Good intentions
"It's time to move away from the stereotype that it's normal to get sick in old age"
Irina Reznik, Mednovosti
In the new "May" decrees, President Vladimir Putin instructed the government to ensure an increase in average life expectancy in Russia is up to 78 years old by 2024 and up to 80 years old by 2030. Today, the average Russian lives 72.7 years – 10 years less than the average European and 15 years less than the Japanese. But things are even worse with the duration of a healthy life – according to this indicator, Russia is not even in the top hundred countries of the world.
The healthy life coefficient is recommended to be calculated by the World Health Organization (WHO). It shows the number of years that a person lives without serious chronic or age-related diseases that would complicate his life or make him disabled. This index shows how the country's medical and social system works, whether it is possible to track serious diseases at an early stage.
According to WHO, healthy life expectancy for Russians will average 63.4 years for children born in 2015 (61.5 years for men and 64.6 for women). At the same time, the expected duration of a healthy life, for example, in Sweden and Italy today is 70 years, and in Switzerland – 81.8 years.
According to the calculations of RANEPA demographers, only 71.8% of men and 70.4% of women remain completely independent of outside help by the retirement threshold in Russia. At the same time, the model used for the absence of serious difficulties is purely medical and roughly corresponds to the idea of group III disability. That is, we are not even talking about some kind of labor or social activity, but about the elementary ability to wash yourself, dress, walk around the room, eat, get out of bed and use the toilet.
In 2015, the average life expectancy in Russia reached a historic high and exceeded the bar of 70 years – this is the figure that distinguishes developed countries from developing ones.Now this indicator is 72.7 years old, the share of elderly people is 14% of the population and continues to grow. At the same time, from the point of view of our state, the coefficient of healthy life expectancy is an insignificant statistical indicator: it is not in any state program related to healthcare and demography. Geriatric specialists, however, do not agree with this. In their opinion, the country needs a healthy longevity program, the main task of which is to reduce the gap between the total life expectancy and its active period.
Modern approach
The modern approach to the problems of old age lies in the fact that it can not only be facilitated – it is quite possible to delay its onset, prolong human life in general and especially its active, full-fledged part.In almost all areas of medicine, it is possible to distinguish features inherent in old age. And geriatrics is engaged not only in the study of "senile" diseases and pathologies, but also in the methods of their treatment and prevention, the peculiarities of hygiene of the elderly. Moreover, the direction of geriatric pharmacotherapy is also being developed, which studies the peculiarities of the effect of drugs and bioactive substances on the elderly.
In Russia, the geriatric service has been actively developing since 2014. Since 2018, geriatric care for elderly patients has been included in the CHI system. At the end of April, the V All-Russian Congress of Gerontologists and Geriatricians with International participation was held in Moscow, at which the chief freelance specialist-geriatrician of the Ministry of Health Olga Tkacheva announced plans and the first results of the development of geriatric services in Russia.
In particular, in 2017, the Ministry of Health launched in seven regions a pilot project "Organization of a modern model of long-term medical care for elderly and senile citizens on the principles of interdisciplinary interaction" ("Territory of care"). According to Tkacheva, this program means combining the efforts and knowledge of not only geriatricians, but also primary care physicians, psychologists, neurologists, psychiatrists and social workers. In addition, an extensive educational program for doctors and nursing staff has been organized in more than 30 regions of the country. In recent years, clinical recommendations and expert agreements on pharmacotherapy for elderly patients, senile asthenia, diabetes mellitus, and chronic heart failure have been approved.
By 2023, 2,500 geriatric doctors will be trained for practical work. In particular, from May 14 to June 20, 2018, on the basis of the Department of Diseases of Aging of the FDPO of the N.I. Pirogov RNIMU, a competitive recruitment for training in clinical residency and postgraduate studies under scholarship programs, including international internships in leading foreign clinics, is held. As part of the second year of study, internships are provided in leading geriatric clinics in Israel, France, and Sweden.
At the congress itself, the first National Guide to Geriatrics was presented, which was created with the participation of more than 40 leading experts in various fields of geriatrics. As well as the first Russian recommendations "Care for the weakened elderly". The National Guidelines pay much attention to the syndrome of senile asthenia ("fragility"), issues of palliative geriatrics and geriatric rehabilitation models, as well as cognitive and psychoemotional disorders, dementia, depression and anxiety disorders. A separate chapter is devoted to the foundation of geriatrics – a comprehensive geriatric assessment. The Care Guide contains 19 sections: theoretical foundations of care, techniques for caring for the elderly and information on how to avoid mistakes by helping weakened elderly people.
To study the prevalence of geriatric syndromes and age-associated diseases in elderly Russians should be a domestic multicenter epidemiological study "EUCALYPTUS". This study will start this year in 23 regions of Russia with different climatic, economic and demographic conditions, and domestic experts expect to get a complete picture of the situation in the country with its help. In the meantime, it is almost impossible to draw conclusions based on average data for the country, since the level of healthcare in Russian regions is very heterogeneous, and this is clearly demonstrated by life expectancy indicators. The difference between the first and last region in the Rosstat list is more than 15 years.
"Old people should be treated the same as everyone else"
According to Tkacheva, it is time for Russian society to move away from the stereotype that it is normal to get sick in old age. According to her, it is necessary to move away from the well-established opinion that an elderly person "should have something to hurt", it is impossible to treat people "with a discount on age" and allow discrimination based on age.
As for neurodegenerative diseases, then, according to the head. the laboratory of Neurogeriatrics and cognitive Disorders of the Russian Gerontological Research and Clinical Center Helen Mkhitaryan, cannot be equated between old age and dementia. Today, according to WHO, Russia ranks sixth in the world in the prevalence of dementia. However, this is largely due to the late diagnosis of the disease: and the patients themselves, and their loved ones, and even doctors write off the symptoms for age and do not refer patients to specialized specialists who can slow down the development of the disease.
This attitude is already becoming a kind of medical and social problem."Sick old people and their relatives are characterized by very low compliance – adherence to treatment and the ability to respond quickly to changes in their health status," Pyotr Tsarkov, director of the Coloproctology and Minimally Invasive surgery clinic of the I.M. Sechenov First Moscow State Medical University, Chairman of the Board of the Russian Society of Colorectal Surgeons, told Mednovosti. – Unfortunately, we (people who are responsible for their elderly relatives) pay less attention to them, and they themselves try not to bother us. Figuratively speaking, they "shrink", reducing the range of claims and attention to themselves over the years. They say: "now I'm going to be a little sick, and everything will pass." Because of their attitude towards themselves, older people are more likely than people of other ages to have advanced forms of malignant diseases."
Previous generations of oncologists also had a negative attitude to the possibility and prospects of treating patients over 75 years of age. Doctors reasoned that if they operated on the elderly, who did not have long left, it would only complicate their already difficult life. Meanwhile, according to Tsarkov, the analysis of the oncological survival of the oldest patients showed that it is comparable to the overall survival in the groups of patients 60-75. And this means that the elderly should be treated in the same way as everyone else. "Today, people have become more engaged in health. Many people enter this age category in good physical shape, and although they have concomitant diseases, they are not so decompensated and may well be treated. And we have to develop treatment protocols for the elderly, because they also want to live," Tsarkov believes. – An old man has many comorbidities competing for the right to be the first in the list of causes of his death. And we understand that this can happen at any moment. But we have to give them a chance, not leave them and watch them slowly leave."
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