Features of physiotherapy in the elderly. Various age-related changes affecting various organs and systems, as well as features of the course of diseases characteristic of elderly and senile people, dictate the need to observe a number of precautions when using physical factors in complex therapy. Summarizing the available data, we can name a number of general principles and features of physiotherapy and physioprophylaxis in patients of older age groups.
1. Due to the reduced reactivity of the aging body, altered receptor activity, impaired compensatory capabilities of organs and systems in elderly and senile patients, it is recommended to carry out physiotherapeutic effects using gentle methods, especially at the beginning of the course of treatment. This requirement applies to almost all dosimetric parameters of physiotherapeutic procedures, primarily their intensity and duration, which should be less than in young and middle-aged patients. Procedures for elderly patients are usually prescribed every other day, and only local effects, if well tolerated and have an adequate response to them, can be prescribed daily to patients under the age of 70 years.
2. Treatment with physical factors is complex. This should also be the case in elderly and senile patients. However, due to their reduced reserve capabilities, no more than two therapeutic physical factors should be used, and mainly according to the alternation method, and only in rare cases can one of them be of general action.
3. As is known, physical factors have a predominant stimulating effect, and therefore most of them (according to conventional methods) are contraindicated in cancer patients. Since malignant neoplasms are more common in older people and often have an atypical course, when prescribing physiotherapeutic procedures to elderly patients, physiotherapists should show increased oncological alertness.
4. The processes of sanogenesis and recovery in elderly patients, especially in the presence of metabolic disorders and neurohumoral regulation, proceed more slowly. In this regard, and especially when prescribing low-intensity physiotherapeutic interventions, the number of procedures per course of treatment should be large (up to 15-20 instead of 10-12 procedures in young and middle-aged people). It should also be considered justified to use cyclic treatment options in elderly patients (primarily in outpatient settings), in which a physiotherapy cycle consists of 2-3 short (4-6 procedures) courses, repeated after short periods (3-4 weeks). periods of time.
5. With aging, conditions are created for the emergence of polypathology. Therefore, the physiotherapist needs to identify the underlying disease and select the leading physiotherapeutic factor accordingly. At the same time, both when prescribing it and when including other physiotherapeutic procedures in the treatment complex, the most serious attention must be paid to concomitant diseases. One should strive to ensure that the prescribed factors are indicated and effective not only for the main disease, but also for other diseases.
6. Due to reduced compensatory capabilities and a higher frequency of inadequate reactions in patients, in geriatric practice preference is given to physical factors of more physiological and local action (direct and pulsed currents, local darsonvalization and franklinization, chamber baths, etc.). Physical factors of general action and with a pronounced thermal effect in elderly patients should be used more carefully.
7. Changes that occur in the skin with age significantly affect its sensitivity to UV irradiation, electrolysis products and drugs administered by physical pharmacological methods. For this reason, the dosage of these factors in older people is reduced, and to protect the skin from the action of electrolysis products during electrophoresis procedures, thicker pads should be used. After the procedure, it is recommended to treat the skin in the area where the electrodes are located with baby cream or glycerin diluted with water.
8. Due to imperfect regulation and weakening of compensatory-adaptive processes after physiotherapeutic procedures, patients in older age groups should rest for a longer time - 1-1.5 hours.
9. The effect of individual physical factors changes significantly with age, and therefore their use in geriatric practice has a number of nuances. The most important of them can be summarized as follows: the dose of medications for elderly and senile patients in aerosol and electro-aerosol mixtures should be reduced by 2-4 times; More adequate and physiological for older people from pulsed currents are sinusoidal modulated and interference currents, and from microwaves - decimeter waves; UHF therapy in geriatrics is carried out in short courses (5-8 procedures) and mainly on portable devices; in elderly people suffering from cardiovascular diseases and degenerative processes, the use of general UV irradiation, as well as infrared and visible rays should be limited; in persons over 50-55 years old, ultrasound therapy should be carried out under ECG control; Among mud treatments, preference is given to mitigated treatment methods, the use of peat, as well as galvanic mud and electrophoresis of mud solutions; baths are prescribed in lower concentrations, after rest before taking it, often in the form of half-baths and chamber baths, for two days in a row with a break on the third; For patients over 60 years of age, it is recommended to prescribe sulfide and carbon dioxide baths with great caution; when prescribing massage to elderly patients, preference is given to influencing reflexogenic zones, as well as acupressure; When performing a massage, you should use creams and ointments, and the room temperature should be about 25 °C.
10. In the prevention and treatment of premature aging, the use of vitamins is of great importance. To a certain extent, this is due to the development of endogenous vitamin deficiency in old age. Physical factors (especially mud therapy, phonotherapy, balneotherapy, etc.) themselves stimulate the metabolism of vitamins and, with prolonged use, can cause vitamin deficiency. Therefore, vitamin therapy should be a common background in the treatment of various diseases in old and senile age, if therapeutic physical factors are included in the therapeutic complex.
11. Sanatorium-resort treatment of elderly and senile patients is recommended to be carried out near their permanent place of residence and without the use of intensive balneoclimatotherapy. With good functional capabilities of the body and repeated treatment in the past in sanatoriums of various resort areas, patients with diseases of the musculoskeletal system, peripheral nervous system and digestive organs can be sent to remote resorts, the climate of which differs from the local one and requires adaptation.
Compliance with the considered features and principles of the use of therapeutic physical factors should contribute not only to increasing the effectiveness of treatment of elderly patients, but also to slowing down aging.
Age-related features of the use of physiotherapy in the treatment of children
Doctors have thousands of medications at their disposal, which are of great benefit in the treatment of many diseases, but with many advantages, almost all medications can have adverse side effects. In relation to children, we are primarily talking about allergic reactions - undesirable reactions, first of all, can be caused by antibiotics, antipyretics and a number of other drugs. Hormonal drugs cause atrophy of the gland to which the action of the hormone is directed.
Today there is not a single area of medicine, not a single specialization, where physiotherapy is not in demand. This is an area that uses natural factors or their reshaped sources. Our body experiences the effects of air, sun and water continuously throughout our lives. A person can and should use their constant influence so that it has the most beneficial effect and stimulates the body’s defenses.
Physiotherapy treatment is based on the therapeutic effects of physical factors (air, water, sun, physical activity) on the body, which not only do not cause allergic reactions in most cases, but themselves have a pronounced anti-allergic effect. The only exceptions are inhalation and phoresis of medicinal substances. With properly selected therapy, even with these procedures, the risk of an allergic reaction is minimal.
In pediatrics, all types of physiotherapy are used, somewhat limiting hydrotherapy - children are prone to colds. Along with therapeutic physical training and massage, physiotherapy forms the basis of rehabilitation.
Physical, therapeutic factors have a multifaceted effect on a living organism, causing changes in various functional systems: at the level of molecules, cells, organs and the whole organism. Physiotherapy is also used during the treatment of an acute process, more often in the subacute period, during the period of residual effects for rehabilitation purposes, for the preventive purpose of various diseases, depending on the severity and type of disease, increasing the body's defenses, timely maturation and development of body systems. The use of physiotherapeutic treatment is possible from the first days of a newborn’s life.
However, the technique and methods of conducting physiotherapeutic procedures in children differ markedly from adults - small doses, low current strength, short duration of the procedure must be used: that is, the strength of the stimulus of the therapeutic factor must be adequate to the degree of reactivity of the body.
Physiotherapy, acting through surface receptors on the regulatory system and stimulating the nervous system to normal activity, is physiological.
Among the characteristics of the child’s body are:
- increased excitability of tissues in children.
- immaturity of the brain (completes formation only by the age of 8).
- lability, vegetative resistance, especially in adolescence, tendency to lethargy, drowsiness or overexcitation.
- A child’s body, unlike an adult’s, consists of 80% water, therefore, its tissues are more electrically conductive and can give a stronger reaction.
- Early childhood, especially newborns, is characterized by instability of thermoregulation, therefore, in the neonatal period, the use of heat therapy and wave methods is abandoned in favor of other factors.
- unsettled mental development - the child’s condition and his psychological readiness are always taken into account, therefore the first procedure, as a rule, is carried out as a placebo, i.e. at idle so that the child does not get scared.
- The feeding factor must be taken into account: all procedures should be carried out 30-40 minutes before feeding or 1 hour after.
Age restrictions for the use of certain physiotherapeutic treatments for children:
- Electrophoresis of medicinal substances and galvanization from 2 weeks of age.
- SMT from 6 months of age.
- Diadynamic currents not earlier than 6 months.
- UHF from birth.
- Darsonvalization from 2 years.
- Ultraton from birth.
- Inductothermy from 4 years.
- DMV 1 year.
- SMV 2 years.
- EHF from birth.
- Ultrasound from 3-4 years old, possible from 2 years old with adequate dosage.
- Ultraviolet rays from birth.
- Inhalation from birth.
- Laser radiation from birth, but with great caution due to the instability of the central nervous system.
- Paraffin from birth.
- Ozokerite from birth.
- Photochromotherapy from birth.
- Mud therapy from 6 months of age.
- Transcranial electrical stimulation and Electrosleep - from birth.
- Magnetic therapy from 2-3 years, low-frequency magnetic therapy is possible at an earlier age.
I would also like to note that physical factors should not frighten parents of children. These are some of the safest treatments. Locality, narrow focus of factors, minimal medicinal dosages make physiotherapy often the only possible type of treatment.
The word “physiotherapy” translated from Greek means “treatment by the forces of nature.” In the modern understanding, physiotherapy is an area of clinical medicine that is directly related to balneology. Physiotherapy provides therapeutic, restorative and preventive effects by stimulating natural protective reactions and normalizing impaired body functions. Physical factors have a beneficial effect on the processes of compensation and adaptation of the cardiovascular, respiratory, immune, endocrine and other systems in the elderly.
Modern physiotherapy has dozens of natural and preformed (artificially created) physical factors, which can be divided into the following groups:
1. Low voltage electric current:
a) galvanization,
b) electrophoresis,
c) diadynamic therapy,
d) amplipulse therapy,
e) fluctuarization,
e) electrosleep,
g) electrical stimulation.
2. High voltage electric current:
a) franklinization,
b) darsonvalization,
d) TNC ultratonotherapy.
3. Electric and magnetic fields:
a) inductor,
b) UHF therapy,
c) UHF inductothermy,
d) microwave therapy,
d) EHF therapy,
e) magnetic therapy.
4. Mechanical vibrations:
a) vibration,
b) ultrasound.
5. Light:
a) infrared rays,
b) visible light,
c) ultraviolet rays,
d) laser.
6. Artificial air environment:
a) aeroionotherapy,
b) hydroaeroionotherapy,
c) aerosol therapy,
d) electroaerosol therapy,
e) speleotherapy, halotherapy.
7. Barometric gas pressure:
a) Kravchenko camera,
b) hyperbaric oxygenation,
8. Heat therapy:
a) paraffin,
b) ozokerite,
c) paraffin-ozokerite mixture,
d) naftalan,
d) healing mud,
e) medicinal peat,
g) heated sand,
h) sauna.
9. Hydrotherapy:
a) fresh water,
b) medicinal baths,
c) mineral baths,
d) drinking mineral waters.
10. Puncture physiotherapy.
11. Herbal medicine.
12. Apitherapy, hirudotherapy.
Most of the listed physical factors can be used for therapeutic, restorative and preventive purposes in elderly and senile people. Age does not affect contraindications for physiotherapy, but its use in geriatrics has its own characteristics. The most important of them are the following:
1. When treating elderly and elderly people, the dose of physical exposure should be reduced by 30-50%. This is expressed in a decrease in power, intensity, current, magnitude of magnetic field induction, temperature, area of influence, duration of the procedure, and the total number of procedures per course of treatment. In geriatrics, “non-stress” physical factors are used that do not cause significant changes, primarily in the cardiovascular and respiratory systems.
2. In geriatrics, preference is given to the use of local methods of influence.
3. During the day, the patient can take no more than two physiotherapeutic treatments. Their simultaneous use is not recommended.
4. When prescribing two physical procedures, the interval between them must be at least 3 hours.
5. Careful multi-stage monitoring of the body’s reaction to the use of physical methods of influence is necessary. The nurse assesses the patient's functional status during the procedure. The physiotherapist prescribes repeat examinations every 2-3 procedures to make the necessary corrections in the treatment method. The attending physician monitors the patient's condition constantly.
6. When prescribing physiotherapeutic methods of treatment to elderly and senile people, it is necessary to take into account the high probability of precancerous processes and oncological diseases in them.
Each of the physical factors acts on certain parts of the pathological process. Therefore, for the same disease, different methods of influence can be used. The art of the doctor is to choose the optimal one, taking into account the mechanism of action and the individual characteristics of the patient: stage of the disease, previous treatment, concomitant diseases, etc.
All physical factors have their own application characteristics, especially for elderly and senile patients.
When carrying out galvanization and medicinal electrophoresis, it is necessary to take into account that the skin of older people contains fewer sweat and sebaceous glands through which galvanic current penetrates, has reduced elasticity and turgor, often with trophic disorders. Therefore, it is necessary to protect it from electrolysis products: for this purpose, the gaskets must be at least 1 cm thick, and the electrodes must be well smoothed and even. Galvanization according to the methods of Shcherbak, Vermeule, four-chamber galvanic baths are indicated for the treatment of diseases of the peripheral nervous system, peripheral vessels and cerebral vessels, diseases accompanied by autonomic disorders and sleep disorders.
When conducting electrophoresis of medicinal substances, especially potent ones, the dose should be reduced by 2-3 times. To do this, use lower concentrations in solution. It is known that during electrophoresis, a depot of a medicinal substance is formed in tissues, which, as a result of deterioration of microcirculation in older people, is absorbed slowly. Therefore, the electrophoresis procedure, especially for potent substances, should be carried out more rarely: every 1-2 days, and sometimes 1-2 times a week. Medicinal electrophoresis is most often used to treat “local” diseases. Indications are determined primarily by the trophic effect of galvanic current and the pharmacological properties of the medicinal substance used.
