The main geriatrician of the city of Moscow talks about why elderly people need a special doctor and how it is planned to train doctors to work with patients at a venerable age.

In 2016, the average life expectancy in Moscow reached 77 years. This is six years more than the average for Russia. This indicator has become the maximum in history, and the capital itself is one of the most "long-lived" cities in the country.

The chief geriatrician Olga Tkacheva, who deals with aging problems, in an interview with the site told about how many elderly people live in Moscow, as well as how to delay aging, make their old age active and help older relatives lead more comfortable lives.

- Olga Nikolaevna, tell us what geriatrics is and who is the patient of a geriatric doctor?

- Geriatrics is a field of medicine that is at the intersection of medical and social problems... She studies the problems of aging and helps solve questions related to how to make this difficult period of a person's life healthier and more active. We must help the patient maintain social skills longer and not be deprived of the opportunity to live life to the fullest.

Now the problem of treatment, socialization and support for the elderly is relevant for the whole world. You will be surprised to know that the fastest growing population on the planet is people in their 80s. At the same time, there are age-associated diseases, the prevalence of which is growing exponentially with an increase in a person's life expectancy. These are cardiovascular and oncological diseases, diabetes mellitus, dementia, diseases of the musculoskeletal system.

The geriatrician is engaged in the prevention of these diseases, as well as their treatment. Our patients are elderly people, old people, long-livers.

The average life expectancy for women is approaching 80 years

- And how many such people are there in Moscow, in which districts of the city are there the most elderly?

- The average life expectancy in the city this year has reached 77 years. I would like to point out that women live longer than men. The average life expectancy for women is approaching 80 years. Estimated The World Organization health care (WHO), a person's youth lasts up to 45 years, then maturity comes, and in elderly age a person enters after 60 years. After 75 years, we can talk about old age.

Moscow, as one of the most prosperous cities in terms of quality of life, level medical care and social services, occupies a leading position both in life expectancy and in the depth of aging, in comparison with other cities of the country.

Moscow has more than four thousand hundred-year-old residents

In the capital, 27 percent of the population is over working age. At the same time, the depth of aging is quite high in our city. For example, we have over four thousand centenary residents. And although the capital is a city with dynamic life, a city of high speeds, one cannot say about it: "There is no place for old men here!"

- How many geriatric doctors are admitting in the capital's polyclinics, are there enough of them?

- In Moscow, geriatricians are accepted in large city polyclinics. To sign up for them, you need to contact your local therapist.

We also have three hospitals for war veterans and invalids. They specialize in providing health care to the elderly. There are doctors who have passed specialization in the profile of "geriatrics". Their goal is to extend the period of independent existence of the patient, his functioning, to reduce the risks of disability and institutionalization in old age. What is institutionalization? This is a placement in a nursing home, when a person cannot live alone, cannot help himself, serve himself.

The geriatrician acts as a physician, psychologist, and social worker. The examination of the geriatrician takes almost an hour

The doctor analyzes the entire complex of the elderly person's problems, identifies those segments that can be influenced, and draws up a treatment plan. This is an individual work. The geriatrician acts as a physician, psychologist, and social worker. The examination of the geriatrician takes almost an hour. And this is quite understandable - elderly patients often have several diseases that are atypical, and the list of drugs that the patient takes is quite large. In addition, the doctor needs to understand the conditions in which a person lives, whether his relatives support him, who can help him in everyday life.

It is not enough for an elderly person, for example, to simply prescribe medications or a diet. It is also necessary to find out who will bring him these medicines and control the regularity of their intake, who will prepare food for him, whether he can do it himself. The geriatrician draws attention to this. And in the end, he determines the patient's routing and decides whether he needs to be placed in a nursing home, whether he needs home patronage, assistance with caring.

- Do all retirees who receive nursing care or go to nursing homes are examined by a geriatrician?

- Of course not. And now the challenge is not just to increase the number of geriatricians. It is necessary that primary care physicians, that is, local therapists, can determine the indications for consulting a geriatrician and refer patients to them.

We will teach how to work with the elderly not only doctors, but also nurses, care specialists, social workers. Courses for relatives will also be included in the project

This requires that all local therapists receive additional education... Now in the Gerontological Scientific and Clinical Center of the N.I. Pirogov for doctors in Moscow, lectures, seminars, classes are held on a regular basis, which are conducted by leading Russian and international experts in the field of geriatrics.

In 2017, a large educational project called "Geriatrics - an investment in the future" will begin at the gerontology center. This is the training of primary care physicians, narrow specialists in the basics of geriatrics. We will train not only doctors, but also nurses, nursing specialists, social workers. That is, everyone who takes part in helping the elderly.

- Will the relatives of the elderly be taught proper care after them?

- This is a very important topic for us. And courses for relatives will also be included in the project. We are ready to teach families to care for “fragile” elderly people. After all, many do not suspect that in order to maintain a comfortable life and health of the elderly, you need to know a lot.

Many old people would be saved, for example, from falls by special arrangement of the apartment and various devices. It is a soft coating on the floor, no slippery surfaces, good lighting, the right shoes, cane or walker, properly fitted glasses

The family needs attention, care, patience, and medical care. If there is a chance that an elderly relative can prolong his activity and serve himself, then it is necessary to explain how this opportunity can be used and realized in simple everyday things. Many old people would be saved, for example, from falls by special arrangement of the apartment and various devices. This is a soft floor covering, no slippery surfaces, good lighting, the right shoes, a cane or walker, the right glasses, and more.

