought up by life in such a way that emotional experiences cannot be a disease. Only consequences, such as exhaustion due to loss of appetite, or frequent illness due to decreased immunity, can attract the attention of relatives or neighbors to the problem of an elderly person. Observe the elderly and show your participation if he: has become withdrawn, has changed his lifestyle, cries often, does not get out of bed for no reason. Do not ignore doctor's orders if you are diagnosed with depression. This is a serious psychological illness; now the meaning of this word is somewhat distorted, calling any decrease in mood depression. This is wrong. If depression is not treated with medication using psychotherapy, it can cause more serious mental illness in older adults. And they will bring a lot of troubles and troubles to the patient himself and his environment.

3) Anxiety. Anxiety is a normal state for any person, but if anxiety interferes with life, especially for older people, it should be talked about as a mental disorder. Constant anxiety is difficult to bear and is aggravated by excessive smoking, drinking, and excessive use of medications. A number of diseases, such as diabetes and angina pectoris, bronchial asthma, strokes, are also associated with the manifestation of severe anxiety. Of course, anxiety in the elderly may be a character trait that has intensified with old age or under the influence of life conditions. Again, if you look at the situation from the other side, it becomes clear that older people, losing physical strength, security, and social activity, really face a lot of alarming situations. These are serious illnesses, loss of contact with adult children, financial difficulties. It should be remembered that Anxiety in older people often occurs with other mental disorders. It often accompanies mental illnesses such as Alzheimer's dementia, depression, and is similar to symptoms of delirium or the “sunset effect.” It is important not to overlook the onset of more severe forms of mental disorders. Before treatment, you need to eliminate coffee, alcohol and heavy smoking from your life, adjust the intake of existing medications, and consult a psychotherapist. Sometimes this is enough to overcome a mental disorder such as anxiety in an elderly person.

4) Hypochondria. Everyone has met elderly people in hospital corridors who, as if on duty, go from one doctor to another. In the offices they complain about bodily ailments, incessant aches, twisting, and exhausting pain. Doctors do not find confirmation either in test results or in x-rays. That's right, because it is not physical diseases that need to be treated, but mental disorders - hypochondria. The age of an elderly person, due to aging, will give signals of malaise; if an elderly person’s fixation on bodily ailments becomes an obsession, treatment must be started. Self-medication is dangerous here. Hypochondriasis is characterized by a person's excessive fixation on their bodily sensations. and can lead to deep confidence in an elderly person about a fatal disease.

5) Manic state. A mental disorder that is dangerous not in itself, but as a result of its manifestation - manic state. An excited mood, excessive boasting, and inadequate self-aggrandizement are replaced by aggressive outbursts of anger in an elderly person. Fussy, always coming up with problems for relatives and friends, annoyingly talkative people, often elderly. Their conversation jumps from one topic to another, you don’t have time to insert a word, and it’s not necessary, the patient is busy with narcissism. It is not difficult to guess that such people most often end up in unpleasant situations, caught by scammers. Without feeling at all like a patient diagnosed with a mental disorder, he will not go to the doctor for a long time. The result in old age will be a leapfrog of severe depression with attacks of manic excitement.

6) Delusional state. The following type of mental disorder is often used in films to show a negative character, often an elderly neighbor. The phrase “What kind of nonsense are you talking about!” is a prophetic diagnosis: delirium. And in life, we often meet older people who start a scandal over every little thing. Delusional ideas are the main manifestation of chronic delusional disorder, a mental illness that often occurs in old age. Patients talk about sabotage, theft, and infringement of their rights. At first we somehow react, deny, try to explain what was wrong, then we simply try to ignore, but the flow of accusations, often without any basis, becomes more and more. The story of a family of three and a neighbor with a manifestation of mental delusional disorder formed the basis of the plot of one film. An apple that fell from a child and rolled across the floor seemed to the person living below to be moving furniture. The neighbor saw wet cleaning of the stairs in the entrance as a way of setting up an accident, because it was damp. The attempts of a non-conflict family to establish contact by treating them to hot cakes in the eyes of an elderly neighbor turned into an attempt at poisoning; calling an ambulance for a brawler turned into an attempt to illegally enter the apartment. We won’t retell the whole film, but the family had to look for another apartment. The new residents did not stand on ceremony with the sick elderly man, and he had to seek refuge with his recent “enemies” - former neighbors who convinced the elderly man of the need for treatment and supported him in a difficult situation. Our audience needs such films to see the problem of a sick person from the inside. He really hears other people's voices, sounds, steps, smells suspicious smells, and is surprised at the change in the taste of familiar food. This is his problem. Depressive experiences are added, and the person himself suffers for years and torments those around him. The only question is the correct treatment of a mental illness, but for this the patient needs to be convinced, and this is very difficult to do. Your concern again transforms into a delusional idea to “heal” him.

