OLD AGE, AGEING

From Big Medical Encyclopedia

Old age — naturally coming final period of age development, the final period of ontogenesis. Aging — the biological destructive process which is inevitably developing with age, leading to restriction of adaptation opportunities of an organism, characterized by development of age pathology and increase in probability of death.

Studying of patterns of aging of living beings, including the person, is engaged gerontology (see), and studying of diseases of people of advanced and senile age — geriatrics (see).

History

in an extreme antiquity people aimed to learn essence of aging and to find a way of extension of life. The problem of aging became a subject not only disputes on specific mechanisms of this process, but also extensive philosophical discussions on essence long ago lives (see) and death (see). Now along with world outlook correct materialistic approaches to the analysis of mechanisms of aging develop, on the one hand, vulgar-materialist (e.g., identifying essence of aging of the organism which is complex biological process with destruction of objects of inanimate nature) and with another — idealistic approaches (e.g., about existence of the incognizable beginning, exhaustion to-rogo leads to aging).

Basic value for understanding of essence of aging has the known provision of dialectic materialism about what life — internally contradictory process and its denial is put in her that leads, eventually, to death of an organism. Consideration of age development as interactions of process of the aging and process directed to preservation of viability of an organism is further development of this situation. Decisive impact on development of a problem of aging was exerted by I. I. Mechnikov, A. A. Bogomolts, I. P. Pavlov, A. V. Nagorny, I. V. Davydovsky's works. I. I. Mechnikov connected aging with disturbance of intercellular regulatory bonds, the accruing accumulation in an organism of metabolites, having laid these the foundation to intoksikatsionny theories of aging. I. P. Pavlov disclosed the most important patterns of changes of century of N of in the course of aging, established dynamics of the main which is their cornerstone fiziol. processes. A. A. The pilgrim considered that in the mechanism of aging changes in a colloid and chemical condition of proteins, shifts of structure and function of connecting fabric have primary value. A. V. Nagorny's theory about aging as the fading self-updating of cytoplasm of cells is all-biological. In formation of ideas of communication of evolution and aging A. Veysman, A. N. Severtsov, I. I. Shmal-gauzen, S. A. Severtsov's works had great value. The role in studying of clinical and social aspects of aging of S. P. Botkin, I. L. Nasher, N. D. Strazhesko, 3 is big. G. Frenkel, D.F. Chebotaryov. Important stages of formation of a problem became creation of the largest Institute of gerontology of the USSR Academy of Medical Sciences in the world in Kiev (1958) and the organization of All-Union society of gerontologists and geriatricians (1963).

Between aging and an old age of beings a cosiness the cause and effect relations. Time of approach of an old age is extremely conditional; with increase life expectancies (see) ideas of it change. According to the decision of the aging seminar of WHO held in Kiev in 1963, the age from 45 to 59 years is considered an average, by 60 — 74 years — elderly; also is more senior than aged people of 75 years call old, and over 90 years — long-livers.

One of the most important demographic features of 20 century consists in progressing of a postareniye of the population of many countries of the world, i.e. increase in both the relative, and absolute number of people of advanced ages. The Postareny population — the social phenomenon which arose at a certain stage of development human about-va. In a crust, time it is peculiar to the developed countries, however the tendency to a postareniye of the population is noted also in developing countries. According to demographic department of department of the UN of economic and social problems, the number of persons at the age of 60 years is also more senior around the world in 1950 made 188 million people; in 1970 — 291 million; according to forecasts by 1985 around the world the number of persons are more senior than 60 years will reach 407 million, and by 2000 — 585 million. In the USSR the share of persons at the age of 60 years is also more senior, according to population censuses, from 1897 to 1939 almost did not change and made 6,8 — 6,9%. Further it increased and in 1959 made 9,4%, in 1970 — 11,8%. In Czechoslovakia in 1970 at the age of 60 years is also more senior there were 16,9%, in Hungary — 17%, and GDR — 21,9% of the population. In the USSR 200 people at the age of 60 years were the share of 1000 people of working-age (15 — 59 years) in 1970 and are more senior, and all persons of disabled age (0 — 14 years and 60 years and more) — the 690th persons.

Aging of the population is caused by features of its reproduction (a ratio of dynamics of birth rate and mortality), achievements of medicine and health care, intensity of population shift, sanitary and demographic effects of wars.

In the USSR according to a population census of 1970 of 2 894 thousand persons — at the age of over 80 years, long-livers (at the age of over 90 years) made 297 thousand of them, including at the age of over 100 years — 19 304 persons. The most expressed geographical zones of longevity — the Nagorno-Karabakh autonomous region, Nakhchivan the ASSR, the South Ossetian autonomous region, Abkhazian and Adzharian the ASSR, Dagestan, Chechen-Ingush ASSR and other districts of the North Caucasus.

The Postareny population exerts impact on economic policy, structure and function of a family, sets important tasks for health care. Involvement of pensioners to work and various forms of public work well affects on their health, is a source of moral satisfaction, is long maintains vitality. It is necessary to use rationally the free time which is available for pensioners, to hold recreational events, to create положитель^ a ny emotional background. Special significance should be attached to promotion of the active motive mode, balanced diet taking into account the decreasing power expenditure, need of an anti-sclerous orientation of a diet.