Only five percent of people who need outside help are in nursing homes. The remaining 95 percent live at home for various reasons: because they themselves do not want, because the family does not want to. And this is true. A person must decide for himself where to live. We must teach nurses, caregivers, social workers and family members to help an elderly person correctly.

- Can you name those patients who definitely need a geriatrician?

- There are problems that we call fragility syndrome. In fact, this is old age. A person's weight, muscle tone decreases, gait becomes slow, urinary incontinence and cognitive impairment are added to the unmotivated weakness that appears.

Bones become fragile in the literal sense of the word. The risk of falls and injury increases. You need to monitor your health regardless of age. But people over 60 years old, in addition to regular medical examination, dispensary observation, I would advise you to consult with a geriatrician.

The body and brain do not need to be allowed to relax. Sports and exercise will help the muscles, and the brain and the preservation of mental activity - the constant learning of something new, reading

- Can aging be premature and can it be healthy?

- There are options for development premature aging that are associated with heredity and gene mutation. This is the so-called progeria. There are few such patients on the planet, dozens of people are counted. But the mechanisms that have been studied in these patients can be regarded as universal. Today, such people are very actively examined, and there is a search for drugs that will help slow down the aging process. Healthy aging is also possible. At the same time, long-term preservation of physical and mental activity and social skills can be considered as health. I can say that within the framework of the project "100-Year-Old Citizen of Moscow", geriatricians have visited the capital's centenarians and talked to them. At such a respectable age, 30 percent of our grandparents have exactly that old age that can be called healthy: they remain physically active, they have hobbies, they continue to take part in the life of their families and in the life of society.

Overeating is a direct path to aging

- Are there any universal advice how to delay old age?

- As I said, the rate of aging is influenced by genetics and lifestyle. And if a person cannot change the first factor, then the second factor is his direct responsibility.

A lifestyle that will help delay old age is based on physical activity, good nutrition, social activity and memory training. The body and brain do not need to be allowed to relax. Sports and exercise will help the muscles, and the constant learning of something new, reading will help the brain and the preservation of mental activity.

When it comes to a balanced diet, I mean a balanced diet without overeating. It is necessary to limit the use of salt, sugar, animal fats. Overeating is a direct path to aging. I recommend everyone to eat more vegetables and fruits. And the most important thing for people entering a mature age is not to lose social ties, contacts with family, friends, colleagues, to remain committed as long as possible to a cause that benefits.

Russian scientists are one step away from creating a "cure for old age." Who the new drug was tested on, how long can you live while remaining socially active and relatively healthy, why diabetics have less chances of longevity and why biohacking has become so popular in last years? These and other questions were answered by the participants round table Izvestia - Chief Geriatrician of the Ministry of Health of Russia, Director of the Russian Gerontological Research and Clinical Center of the Russian National Research Medical University named after V.I. N.I. Pirogov, Head of the Department of Aging Diseases, Russian National Research Medical University named after V.I. NI Pirogova Olga Tkacheva, leading researcher at the Research Institute of Physico-Chemical Biology, Moscow State University, head of the Iona Skulachev project, Maxim Skulachev, and sociologist, demographer and biohacker Daria Khalturina.

120 years is not the limit

Izvestia: Many countries face the problem of population aging. Russia is no exception. An aging population is a burden on pension system, health care, a problem for the country's economy as a whole. Nevertheless, we strive to increase life expectancy. What is its limit from the point of view of science and medicine?

Olga Tkacheva, Chief Geriatrician of the Ministry of Health: The maximum life expectancy on the planet is 122 years, five months and 14 days, Jeanne Calmon. When asked why she lives so long, Jeanne Calmon replied: "I never worked and did what I wanted - that's my whole secret." At the age of 100, Zhanna rode a bicycle, played tennis.

Interestingly, there are “blue zones” on the planet where people live several decades longer. The average life expectancy in these zones is about 90 years, and the number of inhabitants over the age of 100 is reaching record levels.

Scientists are trying to figure out how these zones are similar: are there similar economics, ecology, magnetic fields? But so far, the similarity has been found only in one thing: in these zones there are neither extremely low nor extremely high temperatures.

In Okinawa, one in three is a long-liver, people there simply forget to die. They move a lot, eat little - about 80% of the daily calorie intake, there is a lot of plant foods in the diet, they have a lot of social connections. Here is such a secret, and it is similar for everyone - Costa Rica, California, the islands of Sardinia and Ikaria.

Izvestia: Is there a gene for longevity?

Olga Tkacheva: They are looking for genetic aspects, but so far have only found certain genes in Okinawans. Unfortunately, the "blue zones" are gradually turning into "gray" ones, because fast food has appeared there, the ecology is changing, and life has "accelerated".

Demographers say life expectancy across most of the planet will be 90–95 years by 2100. Thus, the average life expectancy is increasing, but the maximum is not yet increasing. 20 thousand years ago, primitive people depicted horses on rock carvings and thought that it was impossible to ride faster than a horse. Imagine that they were right for exactly 20 thousand years! And then there were cars, airplanes that develop tremendous speeds.

It is quite possible that in 20 thousand years, thanks to our colleagues, we will be able to increase the maximum life expectancy. Scientific research in the field of gerontology is currently very relevant.

The Russian Gerontological Research and Clinical Center, for example, studies the mechanisms of aging, creates panels of biomarkers of a person's biological age, and studies the so-called geroprotective (aging-retarding) potential of many non-drug and medicinal effects.

These are not miracles, but an absolutely recognized, so-called geriatric, approach. And these problems are dealt with by doctors - geriatricians. We work in a clinic, but there are many interesting experimental works in this area in the world. For example, naked mole rats are excellent subjects for research because these animals do not age.

