The Medical-Social and the Forensic-Psychiatric Aspects of Gerontology and Geriatric Psychiatry

By Yuri Davydovich Krivoruchko

In the course of the study, we have used the methodological approach to the scientific substantiation of the comprehensiveness of expert assessments of the mental state of patients-offenders suffering from cerebral-organic pathology. As a result, we have formulated the following general points:

The forensic-psychiatric expert procedure is comprehensive in nature due to the participation of medical doctors, medical psychiatrists, and medical psychologists.

Medical-social examination, which is carried out for the purposes of determining the social status of patients (disabled or not disabled) and their need for social protection, is a processthat is comprehensive due to participation of medical doctors, medical clinicians, and medical psychologists.

The comprehensiveness of expert assessmentsthe forensic psychiatric and the medical social onesis made more complex due to the comprehensiveness of each one of these expert assessments.

The methodological approach to the comprehensiveness of expert assessments is based on taking into account the following three principles: the principle of continuity, the principle of cooperation, and the principle of psychological support for patients-offenders, provided to them over the entire length of their medical-social route.

• Language: English
• Publisher: Xlibris US
• Release date: Apr 12, 2017
• ISBN: 9781543412208

Yuri Davydovich Krivoruchko

Yury Davydovich Krivoruchko - Doctor of Medicine, Psychiatrist, Forensic Psychiatric Expert of highest qualification, Professor.

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Copyright © 2017 by Yuri Davydovich Krivoruchko. 759780

Library of Congress Control Number: 2017904927

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      Hardcover   978-1-5434-1218-5

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Rev. date: 04/10/2017

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Contents

PREFACE

Chapter 1 CERTAIN HISTORICAL ASPECTS OF GERONTOLOGY

Chapter 2 THE DEMOGRAPHIC SITUATION IN THE WORLD AT THE TURN OF THE 21ST CENTURY

Chapter 3 THE CONTEMPORARY DEMOGRAPHIC SITUATION IN RUSSIA

Chapter 4 PRE-RETIREMENT AND RETIREMENT AGE

Chapter 5 OLD AGE AND VERY OLD AGE AS A STAGE IN LIFE

Chapter 6 PSYCHOLOGICAL AND PSYCHIATRIC ASPECTS OF AGING

Chapter 7 GERONTOPHOBIA, AGISM AND CRIMES AGAINST THE ELDERLY

Chapter 8 CRIMES, COMMITTED BY THE ELDERLY

Chapter 9 MENTAL DISORDERS IN THE ELDERLY, WHO HAD COMMITTED THE SOCIALLY DANGEROUS ACTS (DATA FROM THE LITERATURE)

Chapter 10 THE SYSTEMATICS OF MENTAL DISORDERS OF ELDERLY OFFENDERS AND THEIR FORENSIC-PSYCHIATRIC ASSESSMENT

Chapter 11 THE LEGAL FOUNDATIONS OF THE FORENSIC-PSYCHIATRIC EXPERT SERVICE

Chapter 12 THE STATE OF THE PROBLEM OF THE MEDICAL-SOCIAL ASSESSMENT OF ELDERLY MENTAL PATIENTS, WHO HAD COMMITTED OFFENCES

Chapter 13 MEDICAL-SOCIAL CHARACTERISTICS OF PATIENTS AGED OVER 50, WHO SUFFER FROM MENTAL DISORDERS OF CEREBRAL-ORGANIC ETIOLOGY AND UNDERGO INPATIENT MANDATORY TREATMENT

Chapter 14 SOCIALLY DANGEROUS ACTIONS OF PATIENTS AGED OVER 50, WHO SUFFER FROM MENTAL DISORDERS DUE TO CEREBRAL-ORGANIC DISEASES, AND THE APPLICATION OF MANDATORY MEDICAL TREATMENT (THE CLINICAL-STATISTICAL ASPECT)

Chapter 15 THE MEDICAL-SOCIAL AND THE LEGAL FOUNDATIONS OF THE FORENSIC-EXPERT ASSESSMENT OF PATIENTS, AGED OVER 50, WHO SUFFER FROM MENTAL DISORDERS DUE TO CEREBRAL-ORGANIC DISEASES, AND UNDERGO INPATIENT MANDATORY TREATMENT

Chapter 16 MEDICAL-SOCIAL ASPECTS OF DISABILITY OF PATIENTS, AGED OVER 50, WHO SUFFER FROM MENTAL DISORDERS OF CEREBRAL ORGANIC ETIOLOGY, AND UNDERGO MANDATORY TREATMENT

Chapter 17 REHABILITATION OF PATIENTS WITH MENTAL DISORDERS OF CEREBRAL-ORGANIC ETIOLOGY, AGED OVER 50, WHO HAD COMMITTED OFFENCES

Chapter 18 SCIENTIFIC SUBSTANTIATION OF THE COMPREHENSIVE APPROACH TO FORENSIC-PSYCHIATRIC AND MEDICAL-SOCIAL ASSESSMENT AND REHABILITATION OF MENTAL PATIENTS WITH CEREBRAL-ORGANIC PATHOLOGY, WHO HAD COMMITTED OFFENCES AND UNDERGO MANDATORY TREATMENT

Chapter 19 SUICIDAL BEHAVIOR IN OLD AGE

CONCLUSION

BIBLIOGRAPHY IN RUSSIAN

BIBLIOGRAPHY IN ENGLISH

PREFACE

The topicality of studying the problems, faced by people, aged 50 and older, is determined by a number of circumstances, such as: the proportion of pensioner-age individuals in the general cohort of disabled persons equals 56% (Puzin S.N. et al., 2003); the second biggest group among those, who suffer from cardio-vascular disease, is made up of disabled individuals with cerebral vascular pathology (Dymochka M.A., 2008), which oftentimes determines the development of cerebral-organic processes, accompanied by mental disorders in people of this age.

