From Big Medical Encyclopedia

GERIATRICS (Greek ger[on] the aged man + iatreia treatment) — the area a wedge, medicine studying diseases of people of advanced and senile age.

— a component gerontology (see).

The main objectives of G. are: 1) studying of features of development, a wedge, currents, treatment and prevention of various diseases at people of advanced and senile age; 2) clarification of opportunities of influence on process of a senilism.

G.'s development is closely connected with progress in studying of biology of aging and is defined by the need for increase in volume of the medical help to people of the senior age groups since in economically developed countries increase in specific weight of people of advanced and senile age — the so-called postareny population is noted.

On modern views, aging — fiziol, process therefore the feeling sick at elderly people is, as a rule, connected with any pathology. Distinguish the asymptomatic age changes, indispositions which are not giving a wedge, manifestations and often observed at almost healthy people of advanced and senile age, and the diseases of this age having hron, a current, sometimes with complications.

Age changes of an organism cause considerable specificity during infectious diseases, slow development patol, process is characteristic what quite often hidden course of diseases, their bessimptomnost is connected with; bystry exhaustion fiziol, systems and protective mechanisms is observed.

Aging of systems, human organs, as a rule, happens not at the same time. The combination of the diseases which were earlier existing and developed in later age periods explains the plurality which is often observed at advanced and senile age patol, defeats in various combinations. Pathogenetic these diseases often do not depend from each other. The ground mass of patients is more senior than 65 years has three and more illnesses; it complicates the course of diseases and complicates therapy. The structure of incidence of persons of advanced and senile age has the features. The main form of pathology is made hron, by diseases: general arteriosclerosis, cardiosclerosis, idiopathic hypertensia, defeats of vessels of a brain, emphysema of lungs and other diseases of a respiratory organs, diabetes mellitus, diseases of eyes, new growths. Process of «accumulation» hron, diseases begins at the age of 40 — 49 years.

As the independent area a wedge, medicine was defined only in 20 century, however treatment and the prevention of diseases of senile age was a component of medicine in the ancient world. In the compositions attributed to Hippocrates (5 — 4 centuries BC) it is mentioned features of a course of many diseases at old men, frequency hron, diseases at them, about harm of big weight for old men etc. Hippocrates, in essence, defined philosophy of geriatric prevention. At the beginning of our era (1 and 2 centuries) issues G. were touched in A. Tsels and K. Galen's works. Galen specified that the old age in itself is not a disease, but old men are deprived of full-fledged health, their organism is subject to various diseases. K. Galen's rules concerning food at senile age have special value; Galen applied the term «gerokomiya» to hygiene of people of advanced age. In 4 century the Byzantine doctors wrote about diseases of old people and their hygiene. Traditions of medicine of Ancient Greece reached also medicine of the Middle Ages. The review of gerontology of Galen gave Ibn-Xing at the beginning of 11 century in «A canon of medical science», having devoted the special section to the mode at advanced and senile age. In 13 century the English scientist Bacon (R. Bacon, 1214 — 1292), based on Ibn-Sina's works, made the rules published in Oxford in 1590 under the name «About the Prevention of an Old Age and Preservation of Feelings». In 1489 the first monograph according to G. written by the ital. doctor of G. Zerbi — «By Gerontokomiya, i.e. about food and a way of life of old men» was published. In 16 century in a number of the countries (it is preferential in Italy) books about an old age and the way of life recommended for achievement of longevity were published.

The first book on diagnosis and therapy of diseases at people of advanced and senile age «The short review of a question of the prevention of diseases of old men and their treatment» was written by the ital. doctor de D. de Pomis and published in 1588. In 17 and especially 18 centuries there was a number of the theses devoted to questions G. and gerogigiyena which maintenance corresponded to the principles of gerokomichesky medicine which are put forward by Galen.

The beginning of studying of anatomy of old men belongs to 15 century and is connected with Leonardo da Vinci's activity. However only the Russian doctor I. B. Fischer in the book «The Treatise about an Old Age, Its Degrees and Diseases, and also about Its Acquisitions» published in 1754 described morfol, and functional changes of the growing old organism, having given the systematic review of a symptomatology, anatomy and therapy of old people. The ideas stated by Fischer considerably anticipated some rules K. Gufeland's macrobiotics (1796).

In 18 — 19 centuries in Francium and Italy the first large hospitals for hron, patients of preferential old age were created. From works of this period of special attention the two-volume work «Clinic of Old Age» (1857 — 1860) written by L. Geist — the doctor of hospital for aged in Nuremberg deserves. A new stage in G.'s development were works of the fr. neuropathologist Zh. Sharko who published in 1867. «Lectures about diseases of old men and chronic diseases» in which it was pointed out great importance of special studying of diseases at old men and need of the organization of special hospitals for their treatment.

Beginning of development scientific wedge. In Russia it is connected with works of S. P. Botkin and his pupils. Results of the big kliniko-social researches conducted under the leadership of S. P. Botkin formed the basis of a number of theses. In A. A. Kadyan's works (1890), A. N. Alelekova (1892), etc. Botkin's ideas about genesis of aging of the person, features of age changes, development and the course of atherosclerosis and some other diseases at elderly and old people gained development.