It is necessary to differentiate calendar and biological age (see). Biol. the age depends on rate of aging and is defined on the basis of the complex characteristic of a functional condition of various systems, assessment of adaptive opportunities of the growing old organism. For definition biol. age important, on the one hand, studying of a state fiziol. functions and exchange processes changing with age (visual acuity and hearing, an animal force, nek-ry indicators proteinaceous, lipidic and other types of exchange, etc.), on the other hand — establishment of level of adaptive opportunities nervous, cardiovascular, respiratory and other systems of an organism by means of functional loads.

Specific and individual life expectancy is defined by complex relationship of process of the aging and process directed to preservation of viability of the organism, increase in life expectancy which received the name «vitaukt» (Latin of vita life + auctus which increased, increased). Significant differences of life expectancy at different types of animals are in many respects connected with change genome (see). Features of regulation of a genome define rate of aging and specific life expectancy. Essential increase in life expectancy happens due to regulatory modifications of genes (see. Gene ). Correlation between specific life expectancy and DNA repair and inverse relation between the speed of accumulation of aberation chromosomes, formation of adducts of chromosomes and specific life expectancy is known. Correlation between specific life expectancy and duration of a growth period, the level of development of a brain, weight (weight) of a body of animals, duration of pregnancy and maturing, length of intestines, a physical activity, power expenditure, activity of mikrosomny oxidases, a condition of systems of antioxidants, etc. is noted. Correlation of specific life expectancy with many indicators testifies to the multifactorial, system nature of process of aging. Under natural conditions the majority of animals does not live dwelling up to an old age since already the first manifestations of aging, W. h restriction of adaptive opportunities, become the reason of their death. The person, despite decrease in adaptation opportunities in the course of aging, lives up to an old age thanks to the help from a family and society and long employment work.

Distinctions in individual life expectancy of the person are essential. It is known that average life expectancy at women is higher, than at men: in Russia in 1896 — 1897 at women it was 2 years more, than at men; in 1926 — 1927 — for 5 years, and in 1974 — is 10 years more. The distinctions of life expectancy caused by a floor are connected with features of neurohumoral regulation, rate of aging of cardiovascular system, the maintenance of gonosomes (two X-chromosomes at women, XY chromosomes at men), etc. Socio-economic factors can aggravate or smooth natural distinctions in life expectancy of men and women.

Theories of aging

Numerous theories of aging can be divided into two groups. In one it is claimed that age changes are result of the damages appearing and collecting during life activity; in others aging is considered like other stages of an ontogeny as genetically programmed process.

Aging was connected with accumulation in cells of nonremovable metabolic products, «slags of life», free radicals (see. Radicals free ) and emergence of peculiar chain reactions (see). The insufficiency of systems increasing with age antioxidants (see), according to H. The m of Emanuel (1979), promotes damage of the major structures of a cell by free radicals. Assume that free radicals, breaking integrity of a membrane lysosomes (see), increase its permeability for nucleases, and the last, leaving in cytoplasm, can damage a genome of a cell eventually. The connections which are formed in the course of metabolism are capable to initiate emergence of cross stitchings in molecules of proteins, nucleic acids, changing their physiological activity. It is possible that also ions of heavy metals participate in it.

For confirmation of the programmed changes in the course of aging in the genetic device and the leading role in them of vegetative mutations (see the Mutation) refer to strict pattern of development of aging, to a possibility of emergence in the course of aging of new versions RNA and to a possibility of inclusion during aging of the active programmed mechanisms of death of cells.

Primary mechanisms of aging can be connected with changes of processes of biosynthesis of protein. At the same time it is revealed that in the course of aging intensity of methylation of DNA and intensity of its replication decreases (see), there are fragments of molecules DNA, the number of types of again synthesized RNA decreases, the ratio of «active» and «inactive» chromatin, gistonovy and negistonovy proteins changes, communication between DNA and proteins becomes stronger, disturbances in system of DNA repair, etc. appear. According to the theory of mistakes offered in 1963 to Ordzhelom (. E. Orgel) and not having still the sufficient evidence, at different stages of biosynthesis of protein with age the mistakes leading to emergence of defective proteins with the changed primary structure can arise. Aging as believes F. Burnett (1973), is followed by derepression of the loci of chromatin defining synthesis of antibodies on proteins inherent in a look that leads to education in an organism of antibodies to own proteins (see Autoantibodies) and to damage by cell-bound immune complexes of cells and fabrics.

Than level biol is higher. development of an organism, subjects bigger value in genesis of aging have shifts of regulation in it-rogumoraljnoy (see). The great value is attached at the same time to age changes of hypothalamic regulation (see the Hypothalamus). According to V. M. Dilman (1978), at the heart of aging and age pathology activation of hypothalamic structures lies. V. V. Frol-kis (1981) considers that during the aging «hypothalamic misinformation» develops — sensitivity of different structures of a hypothalamus unequally changes thanks to what regulatory hypothalamic influences are inadequate to a condition of an organism.

In the last decades so-called synthetic theories of aging appeared. According to the adaptation and regulatory theory of aging offered by V. V. Frol-kis (1975), age development is defined by interaction of two opposite processes (aging and a vitaukt). Primary mechanisms of aging are connected with change of regulation of a condition of a genome, and change of membrane permeability in neurons leads to disturbance of neurohumoral control and emergence of secondary changes in fabrics.

The wide spread occurance gained insufficiently reasonable impression about aging as about involution (see), i.e. involution of an organism, and about change in process of aging before everything evolutionarily later, perfect, mechanisms. However such statement is contradicted that fading of a metabolism and functions of an organism does not happen smoothly and gradually on the way of simple repetition of last stages with age. In the course of aging many evolutionarily late the mechanism we are quite resistant.