One observes the growth of prevalence of non-psychotic mental disorders of cerebral-vascular etiology in the elderly (Milyutin S.M., 2011); the rate of vascular dementia has been found to increase with age from 2.6% to 7.0% in the over-70 age group (Woods R.T., 1996; Hagnell O. et al., 1999). Difficulties, encountered in diagnosing mental disorders in old age are linked to the fact, that their etiology, structure and development are affected not just by the psychopathological characteristics proper, but also by personality- and age-related peculiarities of changes in mental functions, as well as by the poly-morbidity, inherent to this age (Maksimova N.Ye., 2007; Milyutin S.M., 2011).

The foundation for deliberating this problem is also provided by the present contradictions between the legislative and the normative documents in respect of assigning the disability status; the absence of clear criteria for examining patients and of practice for reviewing the group of disability status, in spite of improvements, noted in their mental state; the growth of disability indices in people of retirement age, as well as the rate of organic cerebral disorders of complex etiology, leading to mental disorders, which increase the risk of offending; and the fact that the system of rehabilitation of disabled individuals has not been adequately developed yet.

The points, presented here, reflect more than forty years of this author’s work experience in forensic psychiatry. This is why the biggest part of the book is devoted to the clinical-psychopathological peculiarities of elderly offenders, the forensic-psychiatric assessment, and the medical interventions, as well as to the scientific research, carried out at the V. Serbsky Centre and at the Federal Bureau for Medical-Social Examinations (as referenced in the text).

Russian forensic psychiatry has not shed sufficient light on the key issues of clinical and expert assessment of the various states of the psyche in older people, either in determining their capacity to enter into contractual relationships and competence in civil cases, or their responsibility in criminal ones; as well as the subsequent resolution of the medical-social problems, which are inseparable from the above-said issues.

The studies, carried out over the last 30 years, followed the principle of providing the evidence for the justifiability of applying the expert criteria to the divers variants of mental disorders, found in seniors in the course of the expert examination, and, should it be necessary, – choosing the appropriate medical interventions.

Following this pattern, we have analyzed the extent, to which the age-related, exogenous, somatic-neurological factors, the premorbid peculiarities, and one’s immediate social environment affected the development of psychopathological disorders in seniors, who were undergoing the forensic-psychiatric examination.

This was necessary for purposes of clarifying the criteria for the correspondence between the totality of mental disorders, found in seniors, and the various expert conclusions, pertaining to an examinee’s ability to comprehend the significance of his/her actions and control them (in civil cases), or be aware of the actual nature and the social dangerousness of his/her actions and control them (in criminal cases).

The evolvement of the clinical picture may be influenced by a multitude of endogenous, exogenous, and psychogenic factors, as well as by the development of the cerebral-organic process proper, which may take either a malignant or benign course, with possible stabilization at a certain level or stage of the disorder.

The clinical picture of mental disorders of cerebral-organic etiology, which underlie offending behavior and have a wide range of manifestations, may be represented by the cognitive disturbances of various degrees of severity, behavioral disorders, organic personality disorders, organic delusional and hallucinatory phenomena (Shostakovich B.V., 2000, 2004; Vandysh-Bubko V.V., 2004, 2012; Len D.G. et al., 2005; Frank M.H., 1992; Holmberg L., 1997; Green M.F. et al., 2000; Bennet D.A., 2004).

In forensic-psychiatric practice, it is in 55% of cases that one encounters the category of cerebral-organic impairment, which, in the clinical sense, amounts to the deficit residual psycho-organic disorders (Vandysh-Bubko V.V., 2004, 2012).

The clinical-psychopathological analysis has shown that by the time of offending, at material time, and subsequently in the course of examination of these individuals, it was quite frequently, that one observed the development of the patients’ mental state over time, which was characterized by a variety of syndromes, the clinical manifestations of which were oftentimes directly dependent on the intactness of the premorbid individual-personality predispositions and the intellectual abilities, which have been formed in the course of patients’ lives, as well as on the patients’ moral-ethical standpoint, their somatic-neurological disturbances, and the impact of the psychogenic-traumatizing factors.

The proposed system of views in the area of forensic-psychiatric approaches, which identifies the main regular patterns in the development of mental disorders in the elderly, with the significance of social factors and situations taken into account, also provides the opportunity for carrying out the practical work, devoted to the study of the issues, pertaining to the differentiated approach to conducting the forensic-psychiatric examinations and arriving at expert conclusions in respect of the above-said cohort of individuals.

The systematics of mental disorders of the elderly, which are seen in forensic-psychiatric practice, has been developed with the current requirements of the ICD-10 taken into account.

The diagnostic descriptions of mental disorders in older people may be very helpful in cases of difficulties, encountered in making a differential diagnosis of mental disorders in this category of examinees.

The present work presents the general picture of all the forms of mental pathology, encountered in offenders, aged over 50. We have analyzed the emergence of mental disorders, their development over time and the part, played by them in offending, as well as the role of other factors in generating the socially dangerous behavior. We have submitted the expert approaches to assessment of various states, as well as the recommendations for the differentiated means of preventing the offending behavior. The system of views on forensic-psychiatric approaches, that is being put forward, identifies the main regular patterns in the development of socially dangerous behavior, and provides the opportunity for practical development of the issues of the differentiated approach in carrying out the forensic-psychiatric examinations and taking the expert decisions in respect of this cohort of individuals.

