Ubudlelwano phakathi kwezemidlalo nokuguga akuyona imfashini yakamuva: kungumugqa wamasu wezempilo yomphakathi i-WHO ewugcizelele Ishumi Leminyaka Lokuguga Okunempilo (2020-2030)Ezimweni zoguquko lwezibalo zabantu kanye nezifo eziwumshayabhuqe, njenge-Spain—enesikhathi sokuphila esiphezulu kakhulu—ukuhlala usebenza akululeki nje kuphela, kuyisisusa sangempela sokulondoloza ukuzimela kanye nezinga lempilo lapho usumdala.
Kunokuba kube yingozi, ukuvivinya umzimba njalo iphephile kubo bobabili abantu abadala abanempilo nababuthaka lapho ivumelana namandla abo okusebenza. Ngaphezu kwalokho, ukukwenza ngeqembu, ngokusekelwa kontanga nabafundisi, kukhulisa ugqozi nokubambelela. Kulesi sihloko, siqoqa izinzuzo zomzimba nezengqondo, idatha ebalulekile, ubungozi bokuphila unganyakazi kanye nezincomo ezisebenzayo ngokusekelwe kumhlahlandlela kanye nezifundo, ukuze umuntu ngamunye osekhulile akwazi ukuthola umgwaqo wabo obheke ekugugeni okusebenzayo.
Izinzuzo ezingokomzimba, ezingokomzwelo nezingokwengqondo zokuzivocavoca kubantu abadala asebekhulile
Ukwenza umsebenzi womzimba njalo kuhumusha kube izinzuzo eziningi: kuyasiza uku londoloza futhi andise amandla ukugcina ukuzimela, ukunikeza amandla okuphila kwansuku zonke nokunciphisa ukukhathala, ukuthuthukisa ibhalansi nokunciphisa ingozi yokuwa nokulimala okuhlobene.
Ngokombono womtholampilo, ukuhamba njalo kunomthelela ukuvimbela nokulawula izifo okuvamile ebudaleni: isifo senhliziyo, unhlangothi, uhlobo 2 lwesifo sikashukela, ukukhumuzeka kwamathambo, nezinhlobo eziningana zomdlavuza (kuhlanganise nebele kanye nekholoni). Iphinde ikhuthaze ukulala okungcono, yehlise ukucindezeleka nokukhathazeka, ilawule isisindo somzimba, futhi ilondoloze umfutho wegazi ezigabeni ezinempilo.
Umthelela awugcini nje ngokomzimba. Ubufakazi bukhombisa ukuthuthuka kwe isimo sengqondo nokunciphisa izimpawu zokucindezelekaUkuzivocavoca nabangani kunikeza ukusekela ngokomzwelo futhi kuqinisa umuzwa wokulawula. Kuphinde kwaqashelwa ukuthi kuzuzise imisebenzi yengqondo enjengokushintsha imisebenzi ngokushesha, imisebenzi yokuhlela, kanye nokushaya indiva ulwazi olungabalulekile.
Ucezu olubalulekile lwephazili yokuqonda luvela ku-Rush Alzheimer's Disease Center (Iphrojekthi Yenkumbulo Nokuguga): amazinga aphezulu okuzivocavoca kwansuku zonke ahlotshaniswa inani elikhulu nokusebenza okungcono kwamaphrotheni e-synaptic ebuchosheni, okuvikela impilo yobuchopho namakhono okuqonda. Izivivinyo ezihambisanayo zomtholampilo ziqinisekisa ukuthi ukuvivinya umzimba okusesilinganisweni kungathuthukisa ukuqonda futhi kuxhunyaniswa nokuqina kwe-cortical, njalo nge-caveat ukuthi ukubekezelela ngokuhamba kwesikhathi iyanquma.
Kubantu abadala asebekhulile, ukuvivinya umzimba kungase kwandise umkhawulo wobuhlungu ocatshangwayo (i-hypoalgesia ebangelwa ukuzivocavoca). Uhlelo lwe-multicomponent lwamasonto angu-12 lubonise a ukwanda komkhawulo wobuhlungu bengcindezi ku-trapezius neminwe, kanye nokwehla kwengcindezi ye-diastolic kanye nobuthaka, kanye nokuthuthukiswa kokusebenza okulinganiswa ne-Barthel Index.
