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FEATURES OF PHARMACOTHERAPY IN ELDERLY AND SENILE
PATIENTS
Alisher Kamilovich Ochilov PhD Associate Professor
Bukhara State Medical Institute,
Bukhara, Uzbekistan.
Resume: Maintaining relatively good health for people aged 75 and over is a
priority for independent and active participation in family and community life. Health
promotion and disease prevention measures can prevent or delay the emergence of
non-communicable and chronic diseases. In order to provide adequate care to the
elderly, it is very important to train competent medical professionals and society, such
as training healthcare professionals to help elderly patients, preventing and managing
chronic diseases, developing sustainable long-term care strategies, and creating
services and environments with favorable conditions for this patient population.
Keywords: aging, quality of life, elderly patients, geriatric service.
Relevance. The impact of population ageing is becoming more and more
obvious. Due to the steady increase in the need to allocate resources for the care of the
elderly, public health measures are needed to manage their specific diseases. Further
understanding of the mortality risk factors of the elderly at different levels of care will
enable patients, families, and interdisciplinary groups to better plan therapeutic
approaches and allocate available resources more effectively. Elderly and senile
patients are one of the most difficult groups in medical practice. The main aggravating
factors are: the presence of multiple diseases, the rapid onset of decompensation of the
condition, a high incidence of complications, and the need for long-term rehabilitation
[1,5,10]. Polymorbidity, decreased performance, physical and mental activity, and a
low level of quality of life all accompany the aging process and manifest themselves
in one way or another in every elderly person [2,3,9]. The presence of multiple diseases
in elderly and senile patients leads to a complex combination of symptoms, hiding
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typical diagnostic signs and worsening of the underlying pathology. The above-
mentioned difficulties in making a correct diagnosis against the background of many
diseases can cause professional errors. All this requires a more detailed approach to
decision-making when making the main diagnosis and prescribing rational therapy
with the involvement of the necessary specialists [3,9,12].
The goals of treating patients of different age categories have their own
characteristics. The treatment of patients in this category requires a special approach,
which is due to the reduced function of the div and the limitation of its physiological
adaptive capabilities [1,4]. The goal of treatment should not be to maximize recovery
of impaired functions, but to reduce severe symptoms without iatrogenic effects on the
div [3,5]. Massive drug therapy of diseases in this cohort of patients often causes
more undesirable effects than the disease itself [6]. In the treatment of young patients,
it is planned to treat the underlying disease with maximum restoration of impaired
functions, and in patients over the age of 70— reduce the severity of symptoms of the
disease and compensate for impaired functions. The main guideline should be the
preservation and improvement of the quality of life, which is the main strategic
objective of geriatrics [5,7,11,14].
Based on the above, the term "quality of life" is becoming increasingly
important and is used in the formation of a humanistic social environment, to solve its
problems due to the need for human adaptation to living conditions with aging, the
appearance and progression of diseases peculiar to this age [8,9]. Quality of life is an
integral characteristic that ensures the physical, social and psychological functioning
of the patient. The concept of quality of life includes at least four different,
interdependent areas: physical (a set of manifestations of health and/or illness);
functional (a person's ability to carry out activities that meet their needs, ambitions and
social role); emotional; social status (the level of social and family activity, including
attitudes towards social support, maintaining daily activity, working capacity, family
responsibilities and relationships with family members, sexuality, communication
skills with other people) [9, 13]. The concept of quality of life is closely related to the
definition of health given by the World Health Organization (WHO): "Health is a state
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of complete physical, social and mental well—being of a person, and not just the
absence of disease" [10, 14].
Functional dependence is a common condition that affects almost 12% of
people aged 75 and older every year. The functional health model proposed by WHO
provides a useful theoretical framework and is a tool that measures functional
autonomy. The functional System for measuring autonomy [SMAF] is a
comprehensive scale consisting of 29 points [11] in accordance with the WHO
classification of disability [12], it measures functionality in 5 areas:
- ADL (nutrition, washing, dressing, hair care, urination and bowel function,
toilet use);
- mobility (transfers, walking inside and outside, putting on a prosthesis,
moving in a wheelchair, moving up stairs);
- communication (vision, hearing, speech);
- mental functions (memory, orientation, understanding, judgment, behavior);
- IADL (housekeeping, cooking, shopping, laundry, phone use, transportation,
medication use, budget).
SMAF is a rating scale that measures actual performance. Testing should
be conducted with the help of trained medical professionals who evaluate the person
after receiving the information, either by interviewing individuals and trusted
individuals or by observing or testing the person.
Functional decline syndrome, in which functional autonomy is reduced or lost,
can occur as an acute condition that requires urgent medical attention. The subacute
form is a more insidious condition in which the patient requires a comprehensive
assessment and rehabilitation program. According to research, a functional decline in
the general condition of the elderly occurs every year in almost 12% of those over 75
years of age, a functional decline in the general condition also reduces the quality of
life and is responsible for a significant part of the costs of the healthcare system.
Approximately one third of those affected regain their lost autonomy, which makes
traditional defeatist attitudes to this issue untenable and justifies assessment, treatment
and rehabilitation programs that are already available or should be available. A
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preventive approach based on screening of people at risk, early interventions according
to indications, should prevent or slow down the onset of functional decline or reduce
its consequences. Effective strategies for the prevention or rehabilitation of functional
decline will help reduce the incidence and severity of disability and shorten the period
of dependence. These are absolute prerequisites for controlling social security costs
and, most importantly, achieving an independent and healthier old age [12]. Various
measures can be taken to prevent, slow down, or compensate for the process of
functional decline. Primary prevention is carried out through individual or collective
efforts aimed at the patient himself (e.g. nutrition and physical activity) or his material
and social resources (e.g. preparation for retirement).
Secondary prevention includes screening of individuals at risk of functional
decline to allow earlier intervention before a decline begins. This screening process
can be carried out during a doctor's appointment (for example, when an elderly person
consults a doctor, visits an emergency room, or receives home care services) or by
universal methods in the field of public health (for example, through a questionnaire)
[14]. Geriatric assessment and rehabilitation services act as a tertiary link by reducing
the effects of functional decline. These geriatric interventions are aimed at correcting
disorders, rehabilitating individuals, and mobilizing social and material resources. A
special feature of age—related patients is that with most diseases at this age, on the one
hand, they cannot fully recover, on the other hand, they desire a full-fledged life, of a
sufficiently high quality. To compensate for the violated interference with a longer
rehabilitation period. The course of diseases against the background of organic and
functional changes in organs and systems that occur during aging, the presence of
concomitant pathology with an atypical clinical picture, complicate therapeutic and
diagnostic processes. Many authors argue for the need for a special approach to
geriatric patients, whose main goal of treatment should be to preserve and improve the
quality of life. Conclusion. Maintaining relatively good health among the elderly is a
priority for independent and active participation in family and community life. Health
promotion and disease prevention measures can prevent or delay the emergence of non-
communicable and chronic diseases. These diseases need to be detected and treated at
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an early stage to minimize the consequences, and patients with complicated diseases
require appropriate long-term care and support services. In order to provide adequate
care to the elderly, it is very important to train competent medical professionals and
society in areas such as training healthcare professionals to help elderly patients.;
prevention and management of chronic diseases, the development of sustainable long-
term care strategies, as well as the creation of services and an environment with
favorable conditions for this patient population.
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