AGING AND MENTAL PROCESSES
DISORDERS IN THE ELDERLY AND SENILE AGE.
Aging is a natural physiological
the process itself is not a disease. Although human aging is
normal process, it is accompanied
a complex set of age-related changes in almost all organs and systems
body. The skin gradually fades and the hair turns grey. Bones become brittle
joints lose mobility. The work of the heart weakens, the blood vessels become smaller
elastic, the speed of blood flow slows down. Metabolism changes, increases
cholesterol, lipid, blood sugar levels.
The activity of the respiratory and digestive systems is disrupted. Decreasing
immune system activity. Visibility decreases, hearing weakens, decreases
acuity of other senses. Endocrine and nervous activity weakens
systems. Age-related changes in the body
although they are not a disease in the medical sense, they cause a feeling
pain, uselessness, weakness.
The psyche also suffers during the aging process. Decreasing
mental flexibility, the ability to adapt to changing conditions
life, activity and general tone decrease, a feeling of weakness and general
ailments, mental processes slow down, memory and attention deteriorate,
the ability to rejoice and react emotionally to life events decreases,
a kind of senile conservatism appears. These mental changes
expressed to a greater or lesser extent,
accompany the aging process
almost every person.
The aging process is extremely uneven. Signs of aging in different organs and systems
organisms do not appear simultaneously. In other words, some organs “age”
earlier, and others later. For example, visual acuity begins to deteriorate already
after 20 years, changes in the musculoskeletal system appear after 30,
cardiovascular and muscular systems – after 40, hearing becomes worse
noticeable after 50. Once begun, age-related changes gradually progress
throughout a person's life. In domestic science, age 45-60 is designated
as a period of reverse development (involutional, climacteric), 60-75 years - as an elderly person
(pre-senile), 75-90 years - as actually senile. Older people
90 years old are considered long-livers.
The aging process is individual.
People age differently. This applies not only to the age of appearance of the first
involutional changes in the body, not only the predominant damage to some
organs and the relative safety of others, but also mental changes,
associated with the aging process. Many old people remain highly creative
activity and the ability to find joy in life in changed conditions.
Accumulated life experience and maturity of judgment allow an aging person
reconsider past attitudes and views, form a new life position, find a calm
contemplative attitude towards life. However, this is not always the case. In many cases the very fact
aging and a number of difficult life situations that accompany it create
conditions for disruption of human adaptation.
Loss of loved ones and the problem of loneliness, retirement, end
professional activities, changes in life stereotypes and emerging
financial difficulties, development of ailments and illnesses that limit physical
opportunities and causing a feeling of weakness, inability to independently
cope with everyday problems, fear of the future, awareness of the inevitability
approaching death - this is not a complete list of psychological problems,
faced by an elderly person.
Age-related biological changes in the body and
socio-psychological factors contribute to the development of mental illness in old age.
The most common manifestations of mental illness in the elderly and
old age - depression,
anxiety and hypochondria.
All old people periodically complain about being in a bad mood. IN
cases when the depressed mood becomes persistent, lasting for weeks,
especially months, we are talking about depression.
Sadness, sadness, gloominess, joylessness, melancholy or melancholy-anxious
mood, painful feeling of emptiness, feeling of one’s own uselessness,
the meaninglessness of existence - this is the main context of the experiences of depression
old man. With depression, activity decreases and interest in familiar activities decreases.
activities and hobbies. A patient with depression often complains that “he does everything
through force." Often appear
various unpleasant sensations and pains, general vitality decreases. Violated
sleep, decreased appetite. Depressed old people don't always tell
to others about their painful experiences. They are often embarrassed by them or
consider their condition as a natural manifestation of old age. If elderly
the person becomes sad, silent, inactive, lies in bed for a long time
bed, cries often, avoids communication - these behavioral changes can
indicate depression.
Depression is a serious illness. No treatment
depression in old age can last for years, creating a lot of
problems both for the patient and his relatives. At the first suspicion of development
depression, you need to see a doctor. The sooner treatment for depression is started
disorders - the faster a positive result is achieved. Depression in
old age is curable. There are a number of medications and
psychotherapeutic techniques that can save an elderly person from
depression and prevent its development in the future.
Many people become more anxious as they get older. Simple everyday situations
which a person could previously cope with without difficulty cause a whole series of
unreasonable fears, excitement and anxiety. Going to the doctor, payment
utilities, meeting with friends, buying groceries, cleaning and much more
others become a source of endless worries and fears. In these cases
talk about the development of anxiety
(neurotic) disorder. Such patients are fussy, restless,
pester those around them with the incessant repetition of their fears. Permanent
a feeling of internal tension with a sense of impending catastrophe makes
The life of such people is unbearable. A frequent topic of fear in old age is one’s own
health or the health and life of loved ones. Such patients are afraid to stay in
alone, they demand that someone close to them constantly
accompanied, they endlessly call their relatives with questions about their well-being. At times anxiety reaches
degree of panic. Patients cannot be at rest, they rush around the apartment,
moaning, crying, wringing their hands. Anxiety is often accompanied by a variety of
unpleasant sensations in the body (pain, palpitations, internal trembling, spasms in the
stomach, etc.), which further increases anxiety and gives rise to new fears. At
Anxiety often disrupts sleep. Patients cannot sleep for a long time and wake up at night.
Sleep disturbances, in turn, become a source of new concerns and fears.
Neuroses accompanied by anxiety are a serious disease that requires treatment from a specialist.
This condition cannot be overcome by the effort of one’s own will. Reception
sedatives provide only temporary relief. Meanwhile,
the use of modern therapeutic techniques allows you to completely get rid of
anxiety and fear.
Hypochondriasis is a person’s excessive fixation on
bodily sensations with the appearance of fears or beliefs in the presence of a serious
physical illness that is not confirmed by objective medical evidence
examinations. Old age itself with the inevitable development of physical illness and
variety of painful sensations provides abundant food for the formation
hypochondriacal experiences. Hypochondria usually manifests itself in the form of new
unusual and extremely painful bodily sensations for a person. Burning,
tightening, twisting, shooting or incessant aching pain, “bumps”
electric shock”, a feeling of burning in the body – this is not a complete list of complaints from patients with
hypochondria. A thorough examination by a therapist or neurologist does not allow
identify the cause of these sensations, and the prescription of painkillers turns out to be
ineffective. Hypochondriacal sensations and ideas are usually accompanied by decreased
mood with a hint of irritability, dissatisfaction, grumbling. These patients
They are distrustful, often change doctors, insist on additional
examinations. Constant fixation on painful sensations, endless
requirement for help from relatives, significant financial costs for everything
new expensive examinations – this is the lifestyle of a hypochondria patient
old man. Meanwhile, painful bodily sensations in hypochondria are based on
mental disorders.
