Anziano fragile
Anziano fragile
Chi è l’anziano fragile?
L’anziano fragile è un individuo che presenta precarie condizioni fisiche e cliniche con un rischio elevato di complicanze che possono sfociare nella progressiva perdita di autonomia. Sebbene una consistente percentuale di anziani sia esente da patologie cliniche di rilievo, una quota rilevante mostra un eccesso di vulnerabilità agli eventi stressanti e una ridotta capacità a mantenere o recuperare l’omeostasi, in seguito a un evento destabilizzante acuto. In ambito geriatrico e clinico, si definisce fragilità una sindrome biologica caratterizzata da una ridotta riserva e resistenza agli eventi stressanti derivante da un declino complessivo di sistemi fisiologici plurimi, che rendono l’anziano particolarmente vulnerabile in occasione di eventi acuti. Al di là dei criteri adottati per la sua identificazione in numerosi studi, la fragilità si è dimostrata un potente predittore di eventi avversi (morte, disabilità, ospedalizzazione, istituzionalizzazione, cadute accidentali). L’individuazione di questi pazienti a maggior rischio dovrebbe quindi costituire un momento fondamentale nella valutazione del paziente anziano in PS, al fine di garantire per questo individui le strategie operative migliori.
Anziano fragile: criteri diagnostici
La maggiore difficoltà per il clinico risiede nella mancanza di criteri diagnostici operativi semplici, univoci, che consentano anche in ambiti non geriatrici di riconoscere e standardizzare agevolmente l’anziano fragile, per il quale non esiste neppure attualmente una definizione unanimamente accettata. Nonostante le divergenze nella definizione di criteri operativi per l’identificazione della fragilità, vi è un sostanziale accordo circa i meccanismi fisiopatologici che a essa conducono.
Modello patogenetico largamente condiviso:
- Perdita di peso > di 4,5 Kg. nell’ultimo anno.
- Affaticamento
- Riduzione della forza muscolare
- Ridotta attività fisica
- Riduzione della velocità del cammino
- Malnutrizione cronica
Presa in carico dell’anziano fragile
Come affrontare i problemi dell’ anziano fragile? L’approccio deve essere multidisciplinare e prevede anche il coinvolgimento dei familiari e di diverse figure professionali che concorrano in maniera sinergica al miglioramento della qualità della vita dell’anziano fragile. L’integrazione socio-sanitaria permette vantaggi significativi in termini di qualità di vita e, nel contempo, una riduzione dei costi ospedalieri grazie alla diminuzione dei ricoveri impropri.
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Demenza: fattori di rischio
Con il termine demenza si intende una compromissione mnesica associata a disturbi cognitivi (funzioni prassiche, fasiche, gnosiche, pensiero astratto e capacità critiche), tali da determinare una compromissione dell’attività sociale e lavorativa del soggetto.
Demenza a corpi di Lewy (DLB)
La demenza con corpi di Lewy è una malattia neurodegenerativa progressiva considerata la seconda forma di demenza degenerativa dopo l’Alzheimer e connessa con il Morbo di Parkinson. La DLB è caratterizzata dall’accumulo all’interno delle cellule neuronali e gliali di aggregati insolubili di alfa-sinucleina denominati corpi di Lewy e neuriti di Lewy.
Morbo di Parkinson: sintomi, diagnosi e terapia
Il morbo di Parkinson fu descritto per la prima volta da James Parkinson nel 1817. Il morbo di Parkinson è un disturbo del sistema nervoso centrale caratterizzato principalmente da degenerazione di alcune cellule nervose (neuroni) situate in una zona profonda del cervello denominata sostanza nera.
Morbo di Alzheimer
Il morbo di Alzheimer venne descritto per la prima volta nel 1907 dal neurologo tedesco Alois Alzheimer, che riconobbe in questa malattia una precisa patologia riscontrata in alcuni pazienti. Il morbo di Alzheimer è caratterizzato da una progressiva perdita di memoria; inizialmente viene danneggiata la memoria a breve termine ma in seguito il malato può essere incapace di ricordare anche nomi e visi dei parenti.
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