We have been the first to analyze and give the critical evaluation to the existent approaches to the medical-social examination of elderly offenders, suffering from mental disorders, who underwent the forensic-psychiatric examination and have been referred for treatment.

We have developed the methodology for cooperation and continuity within the comprehensive expert-rehabilitative approach in the work of the inpatient and outpatient psychiatric medical and social care institutions, as well as the systemic approaches to the medical-social examination and the individual program of rehabilitation (IPR).

We have identified the need for medical-social rehabilitation and the fact that it is not adequately met in older people, who suffer from mental disorders, both in the course of mandatory treatment and following the discharge.

We have presented the original uniform scientifically substantiated methodological approaches to creating the system of expert assessments and the multifaceted rehabilitative interventions for offenders with mental disorders, applicable at all stages of their medical-social route, which will contribute to the reintegration of the above-said category of individuals into society, as well as to the prophylaxis of repeated offending.

The methodological approach, which has been developed, will contribute to improving the measures for assigning disability status to elderly offenders.

The results, obtained in the course of the study, pertaining to the need that the offenders have for various forms of rehabilitation both at the inpatient and the post-inpatient stage, provide the opportunity for carrying out their rehabilitation in a more efficient and targeted way for purposes of ensuring the more secure reintegration of these individuals into society and preventing the recidivating socially dangerous actions.

The data, pertaining to the improvement of the methods of comprehensive expert assessment of mental disorders in elderly offenders, and the more optimal means of medical-social rehabilitation, may be used in the process of lecturing at educational institutions, and serve as the guidelines for medical doctors-experts, working at the forensic-psychiatric and the medical-social expert institutions, in the course of their education (retraining).

Prior to discussing the scientific, clinical, forensic-psychiatric, and medical-social problems, linked to mental disorders, which develop in older people, one should consider a number of moot points, pertaining to the use of terminology for defining the age periods. Drawing on the great number of studies in gerontology and geriatric psychiatry, which have been published over the last few years, we would like to clarify why was it that we have been studying the mental disorders in individuals of pre-retirement and retirement age.

This is based on the necessity to account for the data on the medical-social examinations and rehabilitation of mental patients (Melekhov D.Ye., 1964; Rozova M.S. et al., 1970; Kindras G.P., 2001). Special significance and importance is attributed to considering the approaches to medical-social examination of patients with mental pathology of cerebral-organic etiology (Milyutin S.M., 2011).

The social significance of the problem is further enhanced by the factor of mandatory treatment, which is administered to the above-said category of patients-offenders (Shostakovich B.V., 2001; Dmitrieva T.B., 2004, 2008; Kotov V.P., Maltseva M.M., 2004, 2012; Nedopil N., 1996; Arboleda-Florez J., 2001). This topic is addressed due to the specific features of the cohort and the complexity of mental disorders, which oftentimes determine the nature of the offences, committed by these individuals (Antonyan Yu.M. et al., 2002; Bukhanovsky А.О. et al., 2003; Kotov V.P. et al., 2004, 2012; Grigoriev А.А., 2005; Kondratiev F.V. et al., 2005; Zagitova Zh.B., 2006; Denwiddie S.H., 1996; Eronen M. et al., 1998; Feethous A.R. et al., 2001; Bennet D.A., 2004).

Forensic-psychiatric practice emphasizes the analysis of what caused someone to offend, assessing the connection with the presence of a mental disorder and the eventual experts’ decision (Kerbikov O.V., 1999; Agafonov S.N., 2001; Dmitriev A.S., Kotov V.P., Maltseva М.М., 2004, 2012; Vandysh-Bubko V.V., 2004, 2012; Dmitrieva T.B., 2008).

In the course of arriving at an expert conclusion, great significance is attributed to the comprehensive forensic-psychiatric evaluation of the patients’ state (Kudryavtsev I.A., 1999, 2004; Tkachenko А.А., 2012).

Following the decision on mandatory treatment at inpatient facilities, the length of patients’ stay at those facilities increases, and there emerges the issue, pertaining to patients’ social status, their temporary or permanent inability to work and, therefore, their medical-social examination.

To date we have failed to find any works, devoted to the link between the forensic-psychiatric and the medical-social examination of elderly mental patients-offenders, undergoing mandatory treatment. And yet, this is important not just for the methodologically correct determination of the group of disability status in the situation of mandatory treatment, but also for forecasting the future of these individuals. In most cases, disability status is assigned in accordance with the Federal Law On psychiatric care and guaranteeing the rights of citizens in the course of its provision. In section 2, Article 13 of the above-said Law it is stipulated that … individuals, placed into a psychiatric inpatient facility in accordance with a mandatory treatment order, issued by a Court of Law, would enjoy the rights, listed in Article 37 of the present Law; they would be considered unable to work for the entire duration of their stay at the psychiatric inpatient facility, and would be entitled to receive the national insurance benefits, or pension payments in accordance with the generally accepted procedure. Moreover, in accordance with the Resolution # 95, passed by the Government of the Russian Federation on February 20th 2006, and titled On the procedure and the conditions for assigning disability status, it is necessary to take into account such criteria as: the disturbance of one’s health with persisting impairment of organismic functions; the limitations to one’s living activities; and one’s need for social protection. These points, as applied to elderly mental patients-offenders, undergoing mandatory treatment, need to be specially analyzed, substantiated, and aligned with Article 13 of the Federal Law On psychiatric care and guaranteeing the rights of citizens in the course of its provision.