Pulse currents (DDT, SMT)- widely used in geriatrics for diseases with pain syndrome, as well as to normalize the tone of striated and smooth muscles, improve blood circulation in the affected area. Their use is especially indicated in degenerative-dystrophic processes of the musculoskeletal system. In this case, preference is given to CMT therapy, which is easier to tolerate by patients, less irritates the skin, and improves tissue trophism. In the case of the use of DDT in geriatrics, full-wave currents are more indicated.
Electroson- prescribed for elderly and elderly people with atherosclerosis of cerebral vessels, neuroses, neurasthenia, hypertension I-II degrees, bronchial asthma, neurodermatitis. In geriatrics, pulse current frequencies from 5 to 30 Hz are used.
D'Arsonval currents, ultratonotherapy - have a wide range of applications in geriatrics for the treatment of varicose veins, skin itching, trophic ulcers, neuritis, periodontal disease.
Inductothermy- is a rather stressful thermal procedure, so its use in geriatrics is limited.
UHF therapy- Elderly and senile patients undergo this procedure using low-power devices in non-thermal and low-thermal dosages. The main indication for its use is acute inflammatory processes of various localizations. The course of treatment is 3-5 procedures.
In the treatment of chronic inflammatory and degenerative dystrophic processes, especially during exacerbation, microwave therapy - the use of an ultra-high frequency electromagnetic field - has a positive effect. Treatment is carried out in non-thermal and low-thermal dosages.
EHF therapy- has found wide application in the treatment of gastric and duodenal ulcers, purulent diseases, hypertension, and coronary heart disease.
In geriatric practice, it has a good effect in the treatment of many diseases. magnetotherapy- use of low frequency alternating magnetic field. This method is non-stressful, has a hypocoagulating effect and improves microcirculation in tissues. Therefore, the main indications for magnetic therapy are vascular diseases of various organs.
In medical practice, ultrasound - elastic vibrations in gases, liquids and solids, the frequency of which exceeds 20 kHz - is used in various frequency ranges for therapeutic and surgical treatment and diagnosis. Due to its non-load-bearing nature, it can be widely used in geriatrics for diseases accompanied by excessive development of connective tissue: adhesions, chronic inflammatory and degenerative diseases. In this case, preference is given to ultraphonophoresis of various drugs that enhance the effect of ultrasound.
Infrared rays, Solux, light baths have a pronounced thermal effect, create a load on the cardiovascular system, and therefore are not widely used in geriatrics.
The use of local and especially general ultraviolet irradiation in the treatment of elderly and senile patients should be reduced due to their lack of effectiveness and oncological alertness.
Laser irradiation, on the contrary, can often be used in geriatrics, especially for the treatment of trophic ulcers, wounds, degenerative-dystrophic diseases of the musculoskeletal system: spinal osteochondrosis, deforming arthrosis and other joint diseases. The single dose of laser energy per procedure should be reduced by 30-50%.
Application of negatively charged ions of air and water - aeroionohydroaeroionotherapy- improves the functions of the ciliated epithelium of the respiratory tract, therefore it is widely used for the treatment of chronic nonspecific lung diseases. In the treatment of these diseases, especially bronchial asthma, speleo- and halotherapy are indicated.
When carrying out inhalations, it is necessary to remember that medicinal substances in the form of aerosols are quickly absorbed in the lungs, immediately entering the pulmonary circulation. Therefore, the dosage of medications for elderly and senile people should be reduced by 2-3 times. This method is most often used in the treatment of respiratory diseases.
In the treatment of obliterating diseases of the arteries of the lower extremities in elderly patients, local Kravchenko pressure chamber, in which it is possible to periodically change the air pressure and thereby improve blood circulation in the extremities.
Hyperbaric oxygenation- indicated for the treatment of ischemic diseases in the elderly. The oxygen pressure in the pressure chamber is not recommended to exceed 0.5 atm.
Thermotherapy- assigned to small areas of its application. Various coolants are widely used for thermal effects on the body. Paraffin-ozokerite (mountain wax) applications work well at a temperature of 45-50°C in the form of a molten mass. Therapeutic mud - used in the form of galvanic mud, with a temperature of 38-42°C. Indications for heat therapy are diseases of the support and movement organs.
Hydrotherapy- external use of water for therapeutic and prophylactic purposes. Hydrotherapy procedures include showers, baths, and washing with fresh and mineral water. It is recommended to take a shower for 2-3 minutes as a procedure. Baths are prescribed with minimal concentrations of chemicals and indifferent temperatures. The time for taking the first bath should not exceed 5-7 minutes. Water procedures are prescribed no more than three per week. Their main goal is secondary and primary prevention and rehabilitation treatment.
In geriatrics, the so-called reflex therapy is most often used - corporal and auricular acupuncture, lately su-jok. Most often, biologically active points of local influence are used for acupuncture. During the first procedure, no more than 2-4 points are used, the number of which is increased to 8-10 in subsequent sessions. Acupuncture is usually performed every other day and only daily for the treatment of acute diseases. The course of treatment ranges from 8 to 12 sessions. When treating chronic diseases, repeated shorter courses are desirable.
Biologically active points can be affected not only by inserting needles. The so-called puncture physiotherapy, i.e. the impact of physical factors on biologically active points: electric current, laser, magnet, light, vacuum, acupressure. They are less stressful and easier to tolerate for patients.
Massage- in the treatment of elderly and old patients, gentle techniques using mainly stroking and rubbing techniques are very effective. General massage is not prescribed; segmental massage is used according to strict indications; however, local and acupressure massages are widely used.
Medicinal plants have been used to treat patients since ancient times. In folk medicine herbal medicine More than 2,500 medicinal herbs are used, which are prescribed in the form of infusions, decoctions or tinctures. The raw materials are first crushed: leaves and flowers to a size of no more than 5 mm, roots - no more than 3 mm, fruits and seeds - no more than 0.5 mm. In geriatrics, medicinal herbal collections are often used to treat several diseases. To prepare the infusion, brew a tablespoon of raw material with 200 ml of boiling water, close tightly and leave for 45 minutes. To obtain a decoction, the raw materials are boiled in the same proportion in a water bath for 30 minutes, then cooled to room temperature and filtered. A quarter or a third of a glass of infusion or decoction is prescribed for the appointment. To prepare the tincture, the crushed raw materials are poured with 96° alcohol in a ratio of 1:10 and left for 10 days. Apply drops.
Doctors pay special attention to such waste products of bees as honey, poison, propolis, royal jelly, beebread, bee pollen, and wax. They are considered gerontological remedies. Thus, pollen contains many biologically active substances and, having versatile medicinal properties, is used to treat a number of diseases. That's why apitherapy in geriatrics is very promising. Honey, as a remedy, is prescribed for diseases of the gastrointestinal tract, cardiovascular, nervous systems, and colds: at the rate of 1 tablespoon of honey per glass of water. Often combined with herbal medicine. For joint diseases, compresses are made from honey or honey water. In ophthalmic practice, solutions of honey in distilled water are used in the proportions of 1:3, 1:2, 1:1 for instillation into the conjunctival sac. Propolis, or bee glue, has pronounced antimicrobial properties and is a good adaptogen. Propolis is prepared by dissolving it in alcohol in a ratio of 1:5. In drops it is used to treat sore throats, atherosclerosis, bronchial asthma, gastritis, senile hearing loss and other diseases. Bee venom in the form of bee stings is prescribed in geriatrics for the treatment of diseases of the nervous system, joints, bronchial asthma, hypertension, and enderteritis.
Renaissance occupational therapy primarily due to the need for a number of diseases to introduce into the blood biologically active substances produced by medicinal leeches. The main indications for their use are cardiovascular diseases, increased blood clotting, etc.
The patient's age is not a contraindication for sanatorium treatment. When conducting medical selection of patients for referral to a sanatorium, they are guided by existing indications and contraindications for spa treatment. Elderly people are advised to undergo treatment in local sanatoriums and sanatoriums, since they do not tolerate changes in climatic conditions at certain resorts.
Plan: Purposes of using physical factors Features of the reaction of geriatric patients to physical factors Rules for prescribing physiotherapeutic procedures in gerontology and geriatrics Physiotherapeutic methods used in gerontology and geriatrics
1. Kataev M. R., Kuneev V. G., Tagaev I. R., Khetagurov L. G. Phytolazerophoresis in gerontology // Bulletin of new medical technologies. - 2001. - No. 4. - P. 50. 2. Paramochik V. M., Loboda T. M. Physiotherapy for sick patients // Medical rehabilitation, balneology, physiotherapy. - 2000. - No. 4. - P. 37 -41. 3. Borisova A.I. Features of pharmacology in old age // Abstract collection. - 2001. - No. 1. - P. 3 -8. Erokhina G. A. Features of physiotherapy in the complex treatment of elderly patients / G. A. Erokhina // Physiotherapy, balneology and rehabilitation. – 2012. – No. 1. – P. 39 – 41.
The purpose of using physical factors is to delay the appearance of functional differences or weaken their intensity; increasing protective and compensatory recovery mechanisms; restoration of external functions of various body systems, weakening and elimination of pathological changes.
Physical factors, when used adequately, actively influence the vegetative-trophic function of the nervous system, neuro-endocrine regulation, microcirculation and metabolic processes in organs and tissues, the state of immunocompetent systems, the development and regulation of autoimmune processes. The use of physical factors does not lead to an increase in the physiological norms of homeostasis; in some cases, processes aimed at preserving or strengthening one’s own strengths and methods of self-regulation, protection and compensation are strengthened and in others weakened. Physical factors, unlike many pharmacological drugs, do not cause side effects.
Features of the reaction of geriatric patients to physical factors: a decrease in the body’s reactivity with age, the speed of impulses from the periphery to the center leads to a decrease or absence of response to the first procedures; an inadequate reaction of exacerbation from one or another system is possible as a result of overstimulation
the intensity of the impact (current strength, radiation power, temperature), the length of procedures for the elderly should be lower than for young and middle-aged patients, while the number of procedures per course of treatment increases, since the restoration of impaired systems in the aging body is much slower; physiotherapeutic procedures for the elderly are not carried out on an empty stomach and immediately after eating, rest after the procedure is required for 30 minutes to 1 hour, given the increased sensitivity to medications, especially anticoagulants, elderly people should significantly reduce the use of pharmacological drugs
Direct continuous current and medicinal electrophoresis Has an analgesic and trophic effect, under its influence metabolic processes in tissues and their regeneration improve, capillary permeability increases, blood circulation and phagocytosis increase, normalization of the function of the endocrine glands is noted and the condition of peripheral nerve receptors improves. A small amount is injected into the body medication, and the activity of the drug increases, and only the necessary therapeutic ions penetrate. This method provides a high therapeutic effect without side or allergic reactions and at the same time is the most gentle and adequate in relation to the aging body.
!!! When using direct current, there may be a side effect of electrolysis products on the skin in the places where the electrodes are fixed if the gasket is thinner than 1.5 cm. After the procedure, it is necessary to lubricate the skin in the places where the electrodes are fixed with a neutralizing cream
aerosol and electric aerosol inhalation therapy, due to an increase in the area of interaction of the drug with the mucous membrane of the respiratory tract, a faster and stronger therapeutic effect is observed; it is used for the treatment of bronchopulmonary and cardiovascular diseases; doses of medications in aerosol and electric aerosol combinations for elderly and senile people should be reduced by 3 -4 times, that is, 1/4 or 1/3 of a single dosage of the medicinal substance is prescribed
ultraphonophoresis, drugs phoretized in an ultrasonic field penetrate the epidermis and upper layers of the dermis through the excretory ducts of the sebaceous and sweat glands; when using ultrasound, it is not possible to accumulate drugs in the skin in sufficient concentration, and they act for a relatively short time as a result of the combination of the action of phonophoresis and various therapeutic effects of ultrasonic waves (mechanical, thermal, chemical) therapeutic effects are potentiated and are quite pronounced
pulse current uses pulses with gradually increasing intensity (exponential, Lapic currents) to maintain nutrition and muscle function during the period of recovery of a damaged nerve or temporary forced inactivity of the muscle; sinusoidal modulated currents have analgesic, anti-inflammatory, trophic and resorption effects. They can be used for electrical stimulation for muscle hypertrophy or atrophy, cuts and paralysis. They are most often used in elderly patients for pain syndromes caused by diseases of the peripheral nerves (neuritis, plexitis, radiculitis, neuralgia), traumatic injuries (sprains, bruises)
If there are symptoms of a violation of the cortico-subcortical relationship, electrosleep (Leduc currents) is used for the purpose of sedation and improvement of the functional state of the central nervous system. As a result of exposure to pulsed current, an analgesic effect is observed for pain syndromes, a decrease in high blood pressure, increased performance, and improved sleep. Electrosleep can be combined with electrophoresis of bromine and iodine in one procedure. Electrosleep is prescribed to elderly and senile patients with cerebral vascular sclerosis, neurosis, neurasthenia, hypertension of I-II degrees, coronary heart disease, gastric and duodenal ulcers, bronchial asthma, eczema, neurodermatitis.