Treatment of hypochondria
- difficult task. Only complex prescription of medications and
psychotherapy, persistence on the part of doctors and the help of loved ones will allow
for an elderly person to get rid of painful bodily sensations.
A relatively rare but very dangerous mental disorder
in old age - manic state
(mania). The main manifestation of mania is painfully increased
mood. Inappropriate gaiety with flat, often ridiculous jokes,
a complacent and euphoric mood with a tendency to boast and self-aggrandizement
easily replaced by outbursts of anger and aggression. These patients are tireless, sleep very little,
excited, constantly on the move, talkative, distractible. It's difficult for them
focus on any topic, they easily jump from one thought to
another. In a manic state, a person searches for new acquaintances, uncontrollably
spends money and often becomes a victim of scammers.
During mania
a person is uncritical of his behavior and rarely sees a doctor on his own
desire. Meanwhile, active treatment is necessary not only to
prevent inappropriate behavior during periods of manic excitement, but also
because mania usually gives way to severe depression. Without adequate
therapy in old age there is often a continuous change of manic and
depressive states.
Older people are often suspicious. They often
complain about unfair treatment from others, oppression from
sides of relatives, infringement of rights. In cases where these complaints have no basis
have real grounds, we can talk about the development of delusional ideas - false, untrue
judgments and inferences caused by
mental disorder. Delusional ideas - the main thing
manifestation of chronic delusional disorder - a disease that often
occurring in old age. Gradually suspicion intensifies, any
the actions of others are interpreted as directed against the patient. Content
crazy ideas are varied. Most often these are ideas of theft, material or
moral oppression, persecution for the purpose of taking possession of property, poisoning.
Patients say that ill-wishers want to “get rid of” them, evict them from their apartment,
steal things, products, mock them in every possible way, secretly enter
room, leaving garbage, dirt, adding inedible items to food,
they let gases into the apartment and scatter poisonous powders. Sometimes content
delirium is jealousy. Events that are the content of delirium, as a rule,
occur within the apartment. The detractors are usually
neighbors or relatives. Strangers are less likely to be drawn into the circle of pursuers
people, representatives of the police, public utilities, doctors.
In old age, delusions are often accompanied by false perceptions
(hallucinations). Patients “hear” unusual sounds in the apartment, knocking, steps,
vote. Sometimes they complain about unusual smells in the apartment, a changed taste of food.
Sometimes they “see” strangers in the apartment.
Delirium is always accompanied by anxiety, fear,
often with depressive feelings. The patients themselves suffer from their
diseases no less than the people around them. Crazy sayings from old people
are often perceived by people around them as psychologically understandable. Often
relatives, wanting to protect the patient from
unpleasant neighbors, change apartment. When the situation changes, some delirium
time subsides, but then resumes with the same force.
Patients with delirium are not critical of the content of their experiences; they
impossible to convince, logical arguments cannot prove them false
statements. They refuse psychiatrist consultation and treatment. In the absence of persistence on the part of
relatives, these patients can be at home for years, and sometimes decades, without
treatment. At the same time, having started treatment and feeling relief in the condition (disappearance of anxiety, fear, deactualization
delusional experiences) patients subsequently independently begin
seek the help of a doctor.
Specific
form of mental disorders in old age
is dementia (dementia).
The main manifestation of dementia is impairment of memory and higher mental
human functions. The most common forms of dementia in old age are vascular dementia and Alzheimer's disease.
Unsharp
memory loss
observed during normal mental aging. Decreases with aging
speed of mental processes, ability to concentrate, appears
forgetfulness, difficulty remembering names, worsening
the ability to remember new information. These memory impairments do not prevent
everyday and social life of elderly people remain
all personal characteristics of a person remain unchanged.
A different picture is observed in dementia. Memory impairments are never isolated, but
are always accompanied by changes in other mental functions and behavior in
in general. Alzheimer's disease develops gradually. The first manifestation
diseases are memory disorders and decreased memory for current and
past events. The person becomes forgetful, absent-minded, current events in
his experiences are replaced by the revival of memories of the past. Already in the early
During the stages of the disease, orientation in time suffers. The idea of
time sequence of events. The character also changes
of a person, the previously inherent personal characteristics are erased. He becomes
rude, selfish, sometimes apathy and inactivity come to the fore.
In some cases, the first manifestations
Alzheimer's disease may include delusions or hallucinations, as well as prolonged
depression.
By
As Alzheimer's disease progresses, symptoms of dementia become apparent.
The patient is disoriented in time,
space, environment. These patients cannot name the date, month
and a year, they often get lost on the street, they don’t always understand where they are, they don’t recognize
acquaintances and close people. Orientation in one’s own personality is also disturbed.
Patients cannot tell their age and forget key facts of life. Often
there is a “shift into the past”: they consider themselves children or young
people claim that their long-dead parents are alive. The usual
skills: patients lose the ability to use household appliances, cannot
dress yourself, wash yourself. Conscious actions are replaced by stereotypical ones
wandering and mindlessly collecting things. The ability to count is impaired
letter. Speech changes. At first, the vocabulary becomes significantly poorer. Current
events in the patient's statements are replaced by false memories. Gradually
speech loses more and more meaning, the statements of patients acquire character
stereotypical phrases, fragmentary words and syllables. In advanced stages of Alzheimer's disease, patients completely lose
ability to exist without assistance, speech and motor activity
limited to meaningless screams and stereotypical movements within
bed.
At an early stage
Alzheimer's disease patients rarely see a doctor. Typically, memory impairment and personality changes
are assessed by others as manifestations
natural aging. Meanwhile, treatment started at an early stage of the disease
Alzheimer's, most effective. However, modern medicinal
drugs can slow down the progression of the disease, reduce the severity
memory impairment, facilitate patient care even in later stages of the disease
Alzheimer's.
In vascular dementia, the severity of mental
disorders usually do not reach such a deep degree as with the disease
Alzheimer's. These patients are characterized by significant fluctuations in severity
impairments of memory, orientation, awareness of the surrounding reality sometimes
even during the day. The prognosis in these cases is better than with the disease
Alzheimer's. It is extremely important to clarify the diagnosis in the early stages of the disease,
since therapeutic approaches
vary significantly across different forms of dementia.
Mental illness in old age is not always on time
are recognized. Often the person himself, his relatives, and sometimes general practitioners
practitioners consider the violations that have arisen as a manifestation of the “natural”
aging. Often an elderly person
Having suffered for years from painful manifestations of mental disorders, he is afraid to turn
to a psychiatrist, fearing that he would be considered “crazy.” These people especially need
help and support of relatives. Correctly prescribed treatment allows the elderly
a person to get rid of painful experiences that darken the last stage of his
life, and find a calm and happy old age.