Scientific substantiation should also be provided for the necessity to carry out a number of medical-social examinations of elderly mandatory patients in order to see the changes in their condition over time. This would be similar to the mental state control, which is carried out for purposes of forensic-psychiatric assessment. No studies, reflecting the comprehensive and systemic approach to this problem, have been done earlier.

It is necessary to study the medical-social route, taken by the elderly mental patients-offenders, from the moment they are admitted into mandatory treatment until their discharged, and also, at the post-discharge stage. This should be done on the basis of cooperation between psychiatric inpatient facilities and the psycho-neurological outpatient facilities, continuity in their activities, – on the one hand; and cooperation of the psycho-neurological outpatient facilities (following patients’ discharge from the inpatient facilities) with the institutions, which carry out the medical-social examinations, – on the other hand. These issues are linked not just to the monitoring of the patients’ mental health, but also to their social status (their return into their families, employment, social adaptation and prevention of recidivating socially dangerous actions).

Thus, the topicality of studying this problem is determined by a number of important factors: the contradictions, found between the legislative and the normative documents on the issues of assigning the disability status; the absence of clear-cut criteria for referring mandatory patients for disability assessment; the absence of the practice of reviewing the group of disability status, in spite of improvements of patients’ mental state; the increase of disability rate, as well as of the rate of cerebral organic disorders of complex etiology among persons of retirement age, leading them to develop mental disturbances, which increase the risk of offending; and the insufficient development of the system of rehabilitation of disabled persons, following their discharge from mandatory treatment.

The above-said circumstances attest to the fact that it is necessary to implement the scientifically substantiated systemic approach to resolving the multifaceted and complex problem – that of the interrelation between the forensic-psychiatric examination, the medical-social one, and the rehabilitation of elderly offenders with mental pathology. It is only the unification of the two expert assessments (the forensic-psychiatric and the medical-social ones) that will make it possible not just to make an adequate evaluation of the severity of disturbance of one’s mental functions at material time and limitations to one’s living activities, but also to develop the system of the corresponding adequate rehabilitative interventions for people with mental disorders, as well as the opportunities for reintegrating them into society and preventing the recidivating offences.

Chapter 1

CERTAIN HISTORICAL ASPECTS OF GERONTOLOGY

Any living organism, having reached a certain level of perfection in its development, grows old and eventually approaches its demise.

Aging is a complex, universal and natural biological process, intrinsic to all forms of living matter, characterized by its gradualness and irreversibility, naturally and irrevocably leading to the decline in an organism’s vital activities and the increase in the likelihood of death.

The attitudes toward aging in the animal kingdom and in human society are, in many respects, identical. Zoologists point to the hierarchical structure, intrinsic to most mammals and even to birds. At the top of this structure one finds the older, more experienced individuals, who subdue the younger ones and impart their knowledge on the latter. As the dominant leader grows old and physically weak, he tends to lose authority and is ousted by a stronger adversary; the former then is rejected by the community and passes away in solitude.

In ancient times old people did not die a natural death, as a tribe, that lived under conditions of competing with the surrounding world, had no place for the weak and the infirm. As long as an individual was useful as an experienced hunter and someone knowledgeable about nature, he enjoyed respect. But as soon as his memory and physical health failed him, he became a burden to the tribe, was perceived as a stranger, as the other with all the ambiguity, contained in this concept – he is simultaneously both an under-human and a super-human, both an idol and a useless and used up thing; so he was abandoned to the mercy of destiny.

One observes cases, when the attitude toward old people in various societies was linked to extreme manifestations of cruelty, to the point of having them killed.

Thus, in ancient times, the elderly Yakuts, sensing their approaching death, would ask to be buried alive. To this day some castes in India keep the tradition, according to which, elderly persons get to the cemetery on their own in order to meet their death there. Similar customs are found among the Aboriginal peoples of northern Canada and in ancient Japan.

Some peoples practiced the (as a rule) voluntarily accepted putting to death of their tribal leaders, when the latter manifested signs of getting old. According to ethnologists, the elderly used to accept this way of dying under the influence of the cultural traditions of that time, having experienced the putting to death of their own elders before (including their own parents), and wishing to find themselves in the center of festivities, organized for the occasion.

The custom of putting the elderly to death is also found among the Slavic tribes. It was linked solely to the low level of cultural and psychological traditions, when the elderly used to be perceived as a burden.

The numerous ethnographic treatises by the West European and American scientists, dealing with the attitudes toward the elderly, make it possible to arrive at the conclusion that the conditions of their lives were heavily dependent on the social context.

However, researchers in paleopsychology note that one of the significant peculiarities in the development of human society, as opposed to packs of animals, was caring for the elderly as the keepers of the collective social-psychological experience and as the source of wisdom.

It is important to note that the function of consolidating and transmitting the tribal traditions was performed by the elders. Gradually, a separation of functions had occurred – whereas some elders had personified the cult of forefathers, the others (the priests) – had personified the cult of Gods.

Greatest respect was accorded to the elders at the time of classical antiquity (Ancient Greece, Rome). Wisdom was seen as the privilege of old age.

In Ancient Rome the power, exercised by the father over his family, was comprehensive and life-long. Any member of a family could be killed, sold into slavery or deprived of inheritance by their father. In fact, all of the junior members’ property belonged to their father.

