Abstract of cardiovascular disease in the elderly. Anatomical and physiological changes in the cardiovascular system in old age

Tverskaya

State

Medical Academy

ABSTRACT

For geriatrics

On the topic of: Features of the treatment of cardiovascular vascular system in the elderly.

Group 404

St. t. Deryabkina Yu.L.

1.Introduction……………………………………………………………………………3-5 pages..

2. Goals of cardiovascular disease treatment

in the elderly………………………………………………………………….6 p.

3. Arterial hypertension in the elderly………….7-9 pp.

4. Heart failure in the elderly…………………… 9-10 pp.

5. Stable angina in the elderly……………………… 11-12 pp.

6. General principles elderly patient care

Age……………………………………………………………………………..12-14 pp.

7. Nursing process and treatment of older people with

diseases of cardio-vascular system……………………… 15-16 pp.

8. List of literature used…………………………………….17 p.

INTRODUCTION

age development human is in the interaction of two main processes: aging and vitality. Aging is a universal endogenous destructive process that manifests itself in an increase in the probability of death. Vitaukt (lat. vita- life, auctum- increase) - a process that stabilizes viability and increases life expectancy. Not being a disease, aging creates the prerequisites for the development of age-related pathology. The aging process is a continuous gradual transition from stage to stage: the optimal state of health - the presence of risk factors for the development of diseases - the appearance of signs of pathology - disability - death.

The rate of aging can be quantified using indicators that reflect a decrease in viability and an increase in damage to the body. One of these parameters is age.

Age is the duration of an organism's existence from birth to the present. The current current age standards were adopted by the WHO Regional Office for Europe in 1963.

Currently, there are more than 380 million people in the world whose age exceeds 65 years. In Russia, a fifth of the total population is made up of elderly and senile people. In the next 10 years, they expect an increase in the number of older citizens by about 2 times, i.e. already 40% of the population will be in the category of elderly and senile age. The incidence rate in the elderly compared to younger people is 2 times higher, in old age - 6 times higher.

The processes of human aging are studied by gerontology (gr. gerents- old man, logos- teaching, science). Gerontology is a border area of biology and medicine that studies not so much old age as the process of human aging. Gerontology includes such large main sections as geriatrics, gerohygiene, geropsychology, social gerontology, etc.

Geriatrics (gr. gerents- old man atria- treatment) is a border section of gerontology and internal diseases that studies the characteristics of diseases of elderly and senile people and develops methods for their treatment and prevention.

The main features of elderly and senile patients

Pathological changes, characteristic of people of elderly and senile age, begin to appear already from the age of 40-50.

1. Involutional (associated with reverse development) functional and morphological changes in various organs and systems. For example, with age, the
the vital capacity of the lungs, bronchial patency, the value of glomerular filtration in the kidneys, the mass of adipose tissue increases and the muscle mass decreases (including dia-
fragma).

2. The presence of two or more diseases in one patient. On average, when examining a patient of elderly or senile age, at least five diseases are detected in him. In this regard, the clinical picture of diseases is “blurred”, the diagnostic value of various symptoms decreases. On the other hand, comorbidities can reinforce each other. For example, anemia in a patient with CAD can cause clinical manifestations heart failure.

3. Mostly chronic course of diseases. The progression of the majority chronic diseases contribute to age-related adverse endocrine-metabolic and immune shifts.

Atypical clinical course of the disease. Often, a slower and more disguised course of the disease is detected (pneumonia, myocardial infarction, pulmonary tuberculosis, neoplastic processes, diabetes mellitus, etc.).

For example, fever in the elderly
be one of the main, if not the only, manifestation of tuberculosis or infective endocarditis, abdominal abscesses.

5. The presence of "senile" diseases (osteoporosis, benign hyperplasia prostate, Alzheimer's disease, senile amyloidosis, etc.).

6. Changes in protective, primarily immune, reactions.

7. Change in socio-psychological status. Main reasons social maladaptation are retirement, loss of relatives and friends due to their death, loneliness and limited opportunities for communication, difficulties in self-service, deterioration economic situation, psychological perception age limit over 75, regardless of
health status. Against this background, disorders such as anxiety states, depression, hypochondriacal syndrome (pathologically exaggerated fear for one's health, belief in the presence of a particular disease in its actual absence).

Rational management of an elderly patient implies the obligatory achievement of mutual understanding and agreement in the triad "patient - nurse- doctor". The degree of compliance by the patient with medical recommendations is designated in the medical literature by the term "compliance" (English compliance - consent). Old age in itself is not a cause of lack of compliance, since the right approach fully ensures the achievement of the latter - the use of verbal and written instructions, a decrease in the number of prescribed medications, preference for prolonged dosage forms and combination drugs, etc.

GOALS OF TREATMENT OF CARDIOVASCULAR DISEASES IN ELDERLY PEOPLE.

As in other age groups, the main goals of treatment in the elderly are to improve the quality and increase life expectancy. For a doctor familiar with the basics of geriatrics and the specifics of clinical pharmacology in the elderly, both of these goals are achievable in most cases.

What is important to know when prescribing treatment for the elderly?

Features of the course of diseases in the elderly (other symptoms, polymorbidity).

Features of metabolism in the elderly, affecting the pharmacokinetics and pharmacodynamics of drugs.

Features of prescribing drugs.

Features of monitoring the effectiveness and safety of treatment.

Drugs that often cause side effects in the elderly.