After adequate treatment, older people with manifestations of delusional disorder return to a normal lifestyle; in case of relapses, they are not afraid to return to treatment.

What are organic mental disorders in older people?

As a result of dementia, organic personality and behavior disorders occur. These are serious, irreversible diseases. More often this happens in adulthood.

Dementia (dementia) does not arise suddenly, the development of a mental disorder occurs slowly, from minor manifestations to a severe deterioration of the mental state. Dementia can cause two types of disease: total and lacunar. Total speaks for itself: it is a complete defeat of all body systems. An elderly patient loses his personality, does not understand who he is, does not retain information, is helpless and inadequate. Lacunar dementia is characterized by milder losses: memory is lost, but partially, the person does not lose his “I”.

Degenerative dementia is represented by: organic mental illnesses, such as Alzheimer's disease, Pick's disease and senile dementia.

1) Senile dementia

With this mental disorder, there is a complete (total) loss of intellectual capabilities. The patient's behavior is unpleasant: constant irritation, grumbling, suspicion. Memory fails, and what happened is clearly remembered for a long time, but the events of yesterday are erased. Interestingly, the gaps are subsequently filled in by fantasies, which causes delusions. Mood swings, inappropriate behavior of an elderly person, a complete lack of analysis, no prediction of actions. The patient pours hot tea on the floor and brings an empty mug to his mouth, expecting a cold drink. Instincts manifest themselves frighteningly clearly: either a complete loss of appetite, or overeating with impossible satisfaction of hunger. Sexual instincts increase sharply.

What can be done to help a patient with senile dementia? Only with patient care. There is no cure for this mental illness.

2) Alzheimer's disease

Alzheimer's disease develops gradually.

It is necessary to pay attention to the decline in the memory of an elderly person for long-standing and close events. Absent-mindedness, forgetfulness, confusion in past and present affairs are the first “bells” of mental illness. The sequence of events is disturbed, it is difficult to navigate in time. A person changes, and not for the better: he becomes selfish, intolerant of objections. Prolonged depression, sometimes delirium, and hallucinations are also symptoms of Alzheimer's disease.

As Alzheimer's disease progresses, signs of dementia become clearly visible. An elderly patient is disoriented in time and place, confuses names, does not remember his address, often gets lost on the street, and has difficulty determining his location. Patients are unable to name their own age and confuse the main points of their lives. There is often a loss of real time: they see themselves and speak on behalf of the child, they are sure that their long-dead relatives are in good health. Normal skills are impaired: patients lose the ability to use household appliances and are unable to personally dress or wash themselves. Concrete actions are replaced by chaotic wandering and collecting things. A person has difficulty counting and forgets letters. Speech changes. First, the vocabulary is significantly impoverished. Current actions in a conversation with an elderly patient are replaced by fantasy stories. Over time, speech becomes more meaningless, the patients' expressions consist of fragmentary words and syllables. In advanced stages of Alzheimer's disease, patients completely lose the ability to exist without outside help, meaningful speech is absent, motor activity is chaotic or suspended.

The problem is that early signs of mental disorders and illness (weakened memory, changes in character) often go unnoticed by the doctor. Relatives attribute them to approaching old age. It's no secret that Treatment started early in Alzheimer's disease is most effective. Thanks to modern medications, this mental disorder can be significantly alleviated.

3) Vascular dementia It can be caused by pathology of cerebral vessels, manifests itself in impaired cognitive functions, and rapidly progresses. Social adaptation suffers. The symptoms of this mental disorder are very similar to those of Alzheimer's disease, but are mild. Memory impairment, errors in a person’s awareness of time and space can be abrupt and change throughout the day. The distinction between these two diseases must be made as early as possible, since the approaches to their treatment are fundamentally different.