In gerontology (the science of old age)
distinguish between the concepts of “painful” and “happy” aging. Currently, gerontopsychiatry
has great potential for
early diagnosis of mental disorders in old age and a wide range of
medicinal and psychotherapeutic methods
their effective treatment. Start treatment at the first symptoms
mental disorders in old age – the key to success of therapy and quality improvement
lives of elderly and senile people.
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 by 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.
The aging process occurs individually in each person. Aging is a long process, starting with a gradual decline in the functionality of the human body and ending with death.
There are three stages of this period:
- old age – men: 60-74 years, women: 55-74 years;
- old age – 75-90 years
- centenarians - over 90 years.
It is important to understand that aging is not a disease or a pathology, although during this period complex changes occur in the structure and functioning of all body systems. With age, there is a loss of psychological flexibility and the ability to adapt, men and women become less pliable, the love of the new and unknown is replaced by the desire for stability and reliability.
Old age is an extremely critical period of time. It requires all the strength of the individual to adapt to the environment. Old age is the final period of human life, the conventional boundary of which with the period of maturity is associated with a person’s withdrawal from direct participation in the productive life of society. It is like excessive fatigue, you cannot get rid of it, relax and rest.
However, the number of years lived does not determine the degree of physical and social activity. Some have not lost their shape even at the age of 70, while others are already “a complete wreck” at the age of 60.
The main thing is not to apply the same criterion to everyone. It is important to realize that older people are an age group that has socially specific characteristics, needs, interests, and value orientations.
Are there any special features of the psychology of the elderly and older people? Undoubtedly. But, unfortunately, few people know this elementary truth and understand that the actions and reactions of an elderly person should be assessed adjusted for age, that different age groups have different value systems.
Changes in the character of an elderly person are explained by weakening control over one’s own reactions; it is possible that those traits that were previously able to be masked, understanding their unattractiveness, came to the surface. In addition, this age is characterized by egocentrism, intolerance towards anyone who does not show due attention, and this is “due” at the highest level. Everyone around them is considered selfish, as long as they are not absorbed in caring for the old person. As they say: “An egoist is one who loves himself more than me.”
In the West, people of all ages use the services of psychoanalysts. You can consult with such a specialist about your state of mind. Psychological consultants strive to understand the client, help him see himself from the best side and realize his worth as an individual.
The founder of this direction is the Austrian doctor Sigmund Freud. He studied the theory and practice of treating neuroses. The meaning of the direction is to identify and analyze suppressed (repressed from consciousness) mental experiences, which, according to this theory, are the cause of neuroses. The main method of treatment is the free association of ideas and their interpretation by the patient and the analyst. Treatment takes quite a long time and is not always effective.
A number of studies revealing the gerontological, psychological, and social characteristics of older people show a certain interest in this little-studied problem. Widespread public perceptions of old age increase the burden of actual physiological and psychological ailments of the aging person.
Materials from gerontological studies prove that in old age the mental status of an individual does not decrease, but only changes and is supplemented by such shades as moderation, prudence, caution, and calmness.
With age, the sense of the value of life increases and self-esteem changes. Older people pay less attention to their appearance, and more to their inner world and physiological state. A new rhythm of life emerges.
Research and everyday practice show that there are some characteristic features of the lifestyle and behavior of an elderly person.
Firstly, the social fullness of life is lost, the quantity and quality of connections with society is limited, and sometimes self-isolation from the social environment occurs.
Secondly, psychological defense fetters the mind, feelings and life activities of people of the “third” age. Psychological protection as a personality property allows a person to organize temporary mental balance. But for older people, sometimes such protection brings a negative effect, as it leads to a desire to avoid new information and other life circumstances that differ from established stereotypes.
Thirdly, an old person has a peculiar sense of time. An elderly person always lives in the present. His past, memories, as well as the future, are always with him in the present. This is where traits such as caution, thrift, and thrift appear. The spiritual world, interests, and values are also preserved in a similar way. The passage of time becomes smoother. One or another action is planned in advance: go to the pharmacy, to the store, to see friends, to the hospital. An elderly person prepares for them mentally.
Fourthly, older people often show more clearly certain character traits that were masked in youth and did not appear clearly. Traits such as touchiness, irritability, capriciousness, grumpiness, greed, short temper, etc.
Let us turn to the conclusions of American psychologists who, based on research, identified five main types of life positions of older people.
"Constructive position."
People with this position have been calm, content and cheerful all their lives. They retain these traits in old age, have a joyful attitude towards life, are active, and strive to help each other. They don’t make a tragedy out of their age and illness; they look for entertainment and contacts with other people. Such people are likely to live happily through their “third age.”
"Dependent Position"
It is inherent in people who throughout their lives did not really trust themselves, were weak-willed, compliant, passive. As they grow older, they seek help and recognition with even greater diligence, and when they don’t receive it, they feel unhappy and offended.
"Defensive position"
It is formed in people who are, as it were, “covered with armor.” They do not strive to get closer to people, do not want to receive help from anyone, remain withdrawn, isolate themselves from people, hiding their feelings. They hate old age because it forces them to be dependent and give up work and activity.
"An attitude of hostility to peace."
It is typical for people who blame the environment and society, which, in their opinion, are to blame for all the failures of their past life. People of this type are suspicious and aggressive, do not trust anyone, do not want to depend on anyone, have an aversion to old age, and cling to work as a lifeline.
“A position of hostility towards oneself and one’s life.”
People of this position are passive, prone to depression and fatalism, they lack interests and initiatives. They feel lonely and unnecessary, they consider their life to be a failure, they treat death without fear, as a deliverance from an unhappy existence.
This typology reflects the real picture of the behavior and life activities of older people. It will allow you to objectively approach the assessment of the actions of an elderly person and the choice of forms and methods of communication with him. It can be noted that individual elements of the listed positions may appear in mixed combinations.
However, this is not the only typology of older people; none of the existing typologies claims to be exhaustive, absolute knowledge about the characteristics characteristic of older people.
A. Kachkin, a sociologist from Ulyanovsk, gives a rather original interpretation of this problem. Depending on what interests and aspects of life are dominant for older people, he identifies the following types:
Family – aimed only at the family and its well-being.
Lonely - fullness of life is achieved mainly through communication with oneself, one’s own memories (the option of loneliness together is possible).
Creative - he does not necessarily have to engage in artistic creativity; this type can realize himself in the garden.
Social - a retired social activist engaged in socially useful (according to his ideas) affairs and events.
Political – a person who fills his life with participation (active or passive) in political life.
Religious.
Fading - a person who was unable or did not want to compensate for the former fullness of life with some new activity, has not found a use for his strengths / special attention should be shown to him from relatives and a social worker.
Sick - people of this orientation are busy not so much with maintaining their own health, but with monitoring the progress of the disease.