Maxim Skulachev, molecular biologist, Moscow State University: Almost seven dozen naked mole rats (Heterocephalus glaber) live in our laboratory, which we have been observing for two years. This is an African rodent, its closest relative is a mouse. Mice live 2–3 years and during this time they manage to grow old, their mortality grows exponentially with age - this is the main sign of aging creatures. Mortality is also on the rise in humans. And the plot of the mole rat is a horizontal line. The mortality rate of mole rats does not depend on age.

An experiment on diggers was launched in the 1980s and continues to this day - this study was started by zoologist Rachelle Buffenstein. She caught mole rats in Africa, and they have already lived for over 30 years in captivity. This is ten times the size and metabolic rate that animals should expect. Most importantly, they do not show an increase in age-related diseases: stroke, cancer.

There was a scientific sensation recently. After the analysis of 162 thousand corpses of mole rats, which were kept in different laboratories, they nevertheless found one cancerous tumor. But if we analyzed the corpses of people, a tumor would be found in every third person. This is colossal cancer resistance.

Diggers have a specific anti-cancer defense system. For us, this is a colossal motivating example - it turns out that aging can be "turned off" in mammals.

Daria Khalturina, sociologist, demographer, anthropologist and biohacker: Not so long ago, a demographic study was carried out, according to the results of which it turned out that the age of death is being pushed back. However, after 90 years, even in the most favorable Western conditions, people begin to die. But the increase in life expectancy is the result of scientific advances 25 years ago (the average transmission path from a laboratory opening to pharmacy shelves is 17 years). And we see that medicine with the prevention of risk factors, elimination of pathogenetic mechanisms and lowering pressure gives this result.

Now in laboratories, developments and discoveries are being made, which, most likely, will allow you to go even beyond the natural limits. If there is a well-functioning artificial heart, it is clear that this threshold of death will be pushed back. So far, the methods of regenerative medicine are not particularly involved: stem cells and so on. Therefore, one should not fall into pessimism and say that by the age of 90 we will definitely die, because you cannot predict the future based on the past. This is incorrect mathematical modeling.

Elimination program

Izvestia: What is aging - a failure of each of the body's systems, mutations, diseases, or a genetic program that can be “hacked” under certain skills and conditions?

Olga Tkacheva: There are two main theories of aging. Proponents of one believe that aging is programmed and we must die. Proponents of the second believe that aging is the result of mistakes. As soon as the body stops correcting mistakes, diseases develop and aging progresses.

Daria Khalturina: I think that aging is both a failure of each of the body systems and a program inherent in a person. There are, of course, elements of the program: at a certain age, the production of T cells or B cells stops. Immune T cells during puberty, and B cells - after 35 years, practically do not appear. But these are just "breakdowns". If the car is not repaired, it will also die.

Maxim Skulachev: I am a supporter of a more radical theory - everything is programmed. What we call the accumulation of errors and minor breakdowns that lead to death is orchestrated by our genome and a hypothetical aging program, but at the same time it is quite obvious that one aging gene is missing. It was too dangerous.

Genes mutate sooner or later. Ageless individuals are extremely dangerous for the species. They receive colossal advantages in reproduction over the rest and will displace the young, and the species will cease to evolve, and this is deadly.

Izvestia: Is death a blessing from the point of view of evolution?

Maxim Skulachev: Of course!

Olga Tkacheva: If we didn’t die, we wouldn’t be cultivating.

Daria Khalturina: But not us, but the view. We personally do not improve as we age. As an anthropologist, I want to note that the most ancient people asked questions of aging and death. A man had just appeared, and he was already interested in why he is mortal and why aging occurs.

Izvestia: Is there a gene in the human body that is responsible for aging?

Olga Tkacheva: More than 500 genes have been discovered, each of which is somehow associated with aging. In addition, aging has a complex multifactorial mechanism. It is known that cardiovascular diseases, cancer, type II diabetes mellitus, Alzheimer's disease and diseases of the musculoskeletal system are the five main age-associated diseases.

Medicine lives today in the paradigm of prevention and treatment of each group of these diseases separately, but all these diseases undoubtedly have common roots, the risk factors for these diseases are similar to each other, and are also very similar to the risk factors for accelerated aging. If we learn to slow down aging, we will get a much greater effect than from the prevention and treatment of only cardiovascular or oncological diseases.

Maxim Skulachev: One of the leaders in the study of "blue zones" is the Italian gerontologist and geneticist Claudio Franceschi. He is known for reading the genomes of all 100+ Italian centenarians. But this is still not enough, therefore, no conclusion can be drawn. But Franceschi studied not only the genome of centenarians, but also their physiology. And it turned out that among them there were no diabetics and people predisposed to diabetes. This seems to be a very important factor and diabetes is a sign that something has gone wrong.

Izvestia: Do men and women age differently?

Olga Tkacheva: Yes, women age faster. They develop geriatric syndromes and aging problems more quickly. Moreover, they live much longer. Among 100-year-olds, at best, there will be 8-10 men per 100 people. This phenomenon is currently the subject of scientific research.

Izvestia: There is some Government program for the prevention of aging?

MORE ON THE TOPIC

Olga Tkacheva: In Russia, the preventive direction in medicine is actively developing, and the prevention of aging should be dealt with from childhood. In addition, a new direction in medicine is developing - geriatrics, the main task of which is to prolong the active period of life.

