Among the most important problems, facing the global community, the problem of aging of the population has come to the fore.

According to the WHO Expert Committee, among the inhabitants of the planet in 1950 people are older 50 years were 214 million. human, in 1975 year - 350 million. human, in 2000 year - 590 mln., and to 2010 year according to forecasts they will be 1 billion. 100 million. human, which will amount to more 15% population. Obviously, the rapidly progressing aging of the population, moreover, the proportion of people older is increasing 75 years. This social phenomenon will continue in the 21st century..

Aging is an inevitable stage in the development of the body, however, this concept is not identical to the pathological process. Changes, occurring in the body during aging under a certain set of circumstances, can become the basis for the development of diseases.

In Russia, in recent years, there is also an aging of society.. So, if in 1979 a year in Russia, people are older 60 years were 16.3%, the flow 2000 year, the share of people over working age has already amounted to 20,7%.

This situation makes the medical and social problems of the elderly and senile people at the present time very relevant..

The definition of old age refers to the number of "eternal problems". Discussions are underway around, what is considered old age, its first manifestations, what is the age of old age and what are its boundaries. Difficulties in determination are related, first of all with that, that aging is a long process, smooth, there is no exact border, which separates old age from middle age. Generally, aging is an individual process, for some people it starts earlier, others later.

Comparison of different age classifications gives an extremely variegated picture in determining the boundaries of old age., which range widely from 45 to 70 years. Characteristically, that in almost all age classifications of old age, one can see a tendency towards its differentiation into subperiods. In this case, one must take into account, that from its onset the aging process does not end, it continues, and there are big differences between aging people.

In different periods of the history of society and in different cultures, the beginning of old age was determined as follows: Pythagoras - 60 years, Chinese scientists - 70 years, English physiologists of the XX century - from above 50 years, German physiologist M. Rubner - 50 years old age, 70 years - respectable old age. In recent decades, various options for age classification have been proposed for the later period of human life..  

In the classification of D. Bromley, five development cycles are distinguished. Moreover, each cycle, in turn, is subdivided into several stages.. The cycle of "adulthood" consists of three stages: early adulthood (from 21 years before 25 years), middle adulthood (from 25 to 40 years), late adulthood (from 40 to 5 years). The pre-retirement age is distinguished as a special transitional stage. (from 55 to 65 years). The cycle "old age" starts from 65 years and also includes three stages: resignation (from 65 years), old age (from 70 years), third stage, designated as finish, essentially includes a period of senile illness and dying.

Yu.B. Garnavsky proposes to divide the entire period of late age into separate groups: elderly age (it is also called involutionary or pre-senile) - from 50 to 65 years; old age - from 65 and higher.

E. S. Averbukh, Russian psychiatrist conditionally distinguishes age 45-60 years as a reproductive post (climacteric) period, antecedent (pre-senile - 60-75 years) and senile (75-90 years) age. According to the author, people from above 90 years should be considered centenarians.

According to the documents of the World Health Organization (TRAIN) age from 60 to 74 years old is considered elderly; 75 years and older – old people; age 90 years and older - long-livers.

In foreign literature, there is a difference between the "young elderly" - 65-74 years, "Old" - 75-84 years and "very old" - 85 years and older. TRAIN, Recalling the UN decision from 1980 of the year, age 60 years are recommended to be considered as the border of transition to the group of elderly. According to international criteria, the population of the country is considered old, if the proportion of people aged 65 years and older exceeds 7%. According to this indicator, the population of Russia can be considered as such for a long time., for about 20% its citizens (t. is. every fifth Russian) belong to the above age category. And in several dozen regions of the country, the proportion of the elderly population in rural areas already exceeds 30%.

Sure, all these divisions are conditional, the exact boundaries of different periods of human life cannot be established, as it represents continuous development, and the age-related changes occurring in the body are numerous and varied. so, conventionally, a person is considered old with 75 years, that is through 15-20 years after, how is retirement. In domestic science, the following age periodization scheme:

- Elderly age 60-74 years men, 55-74 woman years.

- Old age 75-90 years old men and women.

- Centenarians - 90 years and older men and women.

The retirement age is also allocated, whose boundaries are set by the state. When determining the retirement age, they proceed from the chronological age - the number of years lived.

There is a concept of functional age, which reflects the age dynamics of physiological functions, determined by the genetic component, way of life, past diseases, stressful situations, physical, mental and intellectual activity; psychological age - a group of indicators, characterizing the age dimensions of the psyche; biological age - an indicator of the level of wear and tear of the structure and functions of the body.

Periodic accruals are conditional, since the calendar and biological, and psychological age does not always coincide.

 

When considering different typologies, it is important to consider, that these classifications are always relative, because. in real life, "pure" psychological types are rare. Typology serves as a guide, basis for a specific job. In old age, a personality change occurs and the picture of measurements is overly saturated with a diverse set of qualities., which are rarely found in one person.