Within the framework of this essay, the features of treatment in elderly patients with the most common cardiovascular diseases are considered:

1. Arterial hypertension, incl. isolated systolic hypertension;

2. Heart failure;

4. Arterial hypertension in the elderly;

ARTERIAL HYPERTENSION IN ELDERLY PERSONS.

Arterial hypertension (AH), according to various estimates, occurs in 30–50% of people over 60 years of age. Diagnosis and treatment of this disease have a number of important features.

Due to the high prevalence of hypertension, especially the isolated increase in systolic blood pressure among the elderly, this disease for a long time was considered as some kind of relatively benign age-related change, the active treatment of which could worsen health due to an excessive decrease in blood pressure. They also feared more than young age, number of side effects drug therapy. Therefore, doctors resorted to lowering blood pressure in the elderly only if there was clinical symptoms(complaints) associated with high blood pressure. However, by the beginning of the 90s of XX century it was shown that regular long-term antihypertensive therapy significantly reduces the risk of major cardiovascular complications of hypertension - stroke, myocardial infarction and cardiovascular mortality. A meta-analysis of 5 randomized clinical trials, including more than 12 thousand elderly patients (aged > 60 years), showed that an active decrease in blood pressure was accompanied by a decrease in cardiovascular mortality by 23%, cases of coronary artery disease - by 19%, cases of heart failure - by 48%, the frequency of strokes - by 34%.

A review of the main prospective randomized trials showed that in elderly patients with hypertension drug reduction BP within 3-5 years significantly reduces the incidence of heart failure by 48%. Thus, today there is no doubt that elderly patients with hypertension receive a real benefit from lowering blood pressure. However, after diagnosis and decision about the treatment of an elderly patient with hypertension, it is necessary to take into account a number of circumstances.

Older people respond very well with lowering blood pressure to salt restriction and weight loss.

Starting doses of antihypertensive drugs are half the usual starting dose. Dose titration is slower than in other patients. You should strive for a gradual decrease in blood pressure to 140/90 mm Hg. (with concomitant diabetes And kidney failure target BP is 130/80 mmHg). It is necessary to take into account the initial level of blood pressure, the duration of hypertension, the individual tolerance of lowering blood pressure.

Essay

Topic: Care of elderly and senile patients with diseases of the cardiovascular system

Completed by a student

Gr. D-106

Yeshutkina Elizaveta Vladimirovna

Checked by the teacher: Vashkevich V.A.

Gomel 2016

Introduction

Age development of a person consists in the interaction of two main processes: aging and vitauction. Aging is a universal endogenous destructive process that manifests itself in an increase in the probability of death. Vitaukt (lat. vita - life, auctum - increase) - a process that stabilizes vitality and increases life expectancy. Not being a disease, aging creates the prerequisites for the development of age-related pathology. The aging process is a continuous gradual transition from stage to stage: the optimal state of health - the presence of risk factors for the development of diseases - the appearance of signs of pathology - disability - death. The rate of aging can be quantified using indicators that reflect a decrease in viability and an increase in damage to the body. One of these parameters is age. Age is the duration of the existence of an organism from birth to the present. The current current age standards were adopted by the WHO Regional Office for Europe in 1963.

Age - years:

Young age - 18-29

Mature age - 30-44

Average age - 45-59

Old age - 60-74

· Senile age - 75-89

Long-livers - 90 and older

Pathological changes characteristic of elderly and senile people begin to appear already from the age of 40-50.

As in other age groups, the main goals of treatment in the elderly are to improve the quality and increase life expectancy.
What is important to know when prescribing treatment for the elderly?
1. Features of the course of diseases in the elderly (other symptoms, polymorbidity).
2. Features of metabolism in the elderly, affecting the pharmacokinetics and pharmacodynamics of drugs.
3. Features of prescribing drugs.
4. Features of monitoring the effectiveness and safety of treatment.
Rational management of an elderly patient implies the obligatory achievement of mutual understanding and agreement in the triad "patient - nurse -

doctor". The degree of compliance by the patient with medical recommendations is indicated by

in the medical literature by the term "compliance" (English compliance - consent). Old age in itself does not cause insufficient compliance, since the correct approach fully ensures the achievement of the latter - the use of verbal and written instructions, a decrease in the number of prescribed medications, preference for prolonged dosage forms and combined drugs, etc.

Anatomical and physiological changes in the cardiovascular system in old age

The features of CVS diseases in the elderly and senile age are due, like diseases of other organs and systems, to involutive processes in the body, but first of all, to sclerotic lesions of both blood vessels and the heart.
With sclerosis of the aorta, coronary, cerebral and renal arteries, their elasticity decreases; thickening of the vascular wall leads to a constant increase in peripheral resistance.
Tortuosity and aneurysmal expansion of capillaries and arterioles occur, their fibrosis and hyaline degeneration develop, which leads to obliteration of the vessels of the capillary network, which worsens the transmembrane exchange.
The blood supply to the main organs becomes inadequate.
As a result of insufficiency of the coronary circulation, dystrophy develops
muscle fibers, their atrophy and replacement with connective tissue. Formed atherosclerotic cardiosclerosis, leading to heart failure and heart rhythm disturbances.
Due to sclerosis of the myocardium, its contractility decreases, dilatation of the heart cavities develops.
"Old Heart" ( age-related changes in the heart muscle) is one of the main factors in the development of heart failure due to changes in neurohumoral regulation and prolonged myocardial hypoxia.
In old age, the blood coagulation system is activated, functional insufficiency of anticoagulant mechanisms develops, and blood rheology worsens.
In the elderly and senile age, a number of hemodynamic features are formed: mainly systolic blood pressure rises, venous pressure, cardiac output decrease, late and minute volume, etc.
Most often, in elderly and senile people, systolic blood pressure rises (more than 140 mm Hg) and so-called isolated systolic arterial hypertension develops. With age, the walls of large vessels lose their elasticity, atherosclerotic plaques appear, in small vessels organic changes develop. As a result, cerebral, renal and muscle blood flow is reduced.

