On aging and aged care in Serbia.

Serbia is a demographically old nation, with 17.4 % of its residents being aged 65 years and older in 2011. The previous two decades of turbulent history have significantly affected the demographic picture of this country, and their ramifications remain visible in Serbia's economic, political, cultural, and health spheres. Major demographic forces behind population aging in Serbia can be attributed to lower fertility rates, migrations, and declining mortality (reflecting improvements in overall health leading to a longer life expectancy). In Serbia, low fertility and migrations appear to play major roles, although the relative contribution of recent migrations cannot be measured with accuracy. Patterns of demographic aging vary considerably across different geographic, socioeconomic, and cultural settings. The common denominator throughout present day Serbia is extensive political and economic transition. One would expect that, given sufficient time, this process will result in improved population health, and yet, at this stage outcomes of major health care reform in Serbia are somewhat perplexing. For the second consecutive year, Serbia's health care system has been ranked at the very bottom of the scale among 34 European countries. It is then no surprise that the elderly represent particularly vulnerable population segment. This paper discusses some of the issues relevant to these demographic patterns of aging and aged care in contemporary Serbia, focusing on the period after 2000.

Nonsteroidal anti-inflammatory drugs: as inappropriate pharmacotherapy in the elderly?

Nonsteroidal anti-inflammatory drugs (NSAID) are one of the most used groups of drugs in elderly population. The aim of this study was to establish the frequency of reported disorders while using NSAID in elderly patients. A multi-centric study was conducted with a standard questionnaire for all geriatrician outpatients who were using NSAID. It has been found that out of 421 patients, 320 reported some kind of disorder; 287 of them used other drugs beside NSAID, 33 used only NSAID during the study. It has been concluded that frequency of reported disorders was significantly higher among patients who used another drug beside NSAID, and statistically most frequent reported disorders were gastrointestinal.

Biogerontology in Serbia.

UNLABELLED: Aging is caused by gradual accumulation of cell and tissue damage. Accumulation of damage begins early and continues progressively throughout life, resulting after several decades in the overt frailty, disability and diseases associated with aging. In Serbia during the last few years, several different institutions participated in the investigation in the aging process: (1) Changes in hormone signaling with aging-the age-related increase in insulinemia and glucose metabolism deregulation was found to be attributed to changes in insulin signaling as demonstrated on murine models. (2) Changes in immunological response in aging-along with involution of thymic lymphoepithelial tissue, it has been demonstrated on a murine model that early thymocyte differentiational steps within the CD4-8-double negative developmental stage are age-sensitive. (3) Changes in cholesterol metabolism and oxidative processes in aging-the beneficial effect of long-term dietary restriction on ageing, was explained as effect on cholesterol metabolism. (4) Alzheimer's disease-the connection between neurodegenerative processes associated to the Alzheimer's disease and the function of the Na-K-ATPase which is known to be altered by ageing has been experimentally shown. CONCLUSION: The recent work of Serbian investigators suggest some new evidence that aging process influences the hormone signaling, immunological response, cholesterol metabolism and oxidative processes.

Acute geriatric units.

Together with increase of population of elderly people, there is an increase of the number of hospital admission for emergencies, especially for elderly people. Serbia shares this need for Acute Geriatric Units (AGU). The National Programme of Health Care of Elderly People Improvement is planning to open the Geriatric Ward in every regional general hospital in Serbia. But in cities with several hospitals, there is a waste need for geriatric ward capable of taking acute care. So, there is a need for geriatric wards in Serbia nowadays. The main targerts for AGU should be: the comprehensive geriatric assessment, prevention of development of worsening of delirium, decubital wounds, incontinence, improving mobility and early planning of discharge. The multidisciplinary team, which includes physicians, nurses, physiatrist and social worker, is the best solution for getting this target day by day. Thus, one of the distinctive features of Acute Geriatric Units should be comprehensive geriatric assessment, the prevention of geriatric syndrome and early planning of discharging the elderly patient.

Self-perception of health (SPH) in the oldest-old subjects.

SPH is a subjective and objective assessment of personal health. It is important in evaluation of health status in the elderly as it has capacity to predict mortality, functional declining, and health-care demands. A lot of research has been published about SPH in the elderly, but little is known about SPH in the very old, especially in comparison with the "younger-old" (YO) population. The study has aimed to investigate SPH in 240 elderly patients and compare the data between the "oldest-old" (OO) (aged >or= 90 years; n=52) and the YO (aged 60-74 years; n=188) subjects. Results have shown that the OO group of patients had better SPH than their YO counterparts. Our findings implicate that very old persons belong to a special sub-group of elderly, the "successfully aged", probably due to their genetic stability, distinctive lifestyle, or both.