Mayelana nokulala, izinhlelo zokuvivinya umzimba zivame ukunciphisa i-hypersomnia Futhi, nakuba kunemiphumela efuna ukwazi ngekhwalithi yokulala kwamanye amasampuli (ngokuzibika), indikimba yobufakazi ikhomba umphumela onenzuzo ekuphumuleni lapho ukuvivinya umzimba kugcinwa ngokuhamba kwesikhathi.
Ingxenye yezenhlalakahle nayo ihlanganisa: umsebenzi weqembu ukhuthaza ukufakwa komphakathi kanye nokuphila kahle ngokomzweloIzinyathelo zomphakathi nezinhlangano ezifana ne-YMCA zinikeza izinhlelo zeqembu ezisekelwe ebufakazini ukuze kuthuthukiswe ukufaneleka, ukulinganisela, nokuvimbela ukuwa, okungeza lolo ngqimba losekelo olusiza ukugcina isimiso.
- Imisebenzi yokumelana njenge ukuhamba, ukuhamba ngebhayisikili noma ukudansa Bakhuphula izinga lokushaya kwenhliziyo futhi bakhulule izinto ezithuthukisa isimo sengqondo.
- Izenzo zomqondo womzimba njenge i-yoga ne-tai chi Bahlanganisa ukuma, ukuphefumula nokuphumula kanye nezinzuzo ngokulinganisela nokuthula.
- Khetha imisebenzi oyithandayo (ukulima ingadi, ithenisi, ukudlala nabazukulu): ukubambelela iba ngcono uma umsebenzi ujatshuliswa.
Izingozi zokuphila unganyakazi kanye nendlela yokuzijwayeza ezemidlalo ngokuphepha
Ukungasebenzi komzimba kuyingozi enkulu: labo abanganyakazi ngokwanele bane-a 20% -30% ingozi enkulu yokufa kunabantu abakhuthele ngokwanele. Kubantu abadala, indlela yokuphila yokunganyakazi ihlotshaniswa nokufa okuphezulu okuvela kuzo zonke izimbangela kanye nomdlavuza noma isifo senhliziyo nemithambo yegazi, kanye nesifo sikashukela sohlobo 2 kanye nesifo senhliziyo.
Ukuzivocavoca kuphephile ezimweni eziningi, kodwa kuwumqondo omuhle ukubukeza ama-contraindications. Ngaphambi kokuqala uhlelo, thintana nodokotela wakho, ikakhulukazi uma unomlando we Isifo senhliziyo esibi kakhulu, ukwehluleka kwenhliziyo, i-angina engazinzile, infarction yakamuva, i-embolism yakamuva, i-arrhythmias engalawuleki, izifo eziyingozi, umfutho wegazi ophakeme ongalawuleki (>180/>110 mmHg), i-myocarditis, i-pericarditis, i-endocarditis esebenzayo noma yakamuva, i-aortic dissection, i-malignant ventricular arrhythmia. noma isifo sikashukela esingalawuleki, noma uma uye wahlinzwa ezinyangeni ezintathu ezedlule.
Ngaphezu kokwenza ukuqina kube ngokwakho (gwema imizamo eseduze nobukhulu futhi ubeke phambili ububanzi maphakathi), nakekela indawo ezungezile: ukulungisa ikhaya lakho ukuze ugweme ukuwa kwenza umehluko. Kubantu abadala abasebenzisa i-hypnotics, ukuyibuyekeza nodokotela wabo ngokulandela izindlela ezifanele kungasiza ukuvivinya umzimba ngokuphumelelayo. iphephile futhi isebenza ngempumeleloFuthi khumbula: ukwesekwa okuvela eqenjini kanye nochwepheshe abaqeqeshiwe kwandisa ukubambelela.
Ezinye iziqondiso ezisebenzayo ziphakamisa ukuthi, kusukela eminyakeni engu-65, umsebenzi kufanele wenziwe umfutho ophakathi noma ophansi futhi ngaphandle kokufinyelela umzamo omkhulu oqhubekayo. Ngezicathulo ezinhle, ukugeleza kwamanzi, ukuqhubekela phambili kancane kancane, nokuphumula okwanele, ingozi yezigameko yehla kakhulu.
