Features of the rehabilitation treatment of a geriatric patient physiotherapy plan. Physiotherapy in the elderly. Physiotherapy in the elderly and senile age Physiotherapy in the elderly and senile age

06.08.2020 Preparations

Old man more susceptible to various types of injuries and diseases, on for a long time leaving him on bed rest. This further reduces the body's resistance to various types of infections and exacerbates the existing pathology.

The main 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 the formation of contractures;
Normalization of the gastrointestinal tract;
Maintaining a good emotional background.

For a positive solution of all these points, complex treatment is used, which includes kinesiotherapy, physiotherapy, work with a psychologist and a psychiatrist (if necessary). Methods kinesiotherapy, including: massage, positional treatment and active-passive gymnastics begin to be carried out for all patients from the very first days of the disease.

Physiotherapy in the elderly begins after the removal of the severity of the process and is the second stage of rehabilitation, connected to kinesiotherapy. It is important to consider both the reduction in dosages of drugs at this age, and the intensity and duration of physiotherapy procedures should be adjusted according to all pathological conditions organism. Must be oncological alertness. In old age, the frequency of malignant diseases often occurs without a typical clinical picture. Before starting physiotherapy, 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 illness;
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 usually 10-12 procedures are required for a course of treatment, 15-20 are prescribed in the elderly;
It is necessary to take into account the thinning of the skin and, when carrying out medicinal phoresis, use thicker pads than usual;
The dosage of the drug for 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 circulatory disorders;
The most physiological at this age are local and general darsonvalization, amplipulse therapy, franklinization, decimeter waves, alternating pulsed currents.
Features of physiotherapy depending on the pathology

myocardial infarction- the most dangerous pathology in physiotherapy with the frequent development of complications. In case of a heart attack at the first stage of rehabilitation, the following are contraindicated: UVI, UST, UHF, infrared ray therapy. At the second stage of rehabilitation, the use of these procedures is allowed under ECG control. Laser therapy and darsonvalization are allowed.

Stroke, fractures and other traumatic injuries of the musculoskeletal system very important to prevent development contractures and muscle atrophy. This is the main problem that physiotherapy helps to solve.

Allowed for stroke: electromyostimulation, laser therapy, phonophoresis, DDT.

After fractures and injuries a good effect is observed from interference currents, ultraviolet radiation, electrophoresis of drugs, myostimulation, ultrasound.

With diabetes first of all, microcirculation is disturbed and damage to the distal parts is noted nervous system. For rehabilitation therapy, the following are shown: magnetotherapy, phonophoresis of drugs, ultrasound, darsonvalization, chamber baths.

Features of physiotherapy in the elderly. A variety of age-related changes relating to various organs and systems, as well as the characteristics of the course of diseases characteristic of elderly and senile people, dictate the need for a number of precautions when using physical factors in complex therapy. Summarizing the available data, we can name a series general principles and features of physiotherapy and physioprophylaxis in older patients age groups.
1. Due to the reduced reactivity of the aging organism, altered activity of receptors, impaired compensatory capabilities of organs and systems in elderly and senile patients, it is recommended to carry out physiotherapy using sparing 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, as a rule, are prescribed every other day, and only local effects with good tolerance and an adequate response to them can be prescribed daily to patients under the age of 70 years.
2. Treatment with physical factors is complex. It should be the same in elderly and senile patients. However, due to reduced reserve capacity, they should use no more than two therapeutic physical factors and mainly according to the method of alternation, and only in rare cases one of them can be of general action.
3. Physical factors are known to have a stimulating effect, and therefore most of them (according to conventional methods) are contraindicated for cancer patients. Since malignant neoplasms in older people are more common and often atypical, 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 above all, when prescribing low-intensity physiotherapeutic effects, the number of procedures per course of treatment should be large (up to 15-20 instead of 10-12 procedures for young and middle-aged people). It should also be considered reasonable to use in elderly patients (primarily in outpatient settings) cyclic exposure options, in which the physiotherapy cycle consists of 2-3 short (4-6 procedures each) courses repeated after short (3-4 weeks) periods of time.
5. With aging, conditions are created for the emergence of polypathology. Therefore, a physiotherapist needs to isolate the underlying disease and, accordingly, choose the leading physiotherapeutic factor. At the same time, when prescribing it, and when other physiotherapeutic procedures are included in the medical complex, the most serious attention should be paid to concomitant diseases. One should strive to ensure that the prescribed factors are indicated and effective not only in the main, but also in other diseases.
6. Due to reduced compensatory capabilities and a higher incidence of inadequate reactions in patients in geriatric practice, preference is given to physical factors of a more physiological and local effect (constant 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 with age in the skin significantly affect its sensitivity to UV radiation, electrolysis products and drugs administered by physicopharmacological methods. For this reason, the dosage of these factors in the elderly is reduced, and thicker pads should be used to protect the skin from the action of electrolysis products during electrophoresis procedures. After the procedure, the skin in the area where the electrodes are located is recommended to be treated with baby cream or glycerin diluted with water.
8. Due to the imperfection of regulation and the weakening of compensatory-adaptive processes after physiotherapeutic procedures, patients of 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 reduced to the following: the dose of medicines for elderly and senile patients in aerosol and electroaerosol mixtures should be reduced by 2-4 times; more adequate and physiological for the elderly 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-dystrophic processes, the use of general UV radiation, as well as infrared and visible rays, should be limited; in persons older than 50-55 years, ultrasound therapy should be carried out under ECG control; from mud therapy procedures, preference is given to mitigated methods of treatment, 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, more often in the form of half-baths and chamber baths, two days in a row with a break on the third; patients over 60 years of age with great caution are recommended to prescribe sulfide and carbonic baths; when prescribing massage for elderly patients, preference is given to the effect on reflexogenic zones, as well as acupressure; during the massage, creams and ointments should be used, and the room temperature should be about 25 ° C.
10. In prevention and treatment premature aging the use of vitamins is of great importance. To a certain extent, this is due to the development of endogenous beriberi in old age. Physical factors (especially mud therapy, phonotherapy, balneotherapy, etc.) in themselves stimulate the metabolism of vitamins and, with prolonged use, can cause vitamin deficiency. Therefore, vitamin therapy should be the usual background for the treatment of various diseases in the elderly and senile age, if therapeutic physical factors are included in the therapeutic complex.
11. Sanatorium-and-spa 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 not only increase the effectiveness of the treatment of elderly patients, but also slow down aging.

