Предупреждение снижения трудоспособности у пожилых: отчет о совещании ВОЗ, Кельн, 16–19 ноября 1981 г.

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CTpeMHJJHCb OrpaHH'OiTb ClC>cy)p;)leHHe BOnpocOM 0 TOM, 'lTO MOJ,;eT OI.ITb c.neJJaHO ClC>b!HHOH, coce.nRMH H .OPY3bRMH, a T~•e caMHMH HHBaJlH,llaMH. Bb1J10 pebleHO He cocpe,nOTO'lHBaTb BHHMal-llie Ha Oone3HRX H He ctJHTaTb ClC>cyJp;J1aeM1Je npoC>ne14,1 OTHO- C.RlllHMHCR TOJlbKO K flOllHJIJ,IM, a B nepayio O'Iepem, yqHTblBaTb 00- b!He npoC>JleMJ,J, B03HHJ<aKll!He BCJle.DCTBHe CJ-ll-lJP;eJ-ll-lR Tpy.nocnocc:>C>- HOC:TH B JllOOoM B03paCTe. 4JleHhl PaOoqeft rpynrn,r pebIHJlH, 'ITO ,lVIR BLIRBJleJ-ll-lR CHHJP;e- HHR Tpy.nocnocoC>HOCTH ,llOJl)P;HLI npe.nnpHHl-!MaTbCR cne,nyl<lltHe blaf'H: OC03HaHHe npoC>neML1; onpe.neneHHe ee xapaKTepa; H oueHKa nareHUHana .lVIR BMeblaTeJlbCTBa; a TaKJP;e, 'ITO OTBeTCTBeHHL1e JlHUa .00.lllllHLI npoBO.llHTb paOoTY, HanpaaneHtty10 Ha: oueHKy npoC>neMLI; nomrblel-llie poJ1H oOblHHht; HCTIOJlb30BcUOle pecypcoB ,lVlR BMeblaTeJlbCTBa; H ycTpaHeJ-llie BLIRBJleHHblX He.nOCTaTKOB. OCHOBHblE .IlAHHUE o nomm,1x ,lleKJJapaUHR, npHHRTaR B 1978 r. Ha AnMa-ATHHCKOH KOH¢e- pem.tHH 003/DHHCEct> no nepBH'OfOH Me.m,IKO-CcUOITapHOH noMOMH ( 5 ) , npH3LIBana K "npoae.neHHJO Me,llHKO-CaHHTapHhlX MeponpHRTHH Ha OCHOBe HayqHO o0oc:HOBaHHLIX H COUHaJlbHO npHeMJJeMLtX MeTO- ,llOB, noBCeMeCTHO ,llOCTYflHblX OT,OeJlbHhlM JUO.ORM H ceMbRM B oC>bIHHe H QCYblecTBMeMLIX npH HX BCeMepHOM yqaCTHH 11 • O.nHa H3 rnaBHhlX narpeOHOCTeA nOJP;HJlLIX, 0 KOTOpoH f'OBOPHTCR B ,lleKna- paUHH, 9TO narpeOHOCTb B paaeHCTBe. noi,;HJ1L1e HaXO.ORTCR B 5 He6naronpHRTHOM nono•emrn H 3aqac-ry~ RBJlfflOTCR caMhlMH 6e)lHblMH H caMLIMH npeHe6peraeMhlMH qneHaMH COBpeMeHHoro oObtecTBa. no.noOHoe pa3HTeJlbHoe HepaBeHCTBO B COCTORHlfJ,I 3,nopoBbR pa3Hb1X rpynn ttaceneHHR .l1IOOoo CTpaHbl 6onee tte,nonyc- THMO HH C COUHanbHOO, HH C 3KOHO~ecKOH, HH C noJJHTHtlecKOO ToqeK 3peHHR. BbmOnHeHHe noBce.[]HeBHJ,IX JDl3HeHHJ,IX «l>yHJ<QHH 3n~eMHononNecKHe H repoHTononNecKHe Hccne.aoBaHHR ,naJlH B03MO•HOCTb onpe,neJIHTb COCTORHHe 3,llOJ)OBbR, ocoOeHHOCTH naTonO[rfqeCJ<oro CTapeHHR H cHH•eHHR Tpy,nocnocoOHOCTH Y . nOJIU.UlblX, 4>aKTopbl, cyllleCTBeHHhlM o0pa30M CBR3aJiHhle C 9THM, paBHO KaK H MaC111TaO npoOneMLI. Cepbe3Hy)O 03a6oqeHHOCTb Bbl3blBaeT cylllecTBOBaJ-!He OoJlbDIOro qHcna JJHU, HaxO,llRldHXCR, KaK nonaraJOT, B cOCToRHHH naTononNecKoro cTapeHHR, y KOTopwc K TOMy •e orpaHHqeHa cnocoOHOCTb BblJlonttRTb noBce.QHeBHWe ,nena. .llnR Toro qTOObl y ,llOBneTBOPHTb caMhle HacylllHLle 1-fYJl,Ql,I 3THX mo.neA, TpeOyeTcR oqeHb bIHJX)KHfl no,nxo,n. 3mmeMHonorn- qecKoe HCCne,noBaHHe 803, nOCBRIJleHHoe OOMOblH OOlnt.TlblM, KOTO- poe npOBO,llHTCR B 11 CTpaHaX EBponeHCKOro perHOHa, RMReTCR oOHa,ne•HBaKllllHM npHMepoM MeJIUIYHapo.