The population in developed countries is steadily aging, gradually increasing specific gravity cardiovascular diseases (CVD) in the structure of morbidity. And the number of elderly patients at the appointment with a cardiologist is gradually increasing.

Most common cardiovascular disease in the elderly

Most often, older people are affected by:

cardiac ischemia;
arterial hypertension;
stenosing atherosclerosis of the main arteries;
violation of the heart rhythm.

The position of cardiologists

In the course of numerous clinical studies, it has been proven that the age of the patient cannot be an obstacle to the active medical and surgical treatment of most cardiovascular diseases. Moreover, the treatment of these diseases in the elderly is more often more effective than in middle-aged and young people.

As for other age groups, the main goal of curing the elderly is:

improve the quality of human life;
increase the life expectancy of the patient.

It is important to note that for a doctor who is familiar with the basics of geriatrics, who is well aware of the features of clinical pharmacology in the elderly, in most cases both of these goals are achievable.

Stable ischemic heart disease in the elderly

The elderly make up the majority of patients suffering from coronary heart disease. Nearly three-quarters of deaths from this disease occur in people over 65 years of age. Nearly eighty percent of the people who die of myocardial infarction belong to this age group. In more than fifty percent of cases, the death of people over 65 years of age occurs from complications of coronary artery disease.

Chronic heart failure currently affects at least two percent of the population in developed countries. Each year, chronic heart failure develops in one percent of people over the age of sixty and ten percent of those over the age of 75. Elderly patients, in the event of the appearance of this disease, are prescribed:

inhibitors;
b-blockers;
diuretics;
spironolactone.

With the syndrome of weakness of the sinus node, intracardiac blockades, they resort to the implantation of a pacemaker. For the successful cure of the disease in the elderly, it is important to timely identify and eliminate or correct concomitant diseases, which are often latent and asymptomatic. This means in particular:

exhaustion;
dysfunction thyroid gland;
anemia;
liver disease;
metabolic disorders;
kidney disease, etc.

Doctors are convinced that the risk of complications in the case of planned invasive studies in the elderly is higher than in the young, but to a small extent. That's why elderly age should not become an obstacle to referring patients for coronary angiography, which will help diagnose and treat the disease.

Tverskaya

State

Medical Academy

ABSTRACT

For geriatrics

On the topic of: Features of the treatment of the cardiovascular system in the elderly.

Group 404

St. t. Deryabkina Yu.L.

1.Introduction……………………………………………………………………………3-5 pages..

2. Goals of cardiovascular disease treatment

in the elderly………………………………………………………………….6 p.

3. Arterial hypertension in the elderly………….7-9 pp.

4. Heart failure in the elderly…………………… 9-10 pp.

5. Stable angina in the elderly……………………… 11-12 pp.

6. General principles for caring for the elderly

Age……………………………………………………………………………..12-14 pp.

7. Nursing process and treatment of older people with

diseases of the cardiovascular system………………………15-16 pp.

8. List of literature used…………………………………….17 p.

INTRODUCTION

Age development of a person consists in the interaction of two main processes: aging and vitauction. Aging is a universal endogenous destructive process that manifests itself in an increase in the probability of death. Vitaukt (lat. vita- life, auctum- increase) - a process that stabilizes viability and increases life expectancy. Not being a disease, aging creates the prerequisites for the development of age-related pathology. The aging process is a continuous gradual transition from stage to stage: the optimal state of health - the presence of risk factors for the development of diseases - the appearance of signs of pathology - disability - death.

The rate of aging can be quantified using indicators that reflect a decrease in viability and an increase in damage to the body. One of these parameters is age.

Age is the duration of an organism's existence from birth to the present. The current current age standards were adopted by the WHO Regional Office for Europe in 1963.

The main features of elderly and senile patients

Pathological changes characteristic of elderly and senile people begin to appear already from the age of 40-50.

2. The presence of two or more diseases in one patient. On average, when examining a patient of elderly or senile age, at least five diseases are detected in him. In this regard, the clinical picture of diseases is “blurred”, the diagnostic value of various symptoms decreases. On the other hand, comorbidities can reinforce each other. For example, anemia in a patient with coronary artery disease can cause clinical manifestations of heart failure.

3. Mostly chronic course of diseases. The progression of most chronic diseases is facilitated by age-related adverse endocrine-metabolic and immune changes.

For example, fever in the elderly
be one of the main, if not the only, manifestation of tuberculosis or infective endocarditis, abdominal abscesses.

5. The presence of "senile" diseases (osteoporosis, benign prostatic hyperplasia, Alzheimer's disease, senile amyloidosis, etc.).