The main patterns of development of aging

in the course of aging develop natural exchange, structural and functional changes; outward, mentality, behavior of the person changes. Skin (see) becomes thinner, its elasticity decreases, wrinkles and a nevus pigmentosus develop. Hair turn gray (see. Canities ), become rare and fragile. Eyes lose the usual gloss, arise senile ectropion (see. Ectropion of a century ) and ptosis (see). An atrophy of muscles (see. Atrophy muscular ) and thinning of hypodermic fatty tissue (see) lead to formation of a set of skin folds. Human height can decrease, quite often appears kyphosis (see). The movements lose smoothness, mobility of joints is limited, gait becomes slow and uncertain. Force decreases muscles (see), working capacity decreases (see. Work ), comes quicker exhaustion (see).

All manifestations of aging divide on chronobiologic and ontobiologichesky. Chronobiologic manifestations of aging of a look (osteoporosis, an angiosclerosis, etc.) match calendar age. They especially are expressed, than longer specific life expectancy. Ontobiologichesky manifestations of aging (molecular and genetic shifts, changes of function of cardiovascular system, neurohumoral regulation, etc.) match rate of aging, i.e. so-called biological age.

Process of aging should be represented as the changes characterizing the level of adaptation of an organism during various age periods (see. Compensatory processes, changes in advanced and senile age ).

One parameters of an organism progressively decrease after achievement of mature age (a number of indicators of century of N of, function of analyzers, intellectual and physical effeciency, sokratitelny ability of heart, secretory activity of digestive glands, etc.), others significantly do not change (concentration of sugar in blood, nek-ry indicators of an acid-base state, activity of many enzymes, membrane potential of nek-ry types of cells, etc.), the third increase (synthesis of a number of hormones of a hypophysis, the ABP, activity of nek-ry enzymes, content in blood of cholesterol, lecithin, (Z-lipoproteids, etc.).

The geterokhronnost, a geterotopnost, a geterokinetichnost, a geterokateftentnost are characteristic of aging. The Geterokhronnost — distinction in time of approach of the expressed manifestations of aging of separate fabrics, bodies and systems. E.g., the atrophy of a thymus (see) at the person begins during puberty, gonads — in climacteric (see); nek-ry functions hypophysis (see) remain on a high level till an extreme old age. The Geterotopnost — unequal expressiveness of process of aging in various bodies and structures of the same body. So, age changes of a puchkovy zone of bark adrenal glands (see) are expressed less, than glomerular and mesh zones; extent of disappearance of neurons in various structures of a brain is not identical. The Geterokinetichnost — various speed of development of age changes. In one fabrics they arise early, but slowly and rather smoothly progress; — develop in others later, but progress promptly. The Geterokateftentnost — the divergence of age changes connected with activation of one and suppression of other vital processes in the growing old organism.

With the general patterns aging is characterized by significant individual differences. In this regard allocate haemo dynamic, neurogenic, endocrine, rather harmonious and other syndromes of aging. Population does not represent is homogeneous the aging group; in it it is possible to allocate several subpopulations differing on rate of aging, features of development of age pathology, life expectancy.

In relation to srednepopulyatsionny rate of a current allocate the slowed-down and accelerated (premature) aging. The slowed-down aging promotes to longevity (see), accelerated leads to early detection of age pathology, first of all atherosclerosis, a diabetes mellitus, malignant new growths. Development of prophylactics of quick-aging plays a huge role in the prevention of diseases, in long preservation of working capacity. At the same time balanced is of particular importance food (see), full-fledged, quantitatively limited diet, active motive work-rest schedule, preservation of a working stereotype, optimistic psikhol. a mood, etc. (see. Gerogigiyena ).

Along with numerous manifestations of aging also process of a vitaukt develops with age. All manifestations of a vitaukt divide on genotypic, strongly fixed in evolution (duplication of genetic information, system of DNA repair, system of mikrosomny oxidation, etc.), and phenotypical, mobilized during aging thanks to mechanisms of self-control (a hypertrophy and hyperfunction of cells, activation of a number of recyclings and local humoral systems, etc.).

Certain changes occur in structure of DNA and chromatin with age. Assume that shifts at stages transcriptions (see) and broadcastings (see) can define age changes in biosynthesis of many proteins. Activity and content of many enzymes (see) decrease or do not change, and nek-ry: monoamine oxidase (see), succinatedehydrogenase (see), zymohexase (see), a fosfofruktokinaza (see. Kinases ), etc. raise. As a result of neravnokhmerny change of activity of enzymes disturbance of approval in separate links of recyclings, during the corresponding exchange processes appears. In the course of aging potentiality of biosynthesis of enzymes decreases. So, at long genetic induction of a number of enzymes — tyrosineaminotransferases (KF 2. 6. 1. 5), triptofanpirrolaza (KF 1. 13. 11:11), glyukozo-6-phosphatases (KF 3. 1. 3. 9), fruktozo-1,6-diphosphatases (fruktozo-bisfos-fatazy; KF 3. 1. 3. 11), etc. — at old animals exhaustion of opportunities of the inductive response to changes of internal environment develops quicker and it sharply limits adaptation metabolic abilities of an organism.