[]Horo ccrrpy.l]I-IH'JeCTBa. Mo•Ho Ha,neRTbCR, qTo aHanH3 H HHTepnpeTaI.lHR pe3yJlbTaTOB 3TOro HCCne,noBaHHR n03BonRT ,naTb peKOMeH,llaI.tHH, KOTOpble y,naCTCR HCnOJlb30BaTb BO MHOrHX rocy.napcTBaX-'lJleHax • . BecbMa npHMeqaTeJibHO, qTo B cornacoBaHHOM npcrroKone 3Toro npo,noJlb- Horo Hccne,noBaHHR 85% nyHKTOB HOCRT HeMe,JlHJ.lHHCKHfl xapaJ<Tep H OTHOCRTCR K <l>YHKUHRM, oOpa3y ,1;H3HH H B9rnR,naM. Ha COBel!laHHH PaOoqclf rpynm,, 0!,1110 npe,nCTaBneHO KpaTJ<Oe onHcaHHe onpoca, npoBe,neHHoro B O,lll-lOH H3 11 CTpaH - llrocna- BHH. Bb111a B3RTa penpe3eHTaTHBHaR Bb10opKa H3 1914 Myll'IHH H •eHlltHH B B03pacre OT 60 ,no 90 neT, npollHBaJllllHX B Benrpa,ne. HM OblJJH 3a,llaHbl BOOJX)Cbl O COCTORHHH HX 3,llopoBbR H cnocoO- HOCTH BLmonHRTb noBce.ntteBl-lble ,nena; ma:e oOoOlneHW nonyqeH- Hble .naHHble. BnHRHHe HMeBIIIHX MecTO B . nJ)C111flOM XpoHlNecKHX 3aOoneBattHfl, TpaBM H HecqaCTHblX cnyqaeB YcTaHOBneHO, qTo noB03paCTHble noKa3aTenH y TeX, KTO 3a- RBHn, qTo "ceffqac He qyBCTByeT ceOR 3,llop0Bb1M 11 , OLIJIH Bblble y •eHl!tHH H YBe.JlH'IHBaJlHCb C 45% B B03paCTHOO rpynne 60-64 ro,na 6 .no 59% B BO3pacTHOH rpynne 85-89 neT. UH(flp1,1 .MR MYlJ.qHH B aHanOOf'IHLIX B03paCTHblX rpynnax COCTaBJlRJlH 45 H 52% COO'rBeT- CTBeHHo. "HeraTHBHoe BOCITpHRTHe COCTORHHR CBoero 3,[lOPQBbR 11 HMe- no TeH.[leHl.IHIO K YBeJIH'leHHIO y MY~H C 22% B B03paCTHOH rpyn- ne 60-64 ro.na .no 42% B B03paCTHOH rpynne 85-89 neT. AHano- nNHaR Tett.nel-U.lHR OTMeqanacb H Y lleHllIHH, Y KOTopblX nOKa3aTe- nH ObIJlH B cpe,llHeM Bblme Ha 50%, Ha'IlfHaR C 19% B B03paCTHOH rpynne 60-64 ro.na H YBeJU-f\lHBaRCb .no 49% B B03paCTHOH rpynne 85-89 neT. AHaJIH3 OTBeTOB Ha BOnpoc, KaCalallHHCR "cpaBHeHHR COCTOR- HHR CBoero 3.[lOPQBbR C COCTORHHeM 3.0OPOBbR poBecHHKOB 11 , TaK- ir;e .nan Oonee BblCOKHe noKa3aTe11H .MR ir.el-llllHH: 3TH noKa3aTe11H KOneOaJIHcb OT 19,4% B B03paCTHOH rpynne 60-64 ro.na .no 30,5% B BO3paCTHOH rpynne 80-84 ro.na. AHanOnNHble UH(flpbl ,nn.R MYll- 'IlfH 0bl.11H 12,7% H 19,8%. 4HcneHHOCTb 11HU, y KOTOpblX Ha BbITTOnHeHHH nOBCe,lll-!eBHblX .nen CKa3blBaJIHCb nocne.nCTBHR HecqaCTHblX cnyqaeB, TpaBM H Oone3HeH, (51,ina paBHa npHMepHO 50% noqTH BO Bcex BO3paCTHblX rpynnax, npH<IeM He O1,1no pa3.11H'Il1R MeJl.llY "Oonee Mono.[lb1MH 11 H "Oonee cTapwMH" nomn1,1MH. H B 3TOM cnyqae OTMeqanHCb 6onee BblCOKHe, Ha 10-20%, noKa3aTeJIH cpe,llH ir.eHlJl}tH. 8 \fifcne Oone3HeH, KOTOpble CKa3blBa11HCb Ha EblnontteHHH noBce.nHeBHblX .nen, C5blJJH cne.llYtaI!He. a) Bone3HH KOCTHO-MblnietJHOH CHCTeMbI. OHH 6onee pacnpocrpaHeHbl cpe,llH iteHllIHH (17-24%), qeM cpe,llH MYll'IHH (16% B B03paCTHOH rpynne 60-64 ro.na H cmaaJOTCR .no 9% B B03paCTHOH rpynne 85-89 neT). (5) Bone3HH cep.netIHo-cocy ,llHCTOH CHCTeMbl. rHnepTeH3HR Bc-rpeqaeTcR qallle y "Oonee MOJJO.llblX" nonun,1x MYll'IHH (8, f% B BO3paCTHOH rpynne 60-64 ro.na H 0,7% B B03paCTHOH rpynne 85-89 neT) H y "Oonee cTapt,tX" JJ.eHlllHH (10,3% y "Oonee Mono- .llblX" H 12, 3% y "Oonee crapt,tx"). B OTHObleHHH HnieMH<IeCKOH Oone3HH cep,nua HaOJIIO,nanaCb Ta JJ.e 3aKOHOMepHOCTb, 'ITO H B OTHObleHHH nmep-reH3HH (pacnpoc~eHHOCTb npHMepHO 10-15%), a Oone3HH CHCTeMbl KpoBoo()paJlleHHR cOCTaBnRnH OT 7 .no 15% y MYlJ.l.lHH H OT 12 .no 20% y JJ.eHIJIHH. 