Diadynamic currents (Bernard currents) are half-sinusoidal pulses of constant polarity with a frequency of 50 and 100 Hz. These frequencies are used separately or in continuous alternation in “short” or “long” periods. Indications for the use of diadynamic current are the same as for sinusoidal modulated current, however, the irritation of receptors and skin caused by diadynamic current, painful burning and tingling sensation under the electrodes limit its use (contraindicated in disorders of the autonomic nervous system)
high frequency alternating currents local darsonvalization of high frequency current (100400 k. Hz), high voltage (100 k. V) and low strength (10 -15 m) has a vasomotor effect, normalizes the vascular tone of the arteries and veins, has an analgesic and anti-inflammatory effect currents d'Arsonval improve the trophism of tissues, especially the skin. In this regard, they are widely used in geriatric practice for the treatment of trophic ulcers, wounds that do not heal for a long time, bedsores, varicose veins, itchy skin, periodontal disease, neuritis of the auditory nerves
high-frequency electromagnetic fields, the franklinization method, in which the active factor is a constant high-voltage electric field, has a positive effect on people in older age groups due to its sedative, hyposensitizing, normalizing effects on sleep, which reduces high blood pressure, improves vascular tone, franklinization is well tolerated by all patients and recommended for the treatment of functional diseases of the nervous system (migraine, insomnia), asthenic conditions, trophic ulcers, wounds that take a long time to heal
UHF electric field UHF at a small dosage (low thermal) has a calming effect on the nervous system, accelerates the regeneration process, helps restore conductivity in case of traumatic damage to nerve trunks, has an anti-inflammatory, anti-edematous, bacteriostatic effect, has an antispasmodic effect on the smooth muscles of the stomach, gall bladder, bronchi and bronchioles , stimulates the secretion of bile, reduces the secretion of bronchial glands in elderly people, short courses of treatment are prescribed (58 procedures)
Magnetic fields have a therapeutic effect manifested in sedative, analgesic, hypotensive, anti-inflammatory, and decongestant effects. A special feature of the therapeutic effect of the magnetic field is its gentle action and the absence of negative reactions, which significantly expands the indications for its use in the elderly
phototherapy laser therapy has a positive effect on wounds that do not heal for a long time, diseases of the joints and spine, peripheral nervous system, skin, gynecological, proctological, dental diseases; infrared radiation has a pronounced thermal effect. Therefore, in elderly patients with cardiovascular diseases, its use should be limited. Infrared rays are used primarily on the upper and lower extremities; ultraviolet radiation is used for rehabilitation treatment and disease prevention, as well as for the purpose of hardening the body. The use of general techniques in patients of older age groups over time should be limited
Phytolaser phoresis, due to the biological commonality with the cells of the body, molecules of plant substances easily overcome cellular barriers and are considered effective even in cases where chemical medicinal substances are not effective. The effect of phytoextrates on the body has a wide range: from local (spasmalytic, analgesic, anti-inflammatory) to general ( tonic, sedative, restorative) - due to its effect on the central nervous system and hormonal regulatory mechanisms
water and heat treatment use various medicinal baths: pine, iodine-bromine, low-mineralization mineral baths, turpentine with white emulsion (15-20 ml per 200 liters of water), oxygen (30-40 mg/l), nitrogen (20-30 mg/l ), carbon dioxide (120 mg/l), sodium chloride (10 mg/l) therapeutic baths are prescribed as local - for the extremities or general, depending on the age and general condition of the patient's body. When prescribing baths (especially general ones) to patients of older age groups, it is necessary to strictly ensure that there is rest for 30 minutes before the procedure, and at least 1-1.5 hours after the procedure. Bathing should not be done after physical exertion, immediately after eating or on an empty stomach. Elderly patients must immerse themselves in and out of the bath slowly and slowly. The heart area should always remain free of water. In geriatric practice, baths are prescribed every other day or two. Patients over 75 years of age are prescribed 2 or 4 chamber baths or half baths
1. Features of the course of diseases of various organs and systems in elderly and senile people.
2. Features of nursing care for elderly and senile patients
3. Boarding homes for the elderly. Features of the work of a nurse.
Geriatric problems require broad participation of the public, health authorities, social security, etc.. This entire set of measures, with appropriate coordination, is important for organizing services for people in older age groups, and the role of the nurse should be given particular importance. Awareness that the basic principle in relation to geriatric The patient must be respected; this is an urgent problem of adequate care for elderly patients.
Geriatrics is a science that studies the patterns of the course of diseases and their treatment in elderly and older people.
Old age is a stage of development of the body. ;
A disease is a disability that can occur at any age.
This is the relationship between these two concepts. Old age is not a disease. These two concepts cannot be confused. The disease in most geriatric patients is associated with natural age-related changes. They often progress for a long time without any noticeable pain. And only some additional factors can lead to a clear manifestation of the disease. Such factors include excessive physical activity, infectious diseases, colds, and stress.
Elderly people are characterized by a multiplicity of pathologies. A detailed examination can detect changes in various body systems. The pathology of older people is compared to an iceberg, in which 6/7 of its volume is hidden under water. The patient's complaints indicate the tip of this iceberg. Detailed questioning and examination of the patient allows you to see the entire “iceberg”.
Diseases of the elderly
On average, at least five diseases can be detected simultaneously in an old person. More often, atherosclerosis of the vessels of the heart and brain, arterial hypertension, chronic bronchitis, tumors, prostate hyperplasia, diabetes mellitus, mental depression, cataracts, hearing loss, etc. are combined.
Features of the course of diseases of various organs.
l Geriatric patients may suffer from diseases that began in their youth. But acute diseases, including infectious diseases, can also arise in them. The age-related characteristics of the body leave an imprint on these diseases. Their features will be: atypicality, absence of clear manifestations of the disease.
Diagnosis, treatment, and care for older patients have their own characteristics and often the methods that are used in young patients are not used in older people. The reasons for this are as follows:
1. Often masked course of pneumonia, myocardial infarction, pulmonary tuberculosis, diabetes mellitus, tumors. Other mechanisms of disease development (ulcers in atherosclerosis). Hidden course of catastrophes in the abdominal cavity, which requires urgent surgical intervention. The severity of the damage to the body does not correspond to the mild symptoms of the disease.
Methodology for collecting anamnesis and examination features of older patients. Clinical manifestations of the disease and mental characteristics of an older person require certain features in conducting a survey and examination of the patient. Age-related changes affect the psychology of an old person, his orientation in the environment. Interview with a patient who has a violation of several systems. lasts much longer, like interviewing a young person. It must be taken into account that an old person has decreased hearing, vision and generally a slower response. n If the patient always wears glasses or a hearing aid, then these auxiliary things should be used during the interview.
Conversation with a geriatric patient
You must speak clearly, slowly, and do not shout into the patient’s ear. The face of the person conducting the survey should be sufficiently illuminated, since the movement of the lips during conversation to a certain extent helps the patient understand the speech addressed to him. Sometimes hearing loss can be caused by the presence of wax plugs in the ears. Therefore, after deleting their survey, it is advisable to repeat it.
If the patient comes with relatives, then first you need to talk with them (but in the absence of the patient). This makes it possible to identify the patient’s personality traits, his relationships with relatives, and the family’s capabilities in the problem of providing home care for the patient. If there are changes in the psyche, the patient must be interviewed with the participation of relatives.
The classic history form for an old person is: u
1) survey on systems
2) previous diseases, operations
3) family history
4) social
5) power mode
6) treatment,
7) psychiatric and sexual history.
Social history allows you to find out the following points:
1) place, living conditions
2) family composition, relationships with relatives
3) contact with friends and acquaintances
4) does he receive help from social services?
5) performance, job satisfaction. Find out from those who are not working how they experienced the termination of their work activity.
6) Attitude towards the death of a spouse, if this happens, there is no tendency towards self-isolation or loneliness.
The diet consists of the following questions:
1) frequency of meals, incl. hot food
2) balanced diet (proteins, fats, carbohydrates)
3) diet in the past and present
4) prepares his own food
5) can chew, presence of dentures
6) did not lose weight
7) whoever buys food has to go far for groceries.
Psychiatric history:
pay attention to the presence of mental illness in relatives,
find out if there is a depressive syndrome or suicidal thoughts.
Sexual history
can only be collected if a relationship of trust is established during the survey.
Features of nursing care for elderly and old patients
General care for elderly and elderly patients is more complex and requires more attention and time from medical staff than regular care. The concept of "care for the sick" includes not only physical care, but also the restoration of impaired mental and physical functions, the maintenance or development of the patient's social ties with the family and community to which he can return, and the medical or social care institution to which he is in.
The basic principle of care is
respect for the patient's personality,
accepting him as he is, with all his shortcomings (physical, mental, irritability, mental disorders). The nurse should know that these deficiencies in most cases are a manifestation of illness, not old age, and appropriate care can improve health.
Urinary system
During the aging process, the function of the urinary apparatus and kidney function change significantly. The concentrating ability of the kidneys decreases and, as a result, nocturnal diuresis increases compensatoryly. In addition, nocturnal diuresis can be a consequence of irritation of the bladder sphincters, prostate hypertrophy in men, and heart failure in cardiac patients. It is necessary to find out how often the patient passes out at night for diuresis, to what extent this disturbs sleep, and give him nighttime dishes.
If you have frequent nocturnal diuresis, you can advise the patient to drink immediately before bedtime, but this must be done carefully, because reducing fluid administration to less than 1/24 hours can lead to general intoxication (accumulation of metabolic products).
Hygienic bathing for elderly patients
· There are accidents when bathing in a bath: a slippery bathtub, a slippery floor, loss of consciousness from too hot water, a heart attack, etc. Therefore, an old person should be warned that first the bathtub is filled with water, the temperature is adjusted to the required temperature, and then you can sit in bath
· In general, in geriatric practice it is better to use a shower rather than a bath. Depending on the condition, the patient takes a shower standing, sitting, or is washed by staff on a special couch in a warm bathroom. . No need to take a shower >35°, direct the hot stream to your head.
· Supports, rubber mats, emergency alarms are mandatory bathroom equipment. The presence of a health care worker when bathing a patient is desirable, and in some cases cases - mandatory. The bathtub should not be closed from the inside.
Caring for patients on bed rest:
Prolonged bed rest leads to significant changes in structure and function, the occurrence of complications such as hypostatic pneumonia, thrombus embolism, urinary tract infection, bedsores, decreased appetite, general weakness. Patients experience muscle atrophy, increased calcium excretion, decreased joint mobility, and constipation. , insomnia, mental disorders, depression. The cardiovascular system is especially affected. Due to physical inactivity, detraining the adaptive capabilities of the heart and blood vessels with corresponding symptoms (palpitations, shortness of breath) quickly decrease.
Defecation
· Elderly and old people often experience constipation. Sometimes linked to food that does not include ballast substances (vegetables, fruits, wholemeal bread), physical inactivity, fluid restriction, and medication. In the treatment of constipation, it must be taken into account that enemas in old people more often cause irritation of the intestines than in young people. The same applies to rectal suppositories.
Rehabilitation and physiotherapy.
Rehabilitation is a restorative therapy, its components:
1) medical - treatment of the patient
2) psychological- removal from a state of depression, reactive neurosis,
3) social - restoration in the family, society
4) labor - partial or complete restoration of working capacity.
Metabolism of drugs in the old body.
1. Due to structural and functional changes in the gastrointestinal tract, the absorption of medications decreases with age. Therefore, medications taken orally enter the body in smaller quantities.
2. Drugs administered by injection also begin to act much later and less intensely due to the fact that their absorption is slowed down
The release of medications from the body also slows down with age. The reasons for this phenomenon are a decrease in the excretory function of the kidneys.
3. Weakening the intensity of metabolic cycles of the liver and skin.
4. Decline detoxification liver functions.
5. Weakening the activity of enzyme systems.
Principles of pharmacotherapy in geriatrics
1. Inadmissibility of polypharmacy.
2. Treatment of the underlying disease.
3. The adverse effects of drugs on the body are higher in older people than in young people.
4. In old age, adaptation to toxic substances is significantly reduced.
5. Doses of antibiotics and antibacterial drugs are not reduced.
6. To prevent honey. and intoxication, monitor proper nutrition and sufficient drinking regime.
7. Due to addiction to sleeping pills, painkillers, sedatives, it is recommended to often replace each other.
8. It is advisable to use a complex of various drugs in low doses, which act similarly, but on different chains of the disease.
9. There is often the possibility of an allergic reaction to medications.
Geriatric drugs are a group of medications that affect the aging body through a general stimulating effect, normalization of impaired metabolism and body functions, and increase the tone and trophism of the central nervous system. To them
2) Microelements (copper, zinc, cobalt, potassium, etc.).
3) Novocain.
4) Thyroid hormones, anabolic.
5) Tissue stimulators (placenta, FIBS).
6) Apilakatherapy (0.01 2 times a day under the tongue for 20 days).
7) Adaptogens (take extract from ginseng root, eleutherococcus, dibazol (0.01 / day).
Side effects of drugs on the old body.
Barbiturates
Diuretics
Aminazine, regitin
Salicylates, NSAIDs
Antibiotics, sulfa drugs
Glucocorticoids
anticholinergic , antispasmodic drugs
Adrenaline and other adrenergic agonists
· Thus, geriatric problems require broad participation of the public, health authorities, social security, etc.. This entire set of measures, with appropriate coordination, is important for organizing services for people in older age groups.
Particular importance should be given to the role of the nurse. Awareness that the basic principle in relation to geriatric The patient must be respected.
· The problem of adequate care for elderly patients is urgent.
Biology of aging. Gerontology as a science. Boarding homes for the elderly.
The social phenomenon of population aging emerged in the second half of the 19th century in industrialized countries, in which the number of elderly people almost doubled. This caused serious economic, social and psychological changes in society and gave impetus to the development of new scientific disciplines, in particular social gerontology and geriatrics.
¡Gerontology is the science of old age, the aging of an individual, its biological mechanisms, rates, characteristics, factors, etc.
It is necessary to clearly distinguish between the concepts of aging and old age.
l Old age is the natural onset of a period of age-related development.
l Aging is a destructive process that occurs as a result of the damaging effects of external and internal factors increasing with age, which leads to a lack of body functions.Aging leads to limited adaptation of the body and the development of age-related pathology.
There are 3 periods in a person's life.
1. growth period - up to 20 years.
2. reproductive (up to 45 years)
3. aging.
External signs of aging:
1) change in body shape and physique
2) slowdown and lack of coordination
3) rapid mental and physical fatigue
4) decreased performance
5) the appearance of wrinkles on the face
6) hair loss, graying of hair
7) decreased visual acuity and hearing
Internal signs of aging:
1) decreased activity of conditioned and unconditioned reflexes
2) muscle strength and muscle tone
3) deterioration in the activity of sucking, digestive organs, excretion
4) suppression of the immune defense system
5) disturbances in the body’s adaptation to the effects of painful factors.)