During the aging in bodies abundance of separate proteins considerably changes (see. Nitrogen metabolism, changes in process of aging ), what is connected with shifts in regulation of a genome. The amount of cytoplasmatic proteins decreases and the maintenance of metaplasmatic grows. Also conformational changes of proteins matter (see. Conformation ) and reactivity of their active groups. Proteinaceous molecules can form among themselves the large inactive complexes collecting in a cell.

The essential changes limiting adaptation opportunities of an organism happen with age and in power processes (see. Metabolism and energy, changes in process of aging ). By an old age standard metabolism (see) and oxygen consumption decrease. In heart, kidneys, a brain, i.e. in bodies with a high level of tissue respiration (see. biological oxidation ), oxygen consumption decreases more considerably, than in fabrics with low oxygen consumption, e.g., to skin or cartilaginous tissue. There is a redistribution of substrates of oxidation, in a number of bodies oxidability of fatty acids decreases (see). The ratio of two main ways of generation of energy — oxidizing changes phosphorylations (see) and glycolysis (see). Decrease in intensity of oxidizing processes and energy potential of cells is in many respects connected with reduction of number of mitochondrions (see) in a cell and change of a condition of their membranes, and also with decrease in biosynthesis of mitochondrial proteins. Emergence of the huge, fragmented mitochondrions cannot compensate changes of energy balance in cells. All these shifts lead to considerable reduction of contents glycogen (see), creatine phosphate (see. Creatine ), ATP (see Adenosine triphosphoric acid). The developing fabric hypoxia (see) defines many functional changes in the growing old organism. In these conditions activation in a number of bodies of aerobic and anaerobic glycolysis and a glycogenolysis, increase in the relation of P/O, i.e. amount of the inorganic phosphate which joined in molecule ATP in terms of each absorbed oxygen atom, activation of a number of key enzymes of glycolysis promote power ensuring function of an organism in old age.

With age in blood the quantity of lipids and lipidopodobny connections, especially cholesterol increases (see. Hypercholesterolemia ). At the same time distribution of cholesterol between fractions changes lipoproteids (see); the quantity of lipoproteids of low and very low density grows; the quantity of lipoproteids of high density and and - the cholesterol having anti-atherogenous properties decreases; the coefficient of an aterogennost representing the attitude of content of cholesterol of atherogenous lipoproteids towards quantity and - cholesterol grows. With age the number of faces with IIB and the IV type of a giperlipoproteinemiya increases, in blood the content of triglycerides, not esterified fatty acids increases. Age changes of proteinaceous and lipidic exchange promote development atherosclerosis (see). At long-livers separate indicators of lipidic exchange change not so sharply.

Knowledge of the main mechanisms of aging formed a basis for experimental development of approaches to increase in life expectancy. Among them quantitatively insufficient, but qualitatively full-fledged diet, antioxidants preventing many damages of macromolecules and cells by free radicals were the most effective


, finally, leads the inhibitors of biosynthesis of protein which are slowing down temn age changes of a genome, etc. == Cell aging, fabrics and physiological systems of an organism == Cell aging to their destruction and death (see. Cell, aging and death ). Loss of cells is not identical in various bodies and parts of the same body. E.g., in a number of areas of a cerebral cortex, gangliya of a spinal cord the number of neurons by an old age decreases by 30 — 40%, and in separate kernels of a hypothalamus practically does not change. Cell aging in the conditions of a complete organism — a difficult combination of their own age changes and regulatory trophic influences. Assume that the high-differentiated postmitoti-chesky cells initially grow old. On dannsh Heyflika (L. Hayflick, 1979), mitotic cells have limited ability to cellular division. There are cells, the Crimea primary aging (nervous cells) is peculiar; cells, aging to-rykh is caused by own age changes and under the influence of the regulatory, trophic, environmental influences connected with primary aging of other cellular elements (muscle cells, cells of a liver, kidneys); cells, aging to-rykh it is connected generally with change of a complex of regulatory influences, including blood supply, permeability of barriers, etc. (epidermis, an epithelium of many bodies, etc.). Besides, rate of cell aging is defined by their relation to this or that functional system. With age many cells along with decrease in functionality are in a condition of hyperfunction. Excitability of one cells falls, napr, muscular, others, napr, motor-neurons of a spinal cord, does not change. The size of their membrane potential changes in different directions, duration of action potential grows, duration of an absolute refractory phase increases; the amount of intracellular sodium increases, the amount of potassium falls; functional lability of a cell decreases, intercellular relationship is broken. Sensitivity of many cells to hormones and mediators increases. In cells the number decreases receptors (see) that is one of causes of infringement of intercellular relationship. Due to the change of activity of enzymes and structure of lipids of a plasma membrane its permeability changes. Due to the disturbance of functioning of the genetic device in old cells the lowered level of biosynthesis of protein is noted.