As you can see, we are talking mainly about healthy people, while many old people become deviants, that is, people with deviant behavior (drunkards, tramps, suicides).
In old age, people rarely develop a new life position. Often the life position of mature people towards old age becomes aggravated under the influence of new circumstances.
Knowledge of behavioral patterns, as well as psychological and emotional traits, is necessary for social workers to accept their mental, physical and psychological state. Depending on membership in one category or another, social assistance programs are developed and methods and techniques for working with older people are selected. One of the basic principles of working with older people is respect for the individual. It is necessary to accept the client as he is with all his advantages and disadvantages.
The professional competence of a social worker lies in knowledge of gerontological and psychological characteristics of age, accounting, and clients’ belonging to a particular social and professional group. The needs, interests, hobbies, worldview, immediate environment, living conditions, material conditions, and lifestyle of clients make it possible to choose the optimal technology for social assistance, to correctly identify the problem and the way to solve it.
Older people should have the hope of being needed by people, society, and being respected by them. Various techniques are used for this. Having identified the problem, help establish contact with relatives, fill out the necessary requests, take action to provide specific assistance: clean up the room of a frail old woman, deliver medications, give the hearing impaired a new hearing aid, invite them to participate in various competitions. Interest in the personality of an elderly client, an emphasis on his need and the usefulness of his experience cause an increase in energy in such a person and can be useful for others, especially teenagers and young adults.
Thus, the world of older people is unique. Most people in our society will come to him. It has its own criteria, its own assessments, its own laws. Helping an elderly person today is, first of all, to perceive and understand his world, the world of a person of the “third age”. The social service takes all necessary measures to improve the well-being of the people, and especially the elderly.
Hello, dear readers! Recently a client came to me with terrible problems with her now elderly mother. She just can’t establish communication with her, she constantly swears, criticizes her, and her age makes itself felt. Today I want to talk to you about what senile aggression is, what to do and how to help your elderly relative. Let's try to figure out where aggression comes from in old people: is it just a character trait or a manifestation of an illness?
Old age is not a joy
Being young and healthy is wonderful. Nothing hurts, your mood and physical condition do not depend on the weather, you wake up easily in the morning, you can easily run a short distance. But with age problems begin. And problems begin not only with the physical condition, but also psychological problems appear.
I bring to your attention some symptoms that accompany normal aging, without the manifestation of any serious diseases. These manifestations are typical for older people, but do not forget that in some cases they can be a signal that the person is seriously ill, but we will talk about this in more detail later.
Deterioration of short-term memory. Have you noticed how old people constantly lose their glasses, forget to take their medicine on time, and don’t remember what they just heard? In addition, older people often have a narrower range of interests. They begin to limit themselves to a small number of dishes, the wardrobe becomes smaller, the desire to change clothes gradually disappears. Moreover, a certain carelessness in appearance and indifference to hygiene may appear.
As for physical indicators, here we are talking about a slowdown in some mental processes. For example, a slow reaction to external stimuli, such as a car horn or a strong and bad smell. Old people recognize colors and sounds worse. It is difficult to teach an elderly person something new.
But what is more interesting is that in old age negative character traits begin to strongly manifest themselves. For example, if a person during his lifetime was prudent in matters of money and economical, then in old age he may well become like Scrooge Ebanezer from A Christmas Story.
Often, with age, relationships with loved ones begin to deteriorate due to strong touchiness. Remember that in old age there are fears of death, loneliness, a feeling that you have been abandoned and no one needs you.
Where does aggression come from?
So, we have already realized that aggression can be a common manifestation of old age. When a person’s most unpleasant character traits begin to burst out.
It is difficult for an elderly person to quickly adapt, he has his own way of life, he needs less and less, he argues more often, insists on his own, does not even agree with obvious facts, because he is used to thinking and acting in a certain way.
But besides this, aggression can be a symptom of the onset of senile insanity, dementia or depression. And it is very important to notice changes in your relative’s behavior in time in order to take the necessary measures. Let's look at each disease separately and see what characteristic features are present in each case.
Senile dementia and dementia are approximately similar in their symptoms. Dementia may begin to manifest itself as unreasonable fears, selfishness, or other behavioral deviations from the usual state. Often these diseases are accompanied by sleep disturbances, increased anxiety and causeless worry.
But the most obvious signs of the disease are problems with memory and thinking, a lack of logic in reasoning, a person gets confused in words, spatial disorientation appears, and over time the person’s very personality begins to be erased. Such old people are very annoying and intrusive in communication, their reaction is completely inadequate to the situation.
Senile depression manifests itself somewhat differently. Here the person is in a depressed, depressed state, but most likely he will not ask for help, because he does not want to change anything in his routine. Indifference to what is happening, lack of emotional reactions. But at the same time, he has a grudge against everyone and everything around him, against his family, against the state, against the younger generation.
More often than not, depression is accompanied by a negative outlook on everything that happens. Such old people are always grumbling, expressing dissatisfaction with them, it is impossible to please them. As for the physical state, ordinary pain will be perceived brighter and stronger with depression. In addition, the slightest stress can cause a heart attack, severely disrupt the heart rhythm, or cause a hypertensive crisis.
How to proceed
In any case, regardless of the symptoms that you notice in your relative, I strongly recommend that you contact a neurologist who will conduct a full examination, take the necessary tests and tell you exactly about the health of your elderly relative.
It’s good if everything is in order and no serious diseases are detected. Then you just have to be patient and be as calm as possible around the person. He needs your support and care, understanding and attention, which is most important in old age.
If it turns out that your old man has signs of a serious illness, the doctor will choose the most appropriate course of treatment and prescribe the necessary medications. Do not self-medicate under any circumstances. Some medications can only make things worse. For example, valocordin impairs memory and reduces intelligence when taken for a long time. Be very careful.
If it is very difficult for you to cope with the constant aggression of your relative, then I first recommend that you read the articles “” and “”. Both articles have nothing to do with senile aggression, but they will definitely help you understand how to behave with a person with whom it is very difficult to communicate.
Moreover, don’t be lazy and read the book by A. Tolstoy and N.J. Smelser " Psychology of old age. Reader" Perhaps it will help you better understand your elderly relative, because we have not yet been given the opportunity to understand what they are really experiencing, how scared they are and why they feel unwanted.
How does your relative's aggression manifest itself? What topics are especially difficult for you to talk about? Do you allow yourself to raise your voice and how does this help solve the problem? Have you gone to the doctor?
Patience and peace to you. Remember, you too will sooner or later become an old person.
All the best!
PREVENTION OF FALLS
IN THE ELDERLY AND SENILE AGE
The reasons, principles of diagnosis and prevention of falls in elderly and senile people are given; basic components of nursing care.