Age periods
(WHO classification)
· 1. childhood
· 2. youth
· 3. youth
· 4. mature age - 40-44 years,
· 45-59 years - average age 60-74 years - elderly, 75-90 years - old, 90 years and older - long-livers.
Biology of aging: human aging is a natural biological process determined by its individual, genetically determined development program. During a person's life, some of the constituent elements of his body age and new ones arise.
The general development of the human body can be divided into 2 periods: ascending (it ends with the period of full maturity of a person) and descending (it begins at the age of 30-35). From this time on, various types of metabolism and the state of the body's functional systems gradually change, which inexorably leads to a limitation of its ability to adapt, and the likelihood of pathological processes, acute diseases and death increases.
Problems of gerontology require broad public participation, organs health, social security, etc.
This whole set of measures with appropriate coordination is important for organizing homes - boarding schools, boarding houses and hospice for people elderly and senile age.
IN these institutions specialists should work who, in conditions multimorbidity with age-related involutive lesions could provide appropriate qualified medical care.
Plan: Purposes of using physical factors Features of the reaction of geriatric patients to physical factors Rules for prescribing physiotherapeutic procedures in gerontology and geriatrics Physiotherapeutic methods used in gerontology and geriatrics
1. Kataev M. R., Kuneev V. G., Tagaev I. R., Khetagurov L. G. Phytolazerophoresis in gerontology // Bulletin of new medical technologies. - 2001. - No. 4. - P. 50. 2. Paramochik V. M., Loboda T. M. Physiotherapy for sick patients // Medical rehabilitation, balneology, physiotherapy. - 2000. - No. 4. - P. 37 -41. 3. Borisova A.I. Features of pharmacology in old age // Abstract collection. - 2001. - No. 1. - P. 3 -8. Erokhina G. A. Features of physiotherapy in the complex treatment of elderly patients / G. A. Erokhina // Physiotherapy, balneology and rehabilitation. – 2012. – No. 1. – P. 39 – 41.
The purpose of using physical factors is to delay the appearance of functional differences or weaken their intensity; increasing protective and compensatory recovery mechanisms; restoration of external functions of various body systems, weakening and elimination of pathological changes.
Physical factors, when used adequately, actively influence the vegetative-trophic function of the nervous system, neuro-endocrine regulation, microcirculation and metabolic processes in organs and tissues, the state of immunocompetent systems, the development and regulation of autoimmune processes. The use of physical factors does not lead to an increase in the physiological norms of homeostasis; in some cases, processes aimed at preserving or strengthening one’s own strengths and methods of self-regulation, protection and compensation are strengthened and in others weakened. Physical factors, unlike many pharmacological drugs, do not cause side effects.
Features of the reaction of geriatric patients to physical factors: a decrease in the body’s reactivity with age, the speed of impulses from the periphery to the center leads to a decrease or absence of response to the first procedures; an inadequate reaction of exacerbation from one or another system is possible as a result of overstimulation
the intensity of the impact (current strength, radiation power, temperature), the length of procedures for the elderly should be lower than for young and middle-aged patients, while the number of procedures per course of treatment increases, since the restoration of impaired systems in the aging body is much slower; physiotherapeutic procedures for the elderly are not carried out on an empty stomach and immediately after eating, rest after the procedure is required for 30 minutes to 1 hour, given the increased sensitivity to medications, especially anticoagulants, elderly people should significantly reduce the use of pharmacological drugs
Direct continuous current and medicinal electrophoresis Has an analgesic and trophic effect, under its influence metabolic processes in tissues and their regeneration improve, capillary permeability increases, blood circulation and phagocytosis increase, normalization of the function of the endocrine glands is noted and the condition of peripheral nerve receptors improves. A small amount is injected into the body medication, and the activity of the drug increases, and only the necessary therapeutic ions penetrate. This method provides a high therapeutic effect without side or allergic reactions and at the same time is the most gentle and adequate in relation to the aging body.
!!! When using direct current, there may be a side effect of electrolysis products on the skin in the places where the electrodes are fixed if the gasket is thinner than 1.5 cm. After the procedure, it is necessary to lubricate the skin in the places where the electrodes are fixed with a neutralizing cream
aerosol and electric aerosol inhalation therapy, due to an increase in the area of interaction of the drug with the mucous membrane of the respiratory tract, a faster and stronger therapeutic effect is observed; it is used for the treatment of bronchopulmonary and cardiovascular diseases; doses of medications in aerosol and electric aerosol combinations for elderly and senile people should be reduced by 3 -4 times, that is, 1/4 or 1/3 of a single dosage of the medicinal substance is prescribed
ultraphonophoresis, drugs phoretized in an ultrasonic field penetrate the epidermis and upper layers of the dermis through the excretory ducts of the sebaceous and sweat glands; when using ultrasound, it is not possible to accumulate drugs in the skin in sufficient concentration, and they act for a relatively short time as a result of the combination of the action of phonophoresis and various therapeutic effects of ultrasonic waves (mechanical, thermal, chemical) therapeutic effects are potentiated and are quite pronounced
pulse current uses pulses with gradually increasing intensity (exponential, Lapic currents) to maintain nutrition and muscle function during the period of recovery of a damaged nerve or temporary forced inactivity of the muscle; sinusoidal modulated currents have analgesic, anti-inflammatory, trophic and resorption effects. They can be used for electrical stimulation for muscle hypertrophy or atrophy, cuts and paralysis. They are most often used in elderly patients for pain syndromes caused by diseases of the peripheral nerves (neuritis, plexitis, radiculitis, neuralgia), traumatic injuries (sprains, bruises)
If there are symptoms of a violation of the cortico-subcortical relationship, electrosleep (Leduc currents) is used for the purpose of sedation and improvement of the functional state of the central nervous system. As a result of exposure to pulsed current, an analgesic effect is observed for pain syndromes, a decrease in high blood pressure, increased performance, and improved sleep. Electrosleep can be combined with electrophoresis of bromine and iodine in one procedure. Electrosleep is prescribed to elderly and senile patients with cerebral vascular sclerosis, neurosis, neurasthenia, hypertension of I-II degrees, coronary heart disease, gastric and duodenal ulcers, bronchial asthma, eczema, neurodermatitis.
Diadynamic currents (Bernard currents) are half-sinusoidal pulses of constant polarity with a frequency of 50 and 100 Hz. These frequencies are used separately or in continuous alternation in “short” or “long” periods. Indications for the use of diadynamic current are the same as for sinusoidal modulated current, however, the irritation of receptors and skin caused by diadynamic current, painful burning and tingling sensation under the electrodes limit its use (contraindicated in disorders of the autonomic nervous system)
high frequency alternating currents local darsonvalization of high frequency current (100400 k. Hz), high voltage (100 k. V) and low strength (10 -15 m) has a vasomotor effect, normalizes the vascular tone of the arteries and veins, has an analgesic and anti-inflammatory effect currents d'Arsonval improve the trophism of tissues, especially the skin. In this regard, they are widely used in geriatric practice for the treatment of trophic ulcers, wounds that do not heal for a long time, bedsores, varicose veins, itchy skin, periodontal disease, neuritis of the auditory nerves
high-frequency electromagnetic fields, the franklinization method, in which the active factor is a constant high-voltage electric field, has a positive effect on people in older age groups due to its sedative, hyposensitizing, normalizing effects on sleep, which reduces high blood pressure, improves vascular tone, franklinization is well tolerated by all patients and recommended for the treatment of functional diseases of the nervous system (migraine, insomnia), asthenic conditions, trophic ulcers, wounds that take a long time to heal
UHF electric field UHF at a small dosage (low thermal) has a calming effect on the nervous system, accelerates the regeneration process, helps restore conductivity in case of traumatic damage to nerve trunks, has an anti-inflammatory, anti-edematous, bacteriostatic effect, has an antispasmodic effect on the smooth muscles of the stomach, gall bladder, bronchi and bronchioles , stimulates the secretion of bile, reduces the secretion of bronchial glands in elderly people, short courses of treatment are prescribed (58 procedures)
Magnetic fields have a therapeutic effect manifested in sedative, analgesic, hypotensive, anti-inflammatory, and decongestant effects. A special feature of the therapeutic effect of the magnetic field is its gentle action and the absence of negative reactions, which significantly expands the indications for its use in the elderly
phototherapy laser therapy has a positive effect on wounds that do not heal for a long time, diseases of the joints and spine, peripheral nervous system, skin, gynecological, proctological, dental diseases; infrared radiation has a pronounced thermal effect. Therefore, in elderly patients with cardiovascular diseases, its use should be limited. Infrared rays are used primarily on the upper and lower extremities; ultraviolet radiation is used for rehabilitation treatment and disease prevention, as well as for the purpose of hardening the body. The use of general techniques in patients of older age groups over time should be limited
Phytolaser phoresis, due to the biological commonality with the cells of the body, molecules of plant substances easily overcome cellular barriers and are considered effective even in cases where chemical medicinal substances are not effective. The effect of phytoextrates on the body has a wide range: from local (spasmalytic, analgesic, anti-inflammatory) to general ( tonic, sedative, restorative) - due to its effect on the central nervous system and hormonal regulatory mechanisms
water and heat treatment use various medicinal baths: pine, iodine-bromine, low-mineralization mineral baths, turpentine with white emulsion (15-20 ml per 200 liters of water), oxygen (30-40 mg/l), nitrogen (20-30 mg/l ), carbon dioxide (120 mg/l), sodium chloride (10 mg/l) therapeutic baths are prescribed as local - for the extremities or general, depending on the age and general condition of the patient's body. When prescribing baths (especially general ones) to patients of older age groups, it is necessary to strictly ensure that there is rest for 30 minutes before the procedure, and at least 1-1.5 hours after the procedure. Bathing should not be done after physical exertion, immediately after eating or on an empty stomach. Elderly patients must immerse themselves in and out of the bath slowly and slowly. The heart area should always remain free of water. In geriatric practice, baths are prescribed every other day or two. Patients over 75 years of age are prescribed 2 or 4 chamber baths or half baths
Features of physiotherapy in the elderly. Various age-related changes affecting various organs and systems, as well as features of the course of diseases characteristic of elderly and senile people, dictate the need to observe a number of precautions when using physical factors in complex therapy. Summarizing the available data, we can name a number of general principles and features of physiotherapy and physioprophylaxis in patients of older age groups.
1. Due to the reduced reactivity of the aging body, altered receptor activity, impaired compensatory capabilities of organs and systems in elderly and senile patients, it is recommended to carry out physiotherapeutic effects using gentle methods, especially at the beginning of the course of treatment. This requirement applies to almost all dosimetric parameters of physiotherapeutic procedures, primarily their intensity and duration, which should be less than in young and middle-aged patients. Procedures for elderly patients are usually prescribed every other day, and only local effects, if well tolerated and have an adequate response to them, can be prescribed daily to patients under the age of 70 years.
2. Treatment with physical factors is complex. This should also be the case in elderly and senile patients. However, due to their reduced reserve capabilities, no more than two therapeutic physical factors should be used, and mainly according to the alternation method, and only in rare cases can one of them be of general action.
3. As is known, physical factors have a predominant stimulating effect, and therefore most of them (according to conventional methods) are contraindicated in cancer patients. Since malignant neoplasms are more common in older people and often have an atypical course, when prescribing physiotherapeutic procedures to elderly patients, physiotherapists should show increased oncological alertness.
4. The processes of sanogenesis and recovery in elderly patients, especially in the presence of metabolic disorders and neurohumoral regulation, proceed more slowly. In this regard, and especially when prescribing low-intensity physiotherapeutic interventions, the number of procedures per course of treatment should be large (up to 15-20 instead of 10-12 procedures in young and middle-aged people). It should also be considered justified to use cyclic treatment options in elderly patients (primarily in outpatient settings), in which a physiotherapy cycle consists of 2-3 short (4-6 procedures) courses, repeated after short periods (3-4 weeks). periods of time.
5. With aging, conditions are created for the emergence of polypathology. Therefore, the physiotherapist needs to identify the underlying disease and select the leading physiotherapeutic factor accordingly. At the same time, both when prescribing it and when including other physiotherapeutic procedures in the treatment complex, the most serious attention must be paid to concomitant diseases. One should strive to ensure that the prescribed factors are indicated and effective not only for the main disease, but also for other diseases.
6. Due to reduced compensatory capabilities and a higher frequency of inadequate reactions in patients, in geriatric practice preference is given to physical factors of more physiological and local action (direct and pulsed currents, local darsonvalization and franklinization, chamber baths, etc.). Physical factors of general action and with a pronounced thermal effect in elderly patients should be used more carefully.
7. Changes that occur in the skin with age significantly affect its sensitivity to UV irradiation, electrolysis products and drugs administered by physical pharmacological methods. For this reason, the dosage of these factors in older people is reduced, and to protect the skin from the action of electrolysis products during electrophoresis procedures, thicker pads should be used. After the procedure, it is recommended to treat the skin in the area where the electrodes are located with baby cream or glycerin diluted with water.
8. Due to imperfect regulation and weakening of compensatory-adaptive processes after physiotherapeutic procedures, patients in older age groups should rest for a longer time - 1-1.5 hours.
9. The effect of individual physical factors changes significantly with age, and therefore their use in geriatric practice has a number of nuances. The most important of them can be summarized as follows: the dose of medications for elderly and senile patients in aerosol and electro-aerosol mixtures should be reduced by 2-4 times; More adequate and physiological for older people from pulsed currents are sinusoidal modulated and interference currents, and from microwaves - decimeter waves; UHF therapy in geriatrics is carried out in short courses (5-8 procedures) and mainly on portable devices; in elderly people suffering from cardiovascular diseases and degenerative processes, the use of general UV irradiation, as well as infrared and visible rays should be limited; in persons over 50-55 years old, ultrasound therapy should be carried out under ECG control; Among mud treatments, preference is given to mitigated treatment methods, the use of peat, as well as galvanic mud and electrophoresis of mud solutions; baths are prescribed in lower concentrations, after rest before taking it, often in the form of half-baths and chamber baths, for two days in a row with a break on the third; For patients over 60 years of age, it is recommended to prescribe sulfide and carbon dioxide baths with great caution; when prescribing massage to elderly patients, preference is given to influencing reflexogenic zones, as well as acupressure; When performing a massage, you should use creams and ointments, and the room temperature should be about 25 °C.