6. Changes in protective, primarily immune, reactions.

7. Change in socio-psychological status. The main causes of social maladaptation are retirement, loss of loved ones and friends due to their death, loneliness and limited communication opportunities, self-service difficulties, worsening economic situation, psychological perception of the age limit over 75 years, regardless of
health status. Against this background, disorders such as anxiety, depression, hypochondriacal syndrome (pathologically exaggerated fear for one's health, belief in the presence of a particular disease in its actual absence) often develop.

Rational management of an elderly patient implies the obligatory achievement of mutual understanding and agreement in the triad "patient - nurse - doctor". The degree of compliance by the patient with medical recommendations is designated in the medical literature by the term "compliance" (English compliance - consent). Old age in itself does not cause insufficient compliance, since the correct approach fully ensures the achievement of the latter - the use of verbal and written instructions, a decrease in the number of prescribed medications, preference for prolonged dosage forms and combined drugs, etc.

GOALS OF TREATMENT OF CARDIOVASCULAR DISEASES IN ELDERLY PEOPLE.

What is important to know when prescribing treatment for the elderly?

Features of the course of diseases in the elderly (other symptoms, polymorbidity).

Features of metabolism in the elderly, affecting the pharmacokinetics and pharmacodynamics of drugs.

Features of prescribing drugs.

Features of monitoring the effectiveness and safety of treatment.

Drugs that often cause side effects in the elderly.

Within the framework of this essay, the features of treatment in elderly patients with the most common cardiovascular diseases are considered:

1. Arterial hypertension, incl. isolated systolic hypertension;

2. Heart failure;

4. Arterial hypertension in the elderly;

ARTERIAL HYPERTENSION IN ELDERLY PERSONS.

Arterial hypertension (AH), according to various estimates, occurs in 30–50% of people over 60 years of age. Diagnosis and treatment of this disease have a number of important features.

Due to the high prevalence of hypertension, especially the isolated increase in systolic blood pressure among the elderly, this disease has long been considered as a relatively benign age-related change, the active treatment of which could worsen well-being due to an excessive decrease in blood pressure. Also feared more than at a young age, the number of side effects of drug therapy. Therefore, doctors resorted to lowering blood pressure in the elderly only in the presence of clinical symptoms (complaints) associated with increased blood pressure. However, by the beginning of the 90s of XX century it was shown that regular long-term antihypertensive therapy significantly reduces the risk of major cardiovascular complications of hypertension - stroke, myocardial infarction and cardiovascular mortality. A meta-analysis of 5 randomized clinical trials, including more than 12 thousand elderly patients (aged > 60 years), showed that an active decrease in blood pressure was accompanied by a decrease in cardiovascular mortality by 23%, cases of coronary artery disease - by 19%, cases of heart failure - by 48%, the frequency of strokes - by 34%.

A review of the main prospective randomized trials showed that in elderly patients with hypertension, drug-induced reduction of blood pressure for 3-5 years significantly reduces the incidence of heart failure by 48%. Thus, today there is no doubt that elderly patients with hypertension receive a real benefit from lowering blood pressure. However, after the diagnosis is made and the decision on the treatment of an elderly patient with hypertension is made, a number of circumstances must be taken into account.

Older people respond very well with lowering blood pressure to salt restriction and weight loss.

Starting doses of antihypertensive drugs are half the usual starting dose. Dose titration is slower than in other patients. You should strive for a gradual decrease in blood pressure to 140/90 mm Hg. (with concomitant diabetes mellitus and renal failure, the target level of blood pressure is 130/80 mm Hg). It is necessary to take into account the initial level of blood pressure, the duration of hypertension, the individual tolerance of lowering blood pressure.

The concomitant decrease in diastolic blood pressure in patients with isolated systolic hypertension is not an obstacle to continuing therapy. In the SHEP study, the mean diastolic BP in the treated group was 77 mmHg, and this was consistent with an improved prognosis.

Thiazide diuretics, b-blockers and their combinations were effective in terms of reducing the risk of cardiovascular complications and mortality in elderly patients with hypertension, and diuretics (hydrochlorothiazide, amiloride) had an advantage over b-blockers. The recently completed large ALLHAT study has clearly confirmed the benefit of diuretics in the treatment of hypertension in all age groups. In the 7 Report of the US Joint National Committee on the detection, prevention and treatment of arterial hypertension (2003), diuretics play a leading role both in monotherapy and in combination treatment of hypertension. The HYVET clinical trial is currently underway in 2100 hypertensive patients aged 80 years and over. Patients will be randomized to placebo and the diuretic indapamide (including in combination with the ACE inhibitor perindopril). The BP target in this study is 150/80 mmHg, the primary end point is cerebral stroke, secondary - total mortality and mortality from cardiovascular diseases.

Studies have shown the effectiveness of the calcium antagonist amlodipine (Amlovas). The advantage of using amlodipine in reducing blood pressure compared with another calcium antagonist, diltiazem, has been shown.

The duration of action of amlodipine is 24 hours, which facilitates a single dose per day and provides ease of use.

In the THOMS study, a decrease in the mass index of the left ventricular myocardium was noted in the group of patients taking amlodipine.

ACE inhibitors are the drugs of choice for at least two categories of elderly patients with hypertension - 1) with left ventricular dysfunction and/or heart failure; 2) with concomitant diabetes mellitus.