WHO defines a fall as “an incident in which a person suddenly finds himself on the ground or
on another low surface, except in cases resulting from a blow, loss of consciousness, sudden paralysis or epileptic seizure.” Falls are the second leading cause of death due to accidents and unintentional injuries. Every year in the world
There are 424 thousand deaths due to falls, 80% of which are recorded in low- and middle-income countries. Greatest
The number of fatal falls with consequences serious enough to require medical attention occurs in people over 65 years of age (WHO).
At a young age, falls are often limited to bruises or abrasions, but in older people they are often accompanied by serious injuries
and fractures that can change your entire life, leading to disability, immobility and early, often painful, death. Fall injuries can come in a variety of forms. The most dangerous complications that entail are traumatic brain injuries, femoral neck fractures, joint dislocations, spinal injuries, and soft tissue injuries. Why do healthy, active people rarely fall?
Firstly, thanks to the reflex regulation of movements, proper operation
balance centers and the vestibular system, which ensure walking and balance. Secondly, thanks to good vision, which allows you to correctly navigate the environment and avoid obstacles. Elderly and old people fall often, in particular due to age-related changes in the musculoskeletal system. Prevalence of violations
walking and balance increases with aging:
- from 25% aged 70–74 years
- up to 60% in the age group 80–84 years.
You can notice how after 60
Over the years, the gait changes a little, and after 75 years a person, as a rule, walks slowly, swaying while walking. This is due to a decrease in stride length and the height to which the foot rises. In young people, the angle of instep is 30º, while in older people it is only 10º. With old age, sensitivity and muscle strength decrease, and coordination of movements is often impaired. In older and older people
the duration of an individual minute “decreases” and the speed of simple motor movement decreases
reactions. Elderly and senile people are characterized by social and mental disadaptation, the reasons for which are: retirement; loss of loved ones; limited ability to communicate with survivors; self-care difficulties; worsening economic situation; dependence on others. This leads to the development in people of older age groups of feelings of inferiority, powerlessness and loneliness, which contributes to the development of psycho-emotional disorders (anxiety, agitation, depression, mania, delirium, decreased cognitive functions). For example, manifestations of depression are observed in 60 and 20% of patients in older age groups, respectively, with severe and mild illnesses. It has been established that depressive states
along with visual and coordination impairments, are a significant factor in accidental falls in older people. The nurse needs to remember
about persons of older age groups with an increased risk of developing psycho-emotional disorders,
contributing to falls. These are patients 80 years of age and older, living alone, including widowers; couples living in isolation, including childless
spouses; persons suffering from serious illnesses and physical ailments; forced to live on minimal government benefits.
The main risk factors for falls, most often
occurring in elderly and senile people: disturbances in maintaining balance; walking disorders; consequences of stroke; pathology
joints; visual impairment; orthostatic hypotension; cognitive impairment (cognitive functions); depression; simultaneous administration of patients
ent 4 medications or more.
The likelihood of falls increases with the number of risk factors:
- in persons without risk factors, falls occur in 8% of cases,
- in persons with 4 risk factors or more – in 78%.
The risk of falls increases significantly with the development of a new or exacerbation of a patient’s existing chronic somatic disease. Dizziness and orthostatic hypotension (a condition in which after
abrupt transition from a horizontal to a vertical position, blood does not have time to enter the brain in sufficient quantities, resulting in dizziness, darkness in the eyes, impaired
there is balance). At the same time, 30% of patients fall out of bed (mainly in the evening and at night when trying to get up), 28% - from armchairs and chairs that do not have
obturator mechanisms, 20% - in the toilet (mainly women, getting up from the toilet after emptying the bladder).
Taking many medications changes the state of vascular tone. These are diuretics (furasemide, hypothiazide), drugs to lower blood pressure (clonidine, co-
rinfar, enalapril, perindopril, lisonopril), beta-blockers that reduce heart rate (metoprolol, atenolol), nitrates, anticonvulsants, benzodiazepines (diazepam, clonesemam, phenazepam), antidepressants, sleeping pills and sedatives. Taking several of these medications at the same time significantly increases the risk of falling. Alcohol abuse contributes to the statistics of falls in the elderly. When visual acuity decreases with age, you need to choose the right glasses. Walking without good glasses, especially at dusk, along a dark staircase or broken asphalt in a yard, often leads to falling.
People who fall frequently need a medical examination to rule out conditions such as heart rhythm disturbances, epilepsy, parkinsonism, anemia, transient cerebrovascular accidents, and carotid sinus syndrome. The development of the latter is associated with bending of the vertebral arteries supplying the brain, with osteochondrosis of the cervical spine. People suffering from osteochondrosis may experience a sudden loss of consciousness, resulting in a fall.
The risk of falling is high in people who spend little time, no more than 4 hours a day, in an upright position, as well as in those who have little stability when standing, are lethargic and depressed, and cannot get out of a chair.
hands-free. Elderly suffering from syncope
in which there is a short-term loss of consciousness, they need outside help and supervision when going outside
and especially in transport. Syncope is caused by a decrease in oxygen delivery to the brain due to disturbances in heart rhythm and conduction, tachyarrhythmia, drug overdose– nitrates, antihypertensive drugs, etc. Such elderly people need outside help when moving and organization
safe home.
External causes of falls
associated with improper organization of safe movement (uncomfortable shoes, bad glasses, lack of auxiliary devices - canes, walkers), and home safety, internal
– with age-related changes in the musculoskeletal system, organ
vision and cardiovascular system.
Whatever the factors that contribute to falls, they should be taken into account, avoided and prevented.
Conditions in which in the elderly and senile
age, care must be taken
do not go outside alone during icy conditions or at dusk,
in foggy or snowy conditions: disturbances in balance and gait; dizziness; confusion; loss of vision; syncope.
If an older person falls in front of witnesses and is seriously injured, their description of the fall can help the nurse determine the circumstances of the fall and correctly determine its cause.
Where do falls most often occur?
In half of the cases - at home, especially in the toilet, bathroom and bedroom. Next come hospitals, which often treat older people. Therefore, relatives
The staff of the hospital where an elderly patient is admitted should always be warned about the possibility of a fall. The nurse should also ask this question to the patient and his relatives.
If medical staff are aware of the patient's predisposition to falls, they will help prevent them. Many patients (about 80%) fall without witnesses, which deprives them of quick help.
Outside the home, falls often occur on slippery sidewalks, wet asphalt, when crossing a sidewalk curb, or exiting public transport. Falls on the street without witnesses often lead not only to injuries, but also to hypothermia,
subsequent development of pneumonia, urinary tract infections and other diseases. 
In many foreign countries, there is a practice when a patient is admitted to a hospital, already in the emergency department, to put on the front side of the medical history a special diagnosis of “falls”. This guides the medical per-
sonal on the need to adhere to fall prevention measures, a thorough examination of the patient and the importance of the consequences of a fall.