Changes in process of aging are less expressed in the renewed cells. Reduction of quantity of cells of a parenchyma is followed by increase in their volume, is preferential at the expense of cytoplasm. Changes kernels of a cell (see) come down to increase in volume of heterochromatin and reduction of euchromatin, emergence in a karyoplasm of nuclear inclusions of unknown genesis; at the same time at the expense of numerous invaginations the area of nuclear membranes and nuclear pores increases. In separate cells density of a cytoplasmatic matrix changes — the centers of consolidation or an enlightenment appear. Constantly there is vacuolation, destruction, spiralling and myelination of an inner membrane of mitochondrions. The quantity of mitochondrions in cells decreases, observed their polymorphism, the number of large, huge mitochondrions increases, however the area of inner mitochondrial membranes decreases by unit of volume of mitochondrions that reflects disturbance of power supply in a cell. There are changes in granular and not granular endoplasmic reticulum (see): it occupies the smaller space, its tanks are expanded, the number of ribosomes on its membranes and the policy in cytoplasm is reduced that demonstrates decrease in plastic processes in a cell. In Golgi's complex (see. Golgi complex ) there is a reduction, reksis, reduction of the linear area of membranes. Quite constant sign of aging is emergence of the increased quantity primary lysosomes (see); activity of lysosomic enzymes changes, stability of lysosomic membranes decreases. Formation of lysosomes of autofagichesky type, the residual little bodies containing grains of lipofuscin (see) is characteristic. In a cellular membrane (see. Membranes biological ) the structural changes testimonial of disturbance of its function are noted — intensity of a mikropino-cytosis decreases (in endotheliocytes), the quantity of neksus (smooth myocytes) and synoptic bubbles, the extent of «active zones» decreases in synapses (see).

During the aging along with destruction, weakening of function of many cells important adaptive reactions develop, thanking the Crimea can is long to be supported optimum level of activity of an organism (see. Compensatory processes, t. 20, additional materials). Such adaptive reactions are the hypertrophy and hyperfunction of separate cells, separate organoids of a cell, inclusion in function of body of the maximum quantity of cells, capillaries «on duty», air cells, neurons, etc. Dystrophic and compensatory changes in process of aging are unequally expressed in various bodies.

Connecting fabric

During the aging changes in all components of connecting fabric are found (see). Collagenic fibers lose fibrillation, are homogenized, along with reinforced fibers thinned appear. Their tink-torialny properties change — the oxyphilia decreases, there is a focal pikrinofiliya and a basophilia in parallel with a metachromasia (see) and the raised argentofiliya. Resistance of collagen (see) to influence of enzymes (trypsin, pepsin) increases; however sensitivity of collagen to a collagenase increases in the centers of destruction of collagenic fibers. In fibers of elastic fabric fragmentation, swelling, a razvolok-neniye, emergence of electronic and dense inclusions are observed, affinity to salts of calcium increases (elastokaltsinoz), sensitivity to elastase increases. In interstitial substance, the quantity to-rogo decreases, reduction of contents hyaluronic to - you and increase in quantity of the sulphated and neutral gli-kozaminoglikan histochemical is defined.

The nervous system

Ageing of an organism is followed by reduction of weight of a brain, and also volume and linear sizes of bark and gangliyev a brain; crinkles become thinner, according to a furrow extend, cavities of ventricles increase (see. Nervous system, changes in process of aging). In cytoplasm of a part of nervous cells (see) Nissl's substance decreases, due to reduction of RNA its basophilia up to development of a so-called senile chromatolysis decreases; the number of lysosomes, autofagosy with inclusion of lipofuscin accrues; the structure of mitochondrions changes. In separate neurons the atrophy and consolidation of a cytoplasmatic matrix with formation of the centers of destruction are expressed; compensatory reorganizations in the form of a hypertrophy of a cell and its kernel, increase in volume of a granular cytoplasmic reticulum, a lamellar complex and mitochondrions develop in others —.

In tissue of a brain so-called senile plaques form, to-rykh connect emergence with changes of neurofibrilla and an amyloidosis of a brain (see the Amyloidosis, t. 10, additional materials). The quantity of glial cells in gray matter of a brain increases, in white — decreases; the number of satellite gliotsit increases. Along with dystrophic changes in cells of a glia there are manifestations of adaptation reorganization. These changes are unequally expressed in various departments of a brain and prevail in bark of frontal and temporal lobes, Purkinye's cells of a cerebellum, motor-neurons of a spinal cord.

In peripheral nerves (see) a pulpy cover becomes thinner, muftoobrazny thickenings and the centers of demyelination form, are fragmented and unevenly impregnated by silver pre-and post-ganglpoparnye nerve fibrils, electron density aksonny the term leu increases.

The most important manifestations of aging of the person (changes of mentality, century of N of, shifts in behavioural and emotional reactions, disturbances of memory, decrease in intellectual and physical effeciency, physical activity, reproductive ability, disturbance of regulation of internal environment of an organism, etc.) are connected with age changes of c. N of page. Dynamics of basic processes in c. the N of page changes, however the high level of intellectual activity, ability to generalizations, to concentration of attention in work often remains. Besides, long maintenance of intellectual activity is based on ability to cope with a wide range of tasks on the basis of rich life experience.

I. P. Pavlov and sotr. showed that before everything mobility of processes of excitement (see) and braking is weakened (see), force of nervous processes and guarding function of braking decrease, conditioned reflexes are more difficultly developed (see).

Also character of instinctive reflexes changes (see), at the same time reflex reactions often gain long character. Changes in activity of analyzers accrue, vibration, tactile, temperature and painful sensitivity (see), sense of smell is weakened (see), decrease visual acuity (see) and force of accommodation of an eye (see), the presbyopy progresses (see), the speed of dark adaptation changes (see visual adaptation), the upper bound of hearing gradually goes down (see). A number of changes of EEG, in particular delay of an alpha rhythm is found. There are shifts in regulation of internal environment of an organism, there occur its failures more often. Due to the weakening of the influence of a nervous system on fabrics connected with destruction of nerve terminations and decrease in synthesis in them in mediators disturbances of a trophicity of fabrics are noted (see the Trophicity). The important adaptive mechanism in these conditions is growth of sensitivity of cells to to mediators (see).