Daria Khalturina: The League for the Health of the Nation and the Ministry of Health of Russia are holding the All-Russian Forum "Health of the Nation - the Basis of Russia's Prosperity." And in 2018, the main topic of the forum will be the priority project "Formation of a healthy lifestyle". In addition, there is the National Technology Initiative. It is a drug therapy developer support program. It just rises from oblivion, there are no specific developments yet. But it is gratifying that within the framework of the National Technology Initiative, the state has recognized healthy longevity as a separate area.

Maxim Skulachev: This is a very progressive point of view. Until very recently, a scientist who announced he was fighting aging was seriously risking his reputation. Building a perpetual motion machine for a physicist and combating aging looked exactly the same for a biologist.

Eternal youth

Izvestia: Are there any scientific discoveries today that can bring us closer, if not to immortality, then at least to a radical extension of youth?

Maxim Skulachev: One of the body’s reactions to the “time to grow old” command is oxidative stress. The reason is not that free radicals come from the outside from bad ecology or something else. Most of the radicals - poisonous substances in the form of toxic forms of oxygen - we synthesize ourselves. The older we are, the more radicals there are. Academician of the Russian Academy of Sciences, biochemist Vladimir Skulachev had a question - what happens in the body with age, what makes us synthesize this poison? And how can you deal with this? As a result, it was possible to create an antioxidant that penetrates into the mitochondria with an accuracy of a nanometer and catches free radicals right there, right at the place of their formation.

This substance does not occur in nature at all - it was invented by Academician Skulachev, and then it was synthesized by the chemists of Moscow State University. We decided to make a medicine based on this substance 10 years ago.

The first drugs have already been created. These are eye drops for topical use - the eyes also age. Studies have confirmed that this substance helps with certain eye diseases. But the main thing that we found out: this substance slowed down the development of certain signs of aging.

And we realized that we need to move on to clinical trials no longer with eye drops, but with a drug for oral administration. We received official permission from the Ministry of Health to conduct them. And the first phase has just ended. 33 people took this substance in Moscow in one of the hospitals.

Izvestia: On what people was the drug tested?

Maxim Skulachev: These are healthy young men under 50. The first three people received 1.7 mg of the substance. Then we looked for several months to see if their condition worsened. The next three people received already twice as much - 3.4 mg. The rest received doses 4, 8 and 16 times higher. They were in the hospital for three days, and we monitored all the parameters of their health.

One of the volunteers said that after being discharged from the hospital, he played his best football match in his life. Maybe he just slept enough? Do not know.

We took blood tests from volunteers after 5, 10, 15, 30, 45 minutes and so on. Then our substance was isolated with a mass spectrometer and found in the blood. It really enters the human body, as well as into the body of a rat and a dog.

Maxim Skulachev: We will choose the disease associated with inflammation because the substance perfectly modulates the inflammatory response. It can be multiple sclerosis or rheumatoid arthritis. This substance appears to break the vicious cycle of inflammation. I think we are one step away from curing these diseases - we have to conduct clinical trials.

The Ministry of Health is ready to give permission for this phase. We already have a dossier, we are calculating the result of the first phase of a clinical study on healthy volunteers and can proceed to trials on volunteers with certain diseases.

Izvestia: When will the cure for these diseases become available to everyone?

Maxim Skulachev: According to our plans, all research will take from two to four years. I hope that by 2021 we can prove the usefulness of our substance in one of the diseases: multiple sclerosis, rheumatoid arthritis or osteoporosis. In models, the drug works well for strokes.

And the entire study will take the next ten years. Then we will come to the Ministry of Health and say: “Here are mitochondria, here is the mechanism of aging. We act on mitochondria. Here we treat or carry out the prevention of such diseases. Let's not beat around the bush and admit that this substance acts on aging. "

We very much hope that they will listen. Veronika Igorevna Skvortsova is a supporter of research and development to combat aging. And she's a co-author of one of our Stroke Research staff.

Biohacking: Science or Shamanism?

Izvestia: Biohacking is very popular now - with the help of medicines, people are trying to prolong youth, a productive period of life. How promising is this new phenomenon?

Maxim Skulachev: Biohacking is a new word, but not a new phenomenon. From our point of view, aging is a program, it needs to be hacked, hacked. We spend a long time and painfully testing certain hypotheses on how to approach this.

Olga Tkacheva: As a practicing doctor, I can say that, excuse me, I have seen a lot of such crazy people. Whatever they do: they cleanse the body this way and that, drink various complexes of dietary supplements and vitamins. The person believes that he is rejuvenating. But this is pure speculation. The most harmless thing is if it does not harm. But when elderly patients or people in need of specialized high-tech care are indoctrinated with myths that they can be saved by biohacking, this must be fought.

Maxim Skulachev: If we are right and we manage to do something with aging, all this will end with biohacking, only scientifically based, and not shamanism.

Olga Tkacheva: That's it. Proven.

Izvestia: But there are people who are serious about biohacking. They do a complete study of the body, see what vitamins and microelements they lack.

Daria Khalturina: I belong to novice biohackers. There is a universal scientific apparatus - the principles of evidence-based medicine. The more clinical research- the higher the level of evidence.

If you look at the research, you can find a lot that is delayed in clinical practice. This is especially sad to observe in oncology. I was amazed: many of what are considered geroprotectors (substances that have been found to have the ability to increase the lifespan of animals. - "News"), increases the survival rate of patients with breast cancer. Moreover, these are cheap things: fish fat, flaxseed, metformin. Oncologists do not prescribe any of this either in our country or in the West.

Age is not a burden

Izvestia: If we achieve an increase in life expectancy, what will this lead to in terms of demography? There will be a huge additional burden on the budget.