4) With damage to the brain, loss of a person as an individual, it makes sense to talk about Pick's disease. The capabilities of the intellect remain unchanged; the patient is able to count and remember dates, events, and facts. He speaks well and uses his vocabulary, which has remained unchanged. What was damaged? An elderly person began to be bothered by anxiety, constant presence in stressful situations, irritability, and does not calculate the consequences of actions.

Treatment and disease progression for this mental illness directly depend on the location of the affected lobe of the brain. The disease has no cure. With the help of medications, the course of the disease slows down.

5) Parkinson's disease

Symptoms of the disease become noticeable to others when all early stages of treatment are missed. The disease can live in the human body for several years without showing itself. Everyone has experienced hand tremors; if you add to it anemia of the limbs for a long time, then it is better for an elderly patient to make an appointment with a doctor. If this is not done, then there will be a lack of coordination when moving, a decrease in reaction, and movements will become slower. Sudden changes in pressure cause fainting, depression ends in severe depression. What is characteristic is Most often, the mental abilities of a person suffering from Parkinson's disease are intact. This, in turn, has its downside. Elderly people, seeing the progress of the disease, their helplessness, and the futility of treatment, usually fall into a severe form of depression. The quality of life of elderly patients, of course, deteriorates, but this is not the main thing. With modern medications, the patient lives a long time, but the danger lies in uncoordinated movements, leading to fractures, falls, and difficulty swallowing food. Caring for an elderly person with a mental disorder must be extremely sensitive so as not to aggravate depressive moods. So that your troubles do not cause the elderly patient to feel guilty, it is better to find an opportunity to treat such a patient in specialized clinics.

Why do mental disorders occur in older people?

Health problems in old age are common, so it is not possible to calculate a particular mental disorder or disease.

The cause of involutional disorders can be depicted as a formula: weakened mental health plus negative thoughts, stress and experiences. Not every nervous system can withstand neuroses and stress, constantly being under tension. Mental disorders are often superimposed on concomitant physical abnormalities.

Organic disorders have different causes. For example, lacunar dementia occurs against the background of lesions of the vascular system, infectious diseases, alcohol or drug addiction, tumors, and injuries. The causes of degenerative dementia are different, but it is known for sure that Alzheimer's disease and Pick's disease are a consequence of damage to the central nervous system. Carefully study your pedigree, because having relatives with mental disorders increases your risk significantly.

How mental disorder manifests itself: symptoms in older people

Involutional (reversible) disorders

A huge responsibility in recognizing mental disorders in older people lies with local therapists. Patients come with psychosomatic disorders, somatic complaints are often of an uncertain nature. The doctor needs to recognize hidden depressive disorders. Such as: tinnitus, heaviness in the head, dizziness, increased fatigue, staggering when walking, irritability, tearfulness, insomnia. Patients with mental disorders are prescribed outpatient treatment.

Great attention should be paid to the signs of depression; it is a symptom of many mental illnesses.

Organic disorders

These diseases are characterized by mental disorders functions and memory.

Early signs Dementia should include disorientation in time and space, absent-mindedness, and forgetfulness. Memories from the past dominate, although this is natural for old age. In this regard, one must pay attention to unrealistic additions, delusions and hallucinations.

Elderly people with mental disorders get lost, forget their address and telephone number, and sometimes do not remember their name.

Mental disorders often lead to speech impairment. The vocabulary melts away, phrases are constructed meaninglessly, then only sounds remain.

In later stages people with dementia are dependent on their caregivers. They cannot move or eat on their own. Such patients with mental disorders are monitored for 24 hours.

Unfortunately, dementia cannot be cured. Although, if at the first signs you consult a doctor for a diagnosis and appropriate treatment, you can slow down the development of mental illness and make the life of the elderly patient and those around him easier.

Can mental disorders in older people be cured?

Treatment depends on the mental illness. People with involutional disorders have a fairly high chance of successful treatment. These diseases are reversible. For example, depression, hypochondria, stress, and paranoia can be successfully corrected by a psychotherapist in combination with drug treatment. Sedatives, anti-anxiety medications and antidepressants prescribed by a doctor will help cope with mental illness. In cities there are group sessions with psychotherapists, this is a good reason to join forces for results.

Organic disorders based on any kind of dementia are irreversible. There are many techniques and therapies that are aimed at maintaining an adequate standard of living for as long as possible. The main thing is to preserve the consciousness and cognitive functions of a person suffering from mental disorders; various drugs are used for this. A huge problem lies in the early diagnosis of these diseases, since dementia is often given out and mistaken for signs of senility and treatment is delayed.

