Increased life expectancy along with an increasing share of elderly and senile patients in the structure of the population make the tasks of longer healthy life expectancy pressing. A set of activities aimed at optimization of management of patients within the framework of gerontological practice should include elimination and prevention of diagnostic and therapeutic errors. The basic risk factors of medical errors include high heterogeneity of elderly and senile patients, overburdened healthcare system, polypharmacy, including due to parallel prescription of drugs to the same patient by multiple medical professionals, concomitant diseases, and high comorbidity, measured by the Charlson Comorbidity Index. Mismanagement of elderly patients can result both from underestimated severity of the patient’s conditions, and from hyperdiagnostics. Typical errors of pharmacotherapy include use of potentially inappropriate medications, potential prescribing omissions, simultaneous prescription of drugs with high risk of clinically significant interactions, incorrect selection of dosage without taking into account the renal failure, which is associated with high risk of toxic effects. Affordability of medical aid for an elderly patient is another important social aspect influencing the patient’s quality of life. As far as basic ethical principles of management of elderly and senile patients go, it is necessary to respect independence, well-being and justice for the patients regarding possible obtaining of qualitative medical aid as compared with other age groups.
VIEWS 1425
A lack of the single criterion for classifying rare diseases as a group of orphan diseases is the main current problem. First, it is associated with rare detection of symptoms among patients, especially children. Second, specialists have a limited number of methods of detecting orphan diseases. As the disease is considered rare, it is not profitable for pharmaceutical companies to produce the preparations which are purchased not in large numbers, but in single packages, because expenses on clinical trials and marketing advertising exceed return of investment. The market of orphan drugs in Russia is at the stage of development and formation. Medical organizations that carry out medicinal therapy of patients with orphan diseases require a clear set of regulatory documents ensuring provision of medical and pharmaceutical aid. Special attention should be paid to drawing up the lists of medicinal preparations to treat the patients. Personified accounting of patients with detected orphan diseases is an important stage for medical and pharmaceutical organizations. Modern diagnostics of orphan diseases at early stages, especially in children, exploration of specialized genetic methods of research and making them accessible for the population constitute an essential problem.
VIEWS 1269