I. Kon gives a classification of the types of old age, depending on the nature of the activity, with which it is filled.

1. The first type is active, creative old age. People parted from professional work and continued to participate in public life., live a full life, not feeling any inferiority.

2. The second type of old age is also distinguished by good social and psychological fitness., but the energy of these people is aimed mainly at organizing their own lives - material well-being, relaxation, entertainment and self-education, for which there was no time before.

3. Third type, dominated by women, finds the main application of strength in the family. They have no time to be depressed or bored, but their life satisfaction is usually lower, than the representatives of the first two types.

4. The fourth type is people, the meaning of life for whom health care has become, which stimulates a fairly diverse form of activity and gives a certain moral satisfaction. However, these people tend to exaggerate the importance of their actual and perceived illnesses..

All these 4 type of old age I.Kon considers psychologically safe, but notices, that there are also negative types of development. These may include aggressive old grumblers., dissatisfied with the state of the aggressive world, criticizing everyone but themselves. Another variant of the negative manifestation of old age is disappointment in yourself and your own life., lonely and sad losers. They blame themselves for real and perceived missed opportunities..

E.S. Averbukh distinguishes two extreme types in his own attitude to his old age. Some do not feel and do not even realize their age for a long time, therefore, in behavior "young", sometimes losing a sense of proportion in this; others - as if overestimating their old age, become overly protective of themselves, ahead of time and more than required, protect themselves from life's worries.

Other domestic psychiatrists conditionally distinguish three types of old age: "Happy", Unhappy and psychopathological. "Happy" old age is characterized by serenity, wise enlightenment of the worldview and worldview, contemplation, restraint and composure. The so-called "unhappy" old age is caused by an increase in the level of personal anxiety., worrying about your physical health. There is also a tendency to frequent doubts and fears about minor matters., diffidence, in future, loss of the former and lack of a different meaning in life, reflections on impending death.

"Psychological old age" is manifested by age-related organic disorders of the psyche, personality and behavior. There is a decrease in the adaptive capabilities of the psychopathic personality with the frequent development of various maladaptive reactions.

A.I.Antsiferova, domestic psychologist, there are two types, differing from each other in the level of activity, coping strategies, attitude to the world and to yourself, life satisfaction.

Representatives of the first type courageously, are experiencing retirement without significant emotional disturbances. They are highly active., which is associated with a positive attitude towards the future. Often these people perceive the attitude as a release from social constraints., and stereotypes of the working period. Doing a new job, establishing friendly contacts, maintaining the ability to control one's surroundings generates life satisfaction and increases its duration.

Representatives of the second type develop a passive attitude towards life., it is alienated from the environment, the circle of their interests is narrowing and the indicators of the intelligence test are decreasing. They lose respect for themselves and experience a heavy feeling of being unnecessary.. Such people are going through their late age hard and do not fight for themselves., plunge into the past and, being physically healthy they quickly become decrepit.

Foreign psychologists were also involved in the development of a typology of aging.. F. Giese suggested 3 like old people and old age.

1) Old man – negative, denying any signs of old age.

2) Old man extroverted, old age, but coming to this recognition through external influence and by observing the surrounding reality, especially in connection with retirement (watching young people grow up, disagreement with her in views and interests, death of loved ones, changes in the family situation).

3) Introverted type, acute aging process. Stupidity appears in relation to new interests, reviving memories of the past, weakening of emotions, desire for peace.

D. B. Bromley offers his five strategies for old age adjustment.

1. Constructive strategy. Characterizes a mature personality, well integrated,who enjoys life, created close and intimate relationships with others. Such people are patient., bending, are aware of themselves, their achievements, opportunities and prospects. They accept the facts of old age, including retirement and, in the end, death. This type retains the ability to enjoy food., work, game and can, and may still, sexually active.

2. "Dependent type". The second strategy is also socially acceptable, but tends to be passive and dependent. The individual is well integrated, but relies on other people to provide him financially and expects emotional support from others. He is happy with his retirement, freedom from work, understands his personal qualities well, combines feelings of general satisfaction with life with a tendency to over-optimize, impracticality.

3. "Defensive type". Less constructive model of adaptation to old age. Such people are exaggerated emotionally reserved., somewhat straightforward in their actions and habits like to be self-sufficient, reluctant to accept help from other people. They avoid expressing their own opinions., Difficulty sharing their life or family problems, refuse help, proving to myself that, that they are independent. Their attitude towards old age is pessimistic., they see no benefits, in old age and envy young people. These people, with a little reluctance and only under pressure from others, leave their professional work.. They sometimes take a defensive position in relation to the whole family., which is expressed in avoiding the manifestation of their claims and complaints to the family. Protective mechanism, used by them against the fear of death and deprivation is activity "through force" constant replenishment of external actions.