Daria Khalturina: We now have a situation where age-related diseases very often send people into retirement who could do a great job. This is a stroke, heart attack, osteoarthritis. If we move them aside with aging, then there will be only benefit for everyone.

Maxim Skulachev: I'm not interested in people living up to 120 years old. It is much more important for me that people at 90 years old play football and work actively. If we succeed, the question of the burden on pensioners will be removed automatically. It is necessary to prolong youth, a period of healthy longevity.

Izvestia: If we want to increase the productive period of our life, what should we focus more on: caring for our body so that it remains young, or is it still on brain function?

Olga Tkacheva: For both. Physical activity reduces the risk of Alzheimer's disease. In 2017 alone, there were three major meta-analyzes of scientific studies that confirmed this. On the other hand, it has been proven that people with good education and high intelligence live longer. Both physical and cognitive training are needed to maintain cognitive function.

The Japanese are tenacious people. In the WHO ranking of countries with the highest life expectancy, Japan has been leading for many years. Every fourth inhabitant of the country is over 65 years old, and as for centenarians who have crossed the century, there are more than 61 thousand of them in Japan. At the first joint conference of Russia and Japan on geriatrics, Japanese specialists talked about what the state is doing and what a person can do to live a long life and get sick less.

Most of the Japanese participate in the program "Gymnastics on the Radio". Photo: Reuters

A hundred years behind for many Japanese people is quite a normal situation. A average in the country - 84 years. Many European countries however, if they are inferior to Japan, then quite a bit. Others, despite a developed economy and high level medicine, lag behind much more. In the United States, for example, people live on average 79.3 years (31st out of 183 countries). Our country has achieved success over the past five years, but in the last official WHO ranking (2015), Russia occupies more than a modest 110th place with an indicator of 70.5 years (the latest data of our Ministry of Health for 2017 is 72.7 years).

"Japan has accumulated experience of not just longevity, but healthy longevity. Now they even propose to move the official age of old age from the current 65 to 75," said Hidetoshi Endo, director of the Center for Training and Innovation of the National Center for Geriatrics and Gerontology. in spite of advanced age, the person remained vigorous, did not need the help of other people. "Now the" average "Japanese live 80 years, and the Japanese - 86, and the active period lasts up to 70 and 73 years.

Japanese scientists are trying to derive a formula for longevity and understand what is more important here: genes, lifestyle, nutrition? Here are the secrets Dr. Hidetoshi Endo shared.

1 Less salt

Japan has not always been as prosperous as it is today. In the 50s of the last century, the country actively fought against tuberculosis. And in the 70s, the Japanese began to eliminate the causes leading to diseases of the heart and blood vessels. In general, their usual food is healthy, fats, especially "harmful", they do not eat much (more on that below). But there was one negative point: too much salt - 30-40 grams per day. And this, with age, led to hypertension, heart attacks and strokes. Now the average daily salt intake does not exceed 10 grams, and the health of blood vessels has improved dramatically. “I am surprised by your Russian habit: salt shaker on the table and add salt to any dish, even without trying it,” noted Dr. Endo.

2 "Hot" is not necessary

Stomach cancer, which for many years was the leading mortality rate, was managed in Japan by introducing compulsory gastroscopy. "When it comes to prevention, we are constantly studying various factors that increase the risk of cancer, explained Mr. Endo. - Many Japanese people had the bad habit of eating rice very hot, straight fiery. Much effort has gone into explaining the harm of very hot food and drink. "

3 Mediterranean diet minus milk

Traditional Japanese food is somewhat reminiscent of the Mediterranean. These are vegetables and fruits every day. Chicken meat and fish, seafood. Up to four eggs per week. Vegetable oil... But the Japanese eat little red meat. Marbled beef is a very expensive product. Average japanese family allows himself it only on holidays. Europeans drink red wine. The Japanese have other drinks, but they drink them in moderation. Sugar is also not in honor, and only unrefined cane sugar. But the Japanese hardly eat milk, yogurt, cheese, unlike Europeans. So the Japanese diet is Mediterranean minus milk.

Specific Japanese food is, of course, seaweed and soy products, primarily tofu cheese and miso paste. Vegetable protein is very useful, but poorly absorbed. In Japan, soybeans are fermented, which makes this protein available.

4 How to cook

Japanese dishes are rarely fried. True, there is something like a European grill: a metal cone is placed in the middle of the table, which is heated from a gas burner. Those sitting at the table take chopsticks of finely chopped meat, various vegetables and lay them out on a cone. After a few minutes, the baked food goes into your mouth. And the fat melted from the meat flows down into the groove under the cone. This dish, more precisely, the method of preparation, is called "Genghis Khan".

In addition, the Japanese steamed and boiled a lot, and they even eat fish almost raw - cutting into thin plates.

Small portions: Food is served in small cups and bowls that look more like saucers. The way of eating with chopsticks slows down the meal. As a result, a Japanese person eats on average 20% less than a European person per meal. It is no coincidence that the saying "eat eight tenths" is used here.

5 Physical activity

The Japanese pay a lot of attention and energy to this. "Walking is fashionable in Japan," noted Dr. Endo. Held in high esteem morning classes gymnastics - the majority of the country's inhabitants participate in the program "Gymnastics on the Radio". And for the older generation, again, the national movement "Straighten the Spine" was invented. Maintaining posture is important for both general health and preventing the risk of falls and injury.