It must be remembered that the deterioration of the course of the underlying disease, a change of environment, including hospitalization, are for an elderly patient
a stressful situation (violation of established life stereotypes - familiar surroundings, communication with loved ones), which can lead to decompensation of mental status (depression or delirium).
The 1st week of hospitalization is especially dangerous. Patients begin to refuse food and have difficulty navigating their surroundings. Episodes of confusion and incontinence may occur
urine, unexplained falls. The risk associated with hospitalization of elderly and senile people
may exceed the risk of cause of hospitalization. Patients with vascular disorders of the brain, mild forms of depression and dementia react especially acutely to hospitalization. In such patients, mental decompensation quickly and sometimes unexpectedly for those around them (nurses, doctors, roommates, relatives) occurs.
status, which contributes to falls with corresponding consequences.
Nursing assessment of patients with falls
includes a survey, physical examination, examination of the patient’s ability to move independently, and an assessment of the patient’s environment.
The nurse asks the patient and his relatives about cases of falls over the past year, clarifies their features: location; suddenness; provoking factors: bending and movements; shoes and clothing; environment; lighting; noise; medications and alcohol. Elderly patients with mental disorders and deterioration
memory may not remember episodes of their falls; in these cases, relatives or caregivers should be contacted for information.
Questions for the patient and family to help the nurse create a fall prevention plan:
Have there been any cases of falling before?
If so, how frequent and predictable were they?
at what time of day do they occur more often?
falls;
where did the fall occur: on the street, stairs, at home (toilet, bath)?
What caused the fall: quickly getting up from the bed, chair, toilet, turning and bending the body, reaching objects located high?
was there any alcohol intake?
Does the patient suffer from epilepsy?
does he have heart palpitations and irregularities?
in the work of the heart?
Is blood pressure monitored and does the patient remember the numbers?
Does the patient have diabetes or is he not receiving insulin?
How many medications does the patient take at the same time (taking 4 or more medications significantly increases the risk of falling)?
Have you had any recent hospitalization or restrictions on physical activity in the next 2 months?
It is necessary to find out what medications the patient is receiving; was there a break in taking them (especially antiarrhythmic ones); whether their doses and regimen have changed; Have any new medications been prescribed recently?
The nurse needs to ascertain not only the conditions in which falls occur, but also the accompanying symptoms; the time of day when the fall occurred and the patient’s behavior after it.
Functional tests to assess fall risk.
- Get up and go test
, performed for a time.
To carry out the test, you need a chair with armrests (seat height 48 cm, armrest height 68 cm), a stopwatch and a space 3 m long. The patient is asked to get up from the chair, walk 3 m,
walk around the object on the floor, come back and sit back on the chair. The patient is warned that the time it takes to complete this activity will be measured, and he can use any usual walking aids (eg, a cane). Normal result: the patient completed the test in 10 seconds or less,
doubtful – 11–29 s. If the test is completed in 30 seconds or more, this indicates a deterioration in function.
national capabilities and increasing the risk of falls. - Chair rise test
. A chair without armrests and a stopwatch are required. The patient is asked to stand up from the chair 5 times in a row with his arms folded
chest, knees should be fully extended with each lift. The patient is informed that the time spent will be measured. The test provides information about the strength and speed of the muscles of the lower extremities. A time of 10 s or less indicates good functional capabilities, and 11 s or more reflects gait instability . - Balance test
. The patient is asked to stand in the “feet pressed together” position for 10 seconds, then in the “one foot in front of the other” position for 10 seconds, and then in the “tandem” position. Impossibility
standing in the tandem position for 10 seconds predicts a high risk of falling. If the patient is able to stand on one leg for less than 10 seconds, the risk of fracture increases 9 times, and the inability to walk more than 100 m increases the risk of fracture.
The most common cause of death in elderly patients
and old age from trauma received in re
As a result of a fall, a fracture of the femoral neck.
This is due to the fact that the nature of the fall changes with age: if younger people more often fall in the anteroposterior direction, then in older groups the most typical fall is on the side. Osteoporosis and the generalized decrease in skeletal muscle mass (sarcopenia) that develops during the aging process are also important, leading to a gradual loss of muscle mass and strength, which causes a significant increase in the incidence of femoral neck fractures in people over 75 years of age. Treatment (with conservation)
tive tactics), usually long-term, sometimes up to 6 months. Patients are forced to lie in a cast for a long time, and then restore motor activity for several months; they suffer from
persistent pneumonia, infection, bedsores.
In 20% of cases of hip fracture, death occurs from complications. After this injury, half of the elderly patients become severely disabled and require constant care. A large proportion of fall injuries in older people occur in wrist bone fractures
. The process of fusion
It takes a long time - from 6 weeks to 3-6 months - and significantly limits a person’s ability to self-care.
Spinal fractures
are often painless and proceed almost unnoticed. After some time, the fracture becomes noticeable in the form of a “senile hump.” To treat such
injury requires a long period (1–2 years) without the certainty of complete recovery. According to statistics, older women fall and get injured more often
men. This is explained by the fact that women at this age suffer from osteoporosis - increased bone fragility. In addition, older women live longer than men, and there are more of them.
The tendency to fall repeatedly is considered one of the components of the “standard frailty phenotype”, which is characterized by a combination of 3
and more of the following signs: causeless loss of body weight; weakness; lack of strength; slow walking speed and low physical activity. Patients who, according to these criteria, are defined as frail have an increased risk of falls, fractures (including -
hips) and death.
Treating the consequences of falls is costly for both the patient and society. A person has to experience mental trauma: regain confidence in his physical strength, overcome
fear of repeated falls. The consequences of a fracture are often loss of independence, the need to hire a nurse, ask family for help,
friends. Restriction of the ability to move forces the convalescent to lie for a long time, which adversely affects his condition:
constipation, bedsores, due to age-related disorders of thermoregulation - hypothermia and pneumonia. Often
It happens that, after undergoing a complex operation on the femoral neck and spending a lot of effort and money on treatment, an elderly person dies from pneumonia or sepsis caused by bedsores. Overall global
The statistics for injuries and deaths among older people due to falls look like this:
- 60% of older people over 65 years of age are hospitalized as a result of a fall;
- 15–20% of them have fractures;
- 5–20% die from complications;
- After discharge, 40% lose independence and become dependent on others.
Analysis of these data leads to the conclusion that it is necessary to take
measures to prevent falls and fractures. The UN has defined the rights of elderly and old people from socio-political positions: INDEPENDENCE, PARTICIPATION, CARE, DIGNITY (Vienna International
Native Plan on Aging, 1982). The concept of active longevity and promotion of health, as opposed to a long dependent life, provides for independence from material and physical help from loved ones or social
nal workers, from illnesses and ailments, from material conditions.