Izincomo, izinhlelo eziphumelelayo, nalokho okushiwo ubufakazi
Imihlahlandlela ye-WHO incoma okungenani Imizuzu eyi-150 yomsebenzi omaphakathi ngesonto (noma imizuzu engu-75 yokuzivocavoca okukhulu), ukwengeza izivivinyo zokuqinisa imisipha izinsuku ezimbili ngeviki kanye nokunciphisa isikhathi sokunganyakazi. Kulabo abangafinyeleli lezi zilinganiso ezincane, noma yikuphi ukukhuphuka kubalwa: wonke umsebenzi ubalulekile.
Empeleni, ukuhlanganisa izingxenye kuwumnqobi: ukubekezela, amandla, ibhalansi, nokuguquguquka. Ukuqeqeshwa kwezingxenye eziningi kufakazele ukuthi kusebenza kahle ikakhulukazi kubantu abadala asebekhulile ukuvimbela i-sarcopenia, ukuthuthukiswa kokusebenza nokulinganiselakanye ukuguqulwa kwezinqubo zokuvuvukala okuhlobene nobuhlungu.
Ibhentshimakhi uhlelo lwe-"Vivifrail", olwakha izikhathi ngezigaba ezintathu: ukuzifudumeza (≈20 min) ngokuhamba nokusebenza okulula kwenhliziyo nemithambo yegazi; ukuqinisa (≈20 min) okuqhubeka ngokwesimo; futhi ukuphumula (≈10 min) ngokuzivocavoca okuguquguqukayo nokulinganisela. Ivumelana nezimo ngeleveli yokusebenza kanye nengozi yokuwa, futhi inamathuluzi e ukuhlolwa kanye nencwadi kadokotela ngokushesha.
Kusetshenziswa eqenjini futhi eliholwa odokotela bomzimba, uhlelo lwamaviki ayi-12 (amaseshini amabili/isonto, imizuzu engama-60) luthuthukise okuguquguqukayo okubalulekile kubantu abadala ababuthaka ngaphambilini nabazimele: ukwehla kwengcindezi ye-diastolic, ubuthakathaka obuncane nokusebenza okukhulu (I-Barthel Index). Imikhawulo yobuhlungu bengcindezi ku-trapezius neminwe yanda; ngokwezinga lempilo (i-GENCAT), inhlalakahle engokomzwelo, ukuthuthukiswa komuntu siqu, inhlalakahle yomzimba, ukuzikhethela, amalungelo, nokufakwa komphakathi okuthuthukisiwe. Kube nezinguquko ezinhle ku-hypersomnia kanye nomphumela omangalisayo wekhwalithi yokulala (ukuzibika), okumema ucwaningo olwengeziwe. Njenganoma yiluphi ucwaningo lwempilo yangempela, bekunemikhawulo (usayizi wesampula omncane, ukubusa kwabesifazane, alikho iqembu lokulawula, kanye ukunamathela okuphansi), kodwa iphethini icacile: imisebenzi yezingxenye eziningi.
Isivinini se-Gait-inkomba enamandla yomtholampilo-ivame ukuthuthuka ngalokhu kungenelela futhi ihlotshaniswe nayo isikhathi eside sokuphila kanye nokukhubazeka kwezehlakalo eziphansi kubantu abakhulile.
Ngaphandle kohlelo olulodwa, izifundo eziningi zamazwe ngamazwe sekela isixhumanisi phakathi kokuzivocavoca nokusebenza kwengqondo kubantu abadala asebekhulile, kokubili kubantu abangenakho ukukhubazeka kanye ne-MCI noma ukuwohloka komqondo, emphakathini nasezikhungweni, ngezivumelwano ezithatha i-1 kuya ezinyangeni ze-12 kanye namaza we-1 kuya ku-5 izikhathi / isonto:
- France (Albinet et al.): Ukuzivocavoca kwe-aerobic nokwelula (3 / isonto, i-60 min, izinyanga ze-3; iminyaka engu-65-78 ngaphandle kokukhubazeka). Ukuthuthukiswa kwemisebenzi yokuphatha ehlolwe ngemisebenzi efana ne-WCST.