7 B) 6OJJe3HH IDilll€BapHTeJibHOH CHCTeMbl. 8 OTHObleHHH HHX HaOJUO,nanacb TeH,DeHUHR K noaweHHm c B03paCToM (c 7 .no 14%) y MY~H HK CHJaeHHm C BO3paCTOM (c 15 .no 6%) y ll€HlllHH. r) Bone3HH HepBHOH CHCT€Mbl H opraHOB 'fYBCTB. 8 OTHO- bleHHH HHX Ha6JUO,nan0Cb yBeJIH'leHHe C BO3paCTOM (c 7 ,no 13%) .l]J1R JtHU oOoero nona , np~eM HaHOonee BMCOKHe noKa3aTenH oTMeqaJIHcb B rpynnax cTapme 70 neT (17%) . .n) TpaBMIJ, HecqacTHMe cnyqaH H OTpaanet-nrn. B OT- HomeHHH HHX OTMeqanHCb Oonee BMCOKHe noKa3aTeJIH Y MYlt'IHH (8-14%), qeM y llteHlllHH (6-10%). Pacnpo<::TpaHeHHOCTb lltanoo Ha COCTORHHe 3,IlOf>OBbR 4Hcno nHu, BblCKa3blBaBIIIHX "KaJ<He-JtHOo llano0bl 11 ( "qacro" HJIH "noqTH nocTORHHO" ) , OblJlO Bblble cpe,IlH lleHlltHH ( 70, 1-78, l % ) , qeM cpe,llH MYllt'll1H (51,6-78,7%), H yB~BaJIOCb C BO3paCTOM y nHu oOoero nona. AHano~HaR 3aKOHOMepHOCTb OTMeqeHa B OTHObleHHH "J1100t.rx cl>H3HOnor~ecKHX lltanoO" (29-63% y MYll'D-IH H 49-63% y ll€Hb1HH) H "nmOblX ncHXOCOMa~ecKHX lltanoo" (40-60% y MY:S'IHH H 60-70% Y llteHIUHH). B OTHOnreHHH HeKOTOpblX HaHOonee qacro BCTpeqaBIJIHXCR llta- no6 noKa3aTenH OblJIH Bblble y :SeHlllHH, H qacrOTa 9THX :aanoO yBeJIH'IHBanaCb C BO3paCTOM. a) "JloMOTa 1-mH OOJib a cycraaax HnH OOJIH a cnHHe" - KOJIHqecrao 3THX lltanoO YBeJ'IH'lliBaJIOCb y MY:a<IHH C 217 Ha 1000 B B03paCTHOH rpynne 60-64 ro,na ,no 419 Ha 1000 B BO3paCTHOH rpynne 85-89 neT, y lleHlltHH - c 413 .no 438 Ha 1000. o) "YcranocTb HJlH OlllYllleHHe cnaOOCTH 11 - KOJIHqeCTBO 3THX lltanOO yBeJIHqHBaJJOCb co 102 .no 287 Ha 1000 MY;aqffH H c 219 .no 391 Ha 1000 llteHIIIHH; "He,n~aTOK 3HeprnH" - c 64 ,no 191 Ha 1000 MYllt'll1H H co 142 .no 274 Ha 1000 1teH11tHH1 qffCno cnyqaea "cep.nue6HeHHR" BO3paCTano co 121 .no 169 Ha 1000 MYJtqHH H yMeH1,manocb c 200 ,no 195 Ha 1000 lleH!llHH. 8 B) 14,2% BCex MYl!tOIH H 9,7% Bcex l!el-llllHH CKa3aJJH, qTo y HHX 11 3aTJ)y,llHeHHR c MoqeHcnyCKaHHeM", Tor.na KaK 11,9% MY~ H 19,9% Bcex l!eHlllHH OTMeTHJlH B KaqecTBe TPY.llHOCTeH "3anop". r) "Yxy,llblemte naMRTH 11 HCTThlTblBaJJH 10,6% MYl!tOIH H 14,1% Jl:el-llllHH. Cpe,llH TeX, y KOro OTMeqanOCJ, 11 HeraTI1BHoe aocnpHRTHe COCTORHHR CBoero s,nopoBbR 11 , C5Ll110 85% MY;,;qJ,fH H 86,3% l!el-llllHH c l!aJJoOaMH ncHXOCOMaTJiqecKoro xapaKTepa, Tor.na KaK cpe.llH JlHU C "no3HTHBHl>IM BocnpHRTHeM COCTORHHR CBoero s,nopom,R" 01,1110 28, 9% MY~H H 39 ,6% l!eHIJIHH C aHaJJOn-NHhlMH l!a11o0aMH. Ja11o01,1 Ha "saTpy,llHeHHR npH BhinOJJHeHHH noBCe,llHeBHhlX ,lle.11 11 HMeJJH TeH,lleHUHJO K yBe~eHHJO C B03paCTOM, npH'JeM OHH qame OTMeqaJJHCb y &el-llllHH (57-85%), qeM y MY)!'{HH · (47-80%). Cpe,llH Tex, y KOro 01,1110 "HeraTHBHoe BOCTlpHRTHe COCTOR- HHJI CBoero 3,llOpofil>R 11 , 68, 7% MY)!'{HH H 81, 7% l!el-llllHH Hcrn.1Th1Ba- JJH saTpy.