How to prevent mental disorders in older people

Old age brings with it many diseases that we cannot insure ourselves against in our youth. Although there are ways to prevent involutional deviations. It is impossible to limit oneself to organic personality disorders in old people. But there are methods of prevention. To help your loved one maintain mental clarity for as long as possible, you need to understand the main factors that can be a stressor. In this regard, it is recommended:

Find new social circles, get involved in handicrafts, feasible physical education;

Prevent loneliness of an elderly person;

Help to cope with the loss of loved ones;

Prepare in advance for retirement, look for like-minded people, options for easier work, or hobbies;

Help an elderly person maintain their standard of living.

The main thing in old age for the prevention of mental disorders is communication with peers who have found their place in life in retirement. Health groups, dance studios, universities of the third age - there are many places where loneliness is not remembered. Grown-up children also need to remember their elderly parents and, with their presence (in person or by telephone), constantly support the vitality of their elderly parents.

One of the most severe stressors is loneliness. For a lonely elderly person, time stands still. He watches the celebration of life and realizes that he is thrown out of this rhythm. Seeing the indifference of people, and especially loved ones, an elderly person comes to the conclusion that he is useless, which causes complex emotional experiences and anxiety. This provokes the emergence and development of mental illnesses . Marvelous , but older people who live with relatives are more likely to feel useless and unnecessary. How is this possible? It is not enough to place an elderly relative in your home; it is important to take time every day to listen to him, encourage him and show his importance to your family. Ask him for some simple help, do not refuse what he himself offers.

What care should be provided if mental disorders are diagnosed in older people?

In ordinary life, we do not notice efforts aimed at self-care. Going to the grocery store, cooking lunch, washing your face, turning off the stove, closing the front door - all this becomes problematic for older people suffering from mental disorders. Providing the elderly with the basic necessities of life falls on the shoulders of caring relatives.

From experience with older patients with memory loss or impairment:

To better understand each other, instructions should be given in short and simple sentences.

Communication for a patient with a mental illness should bring positive emotions, be friendly and at the same time confident and clear.

Information must be presented repeatedly, with reverse action, you must be sure that the patient understood everything correctly.

Reminders, assistance in remembering dates, specific places, names should always be patiently provided.

Always remember that a patient with a mental disorder is not able to remember instantly or respond to an answer in seconds; be patient in the dialogue.

Senseless bickering and discussions have a negative effect on an elderly patient; if you cannot distract the patient, make adequate concessions, at least partially.

Reproaches and discontent will be constant, you need to be prepared for this, perceive it easily and with an understanding of the situation.

Patients with mental disorders respond better to praise, become withdrawn, and stubborn if faced with criticism. Say a kind word, touch gently, smile encouragingly if the patient fulfilled your request correctly, tried, and made an effort for the result.

The organization of care must be correct. Compliance with the following points is mandatory:

Exact daily routine for the patient, changes are undesirable;

The diet is balanced, the drinking regime is correct, exercises, walks are required;

The simplest board games, crosswords, memorizing simple rhymes - forced activation of mental activity should be imperceptible and motivated;

Concomitant diseases should be diagnosed and treated;

A thoughtful, functionally safe place of residence for an elderly patient;

A clean body, clothes, bed are mandatory conditions for minimal comfort;

Optimal time to sleep.

Who should care for a patient with mental disorders? If a relative does this, the elderly patient feels more comfortable. But if this is not possible, then we are talking about a nurse. In addition, with some mental illnesses, the patient does not recognize his relatives. A nurse (usually with a medical education) must be familiar with the course of a specific illness, mental disorder, be prepared for inappropriate actions of elderly patients, be patient, friendly, carry out medical procedures as prescribed by the doctor and care for the patient in everyday life. In a sense, by hiring a caregiver, you are providing your sick relative with more care and support, so there is nothing strange about this. They will give advice on selecting nurses in hospitals, clinics, and special agencies. Another form of care for older people with mental disorders is boarding houses and nursing homes. For example, the Autumn of Life boarding house provides assistance in caring for diseases of vascular dementia, Alzheimer's disease, and decreased mental activity. Round-the-clock care from professionals, high-quality qualified assistance from doctors, provision of useful leisure time - everything that your loved ones who find themselves in a difficult situation need.