4. "Hostile". People of this type are aggressive., explode, suspicious, have a tendency to shift their own claims to others and blame them for all their failures. They are not very realistic in assessing reality.. Mistrust makes them withdrawn and avoid contact with other people. They drive away the thought of retirement, for, like people with a defensive attitude, use mechanisms to discharge stress through activity, with burden. These people do not perceive their old age., think desperately about progressive loss of strength. It connects with youth hostility., sometimes transferring this attitude to the whole world.

5. Self-hating. This type is different from the previous topics, that the aggression is directed at oneself. Such people criticize and despise their own lives.. They are passive, sometimes depressed, not enough initiative. They are pessimistic, don't believe, what can affect your life, feel like a victim of circumstance. People of this type are well aware, aging facts, but they don't envy, young, they do not rebel, against their own old age, they only resignedly accept, what fate sends. Death does not bother them, they perceive it as a deliverance from suffering.

 

Morbidity in the elderly (60-74g.) almost in 2 times higher, and in elderly people (75 years and older) – in 6 times higher, than young people. Noted, that the older population suffers from multiple severe chronic diseases, occurring against the background of reduced compensatory capabilities. To 80% old-age pensioners need medical and social assistance. More 70% this category of persons have 4-5 chronic cardiovascular diseases, nervous, endocrine, hematopoietic, osteoarticular systems, respiratory organs, digestion, etc..

Development features, the course and treatment of diseases in persons of older age groups are: multiplicity of pathological processes; rapid development of drug intoxication; the influence of involutive processes on the course of diseases; nonspecific manifestation of the disease, association with old age (the occurrence of changes in the body), not with disease; rapid deterioration, if treatment is not provided; high complication rate; the need for long-term rehabilitation; more frequent development of oncopathology; development of a syndrome of mutual burdening (depression and somatic pathology).

Aging is associated with an increased risk of death and maladjustment. Beginning with 30-35 years, every 8 years the probability of death doubles, but then 90 years this dependence has been decreasing. The risk of developing oncopathology, from the same age group, doubles every 11 years. FROM 60 years, the risk of maladjustment and the associated pathological process is significantly higher compared to younger age. If we consider the proportion of diseases in these age groups, then IHD is 40%, tumors – 20%, ischemic brain disease -10%.

The quality of life of the elderly deteriorates significantly with the development of senile dementia. If aged 60-70 years it takes 3% in the morbidity structure, then older 75 years – 25%. Diseases of old age also include arterial hypertension that occurs during this period of life., emphysema of the lungs and a number of other pathological conditions.

Delirium often develops in hospitalized patients. Cause delirium – physical limitations, poor nutrition, taking more than three medications, bladder catheterization, iatrogenic disorders.

According to scientific research, the need for outpatient care among the elderly in 2-4 times higher, than people of working age. The need for hospitalization for certain types of specialized medical care (cardiology, endocrinology, pulmonology, urology, ophthalmology, neurology, psychiatry, etc.) in 1,5-3 times higher, than the working-age population.

The elderly and senile age are characterized by a variety of functional disorders and a plurality of chronic diseases. (polymorbidity), defining needs and requirements for various types of medical and social assistance. On examination, they usually reveal 3-9 diseases. This determines the increased need for medical and social assistance.. The presence of chronic diseases is one of the main reasons for the deterioration in the quality of life. Physical discomfort becomes more pronounced with age., memory changes progress. All seniors need annual medical health checks and preventive rehabilitation, about 12-15% in various types of permanent medical and social assistance. In old age (older 75 years) every fourth person does not leave the apartment on their own and uses medical services exclusively at home or in stationary medical and social institutions.

In the elderly and, especially in old age, the morbidity structure changes significantly due to a decrease in the number of acute diseases and an increase in the number of diseases, associated with the progression of chronic pathological processes. In this age group of the population, the blurring of the clinical manifestations of some diseases is often noted., making it difficult to diagnose.

Functional assessment of elderly and old people focuses on two areas. The first – activity of daily life, defining the tasks of personal assistance: walks, taking a bath, dressing, eating, restroom. The second – instrumental activity of everyday life - solves the problems of independent living at home, including shopping, cooking food, housekeeping, money handling, use of the telephone, taking medications.

The functional status of the elderly includes physical, cognitive, behavioral, psychological, social, economic components, as well as such factors, as environment and quality of life.

Other important aspects, reflecting the functional state of the elderly, include psychological, social, the economic status of this population. WHO experts believe, that assessing the functionality of the elderly requires more than just assessing activities in daily life, but also an assessment of mental and physical conditions, socio-economic and environmental conditions.