Great influence over the attitude towards old age was exerted by the doctrine of afterlife. It is of interest, that in Cicero’s dialogue On old age one witnesses the consistent refutation of the four reproofs, often faced by old people: namely, that, allegedly, old age 1) hampers human activity; 2) makes one feeble; 3) deprives one of pleasures; 4) brings one closer to one’s death. Cicero proves that old people are capable of carrying out activity, educating the youth, and working the land. As for death, a human being leaves life, as one would leave a hotel, not one’s own house, because nature gave us life as a temporary, not a constant, abode. According to Cicero, nature establishes a measure for life, just as it does for everything else; and old age is the final stage of life.

Treatises, composed during the Middle Ages, accord a place of special significance to the concept of age. Older age is seen as appropriate for such occupations as science, turning to God. Senility is singled out as a special period – the one of infirmity and senile collapse.

The problem of old age was always among the central ones in the world outlook of people of various epochs and nations. The dream of being able to prolong human life and achieve immortality was born along with the awareness of the value of life and of it being different from the living activities of animals. This took place at the earliest stages of anthroposociogenesis, with the emergence of the first surviving evidence of the origin of art and religion.

In the course of the entire history of the development of countries the attitude towards old people vacillated between gerontophobia (fear of old age) and gerontocracy (predominance of the elderly among the rulers of a state).

The formation of patriarchal relationships in the greater part of the world has led to the sacral attitude towards the personality of the elderly and the development of the cult of an elderly chief. This motive has become pervasive both in the world civilization as a whole, and in the local cultures. It has undergone a particular development in the Eastern Orthodox Christian tradition, in which God is portrayed as a wise old man. Studies have shown that various peoples’ attitude towards old age is quite varied and depends on a multitude of factors, among which, in many religions, the commonplace moral practice also becomes a certain religious norm in the attitude towards old age.

The Vedas and the Bible, the Quran and the teaching of Confucius (in other words, any religion in the world) provide differing approaches to the phenomenon of old age; this was determined by the specific peculiarities of ethnic development in the various regions at the time of the emergence of world religions, which provided certain moral criteria of attitude towards the elderly for centuries to come. One should specifically deliberate on the veneration of old age and the elderly in the Orient, above all, – in Ancient China, where the age between 60 and 70 was perceived as desirable, since, according to Confucius, he at the age of 70 followed the wishes of his heart without trespassing the limitations of good measure. The moral norms of Confucianism and Taoism turned out to be the most significant ones for the consolidation of the Chinese peoples. According to these norms, the main virtue was seen in following the tradition, respecting one’s parents and having the same attitude towards powers that be, as one would have towards one’s father (Smolkin A.A.).

Buddhism sees the meaning of being in the attainment of nirvana; and in this sense its adherents perceive no problem of juxtaposition of beautiful youthfulness and horrible old age. It was thought that the bodies of holy old men are not subject to decay. Later on this concept was further developed in the Christian tradition, according to which, the relics of the saints are imperishable. It should be noted, that almost in all religions this refers specifically to old people.

The subordination of a Muslim’s life to adat and Quran does determine not only his path in life, but also his age-related characteristics. It is not by chance that many orthodox Muslims, having gone on the prescribed Hajj in the later part of their lives, make a conscious effort to distance themselves from all the temptations of the worldly existence, and let both the professional and the domestic affairs be dealt with by their heirs, retaining the right of authoritative participation in the affairs of their ummah (Muslim community, which determines the course of Muslims’ lives in compliance with the laws of ibadah), and fulfilling the duties, which are inseparably linked both to the outward forms of religious god-worshiping, and to the legal norms of Muslims.

It is characteristic of elder Moslems that they participate in the sharia law proceedings. The authority of the elders in the Muslim community is quite high, and old age, when it is achieved by any member of the Muslim community, enhances his authority and respect toward all of his actions, connected to the adherence to the norms and traditions of Islam. For example, Chechens have special stones which they offer to their elders to sit on in the village square. Oftentimes they would use oxen to bring these stones from far away. The seats for the eldest ones were handmade by craftsmen.¹

Christian religion maintains a special, almost mystical attitude towards old age, holding a dualistic view of longevity, seeing it as a special gift, received directly from God by the righteous ones only.

The Bible is, probably, the first document that testifies to human longevity. According to the Old Testament, human life goes on for almost a thousand years! Adam, the very first man, lived to be 930 years old. Noah, who had built the Ark, lived even longer than 950 years, whereas Methuselah lived to be 969. Human longevity in the Bible is quite dubitable. First of all, nothing but the verses of the Old Testament confirm it. Secondly, everyone is aware of human proclivity to exaggerate certain things, especially those, that took place a long time ago; and it is impossible to verify them. Third, it would have been more logical to assume that a somewhat different calendar had been used in those times.

1.jpg

Fig. 1. A work of art, illustrating the Old Testament

As for the prehistoric evidence of longevity, which is referred to in the Bible, – there is a simple and logical explanation for it, put forward by the scientists. A 28-day lunar year is used in the Bible for calculating age. Thus, Methuselah’s 969 years of age would, by our standards, correspond to 74 years, which is still much longer than the average life expectancy for humans, living at that time. So, Methuselah, just as Noah and Adam, truly lived very long lives.

At the same time, Christianity always treated old age with respect, and was getting the believers ready for death, promising them not just the afterlife, but also the encounter with all their relatives and loved ones who are in Heaven. This made the transition from life to death easier. Medical doctors across the world do note, that people who truly believe in God (irrespective of their particular religion), depart with greater calm and dignity, hoping for the new and eternal life.

In the history of our country one can find quite a number of interesting facts about the oldest people.