It is necessary to encourage older people to be more attentive to their health; To do this, it is necessary to use every opportunity
training on: diet; physical exercise; creating a favorable environment; risk factors for disease development; changes
habits and cultural traditions that negatively affect health.
The importance of physical activity in the elderly
people for the prevention of falls is also confirmed in the “Global recommendations for physical activity”
activity for health" (WHO, 2010):
Older adults should engage in at least 150 minutes of moderate-intensity physical activity per week, or perform at least 75 minutes of vigorous-intensity aerobic exercise per week, or have an equivalent amount of moderate-to-vigorous intensity physical activity;
Aerobic exercises should be performed in series lasting at least 10 minutes;
To obtain additional health benefits, increase the duration of moderate-intensity aerobic exercise to 300 minutes per week, or engage in aerobic exercise
high intensity up to 150 minutes per week, or have an equivalent amount of moderate to vigorous intensity physical activity;
older adults with mobility problems should perform balance and fall prevention exercises for 3 or more days
in Week;
strength exercises should be performed
using major muscle groups, 2 or more days a week;
If older people are unable to get their recommended amount of physical activity, they should do exercises that are appropriate to their abilities and health status. 
Regular exercise produces positive physiological results: it helps regulate blood glucose levels; neutralize the negative effects of catecholamines (adrenaline and norepinephrine); improve the quality of sleep, the functioning of all elements of the cardiovascular system; strengthen the muscular system, which prolongs the period of independence in old age; exercises that stimulate movement help maintain and restore flexibility, “postponing” the onset of age associated with deterioration in coordination of movements, which is the main cause of falls.
Physical exercise has a positive effect on psychological status:
reduce symptoms of depression and anxiety;
can reduce the negative effects of stress.
Physical activity helps:
maintaining and strengthening social status (helps to play a more active role in production activities, family life and society);
reduces health and social care costs.
Fall Prevention
. It has been found that 15% of falls in older people are potentially preventable. Programs to prevent falls in the elderly should include the following components (WHO):
screening the household environment to identify fall risk factors;
measures to identify risk factors (checking and changing medical prescriptions, treating low blood pressure, supplementing vitamin D, calcium, and treating vision problems);
assessing home conditions and modifying environmental conditions for people with known risk factors or those who have a history of falls;
prescribing appropriate assistive devices for physical and sensory impairments;
strengthening muscles and restoring vestibular function;
training in fall prevention and exercises aimed at maintaining dynamic balance and developing strength;
Use of special hip protectors in people at risk of femoral neck fracture as a result of a fall.
Safety of life and home
mainly depends on the organization of space in the apartment, the arrangement of furniture, the presence of auxiliary devices in the bathroom and toilet that allow the elderly person to perform the necessary procedures. Often falls occur in the bathroom on a slippery floor. It is better to replace the bath with a shower, placing a special chair (adjusted chair) on which you can wash. If this is not possible, be sure to place a rubber mat with suction cups on the bottom of the bathtub and wash while standing or sitting on a special bathtub seat. If an elderly person intends to take a bath while lying down,
you must remember that you should first fill the bathtub with water at the desired temperature and only then enter
into her. This reduces the risk of scalding from hot water. For the elderly, the recommended water temperature is 35–36°C; warmer water should be avoided. Do not direct a stream of hot water at your head. In general, frail elderly people should not wash alone; it is recommended to seek help from relatives or social workers. People at risk of falling should not lock themselves in the bathroom or toilet.
Elderly people with impaired vision move around the apartment by touch or by memory, focusing on furnishings, touching furniture. Finding yourself in an unusual environment - a foreign one
apartment, hospital or boarding school, they get lost, fear appears, and sometimes confusion. Carpets, doormats, thresholds, glass doors, dark long corridors, and passages cluttered with things can trigger a fall. It is necessary to carefully consider all the details to make the life of an old person safe. It is better to place handrails next to the bathtub and toilet on
level of the wrist joint. Sometimes handrails are installed next to the bed, in the hallway, or in places where there are steps. If an elderly person uses a cane or walker, they must be correctly selected - the handle must be on
level of the wrist joint. If one side of your body is weakened after a stroke or injury, you should use the cane with your stronger hand.
An elderly, frail person spends most of the day in the bedroom, where falls also often occur. This may be due to an uncomfortable bed, too high or too low, a sagging mattress, lack of equipment
a branching device that you can reach with your hand while lying in bed. The height of the bed should be about 60 cm depending on the height of the person. If necessary, you can extend the legs
beds so that an elderly person can easily get on and off the bed. It is better to choose a mattress individually - not too soft, orthopedic is best. If this is not possible, you should evaluate the mattress according to several parameters. A mattress that easily deforms under the weight of a person, quickly forms holes, lumps, and is poorly supported.
given to hygienic processing is not suitable. A mattress that is too soft has a bad effect on the spine, causing pain and suffering. The bedside table should not be too far from the headboard; it is recommended to place a nightlight or a regular lamp with adjustable light intensity on it.
Since sleep in older people is often disturbed, they often wake up, read at night, and sometimes take medications. Therefore, all the necessary items - glasses, books, newspapers, medicines,
drinking water, a watch, a telephone should lie next to the head of the bed. This will help avoid night walking around the room and reduce the risk of falling. In cases where getting out of bed at night cannot be avoided
succeeds, especially in men with prostate disease, patients with heart failure, who have nocturnal enuresis, people
those suffering from renal failure need to ensure sufficient lighting of the night “route”. In a state of half-asleep, especially in poor lighting, night sleep often occurs.
Denia. There should be no wires, unnecessary objects, shoes, animal bowls, bags or other items on the route to the toilet. Next to the bed
At night there should always be a bedpan or duck, and bedridden patients should wear diapers at night. If there is a staircase in an apartment (house), it should have railings, and it is better to paint the first and last steps of the staircase.
metal color (yellow, white, red); A rubber strip 2–3 cm wide is glued to the edge of each step so that the sole does not slip off.
House shoes should fit your feet well, should not slip on linoleum and parquet, the heel should be low and the heel should be soft. If it is difficult for a person to lace up shoes, it is advisable to sew wide elastic bands instead of laces or make a Velcro fastener. Flip-flops without backs are not recommended as house shoes; wearing such shoes increases the risk of falling, the foot is unstable in them, and flip-flops often slip off the foot. It is not recommended for an elderly person to independently reach objects from the upper shelves and mezzanines, or stand on stepladders and chairs, since this raises the arms and head upward, dizziness often occurs, leading to falls, and the injury that most often occurs with such a fall is a fracture of the neck hips. The chair of an elderly person, in which he spends quite a lot of time, should be shallow, with a high back and headrest, and low, comfortable armrests. It is important that the edge of the chair does not put pressure on the popliteal fossa, as this impairs blood circulation in the legs and increases the risk of developing thrombosis,
thromboembolism.