- USA (Anderson-Hanley, Barcelos, Barella, Barnes, Smiley-Oyen, Ruscheweyh, Williamson): ukuhamba ngebhayisikili noma ngaphandle kokukhuthazwa kwengqondo, ukuhamba, inhlanganisela yokuzivocavoca nemisebenzi yengqondo, kanye nokuqhathanisa nokuzelula noma imfundo. Izinguquko kumemori, ukunaka, isivinini sokucubungula, nemisebenzi yokuphatha (ADAS, RAVLT, Stroop, DSST, TMT), ngezinzuzo zomzimba ezilinganiswa ngokuhlolwa okufana nokuhlolwa kokufaneleka okukhulu, i-SPPB, nesivinini sokuhamba.
- I-Spain (Khansela): Ukusetshenziswa kwamabhayisikili amile nsuku zonke ezigulini ezikhungethwe ukuwohloka komqondo (imizuzu eyi-15 amaviki ayi-15). Imithelela ekusebenzeni kwengqondo (MMSE, FOME) kanye nokuhamba (TUG).
- Japan (Cheng, Maki, Nouchi, Satoh, Suzuki): I-Tai Chi, ukuhamba ngokuqeqeshwa kwenkumbulo, i-aerobics ngokwelashwa komculo nezinhlelo ezihlangene; ukuthuthukiswa kubonwe ku inkumbulo enengqondo, ukunaka, imisebenzi yokuphatha nokusebenza ngokomzimba (i-BBS, i-TUG, amandla esibhakela, isivinini sokuhamba).
- I-Brazil (Christofoletti, Nascimento): Ukuvivinya umzimba ngokumelene nezilawuli ku-MCI noma ukuwohloka komqondo okwenziwe esikhungweni. Imiphumela ekuqondeni (MMSE, MoCA) kanye nebhalansi (BBS).
- I-Sweden ne-Ireland/Italy (Eggenberger, Forte): imidlalo yevidiyo yokudansa, ukuhamba ngenkumbulo, nokuxhumana/ubuchule. Ukuthuthukiswa kokulawula okuphezulu, isivinini sokuhamba, namandla emisipha.
- I-Germany (Klusmann): Ukuqhathanisa izifundo zekhompiyutha nokuzivocavoca kwembula izinzuzo zokuqonda okubangelwa ukuvivinya umzimba kwabesifazane abaneminyaka engama-70-93 ubudala.
- I-China (Lam)Ukungenelela okuhlanganisiwe ngokomzimba, kwengqondo, kanye nomsebenzi womphakathi ku-MCI kubonisa imiphumela emihle ku-MMSE, i-ADAS-Cog, nokusebenza (DAD-IADL). Ezigulini ezikhungweni, i-tai chi ngokumelene nokwelula/ukumelana ihlinzeka ukuzuza kwengqondo.
- I-Australia (Lautenschlager): Ukuvivinya umzimba kwe-Aerobic eminyakeni engu-≥50 (nge-MCI nangaphandle kwayo) ngokuthuthukiswa kwe-ADAS-cog kanye nezinyathelo zokuziphatha zomsebenzi (CHAMPS).
- I-Netherlands neFinland (van Uffelen, Prick, Kivipelto): ukuhamba okulingene, izinhlelo ezihlanganisa izingxenye eziningi (ukuzivocavoca, ukudla, ukuvuselela ingqondo, ukuphathwa kwenhliziyo nemithambo yegazi) kanye nemithethonqubo ye-psychoeducational ekhombisa izinzuzo zokuqonda kanye umsebenzi womzimba.
Idatha yomhlaba wonke ye-WHO ihlanganisa ukuphuthuma: i Abantu abadala abangama-31% futhi u-80% wentsha ayiwafinyeleli amazinga omsebenzi anconyiwe. Umgomo wamazwe ngamazwe ukunciphisa ukungasebenzi ngo-10% ngo-2025 kanye no-15% ngo-2030 (uma kuqhathaniswa no-2010). Ukwehluleka ukwenza okuthile kulinganiselwa ukuthi kuzobiza 300.000 billion USD (≈27.000 ngonyaka) phakathi kuka-2020 no-2030 wezinhlelo zezempilo.