This is based on a proven reduction in cardiovascular mortality in the first case and a slowdown in the development of kidney failure in the second. In case of intolerance, ACE inhibitors can be replaced by angiotensin receptor antagonists.

a-blockers (prazosin, doxazosin) are not recommended for the treatment of hypertension in the elderly due to the frequent development of orthostatic reactions. In addition, a large clinical study ALLHAT showed an increased risk of heart failure in patients treated with α-blockers for hypertension.

HEART FAILURE IN ELDERLY PEOPLE.

Currently, chronic heart failure (CHF) affects 1–2% of the population in developed countries. Annually, chronic heart failure develops in 1% of people over 60 years of age and in 10% of people over 75 years of age.

Despite the significant progress made in the last decades in the development of therapeutic algorithms for the treatment of CHF using various drugs and their combinations, the specifics of the treatment of elderly and elderly patients remain poorly understood. The main reason for this turned out to be the targeted exclusion from most prospective clinical trials on the treatment of CHF in people over 75 years of age - primarily women (who account for more than half of all elderly people with CHF),

as well as persons with comorbidities (also, as a rule, the elderly). Therefore, before obtaining data from clinical studies specifically designed for the population of elderly and elderly people with CHF, one should be guided by proven principles for the treatment of CHF in middle-aged people, taking into account the above age characteristics of the elderly and individual contraindications.

Elderly patients with CHF are prescribed ACE inhibitors, diuretics, b-blockers, spironolactone, as drugs that have been proven to improve survival and quality of life. With supraventricular tachyarrhythmias against the background of CHF, digoxin is very effective. If it is necessary to treat ventricular arrhythmias against the background of CHF, preference should be given to amiodarone, since it minimally affects myocardial contractility. In severe bradyarrhythmias against the background of CHF (sick sinus syndrome, intracardiac blockades), the possibility of implanting a pacemaker should be actively considered, which often greatly facilitates the possibilities of pharmacotherapy.

It is extremely important for the successful treatment of CHF in the elderly is the timely detection and elimination / correction concomitant diseases, often hidden and oligosymptomatic (exhaustion, anemia, thyroid dysfunction, liver and kidney disease, metabolic disorders, etc.).

STABLE ANGINA IN THE ELDERLY.

The elderly make up the majority of CAD patients. Almost 3/4 of deaths from coronary artery disease occur among people over 65 years of age, and almost 80% of people who die from myocardial infarction belong to this age group. At the same time, in more than 50% of cases, the death of people over 65 years of age occurs from complications of coronary artery disease.

The prevalence of coronary artery disease (and, in particular, angina pectoris) in young and middle age is higher among men than among women, but by the age of 70-75, the frequency of coronary artery disease among men and women is comparable (25-33%). Annual mortality among patients in this category is 2-3%, in addition, another 2-3% of patients may develop non-fatal myocardial infarction.

Features of IHD in the elderly:

Atherosclerosis of several coronary arteries at once;

Often there is a stenosis of the trunk of the left coronary artery;

Often there is a decrease in left ventricular function;

Often there are atypical angina pectoris, painless myocardial ischemia (up to painless MI);

The risk of complications during planned invasive studies in the elderly is slightly increased, so old age should not be an obstacle to referring a patient to coronary angiography.

Features of the treatment of stable angina in the elderly.

picking up drug therapy elderly patients, it should be remembered that the treatment of coronary artery disease in the elderly is carried out according to the same principles as in young and middle age, however, taking into account some features of pharmacotherapy.

Efficiency medications prescribed for coronary artery disease, with age, as a rule, does not change. Active antianginal, anitischemic, antiplatelet and lipid-lowering therapy can significantly reduce the incidence of coronary artery disease complications in the elderly. All groups are used according to indications medicines- nitrates, b-blockers, antiplatelet agents, statins. However, evidence-based studies specifically addressing the treatment of coronary artery disease in older and old age while not enough.

At the same time, the proven advantage of the calcium channel blocker amlodipine at a dose of 5–10 mg/day in reducing the frequency of episodes of myocardial ischemia (Holter monitoring data). Frequency reduction pain attacks compared with placebo make the use of the drug promising in this category of patients, especially in those who suffer from hypertension. IN last years clinical trials are being conducted specifically on the effectiveness of medical treatment of coronary artery disease in the elderly.

GENERAL PRINCIPLES OF CARE OF THE PATIENTS OF THE ELDERLY AGE.

Medical ethics. When caring for elderly and senile patients, compliance with the norms of medical ethics and deontology is of particular importance. Often a nurse becomes the only close person for a patient, especially a lonely one. Every patient needs individual approach taking into account the personal characteristics of the patient and his relationship to the disease. To establish contact, the nurse should speak in a calm, friendly voice, be sure to greet patients. If the patient is blind, you should introduce yourself every day when entering the ward in the morning. Patients should be treated with respect, by name and patronymic. It is unacceptable to call the patient familiarly "grandmother", "grandfather", etc.

Geriatric patients often "withdraw into themselves", "listen" to their condition, they develop irritability, tearfulness. Preparing the patient for various medical procedures, the ability to listen, empathize and give advice are important factors in successful treatment. However, the nurse herself, in addition to the doctor, should not give the patient or his relatives information about the nature and possible outcome of his disease, discuss the results of the study and treatment methods.

The problem of insomnia. Elderly patients often complain of insomnia, their sleep patterns change - often they sleep more during the day, and at night lead a more active lifestyle (eat, walk around the ward, read).