Features of the use of physiotherapy exercises in the elderly and senile age

According to the WHO classification, the age of people is divided into middle - 45-59 years old, elderly - 60-74 years old, senile - 75-90 years old, centenarians - over 90 years old. Over the past decades, in our country and in all highly developed countries, there has been a trend towards a steady increase in the number of elderly and senile people. Every year there is an increase in this contingent of patients, which, due to their age characteristics, requires a special approach to the organization of sanatorium treatment.

It is known that people of elderly and senile age are characterized by a number of age-related changes:

atrophic and degenerative-dystrophic changes in organs and systems;
decreased function of vital organs and systems (cardio-respiratory, nervous, endocrine, etc.);
weakening of the adaptive and compensatory capabilities of the body;
progression of atherosclerosis of the cardiovascular system;
a decrease in neuroreflex activity, causing a slow response to the influence of external factors;
impaired coordination of movements;
decreased memory, intelligence, performance; -development of stiffness in the joints.

In addition, the development of age-related involutive processes is greatly accelerated due to physical inactivity. Therapeutic physical culture is a method of pathogenetic therapy of diseases in elderly and senile people and is used to:

improving the function of vital organs and systems (cardio-respiratory, digestive, endocrine, nervous systems, musculoskeletal system, etc.);
increase the vital activity of the body and slow down the aging process.
Positive influence exercise on the body due to:
activation of enzymatic and redox processes;
improvement of trophism and blood supply to organs and tissues;
increasing the adaptive capacity of the body to physical stress;
stimulation of compensatory reactions; - creating a positive emotional background. All these factors also contribute to the removal of neuropsychic stress, strengthening of natural defense mechanisms, improving the parameters of the body's immunological reactivity, the function of the cardio-respiratory system as the basis of life support.

Contraindications for the appointment of exercise therapy for patients of elderly and senile age, in addition to those generally accepted for all age groups, include the following conditions:

diseases internal organs in the acute stage, accompanied by phenomena of pronounced insufficiency of their function;
aneurysm of the heart, aorta, large vessels;
involutional mental disorders with pronounced memory changes, disorientation in time and space, inadequate psycho-emotional reactions to external stimuli, etc.;
pronounced muscle atrophy, gross dystrophic and destructive changes in the musculoskeletal system, significantly limiting the range of motion and preventing exercise therapy.

Purpose various forms Exercise therapy for patients over the age of 70 is carried out exclusively individually and is used under strict medical supervision in a regimen that does not exceed normal household loads. The most acceptable and easily dosed forms of exercise therapy for patients in the elderly and senile age are: morning hygienic exercises, therapeutic exercises and dosed walking.

It is advisable to recommend independent UGG classes, using the previously mastered and familiar complex for the patient, which must first be studied by the exercise therapy instructor and, if necessary, make appropriate changes. UGG can also be carried out by a small group method in gyms, halls or outdoors, preferably with musical accompaniment. When selecting exercises, attention should be paid to the simplicity and accessibility of the complex, to exclude exercises that are strength, isometric, complex in terms of coordination. The complex should be based on elements that include small muscle groups, alternating dosed efforts and relaxation, and breathing exercises. The duration of UGG should not exceed 15-20 minutes.

A feature of the construction of the LG complex is a longer introductory and final part, while the main part should be no more than 40% of the total time. In addition, the LH complex should be built in such a way that different muscle groups are switched on sequentially, and rest pauses and intervals between individual exercises are increased. Exercises with straining, holding the breath, with static tension, power elements, as well as those associated with sudden movements in the joints are excluded from the complex. Motor density of occupations should not exceed 40%. In the final part of the CG, relaxation exercises are mandatory, then passive rest for at least 1.5 hours. Significantly increases the effectiveness of exercise therapy psycho-therapeutic mediation of physical exercises and autogenic training.

The most physiological, natural for a person and accessible type of exercise therapy is dosed walking, carried out in sanatorium conditions along standard routes at a pace familiar to the patient. An increase in the load on the DH route with good tolerance is allowed, mainly only due to the duration, and the change in intensity (tempo) is carried out purely individually, and in exceptional cases and necessarily under medical supervision. The first DH procedures must be carried out under the supervision of an exercise therapy instructor.

It should be noted that when prescribing various forms of exercise therapy, it is necessary to take into account the total load as a result of exercise therapy, taking medical procedures and household loads during the day. In elderly and senile people, “working in” to the load occurs more slowly than in young people, and subjective improvement in health (“motor euphoria”) occurs earlier than improvement in objective indicators. Therefore, during medical monitoring, preference should be given to objective data (ECG, ECG and blood pressure monitoring, biotelemetry, echocardiography).

The word "physiotherapy" in Greek means "treatment by the forces of nature." In the modern sense, 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 disturbed body functions. Physical factors favorably affect 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 conditionally divided into the following groups:

1. Low voltage electric current:
a) galvanization,
b) electrophoresis,
c) diadynamic therapy,
d) amplipulse therapy,
e) fluctuorization,
e) electrosleep,
g) electrical stimulation.

2. High voltage electric current:
a) Franklinization
b) darsonvalization,
d) TNF-ultratonotherapy.

3. Electric and magnetic fields:
a) induction
b) UHF therapy,
c) UHF inductothermy,
d) microwave therapy,
e) EHF-therapy,
e) magnetotherapy.

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's camera,
b) hyperbaric oxygenation,

8. Heat treatment:
a) paraffin
b) ozokerite,
c) paraffin-ozokerite mixture,
d) naftalan,
e) healing mud,
e) medicinal peat,
g) heated sand,
h) sauna.

9. Hydrotherapy:
a) fresh water
b) medicinal baths,
c) mineral baths,
d) drinking mineral water.

10. Punctural physiotherapy.

11. Phytotherapy.

12. Apitherapy, hirudotherapy.

Most of the listed physical factors can be used for therapeutic, restorative and prophylactic purposes in elderly and senile people. Age does not affect the 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 old people, the dose of physical exposure should be reduced by 30-50%. This is expressed in a decrease in power, intensity, current strength, magnitude of magnetic field induction, temperature, area of exposure, duration of the procedure, total number procedures for a course of treatment. In geriatrics, “non-stressful” 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 exposure.

