title: [Living with lost individuality. Special concerns in medical care of severely demented Alzheimer patients].
abstract: While the expected life-time increases dementias will show a pandemic nature. Author analyses the special medical and social concerns of severe states of Alzheimer disease. Having introduced the epidemiologic, diagnostic data and forms of palliative therapies he concentrates on the hitherto unsolved problems of patients and caregivers. He belongs to the experts identifying the Alzheimer diseases as a forced aging process. Accepted the theory of L. Hayflick he evaluates the aging process in frame of an evolution model. He states that for aged human beings having already performed the task of reproduction further conditions of living circumstances and even that of death are no more programmed. This hypothesis may have a very negative content at the first sense. But the author rather considers the uncertainty of aging a positive message. He establishes that the occurrence of degenerative processes connecting the aging must be limited by preventive interventions far more efficient than the present possibilities. Concerning these steps we are still on the level of recommendations for preserving our general health and data of relevant science are quite contradictory. Although criteria of "healthy", "qualified" or "assumable" aging are getting defined, we still do not know exactly how we should live optimally and what should we do for this in different epochs of our life. Somatic and psychological parameters are lacking which would be able to signalize the actual level of the aging process in a given person. We, physicians, also do not have exact opinion on the level of severity of dementias at which the patient already lost his her features of personality and individuality on an irreversible way. We have no idea on the phase when the ratio of joy and suffer falls below the value of 1.0 because we still have no tool for its measure. The author pointed the necessity of acceptance of a new preventive attitude and application of new methods in the medical care of the forced or pathological aging, instead of the present approaches based on the "wait and treat" attitude. Because of the intensive increase of the patient population the identification and care of patients can be efficient with a much more involvement of the basic medical network. Financial background can be improved by new theoretical bases of criteria of the palliative treatments. But the direct professional programs can be planned after solution of the existing moral and social dilemmas.
authors.affiliation: Semmelweis Egyetem, Pszichiátriai és Pszichoterápiás Klinika, Budapest. rajna@multiart.hu
authors.forename: Péter
authors.initials: P
authors.lastname: Rajna
mesh_terms: D000375:Aging / Q000523:psychology; D000544:Alzheimer Disease / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy*; D000975:Antioxidants / Q000627:therapeutic use; D035843:Biomedical Research; D017028:Caregivers / Q000523:psychology; D015897:Comorbidity; D016265:Conflict of Interest; D003242:Conscience; D003704:Dementia / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000523:psychology; D005853:Geriatrics / Q000639:trends; D017048:Health Care Costs / Q000639:trends; D006291:Health Policy / Q000639:trends*; D006801:Humans; D007206:Individuality; D008019:Life Style; D008568:Memory / Q000187:drug effects; D009462:Neurology / Q000639:trends; D018697:Nootropic Agents / Q000627:therapeutic use; D010166:Palliative Care / Q000379:methods / Q000592:standards* / Q000639:trends; D058873:Pandemics; D010348:Patient Care Team / Q000639:trends; D028723:Personhood; D005082:Physical Exertion; D011157:Population Dynamics; D015995:Prevalence; D011570:Psychiatry / Q000639:trends; D012307:Risk Factors; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000523:psychology; D011795:Surveys and Questionnaires
chemical_list: D000975:Antioxidants; D018697:Nootropic Agents