6 Be useful

Most Japanese succeed in retaining the ability to think clearly into old age. Although Alzheimer's disease occurs here, 15% of the elderly suffer from it. Cures for senile dementia have not yet been invented, although the Japanese are actively working on it. And the main blow to Alzheimer's is the fight for cerebrovascular health. "Everything that is good for health in general, that prevents the development of diabetes and hypertension, - all this is at the same time prevention of senile dementia," says the Japanese gerontologist. In addition to eating the right food, dealing with stress (which, by the way, is promoted by the Japanese habits of stability at work and family life), physical activity in Japan is considered important to remain socially active. Keep working, keep up social connections... If there are no relatives, various hobby clubs help out.

7 Affordable medicine

Since the 60s of the last century, a compulsory insurance system has been introduced in Japan, all types of treatment and medicines are available to the Japanese. And this, of course, could not but affect life expectancy.

Olga Tkacheva, Director of the Russian Gerontological Research and Clinical Center, Chief Freelance Geriatrician of the Ministry of Health of Russia

With the increase in life expectancy in our country, the problem of treatment and rehabilitation of the elderly has become a state task. In Russia, a system of geriatric care is being created, the specialty of a geriatrician is being introduced in clinics, any citizen over 65 can make an appointment with him. The task of a geriatrician is not to cure an individual disease, but to solve the whole complex of problems of an elderly person associated with the aging process. The goal is to improve the quality of life, to preserve a person's ability to self-service. We are confident that this is possible. It is time for us to move away from the stereotype that it is normal to get sick in old age.

"RG" / Anton Perepletchikov / Irina Nevinnaya

Olga Tkacheva spoke about the optimal time for retirement and gave recommendations for increasing active life

Olga Tkacheva, Chief Freelance Geriatrician of the Ministry of Health of the Russian Federation

Photo of the Russian Gerontological Research and Clinical Center

Moscow. September 18th. site - Chief freelance geriatrician of the Russian Ministry of Health, director of the Russian Gerontological Research and Clinical Center Olga Tkacheva told Interfax correspondent Anna Sineva life and services provided by geriatricians.

According to official data from the Ministry of Health in April 2018, life expectancy in Russia has increased to 72 years, for men it is 67 years, for women - 77 years. And every year life expectancy, according to statistics, is growing. How fair is this increase if retired men will live on average 2 years, and women - 17 (although it is clear that many men die at an early age)?

A distinction must be made between life expectancy after birth and life expectancy after retirement. In the context of raising the retirement age, we are concerned with the second question - how many years after retirement do men and women currently live. For women, this figure is 25 years, for men - 16 years. It turns out that if men live to retire, then life expectancy after retirement is not two years.

But we still need to increase life expectancy after retirement. For this, special medical technologies exist and are being created. These are, first of all, geriatric technologies specially developed for the elderly, the purpose of which is to increase the period of active life in old age.

The third point worth mentioning is that the increase in the retirement age will not occur immediately, but gradually, against the background of increasing life expectancy, including after 50-60 years.

Do you think it optimal to raise the retirement age to 60 for women and 65 for men? Or when would it be better to retire (for both men and women)?

It is necessary to distinguish between morbidity, functional preservation, physiological age. So far, we have a fairly high incidence among older people. First of all, cardiovascular, oncological diseases, diabetes mellitus... On the other hand, at this age, many people are quite intact both cognitively and physically. But if they have a complex of diseases that do not allow them to fulfill their functional duties at work, then it is necessary to obtain a disability.

Second point. Safety, the speed of the aging process, morbidity, human health depend only 20% on health care, and the rest is a person's way of life, his habits, responsibility for his health.

If you yourself do not want to preserve your health, then no one can do this, neither the doctor nor the minister. This is the responsibility of the person himself. The upcoming increase in the retirement age should focus the attention of citizens on the fact that they must take care of their health, since they will have to work longer, which means that not only for work, but also for a normal life in retirement, you need to try to maintain health.

In what state of health are women 55 and men 60 years old now, and in what state are 60-65 years old? How efficient are they (not to mention the competition between young and old, who find it much harder to find a job)?

The prevalence of chronic diseases is, of course, higher among those who are older - both women and men. This pattern is well known, with age, the dependence on chronic diseases, health problems grows, the patient may have many diseases.

At the same time, the concept of "physiological age" is very variable. One person at 80 years old can be active, in demand, continue to work, travel, be physically active, be interested in the world. And another at this age completely loses its functionality, cannot do without outside help.

We know for sure the stages of a child's growing up - at 6 months he sits down, teeth appear, in a year he walks, begins to speak. We can tell if the child is lagging behind in development or ahead of him. But we cannot say this about the elderly. These are very variable indicators. And they depend not only on genetics, but, above all, on the way of life.

Do you think it will be necessary to expand the list of professions, working in which people will be able to retire earlier (so that, for example, they can retire at 55-60, as they are now leaving due to the current retirement age)?

This issue requires serious discussion and analysis. A number of professions make serious demands on human health. And these are not only professions associated with heavy physical exertion and other occupational hazards, but also professions that require increased attention, stress resistance, good hearing and vision. This must be taken into account. At some point, a person can no longer perform his functional duties, it can be difficult for him and risky for others in a certain situation.

It is necessary to analyze the existing list of professions, perhaps in some cases to keep the current retirement age. This issue requires serious work of specialists in the labor sphere.

Does medicine now really allow for later retirement? The main causes of death are cardiovascular and oncological diseases. Are there major improvements in these areas?