3. During the day, the patient can take no more than two physiotherapy treatments. Their simultaneous use is not recommended.

4. When assigning two physical procedures, the interval between them must be at least 3 hours.

5. Careful multi-stage control over the body's response to the use of physical methods of influence is necessary. The nurse evaluates the functional state of the patient during the procedure. The physiotherapist prescribes repeated examinations every 2-3 procedures to make the necessary correction in the treatment method. The attending physician constantly monitors the patient's condition.

6. When prescribing physiotherapeutic methods of treatment for 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, with the same disease, different methods of exposure can be used. The art of the doctor consists in choosing the optimal one, taking into account the mechanism of action and the individual characteristics of the patient: the stage of the disease, previous treatment, concomitant diseases, etc.

All physical factors have their own characteristics of application, especially for elderly and senile patients.

When carrying out galvanization and drug electrophoresis, it must be taken 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 have a thickness of at least 1 cm, and the electrodes must be well smoothed and even. Galvanization according to the methods of Shcherbak, Vermel, 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. For this, lower concentrations of them in solution are used. It is known that during electrophoresis, a depot of a medicinal substance is formed in the tissues, which, as a result of the deterioration of microcirculation in the elderly, is absorbed slowly. Therefore, the electrophoresis procedure, especially of potent substances, should be carried out more rarely: after 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 the galvanic current and the pharmacological properties of the medicinal substance used.

Impulse currents (DDT, SMT)- are 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 shown in degenerative-dystrophic processes of the musculoskeletal system. At the same time, preference is given to CMT therapy, which is easier tolerated by patients, less irritating to the skin, and improves tissue trophism. In the case of the use of DDT in geriatrics, full-wave currents are more indicated.

electrosleep- is prescribed for elderly and old people with atherosclerosis of cerebral vessels, neurosis, neurasthenia, hypertension I-II stage, with bronchial asthma, neurodermatitis. In geriatrics, pulsed 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 from low-power devices in non-thermal and low-thermal dosages. The main indication for its use are acute inflammatory processes of various localization. The course of treatment is 3-5 procedures.

In the treatment of chronic inflammatory and degenerative dystrophic processes, especially during an exacerbation, a positive effect is obtained by microwave therapy - the use of an electromagnetic field of ultrahigh frequency. Treatment is carried out in non-thermal and low-thermal dosages.

EHF-therapy- has found wide application in the treatment of gastric ulcer and duodenal ulcer, purulent diseases, hypertension, coronary heart disease.

In geriatric practice, a good effect in the treatment of many diseases gives magnetotherapy- use of an alternating magnetic field of low frequency. This method is non-loading, has a hypocoagulant effect and improves microcirculation in tissues. Therefore, the main indications for magnetotherapy are vascular diseases of various organs.

In medical practice, ultrasound - elastic vibrations in gases, liquids and solids, the frequency of which exceeds 20 kHz - in a different frequency range is used for therapeutic and surgical treatment and diagnosis. Due to its non-load-bearing capacity, it can be widely used in geriatrics for diseases accompanied by excessive development of connective tissue: adhesive processes, chronic inflammatory and degenerative-dystrophic 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, therefore they are not widely used in geriatrics.

The use of local and especially general ultraviolet radiation in the treatment of elderly and senile patients should be reduced due to their insufficient 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: osteochondrosis of the spine, deforming arthrosis and other diseases of the joints. A single dose of laser energy per procedure should be reduced by 30-50%.

The use 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 non-specific lung diseases. In the treatment of these diseases, especially bronchial asthma, speleo- and halotherapy are indicated.

When carrying out inhalations, it must be remembered that medicinal substances in the form of aerosols are quickly absorbed in the lungs, immediately entering the pulmonary circulation. Therefore, the dosage of drugs for the elderly and senile 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 lower extremities in elderly patients, local pressure chamber Kravchenko, in which it is possible to periodically change the air pressure and thereby improve blood circulation in the limbs.

Hyperbaric oxygen therapy- 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.

Heat therapy- assigned to small areas of its application. Various coolants are widely used for thermal effects on the body. Paraffin ozokerite (mountain wax) applications - have a good effect 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 thermotherapy are diseases of the organs of support and movement.

Hydrotherapy- external use of water for therapeutic and prophylactic purposes. Hydrotherapy procedures are showers, baths, washing with fresh and mineral water. Shower as a procedure is recommended for 2-3 minutes. Baths are prescribed with minimal concentrations of chemicals, indifferent temperatures. The time of 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, v Lately su-jok. Most often, acupuncture uses biologically active points of local influence. During the first procedure, no more than 2-4 points are used, the number of which in subsequent sessions is increased to 8-10. Acupuncture is carried out, as a rule, every other day and only in the treatment of acute diseases daily. The course of treatment is from 8 to 12 sessions. In the treatment of chronic diseases, repeated shorter courses are desirable.

It is possible to act on biologically active points not only by introducing needles. Widely shown in geriatrics is the so-called puncture physiotherapy, i.e., the impact on biologically active points of physical factors: electric current, laser, magnet, light, vacuum, acupressure. They are less stressful and easier to tolerate by patients.

Massage- in the treatment of elderly and old patients, sparing techniques are very effective using mainly stroking and rubbing techniques. General massage is not prescribed, according to strict indications, segmental massage is used, but local and acupressure massages are widely used.

For the treatment of patients from ancient times use medicinal plants. In folk medicine, herbal medicine more than 2500 medicinal herbs are used, which are prescribed in the form of infusions, decoctions or tinctures. Raw materials are pre-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 herbs are often used to treat several diseases. To prepare the infusion, a tablespoon of raw materials is brewed with 200 ml of boiling water, tightly closed and infused for 45 minutes. To obtain a decoction, the raw materials in the same proportion are boiled in a water bath for 30 minutes, then cooled to room temperature, filtered. A fourth or third part of a glass of infusion or decoction is prescribed for admission. To prepare the tincture, crushed raw materials are poured with 96 ° alcohol in a ratio of 1:10 and infused for 10 days. Apply drops.