[IHemtR npH mrnonHeHHH noace,llHeBHhlX .ne11, Tor.na KaK cpe,llH Tex, y 1<oro ~110 n03HTHBHOe BocnpHRTHe COCTORHWI CBOe- ro s.nopoBbR, COOTBeTCTBytallHe noKasaTeJJH COCTaB11RJJH 39,1% H 59%. 4HC110 yTBep,llHTeJlbHhlX OTBeTOB Ha Bonpoc, "eCTb 11H KaKHe- JJHOo HapytdeHHR cnyxa", HMe110 TeH,lleHUHJO K ya~eHHIO C B03- paCTOM y JIHU oOoero nona - c 13% cpe.llH "Oo11ee M0110.DhlX" nom- JlhtX .no 66% cpe,llH "Oonee crap1,1x" OOllGIJlhtX. Ja11o61,1 Ha 113aTpy,n- HeHHJI npH l!eBaHHH nHl!IH" TaKl!e y'{ablaJJHCb C B03paCTOM Y JJHU oOoero no11a - c 19 .no 34% cpe,llH MY)!'{HH H c 22 .no 36% cpe.nH l!eHIJIHH. CnocoOHOCTb I( caMooOcnyl!HBaHHIO Onpe.ne11eHHe Toro, B Ka1<00 creneHH nomJlh1e cnocoOmt caMH ceOR oOcJ1YllU1BaTb, HMeeT Oom,bloe 3Ha'JeHHe, H npH npoBe.neHHH ,naHHoro oOcne,noBaHHJI 01,1110 oOHapy:i,;etto, 'ITO 11 Hecnoco6HOCTb .rnoOoro po,na" BCTpe'JaJJaCb npHMepHO y 50% 11HU B B03paCTe 60-69 11eT H y 91-97% cpe.llH "caMhtX crap1,1x 11 nOllCHJU,IX. Cpe,llH ll(el-llllHH 'JaJlle BCTJ)eqaJIHCb CJJy'{fil! Hecnoco6HOCTH caMOCTORTem,Ho nepe,naHraTbCR 3a npe.ne11aMH caoero .noMa - 12% (y MYll('IHH 1,2%), Tor.na Kai< HecnocoOHOCTb nepeHTH H3 O,llHOH 9 KOMH3Tbl B ,upyry10 OTMettaJJaCb y MY~HH B 0, 6%, a y ip;el-llllHH - B 6,0% cnyttaeB, HecnocooHOCTb nOJlb30B3TbCR yOopHOH Oe3 nOCTOpDHHeH nOMOIIIH ttatne BCTpettanaCb y MYr.tHH - 6%, a y 1teH111HH 9TOT noKa3aTeJlb COCTaBJlRn 1,2%. 4TO KacaeTCR cnocOOHOCTH MhlTbCR H KynaTbCR, TO OTBeT "He B COCTORHHH 11 BCTpettancR C pa3Jlli'tHOO ttaCTOTOH: OT 1,2% B B03paCTHOH rpynne 60-64 ro.ua .uo 9,3% a B03paCTHOH rpyrme 85-89 neT, 3TOT noKa3aTeJlb yBe.11H'01BaJ!CR C B03paCTOM Y Jn1U oOoero nona. HecnocooHOCTb .UOOTH ne111KoM HJIH .uoexaTb Ha 00111ecraeH- HOM TpaHcnop-re .00 CiJIHl@il:blero Me,llHUHHCKOro yqpe.s,neHHR <table BCTpettanaCb y 1teHll1HH ( 11, 4-63 % ) H CiLlna nO'ITH B,UBoe Bl,Ude, tteM Y MY;r;'-Il!H, noKa3aTenH, nonytteHHble Ha ocHoBaHHM 9THX .[laHHJ,IX, 0Tpa- ..a10T cneUH¢HtteCKHe ocoOeHHOCTH nonepettHoro, a He npocneKTHB- Horo aHanH3a, 9TO HMeeT ocoOoe 3HatteHHe ,llJ1ff HHTepnpeTaUHH pa3nH'-IHblX ¢al<TopoB PHCKa, BwcOKaR pacnpocrpaHeHHOCTb HeKO- TOpt,IX "nerKHX" COCTOIIHHA HnH Cione3HeH H HH3KaR pac:npocTpa- HeHHOCTb Cionee TRltem.tX 3aCioneBaIDIH C03,[lalOT KaPTHHY, npOTH- aononOltHYIO TOH, KOTOpaR CKna.mtaaeTCR Ha OCHOBaJOiH npocneK- THBHblX Hccne.ooaaIDIH, Cne.oyeT onpe.oe.nHTb "HaHCionee CHJibHb!H" ¢aKTOP pHCKa B npouecce CTapeHHRJ 3TO cwrpaeT BamJYlO poltb B nOHHMaHHH pa3BHTHR Cione3HH H CHHlteHHfl Tpy.nocnocooHOCTH, noHHMaHHe no.oooHoro B3aHMO.[leHCTBHfl ct,aKTopoB PHCKa HMeeT aamoe 3HatteHHe .llJlR pa3paCioTKH cpe.QCTB npe.oynpea,neHHR cmueHHR Tpy.oocnocooHOCTH y nom.mrx. YcnOBHR ltH3HH B nocne.oHHe 30 neT npoH30111no 3HattHTeJlbHoe noBLlllteHHe ltH3HeHHoro ypoBHR HaceneHHR eaponeHCKHX CTpaH. Tell He MeHee .oa1te B Cionee Cioran,x crpaHax PernoHa llH3HeHHLr:A ypoaeHI> no;,,;HJI1,1x 3aqacryJO HHJp;e, tteM y paCioTatanHX rpyrm, y KOTOpblX OH ocoOeHHO Cibrcrpo B03poc, 'ITO np1-1aeno K 3Ha'IH'I'e1tb- HOMY yBenHtteHHIO pa3~Ba Melt.