Aging in Serbia.

Serbia has one of the largest elderly population segments in the World, with 17.2% of its citizens estimated to be 65 years and older in 2007. In the period of last 50 years, important demographic changes had occurred in Serbia. In 2002, Serbian demographic situation for the first time reached the point where the number of the older exceeded the number of the youngest. In 2007 this tendency continues to persist, with 22.1% of Serbians estimated to be 60 years or older, and 21.7% to be 20 years or younger. For the same year, life expectancy at birth was estimated to 70.7 years for the male, and 76.2 years for the female Serbian newborns. Elderly represent major consumers of health services, and yet, not always do they receive the quality of care they are entitled to. Family still holds a predominant role in providing social support and care for their elderly members. During the last 30 years, number of long term care facilities (primarily aimed at old people not competent of independent living) has gone up in Serbia from 35 to 43. Yet, they provide accommodation and care to only a small number of residents, ranging from 5996 in 1976 to 12,160 in 2005. Such institutions are named "Homes for the elderly" or "Geronto centers". The aims of aged care reform in Serbia include not only better education for the medical and other affiliated stuff, but, also, improvements in intersectoral collaboration, structural reforms of the social and health care systems, innovative capacity building, and the promotion of concepts that would replace, or at least ease the burden off the traditional family.

Psycho-social model of depression within the elderly population in the institutional and non-institutional life conditions.

The aged people are often in need of other people's help available at their home or in institutions for long term care. On the other hand depression is one of the most prevalent psychiatric disorders and a common cause of disability in the elderly. The study included N=100 participants. Subjects are individuals in the age of 65 or more, 39 men and 61 women. Fifty subjects have been accommodated in the Elderly Centres (homes for retirees), and fifty have been using gerontology centre services at their homes. Depression, functional capability, psychosomatic disorders and subjective estimate of health have been investigated. It has occurred that depression in general was more present among the subjects who lived in the institutional life conditions, namely that depression major (major, regarding severity of the disease) is more frequently present in this group. Depression minor is more frequent among those subjects who live in the non-institutional conditions. Psychosomatic disorders, decreased functional capability and lack of contacts outside homes are in larger correlation to depression among subjects living in the non-institutional life conditions. Depression and subjective health estimate are highly correlated in both groups. Depression is more widely present among women and subjects with higher education levels.

Progression of polyvascular disease--is there any rule?

The polyvascular disease (PVD) is presented by coexistence of ischemic heart disease (IHD),carotid disease (CD) and peripheral arterial disease (PAD). In the essence of this disease is atherosclerosis. The aim of the research was to learn what is the course of the worsening multiple arterial diseases during the two-year period considering the new cardiac, cerebrovascular and peripheral vascular events. Among 150 patients with clinical manifestations of obliterate vascular disease of at least two aforementioned vascular diseases, we investigated the incidence of new coronary, carotid and peripheral vascular events during the two-year period. New coronary events were the most common in PVD patients with preexisted IHD (88 persons, 58.7%, p < 0.01), in PVD patients with preexisted CD (51 persons, 34.0%, p < 0.01) and in PVD patients with preexisted PAD (61 persons, 40.7%, p < 0.01) as well. The second most common event is the worsening of the preexisting dominating vascular disease. Thus, whatever the predominant vascular disease was, in the further two-year course of polyvascular disease, the new coronary events are the most frequent.

Cross-sectional study on health and social status of the oldest old patients at home care in Belgrade.

In the period of the last 50 years important changes in the age structure of the population in Serbia occurred. There was a very pronounced tendency of the total demographic aging of the population. The main aim of the Study is evaluation of basic health, functional and social status of the elderly patients (N = 645) admitted in Institute of Gerontology, Home Treatment and Care (IGHTC) Belgrade in 2001. Particular attention has been paid to the health and social status of the "oldest old" (90+ age) patients in comparing to the group of the "young old" (60-74 age). The purpose is to explore specific health and social need of the oldest old patients, which determine requirements for home care and could present risk factors for their institutionalization. Results can help in health promotion and preventive health care of the oldest old. The results show significantly smaller degree of utilization of health care services in the population of age 90+. We may raise the question of reason for this: the discrimination of the "oldest old" patients in the health security system, unavailability because of functional dependence and non-adjusted system of health care to the oldest patients. This fact confirms the importance of home care services. Home care services, not only contribute to the maintaining quality of life in the old age, but delay and/or prevent institutionalization of patients who are under greatest risk of this. This is for sure one step towards the rationalization of health care costs.