Often used by patients in this case sleeping pills can quickly become addictive. In addition, against the background of taking sleeping pills, weakness, headaches, a feeling of morning “brokenness”, and constipation may appear. If necessary, sleeping pills are prescribed by a doctor. The nurse can recommend the patient an appointment medicinal herbs(for example, a decoction of motherwort 10-15 ml 40 minutes before going to bed), 10-20 drops of Valocordin, a glass of warm milk with honey dissolved in it (1 tbsp), etc.

Ensuring personal hygiene measures. It is often difficult for an elderly and senile patient to take care of himself. He should be assisted in changing bed and underwear, if necessary, take care of his hair, nails, etc. It is necessary to monitor the condition of the patient's oral cavity. After each meal, the nurse should give the patient boiled water so that he can rinse his mouth thoroughly. A seriously ill nurse must wipe her mouth with a swab moistened with 1% hydrogen peroxide solution or sodium bicarbonate solution. When caring for a patient who is on a long-term bed rest, it is necessary to carry out careful skin care and prevent bedsores. The nurse should help the patient change position in bed, periodically, if his condition allows, sit on the bed, propped up on all sides with pillows for stability, lightly massage the back, feet and hands. The physiological functions of patients should be monitored and, if necessary, regulate bowel function with a diet (inclusion in the diet of dried fruits, lactic acid products, etc.), the use of laxatives or enemas as prescribed by the doctor.

Any deterioration in the patient's well-being, the appearance of new symptoms, the nurse should immediately inform the doctor. Before his arrival, you need to lay the patient down or help him take the appropriate position (for example, when suffocating, the patient should take a sitting or half-sitting position), ensure peace, and, if necessary, provide first aid.

Injury prevention. WITH special attention precautions should be taken to prevent possible injury. Bruises and fractures (especially necks femur) immobilize patients, accompanied by the development of complications such as pneumonia, pulmonary embolism, which can lead to death.

When washing the patient in the bath, you need to support him, help him get in and out of the bath, a rubber mat should be laid on the floor so that the patient does not slip. The nurse is obliged to monitor the condition of the hospital premises, their sufficient illumination. Should not be on the floor foreign objects, the presence of spilled liquid is unacceptable, since the patient may not notice them and fall. The corridors of the geriatric department should be spacious, not cluttered with furniture, and railings should be fixed along the walls of the corridor so that patients can hold on to them.

Medication control. The nurse must monitor the intake of prescribed medications by patients. With a decrease in memory and the development of dementia (lat. dementia- dementia), patients may forget to take the medicine or, conversely, take it again. Therefore, elderly and senile patients should be provided with clear instructions given by the doctor not only orally, but also in writing. It is necessary to monitor the water balance, since insufficient fluid intake can increase the concentration of prescribed drugs in the body, the appearance of side effects and the development of drug intoxication.

NURSING PROCESS AND TREATMENT OF ELDERLY PEOPLE WITH DISEASES OF THE CARDIOVASCULAR SYSTEM.

With sclerosis of the aorta, coronary, cerebral and renal arteries, their elasticity decreases; thickening of the vascular wall leads to a constant increase in peripheral resistance.

Tortuosity and aneurysmal expansion of capillaries and arterioles occur, their fibrosis and hyaline degeneration develop, which leads to obliteration of the vessels of the capillary network, which worsens the transmembrane exchange.

The blood supply to the main organs becomes inadequate.

As a result of insufficiency of the coronary circulation, dystrophy develops
muscle fibers, their atrophy and replacement with connective tissue. Formed atherosclerotic cardiosclerosis, leading to heart failure and heart rhythm disturbances.

Due to sclerosis of the myocardium, its contractility decreases, dilatation of the heart cavities develops.

The "senile heart" (age-related changes in the heart muscle) is one of the main factors in the development of heart failure due to changes in neurohumoral regulation and prolonged myocardial hypoxia.

In old age, the blood coagulation system is activated, functional insufficiency of anticoagulant mechanisms develops, and blood rheology worsens.

In the elderly and senile age, a number of hemodynamic features are formed: mainly systolic blood pressure rises, venous pressure, cardiac output decrease, late and minute volume, etc.

Most often, in elderly and senile people, systolic blood pressure rises (more than 140 mm Hg) and so-called isolated systolic arterial hypertension develops. With age, the walls of large vessels lose their elasticity, atherosclerotic plaques appear, and organic changes develop in small vessels. As a result, cerebral, renal and muscle blood flow is reduced. To date, a system of normative values of blood pressure has not been developed depending on age - a number of specialists consider an increase in blood pressure in elderly and senile people as a normal compensatory phenomenon.

When caring for a patient, it must be remembered that deterioration in the condition of elderly and senile patients with coronary artery disease can provoke concomitant bronchopulmonary diseases, exercise stress, overeating, psycho-emotional stress, acute infections, inflammatory processes V urinary tract, surgical interventions and etc.

The nurse should actively work with patients, explaining to them the need to deal with bad habits. It should be explained to the patient that after smoking a cigarette, the frequency and strength of heart contractions increase, blood vessels narrow, and blood pressure rises. Smokers are more likely to develop malignancy arterial hypertension, the effect of treatment decreases, mortality from cardiovascular diseases increases almost 2 times.

Patients of elderly and senile age need a little rest during the day and restful sleep at night. Targeted relaxation exercises are helpful. The patient needs a diet that is moderately saturated with calories and rich in vitamins. You should abandon the use of animal fats, sweets, "interception" between the main meals, as excess body weight interferes with the work of the heart.