[ly .OBYMR rpynnaMH. BnHRHHe ycnoal-G\ llH3HH Ha noltHJlbtX - 3TO e111e o.m-ta TeMa, . KOTOpail H3yttanaCb npH QCyllleCTBneHHH Melt.[lyHapo,llHOrO npoeKTa, H PaCiottaR rpynna 3acny111ana KpaTKoe H3no1teHHe pe3y1tbTaTOB oocne.ooBaHHR B nRTH ropo.oax. OpoBO.llHBIIIHe ero yqeHWe no.ottepKttynH, 'ITO llH3HeHHLIH ypoBeHb 3aBHCHT He TOJlbKO OT 00'.beKTHBHblX ueHHOCTeH, HO H OT Mecnn.ix oCiwlaeB. PaccMCYrpeHHe eonpoca 00 ycnOBHJIX ll(H3HH HeJll:>3R OT,OenRTb or npoO.neM, CBR3aHHl,IX co CHHll(eHHeM -rpy.nocnoco6HOCTH. nno- XHe m3HeHHble YCOOBHR MOryT cnOCOOCTBOBaTb H30 JIRLOiH H TeM caMLIM yeeJIHt.1emno trncna cnyqaee CHHll(eHHR TPY .nocnoco6HOCTH. C ,m,yroA CTopoHbl, 3Ha'C.IHTenbHoe HapymeHHe .OBHraTenbffilX HnH ncHXJNecKHX ~YHKUl1A MOll(eT orpaHH'C.IHBaTb HCnOnb30BaHHe 6MTO- BblX y.no6cTB H oOopy,noBaHHR H TeM caMblM KOCBeHHO yMeHbmaTb norpeOHOCTb B HHX, TaKHM o6pa30M, npH pa3paoorKe cpe.ncrB npe.nynpell(JleHHR CHHJteHH/1 Tpy.nocnocOOHOCTH HeOOXO,llHMO y~Tbl- BaTb TaKlle ycnoBHR llH3HH B moC'>OM .naHHOM oomecrBe H HH.IU-IBH- .llYaJlbffile yCJIOBHR npomBaHHR KOHKpeTHMX nHU. BblCKa3aHO npe.1U1onoi1et-n1e, 'C.ITO ~TopaMH, B HaH6o11hllleH cTeneHH BnHRl<lllHMH Ha ycnOBHR llH3t-ni nomnoro 'C.leJlOBeKa, RBJIRJOTCR CTPYKTypa ceMbH, HCTO'IIDIK .noxo.na H Ka'C.leCTBO ll(HnbR. B OonblllHX ropo.nax 3ana,nHOH Eapom,i Ha6mo.naeTCR TeH.neH- UHR K pa3,neneHHIO not<OJJeHHH. 8 CTf)aHaX DllHOH H BOCTO'C.IHOH EBporibl 3'1'0 BCTpeqaeTCR pei,;e, a . B HCnaMCKHX CTpaHax - COBCeM pe,lll<O, Cae.neHHR O 'C.IHCJle nOllGfJ!blX, llHBymHX B O)lHHO'C.leCTBe, co~epi,;aTCR B Heony0JIHl(OBaHHblX pe3ynbTaTaX o6cne.noBaHHR 1978-1979 rr., opraHH30BaHHoro 803, B 3ana,nHoM BepJIHHe 3TCYr noKa3aTeJlb COCTaBJJRn 23,7% .nnR MY~ H 62% ,nnR i,;eH- lllHH, B TaMI1epe (~HHJJRH,JlHR) - 21,7% H 50%, BO ~JJopeHI.OiH - 6,8% H 21,1%, e nOnbme - 5,4% H 19,7%, Tor.na KaK e KyeeHTe B O)lHHO'C.leCTBe, KaK OKa3anOCb, llHBYT TOJll:>KO 1,6% no;nun,ix MYll'C.IHH H O, 42% nOllHJIJ,IX lleHlllHH. ~nR ceMbH, KCYropaR ee.neT 00111ee X03RHCTBO, ropa3,00 Jlef"'.le OKa3blBaTb nOMOlllb CBOHM HeMOIUHI,IM 'C.lneHaM H ocyrueCTBnRTb yxo.n 3a HHMH, nollCH.Tlble, llHBYIIJHe ar.nem,Ho, 3aqaCTy10 He nonyqaJOT peryJJRpHOO nOMOIIIH OT CBOHX ceMeH. 3TO O)lHa H3 npwnm, no KaropblM npoOneMY ommoqecraa cne.nyeT peruaTb pa3.11H'C.IHhlMH nyTRMH B 3aBHCHMOCTH or CTpaHI,I H HH)lHBHJlYanbHI,IX OOC'TORTeJlbCTB: npH'OU-lbl 0.llHHO'C.lecTBa, paBHO KaK H CJJe,OCTBHR, ttepe.llt<O OblBaJOT coeepmeHHO pa3mNHblMH, BTopblM BamtblM ~opoM, OKa3blBalCll(HM B.JJHRHHe Ha ycnoBHR JP;H3HH, RBJJReTCR .noxo.n, Bo acex CTpaHax .PerHOHa OCHOBHI,IM HCTO'C.IHHJ;<OM .noxo.na nOIGUlblX RBJIRIOTCR nettorn, nettCHH, O)lHaKo, TOlle pa3.JllNHbl KaK no pa3Mepy, TaK H no noKynaTenbHOH cnocoo- HOCTH, Bo3MOllHOCTb nonyqeHHR .nono.11HHTenbHoro .noxo.na HnH ~HHaHCOBblX m,ror H nocoOHH TaKlle pa3nH'C.IHa B pa3HI,IX CTpaHax, a HHor.na .na.1te B npe.nenax 0.