Changes of mentality

Among the mental changes caused by aging the most essential is decrease in mental activity — delay of rate of mental activity, difficulty of perception and narrowing of its volume, deterioration in ability of focusing and its switching, delay of psychomotor reactions (see. Psychomotor system ); the most complex parties of mental activity, napr, ability to abstraction and integration weaken. The affective resonance decreases that is shown, e.g., by callousness unusual earlier, it is frequent at simultaneous strengthening of alarming fears, sensitivity and a capriciousness. Mental rigidity — conservatism in judgments and acts, rejection new amplifies, more frequent appeal to the past and is frequent its praise, tendency to lectures and one-vrvkhmenno the arising selective suggestibility. There are such lines as avarice, mistrust, an egocentrism and the introspection directed, first of all, to own physical health and various fiziol. departures. Perception of most of the aging people of the aging has negative coloring. Along with these general, leveling psychological shifts differing in irregularity of development there is a point of a number of characterologic features. In one cases the listed changes are not obviously expressed and they can be carried, according to I. V. Davydovsky, to «illnesses of an old age», in others, napr, in a debut of senile dementia (see), they have the nature of a disease. The clear boundary between them is absent.

During aging in genesis psikhogenno of the arising mental reactions very great value belongs to also injuring factors connected with changes of a social status of the personality. Among such reactions of the most important suicide is (see); frequency of suicides in old age reaches the highest level.

Endocrine system

in the course of aging atrophic and sclerous changes of closed glands are noted. In hypophysis (see) the quantity of basphilic increases and the quantity acidophilic (or eosinophilic) cells decreases. In them the content of RNA, specific granulny inclusions decreases, the colloid collects. In a thyroid gland (see) flattening of epithelial cells, depletion of their RNA is noted. In the insulyarny device of a pancreas (see) the number of large islands decreases, the number of small increases, the ratio is broken and - and (3 cells due to reduction of number of r-cells that promotes development of a diabetes mellitus. In glomerular and mesh zones of adrenal glands (see) the structure of spongiocytes changes.

Uneven changes occur in different links of system of hormonal regulation (see): secretory function thyroid decreases, a pancreas, gonads, bark of adrenal glands, their gipotalamo-pituitary regulation changes and sensitivity to tropny hormones grows. High doses of triple hormones suppress activity of closed glands that can become one of mechanisms of oppression of their function. Changes of hormonal control can lead to disturbances of metabolism. Important adaptive mechanisms in endocrine system during the aging are sensitization of a number of closed glands to effect of triple hormones of a hypophysis, and also target tissues to effect of hormones, reduction of maintenance of the connected form of a number of hormones at preservation of quantity of a free form, change of intensity of disintegration of hormones, etc.

is warm - the vascular system

Restriction of adaptation opportunities of the growing old organism in many respects is defined by age changes of cardiovascular system (see).

60 years are aged more senior weight decreases hearts (see), expansion of his cavities, shift of papillary muscles to a top of heart, a thickening of an endocardium, the increase in the sizes of cardiomyocytes which is followed by reduction of a kernels-but-cytoplasmatic index at senile age is noted; a part of cardiomyocytes atrophies, in others there is so-called basphilic dystrophy to formation of «a cordial colloid». The quantity of the large, bulked-up and changed mitochondrions, and also lysosomes, autofagosy and residual little bodies with lipofuscin grows in cardiomyocytes; tubules of sarkotubulyarny system, inserted disks extend. In myofibrils the centers of disturbance of clearness of Z-membranes, dissociation of thin and thick pro-fibrilla quite often are found.

An internal cover of blood vessels (see) elastic and ela-sticheski-muscular type it is thickened, in a muscular layer the amount of reticular and collagenic fibers increases, tinktorialny properties of elastin change, acid glikozaminoglikana collect, salts of calcium are laid, decreases lipolytic and ATF-aznaya activity in smooth muscle cells.

In various bodies density of capillaries decreases, the radius of diffusion increases, the basal layer of walls of capillaries extends, dystrophic changes in endotheliocytes develop that worsens conditions of transcapillary exchange. The ABP and to a lesser extent average dynamic and diastolic the ABP raises systolic, final, side, shock, pulse (see. Blood pressure, changes in advanced and senile age). The rhythm of cordial reductions is slowed down and becomes less labile a little, premises for development of disturbances of a cordial rhythm are created. Significantly the hemodynamics and cardiodynamics changes: the minute and stroke output of heart, cardiac index, an index of contractility, systolic pressure in a left ventricle decrease, the maximum speed of increase of chamber pressure, the maximum speed of shortening of fibers of a myocardium, changes duration of phases of a cardial cycle, etc. (see Blood circulation, at advanced and senile age). On an ECG reduction of teeth of P, QRS, small disturbances of conductivity, moderate expansion of the QRS complex is often noted (see. Elektrokardiografiya ). At a vektorkardiografichesky research decrease in the main vector of a loop of T, discrepancy between the main vectors of a loop of the ventricular QRS complex and a loop of T is noted (see. Vektorkardiografiya ).