Now in Russia innovative technologies are really being applied in oncology, cardiology, and other fields of medicine. And age should not be a reason to refuse the most modern high-tech treatment. This is what is happening now. According to statistics, the number of elderly and senile people who receive high-tech assistance is increasing in Russia. Until recently, there were isolated situations when hip joints were replaced with people aged 80-90 years. Now it is, in general, a routine. Also, older people undergo cataract surgeries, dental prosthetics, etc. All this allows you to prolong your active life. There should be no age discrimination.

On the other hand, all these new technologies do not change the geriatric approach, which can also be called modern technology treatment of elderly patients. This approach allows you to avoid many drugs, to understand what are the threats of loss of autonomy. Geriatrics devotes more time to the patient than other specialties. The geriatrician carefully collects anamnesis, evaluates functionality. It would seem that this is a simple technology, but it is new and requires skills, a sufficient amount of time. When we talk about increasing the life expectancy of people 70-80 years, this is where geriatric approaches work.

- Are the services of a geriatrician now provided free of charge?

Yes, since 2017 this assistance has been provided under the compulsory health insurance scheme. Moreover, the patient who comes to the geriatrician gets the opportunity to receive more examinations, procedures - precisely because, as a rule, these are patients with many diseases, which requires an integrated approach.

And the geriatrician spends more than 10 minutes on the patient. There is a special service - a geriatric assessment. It takes from an hour to 1.5 hours. A sufficient amount of time allows you to correctly assess the patient's condition, develop a plan for its management.

The geriatrician acts as a consultant. The patient is still led by a first-line doctor, a therapist. They, too, should be familiar with the skills of working with elderly patients. The percentage of the elderly among those who seek help at polyclinics now reaches 50-70%.

Is retraining possible for older people? Now there is a lot of talk about the fact that people must improve their qualifications in order to remain in demand as workers.

Doubts that older people can get an education, that a person loses the ability to learn with age, does not understand modern trends, growing informatization, gadgets, new technologies - this is a kind of manifestation of ageism. If there would be educational programs, special equipment for children and young people, it would have been impossible for them.

Here we need to talk about something else. It is required to create new programs, structures to teach people from a certain age. These are already established people with a profession, life experience.

A certain contingent of elderly people who have a cognitive deficit, probably, cannot fully deal with new knowledge and technologies. But absolutely all the elderly cannot be said like that.

It happens that when you come to the lake, it seems that the water is cold, but when you look at other bathers, you emotionally rebuild and you also start swimming. It seems to me that we also treat education, development in old age. We stand and think - I can no longer do anything, life is over. If the maximum life expectancy already reaches 120 years, then by 60 years it is only half of life, where did you get the idea that you cannot develop further?

At the same time, realistic tasks must be set. Of course, maybe you won't get a profession that requires a lot of knowledge, like medical specialties, if you work in a completely different field. Although it also happens. But, as a rule, people after the first education, work for some time go to improve their qualifications, to develop in this direction. In any case, it is necessary to expand the horizons, not to be afraid of the new.

What professions are optimal for older people? They are willingly hired only as security guards or concierges, at most - as cashiers ... However, this is a sedentary job, is it good?

Elderly people work not only in these professions. Teachers, doctors, for example, continue to work at an older age. Different variants possible, in addition to hard work, work with night shifts. It all depends on the education, the history of a person's life.

If we talk about a sedentary lifestyle at work, life at work does not end this way, you can walk to work, not use the elevators. The main desire is here.

Various retraining programs are being developed for the elderly, for example, they offer to become nannies. This, of course, is great, but this is not the whole list. I think there is ageism here too. Everyone has a different education, opportunities. It would be nice to be able to choose.

When they raise retirement age, first of all, the question arises - where to find a job, new requirements for a person arise, and these issues should be resolved in parallel with an increase in the retirement age and the development of new approaches to the treatment of older people.

What should be done to prolong life? Healthy lifestyle, rejection of bad habits, sleep, healthy food? And what food is considered healthy? Is meat allowed? And a glass of wine?

The main thing to do old man- be sufficiently physically active. It is also important to have a balanced diet, a sufficient amount of vegetables, fruits, that is, fiber, restriction of easily digestible carbohydrates, salt - up to 10 g per day. A glass of wine - why not, if you like it and enjoy it. It doesn't matter whether you eat meat or not, the main thing is that there is a sufficient amount of protein in the diet. As you age, you need more protein to avoid muscle wasting (a decrease in muscle volume and strength). But in what form to use it depends on taste preferences. You can be a vegetarian, eat legumes, mushrooms. It doesn't have to be meat.

There should also be social activity, communication. Any kind of activity, involvement in social life is useful.

Sleep is also a guarantee of a sufficient life expectancy. Six to eight hours - normal duration sleep. There are, of course, those who sleep 4-5 hours, but this is rarely the norm for anyone.

Quitting smoking is unambiguous.

Alcohol abuse is not even worth discussing. Bad habits will definitely shorten life.

But what about the growing number of people who become depressed after retirement and start to abuse alcohol?

We need to prepare for retirement. When a person leaves work, all activity stops, the phone goes silent - this is the deepest stress that can lead to depression and alcohol abuse. A person must prepare himself, find new occupations, interests. It is possible to get a new education, retrain, if he cannot stay in his main job. Retirement is especially difficult for men. In addition to work, women have household chores. For men, it becomes more stressful, they are psychologically more connected with work.

40 minutes of brisk walking a day is a must, in addition, it is recommended to swim twice a week, go to the gym, ride a bike. Lots of options. Depends on the health of the people. There are those who start diving at the age of 80. Probably an extreme sport for an elderly person, but one of my patient's friends likes it, she goes to the resort every year to go diving, there are no contraindications, she feels great. But these are rare cases. Of course, there is no need to start parachuting or rock climbing in old age. There are acceptable activities. Walking with Scandinavian poles, for example, perfectly distributes the load on all muscles, relieves the joints.