[lHOH H TOH lie CTpaHI,I, 11 8 HeKOTOPblX CTpaHax HMeeTCR 3HatrnTeJlbHblA npoueHT JJHU, Bb1111e,IU11HX Ha neHCHm, HO see eooe He npeKpamal<IIIJ,fX ceom npo<l>ec- CHOHaJlbHYm .neRTeJlbHOCTb. 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Otta OTMetfeHa Kai< y MYJIC'IHH, Tai< Hy lleHblHH HBO BCex B03paCTHblX rpynnax crapme 65 neT. Kor.na Bbl0opl<y pa3.llemurH Ha COUHaJibHO-KnBCCOBble rpynnbl, TO B l<all,QOO rpynne Cit.ma npo,neMOHCTPHp<)Batta 'leTKaR . KOppenRUHR 15 Mell\JlY ncHXJ-NeCKHMH 3aOoneBaHHRMH H ¢H3H'lecJ<oA HenOJIHOUeH- HOCTblll, H HaoOopor, KOr~a creneHl> ¢H3WlecKoA HenoJIHOUeH- HOC"rH OCTaBaJJaCb nocroRHHoA, TO CBR3b Me-.ny ncHXH'lecKHMH 3aOoneBaHHRMH H COUHaJlbHhlM KnaCCOM B 3HatOITern,HoA creneHH Hcqe3ana1 3'1'0 npoHCXO,llHJ!O Bcne~CTBHe Toro, 'ITO pacnpe~ene- HHe ¢H3H'leCKOA Henam-ioueHHOCTH CaMO HOCWIO CHJibHO BYpalleH- HbIH KnacCOBblH xapru<Tep . TaKHM o0pa30M, HaCiJIJO~EldeecR cocpe- ~OTO'leHHe nCHXH'leCKHX paCCTJX)ACTB B rpyrmax nOllHJ'll,IX C Oonee HH3KHM COUHaJlbHblM CTaTYCOM, B03MOlKHO, Bl,13BaHO B OCHOBHOM TeM, 'ITO 9TH nHUa B OoJibmeA creneHH noJIBepraJOTCR PHCKY pa3BHTHR xpoHH'leCKHX ¢H3H'leCKHX 3aOoneeaHHA H HapyJllel-lHA . PaOo1.1a.R rpynna npHmna K 3aKJ1JOt1eHH10, 'ITO nonepe'IHYe HCcne~OBaHHR TaKoro po~a MOryT OKa3aTbC.R none3HblMH ,ll.11.R BblRBneHH.R CBR3eH Mell(Jly nCHXH'leCKHM paccrpoACTBOM H HHTeHCHBHOCTblll CiHonOrWiecKHX HJlH COUHaJlbHhlX ¢aKTOpoB PHCKa, no~oOHble CB.R3H MOllHO nOTOM H3yqaTb B Kat1ecree OTnpaBHblX nyHKTOB ~n.R pa3pa0oTKH B03MOlKHhlX npH'OfHHIJX nmOTe3, npo¢HnaKTH\lecKHX Mep H ,ll.11.R BY.RBneHH.R nOTpeOHOCTH B pa31IH'IHl,IX ¢QpMaX o0cnylltHBaJ-Offl, Bone3Hb H CHHlKeHHe !PY~ocnocoOHOCT~ .IlOBOJibHO TPY~O npoBecTH pa3.1IH'IHe Me-.ny MHOro\lHcneH-- HblMH Oone3H.RMH, KOTopblMH CTpa,[laJOT noll(HJ'll,le, H HOpMaJlbHhlM npoueccoM crapeHHR, o,llHal(o npoee~eHHYe Hccne~oBaHH.R noKa- 3aJIH, 'ITC yTpaTa TPY~ocnocoOHOCTH (cOUHaJibHa.R He~OCTaT0'-1- HOCTb), Bbl3BaHHa.R Oone3Hl>lll, HexapaJ<TepHa ,ll.11.R 1IHU MOno•e 75 neT. H3 TeX, KTO CTpa~aer CHHllteHHeM paOoTocnocoOHOCTH B KaKOH-JlHOo ¢opMe, 3Ha'IHTe.TlbHa.R 'laCTb BO MHOnfX CTpaHax npolKHBaeT ~OMa, a He B cneUHaJIH3HpoBaHHl>IX yqpeJl,lleHH.RX. H3 9Toro cne~eT, 'ITO noMOll(b TaKHM mmaac .llOJlllHW OKa3YBaTb npeHMyblecTBeHHO paOoTHHKH 3~paeooxpaHeHH.R H COUHaJibHhlX cnylKCi BHe OoJibHHU H cneUHanH3HpoBaHHhlX yqpeJl,lleHJ-0\. a ,llono.m-ntTern,Ha.R HH¢oPMaUH.R no STONY Bonpocy npHBe~eHa B paOoTe Svanborg, A. et al. Epidemiological studies on social and medical conditions of the elderly : report on a Survey. Copenhagen, WHO Regional Office for Europe, 1982 (EURO Reports and Studies, No. 62). 