Is there such thing as "reversible dementia" (RD)?

RD is an extremely important problem for the practice of geriatricians. Rationale for this review had come from our question: could we increase and improve the cognitive function of our patients by treating some of "internal medicine" diseases at our hospital. Our clinical experience is telling us that it might be so. We administered the mini mental state examination (MMSE) test on 77 patients to check, if there is a relation between mental state and physical health. Patients were treated with appropriate cardiological, pulmonological and other needed therapies. Results indicate that recovering from the main disease increases the MMSE scores. This leads to the conclusion that successful treatment of patients can be followed and also confirmed by the results of the MMSE test. We have also observed that damaged physical health can inflict cognitive functions, no matter how old a person is.

Is there such thing as "vaccine against aging"?

Problem could be found in the fact that very often we look for one deciding, definitive reason for the process of aging. It is a sort of search for a big discovery, like a fountain of youth or such. More and more authors are trying to explain the unknowns in the understanding of these observations about ageing, by adding the statement that there are two subgroups in the general population. This acknowledgement of two subpopulations explains why there are numerous cases that can not be explained or defined or fitted in these basic observations about caloric restrictions and the delay of reproduction. The identification of those two groups would allow us to find more realistic results in studies, and therefore a more efficient therapy of certain diseases. This hypothesis does not contradict theories of aging that we have accepted (at least not the majority of accepted theories), and this hypothesis also does not contradict the fact that there is a large interindividual variability. This hypothesis doubts, and claims there are exceptions to the starting assumption of geriatrics and gerontology's that: "parallel to the aging process the functions of all organs and organ systems lessen". In future we could use one of these screening tools to detect genetic instable population: the cytokinesis-block micronucleus assay, expression of hTERT, the component of the enzyme telomerase, identification of the "longevity" genes like daf-16, p53, THO, HSP70 or the level of insulin-growth factor-I. This would enable us to correct genetic instability in this population with "vaccine of youth", making the human race living 30 years longer with excellent life quality.

The principles of chemotherapy of colorectal cancer in elderly.

The prevalence of colorectal cancer (CRC) increases significantly with age, with 40% of patients in Europe being older than 74 years of age at the time of initial diagnosis. The individualized management of the older-aged patient with cancer is based on the answers to the following questions: 1) will the patient die of cancer or with cancer; 2) will the patient suffer cancer-related morbidity; and 3) is the patient able to handle the toxicity of treatment? More than chronological age, the following parameters are important when elderly patients are to be treated with antineoplastic agents: general condition, liver function, kidney function and bone marrow status. Frail elderly with malignant disease should not be treated with cytostatic therapy. In the case of fit elderly, the standard chemotherapy (i.e. FOLFOX) regimen could be administered. In elderly ineligible for combination chemotherapy, the capecitabine used orally, as a single-agent therapy, is an important therapeutic option for colorectal cancer.

The privilege to be old.

BACKGROUND: Ample evidence has proven that the functional property of cells decreases over the years. Nevertheless, although it has taken decades to convince ourselves that elderly people belong to a specific age group both biologically and medicinally, and in whom special criteria have to be taken into consideration, it seems that even they themselves do not present an homogenous group. OBJECTIVE: Today we often hear of authors of studies speaking of two subpopulation groups--one group that ages by all the laws of aging that we have encountered and accepted thus far, and the other group that seems to postpone aging due to 'programmed death', or more specifically due to low mastery/low emotional support or because of additional reasons; however, the existence of the two groups seems eminent. METHODS: The identification of these two groups would allow us to find more realistic results in studies, and therefore a more efficient therapy for certain diseases. RESULTS: This hypothesis does not contradict the theories of aging that we have accepted (at least not the majority) and also does not contradict the fact that there is a large interindividual variability. This hypothesis doubts and claims there are exceptions to the initial assumption of geriatrists and gerontologists that 'parallel to the aging process, the functions of all organs and organ systems lessen.' CONCLUSION: The identification of these two groups would allow us to find more realistic results in studies, and therefore more efficient therapy for certain diseases.