Essential changes occur and the general peripheric resistance grows in a vascular bed — in connection with increase in rigidity of a wall of vessels rate of propagation of pulse wave on vessels of elastic and muscular type increases. Elasticity of vessels of elastic type changes more, than muscular. Changes of vessels of the lower extremities are expressed to a large extent, than upper extremities. Reduction of elasticity of an aorta limits transition of a motive energy of a blood flow during a systole in a potential energy of the stretched vascular walls and fall of walls during a diastole that breaks a continuity of the thrown-out stream of blood. Passability of arterioles, and also quantity of the functioning capillaries per acre decreases; the zones deprived of capillary loops, the so-called field of baldness are formed; there is a crimpiness of arterial and especially venous branches; capillary loops are extended, expanded capillaries quite often meet, it is noted peri-capillary hypostasis.

Reflex reactions of cardiovascular system become more inert, and reactions to many humoral factors gain long character. It is connected with weakening of adrenergic and cholinergic nervous control, sensitization of heart and vessels to hormones and mediators, weakening of reflexes from mechanioreceptors of cardiovascular system.

The respiratory system

Ageing is followed by atrophic processes in a mucous membrane of a respiratory organs, dystrophic changes in cartilages and a sclerosis of walls of bronchial tubes (see. Respiratory system, age features). In lungs the configuration of alveoluses changes and their depth decreases, the basal membrane is thickened, properties of elastic fibers are broken. However unlike obstructive emphysema (see Emphysema of lungs) the volume of a lung does not increase, the reduction of capillaries of lungs does not occur, the right heart does not hypertrophy.

A little the respiratory rhythm becomes frequent, there are respiratory arrhythmias more often, the reserve volume of a breath and exhalation decreases, decrease the vital capacity of lungs (see) and their maximal ventilation (see Breath, features at advanced age; Lung ventilation). Decrease in vital capacity of lungs is connected with growth of rigidity of a thorax, reduction of force of respiratory muscles and elasticity of lungs, deterioration in bronchial passability. Partial pressure of oxygen (r02) in alveoluses does not change, the partial pressure of carbonic acid (rs02) falls a little. In connection with decrease in diffusion capacity of lungs, their uneven ventilation, increase in anatomiches-sky shunting oxygen saturation of an arterial blood decreases — the arterial anoxemia develops, the alveolar and arterial gradient r02 increases. Similar changes lead to decrease in adaptation opportunities of respiratory system, to emergence at various loadings of a gipoksemicheeky hypoxia (see). Goering's reflex — Breyer is weakened (see Breath), sensitivity of hvkhmoretseptor of vessels increases, there comes the diskoor-dination in work of a respiratory center more often (see). Maintenance of optimum level of breath is promoted by preservation of minute volume of breath, increase of breath, less expressed decrease in reserve volume of a breath in comparison with the reserve volume of an exhalation, shift of curve dissociation of oxyhemoglobin to the right. In these conditions return of oxygen to fabrics is easier carried out, sensitivity of vascular chemoceptors to gipoksichesshsh and to other factors increases.

The alimentary system

in the course of aging in bodies went. - kish. a path atrophic changes of an epithelium accrue. In a mucous membrane of a stomach the quantity of obkladochny cells decreases and epithelial cells of intestines appear. The weight of a liver and the sizes of its shares decrease, in hepatocytes the area of the power forming and beloksinteziruyushchy structures is reduced, lipids, lipofuscin collect. At the same time the number of two-nuclear and polyploid cells increases. In sialadens, an epithelium went. - kish. a path the number of oncocytes increases (see. Oncocytoma ).

Significantly function of a digestive sistelya changes (see). Weakening of conditional and bezuslovnoreflektorny salivation (see) and dedentition (see), worsening machining of food in an oral cavity, create unfavorable conditions for its digestion. Quantity of the secret allocated by cells of a mucous membrane of a gullet (see) the tone of his muscles, gastric secretion and motor function of a stomach decrease (see), often there are subacid states, reflex influences on gastric secretion are weakened. Vneshnesekretorny function of a pancreas (see) weakens, the maintenance of a lipase, trypsin, amylase in pancreatic juice decreases. Salt to - that, secretin, pancreozymin influence secretion less actively. In a small bowel process of absorption is broken (see), absorption fat to - t, amino acids, calcium, phosphorus, a galactose, vitamins, etc. decreases. The peristaltics weakens intestines (see) that quite often is the reason of senile locks (see). Disturbance of secretory function and motility promotes reproduction in went. - kish. path of microflora, time pathogenic. Disintoxication function of a liver (see) weakens and decreases the evakuatorno-motor-naya function of a gall bladder (see).

The secretory system

is significantly reduced renal blood circulation With age, also the blood stream, a glomerular filtration rate, excretory and water secretory functions of kidneys (see), a canalicular reabsorption, allocation of a number of electrolytes decrease renal plazmo-. However thanks to mobilization of adaptable mechanisms can it is long to be supported concentration and azotovydelitelny functions, ability of kidneys to react to many vasoactive substances.

The bone and joint device

Changes are shown by senile osteoporosis (see) and osteochondrosis (see), in skeletal muscles the phenomena of an atrophy are noted (see the Atrophy muscular).

Aging and diseases

Decrease in reliability of mechanisms of self-control, restriction of adaptive opportunities of the growing old organism become a basis of development of pathology. The internal and exogenous causes causing proper responses at mature age at advanced and senile age quite often become the reason of disturbances of exchange and functions of an organism.