Particular attention of doctors is attracted by such waste products of bees as honey, poison, propolis, royal jelly, perga, bee pollen, wax. They are considered gerontological remedies. Thus, flower pollen contains many biologically active substances and, having versatile medicinal properties, is used to treat a number of diseases. So apitherapy very promising in geriatrics. Honey, as a remedy, is prescribed for diseases of the gastrointestinal tract, cardiovascular, nervous systems, for colds: at the rate of 1 tablespoon of honey per glass of water. Often combined with herbal medicine. In diseases of the joints, compresses are made from honey or honey water. In eye practice, solutions of honey in distilled water are used in a ratio 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 tonsillitis, 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, enderteritis.

rebirth occupational therapy primarily due to the need for a number of diseases of the introduction into the blood of biologically active substances produced by medicinal leeches. The main indications for their use are cardiovascular diseases, increased blood clotting, etc.

The age of the patient is not a contraindication for sanatorium treatment. When conducting a medical selection of patients for referral to a sanatorium, they are guided by existing indications and contraindications for resort treatment. Elderly people are shown treatment in local sanatoriums and sanatoriums, as they do not tolerate changes in climatic conditions at certain resorts.

Age features of the use of physiotherapy in the treatment of children

Doctors are armed with thousands of drugs that are of great benefit in the treatment of many diseases, but with many advantages, almost all drugs can have adverse, side effects. In relation to children, first of all we are talking about allergic reactions - undesirable reactions, first of all, can cause antibiotics, antipyretics and a number of other drugs. Hormonal drugs cause atrophy of the gland to which the action of the hormone is directed.

To date, there is not a single direction of medicine, not a single specialization, wherever physiotherapy is in demand. This is an area that uses the natural factors of nature or their re-formed sources. Our body experiences the action of air, sun and water continuously throughout life. A person can and should use their constant influence so that it has the most beneficial effect, stimulates the body's defenses.

Physiotherapy treatment is based on the therapeutic effect of physical factors (air, water, sun, physical activity) on the body, which not only do not cause allergic reactions in most cases, but also have a pronounced anti-allergic effect. The only exceptions are inhalations 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 culture 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 a molecule, cells, an organ 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 with a rehabilitation purpose, with a preventive purpose various diseases depending on the severity and type of the disease, increasing the body's defenses, timely maturation and development of body systems. The use of physiotherapy treatment is possible from the first days of a newborn's life.

However, the technique and methods of carrying out physiotherapeutic procedures in children differ markedly from adults - small doses, low current strength, short duration of the procedure should be used: that is, the strength of the stimulus of the therapeutic factor should be adequate to the degree of reactivity of the body.

Physiotherapy, acting through surface receptors on the regulatory system and inducing the nervous system to normal activity, is physiological.

Among the features of the child's body can be identified:

hyperexcitability of tissues in children.
unformed brain (finishes to form only by 8 years).
lability, vegetative resistance, especially in adolescence, a tendency to lethargy, drowsiness or overexcitation.
the body of a child, unlike an adult, 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 treatment and wave methods is abandoned in favor of other factors.
unsettled mental development - the state of the child, his psychological readiness is 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 is not afraid.
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 on the use of some physiotherapeutic methods of treatment 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 old.
Ultratone from birth.
Inductothermy from 4 years old.
DMV 1 year.
SMV 2 years.
EHF from birth.
Ultrasound from 3-4 years old, possible from 2 years old with an adequate dosage.
UV rays from birth.
Inhalation from birth.
Laser radiation from birth, but with great care due to the instability of the central nervous system.
Paraffin from birth.
Ozokerite from birth.
Photochromotherapy from birth.
Mud treatment from 6 months of age.
Transcranial electrical stimulation and Electrosleep - from birth.
Magnetotherapy from 2-3 years old, low-frequency magnetotherapy is possible at an earlier age.

I would also like to note that physical factors should not frighten the parents of children. This is one of the safest treatments. Locality, narrow focus of factors, minimal drug dosages make physiotherapy often the only possible type of treatment.

Aging is a genetically determined long-term process characterized by a variety of structural and functional changes in the body and its various organs and systems. Physiotherapy in the elderly has its own characteristics.

How is physiotherapy performed in the elderly and senile age?

Let's discuss how the physiotherapy treatment of the elderly is carried out:

Methods for correcting dysmetabolic syndrome during physiotherapy: oxygen baths, UV radiation in erythemal doses, round-the-clock aerotherapy.

Hormone-correcting methods: mesodiencephalic modulation, transcerebral UHF-therapy, transcerebral low-frequency electrotherapy.

Colonokinetic methods of physiotherapy: colonohydrotherapy, 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 the observance of the general principles and features of physical methods of treatment and physioprophylaxis in patients of older age groups.

Courses of physiotherapy methods should be prescribed according to gentle regimens (especially at the beginning of treatment) due to the reduced reactivity of the aging organism and impaired adaptive-compensatory mechanisms of organs and systems. The intensity and duration of procedures in elderly patients have features. So, for example, in patients of this age, massage of reflexogenic zones and acupressure are preferable, from mud therapy procedures it is advisable to use mitigated techniques, galvanic mud and electrophoresis of mud solutions, use baths of lower concentrations, more often in the form of semi-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 the 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 exposure options in such patients is justified - 2-3 short (4-6 procedures each) courses, repeated at short (2-3 weeks) intervals. Due to the imperfection of regulation and the weakening of compensatory-adaptive reactions after the procedures, such patients should rest for a longer time (1-1.5 hours).

Due to the multiformity of diseases in the elderly and the close relationship between the condition of the skin and internal organs, it is necessary to single out the underlying and concomitant diseases and use a syndrome-but-pathogenetic approach to prescribing therapeutic physical factors. The prescribed methods of physiotherapy should be effective not only in the main, but also in concomitant diseases. The aging process necessitates complex treatment by physical factors. At the same time, due to the reduced reserves of adaptation in the elderly, combinations of no more than two physical factors, mainly of general and local action, should be used.