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

24-hour care for the elderly by professional nurses (all staff are citizens of the Russian Federation).

5 full and dietary meals a day.

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

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

Individual work by psychologists: art therapy, music classes, modeling.






Schizophrenia in the elderly: how to recognize the disease in time

The soul, like the body, is subject to change. These changes become especially noticeable in old age. This is a period when a turning point occurs in a person’s consciousness; it is necessary to find a foothold not in the outside world, but in oneself.

Mental disorders that arise at this age are, to a large extent, a reaction of the human psyche to physiological changes in the body and to changes in the environment.

Schizophrenia is one of the most serious mental disorders in older people!

How to recognize the first symptoms of schizophrenia in old age in order to seek medical help in time and begin timely treatment.

The following factors should be taken into account:

• Rave;
• Confusion, which is a disorder of formal thinking;
• Inappropriate behavior (laughing for no reason, tears, inappropriate clothing);
• Affect (complete absence or dullness of reactions);
• Alogia (lack or lack of speech);
• Social dysfunction (interpersonal contacts and self-care are kept to a minimum).



If all of the above symptoms are present for more than a month, then schizophrenia is diagnosed.

Types of schizophrenia

Hebephrenic schizophrenia

Characterized by the presence of childishness and foolishness in behavior. Sick people are shy and prefer.

The disease is characterized by the following symptoms:

1. capriciousness;
2. foolishness;
3. childishness;
4. grimacing;
5. hallucinations;
6. delusional;
7. sudden mood swings;

It differs from infantilism in the unreasonableness of actions, indecent behavior, and brutality. Patients completely cease to be interested in what previously attracted them, and cannot even perform simple work.

The disease is diagnosed after observing such signs for at least 2-3 months. The prognosis is unfavorable; personality disintegration develops over time.

Paranoid

The main clinical picture is delirium.

For older people, these are delusions of persecution, attempted murder, theft, infringement of rights by neighbors, and so on. Hallucinations, both auditory and visual, are very common.

The main manifestation of senile delirium is the assertion of a negative attitude of people around them, namely, that all the people around them have begun to treat them badly, they want to take away the apartment, poison them, rob them.

Paranoid schizophrenia is the most common form of the disease among older people

Such statements should alert loved ones, since the person not only suffers himself, but also poses a serious danger to the people around him.

The prognosis of the disease is unfavorable; in advanced stages of the disease, personality degradation occurs.

Catatonic

A combination of mental and muscular-motor disorders, with phases of stupor and excitement alternating. When a catatonic stupor occurs, the patient assumes a certain position for a long time.



There is a lack of speech and reaction to external stimuli, delusions, and hallucinations. The patient can remain in this state from several hours to several days. A characteristic feature of this form is negativism.

The person ignores any extraneous requests, does everything the opposite, refuses food. The disease manifests itself periodically, with light intervals possible between attacks.

*You can learn about other mental disorders in the article:

Residual or residual

A chronic, protracted form of the disease, in which there are no obvious signs of an acute schizophrenic disease, but deviations in behavior from accepted norms of behavior indicate the presence of the disease.

Patients present with the following symptoms:

• decreased activity;
• emotional activity;
• withdrawal into oneself.

Speech is inexpressive and meager, self-care skills are lost, interest in married life and communication with loved ones is lost, and indifference to children and relatives appears.

With a long course of the disease, patients can no longer cope without outside help, so special commissions assign them a disability group.

Simple or classic

It is characterized by imperceptible but progressive eccentricities and changes in the patient’s behavior.

This form of schizophrenia is characterized by symptoms of schizophrenic diseases such as isolation, focus on oneself and the structure of one’s body, and lack of emotions.

Video: How to recognize schizophrenia

A sick person becomes indifferent to his fate, the fate of people close to him. He withdraws completely into himself and begins to have delusional ideas. The disease develops slowly and imperceptibly, which delays the time to see a doctor and worsens the prognosis.

Treatment of schizophrenia

Treatment of all forms of schizophrenia is predominantly symptomatic and social. Antipsychotics are widely used in combination with other drugs.

Drug treatment is carried out simultaneously with the provision of psychological and social support to the patient.

In the acute phase of the disease, the patient should be admitted to a hospital. Treatment methods and doses of medications are selected by the attending physician individually for each patient, based on the symptoms of mental disorders.

Drugs

Tranquilizers: Seduxen, Phenazepam, Moditen-depot, and Haloperidol-decanoate.

