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Geriatricians against age discrimination. Is healthy aging possible without a decline in mental and physical activity?
Olga Nikolaevna! What is the difference between geriatrics and geriatric medicine? Gerontology deals with elderly people, and geriatrics deals with preventing their diseases?
Olga Tkacheva: Gerontology is a science that studies the biological, social and psychological aspects of aging, their causes and ways to combat them. Geriatrics is a section of geriatrics that deals with the treatment of elderly people.
Olga Tkacheva: According to the WHO classification, the age of elderly people is 60-75 years. Geriatric age (although I don’t like this term!) is from 75 to 90 years. People over 90 years old come to us. The classification of ages over 100 years old is very interesting. 100-105 years old - young 100 years old, 105-110 years old - middle age 100 years old, 110 years and older - 100 years and older. So at 100 years old you can still look young!
Olga Tkacheva: According to Rosstat, at the beginning of 2024, there will be 13,253 centenarians living in Russia. Of these, 2,842 will live in Moscow and, for example, more than 93,000 in Japan.
Let's start with a poem about medicine for the elderly. "Everything in the world has an end, including love, dreams and pain, but there is no end to memories." And the hardest thing is for those who know everything. So you don't have to know everything? Why don't you just live? Isn't old age a joy? Or can old age still be a joy?
Olga Tkacheva: Possibly! And our mission is not just to extend life expectancy, but to extend healthy, active life and maintain its high quality for as long as possible.
They say: "What do you want? You are already 80 years old. At this age, it is normal to be sick!" - This is simply illiteracy. Geriatric medicine can significantly improve the condition of elderly people.
Olga Tkacheva: Of course. It is important to delay the onset of a chronic disease. And if it already exists, it can be effectively treated. And geriatric medicine deals with the issue of improving the quality of life in old age. Thus, you will be able to enjoy life even in old age. By the way, we are not talking about diseases that are treated differently in older people. Other problems associated with aging are also described: loss of physical, functional and cognitive activity.
We need to provide a comfortable environment for older people so that they can maintain their independence and autonomy from others for as long as possible.
Olga Tkacheva: Medicine is becoming more and more preventive. Medical examination and prevention programs have been created for the elderly. It not only prevents the occurrence of diseases and complications, but also slows down aging. More specifically? The health check program includes special blocks related to memory impairment, risk of falling, eating disorders, urinary incontinence and much more.
It is important to encourage older people to undergo preventive examinations and see a doctor. Often, patients believe that their health problems are related to old age. This is a mistake! Healthy aging is possible without pain, without a decrease in mental or physical activity, and without depression.
Olga Tkacheva: Of course, despite the progress of modern science, we cannot yet stop aging. However, the rate of aging may vary. For some it is faster, for others it is slower. It depends on your lifestyle, genetics and ecology. Many studies are aimed at studying the mechanisms of aging and developing technologies to slow down aging. So far, real success has been achieved only in experimental work: on cell cultures, animals.
We are trying to apply these results in clinical practice. Our center is developing methods for measuring the rate of human aging and evaluating various medical interventions in terms of their possible impact on the aging process.
Olga Tkacheva: We include six groups of diseases in age-related diseases: cardiovascular diseases, oncological diseases, diabetes, Alzheimer's disease or other types of dementia, chronic obstructive bronchitis, and diseases of the musculoskeletal system (osteoporosis, osteoarthritis, etc.). In general, there is no single disease in old age. There are several of them, and they are usually combined together. Each person ages according to their own scenario, and the combination of diseases can also be different. Therefore, in geriatric medicine, each clinical case is unique.
The prevalence of chronic non-communicable diseases is associated with the aging of the world population. For example, our epidemiological studies show that arterial hypertension occurs in almost 80% of people over 80 years of age. 20% of this age group suffer from diabetes, and about 80% live with various local pains. Memory impairment occurs in half of people over 85 years of age. Urinary incontinence affects every third person aged 65 to 75 years and almost every second person over 75 years of age.
The most common geriatric problem is frailty syndrome, which is characterized by weakness, weight loss, slow walking, poor memory, and difficulty caring for oneself. It affects 7% of people aged 65 to 75, 15% of people aged 75 to 85, and 1 in 3 people over 85. What does this mean? By age 85, one-third of patients will need outside help.
The need for geriatric medicine is obvious. How many such specialists are there now? Where is gerontology taught?
Olga Tkacheva: In Russia, there are more than 1,700 geriatricians and more than 40 universities where geriatrics is taught as part of postgraduate training. In the near future, we should move to teaching geriatrics to medical students.
Olga Tkacheva: Imagine that a person has not one disease, but four or five. Much more. In older people, it occurs against the background of aging. And this introduces additional complexity into the treatment algorithm. In some cases, extensive tests and drug treatment are required. Geriatricians identify the most important problems and develop an individual care plan for the patient in such a way as to minimize the number of interventions. In addition, when using drugs to treat one disease, treatment is monitored so as not to worsen the course of another disease.
In the end, a fifth of our patients take several medications at the same time. In addition, I often take medications on the recommendation of a neighbor, which I heard on TV. This is an issue that a geriatrician should deal with. You must be able to communicate with older people and their relatives and explain the risks and benefits of taking medications.
