Features of physiotherapy in elderly people
Peculiarities of physiotherapy in elderly people. Different age-related changes in different organs and systems, as well as disease patterns specific to older persons, require a number of precautions when using physical factors in integrated therapy.
Summarizing the available data, a number of general principles and features of physiotherapy and physical prophylaxis in older age groups can be identified.
Due to the reduced reactivity of an aging organism, altered receptor activity, and impaired compensatory capacity of organs and systems in elderly and senile patients, it is recommended that physiotherapeutic intervention be carried out using gentle methods, especially at the beginning of treatment.
This requirement concerns almost all dosimetric parameters of physiotherapeutic procedures, first of all their intensity and duration, which should be less than in patients of young and middle age. Procedures for elderly patients are usually prescribed after a day, and only local effects, with good tolerance and adequate response, can be prescribed daily for patients under 70 years of age.
Treatment with physical factors is complex. This should also be the case for elderly and seniors. However, because of their reduced reserve capacity, they should have no more than two physical therapeutic factors and should be used, mainly by alternating methods, and only in rare cases can one of them be a common action.
Physical factors are known to have a stimulating effect, and therefore most of them (by usual methods) are contraindicated to cancer patients. Since malignant neoplasms in older persons are more frequent and often occur atypically, doctors-physiotherapists should show increased oncological vigilance when prescribing physiotherapeutic procedures for elderly patients.
The processes of sanogenesis and recovery in elderly patients, especially in the presence of metabolic disorders and neurohumoral regulation, are slower. In this regard, and above all when prescribing low-intensity physiotherapeutic effects, the number of procedures for treatment should be large (up to 15-20 instead of 10-12 procedures in young and middle-aged people).
It should be considered reasonable to use cyclic variants of treatment in elderly patients (primarily in outpatient polyclinic conditions), in which the cycle of physiotherapy consists of 2-3 short (4-6 procedures) courses, repeated at short (3-4 weeks) intervals.
During aging, conditions for the emergence of polypathology are created. Therefore, the physiotherapist should select the main disease and choose the leading physiotherapeutic factor accordingly.
At the same time, both at its appointment, and at inclusion in a medical complex of other physiotherapeutic procedures the most serious attention should be paid to accompanying diseases. It is necessary to strive to ensure that the prescribed factors were shown and effective not only in the main, but also in other diseases.
Due to the reduced compensatory possibilities and higher frequency of occurrence of inadequate reactions in geriatric practice, preference is given to physical factors of more physiological and local action (direct and impulse currents, local darsonvalization and franklinization, chamber baths, etc.).
Physical factors of general action and with pronounced thermal effect in elderly patients should be used more carefully.
Changes that occur with age in the skin, significantly affect its sensitivity to UV radiation, electrolysis products and drugs administered by physical and pharmacological methods.
For this reason, the dosage of these factors in older people is reduced, and to protect the skin from the effects of electrolysis products in the course of electrophoresis procedures should use thicker pads. Skin in the area of the electrodes after the procedure is recommended to treat with children’s cream or glycerin diluted with water.
Due to imperfect regulation and weakening of compensatory and adaptive processes after physiotherapeutic procedures, patients of older age groups should rest for a longer period of time -1-1.5 hours.
The effect of certain physical factors changes significantly with age, and therefore their use in geriatric practice has a number of nuances.
The most important of them can be reduced to the following: The dosage of medications to elderly and senile patients in aerosol and electroaerosol mixtures should be reduced by 2-4 times; more adequate and physiological for elderly people from impulse currents are sinusoidal modulated and interference currents, and from microwave – decimeter waves;
UHF therapy in geriatrics is carried out in short courses (5-8 procedures) and mainly on portable devices; in elderly people suffering from cardiovascular diseases and degenerative-dystrophic processes, it is necessary to limit the use of general UV radiation, as well as infrared and visible rays; in people over 50-55 years old, ultrasound therapy should be conducted under ECG control;
from mud treatment procedures preference is given to migrated methods of treatment, the use of peat, as well as galvanic mud and electrophoresis of mud solutions; baths are prescribed in lower concentrations, after rest before its reception, often in the form of half baths and chamber baths, for two consecutive days with a break for the third;
Sulfide and carbon dioxide baths are recommended for patients over 60 years of age with great care; when prescribing massage for elderly patients, preference is given to the impact on the reflexogenic zones, as well as point massage; during the massage should be used creams and ointments, and the temperature of the room should be about 25 ° C.