First complete overview wedge. It was made in 1909 Mr. of J. Schwalbe. The same year I. L. Nasher published the first program article according to G. V 1912 he based New York geriatric about-in, in 1914 published the guide to diseases of senile age. I. L. Nasher offered the term «geriatrics» and made the insistent demand to allocate G., by analogy with pediatrics, in independent a wedge, discipline. From 30th years of our century the period of rapid development of G., especially in the countries of Europe and America began. Scope of researches in the field of gerontology and G. in 30 — is confirmed the 40th years by the edition of the bibliographic reference book (1951) made by N. Shok which contained 18 thousand names. In 60 — 70-x years the flow of information on various questions G. increased several times. In the USSR researches in the area G. were already in the thirties conducted in close connection with studying of biology of aging of the person. The Old age conference organized in 1938 in Kiev by A. A. Bogomolts was an important stage of these researches. N. D. Strazhesko and his pupils — V. V. Bazilevich, V. of X. Vasilenko, I. M. Turovts, V. A. Elberg and others — submitted scientific data on a condition of cardiovascular system and some types of a metabolism at long-livers, features of a course of diseases at old men are generalized. In the next years problems G. were developed by many scientists in various cities of our country.

Growth of researches on G. in the USSR is considerably connected with the organization in 1958 in Kiev in system of the USSR Academy of Medical Sciences Ying-that gerontology. Problems G. are developed also in clinics, nauch. - issled. in-ta, at departments of medical institutes and in practical institutions of the country. In Ying-those gerontology of the USSR Academy of Medical Sciences clinical physicians study in long-term dynamics as process fiziol, aging, and it patol, complications; the process of aging of the person and factors causing it study together with theorists and hygienists.

For a number of years in the USSR, the USA, Hungary, the Netherlands and other countries kliniko-statistical and social and hygienic researches of longevity were conducted (see. Longevity ). The great value is gained by researches of features of aging of men and women. In economically developed countries the significant difference in average life expectancy at men and women is noted; at women in a number of the countries it is 8 — 9 years more. The reasons of this fact are not found out yet.

An old age as a certain stage of existence and aging as dynamic process — different concepts (see. Old age, aging ). Along with knowledge patol, the processes inherent in an old age, a clear understanding of biology of aging of an organism is necessary. It is deeply necessary to analyze what age changes and why create conditions or become a basis of development of diseases in old age. Studying of interrelation is especially important atherosclerosis (see) with age. Emergence in persons of advanced and senile age of so-called sclerous hypertensia demands an explanation of the mechanism of its emergence and interrelation of this mechanism with genesis of other forms of arterial hypertension (see. arterial hypertension ) for development of rational complex therapy.

One of urgent problems of pathology of advanced and senile age is the problem of a diabetes mellitus — studying of age features of function of a pancreas, exchange of insulin, reaction of fabrics to effect of this hormone.

Researches on clarification of mechanisms of age changes of a musculoskeletal system, communication of these changes with development of the dystrophic processes in the bone and joint device of the aging person which are so often causing his indispositions and diseases continue.

Huge value has clarification of a role of age changes in development onkol, diseases. At the same time comparison of changes in the genetic device, changes of biosynthesis of protein, cell fission in an old age is important and with a tumoral growth. In psychiatry, surgery, urology, ophthalmology, otorhinolaryngology, stomatology and other fields of medicine there are the scientific and practical problems connected since.

Important tasks face geriatric pharmacology and pharmacotherapy. This studying of features of impact of various pharmaceuticals on the growing old and grown old organism, development, use and studying of efficiency of action of biologically active means for fight against a senilism of the person, for maintenance on datum level of activity of systems of an organism and different types of exchange.

Questions of the organization of medical aid to elderly and old people are solved, as a rule, in close contact with bodies of social security differently for the people who are in nursing homes and living out of them in families or alone.

At implementation of medical aid elderly and old people should consider that sharp change of their way of life quite often is the reason of development physical. or mental decompensation. Therefore all system of the organization of the medico-social help in G. shall promote stay of the old man of the house, it is natural in that measure in what state of his health, a possibility of the organization of leaving, a surrounding situation allows.

In 1970 in Florence there took place the meeting of the working group of the European regional office of WHO devoted to forms of rendering the stationary help and training for hospitals of long-term treatment including geriatric. The special meeting of committee of WHO on the organization of the geriatric help is held in Geneva in 1973.

In the Soviet Union in 1970 in Kiev in-those improvements of doctors the department of gerontology and geriatrics which is carrying out the activity on base Ying-that gerontology of the USSR Academy of Medical Sciences was organized. In Europe more than 20 departments of gerontology and geriatrics on a medical f-takh of high fur boots are organized. The first departments were organized in 1963 in France (Paris) and Italy (Florence). In 1966 the department G. was organized in England (Glasgow). Further they arose in Belgium (Ghent), Holland (Utrecht), Sweden (Uppsala), in a number of the cities of Italy, etc. In the USA by 1970 the gerontological centers and in-you existed in 17 high fur boots.

In the majority of the countries the joint science foundations of gerontologists and geriatricians function, the joint congresses and congresses will be organized.

See also Gerogigiyena , Gerontology .

Bibliography: Astrakhantseva L. 3. Geriatric pharmacology, L., 1972, bibliogr.; Gerontology and geriatrics, the Year-book, under the editorship of D.F. Chebotaryov, etc., Kiev, 1968 — 1974; The Reference book on geriatrics, under the editorship of D.F. Chebotaryov and N. B. Mankovsky, M., 1973; The Old age, under the editorship of. A. A. Bogomoltsa, Kiev, 1939; Burger M. Altern und Krankheit, Lpz., 1960; Clinical geriatrics, ed. by I. Rossman, Philadelphia, 1971; Handbuch der praktis-chen Geriatrie, hrsg. v. W. Doberauer u. a., Bd 1 — 3, Stuttgart, 1965 — 1969; Hawker M. Geriatrics for physiotherapists and the allied professions, L., 1974; Ltith P., Geschichte der Geriatrie, Stuttgart, 1965, Bibliogr.

Periodicals — Geriatrics, Minneapolis, since 1946; Journal of the American Geriatrics Society, Baltimore, since 1952; Medicina Geriatrica, Firenze, since 1969; see also bibliogr, to St. Gerontology .

D.F. Chebotaryov.