Sanatorium-resort therapy in the elderly and senile age

Elderly patients are referred for sanatorium-resort treatment for the underlying disease, mainly in local sanatoriums of the corresponding clinical profile. This is due to the increased meteorological and chronological lability of older people who are prone to the formation of physical reactions due to:

age-related changes in neurohumoral regulation,

frequent development of chronic pathological processes that significantly reduce the adaptive capabilities of an aging organism and the adequacy of its reactions to changing environmental factors.

For the prevention of meteopathological reactions, along with the prescription of medications (analgesics, sedatives and other drugs), local sanatoriums use some sedative and psycho-relaxing physical methods of treatment.

Features of physiotherapy in elderly and senile people

In the elderly body, the pharmacokinetics and pharmacodynamics of medicinal substances change, which leads to an increased risk of toxic manifestations, undesirable cumulation and side biological effects of drugs on the body, a weakening of the interaction between individual drugs and an increase in sensitivity to individual 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 is significantly weakened, including the cortex, subcortical formations, and especially the higher centers of the neuro endocrine systems s - hypothalamus and pituitary gland;

the mobility of the processes of excitation and inhibition in the cerebral cortex decreases, the activity of the central and peripheral parts of the autonomic nervous system decreases,

its trophic function is inhibited

and the sensitivity of molecular receptors of various cells is perverted, 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 physiotherapy.

What aspects should be taken into account in physiotherapy in elderly 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 an aging organism to physical factors. Pronounced changes occur in all parts of the humoral regulation of the body: the secretory function of most endocrine glands decreases, 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 shifts in the elderly cause age-related metabolic disorders, immunological deficiency and autoimmune disorders, which leads to a synchronous inhibition of the mechanisms of formation of the systemic adaptive response of the body.

The internal organs and systems of the body also undergo serious age-related changes. Hemodynamics and cardiac activity of patients change significantly:

decreased exercise tolerance

contractile and diastolic functions of the myocardium,

Decreased cardiac output and stroke volume

heart index.

All this significantly limits the adaptive capabilities of the cardiovascular system, which are aimed at increasing the action of a whole group of cardiotonic methods of physiotherapy. The hemodynamics in elderly patients also changes: the 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 inertness of the 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, impairing 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 dystrophy of their constituent tissues, lead to a progressive decrease in their functions. These changes significantly reduce the degree of adaptive-compensatory capabilities of the aging organism and sensitivity to various drugs and therapeutic methods of physiotherapy. Successfully implemented in other cases, an increase in the intensity of physical factors influencing in order to achieve the necessary therapeutic effect is unacceptable here due to the danger of provoking pathological reactions to deterioration in the well-being and functional state of the elderly.

In older people, as a rule, there is not one, but several diseases. In women older than 60 years, the average number of diagnosed diseases exceeds five nosological forms, and in men - four. Often these diseases are pathogenetically interconnected and have a common cause - a violation of the central mechanisms of regulation of functions.

In addition, for people in old age, significant deviations from the classical picture of diseases are characteristic: smoothing of clinical manifestations, unresponsiveness and atypicality. In this case, the severity of the symptoms of the disease often does not correspond to the severity of the damage to the body. Older people often show a tendency to a slow increase in pathological processes, which leads to the latent course of diseases, their widespread asymptomaticity, protracted nature and chronic course.

The processes of sanogenesis and restitution (recovery and recovery) in old age are slower, less perfect, protracted, which requires more attention and perseverance in treatment. The combination of pathology, the difficulty of monitoring the course of treatment, frequent symptoms of depression and dementia, a wary attitude or rejection of doctors' recommendations create significant difficulties in conducting adequate therapeutic measures in geriatric patients.

Finally, age-related changes in the nervous system of physiotherapy 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 due to both age-related changes and personality changes associated with various vascular and tumor lesions of the brain and mental illness. Such patients are characterized by extra- and introversion, a narrowing of the circle 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 the elderly

In the process of aging and prolonged exposure to adverse factors (frequent hypothermia when working outdoors, constant weathering, prolonged exposure to direct sun rays 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 amount of its derivatives and epithelial permeability change. With severe atrophy, superficial small grooves in the form of a grid appear in the skin and it loses its barrier, thermoregulatory and excretory functions. Extracellular dehydration and atrophy of the dermis capture elastic, epithelial, vascular, muscle and bone elements. Fibrous hypertrophy of the interstitial connective tissue and the 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, flaccid skin in old age can occupy an area 2 times larger than before.

The most commonly affected areas of the body (face, neck, hands).

The skin in these areas becomes dry, rough, thickened, rough and acquires a bronze color.

Its relief is significantly enhanced, telangiectasias appear, which, together with hyper- and depigmented areas of the skin, form a motley clinical picture.

The picture of an aging face in the elderly and senile age is often supplemented by drooping of the cheeks, the appearance of excess skin folds on the neck, in the region of the upper and lower eyelids, and the so-called fatty hernia of the eyelids - xanthomas.

Premature fading of the skin, the appearance of wrinkles in people of a relatively young age (at 30-35 years old and earlier) occurs mainly as a result of diseases of the internal organs: the gastrointestinal tract, liver, kidneys, metabolic disorders, as well as nervous disorders. Here it is appropriate to recall the statement of the outstanding domestic pathologist I.V. Davydovsky (1969) that "... the aging processes are caused not by the aging of the cells themselves, but by the" aging "of the environment in which they are located." Anatomical and physiological features of the skin of the face clearly demonstrate the role of functional relationships 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 are initially subject to aging, and much later - vital organs (heart, brain, liver). This is because the basis of the pathogenesis of withering and aging of the skin is formed by the same type of pathophysiological mechanisms caused by disorders of the microcirculation of the skin and vessels of the subcutaneous tissue and skeletal muscles. They manifest themselves in the form of vasoconstriction of arterioles and capillaries, which leads to ischemia and venous-lymphatic congestion in tissue structures. Stagnation of interstitial fluid causes hypoxia and acidosis, which exacerbate regulatory and metabolic disorders of tissue function. These vascular disorders are most pronounced in the skin, which has a weak vascularization and is therefore extremely "sensitive" to microcirculation disorders.

The trigger mechanisms of 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 "starting" role in the mechanism of action of many therapeutic factors, its age-related changes significantly affect the formation of their physiological and therapeutic effects of physiotherapy.