Captain Jacques Margeret, who was hired as a mercenary by the tsar Boris Godunov, in his book, entitled Estate de l’Empire de Russie et de Grand Duché de Moscovie (1606), wrote with astonishment that Many Russians live to be 90-100 and 120 years old and experience illness only in old age. Nobody accepts the use of medication, except for the tsar himself and the top grandees. Indeed, people always die of illness, and not of old age. This is a fact of medical science.

A.S. Pushkin in his memoires provided an account of his encounter with a 160-year old Cossack, which took place in the steppes of Orenburg. That Cossack had clear recollections of the rebellion, led by Stepan Razin (1667-1671), in which he himself took an active part.

In the Saint Alexander Nevsky Monastery one can see the tombstones with inscriptions of unusually old age – those of the monk Patermuthius, who took a vow of silence and died at the age of 126; Abraham the cenobite, who lived to be 115; and the 107-year old V.R. Shcheglovsky, the well-known hero of the times of Empress Elizabeth and Catherine the Great, who was sent into Siberian exile by Prince Potemkin out of jealousy.

Melnikov-Pechersky provided an account of a 114-year old female landowner, and V. Pikul wrote about a 118-year old starets monk.

On October 8th 1904 The newsletter of Tiflis reported that Tense Abalva, a 180-year old Ossetian woman, lived in the village of Sba, Gori county. She was, reportedly, vigorous enough to do her domestic chores herself, and her eyesight was good enough for her to be able to sew. Her reported age suggested that she had been born in 1724 when Peter the Great was still around.

At the time of the celebrations of the 100th Anniversary of Napoleon’s defeat near Moscow, the Russian papers narrated about the witnesses and the participants of the events of 1812, who were still alive and well in 1912 – the 108-year old non-commissioned officer Ivan Zorin, the 111-year old Nadezhda Surina, and the 139-year old Rodion Medvedev.

There was a time when the names of the oldest people of the Soviet Union were well known. Mahmud Eivazov and Medzhit Agayev of the Lerik area of Azerbaijan lived to be 148 and 140 years of age respectively, while Shirali Muslimov of Barzavu lived till the age of 168. Shirin Gasanov from the Jabrayil area lived to be 150. All of them used to work as sheepherders. Shirali Muslimov had 13 sons, 10 daughters, and 106 grandchildren, greatgrandchildren and great-greatgrandchildren.

At present, the following persons are known to be the oldest living people on Earth:

138 y.o. – male, Habib Miyan, India

134 y.o. – female, Moloko Temo, Limpopo

123 y.o. – male, Carmelo Flores Laura, Bolivia

123 y.o. – female, Ulya Margusheva, Russia

122 y.o. – female, Jeanne Louise Calment, France

121 y.o. – male Magomed Labazanov, Russia (Dagestan)

117 y.o. – female, Varvara Semennikova, Russia (Yakutia)

116 y.o. – female, Kesi Karuyeva, Russia (Chechnya)

116 y.o. – male, Walter Breuning, USA

114 y.o. – female, Edna Parker, USA

114 y.o. – male, Jiroemon Kimura, Japan

At the time of writing, Varvara Konstantinovna Semennikova, who was born on May 22nd 1890, is officially recognized to be the oldest living person in Russia. In July 2007 she had been awarded the Honorary Certificate of the Federation Council at the Sixth European Congress of the International Association of Gerontology and Geriatrics, held in Saint-Petersburg.

The oldest living person in Moscow is the 113-year old Lyudmila Nikolayevna – the great-great-granddaughter of the infamous duelist Georges d’Anthès. She lives in the Maryino district. For many years she had worked at the Bolshoi Theatre as a supernumerary, and she can’t imagine her life without art. She still tests her daughter’s granddaughter’s and great-granddaughter’s knowledge of Russian poetry.

All in all, there are almost 400 centenarians and supercentenarians living in Moscow.

According to data, published in Britain in 2011 (Office for National Statistics. Older People’s Day, 2011), the number of supercentenarians living in the UK equals 12640 (20 persons per 100 000 population). In Australia it equals 3700 (17 persons per 100 000 population), in France – 16790 people (26 persons per 100 000 population), in Japan – 48000 (38 persons per 100 000), in Spain – 8080 (18 persons per 100 000), in the USA – 53360 (17 persons per 100 000 population).

According to I.V. Davydovsky, the well-known soviet gerontologist, old age was just the autumn of life, its final stage, and the illnesses of old age were a form or a way of dying. There was a time when old people, the disabled, worn out by the prolonged excessively strenuous work, enjoyed the relative peace and quiet and they died, as a sort of used up part of humanity. By biological, as well as by social standards they were exactly that – the used up, i.e. decrepit or dying people, both physically and socially inferior, and deserving only of pity. These old people, no longer needed by society, filled up the almshouses, care homes, and residential facilities for the elderly. Medicine, as some sort of a component of the public compassion, observed and described the symptoms of a departing life, providing therapy whenever possible.

As for average life expectancy, it was constantly on the rise, due to progress in medicine and the improving social conditions of life.

The report of the UN Secretary-General Ban Ki-moon of April 12-16 2010 titled Health care, morbidity, mortality and development states that life expectancy grew from 30 to 68 years since 1800. This led to a rapid population growth from 1 billion people in 1810 to almost 7 billion in 2010. The universal decrease in mortality, which began in the developed regions of the world in the 19th century and had spread to all regions in the 20th, represents one of the major achievements of humanity.