BIBLIOGRAPHY.

1. Belenkov Yu.N., Mareev V.Yu., Ageev F.T. "National guidelines for the diagnosis and treatment of chronic heart failure". "Heart failure", 2002, no. 6: 3–8

2. Lazebnik L.B., Komissarenko I.A., Huseynzade M.G., Preobrazhenskaya I.N. "Beta-blockers in geriatric practice" RMJ, 1999, v 7 No. 16: 66–70

3. Lazebnik L.B., Komissarenko I.A., Milyukova O.M. " Medical treatment isolated systolic hypertension in the elderly” BC, 1998, vol. 6, no. 21: 25–29

4. Lazebnik L.B., Postnikova S.L. "Chronic heart failure in the elderly" RMJ, 1998, vol. 6, no. 21: 34–38

From prenatal development to old age, age-related features of the cardiovascular system are observed. Every year there are new changes that ensure the normal functioning of the body.

The aging program is embedded in the human genetic apparatus, which is why this process is an invariable biological law. According to gerontologists real term life expectancy is 110-120 years, but this moment depends only on 25-30% of inherited genes, everything else is an influence environment which affects the fetus while still in the womb. After birth, you can add ecological and social conditions, health status, etc.

If you add everything together, not everyone can live more than a century, and there are reasons for that. Today we will consider the age-related features of the cardiovascular system, since the heart with numerous vessels is the “engine” of a person, and life is simply impossible without its contractions.

How does the fetal cardiovascular system develop in the womb?

Pregnancy is a physiological period during which a new life begins to form in a woman's body.

All intrauterine development can be divided into two periods:

embryonic– up to 8 weeks (embryo);
fetal- from 9 weeks to childbirth (fetus).

The heart of the future man begins to develop as early as the second week after the fertilization of the egg by the spermatozoon in the form of two independent heart germs, which gradually merge into one, forming a semblance of a fish heart. This tube grows rapidly and gradually moves down into the chest cavity, where it narrows and bends, taking on a certain shape.

At week 4, a constriction is formed, which divides the organ into two sections:

arterial;
venous.

At week 5, a septum appears, with the help of which the right and left atrium appears. It is at this time that the first pulsation of a single-chamber heart begins. At week 6, heart contractions become more intense and clearer.

And by the 9th week of development, the baby has a full-fledged four-chamber human heart, valves and vessels for moving blood in two directions. The complete formation of the heart ends at week 22, then only the muscle volume increases and the vascular network expands.

You need to understand that such a structure of the cardiovascular system implies some distinctive features:

Prenatal development is characterized by the functioning of the "mother-placenta-child" system. Oxygen, nutrients, as well as toxic substances (drugs, alcohol breakdown products, etc.) enter through the umbilical vessels.
Only 3 channels work - an open oval ring, botalla (arterial) and arantia (venous) duct. This anatomy creates parallel blood flow as blood flows from the right and left ventricles to the aorta and then through the systemic circulation.
Arterial blood from the mother to the fetus goes through the umbilical vein, and saturated with carbon dioxide and metabolic products returns to the placenta through 2 umbilical arteries. Thus, we can conclude that the fetus is supplied with mixed blood, when, after birth, arterial blood flows strictly through the arteries, and venous blood through the veins.
The pulmonary circulation is open, but a feature of hematopoiesis is the fact that oxygen is not wasted on the lungs, which during intrauterine development do not perform the function of gas exchange. Although a small amount of blood is taken, this is due to the high resistance created by non-functioning alveoli (respiratory structures).
The liver receives about half of the total blood delivered to the baby. Only this organ boasts the most oxygenated blood (about 80%), while others feed on mixed blood.
It is also a feature that the blood contains fetal hemoglobin, which differs best ability bind with oxygen. This fact is connected with the special sensitivity of the fetus to hypoxia.

It is this structure that allows the baby to receive vital oxygen with nutrients from the mother. The development of the baby depends on how well a pregnant woman eats and leads a healthy lifestyle, and the price, mind you, is very high.

Life after birth: features in newborns

Termination of the connection between the fetus and the mother begins immediately with the birth of the baby and as soon as the doctor bandages the umbilical cord.

With the first cry of the baby, the lungs open and the alveoli begin to function, reducing resistance in the pulmonary circulation by almost 5 times. In this regard, the need for the arterial duct stops, as it was necessary before.
The heart of a newborn baby is relatively large and equals approximately 0.8% of body weight.
The mass of the left ventricle is greater than the mass of the right.
A full circle of blood circulation is carried out in 12 seconds, and blood pressure averages 75 mm. rt. Art.
The myocardium of the born baby is presented in the form of undifferentiated syncytium. Muscle fibers are thin, do not have transverse striation and contain a large number of nuclei. Elastic and connective tissue is not developed.
From the moment the pulmonary circulation is launched, active substances are released that provide vasodilatation. Aortic pressure significantly exceeds compared with the pulmonary trunk. Also, features of the neonatal cardiovascular system include closure of bypass shunts and overgrowth of the annulus ovale.
After birth, the subpapillary venous plexuses are well developed and located superficially. The walls of the vessels are thin, elastic and muscle fibers are poorly developed in them.

Attention: the cardiovascular system has been improving for a long time and completes its full formation in adolescence.