Modern physiotherapy has dozens of natural and preformed (artificially created) physical factors, which can be conditionally divided into the following groups:

1. Low voltage electric current:
a) galvanization,
b) electrophoresis,
c) diadynamic therapy,
d) amplipulse therapy,
e) fluctuorization,
e) electrosleep,
g) electrical stimulation.

2. High voltage electric current:
a) Franklinization
b) darsonvalization,
d) TNF-ultratonotherapy.

3. Electric and magnetic fields:
a) induction
b) UHF therapy,
c) UHF inductothermy,
d) microwave therapy,
e) EHF-therapy,
e) magnetotherapy.

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's camera,
b) hyperbaric oxygenation,

8. Heat treatment:
a) paraffin
b) ozokerite,
c) paraffin-ozokerite mixture,
d) naftalan,
e) healing mud,
e) medicinal peat,
g) heated sand,
h) sauna.

9. Hydrotherapy:
a) fresh water
b) medicinal baths,
c) mineral baths,
d) drinking mineral water.

10. Punctural physiotherapy.

11. Phytotherapy.

12. Apitherapy, hirudotherapy.

1. When treating elderly and old people, the dose of physical exposure should be reduced by 30-50%. This is expressed in a decrease in power, intensity, current strength, magnitude of magnetic field induction, temperature, area of exposure, duration of the procedure, and the total number of procedures per course of treatment. In geriatrics, “non-stressful” 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 exposure.

3. During the day, the patient can take no more than two physiotherapy treatments. Their simultaneous use is not recommended.

4. When assigning two physical procedures, the interval between them must be at least 3 hours.

All physical factors have their own characteristics of application, especially for elderly and senile patients.

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- for elderly and senile patients, this procedure is performed from low-power devices in non-thermal and low-thermal dosages. The main indication for its use are acute inflammatory processes of various localization. The course of treatment is 3-5 procedures.

EHF-therapy- has found wide application in the treatment of gastric ulcer and duodenal ulcer, purulent diseases, hypertension, coronary heart disease.

infrared rays, solux, light baths have a pronounced thermal effect, create a load on the cardiovascular system, therefore they are not widely used in geriatrics.

The use of local and especially general ultraviolet radiation in the treatment of elderly and senile patients should be reduced due to their insufficient effectiveness and oncological alertness.

In the treatment of obliterating diseases of the arteries of the lower extremities in elderly patients, local pressure chamber Kravchenko, in which it is possible to periodically change the air pressure and thereby improve blood circulation in the limbs.

Hyperbaric oxygen therapy- 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.

In geriatrics, the so-called reflex therapy is most often used - corporal and auricular acupuncture, recently su-jok. Most often, acupuncture uses biologically active points of local influence. During the first procedure, no more than 2-4 points are used, the number of which in subsequent sessions is increased to 8-10. Acupuncture is carried out, as a rule, every other day and only in the treatment of acute diseases daily. The course of treatment is from 8 to 12 sessions. In the treatment of chronic diseases, repeated shorter courses are desirable.

Medicinal plants have been used to treat patients since ancient times. In folk medicine, herbal medicine more than 2500 medicinal herbs are used, which are prescribed in the form of infusions, decoctions or tinctures. Raw materials are pre-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 herbs are often used to treat several diseases. To prepare the infusion, a tablespoon of raw materials is brewed with 200 ml of boiling water, tightly closed and infused for 45 minutes. To obtain a decoction, the raw materials in the same proportion are boiled in a water bath for 30 minutes, then cooled to room temperature, filtered. A fourth or third part of a glass of infusion or decoction is prescribed for admission. To prepare the tincture, crushed raw materials are poured with 96 ° alcohol in a ratio of 1:10 and infused for 10 days. Apply drops.

Old man more than others is subject to various types of injuries and diseases, for a long time leaving him on bed rest. This further reduces the body's resistance to various types of infections and exacerbates the existing pathology.

The main 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 the formation of contractures;
Normalization of the gastrointestinal tract;
Maintaining a good emotional background.

Physiotherapy in the elderly begins after the removal of the severity of the process and is the second stage of rehabilitation, connected to kinesiotherapy. It is important to consider both the reduction in dosages of drugs at this age, and the intensity and duration of physiotherapy procedures should be adjusted in accordance with taking into account all the pathological conditions of the body. Must be oncological alertness. In old age, the frequency of malignant diseases often occurs without a typical clinical picture. Before starting physiotherapy, 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 illness;
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 usually 10-12 procedures are required for a course of treatment, 15-20 are prescribed in the elderly;
It is necessary to take into account the thinning of the skin and, when carrying out medicinal phoresis, use thicker pads than usual;
The dosage of the drug for 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 circulatory disorders;
The most physiological at this age are local and general darsonvalization, amplipulse therapy, franklinization, decimeter waves, alternating pulsed currents.
Features of physiotherapy depending on the pathology

Allowed for stroke: electromyostimulation, laser therapy, phonophoresis, DDT.

After fractures and injuries a good effect is observed from interference currents, ultraviolet radiation, electrophoresis of drugs, myostimulation, ultrasound.

With diabetes first of all, microcirculation is disturbed and damage to the distal parts of the nervous system is noted. For rehabilitation therapy, the following are shown: magnetotherapy, 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 patients of elderly and senile age

3. Nursing homes. Features of the work of a nurse.

Geriatric problems require broad participation of the public, health authorities, social security, etc. All this set of measures, with appropriate coordination, is important for organizing services for people of older age groups, and the role of a nurse should be given special importance. Realizing that the basic principle regarding geriatric the patient should be respected, is an urgent problem of adequate care for elderly patients.

Geriatrics is a science that studies the patterns of the course of diseases, their treatment in elderly and older people.

Old age is a stage in the development of the body. ;

Illness 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 should not be confused. The disease in most geriatric patients is associated with regular age-related changes. Often they progress and for a long time without any special obvious pain phenomena. And only some additional factors can lead to a vivid manifestation of the disease. These factors include excessive physical activity, infectious diseases, colds, stress.