Diet plays an important role in preventing falls.
The adverse effects of alcohol on the cardiovascular system of an elderly person have been proven; its consumption often causes falls. In some elderly people with vascular diseases of the internal organs, after a hot and heavy meal, blood flow to the stomach increases and decreases -
to the brain. This causes lightheadedness, dizziness, darkening of the eyes and can lead to a fall. In such cases, the patient is advised to limit the amount of food taken at one time, eat fractionally, often, in small portions. After eating you should lie down.
The difficulty of learning the principles of healthy eating and giving up bad habits is known. A.P. Chekhov in a letter to A.S. Suvorin reported: “In general, in my practice and in my home life I noticed that
When you advise old people to eat less, they take it almost as a personal insult.”
It is also necessary to remember about malnutrition as a cause of falls. In older and older adults, it may be associated with socioeconomic insecurity, physical frailty, isolation, household inconveniences, dental problems and decreased nutritional needs due to low physical activity. If older people have problems with gait, balance and an increased risk of falls,
The nurse should discuss with the physician the advisability of prescribing vitamin D, which has been shown to reduce the incidence of falls by more than 20%.
Advice from a nurse to an elderly patient about safety
of his motor activity and everyday life.
Do not lift heavy things, do not strain your back, do not carry objects heavier than 2 kg, carry the load in front of you, holding it close to your body. When walking, especially outdoors, use a cane or walker. Purchase special protective shields that protect the femoral neck from fracture. They invest in their underpants and don't
interfere with walking. Do not make sudden movements that may cause dizziness or misalignment of the vertebrae. Sitting on a chair or in an armchair, neither
When not leaning to the side to get something from the floor. If you want to pick up an object from the floor, do not bend over, sit down with a straight back and pick it up. If you have had a fracture
femoral neck, use another safe method - lean your hand on a table or other stable support, stand on your uninjured leg, bend your torso and at the same time abduct the injured leg.
put your foot back, and use your free hand to reach for the object. When waking up, do not get out of bed too quickly, as reflex reactions do not have time to ensure adequate blood flow in the vessels
brain and may feel dizzy. The spine is also very vulnerable in the first 15 minutes after waking up. First, slowly take an upright position in bed, leaning on your hands
with your back, bend your legs slightly and cross them at the ankles, then simultaneously turn your pelvis and legs towards the edge of the bed, bring your legs together and slowly get out of bed. You should not suddenly get up from a chair or chair. Avoid deep, too soft and low chairs. You should not sit on a chair or armchair with your legs crossed if you have had surgery.
femoral neck joint. Try to sit on a chair or armchair with your legs at right angles to your body. The most suitable chairs and armchairs for you
those that have adjustable seat height and backrest tilt and have armrests. Stand up with both hands on the back of a chair or armchair.
Stand correctly, leaning on both feet, heels together, toes apart, or feet shoulder-width apart. If If your hip joints have been operated on, always turn back and to the sides only slowly, turning your legs and pelvis at the same time. Neverstand and do not walk for too long, take short breaks to rest.
Dressing in old age is difficult, so useuse simple devices for putting onlinen, clothes and shoes. For clothes make“long arms”, take 2 slats 35–45 cm long,Attach a clothespin to the end of eachor a suspender clip. Clip your belt with clothespinsor an elastic band of that item of clothing that you collectIf you're hesitant to wear shorts, trousers or a skirt, takeslats at the ends and, sitting on a chair, put on underwear.When you have tightened your wardrobe item enoughjuice, unfasten the clothespins and put on the underwear by hand.Having trained, with the help of “long arms” you canput on socks and stockings. To put on socksbetter, attach the rail to the shoe horn andadjust the heel of the sock with it. Put on shoes and bootsYou can use a regular chair. Stand in frontchair, hold the back with your right hand, hold your left handtake the shoe, bend your left leg and place it onlaid on the seat of a chair. Put the shoe on your footTake off your foot and hand and put on another shoe.
A special shoe board with a V-shaped cut at one end and a block nailed to the middle at the bottom will help you remove shoes. Place one foot on the end without a drink, press the board
to the floor, the end with the cut will be raised up thanks to the block. Place the heel of the shoe on the other foot into the V-shaped notch and remove the foot from the shoe. Do the same with the other shoe.
Some tools can help you use the toilet and bath safely. Raise the toilet to a comfortable height for you so that your legs are bent at a right angle. Sit on the chair and stand up, holding the handrails built into the walls and leaning on both feet. To wash in the bathtub, use a special stool of the same height as the bathtub or slightly higher, a hanging bathtub seat, and a special rubber mat with suction cups. Place a rubber mat on the bottom of the bathtub, sit on a stool,
first put one leg into the bath, then the other. Hold the handrail on the wall with your hand and, with both feet in the tub, slowly stand up and sit on the hanging seat. Exit the bath after washing in the same way. Instead of a hanging seat, you can install a folding seat into the wall above the bathtub. Use a sponge or brush to wash your feet
on a long handle. At home, a nurse, after consultation with a doctor, can recommend simple sets of exercises to the patient.
Sudden movements should be avoided.
Several exercises to strengthen the muscles and ligaments of the lower extremities
Starting position – standing, legs together, hands on the waist. Raise your straight leg forward and up, slowly move it to the side, return to the starting position. Repeat with the other leg.
- The starting position is the same. Raise your leg forward and up, bend your knee, straighten it, return to the starting position. Repeat with the other leg.
- The starting position is the same. Squats at a moderate pace.
- Starting position – standing, feet shoulder-width apart, hands on the waist. Slowly squat down without lifting your heels off the floor, as low as possible, and slowly return to the starting position.
- Starting position – standing, legs together, arms down. Lunge with your foot forward, placing your hands on your knee, return to the starting position. Repeat with the other leg.
- The starting position is the same. Rise onto your toes and return to the starting position.
Several exercises to develop and maintain flexibility
- Starting position – standing, feet shoulder-width apart, hands on the waist. Bends forward, sideways, backwards.
- The starting position is the same. Circular movements of the body to the right, then to the left.
- The starting position is the same. Lean forward, try to reach the sock with your right hand
left leg, repeat with the other hand.
Exercises to strengthen muscles and ligaments abdomen and pelvis
Starting position – sitting on the floor, hands resting on the floor behind your back. Alternately bend and straighten your knees.
People fall due to many internal and external factors. Individuals who fall regularly require a thorough evaluation, including a detailed history, physical examination, and assessment of functional status. Prevention of falls involves the treatment of acute and chronic diseases of the nervous, cardiovascular, hematopoietic systems, musculoskeletal system, organs of vision, hearing, etc., as well as increasing physical activity and systematic exercise therapy. In terms of prevention, it is mandatory to assess the home environment and, if necessary, correct it, creating a safe hospital environment.
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