10. In the prevention and treatment of premature aging, the use of vitamins is of great importance. To a certain extent, this is due to the development of endogenous vitamin deficiency in old age. Physical factors (especially mud therapy, phonotherapy, balneotherapy, etc.) themselves stimulate the metabolism of vitamins and, with prolonged use, can cause vitamin deficiency. Therefore, vitamin therapy should be a common background in the treatment of various diseases in old and senile age, if therapeutic physical factors are included in the therapeutic complex.
11. Sanatorium-resort treatment of elderly and senile patients is recommended to be carried out near their permanent place of residence and without the use of intensive balneoclimatotherapy. With good functional capabilities of the body and repeated treatment in the past in sanatoriums of various resort areas, patients with diseases of the musculoskeletal system, peripheral nervous system and digestive organs can be sent to remote resorts, the climate of which differs from the local one and requires adaptation.
Compliance with the considered features and principles of the use of therapeutic physical factors should contribute not only to increasing the effectiveness of treatment of elderly patients, but also to slowing down aging.
The word “physiotherapy” translated from Greek means “treatment by the forces of nature.” In the modern understanding, physiotherapy is an area of clinical medicine that is directly related to balneology. Physiotherapy provides therapeutic, restorative and preventive effects by stimulating natural protective reactions and normalizing impaired body functions. Physical factors have a beneficial effect on the processes of compensation and adaptation of the cardiovascular, respiratory, immune, endocrine and other systems in the elderly.
Modern physiotherapy has dozens of natural and preformed (artificially created) physical factors, which can be divided into the following groups:
1. Low voltage electric current:
a) galvanization,
b) electrophoresis,
c) diadynamic therapy,
d) amplipulse therapy,
e) fluctuarization,
e) electrosleep,
g) electrical stimulation.
2. High voltage electric current:
a) franklinization,
b) darsonvalization,
d) TNC ultratonotherapy.
3. Electric and magnetic fields:
a) inductor,
b) UHF therapy,
c) UHF inductothermy,
d) microwave therapy,
d) EHF therapy,
e) magnetic therapy.
4. Mechanical vibrations:
a) vibration,
b) ultrasound.
5. Light:
a) infrared rays,
b) visible light,
c) ultraviolet rays,
d) laser.
6. Artificial air environment:
a) aeroionotherapy,
b) hydroaeroionotherapy,
c) aerosol therapy,
d) electroaerosol therapy,
e) speleotherapy, halotherapy.
7. Barometric gas pressure:
a) Kravchenko camera,
b) hyperbaric oxygenation,
8. Heat therapy:
a) paraffin,
b) ozokerite,
c) paraffin-ozokerite mixture,
d) naftalan,
d) healing mud,
e) medicinal peat,
g) heated sand,
h) sauna.
9. Hydrotherapy:
a) fresh water,
b) medicinal baths,
c) mineral baths,
d) drinking mineral waters.
10. Puncture physiotherapy.
11. Herbal medicine.
12. Apitherapy, hirudotherapy.
Most of the listed physical factors can be used for therapeutic, restorative and preventive purposes in elderly and senile people. Age does not affect contraindications for physiotherapy, but its use in geriatrics has its own characteristics. The most important of them are the following:
1. When treating elderly and elderly people, the dose of physical exposure should be reduced by 30-50%. This is expressed in a decrease in power, intensity, current, magnitude of magnetic field induction, temperature, area of influence, duration of the procedure, and the total number of procedures per course of treatment. In geriatrics, “non-stress” physical factors are used that do not cause significant changes, primarily in the cardiovascular and respiratory systems.
2. In geriatrics, preference is given to the use of local methods of influence.
3. During the day, the patient can take no more than two physiotherapeutic treatments. Their simultaneous use is not recommended.
4. When prescribing two physical procedures, the interval between them must be at least 3 hours.
5. Careful multi-stage monitoring of the body’s reaction to the use of physical methods of influence is necessary. The nurse assesses the patient's functional status during the procedure. The physiotherapist prescribes repeat examinations every 2-3 procedures to make the necessary corrections in the treatment method. The attending physician monitors the patient's condition constantly.
6. When prescribing physiotherapeutic methods of treatment to elderly and senile people, it is necessary to take into account the high probability of precancerous processes and oncological diseases in them.
Each of the physical factors acts on certain parts of the pathological process. Therefore, for the same disease, different methods of influence can be used. The art of the doctor is to choose the optimal one, taking into account the mechanism of action and the individual characteristics of the patient: stage of the disease, previous treatment, concomitant diseases, etc.
All physical factors have their own application characteristics, especially for elderly and senile patients.
When carrying out galvanization and medicinal electrophoresis, it is necessary to take into account that the skin of older people contains fewer sweat and sebaceous glands through which galvanic current penetrates, has reduced elasticity and turgor, often with trophic disorders. Therefore, it is necessary to protect it from electrolysis products: for this purpose, the gaskets must be at least 1 cm thick, and the electrodes must be well smoothed and even. Galvanization according to the methods of Shcherbak, Vermeule, four-chamber galvanic baths are indicated for the treatment of diseases of the peripheral nervous system, peripheral vessels and cerebral vessels, diseases accompanied by autonomic disorders and sleep disorders.
When conducting electrophoresis of medicinal substances, especially potent ones, the dose should be reduced by 2-3 times. To do this, use lower concentrations in solution. It is known that during electrophoresis, a depot of a medicinal substance is formed in tissues, which, as a result of deterioration of microcirculation in older people, is absorbed slowly. Therefore, the electrophoresis procedure, especially for potent substances, should be carried out more rarely: every 1-2 days, and sometimes 1-2 times a week. Medicinal electrophoresis is most often used to treat “local” diseases. Indications are determined primarily by the trophic effect of galvanic current and the pharmacological properties of the medicinal substance used.
Pulse currents (DDT, SMT)- widely used in geriatrics for diseases with pain syndrome, as well as to normalize the tone of striated and smooth muscles, improve blood circulation in the affected area. Their use is especially indicated in degenerative-dystrophic processes of the musculoskeletal system. In this case, preference is given to CMT therapy, which is easier to tolerate by patients, less irritates the skin, and improves tissue trophism. In the case of the use of DDT in geriatrics, full-wave currents are more indicated.
Electroson- prescribed for elderly and elderly people with atherosclerosis of cerebral vessels, neuroses, neurasthenia, hypertension I-II degrees, bronchial asthma, neurodermatitis. In geriatrics, pulse current frequencies from 5 to 30 Hz are used.
D'Arsonval currents, ultratonotherapy - have a wide range of applications in geriatrics for the treatment of varicose veins, skin itching, trophic ulcers, neuritis, periodontal disease.
Inductothermy- is a rather stressful thermal procedure, so its use in geriatrics is limited.
UHF therapy- Elderly and senile patients undergo this procedure using low-power devices in non-thermal and low-thermal dosages. The main indication for its use is acute inflammatory processes of various localizations. The course of treatment is 3-5 procedures.
In the treatment of chronic inflammatory and degenerative dystrophic processes, especially during exacerbation, microwave therapy - the use of an ultra-high frequency electromagnetic field - has a positive effect. Treatment is carried out in non-thermal and low-thermal dosages.
EHF therapy- has found wide application in the treatment of gastric and duodenal ulcers, purulent diseases, hypertension, and coronary heart disease.
In geriatric practice, it has a good effect in the treatment of many diseases. magnetotherapy- use of low frequency alternating magnetic field. This method is non-stressful, has a hypocoagulating effect and improves microcirculation in tissues. Therefore, the main indications for magnetic therapy are vascular diseases of various organs.
In medical practice, ultrasound - elastic vibrations in gases, liquids and solids, the frequency of which exceeds 20 kHz - is used in various frequency ranges for therapeutic and surgical treatment and diagnosis. Due to its non-load-bearing nature, it can be widely used in geriatrics for diseases accompanied by excessive development of connective tissue: adhesions, chronic inflammatory and degenerative diseases. In this case, preference is given to ultraphonophoresis of various drugs that enhance the effect of ultrasound.
Infrared rays, Solux, light baths have a pronounced thermal effect, create a load on the cardiovascular system, and therefore are not widely used in geriatrics.
The use of local and especially general ultraviolet irradiation in the treatment of elderly and senile patients should be reduced due to their lack of effectiveness and oncological alertness.
Laser irradiation, on the contrary, can often be used in geriatrics, especially for the treatment of trophic ulcers, wounds, degenerative-dystrophic diseases of the musculoskeletal system: spinal osteochondrosis, deforming arthrosis and other joint diseases. The single dose of laser energy per procedure should be reduced by 30-50%.
Application of negatively charged ions of air and water - aeroionohydroaeroionotherapy- improves the functions of the ciliated epithelium of the respiratory tract, therefore it is widely used for the treatment of chronic nonspecific lung diseases. In the treatment of these diseases, especially bronchial asthma, speleo- and halotherapy are indicated.
When carrying out inhalations, it is necessary to remember that medicinal substances in the form of aerosols are quickly absorbed in the lungs, immediately entering the pulmonary circulation. Therefore, the dosage of medications for elderly and senile people should be reduced by 2-3 times. This method is most often used in the treatment of respiratory diseases.
In the treatment of obliterating diseases of the arteries of the lower extremities in elderly patients, local Kravchenko pressure chamber, in which it is possible to periodically change the air pressure and thereby improve blood circulation in the extremities.
Hyperbaric oxygenation- indicated for the treatment of ischemic diseases in the elderly. The oxygen pressure in the pressure chamber is not recommended to exceed 0.5 atm.
Thermotherapy- assigned to small areas of its application. Various coolants are widely used for thermal effects on the body. Paraffin-ozokerite (mountain wax) applications work well at a temperature of 45-50°C in the form of a molten mass. Therapeutic mud - used in the form of galvanic mud, with a temperature of 38-42°C. Indications for heat therapy are diseases of the support and movement organs.
Hydrotherapy- external use of water for therapeutic and prophylactic purposes. Hydrotherapy procedures include showers, baths, and washing with fresh and mineral water. It is recommended to take a shower for 2-3 minutes as a procedure. Baths are prescribed with minimal concentrations of chemicals and indifferent temperatures. The time for taking the first bath should not exceed 5-7 minutes. Water procedures are prescribed no more than three per week. Their main goal is secondary and primary prevention and rehabilitation treatment.
In geriatrics, the so-called reflex therapy is most often used - corporal and auricular acupuncture, lately su-jok. Most often, biologically active points of local influence are used for acupuncture. During the first procedure, no more than 2-4 points are used, the number of which is increased to 8-10 in subsequent sessions. Acupuncture is usually performed every other day and only daily for the treatment of acute diseases. The course of treatment ranges from 8 to 12 sessions. When treating chronic diseases, repeated shorter courses are desirable.
Biologically active points can be affected not only by inserting needles. The so-called puncture physiotherapy, i.e. the impact of physical factors on biologically active points: electric current, laser, magnet, light, vacuum, acupressure. They are less stressful and easier to tolerate for patients.
Massage- in the treatment of elderly and old patients, gentle techniques using mainly stroking and rubbing techniques are very effective. General massage is not prescribed; segmental massage is used according to strict indications; however, local and acupressure massages are widely used.
Medicinal plants have been used to treat patients since ancient times. In folk medicine herbal medicine More than 2,500 medicinal herbs are used, which are prescribed in the form of infusions, decoctions or tinctures. The raw materials are first crushed: leaves and flowers to a size of no more than 5 mm, roots - no more than 3 mm, fruits and seeds - no more than 0.5 mm. In geriatrics, medicinal herbal collections are often used to treat several diseases. To prepare the infusion, brew a tablespoon of raw material with 200 ml of boiling water, close tightly and leave for 45 minutes. To obtain a decoction, the raw materials are boiled in the same proportion in a water bath for 30 minutes, then cooled to room temperature and filtered. A quarter or a third of a glass of infusion or decoction is prescribed for the appointment. To prepare the tincture, the crushed raw materials are poured with 96° alcohol in a ratio of 1:10 and left for 10 days. Apply drops.
Doctors pay special attention to such waste products of bees as honey, poison, propolis, royal jelly, beebread, bee pollen, and wax. They are considered gerontological remedies. Thus, pollen contains many biologically active substances and, having versatile medicinal properties, is used to treat a number of diseases. That's why apitherapy in geriatrics is very promising. Honey, as a remedy, is prescribed for diseases of the gastrointestinal tract, cardiovascular, nervous systems, and colds: at the rate of 1 tablespoon of honey per glass of water. Often combined with herbal medicine. For joint diseases, compresses are made from honey or honey water. In ophthalmic practice, solutions of honey in distilled water are used in the proportions of 1:3, 1:2, 1:1 for instillation into the conjunctival sac. Propolis, or bee glue, has pronounced antimicrobial properties and is a good adaptogen. Propolis is prepared by dissolving it in alcohol in a ratio of 1:5. In drops it is used to treat sore throats, atherosclerosis, bronchial asthma, gastritis, senile hearing loss and other diseases. Bee venom in the form of bee stings is prescribed in geriatrics for the treatment of diseases of the nervous system, joints, bronchial asthma, hypertension, and enderteritis.
Renaissance occupational therapy primarily due to the need for a number of diseases to introduce into the blood biologically active substances produced by medicinal leeches. The main indications for their use are cardiovascular diseases, increased blood clotting, etc.
The patient's age is not a contraindication for sanatorium treatment. When conducting medical selection of patients for referral to a sanatorium, they are guided by existing indications and contraindications for spa treatment. Elderly people are advised to undergo treatment in local sanatoriums and sanatoriums, since they do not tolerate changes in climatic conditions at certain resorts.