For older people, a multiplicity of pathologies is characteristic. With a detailed examination, changes in various body systems can be detected. The pathology of the elderly is compared to an iceberg, in which 6/7 of the 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 in an old person at the same time. More often combined are atherosclerosis of the vessels of the heart and brain, arterial hypertension, chronic bronchitis, tumors, prostate hyperplasia, diabetes mellitus, mental depression, cataracts, hearing loss, etc.

Features of the course of diseases of various organs.

l Geriatric patients may suffer from diseases that have arisen in their early years. But they can also cause acute, including infectious diseases. Age-related features of the body leave an imprint on these diseases. Their features in this case will be: atypicality, the absence of clear manifestations of the disease.

Diagnosis, treatment, care for older patients has its own characteristics and often the methods that are used in young patients are not used in old people. The reasons for this are as follows:

1. Often masked course of pneumonia, MI, pulmonary tuberculosis, diabetes mellitus, tumors. Other mechanisms of disease development (ulcer in atherosclerosis). Latent 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 slightly pronounced symptoms of the disease.

Methodology for collecting anamnesis and features of examination of older patients. The clinical manifestations of the disease, the features of the psyche of an older person require certain features in the conduct of a survey and examination of the patient. Age-related changes affect the psychology of an old person, his orientation in the environment. A survey of such a patient who has a violation from several systems. d lasts significantly longer, like a poll young man. It should be borne in mind that an old person has a decrease in hearing, vision and, in general, a delayed response. n If the patient constantly wears glasses or a hearing aid, then these auxiliary things should be used during the interview.

Conversation with a geriatric patient

Speak clearly, slowly, 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 a 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 came with relatives, then first you need to talk with them (but in the absence of the patient). This allows you to identify the characteristics of the patient's personality, his relationship with relatives, the possibilities of the family in the problem of providing home care for the patient. If there are changes in the psyche of the patient, the patient must be interviewed with the participation of relatives.

The classic form of history for an old person is: u

1) survey by 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, acquaintances

4) whether he receives assistance from social services

5) efficiency, job satisfaction. Find out from the unemployed how the termination of employment is experienced.

6) Attitude towards the death of a spouse, if this happened, there is no tendency to self-isolation, loneliness.

The diet consists of the following questions:

1) power supply, incl. hot food

2) a balanced diet (proteins, fats, carbohydrates)

3) diet past and present

4) cooks his own food

5) can chew, the presence of prostheses

6) did not lose weight

7) who buys food, go far for groceries.

Psychiatric history:

pay attention to the presence of mental illness in relatives,

find out if there is a depressive syndrome, suicidal thoughts.

Sexual history

can only be collected when a trust relationship is formed during the survey.

Peculiarities of nursing care for elderly patients

General care of the elderly and old is more complex and requires more attention and time from the medical staff than ordinary care. The concept of "care of 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 society to which he can return, and medical institution or institution social assistance in which it is located.

The basic principle of care is

respect for the individual patient,

accepting him as he is, with all his shortcomings (physical, mental, irritability, mental disorders). The nurse should be aware that these deficiencies are in most cases a manifestation of illness, not old age, and appropriate care can improve health.

urinary system

In the process of aging, the function of the urination apparatus and the function of the kidneys change significantly. The concentration ability of the kidneys decreases and, as a result, nocturnal diuresis increases compensatory. In addition, nocturnal diuresis may be the result of irritation of the sphincters of the bladder, prostate hypertrophy in men, heart failure in cardiac patients. It is necessary to find out how often the patient passes at night for diuresis, to what extent this disturbs sleep and give him night dishes.

With frequent nocturnal diuresis, you can advise the patient to drink just before bedtime, but this must be done carefully, because reducing the introduction of fluid less than Il / day can lead to general intoxication (accumulation of metabolic products).

Hygienic bathing of elderly patients

There are accidents when bathing in a bath: a slippery bath, a slippery floor, loss of consciousness from too hot water, a heart attack, etc. bath.

In general, in geriatric practice it is better to use a shower rather than a bath. Depending on the patient's condition, the patient takes a shower while standing, sitting, or is washed by the staff on a special couch in a warm bathroom. . Do not take a shower > 35 °, direct the hot jet to the head.

· Supports, rubber mats, emergency alarms are essential bathroom equipment. The presence of a health worker when bathing a patient is desirable, and in some cases cases-mandatory. The bath must not be closed from the inside.

Care of 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, loss of appetite, general weakness. Patients experience muscle atrophy, increased calcium excretion, decreased joint mobility, and constipation. , insomnia, mental disorders, depression. Particularly affected the cardiovascular system. Due to hypodynamia, detraining the adaptive capabilities of the heart and blood vessels with corresponding symptoms (palpitations, shortness of breath) are rapidly decreasing.

defecation

· Elderly and old people often have constipation. Sometimes linked to food that does not include dietary fiber (vegetables, fruits, wholemeal bread), physical inactivity, fluid restriction, medication. In the treatment of constipation, it must be borne in mind that enemas in old people 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 organism.

1. Due to structural and functional changes in the gastrointestinal tract, the absorption of drugs decreases with age. Therefore, drugs taken orally, in smaller quantities enter the body.

2. Drugs administered in the form of injections also begin to act much later and less intensively due to the fact that their absorption is slowed down

The excretion of drugs 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 of the intensity of metabolic cycles of the liver, skin.

4. Decrease detoxification liver function.

5. Weakening of the activity of enzyme systems.

Principles of pharmacotherapy in geriatrics

1. The inadmissibility of polypharmacy.

2. Treatment of the underlying disease.

3. The adverse effects of drugs on the body in old people are higher 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, follow a good diet and an adequate drinking regimen.

7. In connection with addiction to sleeping pills, painkillers, sedatives, it is often recommended to replace each other.

8. It is advisable to use a complex of different drugs in low doses, which act similarly, but on different chains of the disease.

9. Often the possibility of an allergic reaction to medications.

Geriatric means - this is a group of medicines that affect the aging body through a general stimulating effect, normalization of disturbed metabolism and body functions, increase the tone and trophism of the central nervous system. To them

2) Trace elements (copper, zinc, cobalt, potassium, etc.).

3) Novocain.

4) Thyroid hormones, anabolic.

5) Tissue stimulants (placenta, FIBS).