But can a person drink a glass of water if he is elderly?
Olga Tkacheva: In principle, it is possible. For example, it is not bad to have a glass of wine from time to time. Let me tell you more. The older he gets, the less restrictions we impose on him. We focus on quality of life and the opportunity to experience positive emotions.
Olga Tkacheva: Exactly. For example, in old age we are afraid of loss of appetite, which leads to protein-energy deficiency. Therefore, we try to follow the tastes of an older person and focus on his desires.
Breakfast in childhood consisted of eggs in a bag, a sandwich and cocoa with milk and sugar. Now it is considered that two eggs a day is too much. It is forbidden! What is possible?
Olga Tkacheva: We prohibit certain things for people over 70-75. We say: eat well and eat well. This is because poor nutrition puts you at risk of losing muscle mass. This can lead to a slower walking speed, less physical activity and an increased risk of falls. In addition, physical activity such as walking, gymnastics and swimming is encouraged. In other words, anything that brings pleasure is possible.
Remember Winston Churchill? He loved to lie on the sofa and drink Armenian cognac. And with a sound mind and strong memory, he lived to be almost a hundred years old.
Olga Tkacheva: No one has cancelled genetics. But perhaps if Churchill had not smoked and had not led a physically active lifestyle, he would have lived much longer.
And as one great man once said, the only known luxury is the luxury of human communication? The Moscow Longevity Center has opened near my home.
Olga Tkacheva: I love it! In these centers, seniors can realize a variety of interests, including drawing, dancing, working on a computer, handicrafts, learning foreign languages. And most importantly, it is the luxury of communication, being in demand, and an interest in life.
Interest in life. Sometimes elderly patients suffering from various diseases lose it after visiting a doctor. How long do geriatricians visit?
Olga Tkacheva: From 2024, the time it takes for a patient to see a geriatrician will be 45 minutes. What can I do during this time? They collect complaints, amnesia, and examine the patient. We conduct a comprehensive geriatric examination. This is a special way of questioning, examining, and testing to assess your physical strength, memory, and quality of life.
But often – and you probably know this – when older people complain, doctors respond: “What do you want? Have you forgotten how old you are?”
Olga Tkacheva: What you are talking about is ageism, that is, ageism. In the medical world, it is not such a big problem. Nowadays, doctors increasingly understand that elderly patients can be effectively helped. The problem is different. There is an established paradigm. If a person is old, he or she must suffer. As a result, patients come to the doctor late. Moreover, when you ask why they did not come earlier, they answer: “We are probably old.”
Ageism is often a problem for older people themselves. Instead of going to the doctor, they think, “I must be sick, weak, and have a bad memory because I’m old.” You shouldn’t!
And they said, "Grandma, what do you want? "It's normal to be sick at this age!" - That's just ignorance. Geriatric medicine can lead to significant improvements in the condition of the elderly.
In 2016, Russia adopted the Strategy of Actions for the Elderly. It formalizes the principle that all age groups have equal access to health care and social support. This means that it can and should be treated at any age, including using advanced treatment methods. If a person is 90 years old and needs dentures, they should get dentures. If a patient with cataracts needs to be operated on, they should have the operation. This is because your vision should be good even at the age of 80 or 85 and older.
Old age is not a contraindication for modern healthcare. Currently, about 55% of high-tech surgeries are performed on patients over 60. Examples include cataract surgery, vascular stent placement, and joint transplantation. We know how to prepare patients for surgery and how to rehabilitate them after surgery.
Since 2016, Russia has created an infrastructure for caring for the elderly. Centers for the elderly operate in almost every region. There are 8,261 geriatric beds in hospitals and 1,481 geriatric beds in clinics. Assistance to the elderly can be provided in any medical institution. Almost every doctor has the skills to provide this.
What about social support? A lonely patient is discharged after surgery...
Olga Tkacheva: The issue of interaction between the healthcare system and social support is complex. We are very much counting on the support of a social worker who will resolve everyday issues, ensure communication with doctors, and monitor medication intake.
However, there is still no real support system, making it difficult to get help at home.
Olga Tkacheva: In fact, it is impossible to treat chronic diseases during hospitalization. Long-term monitoring and treatment adjustments, as well as regular check-ups, are required. It is more comfortable to receive such care at home. And some patients need help with daily activities and hygiene procedures. For this purpose, we are developing a long-term care system. This includes elderly people and people with disabilities who are unable to fully or partially care for themselves, move independently, or meet basic life needs. Caregivers provide such citizens with a social package, including individually selected social services to maintain health, hygiene, mobility, and nutrition.
You, Olga Nikolaevna, are the director of the geriatric center. How can I get there? How can I make an appointment with a geriatrician?
Olga Tkacheva: A polyclinic doctor can refer you to our center. We treat patients from Moscow and the region. We work in the compulsory medical insurance system.
Finally: should I live long or not? How many years do you personally want to live?
Olga Tkacheva: It is difficult to answer this question. Probably many people would like to live to 100 years. But due to the infirmities and illnesses that come with age, they stop. However, the case of Jeanne Calment, a French woman who lived to 122 years, inspires optimism. Even at 100, he rode a bicycle, had a good memory and a great sense of humor. If she can do it, why shouldn't she try!