Здоровье населения старшего возраста (на примере Республики Коми)

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

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Objective To investigate the correlation between hemoglobin level and health status of the elderly living in communities in Beijing. Methods A random cluster sampling method was used to select residents living in communities of Beijing city, and a cross-sectional study was carried out by questionnaires, scene testing and blood sample collection.WHO-formulated criteria were applied for diagnosing anemia.The health indicators in questionnaires included visual impairment, physical disability, decreased health, self-care, fatigue, anorexia, independent walking distance, exercise frequency, intelligence status and computing power. Results Complete information was obtained in a total of 1 948 elderly people, including 790 cases of male and 1 158 cases of female, with an average age of(73.9±6.1)years and a median age of 74 years(65-100). The mean level of hemoglobin in the 1 948 people was(135.65±14.48)g/L, with(142.56±15.56)g/L in male and(130.95±11.53)g/L in female.Hemoglobin level was significantly lower in female than in men(t=54.739, P<0.01). Hemoglobin level was decreased with aging, and negatively associated with appetite, physical strength, walk assistance, visual acuity and physical ability(r=-0.055, -0.067, -0.071, -0.114, -0.095; P=0.022, 0.005, 0.004, 0.000, 0.000), while positively associated with health status, activities in daily life, athletic ability, exercise frequency and intelligence(r=0.073, 0.126, 0.122, 0.066, 0.124; P=0.002, 0.000, 0.000, 0.006, 0.000). Conclusions The hemoglobin level of the elderly decreases with aging and is associated with health status and quality of life in the elderly, which should be taken care seriously. Key words: Hemoglobins; Health status

One of the great success stories in the UK is that people are living longer. Improvements in life expectancy at older ages have particularly accelerated in recent decades. However, there are three unanswered questions -namely, what will life expectancy be in the medium term (10 –20 years, say), will it go on rising indefinitely and what will be the variation in age of death? We find there is a need for better information about life expectancy at both the population and individual level. Policies must be durable, especially anything to do with pensions, health and social care, or housing needs. In this paper we present a new method for forecasting life expectancy based on decomposition techniques. The key advantages are more certainty over which age groups are affected and more accurate information about possible limits to life. Results are presented for England and Wales and the implications discussed. A concluding section briefly compares our approach with other methods.

Objective To observe the incidence, clinical characteristics, related factors, adverse events during hospitalization and short-term prognosis of postprandial hypotension (PPH) in elderly patients with coronary heart disease. Methods One hundred and sixty-eight elderly patients with coronary heart disease hospitalized in the Department of Cardiology, Second Hospital of Hebei Medical University from January 2014 to January 2015 were selected as the research subjects.They were monitored by 24 h ambulatory blood pressure monitoring.According to the diagnostic criteria of PPH, they were divided into postprandial hypotension group (PPH group) 34 cases and non-postprandial hypotension group (NPPH group) 134 cases.The clinical characteristics, risk factors related to PPH, occurrence of adverse events and prognosis of all-cause death, cardiovascular and cerebrovascular adverse events were compared between the two groups. Results Among 168 elderly patients with coronary heart disease, thirty-four patients had PPH, and the incidence rate was 20.2%(34/168). The average systolic blood pressure before meals in PPH group was (139.8±18.6) mmHg (1 mmHg=0.133 kPa). The proportion of taking calcium antagonists was 50.0% (17/34) higher than that in NPPH group (127.4±13.2)mmHg, 27.6% (37/134). The difference between the two groups was statistically significant(t=6.463, χ2=6.232, P<0.05). PPH was higher in breakfast and dinner than in lunch; the higher the basal systolic blood pressure level, the higher the incidence of PPH.Logistic regression analysis showed that the basal systolic blood pressure level and age were positively correlated with the occurrence of PPH (r=0.301, r=0.208, P<0.05). Follow-up for 26 months showed that the incidence of all-cause death and cerebrovascular events in PPH group was higher than that in NPPH group (χ2=5.800, 11.560, P<0.05). Conclusion The incidence of PPH in elderly patients with coronary heart disease during hospitalization is 20.2%.Breakfast and dinner at three meals are prone to PPH.Older age and high systolic blood pressure level will increase the incidence of PPH.PPH will increase the incidence of mid-term all-cause death and cerebrovascular events. Key words: Postprandial hypotension; Coronary heart disease; Prognosis