Maybe you see the need to introduce compulsory medical examination for people from a certain age? It is now voluntary.

We cannot force all people to undergo medical examination, we can only explain what needs to be checked. We need to motivate our citizens to take care of their health. And raising the retirement age is also motivation. But there is no need to apply punitive measures, it will not work.

Life in Moscow is very different from life in the regions - what do you think is the best place for older people to live? On the one hand, fresh air, perhaps some kind of physical work / activity in the regions, on the other hand, much more good conditions life in the city, including opportunities for social activity.

The maximum life expectancy in Russia is now recorded in Moscow, St. Petersburg, and the Caucasus. As you can see, these are zones with good and bad ecology. Everything matters here - morbidity, standard of living, social assistance, health care. Now the challenge for health care is to equalize the rates of morbidity, mortality, and average life expectancy in different regions.

Olga Tkacheva, Chief Geriatrician of the Ministry of Health of Russia and Director of the Russian Gerontological Research and Clinical Center, became a guest of the "Literally" program on the MIR 24 TV channel.

- Who is a geriatrician? What does he do?

Olga Tkacheva: A geriatrician is a doctor who treats elderly and senile people. Despite the fact that we treat elderly patients, the specialty is very young, because this phenomenon of the appearance of elderly and senile people in such a huge number of people is, in general, a completely new phenomenon. The fastest growing population on the planet today is the 80-year-old population.

- In ordinary hospitals, clinics, elderly people are still treated by a therapist. Is this due to a lack of specialists?

Olga Tkacheva: First, the geriatric service in Russia began to develop only a few years ago. But I can say that primary care doctors and, in general, doctors of any specialty receive education in geriatrics, because an elderly or senile person can turn to any doctor.

- In the future, such doctors will appear in hospitals, clinics?

Olga Tkacheva: Of course. They are already appearing. We have regions in Russia where geriatric services are already well developed. For example, the Volgograd region, the Republic of Bashkiria, Voronezh, Moscow.

- You recently announced that the average life expectancy of Russians will increase in the near future. What are these predictions based on?

Olga Tkacheva: These are the plans. And these forecasts are based on some programs that are now being implemented by the Ministry of Health. Our medicine has slightly changed its paradigm. We pay more attention to prevention, and a whole preventive structure has been opened in our country. These are structures that are engaged in counseling not sick people, but healthy people. And this is of decisive importance, because no matter how we develop high technologies, miraculous medicines, they, unfortunately, will not solve all our problems. In addition to these preventive programs, we are actively implementing programs for the development of vascular centers. You know that this is the year of the fight against cancer. Special attention will apply for early detection of oncological diseases. After all, the main cause of death today is cardiovascular and oncological diseases.

- I think you will agree with me. It is one thing to live a long life; it is another thing to live this long life with quality. In your opinion, is such a scenario possible in Russia?

Olga Tkacheva: Such a scenario is quite possible, and now I will say a phrase that, perhaps, not everyone likes. But I always say that everyone should be responsible for their health. Any of our interventions, any of our programs will be absolutely powerless if we ourselves do not want to preserve our health. It is possible to live an active life in our country if the person himself wants it. There are rules for a healthy lifestyle. There is a need for a timely visit to a doctor, not only about the disease, but about prevention. Now there is such an opportunity. In addition, a new specialty is developing called geriatrics. Its main task is to increase the duration of an active life after 60 years.

- What is the average life expectancy of a person today?

Olga Tkacheva: According to statistics, today the average life expectancy is 73.5. Men - 68.6, women - 78.3. Of course, there is a difference between men and women, but we must reduce it.

- If you manage to extend the average life expectancy in the future, won't there come a moment when there will be a shortage of medical care?

Olga Tkacheva: Population aging is accompanied by increased health care costs and social assistance... But in the event that we will not only increase life expectancy, but the duration of active life, then it is not at all necessary to increase health care costs. In addition, I want to say once again that we must follow the path of prevention. And prevention should be at a young and old age. Geriatrics is largely prevention.

- So, the retirement age is planned to be raised for a man by five years, for women at once by eight. How justified is this decision from a medical point of view?

Olga Tkacheva: Let's start with the fact that life expectancy on the planet is increasing. And not only life expectancy is growing, but the duration of active life. The retirement age will inevitably rise. This is most likely due to economic reasons. But on the other hand, people are aging more slowly now.

- What does a person need to do in order not only to live a long life, but also to be healthy?

Olga Tkacheva: We need to start thinking about aging as early as possible. Scientists say that aging begins in the prenatal period. Therefore, even mom's health has great importance, and the rate of aging is laid in utero. To lead healthy image life should start as early as possible, but on the other hand, it is never too late. Here, understanding what needs to be done is very important. We are talking a lot about this now. Adequate physical activity is a very important factor in increasing life expectancy. Quitting smoking, for example. Blood pressure control. I have now listed three factors. Do you know how much they add years of life with proper control? According to some studies, up to 14 years old. Adequate intake of fruits and vegetables, weight control, control of cholesterol levels. If we are talking about elderly people, then social activity is of great importance here. According to the Ministry of Labor, 50% of those retiring express a desire to continue working and continue to work. Many people today talk about the problem of eijism - that as soon as a person crosses a certain age threshold, he is no longer hired, and so on. This is true. And this problem needs to be addressed.