In comparison, average life expectancy in primeval society equaled 15-22 years, and in the Ancient World – 20-30 years. It grew somewhat during the Middle Ages and the Renaissance (25-30 years), and by the 17th - 18th centuries, on the whole, it did not exceed 40 years. By the end of the 19th century average life expectancy reached 47-50 years, and it increased gradually over the course of the 20th century. Whereas in 1950 average life expectancy equaled 47 years, by 2010 it already reached 69-80 years (Fig. 2).

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Fig. 2. Average life expectancy

All this changed radically over the last 50 years. Thanks to the economic, medical, cultural and other progressive social achievements across the world, accompanied by significant social-economic well-being, a unique demographic phenomenon took place – that of the population aging, alias – the demographic old age (the increase of the elderly in absolute and relative numbers in the general makeup of the population). Most demographers assert that this process is irreversible, stating that the world has entered the age of the elderly. The increase of average life expectancy has provided the foundation for studying old age as a social problem. A system of theoretical and applied knowledge has been formed in the second half of the 20th century, pertaining to the essence and the significance of the final stage of the life cycle of any living organism on Earth, including human beings – a science in its own right – the science of gerontology.

Its main trend is the study of the biological, social and psychological aspects of human aging. The constituent parts of gerontology are geriatrics – the study of illnesses, linked to involution, as well as the peculiarities of treatment and prevention of illnesses in old and very old age; and geriatric psychology, which studies the psychological-behavioral peculiarities of old and very old people.

The first philosopher to describe the general purpose of gerontology as a science was Immanuel Kant. He was the first thinker to formulate the problem of aging, asserting that the essence of gerontology was in adding more life to one’s years, rather that more years to one’s life.

One can identify a number of key points in the history of Russian gerontology. The first one is the publication of I.I. Mechnikov’s book titled The essays of optimism (1903), in which he introduced the term gerontology for the first time, laying its foundations as a scientific discipline, concerned with the biology and the physiology of aging. It was Mechnikov who provided justification for the combined approach towards the problems of aging and the experimental study of these problems, based on the achievements of various sciences.

D.I. Mendeleev, besides the periodic table of elements, had authored one of the first theoretical concepts, pertaining to the problem of aging, longevity and death. In 1905 he had published the Sacramental thoughts, in which he submitted that, in his opinion, no one has yet dealt with the issue of the normal law of distribution of the Earth’s population by age.

With the growing proportion of vigorous old people, humanity should improve, since these old people, enriched by the wisdom of lived experience, would make a beneficial impact on the youth, no matter with which conceited self-importance this latter might be infected. In 1917 the famous books by I.I. Mechnikov, titled The essays on human nature and The essays of optimism had been published. These were devoted entirely to individual aging, longevity and death of humans and animals. It was in these works that I.I. Mechnikov for the first time suggested that … old age, which is something of an unwanted burden to society now, will eventually become… a period in life, that is useful for society. Old people will be able to draw on their greater experience to deal with the most complex and delicate problems of public life. Mechnikov’s convictions were based on his aspiration to look at the phenomena of living nature and at the problems, pertaining to the peculiarities of the final stage in the life cycle of a human, strictly from the evolutionary standpoint, taking into account the social-biological essence of human beings. He also, on a number of occasions, revisited the concept of experience of older people, without, however, delving deep into analyzing it in its application to a human being as a phenomenon of nature.

Later on, Z.G. Frenkel, a country doctor and a graduate of the Dorpat (Tartu) University (1896), had continued developing the ideas of gerontology. The works by D.I. Mendeleev and I.I. Mechnikov became an inspiration for Z.G. Frenkel in his creating the fundamental theoretical work, titled Prolongation of life and the actively engaged old age (1945, 1949), which made it possible to formulate not just the theoretical basics, but also the applied aspects of gerontology pertaining to human beings. One of Z.G. Frenkel’s main achievements, that should be recognized, is that in his fundamental work he shed light on both sides of the problem, pertaining to the elder:

− the peculiarities of changes in the population of the elderly as carriers of experience of the preceding generations and as a component of the specifically social living environment, which determine the nature of their needs;

− the peculiarities of individual alterations in the organism of a human being at the final stage of his/her ontogenetic development, which are characterized by the negative dynamics of his/her functional capabilities.

It was Z.G. Frenkel who had submitted the most up-to-date and detailed elucidation of the concept of experience. However, the most essential part of his concept was the point, pertaining to the significance of human experience, at least the professional one, as the source of the wealth of society as a whole (Alexeyeva L.P., Merabishvili V.M., 1971; Bakhtiyarov R.Sh., 1996).

Z.G. Frenkel came to the conclusion that professional and social experience, which are at the disposal of the older generation, represent one of the factors (alongside other sources of public wealth), which determine the economic viability of their society.

The first national scientific conference, devoted to the problems of aging, took place in Kiev in 1938.

The emergence of international interest towards the problems of aging in the post-war period stimulated the setting-up of national gerontological unions, in particular, the Gerontological Society of America, founded in 1945.

It was the initiative of the UN to hold the International health-care conference in New York in 1946, during which the decision was taken to set up the World Health Organization (WHO), with its Charter ratified in 1948. One of the tasks, faced by the UN and the WHO was assisting in the development of measures, aimed at providing health care and social protection for the elderly. This is why the Department on issues of aging had been organized in the UN and the Department of Aging and Life Course – in the WHO. A non-governmental committee on aging had also been set up under the auspices of the UN.

Following this, a number of similar unions had been set up across Western Europe and America. The main tasks of the national gerontological societies were cooperating and coordinating scientific research in the area of gerontology and geriatrics; cooperating in organizing the geriatric service and the social care for the elderly.