What changes are typical for children and adolescents

The most important function of the circulatory organs is to maintain a constancy of the body's environment, supply oxygen and nutrients to all tissues and organs, excretion and removal of metabolic products.

All this happens in close interaction with the digestive, respiratory, urinary, vegetative, central, endocrine system etc. Growth and structural changes in the cardiovascular system are especially active in the first year of life.

If we talk about the features in children's, preschool and teenage years, the following distinguishing features can be distinguished:

By 6 months, the mass of the heart is 0.4%, and by 3 years and beyond, about 0.5%. The volume and mass of the heart increases most intensively in the first years of life, as well as in adolescence. In addition, it happens unevenly. Up to two years, the atria grow more intensively, from 2 to 10 years, the entire muscular organ as a whole.
After 10 years, the ventricles increase. The left one is also growing faster than the right one. Speaking about the percentage ratio of the walls of the left and right ventricles, the following figures can be noted: in a newborn - 1.4: 1, at 4 months of life - 2: 1, at 15 years old - 2.76: 1.
All periods of growing up in boys, the size of the heart is larger, with the exception of from 13 to 15 years old, when girls begin to grow faster.
Up to 6 years, the shape of the heart is more rounded, and after 6 it acquires an oval, characteristic of adults.
Up to 2-3 years, the heart is located in a horizontal position on an elevated diaphragm. By the age of 3-4, due to an increase in the diaphragm and its lower standing, the heart muscle acquires oblique position with a simultaneous flip around the long axis and the location of the left ventricle forward.
Up to 2 years, the coronary vessels are located according to the loose type, from 2 years to 6 they are distributed according to the mixed type, and after 6 years the type is already main, characteristic of adults. The thickness and lumen of the main vessels increase, and the peripheral branches are reduced.
In the first two years of a baby's life, differentiation and intensive growth myocardium. A transverse striation appears, muscle fibers begin to thicken, a subendocardial layer and septal septa are formed. From 6 to 10 years of age, the gradual improvement of the myocardium continues, and as a result, the histological structure becomes identical to adults.
Up to 3-4 years, the instruction for the regulation of cardiac activity involves the innervation of the nervous sympathetic system, which is associated with physiological tachycardia in babies of the first years of life. By the age of 14-15, the development of the conductor system ends.
Children early age have a relatively wide lumen of the vessels (in adults 2 times already). Arterial walls are more elastic and that is why the rate of blood circulation, peripheral resistance and blood pressure are lower. Veins and arteries grow unevenly and do not match the growth of the heart.
Capillaries in children are well developed, the shape is irregular, tortuous and short. With age, they settle deeper, elongate and take on a hairpin shape. The permeability of the walls is much higher.
By the age of 14, a full circle of blood circulation is 18.5 seconds.

The heart rate at rest will be equal to the following figures:

Heart rate according to age. Learn more about age features cardiovascular system in children can be from the video in this article.

Cardiovascular system in adults and the elderly

Age classification according to WHO is equal to the following data:

Young age from 18 to 29 years.
Mature age from 30 to 44 years.
Average age from 45 to 59 years.
Elderly age from 60 to 74 years.
Senile age from 75 to 89 years.
Long-livers from 90 years and older.

All this time, cardiovascular work is undergoing changes and has some features:

During the day, the heart of an adult pumps more than 6,000 liters of blood. Its dimensions are equal to 1/200 of the body part (for men, the mass of the organ is about 300 g, and for women, about 220 g). The total volume of blood in a person weighing 70 kg is 5-6 liters.
The heart rate in an adult is 66-72 beats. in min.
At the age of 20-25, the valve flaps thicken, become uneven, and in the elderly and senile age, partial muscle atrophy occurs.
From the age of 40, calcium deposits begin, at the same time, atherosclerotic changes in the vessels progress (see), which leads to a loss of elasticity of the blood walls.
Such changes lead to an increase blood pressure, especially this trend is observed from the age of 35.
With aging, the number of red blood cells decreases, and, consequently, hemoglobin. As a result, you may experience drowsiness fast fatiguability, dizziness.
Changes in the capillaries make them permeable, which leads to a deterioration in the nutrition of body tissues.
With age, myocardial contractility also changes. In adults and the elderly, cardiomyocytes do not divide, so their number may gradually decrease, and connective tissue is formed at the site of their death.
The number of cells of the conducting system begins to decrease from the age of 20, and in old age their number will be only 10% of the original number. All this creates the prerequisites for the violation of the rhythm of the heart in old age.
Starting from the age of 40, the efficiency of the cardiovascular system decreases. Increases endothelial dysfunction, both in large and small vessels. This affects changes in intravascular hemostasis, increasing the thrombogenic potential of the blood.
Due to the loss of elasticity of large arterial vessels, cardiac activity becomes less and less economical.

Features of the cardiovascular system in the elderly are associated with a decrease in the adaptive capacity of the heart and blood vessels, which is accompanied by a decrease in resistance to adverse factors. It is possible to ensure maximum life expectancy by preventing the occurrence of pathological changes.

According to cardiologists, in the next 20 years, diseases of the cardiovascular system will determine almost half of the mortality of the population.

Attention: for 70 years of life, the heart pumps about 165 million liters of blood.

As we can see, the features of the development of the cardiovascular system are really amazing. It is amazing how clearly nature has planned all the changes to ensure normal human life.

To prolong your life and provide happy old age must adhere to all recommendations for healthy lifestyle life and heart health.