Aging is a genetically determined long-term process characterized by various structural and functional changes in the body and its various organs and systems. Physiotherapy for older people has its own characteristics.
How is physiotherapy carried out in the elderly and senile?
Let's discuss how physiotherapeutic treatment is carried out for older people:
Methods for correcting dysmetabolic syndrome during physiotherapy: oxygen baths, SUV irradiation in erythemal doses, round-the-clock aerotherapy.
Hormone-corrective methods: mesodiencephalic modulation, transcerebral UHF therapy, transcerebral LF electrotherapy.
Colon-kinetic methods of physiotherapy: colon hydrotherapy, enemas, mineral waters.
Contraindications to physiotherapeutic treatment of the elderly are general contraindications to physiotherapy, hypertrophic changes in internal organs, the presence of severe chronic diseases, concomitant diseases in the acute phase, decompensation and severe violations of the functional properties of organs and systems.
In elderly and senile patients, almost all therapeutic physical factors can be used, taking into account generally accepted contraindications. However, multiform age-related changes and features of the clinical picture of diseases characteristic of such patients necessitate compliance with the general principles and features of physical methods of treatment and physical prevention in patients of older age groups.
Courses of physiotherapy methods must be prescribed according to gentle regimens (especially at the beginning of treatment) due to the reduced reactivity of the aging body and impaired adaptive-compensatory mechanisms of organs and systems. The intensity and duration of procedures in elderly patients have characteristics. For example, in patients of this age, massage of reflexogenic zones and acupressure are preferable; among mud treatments, it is advisable to use mitigated techniques, galvanic mud and electrophoresis of mud solutions, use baths of lower concentrations, often in the form of half-baths and chamber baths for 2 days in a row with a break for third.
The number of procedures per course of physiotherapy treatment in elderly and senile age is increased to 15-20 - mainly low-intensity factors (instead of 10-12 procedures in young and middle-aged people), since the processes of sanogenesis and restoration of skin turgor in such patients, especially in the presence of disorders metabolism and neuro-humoral regulation proceed slowly. The use of cyclic treatment options in such patients is justified - 2-3 short (4-6 procedures each) courses, repeated at short (2-3 weeks) intervals. Due to imperfect regulation and weakening of compensatory-adaptive reactions after procedures, such patients must rest for a longer time (1-1.5 hours).
Due to the multiformity of diseases in older people and the close relationship between the condition of the skin and internal organs, it is necessary to identify the main and concomitant diseases and use a syndrome-pathogenetic approach to prescribing therapeutic physical factors. The prescribed methods of physiotherapy should be effective not only for the main disease, but also for concomitant diseases. The aging process necessitates complex treatment with physical factors. At the same time, due to reduced adaptation reserves in elderly people, combinations of no more than two physical factors, mainly general and local action, should be used.
Sanatorium-resort therapy in the elderly and senile age
Elderly patients are sent for sanatorium-resort treatment for their underlying disease, mainly to local sanatoriums of the appropriate clinical profile. This is due to increased meteo- and chronolability of older people who are prone to the formation of physical reactions caused by:
age-related changes in neurohumoral regulation,
frequent development of chronic pathological processes, significantly reducing the adaptive capabilities of the aging organism and the adequacy of its reactions to changing environmental factors.
To prevent meteorological reactions, along with the prescription of medications (analgesics, sedatives and other drugs), some sedative and psychorelaxing physical treatment methods are used in local sanatoriums.
Features of physiotherapy in elderly and senile people
In an elderly body, the pharmacokinetics and pharmacodynamics of drugs change, which leads to an increased risk of toxic manifestations, unwanted accumulation and side biological effects of drugs on the body, a weakening of the interaction between individual drugs and increased sensitivity to certain drugs. These phenomena significantly affect the treatment strategy for elderly patients and the prognosis of the therapeutic effects of complex exposure to factors.
In older people:
the regulatory activity of the central nervous system, including the cortex, subcortical formations and especially the higher centers of the neuroendocrine system - the hypothalamus and pituitary gland, is significantly weakened;
the mobility of excitation and inhibition processes in the cerebral cortex, the activity of the central and peripheral parts of the autonomic nervous system decreases,
its trophic function is inhibited
and the sensitivity of the molecular receptors of various cells is distorted, which increases the likelihood of inadequate reactions of the body to generally accepted doses of physical factors.
In older people, it is also more difficult to develop conditioned reflexes, which significantly weakens the neuro-reflex reactions of such patients to physical therapy.
What aspects need to be taken into account when doing physiotherapy for older people?
An increase in the sensitivity of cells and tissues to mediators and hormones leads to an increase in the proportion of the humoral component in the response of the aging body to physical factors. Pronounced changes occur in all parts of the body's humoral regulation: the secretory function of most endocrine glands and the hypothalamic-pituitary regulation of their activity decreases. In humans, the sensitivity of the endocrine glands to tropic hormones increases, the concentration of bound forms of hormones in the blood decreases, which leads to a weakening of their functional activity. Endocrine changes in old age cause age-related metabolic disorders, immunological deficiency and autoimmune disorders, which leads to synchronous inhibition of the mechanisms of formation of the body's systemic adaptive response.
The internal organs and systems of the body also undergo serious age-related changes. The hemodynamics and cardiac activity of patients change significantly:
exercise tolerance decreases,
contractile and diastolic functions of the myocardium,
minute and stroke volumes of the heart decrease,
cardiac index.
All this significantly limits the adaptive capabilities of the cardiovascular system, which the action of a whole group of cardiotonic methods of physiotherapy is aimed at increasing. Hemodynamics also change in elderly patients: total peripheral resistance increases, which, combined with a decrease in the number of functioning capillaries, leads to an increase in blood pressure. With age, the inertia of reflex reactions of the cardiovascular system and the sensitivity of the heart and blood vessels to hormones and mediators increase. Macrohemodynamic shifts change local blood flow in organs and tissues, worsening their transcapillary exchange and oxygen supply, and provoke inadequate reactions of the body mainly to thermo- and hydrotherapeutic methods of physiotherapy.
Age-related changes in other organs and systems of the body, which are manifested by degeneration of their constituent tissues, lead to a progressive decline in their functions. These changes significantly reduce the degree of adaptive and compensatory capabilities of the aging body and sensitivity to various medications and physical therapy methods. Implemented with success in other cases, increasing the intensity of the influencing physical factors in order to achieve the necessary therapeutic effect is unacceptable here due to the danger of provoking pathological reactions that deteriorate the well-being and functional state of older people.
Elderly people, as a rule, have not one, but several diseases. In women over 60 years of age, the average number of diagnosed diseases exceeds five nosological forms, and in men - four. Often these diseases are pathogenetically related to each other and have a common cause - a violation of the central mechanisms of regulation of functions.
In addition, elderly people are characterized by significant deviations from the classical picture of diseases: smooth clinical manifestations, unresponsiveness and atypicality. At the same time, the severity of the symptoms of the disease often does not correspond to the severity of the damage to the body. Elderly people often show a tendency towards a slow increase in pathological processes, which causes the latent course of diseases, their widespread asymptomatic nature, protracted nature and chronic course.
The processes of sanogenesis and restitution (restoration and recovery) in old age occur more slowly, are less perfect, and are protracted, which requires more attention and persistence in treatment. The combination of pathology, the difficulty of monitoring the progress of treatment, frequent symptoms of depression and dementia, a wary attitude or rejection of doctors’ recommendations create significant difficulties in carrying out adequate treatment measures in geriatric patients.
Finally, age-related changes in the nervous system of physical therapy initiate progressive mental disorders in patients, which must be taken into account when prescribing physical methods of treatment. Deviations in the psyche of elderly patients can be caused by both age-related changes and personality changes associated with various vascular and tumor lesions of the brain and mental illnesses. Such patients are characterized by extra- and introversion, a narrowing of the range of interests and a kind of conservatism, a decrease in the emotional coloring of cortical processes, an increase in egocentrism, etc.
The role of the skin in physiotherapy in old age
In the process of aging and prolonged exposure to unfavorable factors (frequent hypothermia when working outdoors, constant chapping, prolonged exposure to direct sunlight, etc.), degeneration of collagen fibers and gradual inhibition of differentiation of the basal layer of the epidermis occur. The skin becomes thinner, its tightness, sensitivity and elasticity decrease, the number of its derivatives and epithelial permeability change. With severe atrophy, superficial small grooves in the form of a mesh appear in the skin and it loses its barrier, thermoregulatory and excretory functions. Extracellular dehydration and atrophy of the dermis involves elastic, epithelial, vascular, muscle and bone elements. Fibrous hypertrophy of interstitial connective tissue and subsequent weakening of the collagen “framework” lead to a decrease in skin elasticity, excess skin on the face and neck, and the formation of deep wrinkles. Stretched, flabby skin in old age can occupy an area 2 times larger than before.
Exposed areas of the body (face, neck, hands) are most often affected.
The skin in these areas becomes dry, rough, thickened, rough and takes on a bronze color.
Its relief significantly increases, telangiectasias appear, which, together with hyper- and depigmented areas of the skin, form a motley clinical picture.
The picture of an aging face in old age is often complemented by drooping cheeks, the appearance of excess skin folds on the neck, in the upper and lower eyelids, and so-called fatty hernias of the eyelids - xanthomas.
Premature aging of the skin and the appearance of wrinkles in people of relatively young age (30-35 years old and earlier) occurs mainly as a result of diseases of the internal organs: gastrointestinal tract, liver, kidneys, metabolic disorders, as well as nervous disorders. Here it is appropriate to recall the statement of the outstanding Russian pathologist I.V. Davydovsky (1969) that “...the aging process is not caused by the aging of the cells themselves, but by the “aging” of the environment in which they are located.” The anatomical and physiological characteristics of facial skin clearly demonstrate the role of functional connections in the development of aging and fading of the skin of the face and body as a whole.
It is known that skin and muscles initially undergo aging, and much later vital organs (heart, brain, liver). This happens because the pathogenesis of skin withering and aging is based on the same type of pathophysiological mechanisms caused by disorders of microcirculation of the skin and blood vessels of the subcutaneous base and skeletal muscles. They manifest themselves in the form of vasoconstriction of arterioles and capillaries, which leads to ischemia and venous-lymphatic stagnation in tissue structures. Stagnation of interstitial fluid causes hypoxia and acidosis, which aggravate regulatory and metabolic disorders of tissue function. These vascular disorders are most pronounced in the skin, which has weak vascularization and is therefore extremely “sensitive” to microcirculation disorders.
The triggering mechanisms for the processes under consideration are chronic psycho-emotional stress, physical inactivity, inadequate nutrition and diseases of internal organs. Due to the fact that the skin plays a “trigger” role in the mechanism of action of many therapeutic factors, its age-related changes significantly influence the formation of their physiological and therapeutic effects of physiotherapy.
The word “physiotherapy” translated from Greek means “treatment by the forces of nature.” In the modern understanding, physiotherapy is an area of clinical medicine that is directly related to balneology. Physiotherapy provides therapeutic, restorative and preventive effects by stimulating natural protective reactions and normalizing impaired body functions. Physical factors have a beneficial effect on the processes of compensation and adaptation of the cardiovascular, respiratory, immune, endocrine and other systems in the elderly.
Modern physiotherapy has dozens of natural and preformed (artificially created) physical factors, which can be divided into the following groups:
1. Low voltage electric current:
a) galvanization,
b) electrophoresis,
c) diadynamic therapy,
d) amplipulse therapy,
e) fluctuarization,
e) electrosleep,
g) electrical stimulation.
2. High voltage electric current:
a) franklinization,
b) darsonvalization,
d) TNC ultratonotherapy.
3. Electric and magnetic fields:
a) inductor,
b) UHF therapy,
c) UHF inductothermy,
d) microwave therapy,
d) EHF therapy,
e) magnetic therapy.
4. Mechanical vibrations:
a) vibration,
b) ultrasound.
5. Light:
a) infrared rays,
b) visible light,
c) ultraviolet rays,
d) laser.
6. Artificial air environment:
a) aeroionotherapy,
b) hydroaeroionotherapy,
c) aerosol therapy,
d) electroaerosol therapy,
e) speleotherapy, halotherapy.
7. Barometric gas pressure:
a) Kravchenko camera,
b) hyperbaric oxygenation,
8. Heat therapy:
a) paraffin,
b) ozokerite,
c) paraffin-ozokerite mixture,
d) naftalan,
d) healing mud,
e) medicinal peat,
g) heated sand,
h) sauna.
9. Hydrotherapy:
a) fresh water,
b) medicinal baths,
c) mineral baths,
d) drinking mineral waters.
10. Puncture physiotherapy.
11. Herbal medicine.
12. Apitherapy, hirudotherapy.
Most of the listed physical factors can be used for therapeutic, restorative and preventive purposes in elderly and senile people. Age does not affect contraindications for physiotherapy, but its use in geriatrics has its own characteristics. The most important of them are the following:
1. When treating elderly and elderly people, the dose of physical exposure should be reduced by 30-50%. This is expressed in a decrease in power, intensity, current, magnitude of magnetic field induction, temperature, area of influence, duration of the procedure, and the total number of procedures per course of treatment. In geriatrics, “non-stress” physical factors are used that do not cause significant changes, primarily in the cardiovascular and respiratory systems.
2. In geriatrics, preference is given to the use of local methods of influence.
3. During the day, the patient can take no more than two physiotherapeutic treatments. Their simultaneous use is not recommended.
4. When prescribing two physical procedures, the interval between them must be at least 3 hours.
5. Careful multi-stage monitoring of the body’s reaction to the use of physical methods of influence is necessary. The nurse assesses the patient's functional status during the procedure. The physiotherapist prescribes repeat examinations every 2-3 procedures to make the necessary corrections in the treatment method. The attending physician monitors the patient's condition constantly.
6. When prescribing physiotherapeutic methods of treatment to elderly and senile people, it is necessary to take into account the high probability of precancerous processes and oncological diseases in them.