The science of old age and aging (gerontology) had officially been established at the international level in 1950, when the first Congress of Gerontology had been held in the Belgian city of Liege.

It was at this Congress that the international association of gerontological societies had been set up, which that same year had been named the International Association of Gerontology and Geriatrics (IAGG). The IAGG Charter emphasizes that the main goals of this Organization are seen in aiding the research in the various areas of gerontology; training staff; building international links between the National Societies; organizing international congresses of gerontology. As was pointed out by G.R. Andrews, the President of IAGG, the ultimate goal is aiding the achievement of the highest standards in gerontological education, research and practice.

In 1957 it was the initiative of Z.G. Frenkel to set up the municipal Scientific Society of Gerontologists and Geriatricians in Leningrad, the first one in the country (Bakhtiyarov R.Sh., 1997). The gerontological section of the Moscow Society of Naturalists (MSN) had been set up in Moscow.

The Gerontology Research Institute of the Academy of Medical Sciences of the Soviet Union had been created in 1958 in Kiev, which served as the foundation for the scientific councils on gerontology of the Academy of Medical Sciences and the Academy of Sciences of the Soviet Union.

It was in 1963 that the first All-Union conference (congress) on gerontology and geriatrics had been held in Kiev, and the All-Union Scientific and Medical Society of Gerontologists and Geriatricians had been established, which operated successfully till the late 1980-ies.

Humanity began looking at the process of population aging seriously in the late 1950-ies, when, in 1959, the experts at the UN Demographics Department adopted the threshold of 65 years of age for purposes of measuring the processes of demographic old age. This age had been used to delimit the lower threshold of old age, as it is at this age that most people enter retirement in the countries of Western Europe and a number of other developed countries. However, there are no precise calendar dates for the arrival of old age.

The European Regional Society (ERS), as well as the Regional Societies for North America, Latin America, Asia and Oceania had been set up at the 7th World Congress of Gerontology, held in Vienna in 1966.

Four All-Union Congresses had been held in the Soviet Union (1972, 1976, 1982, 1988), and the Chair for Geriatrics had been set up at the Leningrad Institute for Continuing Medical Education (1986), the first one in Russia. The All-Union Journal, titled Problems of aging and longevity, began to be published in Kiev in 1990.

Also, a network of the geriatric organizational-methodological offices had been formed in health-care institutions. The long-term All-Union comprehensive program of scientific research in gerontology and geriatrics had been developed and implemented between 1981 and 1990.

Up until the mid-1980-ies, the main and, probably, the only form of social care for the old and very old was provided by residential homes. In 1989 the network of residential homes for the elderly and the disabled in Russia included 711 institutions with 223.5 thousand beds (15 beds per 10 thousand total population).

At this time gerontology actively evolved in various regions of the country – in Leningrad (I.I. Likhnitskaya, N.S. Kosinskaya, M.D. Alexandrova, V.М. Dilman), in Moscow (I.А. Arshavsky, N.M. Emanuel, B.F. Vanyushin, I.V. Davydovsky, L.V. Komarov), in Kiev (D.F. Chebotarev, V.V. Frolkis, V.N. Nikitin), in Tbilisi (N.N. Kipshidze), in Kishinev (V.Kh. Anestiadi), and in Minsk (T.L. Dubina).

The first UN World Assembly on aging took place in Vienna in 1982. It was at that Assembly that it has been acknowledged for the first time that the process of population aging was taking on the global character and was one of the priorities for humanity. And this was emphasized by all the speakers, representing the economically well-to-do countries.

The International Action Plan, adopted by the Assembly on aging, included: health-care and nutrition; protecting the elderly consumers; housing, family and environment; social security.

As the main policies and initiatives evolved, it determined the development of the theoretical thought and the practical activities on issues of aging over the next 20 years. (World Assembly on Aging Report, Vienna, July 26 – August 6, 1982 (Published by the United Nations, sales No R.82.I.16, chapter IV, section A).

The report on the prospects of population growth in the world states that already by 2023 it will equal 8 billion people. In 2041 there will be 9 billion people living in the world, and in 2081 – already 10 billion people.

According to forecasts, by the year 2050 80% of all elderly will be living in the developing countries. Between 2009 and 2050 the number of the elderly in these countries will grow from 481 million to 1.6 billion people, whereas in the developed countries it will grow from 262 to 406 million people.

In the wake of the Assembly the interest towards older people has grown considerably, and most importantly, it has been acknowledged that national social policies in regard of the older generation need to be developed. The fact that the study of gerontology had been introduced into the curricula of many institutions of higher and secondary education, may be seen as the indubitable success. The range of studies of the issues of aging has broadened, especially in terms of the status quo of the older generation.

As was pointed out by Ban Ki-moon, the UN Secretary-General, in the preface to the Report, the social and the economic consequences of this phenomenon are of great significance; they affect, in the most unprecedented way, not just some concrete elderly person and his/her closest relatives, but also those around them, and the entire global community. This is why population aging is the phenomenon which can no longer be ignored. The significance of the problem of demographic aging is so great, that the UN sees it as being on a par with the problem of keeping peace on Earth.

The global community became aware of population aging as a problem in the early 1980-ies, and from that time onwards it takes active steps to find a solution for it. The programs and policies for the elderly are being considered by a variety of international organizations: United Nations Organization (UN), the World Health Organization (WHO), the Council of Europe (СЕ), the International Labor Organization (ILO), the international and the national research centers (the European Centre for Social Welfare Policy and Research in Vienna, etc.). The UN data attest to the