16 lfneHLI PaCoqeA rpynrn,r npH11111H K 3aKnmemuo, 'lTO nomlll>re He CTpaJlaJOT CHHICeHHeM Tpy.nocnocoCiHOCTH per se, XOTR HeKOTO- pbre CTaTHCTH'-lecKHe ,naHHbre H npaKTH'leCKHH orn,rr noKa3blBalOT, 'ITO OHH 3aqacrym \Jpe3MepHO npe,IlCTaBneHhl B rpynnax HHBaJIH,IlOB. f'pynna CO'lna nonOICHTe.Jll,HJ,[M H oCiHa,IlelCHBaKIJlHM TO OOCTORTe.Jll,CT- BO, 'ITO no ,llaHHJ,IM npe.ncTaBneHHhlX 311H,IleMHonon-NecKHX oCicJJe- .noaaJ-IJ,O\ 40% 1IHU, OTHOCJllllHXCR K B03paCTHOH rpyrme 60-74 ro.na, H 20-25% J!HU crapme 75 neT C'lHTaJIH, 'ITO y HHX HeT CHHJr;eHHR Tpy.nocnocoCiHOCTH. HcnOJlb3OBaHHe HMelaltHXCR 9rJH.QeMHonon-NecKHX ,naHHblX B HeKOTOpMX CTpaHaX (HJ!H palioHax B KaKOH-nHCo CTpaHe) ()IJtybtaeTCfl HeXBaTKa 3nH,QeMHonorH'leCKHX .naHHhlX H TeM He Mettee Te ,IlaHHble, KOTopwe y1r:e HMelOTCR, 3a'laCTylO HenpaBHJlhHO HHTep- npeTffPYIOTCR HJlH BQOOIJle He HCJ1OJlb3YIOTCR. Cae.neHHR O nonoJ,;H- Te.Jll,HOM onLITe H oueHJ<e 9Cf><l)eKTHBHOCTH HOBblX MeTO,[lOB npe,noT- Bpa)lleHHR onaCHblX RBneHHfl ( K KOTopblM OTHeceHbl cnyTaHHOCTb CO3HaHHR, na.neHHR, He.nepi,;aHHe MO'lH H HeKOMMYHHKa0eJlbHOCTb), a TaKICe cnocoCoB npe,nynpell,lleHHR H ne'leHHR Cone3HeH H cHHir;e- HHR Tpy.nocnocoCiHOCTH y nO),;fflll>IX, pacnpoc-rpaHReTCR nnoxo. f'pyrma no,Il'lepKttyna, 'ITO Te HapYJdeHHR, KOTopble npHBO,IlRT K HeCJlOCOOHOCTH oCiblaTbCR, TpeOYJOT ocoCoro BHHMaHHR, H HaCTOR- TeJlbHO peKOMeH,[lOBana, 'lTOObl HH4>0PMauHR O cpe,IlCTBaX npe.ny- npell,lleHHR 3THX HaPYJdeHHH H CopbObl C HHMH pacnpOCTpaHRnaCb Oonee IIIHJX)KO Ha Bcex ypoBHRX. nOCKOJlbKY TaJ<He HapyMeHHfl qacro Bbl3blBaJOT HJ!H OOOCTPRIOT CnyTaHHOCTb CO3HaHHR H .npyrne nCHXH'lecKHe paccrpoHCTBa, Oblno OTMe'leHO, 'lTO OOJU:,ldQe 3Ha'leHHe KaK ,[lnfl nCHXH'lecKOro 3,IlOpoBbR, TaK H ,[lJIR npe.ny- npell,lleHHR ¢H3H'lecKHX onacHOCTeH HMeeT C03,[laHlle ycnoBHH, MaKCHMaJlbHO oCiner'laJallHX cnocoCiHOCTb nomm1x CJJYlllaTb, roBOPHTb H BH.QeTb. nPFJlY{lP~ H YHEHbblEHME arnJ:EHHfl TPY JlOCJlOCX)BHOCTII Tpy,llHOCTH, Ha KOTopwe ICa..nyJOTCR caMH noJniJlhle, He acer.na CBR3aHJJ C Cone3HbE. lfneHbl ceMbH, .DPY3bR H .nair;e paCoTHHKH 3,IlpaBOOXpaHeHHR OObl'lHO C'lHTaIOT, 'ITO Bee npoOneMbl noJr;Hnoro qenoBeKa HOCRT 11 Me,llHUHHCKHH 11 xapaKTep, O,IlHaKO caMH nOJr;HJll>(e Conee cKnOHHY roBOPffTb 00 HCllblTblBaeMOH HMH ¢pacTpauHH 1,13-3a Toro, 'ITO OHH He B COCTORHHH ¢H3H'leCKH c.nenaTb TO, 'ITO OHH 17 XOTRT c.nenaTb. OHH pe.m<O roeopRT: "MeHR OOCOOKOHT Moe 3,oopom,e". 3To nomeepi,;,naeT MHeHHe o TOM, '4TO rnaeHaR uem, Oom,DJlfHCTBa nOll'JiJlLIX - OCTaBaTbCR (HIIH CTaTb) He3aBHCHMblMH. no3'l'OMY rnaeHaR uem, ecex paOoTHHKOB cnyi,;O 3.opaeooxpaHeHHR H COUHa1ll>HhlX cnyi,;O .no1mtta 3aKnl0'4aTbCR B TOM, '4To0M OOMO'-lb HM B 3'l'OM. 4neHhl rpyrnn,1 no.[l'lepKffYIIH, '4TO Ha BTopH'lHOM ypoeHe Ba;TiieHIIIYJO para, HrpaeT npe.nynpeJUleHHe roro, '4ToOl,t HapymeHHR He nepemnH B CHHllteHHe Tpy.oocnocoOHOCTH, Karopoe npenRTCTByeT H1IH MOlleT npenRTCTBOBaTb co epeMeHeM ewno11He- HHIO noece,llHeBHhlX .nen. OHH npHlllnH K 3aK.Jll0'4eHHIO, '4TO paHHee pacnO3HaBrurne, KOHcy1ll>TaTHBHaR nOMOll(b H KOHTpom, npe.nc-rae- JIRIOT coOoH BcUCHeHIIIHe 3a,[la'4H Ha nepBH'4HOM, BToplNHOM H TpeTH'4HOM YPOBHe ecex CHCTeM 3,DpaBOOXpaHeHHR. nporpaMMbl BblRBneHHR 3a0oneBa.J-ilni .