6) Apilakatherapy (0.01 2 times a day under the tongue for 20 days).

7) Adaptogens (take an extract from ginseng root, eleutherococcus, dibazol (0.01 / day).

Side effects of drugs on the old organism.

Barbiturates

Diuretic

Aminazin, regitin

Salicylates, NSAIDs

Antibiotics, sulfa drugs

Glucocorticoids

anticholinergic , antispasmodic drugs

Adrenaline and other adrenomimetics

· Thus, the problems of geriatrics require broad participation of the public, health authorities, social security, etc. All this set of measures, with appropriate coordination, is important for organizing services for people of older age groups.

Particular importance should be given to the role of the nurse. Realizing that the basic principle regarding geriatric the patient must be respected.

· The problem of adequate care for patients of senile age is relevant.

Biology of aging. Gerontology as a science. Nursing homes for the elderly.

The social phenomenon of population aging arose 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 shifts 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 a natural onset of a period of age development.

l Aging is a destructive process that occurs as a result of the damaging effects of external and internal factors that increase with age, which leads to insufficiency of body functions.Aging leads to a limitation of the adaptation of the body, 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)

3. aging.

External signs of aging:

1) change in the shape and physique of the body

2) slowing down and incoordination

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) impaired adaptation of the body 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 old - average age 60-74 years old - elderly, 75-90 years old - old 90 years old and older - centenarians.

Biology of aging: human aging is a natural biological process determined by its individual, genetically determined development program. During a person's life, aging of some constituent elements of his body and the emergence of new ones occur.

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 as early as 30-35 years). Since that time, various types of metabolism, the state of the functional systems of the body have gradually changed, which inexorably leads to a limitation of its ability to adapt, the likelihood of pathological processes, acute illnesses and death increases.

Gerontology problems require broad public participation, bodies health care, social security, etc.

This whole set of measures with appropriate coordination is important for organizing boarding schools, boarding houses and hospitals for people elderly and senile age.

V these institutions should work professionals who, in conditions polymorbidity with age-related involutive lesions could provide appropriate qualified medical care.

Age features of the use of physiotherapy in the treatment of children

Doctors are armed with thousands of drugs that are of great benefit in the treatment of many diseases, but with many advantages, almost all drugs can have adverse side effects. In relation to children, first of all we are talking about allergic reactions - undesirable reactions, first of all, can cause antibiotics, antipyretics and a number of other drugs. Hormonal drugs cause atrophy of the gland to which the action of the hormone is directed.

Physical, therapeutic factors have a multifaceted effect on a living organism, causing changes in various functional systems: at the level of a molecule, cells, an organ 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 physiotherapy treatment is possible from the first days of a newborn's life.

Physiotherapy, acting through surface receptors on the regulatory system and inducing the nervous system to normal activity, is physiological.

Among the features of the child's body can be identified:

hyperexcitability of tissues in children.
unformed brain (finishes to form only by 8 years).
lability, vegetative resistance, especially in adolescence, a tendency to lethargy, drowsiness or overexcitation.
the body of a child, unlike an adult, 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 treatment and wave methods is abandoned in favor of other factors.
unsettled mental development - the state of the child, his psychological readiness is 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 is not afraid.
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 on the use of some physiotherapeutic methods of treatment 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 old.
Ultratone from birth.
Inductothermy from 4 years old.
DMV 1 year.
SMV 2 years.
EHF from birth.
Ultrasound from 3-4 years old, possible from 2 years old with an adequate dosage.
UV rays from birth.
Inhalation from birth.
Laser radiation from birth, but with great care due to the instability of the central nervous system.
Paraffin from birth.
Ozokerite from birth.
Photochromotherapy from birth.
Mud treatment from 6 months of age.
Transcranial electrical stimulation and Electrosleep - from birth.
Magnetotherapy from 2-3 years old, low-frequency magnetotherapy is possible at an earlier age.

Significant changes occur in the human body with age: the regulatory role of the central nervous system decreases significantly, the "mobility" of nervous processes decreases, cortical-subcortical relationships change, the activity of enzyme systems and immunity weaken, the degree of oxygen consumption by the body decreases, resistance to infections, predisposition to malignant neoplasms.

The use of physical methods for therapeutic and prophylactic purposes has a stimulating effect on all major body systems, increases the defenses and adaptive capabilities of an aging organism. It must be remembered that the inept use of physical factors can lead to an exacerbation of the disease and adversely affect the state of health. The effectiveness of treatment often depends on the choice of the optimal dose of the physical factor, the methodology for performing the procedure. Before prescribing physiotherapy, it is necessary to completely exclude oncological and other diseases that are an absolute contraindication.

The use of physiotherapy in the elderly has a number of features:

The intensity of physical factors (current strength, radiation power, magnitude of magnetic induction, degree of mechanical action, etc.). the concentration of drugs used for electrophoresis, inhalation therapy, the concentration of gases and salts in mineral waters, the temperature factor, the duration of exposure should be less, and the number of procedures may be more than in the treatment of young and middle-aged people:

When prescribing hardware methods of physiotherapy, preference should be given to methods of local exposure, pulse mode, as well as methods that do not cause an intense thermal effect;

It is important to observe certain caution when prescribing several procedures in combination - during the day, one session of general and one local impact can be prescribed, while significantly increasing the rest time after the end of the procedure;

Balneo, mud and other types of heat treatment require the organization of careful medical control, including functional and laboratory, of its tolerability, the body's response to exposure, which will allow timely identification of undesirable effects and, if necessary, appropriate correction of the treatment.

Below are some features of the use of various physical factors in the treatment of the elderly.

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Features of the rehabilitation treatment of a geriatric patient physiotherapy plan. Physiotherapy in the elderly. Physiotherapy in the elderly and senile age Physiotherapy in the elderly and senile age

Among the features of the child's body can be identified:

Age restrictions on the use of some physiotherapeutic methods of treatment for children:

How is physiotherapy performed in the elderly and senile age?

Features of physiotherapy in elderly and senile people

Among the features of the child's body can be identified:

Age restrictions on the use of some physiotherapeutic methods of treatment for children:

More on the topic Chapter 27 FEATURES OF PHYSIOTHERAPY IN THE OLDER AGE:

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