The population of industrialized countries is aging as a consequence of the increase in life expectancy, due to health and medical progress, and of the decrease in birthrate. A balanced nutrition covering nutrient demands, an adequate lifestyle and an improved quality of life are important factors for healthy aging. From 1960 to 2000, the average life expectancy at birth for the European Union countries rose from 70 to 78 years. Between 1960 and 2004, the proportion of older people (65 years and over) in the population has risen from 10% to almost 17% in these countries. All the signs indicate that this trend will continue well into the new century. The proportion of people aged 65 and more in the total population is expected to rise in the period until 2050. The population in the European countries is expected to increase from 16% in 2004 to 30% in 2050 or from 75, 3 million in 2004 to 134, 5 million in 2050. The largest shares of elderly people in 2050 are expected in Spain (36%), Italy (35%), and Greece (33%), and the lowest in Luxembourg (22%), the Netherlands (24%) and Denmark (24%). The growth of the population aged 80 or more will be even more pronounced in the future as more people are expected to survive to higher ages [1]. In the United States, the Centers for Disease Control and Prevention (CDC) estimate that by 2030 the US population will double, to about 71 million older adults [2], that is about one every five individuals. We are, as they say, on the “brink of a longevity revolution”. These demographic changes present challenges to health care, food supply systems, and nutrition services for older individuals. Due to the increasing aging process the knowledge of health and nutritional status, as well as of the nutritional behavior, might help to improve the quality of life in the third and fourth life span. Aging is often associated with a stage of life accompanied by illness and frailness, as well as by a variety of physiological, psychological, economic and social changes that may adversely affect nutritional status. Older people may have a higher prevalence of chronic diseases associated with increased costs for health care and long-term care, they may take multiple medications and tend to be sedentary. While basal metabolic rate decreases with age, physical inactivity and an unhealthy diet, rich in fat and sugar, are likely the main causes of overweight and obesity, which have high prevalence rates also in the elderly, especially low income ones.

Foot pathologies among older people have increased considerably, especially as life expectancy has increased, becoming a common reason for podiatric and medical foot care. The purpose of this investigation was to determine the variances in the quality of life (QoL) linked to overall foot health in older population with presence or absence of foot problems. A retrospective case-control investigation was performed in an outpatient health center, where a senior clinician recorded information linked to clinical and sociodemographic features. Besides, self-reported information on QoL and overall foot health were analyzed through the specific tool known as Foot Health Status Questionnaire in all older participants. A total sample consisted of 120 older people (60 controls and 60 cases), with a median age of 73.50 years and recorded the interquartile range as 23 years of age. The older adults recorded lower values for all domains related with foot health and the overall health compared with the control group. Older people with foot problems such as hallux abducto valgus, pes planus, metatarsalgias, keratotic disorders, heel pain, toenail deformities, deformed toes, Morton neuroma, and cavus foot present a negative influence linked to QoL and to overall foot health, which seems to be marked with the aging process and the presence of alterations on the foot in the older population.

Objective To investigate the self perceived health status of the eMerly in nursing home of Hengyang and analyze the related factors. Methods 200 elderly were investigated on their perceived health status by self- rated health measurement scale. Data were analyzed by statistical package for the social science (SPSS)13.0 version. Results Mean score of self- perceived health condition of the elderly was (231.79± 59.71 ),just 40.5% of them believed that their health status was at high level. There were significant differences in self-perceived health status between the elderly with different age, reason for admission, check-in time, self-care abihty, interests and the number of visits. There were no significant differences in self- perceived health status between the elderly with different genders, education, marriage status, occupation. Conclusions The health level of the elderly is low in Hengyang. Nurses should make full use of all the society strength to provide substance, psychological and social supports to impreve health level of the elderly. Key words: Nursing home; The elderly; Health