Amathrendi aphinde abonise ukwenyuka kwamaphesenti angu-5 kokungasebenzi uma kuqhathaniswa no-2010 kanye nomehluko ngokocansi (abesifazane ngokwesilinganiso bamaphesenti angu-5 abakhuthele kancane) kanye neminyaka yobudala: Ngemuva kweminyaka engama-60, umsebenzi uyawa kokubili kubafana namantombazane. U-81% wentsha eneminyaka engu-11 kuya kwengu-17 ingaphansi kwezincomo, kanti amantombazane (85%) anamazinga aphansi emisebenzi kunabafana (78%).
Yini amazwe namadolobha angayenza? I-WHO Global Action Plan iphakamisa izinqubomgomo ezizokhuthazwa ukuhamba okusebenzayo (ngezinyawo, ngebhayisikili), andisa amathuba ezikoleni, emisebenzini, ekunakekelweni kwezingane, nasekunakekelweni kwezempilo, nokuvula ukufinyelela kwezemidlalo ezithandwayo nasezindaweni zomphakathi eziphephile. Kudinga ukusebenzelana kwemikhakha ehlukene (ezempilo, ezokuthutha, imfundo, ukuqashwa, ezemidlalo, ezokungcebeleka, nokuhlela amadolobha) kanye nobudlelwano bendawo obubeka phambili ukwehlisa ukungalingani ekufinyeleleni.
- Impendulo ye-WHO ihlanganisa: imihlahlandlela yomhlaba wonke esekelwe ebufakazini; ukwesekwa kwenqubomgomo kuzwelonke; ukuqwashisa nokuhlaziya umnotho; amathuluzi ezobuchwepheshe nokuqeqeshwa; ukuxhumanisa umbimbi; futhi inqubekela phambili yokulandelela ngo-2030.
Amacebiso awusizo okuphila kwansuku zonke: hlanganisa umsebenzi ohambweni lwakho lokuya emsebenzini (hamba, suka endaweni eyodwa ngaphambi kwesikhathi, sebenzisa izitebhisi), yephula indlela yokuphila yokuhlala Ukusukuma imizuzu engu-1–3 njalo ngehora, qala ngokushuba okuphansi nenqubekela phambili, gqoka izicathulo ezifanele futhi wabelane ngesimiso sakho nothile (inkampani iphindaphinda isifiso).
Imicimbi yomphakathi iyihange elihle. Isibonelo esisodwa yi- I-Amavir's Golden Mile e-Alcorcón, umjaho wemikhosi enezigaba eziguquliwe (abadala abahamba ngezihlalo zabakhubazekile, abantu abahamba ngezinyawo, amalungu omndeni, izisebenzi, omakhelwane, izingane), owenzeka ekuseni futhi ohlanganisa amakhulu ababambiqhaza mayelana nokuvivinya umzimba nokuzijabulisa.
Uma ufuna izinsiza, amabhizinisi afana ne- I-YMCA Banezinhlelo zeqembu zabantu abadala ezisekelwa ubufakazi, nezinhlangano ezifana ne CDC futhi i-NIA/NIH ngokwayo inikeza ulwazi oluthembekile nolwakamuva ukuze isinqumo sakho sokuthutha sihlale sisekelwa kahle.
Ukuzivocavoca njalo, ngamandla alungile kanye nezingxenye zokubekezela, amandla, ibhalansi, nokuvumelana nezimo, kuwutshalomali olungcono kakhulu: kunciphisa ubuthakathaka kanye nengcindezi ye-diastolic, ithuthukisa ukusebenza, ikhwalithi yokuphila, nezici ezithile zokulala nobuhlungu, kuyilapho ithuthukisa impilo yobuchopho. Ngokusekelwa komphakathi, izinhlelo eziklanywe kahle, nezinqumo ezincane zansuku zonke zokuhambisa ngaphezulu, ukuzivocavoca kuba umngane wangempela wokuguga ngokuzimela okukhulu nokuphila kahle.