Neuroleptics: Risperidone and Olanzapine, Triftazin, Haloperidol, Aminazina, Stelazin, Sonapax, Tizercin, Haloperidol, Etaperazine, Frenolone.
Nootropics: Racetam, Antiretsam, Nootropil (Piracetam), Oxiracetam.

It should be taken into account that the doses of drugs prescribed to older people should be reduced compared to younger patients. This is due to physiological changes in the body of older people.

Treatment of schizophrenia is impossible without psychotherapy. At the first stage, treatment occurs individually, then group and family therapy is carried out.

The psychotherapy method allows the patient to understand his illness, understand what he feels and does. Various trainings and group conversations help the patient improve relationships with others.



The goal of family psychotherapy is to explain to the patient’s relatives the symptoms of the disease and the need for long-term treatment. Relatives should know all the factors that can worsen the patient’s condition and strive to harmonize family relationships.

Attention: Do not self-medicate - at the first signs of illness, consult a doctor!

Conclusion

Modern medicine, unfortunately, cannot completely cure a disease such as schizophrenia in old age. But, if you are attentive to your elderly parents, you will be able to notice the first alarm bells.

This could be sleep disturbance, grumpiness, irritability, unreasonable fears, sudden mood swings, aloofness, isolation, and suspicion.

Adequate treatment started on time will help reduce the frequency of relapses and hospitalization, and will help reduce the rate of destruction of human life and family relationships.

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 mmHg. Art.

II degree: blood pressure numbers 160-179/100-109 mm Hg. Art.

III degree: blood pressure numbers 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.

In the treatment of arterial hypertension, various groups of drugs are used, 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 blood volume 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.

There are 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, and 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 and 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. Kidney 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 table salt are required. 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.

During drug 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 of installing an artificial pacemaker for the patient, which, by generating electrical discharges through a wire inserted into the heart through a vein, stimulates heart contractions. An artificial pacemaker is sewn into the patient for 5-8 years. Such a patient should be located away from areas with high magnetic fields (industrial transformers, high-voltage power lines, using a radiotelephone and cellular communications, etc.); he can “interfere” with the reception of radio and television programs if he is close to the antenna.

Chronical bronchitis is an inflammatory diffuse lesion of the bronchial tree. The causes of bronchitis are viral and bacterial infections, exposure to toxic substances, and 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 impaired absorption of blood glucose by cells, resulting in progressive damage to large and small vessels. There are types I and II diabetes; type II diabetes is typical for older people. Type II diabetes mellitus occurs as a result of exposure to many factors on the body, including smoking, alcoholism, and severe stress.

Patients with diabetes mellitus experience itching of the genitals, thirst, they begin to drink a lot of liquid, polydipsia (patients eat a lot), polyuria (patients excrete a lot of urine) also occurs. However, in older patients, not all of these symptoms are pronounced. Accurate diagnostic criteria for the development of diabetes mellitus in a patient are the detection of high blood glucose levels (above 6.0 mmol/l) in a biochemical blood test and in a glycemic profile study, as well as the presence of sugar in a general urine test.

In the treatment of diabetes mellitus, following a diet that excludes sugar and foods containing carbohydrates is of great importance. Patients are recommended to use sugar substitutes - saccharin and aspartame. Regular blood glucose testing is necessary in the clinic or at home.

Patients are prescribed glucose-lowering drugs: glibenclamide, maninil. In severe cases, when correction of blood sugar levels with hypoglycemic drugs is impossible, insulin administration is prescribed during operations.

The presence of diabetes mellitus in an elderly patient always complicates the course of coronary heart disease and arterial hypertension. Since diabetes mellitus affects small and large vessels, the sensitivity in such patients is reduced, and the clinical course of many diseases is not so typical, more blurred. For example, myocardial infarction in such patients may occur with less intense pain. This can lead to untimely provision of 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 experiences a feeling of anxiety, trembling throughout the body, and a feeling of hunger. He becomes covered in cold sweat, weakness and confusion appear. In this condition, the patient needs to give a piece of sugar under the tongue, this will improve his well-being. In a hyperglycemic state, the glycemic level is corrected by careful administration of insulin under the control of blood sugar testing.

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, Plavike and Vasoprostan are used.

Proper foot care is also necessary. 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. For scuffs, 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 takes 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 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 gland. 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.