Each of the physical factors acts on certain parts of the pathological process. Therefore, for the same disease, different methods of influence can be used. The art of the doctor is to choose the optimal one, taking into account the mechanism of action and the individual characteristics of the patient: stage of the disease, previous treatment, concomitant diseases, etc.
All physical factors have their own application characteristics, especially for elderly and senile patients.
When carrying out galvanization and medicinal electrophoresis, it is necessary to take into account that the skin of older people contains fewer sweat and sebaceous glands through which galvanic current penetrates, has reduced elasticity and turgor, often with trophic disorders. Therefore, it is necessary to protect it from electrolysis products: for this purpose, the gaskets must be at least 1 cm thick, and the electrodes must be well smoothed and even. Galvanization according to the methods of Shcherbak, Vermeule, four-chamber galvanic baths are indicated for the treatment of diseases of the peripheral nervous system, peripheral vessels and cerebral vessels, diseases accompanied by autonomic disorders and sleep disorders.
When conducting electrophoresis of medicinal substances, especially potent ones, the dose should be reduced by 2-3 times. To do this, use lower concentrations in solution. It is known that during electrophoresis, a depot of a medicinal substance is formed in tissues, which, as a result of deterioration of microcirculation in older people, is absorbed slowly. Therefore, the electrophoresis procedure, especially for potent substances, should be carried out more rarely: every 1-2 days, and sometimes 1-2 times a week. Medicinal electrophoresis is most often used to treat “local” diseases. Indications are determined primarily by the trophic effect of galvanic current and the pharmacological properties of the medicinal substance used.
Pulse currents (DDT, SMT)- widely used in geriatrics for diseases with pain syndrome, as well as to normalize the tone of striated and smooth muscles, improve blood circulation in the affected area. Their use is especially indicated in degenerative-dystrophic processes of the musculoskeletal system. In this case, preference is given to CMT therapy, which is easier to tolerate by patients, less irritates the skin, and improves tissue trophism. In the case of the use of DDT in geriatrics, full-wave currents are more indicated.
Electroson- prescribed for elderly and elderly people with atherosclerosis of cerebral vessels, neuroses, neurasthenia, hypertension I-II degrees, bronchial asthma, neurodermatitis. In geriatrics, pulse current frequencies from 5 to 30 Hz are used.
D'Arsonval currents, ultratonotherapy - have a wide range of applications in geriatrics for the treatment of varicose veins, skin itching, trophic ulcers, neuritis, periodontal disease.
Inductothermy- is a rather stressful thermal procedure, so its use in geriatrics is limited.
UHF therapy- Elderly and senile patients undergo this procedure using low-power devices in non-thermal and low-thermal dosages. The main indication for its use is acute inflammatory processes of various localizations. The course of treatment is 3-5 procedures.
In the treatment of chronic inflammatory and degenerative dystrophic processes, especially during exacerbation, microwave therapy - the use of an ultra-high frequency electromagnetic field - has a positive effect. Treatment is carried out in non-thermal and low-thermal dosages.
EHF therapy- has found wide application in the treatment of gastric and duodenal ulcers, purulent diseases, hypertension, and coronary heart disease.
In geriatric practice, it has a good effect in the treatment of many diseases. magnetotherapy- use of low frequency alternating magnetic field. This method is non-stressful, has a hypocoagulating effect and improves microcirculation in tissues. Therefore, the main indications for magnetic therapy are vascular diseases of various organs.
In medical practice, ultrasound - elastic vibrations in gases, liquids and solids, the frequency of which exceeds 20 kHz - is used in various frequency ranges for therapeutic and surgical treatment and diagnosis. Due to its non-load-bearing nature, it can be widely used in geriatrics for diseases accompanied by excessive development of connective tissue: adhesions, chronic inflammatory and degenerative diseases. In this case, preference is given to ultraphonophoresis of various drugs that enhance the effect of ultrasound.
Infrared rays, Solux, light baths have a pronounced thermal effect, create a load on the cardiovascular system, and therefore are not widely used in geriatrics.
The use of local and especially general ultraviolet irradiation in the treatment of elderly and senile patients should be reduced due to their lack of effectiveness and oncological alertness.
Laser irradiation, on the contrary, can often be used in geriatrics, especially for the treatment of trophic ulcers, wounds, degenerative-dystrophic diseases of the musculoskeletal system: spinal osteochondrosis, deforming arthrosis and other joint diseases. The single dose of laser energy per procedure should be reduced by 30-50%.
Application of negatively charged ions of air and water - aeroionohydroaeroionotherapy- improves the functions of the ciliated epithelium of the respiratory tract, therefore it is widely used for the treatment of chronic nonspecific lung diseases. In the treatment of these diseases, especially bronchial asthma, speleo- and halotherapy are indicated.
When carrying out inhalations, it is necessary to remember that medicinal substances in the form of aerosols are quickly absorbed in the lungs, immediately entering the pulmonary circulation. Therefore, the dosage of medications for elderly and senile people should be reduced by 2-3 times. This method is most often used in the treatment of respiratory diseases.
In the treatment of obliterating diseases of the arteries of the lower extremities in elderly patients, local Kravchenko pressure chamber, in which it is possible to periodically change the air pressure and thereby improve blood circulation in the extremities.
Hyperbaric oxygenation- indicated for the treatment of ischemic diseases in the elderly. The oxygen pressure in the pressure chamber is not recommended to exceed 0.5 atm.
Thermotherapy- assigned to small areas of its application. Various coolants are widely used for thermal effects on the body. Paraffin-ozokerite (mountain wax) applications work well at a temperature of 45-50°C in the form of a molten mass. Therapeutic mud - used in the form of galvanic mud, with a temperature of 38-42°C. Indications for heat therapy are diseases of the support and movement organs.
Hydrotherapy- external use of water for therapeutic and prophylactic purposes. Hydrotherapy procedures include showers, baths, and washing with fresh and mineral water. It is recommended to take a shower for 2-3 minutes as a procedure. Baths are prescribed with minimal concentrations of chemicals and indifferent temperatures. The time for taking the first bath should not exceed 5-7 minutes. Water procedures are prescribed no more than three per week. Their main goal is secondary and primary prevention and rehabilitation treatment.
In geriatrics, the so-called reflex therapy is most often used - corporal and auricular acupuncture, lately su-jok. Most often, biologically active points of local influence are used for acupuncture. During the first procedure, no more than 2-4 points are used, the number of which is increased to 8-10 in subsequent sessions. Acupuncture is usually performed every other day and only daily for the treatment of acute diseases. The course of treatment ranges from 8 to 12 sessions. When treating chronic diseases, repeated shorter courses are desirable.
Biologically active points can be affected not only by inserting needles. The so-called puncture physiotherapy, i.e. the impact of physical factors on biologically active points: electric current, laser, magnet, light, vacuum, acupressure. They are less stressful and easier to tolerate for patients.
Massage- in the treatment of elderly and old patients, gentle techniques using mainly stroking and rubbing techniques are very effective. General massage is not prescribed; segmental massage is used according to strict indications; however, local and acupressure massages are widely used.
Medicinal plants have been used to treat patients since ancient times. In folk medicine herbal medicine More than 2,500 medicinal herbs are used, which are prescribed in the form of infusions, decoctions or tinctures. The raw materials are first crushed: leaves and flowers to a size of no more than 5 mm, roots - no more than 3 mm, fruits and seeds - no more than 0.5 mm. In geriatrics, medicinal herbal collections are often used to treat several diseases. To prepare the infusion, brew a tablespoon of raw material with 200 ml of boiling water, close tightly and leave for 45 minutes. To obtain a decoction, the raw materials are boiled in the same proportion in a water bath for 30 minutes, then cooled to room temperature and filtered. A quarter or a third of a glass of infusion or decoction is prescribed for the appointment. To prepare the tincture, the crushed raw materials are poured with 96° alcohol in a ratio of 1:10 and left for 10 days. Apply drops.
Doctors pay special attention to such waste products of bees as honey, poison, propolis, royal jelly, beebread, bee pollen, and wax. They are considered gerontological remedies. Thus, pollen contains many biologically active substances and, having versatile medicinal properties, is used to treat a number of diseases. That's why apitherapy in geriatrics is very promising. Honey, as a remedy, is prescribed for diseases of the gastrointestinal tract, cardiovascular, nervous systems, and colds: at the rate of 1 tablespoon of honey per glass of water. Often combined with herbal medicine. For joint diseases, compresses are made from honey or honey water. In ophthalmic practice, solutions of honey in distilled water are used in the proportions of 1:3, 1:2, 1:1 for instillation into the conjunctival sac. Propolis, or bee glue, has pronounced antimicrobial properties and is a good adaptogen. Propolis is prepared by dissolving it in alcohol in a ratio of 1:5. In drops it is used to treat sore throats, atherosclerosis, bronchial asthma, gastritis, senile hearing loss and other diseases. Bee venom in the form of bee stings is prescribed in geriatrics for the treatment of diseases of the nervous system, joints, bronchial asthma, hypertension, and enderteritis.
Renaissance occupational therapy primarily due to the need for a number of diseases to introduce into the blood biologically active substances produced by medicinal leeches. The main indications for their use are cardiovascular diseases, increased blood clotting, etc.
The patient's age is not a contraindication for sanatorium treatment. When conducting medical selection of patients for referral to a sanatorium, they are guided by existing indications and contraindications for spa treatment. Elderly people are advised to undergo treatment in local sanatoriums and sanatoriums, since they do not tolerate changes in climatic conditions at certain resorts.
Old man more than others, he is susceptible to various types of injuries and diseases, leaving him on bed rest for a long time. This further reduces the body’s resistance to various types of infections and aggravates the existing pathology.
Basic principles of rehabilitation measures in this period are:
- Improving blood circulation both locally in the area of damage and throughout the body;
- Prevention of bedsores and blood clots;
- Prevention of the development of congestive pneumonia;
- Prevention of contracture formation;
- Normalization of the gastrointestinal tract;
- Maintaining a good emotional background.
Physiotherapy in old age begins after the severity of the process has been relieved and is the second stage of rehabilitation, connected to kinesiotherapy. It is important to consider how to reduce the dosage of medications at this age, as well as the intensity and duration physiotherapeutic procedures must be adjusted in accordance with all pathological conditions of the body. Must be cancer alertness. In old age, the frequency of malignant diseases increases, often occurring without a typical clinical picture. Before starting physical therapy, it is necessary to conduct a complete examination of the patient to exclude this type of pathology.
Features of physiotherapy in old age:
- The intensity and duration of the procedure are reduced, especially in the first days of the disease;
- No more than two methods are used, subject to their alternation;
- Procedures are prescribed every other day, reducing the duration, but increasing the number of procedures themselves. So, if a course of treatment usually requires 10-12 procedures, in old age 15-20 are prescribed;
- It is necessary to take into account the thinness of the skin and when carrying out medicinal phoresis, use thicker pads than usual;
- The dosage of the drug during electro- and phonophoresis should be reduced;
- It is not recommended to use thermal procedures for rehabilitation in the first weeks of the disease, as this can cause a paradoxical reaction of the body, manifested in a sharp increase in blood pressure and impaired circulation;
- Local and general darsonvalization, amplipulse therapy, franklinization, decimeter waves, alternating pulse currents are considered the most physiological at this age.
- Features of physiotherapy depending on the pathology
For stroke, fractures and other traumatic injuries of the musculoskeletal system prevention of development is very important contractures and muscle atrophy. This is the main problem that physical therapy helps solve.
Allowed for stroke: electromyostimulation, laser therapy, phonophoresis, DDT.
After fractures and injuries a good effect is observed from interference currents, ultraviolet irradiation, electrophoresis of drugs, myostimulation, and ultrasound.
For diabetes First of all, microcirculation is disrupted and damage to the distal parts of the nervous system is noted. For rehabilitation therapy, the following are indicated: magnetic therapy, phonophoresis of drugs, ultrasound, darsonvalization, chamber baths.
1. Features of the course of diseases of various organs and systems in elderly and senile people.
2. Features of nursing care for elderly and senile patients
3. Boarding homes for the elderly. Features of the work of a nurse.
Geriatric problems require broad participation of the public, health authorities, social security, etc.. This entire set of measures, with appropriate coordination, is important for organizing services for people in older age groups, and the role of the nurse should be given particular importance. Awareness that the basic principle in relation to geriatric The patient must be respected; this is an urgent problem of adequate care for elderly patients.
Geriatrics is a science that studies the patterns of the course of diseases and their treatment in elderly and older people.
Old age is a stage of development of the body. ;
A disease is a disability that can occur at any age.
This is the relationship between these two concepts. Old age is not a disease. These two concepts cannot be confused. The disease in most geriatric patients is associated with natural age-related changes. They often progress for a long time without any noticeable pain. And only some additional factors can lead to a clear manifestation of the disease. Such factors include excessive physical activity, infectious diseases, colds, and stress.
Elderly people are characterized by a multiplicity of pathologies. A detailed examination can detect changes in various body systems. The pathology of older people is compared to an iceberg, in which 6/7 of its volume is hidden under water. The patient's complaints indicate the tip of this iceberg. Detailed questioning and examination of the patient allows you to see the entire “iceberg”.
Diseases of the elderly
On average, at least five diseases can be detected simultaneously in an old person. More often, atherosclerosis of the vessels of the heart and brain, arterial hypertension, chronic bronchitis, tumors, prostate hyperplasia, diabetes mellitus, mental depression, cataracts, hearing loss, etc. are combined.
Features of the course of diseases of various organs.
l Geriatric patients may suffer from diseases that began in their youth. But acute diseases, including infectious diseases, can also arise in them. The age-related characteristics of the body leave an imprint on these diseases. Their features will be: atypicality, absence of clear manifestations of the disease.