Decrease in intensity of power processes and sokratitelny ability of a myocardium promote development of heart failure (see). The possibility of failure of hypothalamic mechanisms of regulation of blood circulation, weakening of reflexes from mechanioreceptors of vessels, growth of concentration of vasopressin in blood and sensitization to it of vessels, decrease in intensity of a renal blood-groove promote development of arterial hypertension (see arterial hypertension). The sclerosis of coronary arteries, weakening of control of their tone from a nervous system, sensitization of vessels to vasopressin, emergence of the perverted reactions to catecholamines promote development of coronary heart disease (see). Reduction of number of r-cells of a pancreas and their destruction, emergence in blood of inhibitors of insulin, increase of concentration of a prein-sulin promote development of a diabetes mellitus (see a diabetes mellitus). Disturbance of exchange of catecholamines in striopallidal system creates premises for development of parkinsonism (see). Age changes of regulation of a genome, shifts in reception of a cell and its hormonal regulation cause a malignancy of cells (see the Carcinogenesis).

The mental diseases arising in old age are followed certain, inherent only in this age by frustration.

Among neurotic or nevro-zoiodobny frustration dominate asthenic (see. An asthenic syndrome), often combined with the supervaluable ideas (see) or alarming morbid depression (see. Hypochiondrial syndrome).

For patients with depressions (see. Depressive syndromes) the condition of powerlessness, slackness or alarm which is often followed by discontent, irritability and peevishness is peculiar. At depressive nonsense the ideas of self-abasement, an impoverishment and hypochiondrial character are observed first of all. Quite often there is Kotar's nonsense (see Kotar a syndrome), the hypochiondrial option is more often than it. At hypomaniacal and maniacal states (see. Maniacal syndromes) unproductive efficiency or fussiness prevails.

At crazy psychoses the ideas of material damage, humiliation, mockery, poisonings pursuing the mercenary aims, the ideas of marital infidelity extending to persons of the immediate environment — nonsense of small scope and the usual relations prevail. Often meets hypochiondrial and hypochiondrially - nigilistic nonsense (see). The expansive crazy ideas (inventions, reformatorstvo, etc.) often concern the past. Quite often crazy ideas of the most various contents have konfabu-lyatorny character (see Konfabu-lez). Considerably touch frustration change. At Kandinsky's syndrome — Klerambo (see. To andinsky — Klerambo a syndrome) ideatorny avtomatizm are shown by preferential acoustical pseudohallucinations. The greatest development is reached by touch avtomatizm. Arising at them patol. feelings are often localized only on a body surface. Considerably the frequency of olfactory and tactile hallucinations increases. Quite often there are tactile gallyutsinoza. Preferential in old age the nonsense of skin parasites — a derma-tozoyny Ekbom's nonsense meets (see. Senile psychoses), only in old age there is a development of hallucinosis of Bonnet (see. Hallucinations ).

Catatonic frustration are usually shown in the form of negativism and are much more rare in the form of a mutism (see the Speech, frustration). From all forms of stupefaction in old age oneiroid, a delirium and a twilight state most change. The oneiric syndrome (see) arises only in the form of separate episodes and is observed only at an exogenous pathopsyhosis (vascular, alcoholic, in debuts of senile dementia, etc.). Delirious sind ~ rum (see) and a twilight state usually proceed without the expressed hallucinatory, crazy and affective frustration. The motive disturbances observed at them are simple and happen on limited space. After a delirium and oneiroid full amnesia is often noted (see). After disappearance of a condition of stupefaction often there are transitional syndromes of Vick (see. Symptomatic psychoses) in the form of various on degree and features of manifestations of a psychoorganic syndrome (see); much less often the residual nonsense meets (see).

At all mental disturbances in old age the frustration inherent to a psychoorganic syndrome are observed. They often lead to emergence of symptomatic lability — to the frustration, various on degree of manifestation, relating to exogenous type of reaction and arising at intercurrent diseases or reactive lability — to development of psychogenic reactions under the influence of mental injuries. With the advent of symptomatic lability also such important fact as development at somatopathies of mental disturbances is connected even before emergence of symptoms of this somatopathy. Often the current, in particular rate of a progrediyentnost, many mental diseases which for the first time arose during the age periods preceding an old age changes. The pathomorphism of mental diseases is caused by age changes of mental activity and shifts in reaction of the brain changed by aging. Therefore in gerontological psychiatry as well as in geriatrics in general, by words I. V. Davydovsky, «individual and personal find abundance of mental and somatic refractions».

In old age there can be mental diseases inherent only to this period of life, i.e. a disease, at to-rykh aging in certain cases represents etiol. a factor — senile dementia (see), Alzheimer's disease (see Alzheimer a disease), Peak (see Peak a disease), etc.

At treatment of mental disorders in old age it is always necessary to consider a somatic condition of patients. Due to lowered and even bad portability in an old age of treatment by psychopharmacological means their use demands care: slow increase in doses, reduction of most applied doses (approximately twice in comparison with the doses used at treatment of patients of young and middle age), careful use of a number of drugs, napr, tranquilizers, in connection with their expressed myorelaxation effect, co-administration of proofreaders (Cyclodolum, etc.) because of a possibility of sudden development badly giving in to correction nevrol. complications. At treatment of depressions rather widely use electroconvulsive therapy (see). From psychotherapeutic methods bigger significance is attached to family psychotherapy (see).

Reabshshtation of patients is constructed on skillful stimulation of their mental and physical capacities, first of all by means of those forms of activity, to-rye were the most usual and valued, on observance of the vital stereotype developed in the past, the prevention and timely treatment of intercurrent diseases earlier.



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B. V. Frolkis; A. S. Stupino (stalemate. An.), H. G. Shumsky (psikhiat.).

Яндекс.Метрика