There is a close relationship between aging and a number of human diseases, moreover, for the elderly and senile age, a multiplicity of pathology is characteristic. The close relationship between aging and disease does not mean that they are identical – aging creates the preconditions for the development of pathology, age-related shifts can be summed up with pathological ones or develop into diseases. Plurality arises, usually, due to chronic diseases. 3-5 diseases or more may develop at the same time.

Several ways are recommended for assessing the health status of older people: personal perception of the elderly, the degree of limitation of their usual activity, the number of days of activity restrictions and the number of bed-days of patients with functional impairments.

According to researchers 85% persons older 65 years have, at least, 1 chronic illness; 46% the elderly report being restricted from normal activities, associated with chronic disease.

Chronic illnesses often create multiple physical, psychological and social problems: a large number of medications are often required to treat chronic diseases, and their interaction creates additional problems for older patients.

Falls are a common cause of morbidity and complications in the elderly.. About 33% of people 65 years and older are falling, at least, once every year; 40–60% of falls result in damage. 30-50% falls cause minor damage; in 5-6% of cases - the cause of severe injuries and injuries; in 5% falls lead to fractures.

Fall injuries are the fifth leading cause of death in the elderly population. Fractures are the most serious complication of falls., which, according to WHO experts, – one of the usual reasons, causing morbidity among the elderly.

Aged 90 years, hip fractures occur in every fourth woman and every eighth man, it is one of the most important causes of illness and death in the elderly; about a third of them are in bed during the first year after the fracture with subsequent disturbances in activity.

Maintaining vision and hearing is essential to improve the quality of life of the elderly, disorders of sensory organs negatively affect the participation of an individual in society. Sensory impairment in older adults 65 years increase in proportion to age.

Data on the frequency of damage to the organs of vision by various diseases (cataract, retinal dystrophy, glaucoma) different.

Hearing impairment occurs in older people 65 years in 10-60% of cases. They may be due to diabetes, hypothyroidism, hyperlipidemia, hypertension, coronary heart disease, stroke, vascular diseases, kidney disease, viral and bacterial causes, as well as behavioral factors and the environment. Hearing impairment may be associated with cognitive and emotional impairment, memory loss and depression.

Proper nutrition is also a powerful means of managing the aging process and preventing the premature development of changes and disorders in the body.. Generally accepted, that with aging there is a decrease in the adaptive capabilities of the body and the functional abilities of organs and systems. Aging is accompanied by, primarily, gradual decrease in the intensity of metabolic processes, underlying the life of the body. The most common sign of premature aging is an energy imbalance, obese, decreased mobility, a decrease in the rate of neurohumoral regulation of metabolism and a number of other physiological functions of the body. Often, energy imbalance manifests itself in a violation of lipid metabolism, in particular cholesterol, leading to atherosclerosis and other changes in the work of the cardiovascular system. In old age, excessive food cravings are often observed.. Overeating leads to weight gain and metabolic disorders, what, in turn, adversely affects health. Overeating and subsequent obesity is by no means indifferent to the body of an elderly person.. As known, obesity predisposes to such diseases, like diabetes, gastrointestinal, cardiovascular diseases, urine- and gallstone disease, gout.

Therefore, the first nutritional requirement for the elderly is – moderation, t. is. a reasonable restriction on the amount of food.

The second nutritional requirement for the elderly – high biological value of the diet, which must contain sufficient amounts of vitamins and other nutrients necessary for the body.

The third nutritional requirement for the elderly – enrichment of it with anti-sclerotic nutritional factors, found in many foods.

The fourth nutritional requirement for the elderly – it is necessary to change the diet: it is better to take small amounts of food but do it more often – four to five times a day.

It is generally accepted, that the most useful products for the elderly are fermented milk products. Examination of the actual diet of centenarians shows, that their nutrition is characterized by a pronounced lacto-vegetable orientation, low salt intake, Sahara, animal oil, meat, fish.

Summarizing the above, we can draw the following conclusions..

Population aging – the most characteristic demographic phenomenon of the modern era. It is due to a complex set of factors. The main feature of changes in the structure of the population of many countries is a noticeable decrease in the relative size of the child population. (0-14) years and a pronounced increase in the share of the older population.

According to the documents of the World Health Organization (TRAIN) as an elderly age is considered from 60 to 74 years; 75 years and older – old people; aged people 90 years and older are centenarians.

Persons of the elderly and senile age are characterized by a variety of functional disorders..

More than half of people are older 60 years have certain violations of the functional status (physical, psychological, social, economic), the frequency of which progresses with age. In the age group 75 years and older, half of old people have a combination of functional disorders and chronic diseases.

Also, the elderly and old people are characterized by the simultaneous development of 3-5 or more diseases, predisposing to multiple physical, mental and social problems. Sensory impairments are especially common, diseases of internal organs and injuries, caused by falls.