Older people: forgotten victims amid the Ukrainian humanitarian disaster

Background: Population ageing is causing important and fundamental changes for health and social care services nationally and internationally. Many people remain well, engaged and active into later life and continue to make a major contribution to local communities and society. However increasing age also brings an increasing chance of long-term medical conditions, frailty, dementia, disability, dependence or social isolation. Life expectancy at age 75 increased by 29% (female) and 39% (males) between 1993 and 2013 (Eurostat 2014) and the number of people over 80 in Ireland will doubled in the next ten years (CSO 2011). People aged 65 and over now constitute 11.7% of the population and use 61%% of acute hospital inpatient bed days (HIPE 2014). The growing older population has consequences for the nursing profession and for nurse education. An increasing demand for nurses to work with older people over a wide range of services including hospitals, residential care, health and community services is inevitable. If nurses are to gain a holistic perspective and expertise in this specialist area of care, their preparation and ongoing professional development will need to focus on the competencies required for working with older people.Therefore, nurse education and curricula need to be responsive to the diverse and holistic needs of older people and changing care environments. It is imperative that the future of gerontological nurse education is designed to equip nurses with the knowledge skills and competencies necessary to meet those needs. Project: While the Clinical Strategy & Programmes Division seek to implement models of care (HSE 2012), a parallel vision for the future of gerontological nursing is necessary to ensure we provide age attuned services into the future. The National Clinical Programme for Older People (NCPOP) in collaboration with the Office Nursing Midwifery Services Directorate (ONMSD) are developing a strategic vision and educational framework for nurses working with older people across the spectrum of healthcare. The aim of this work is to develop a nursing service that has the knowledge, skills and competencies to meet the needs of the older population into the future. The proposed framework will incorporate a vision for gerontological nursing to include career pathways and the competencies and educational requirements required to effectively fulfil these roles. The methodology applied by the National Cancer Control Programme has been replicated to inform and direct this body of work. In 2016 a systematic literature review was undertaken by the McAuley School of Nursing & Midwifery, University College Cork, to inform the development of an educational framework to enable nurses to acquire and maintain the necessary knowledge, skills and competence, at the appropriate level to deliver quality person centred care to older people, throughout the Irish health service.The second part of the methodology was the completion of a number (n=5) national focus groups with relevant stakeholders which will included older people, healthcare professionals, educators, policy makers, carers and other interested parties (n=280). The overall research question to be answered is “What knowledge, skill and competence are required to produce a nursing workforce that can provide quality person centred care to older people wherever they access healthcare? The final framework document will be completed in November 2017

Ageing and health

BackgroundThe population of China is aging rapidly. However, the long-term trajectories of functionally dependent late middle-aged and older Chinese people are currently absent. The present study aimed to estimate the population size and proportion of late middle-aged and older adults with difficulties and dependence on activities of daily living (ADL) and instrumental activities of daily living (IADL) in China from 2018 to 2048.MethodsWe constructed a dynamic microsimulation model to project the population size and proportions of late middle-aged and older Chinese people who have difficulty and dependence in ADL and IADL from 2018-2048. The model was populated with a representative sample of the target population and allowed individual-level interaction between risk factors, diseases, and health outcomes. Analyses by socioeconomic subgroups were also conducted.ResultsAlmost 25% and 38% of late middle-aged and older people in China will become ADL- and IADL-dependent by 2048, respectively. Also, 17% of the target population will be severely ADL-disabled by 2048. The inequity in functional status across subgroups by sex, educational level, and urban/rural residency will become substantial.ConclusionsThe numbers and percentages of China's functionally difficult and dependent late middle-aged and older population will increase by magnitudes as of the mid-21st century, the pressure of which is compounded by its disproportionate distribution across subgroups. To alleviate the overwhelming challenge, efforts to improve the functional status of the underserved subpopulation should also be iterated.

Health perception and health status in advanced old age: A paradox of association

This paper examines the trends in life expectancy and life disparity among the older population in China and its sub-national regions based on China National Population Census data from 1981 to 2020, using the life disparity indicator developed by Zhang and Vaupel. It is shown that, first, the life expectancy of the older population in both China and its sub-national regions has experienced a significant upward trend; however, the growth is uneven across regions. Second, life disparities due to deaths among the elderly in China and its sub-national regions followed a downward trend, but life disparities due to deaths among the elderly as a ratio of total life disparities increased, indicating an increasing importance of deaths among the elderly in life disparities amid overall mortality improvements. Third, multiple linear regression models indicate that variations in life expectancy and life disparity among the older population across regions in China may stem from uneven development in the health transition process and resulting disparities. The eastern region of China has experienced a faster health transition compared to the western region, as evidenced by the greater impact of investments in medical facilities and economic development levels on increasing old-age life expectancy and reducing old-age life disparities in the eastern region. This paper reveals that the life expectancy and life disparity of China's older population has improved considerably over the past four decades, and its relatively lagging improvement compared to that of developed countries over the same period may be related to the relatively lagging health transition in the western region of the country.

Abstract. Cardiovascular disease is the leading cause of death, morbidity and disability in older people. Strategies for cardiovascular disease prevention and intervention in older people are similar to those available for younger ages. The population strategy for primary prevention is broad ranging from food and tobacco policy legislation and media communication to simple and direct advice delivered by all health workers. High risk strategies for reducing elevated levels of the major cardiovascular risk factors such as hypertension and hypercholesterolemia in older populations indicate that gains in life expectancy are greatest where absolute risk is highest and the intervention is the cheapest available. Non‐pharmacological treatment, in particular dietary therapy, is recommended as the first line of treatment for both raised blood pressure and blood cholesterol. Because of the high excess mortality associated with smoking, even a brief advice package associated with modest success is cost effective in older people. Health policy for older people should be directed towards the overall goal of maintenance of autonomy and should include prevention, treatment and rehabilitation of cardiovascular disease as part of a comprehensive program for the prevention and control of all diseases.