Diagnosis, treatment, and care for older patients have their own characteristics and often the methods that are used in young patients are not used in older people. The reasons for this are as follows:
1. Often masked course of pneumonia, myocardial infarction, pulmonary tuberculosis, diabetes mellitus, tumors. Other mechanisms of disease development (ulcers in atherosclerosis). Hidden course of catastrophes in the abdominal cavity, which requires urgent surgical intervention. The severity of the damage to the body does not correspond to the mild symptoms of the disease.
Methodology for collecting anamnesis and examination features of older patients. Clinical manifestations of the disease and mental characteristics of an older person require certain features in conducting a survey and examination of the patient. Age-related changes affect the psychology of an old person, his orientation in the environment. Interview with a patient who has a violation of several systems. lasts much longer, like interviewing a young person. It must be taken into account that an old person has decreased hearing, vision and generally a slower response. n If the patient always wears glasses or a hearing aid, then these auxiliary things should be used during the interview.
Conversation with a geriatric patient
You must speak clearly, slowly, and do not shout into the patient’s ear. The face of the person conducting the survey should be sufficiently illuminated, since the movement of the lips during conversation to a certain extent helps the patient understand the speech addressed to him. Sometimes hearing loss can be caused by the presence of wax plugs in the ears. Therefore, after deleting their survey, it is advisable to repeat it.
If the patient comes with relatives, then first you need to talk with them (but in the absence of the patient). This makes it possible to identify the patient’s personality traits, his relationships with relatives, and the family’s capabilities in the problem of providing home care for the patient. If there are changes in the psyche, the patient must be interviewed with the participation of relatives.
The classic history form for an old person is: u
1) survey on systems
2) previous diseases, operations
3) family history
4) social
5) power mode
6) treatment,
7) psychiatric and sexual history.
Social history allows you to find out the following points:
1) place, living conditions
2) family composition, relationships with relatives
3) contact with friends and acquaintances
4) does he receive help from social services?
5) performance, job satisfaction. Find out from those who are not working how they experienced the termination of their work activity.
6) Attitude towards the death of a spouse, if this happens, there is no tendency towards self-isolation or loneliness.
The diet consists of the following questions:
1) frequency of meals, incl. hot food
2) balanced diet (proteins, fats, carbohydrates)
3) diet in the past and present
4) prepares his own food
5) can chew, presence of dentures
6) did not lose weight
7) whoever buys food has to go far for groceries.
Psychiatric history:
pay attention to the presence of mental illness in relatives,
find out if there is a depressive syndrome or suicidal thoughts.
Sexual history
can only be collected if a relationship of trust is established during the survey.
Features of nursing care for elderly and old patients
General care for elderly and elderly patients is more complex and requires more attention and time from medical staff than regular care. The concept of "care for the sick" includes not only physical care, but also the restoration of impaired mental and physical functions, the maintenance or development of the patient's social ties with the family and community to which he can return, and the medical or social care institution to which he is in.
The basic principle of care is
respect for the patient's personality,
accepting him as he is, with all his shortcomings (physical, mental, irritability, mental disorders). The nurse should know that these deficiencies in most cases are a manifestation of illness, not old age, and appropriate care can improve health.
Urinary system
During the aging process, the function of the urinary apparatus and kidney function change significantly. The concentrating ability of the kidneys decreases and, as a result, nocturnal diuresis increases compensatoryly. In addition, nocturnal diuresis can be a consequence of irritation of the bladder sphincters, prostate hypertrophy in men, and heart failure in cardiac patients. It is necessary to find out how often the patient passes out at night for diuresis, to what extent this disturbs sleep, and give him nighttime dishes.
If you have frequent nocturnal diuresis, you can advise the patient to drink immediately before bedtime, but this must be done carefully, because reducing fluid administration to less than 1/24 hours can lead to general intoxication (accumulation of metabolic products).
Hygienic bathing for elderly patients
· There are accidents when bathing in a bath: a slippery bathtub, a slippery floor, loss of consciousness from too hot water, a heart attack, etc. Therefore, an old person should be warned that first the bathtub is filled with water, the temperature is adjusted to the required temperature, and then you can sit in bath
· In general, in geriatric practice it is better to use a shower rather than a bath. Depending on the condition, the patient takes a shower standing, sitting, or is washed by staff on a special couch in a warm bathroom. . No need to take a shower >35°, direct the hot stream to your head.
· Supports, rubber mats, emergency alarms are mandatory bathroom equipment. The presence of a health care worker when bathing a patient is desirable, and in some cases cases - mandatory. The bathtub should not be closed from the inside.
Caring for patients on bed rest:
Prolonged bed rest leads to significant changes in structure and function, the occurrence of complications such as hypostatic pneumonia, thrombus embolism, urinary tract infection, bedsores, decreased appetite, general weakness. Patients experience muscle atrophy, increased calcium excretion, decreased joint mobility, and constipation. , insomnia, mental disorders, depression. The cardiovascular system is especially affected. Due to physical inactivity, detraining the adaptive capabilities of the heart and blood vessels with corresponding symptoms (palpitations, shortness of breath) quickly decrease.
Defecation
· Elderly and old people often experience constipation. Sometimes linked to food that does not include ballast substances (vegetables, fruits, wholemeal bread), physical inactivity, fluid restriction, and medication. In the treatment of constipation, it must be taken into account that enemas in old people more often cause irritation of the intestines than in young people. The same applies to rectal suppositories.
Rehabilitation and physiotherapy.
Rehabilitation is a restorative therapy, its components:
1) medical - treatment of the patient
2) psychological- removal from a state of depression, reactive neurosis,
3) social - restoration in the family, society
4) labor - partial or complete restoration of working capacity.
Metabolism of drugs in the old body.
1. Due to structural and functional changes in the gastrointestinal tract, the absorption of medications decreases with age. Therefore, medications taken orally enter the body in smaller quantities.
2. Drugs administered by injection also begin to act much later and less intensely due to the fact that their absorption is slowed down
The release of medications from the body also slows down with age. The reasons for this phenomenon are a decrease in the excretory function of the kidneys.
3. Weakening the intensity of metabolic cycles of the liver and skin.
4. Decline detoxification liver functions.
5. Weakening the activity of enzyme systems.
Principles of pharmacotherapy in geriatrics
1. Inadmissibility of polypharmacy.
2. Treatment of the underlying disease.
3. The adverse effects of drugs on the body are higher in older people than in young people.
4. In old age, adaptation to toxic substances is significantly reduced.
5. Doses of antibiotics and antibacterial drugs are not reduced.
6. To prevent honey. and intoxication, monitor proper nutrition and sufficient drinking regime.
7. Due to addiction to sleeping pills, painkillers, sedatives, it is recommended to often replace each other.
8. It is advisable to use a complex of various drugs in low doses, which act similarly, but on different chains of the disease.
9. There is often the possibility of an allergic reaction to medications.
Geriatric drugs are a group of medications that affect the aging body through a general stimulating effect, normalization of impaired metabolism and body functions, and increase the tone and trophism of the central nervous system. To them
2) Microelements (copper, zinc, cobalt, potassium, etc.).
3) Novocain.
4) Thyroid hormones, anabolic.
5) Tissue stimulators (placenta, FIBS).
6) Apilakatherapy (0.01 2 times a day under the tongue for 20 days).
7) Adaptogens (take extract from ginseng root, eleutherococcus, dibazol (0.01 / day).
Side effects of drugs on the old body.
Barbiturates
Diuretics
Aminazine, regitin
Salicylates, NSAIDs
Antibiotics, sulfa drugs
Glucocorticoids
anticholinergic , antispasmodic drugs
Adrenaline and other adrenergic agonists
· Thus, geriatric problems require broad participation of the public, health authorities, social security, etc.. This entire set of measures, with appropriate coordination, is important for organizing services for people in older age groups.
Particular importance should be given to the role of the nurse. Awareness that the basic principle in relation to geriatric The patient must be respected.
· The problem of adequate care for elderly patients is urgent.
Biology of aging. Gerontology as a science. Boarding homes for the elderly.
The social phenomenon of population aging emerged in the second half of the 19th century in industrialized countries, in which the number of elderly people almost doubled. This caused serious economic, social and psychological changes in society and gave impetus to the development of new scientific disciplines, in particular social gerontology and geriatrics.
¡Gerontology is the science of old age, the aging of an individual, its biological mechanisms, rates, characteristics, factors, etc.
It is necessary to clearly distinguish between the concepts of aging and old age.
l Old age is the natural onset of a period of age-related development.
l Aging is a destructive process that occurs as a result of the damaging effects of external and internal factors increasing with age, which leads to a lack of body functions.Aging leads to limited adaptation of the body and the development of age-related pathology.
There are 3 periods in a person's life.
1. growth period - up to 20 years.
2. reproductive (up to 45 years)
3. aging.
External signs of aging:
1) change in body shape and physique
2) slowdown and lack of coordination
3) rapid mental and physical fatigue
4) decreased performance
5) the appearance of wrinkles on the face
6) hair loss, graying of hair
7) decreased visual acuity and hearing
Internal signs of aging:
1) decreased activity of conditioned and unconditioned reflexes
2) muscle strength and muscle tone
3) deterioration in the activity of sucking, digestive organs, excretion
4) suppression of the immune defense system
5) disturbances in the body’s adaptation to the effects of painful factors.)
Age periods
(WHO classification)
· 1. childhood
· 2. youth
· 3. youth
· 4. mature age - 40-44 years,
· 45-59 years - average age 60-74 years - elderly, 75-90 years - old, 90 years and older - long-livers.
Biology of aging: human aging is a natural biological process determined by its individual, genetically determined development program. During a person's life, some of the constituent elements of his body age and new ones arise.
The general development of the human body can be divided into 2 periods: ascending (it ends with the period of full maturity of a person) and descending (it begins at the age of 30-35). From this time on, various types of metabolism and the state of the body's functional systems gradually change, which inexorably leads to a limitation of its ability to adapt, and the likelihood of pathological processes, acute diseases and death increases.
Problems of gerontology require broad public participation, organs health, social security, etc.
This whole set of measures with appropriate coordination is important for organizing homes - boarding schools, boarding houses and hospice for people elderly and senile age.
IN these institutions specialists should work who, in conditions multimorbidity with age-related involutive lesions could provide appropriate qualified medical care.
Age-related features of the use of physiotherapy in the treatment of children
Doctors have thousands of medications at their disposal, which are of great benefit in the treatment of many diseases, but with many advantages, almost all medications can have adverse side effects. In relation to children, we are primarily talking about allergic reactions - undesirable reactions, first of all, can be caused by antibiotics, antipyretics and a number of other drugs. Hormonal drugs cause atrophy of the gland to which the action of the hormone is directed.
Today there is not a single area of medicine, not a single specialization, where physiotherapy is not in demand. This is an area that uses natural factors or their reshaped sources. Our body experiences the effects of air, sun and water continuously throughout our lives. A person can and should use their constant influence so that it has the most beneficial effect and stimulates the body’s defenses.
Physiotherapy treatment is based on the therapeutic effects of physical factors (air, water, sun, physical activity) on the body, which not only do not cause allergic reactions in most cases, but themselves have a pronounced anti-allergic effect. The only exceptions are inhalation and phoresis of medicinal substances. With properly selected therapy, even with these procedures, the risk of an allergic reaction is minimal.
In pediatrics, all types of physiotherapy are used, somewhat limiting hydrotherapy - children are prone to colds. Along with therapeutic physical training and massage, physiotherapy forms the basis of rehabilitation.
Physical, therapeutic factors have a multifaceted effect on a living organism, causing changes in various functional systems: at the level of molecules, cells, organs and the whole organism. Physiotherapy is also used during the treatment of an acute process, more often in the subacute period, during the period of residual effects for rehabilitation purposes, for the preventive purpose of various diseases, depending on the severity and type of disease, increasing the body's defenses, timely maturation and development of body systems. The use of physiotherapeutic treatment is possible from the first days of a newborn’s life.
However, the technique and methods of conducting physiotherapeutic procedures in children differ markedly from adults - small doses, low current strength, short duration of the procedure must be used: that is, the strength of the stimulus of the therapeutic factor must be adequate to the degree of reactivity of the body.
Physiotherapy, acting through surface receptors on the regulatory system and stimulating the nervous system to normal activity, is physiological.
Among the characteristics of the child’s body are:
- increased excitability of tissues in children.
- immaturity of the brain (completes formation only by the age of 8).
- lability, vegetative resistance, especially in adolescence, tendency to lethargy, drowsiness or overexcitation.
- A child’s body, unlike an adult’s, consists of 80% water, therefore, its tissues are more electrically conductive and can give a stronger reaction.
- Early childhood, especially newborns, is characterized by instability of thermoregulation, therefore, in the neonatal period, the use of heat therapy and wave methods is abandoned in favor of other factors.
- unsettled mental development - the child’s condition and his psychological readiness are always taken into account, therefore the first procedure, as a rule, is carried out as a placebo, i.e. at idle so that the child does not get scared.
- The feeding factor must be taken into account: all procedures should be carried out 30-40 minutes before feeding or 1 hour after.
Age restrictions for the use of certain physiotherapeutic treatments for children:
- Electrophoresis of medicinal substances and galvanization from 2 weeks of age.
- SMT from 6 months of age.
- Diadynamic currents not earlier than 6 months.
- UHF from birth.
- Darsonvalization from 2 years.
- Ultraton from birth.
- Inductothermy from 4 years.
- DMV 1 year.
- SMV 2 years.
- EHF from birth.
- Ultrasound from 3-4 years old, possible from 2 years old with adequate dosage.
- Ultraviolet rays from birth.
- Inhalation from birth.
- Laser radiation from birth, but with great caution due to the instability of the central nervous system.
- Paraffin from birth.
- Ozokerite from birth.
- Photochromotherapy from birth.
- Mud therapy from 6 months of age.
- Transcranial electrical stimulation and Electrosleep - from birth.
- Magnetic therapy from 2-3 years, low-frequency magnetic therapy is possible at an earlier age.
I would also like to note that physical factors should not frighten parents of children. These are some of the safest treatments. Locality, narrow focus of factors, minimal medicinal dosages make physiotherapy often the only possible type of treatment.