[lOJlEil,I ecer.na Ot.iTb MaKCHMa1ll>HO npocntMH H rHOKHMH, npH 3TOM HeoOXO.[lHMO y .Oe.nRTb .OOJIJIHoe BHHMaHHe ncHxononNecKOMy B03.lleHCTBHI> HHTepBblO H CKPHHHHra. HeoOXO.[lHMO nOOIIIPRTb aKTHBHoe yqaCTHe '4neHOB OpHra.n nepBH'4HOH Me.[lHKO-ca.HHTapHOH nOMOIIUi, KCYI'q:>Me XOpolllO 3HalOT no;nun.,x H H3BeCTHbl HM, B pa3paOCYI'Ke COOTBeTCTBytCIJIHX MeTO.0OB BblRBneHHR. Ha TPeTH'4HOM ypoBHe uem, .[lOJTlltHa COCTORTb B TON, '4To0w CHHJICeHHe Tpy.nocnocoOHOCTH He npeBpaTHJIOCb B yTpaTY TPY.00- cnocoOHOCTH (cOUHa1ll>ffYIO He.nocraT0'4HOCTb), He OrpaHH'OfBaJIO HopMa1ll>ffYIO pom, nOll'JiJlLIX H He OKa3MBaJIO CYI'PHl.laTenbHOro B03.lleHCTBHR Ha Ka'4ecTBO llH3HH. nepB00'4epe,DHOO 3a,Oa'4eA .OOJIJIHO CTaTb TaKlle H3MeHeHHe HeraTHBHOro OTHOldeHHR ceMeH H oO!rleCTBa eoo0111e. HanpHMep, peaOHIIHTaUHIO '4aCTo C'4HTalOT cno~OH H KOMnneKCHOH .neRTeill,HOCTblO, HanpaB.11eHHOH Ha TO, '4To0bl OOMO'-lb JIIO.[lRM, CTpa,[latadHM TRlleJJOO HHBaJIH,DHOCTblO (KaK HanPHMep, cnenblM H1IH nHUaM C TRllteJlblMH .nBHraTenbHblMH HapYJdeHHRMH); O.OHaKO peaOHIIHTaUHR KaK TaKOBaR OXBaTblBaeT TaKlle H HeBHJll,IMble rna3y HapY111eHHR, HanpHMep, xpoHH'4ecKYIO Oone3Hb H XpoHH'4eCKYIO Oom,. CoareeTCTBYJ(IIIHe cny:a~ .no.n:aHbl Ob1Tb opraHH3OBaHbl Ha KOMM}'Ha1ll>HOM ypoBHe H HMeTb HeoOXO.[lH- Mbte CHCTeMbt .llJlR KOHTpOJIR H HanpaeneHHR Ha KOHcy1ll>TaUHH. YnpaeneHHe npo¢HJJaJ<TH'4ecKHMH nporpaMMaMH H HX opraHH3auHR .OOnlltHbl 6b1Tb CTPYKTYPHO nepeCTpoeHbl H nepeopHeHTHpoBaJ-W B HeoOXOJll,IMblX c.rty'laRX TaK, '4To0bl OHH OTpaltaJ1H HOBbte OO.[lXOlll,I • KaK npcxf)HnaKTHJ<a, TaK H peaOHJJHTal.Offl npe.nCTaBJIRIOT coOoA BcUCHbte cpe.nc-rea ocy111ecreneHHR c-rpaTenm .OOCTHllteHHR 18 3,nopoBbR ,llJ'1fl ecex K 2000 r. BLrno OTMettetto, ttTO ea;,;tteH111y10 poJlb ,llOJ'lltHLI 3,lleCb Oirpa.Tb 061,e,llHHeHHJ,(e YCWIHR Me,llHUHHCKHX, naTpoHaltHMX H COUHaJlbHhIX CTJyltO, CHHJteHHe Tpy,nocnoco6HOCTH, BLI3 eamme XpoHHt{eCKHM 3a0oJJeeaHHeM rpynna 03HaKOMHJJaCb TaK1te c pe3YJibTaTaMH o6cne.noaaHHR COCTORHHR 3,llOpc)BbR B 11 MHHH-<l>HHJIRH,IlHH 11 , npoae.neHHOM HHCTHTY- TOM COUHaJlbHOro CTJ)aXOBaHHR <l>HHnRH,llHH. Otto C5Lrno HanpaeneHO Ha pa3paCX>TKY MeTO,llOB H Ha nonytteHHe HH<l>OPMcU.UiH, HeoOXO,llH- MLIX ,llJ'1fl npe.nynpell,IleHHR xpoHHt{eCKHX 3aOoneBaHHH. OueHJ<a COCTORHHR 3,llOpc)BbR ttaceneHHR <l>HHnRH.IIJ,fH c:t,ma nonytteHa nyTeM onpe.neneHHR: a) pacnpoCTpaHeHHOCTH r naBHLIX xpoIDft{eCKHX npooneM oCSblecreeHHOro 3.npaBOOXpaHeHHR (cep.nettHO-cocy,llHCTLIX H pecnHPaTopm1x 3aOoneeaHHH, Oone3HeH onoptto-,naHraTeJlbHoro annapaTa H ncHXJ.NeCKHX 3aOoneBaHHH); 0) y .noene-reopeHHLIX H Hey .noeneTBOpeHHbIX nOTpeCiHOCTeH B yxo.ne, B) COUHaJlbHJ,(X nocne,nCTBHH Oone3HH I H r) MeTO,llOB oueHJ<H H MOHHTOpHHra COCTORHHR 3,llOpc)BbR ttaceneHHR, .llBYX9TanHaR CTJ)aTH¢HUHPOBaHHaR rne3,llOBaR E'LIOopKa H3 8000 ttenoeeK e eo3pacre 30 neT HJJH crapme, penpe3eHTaTHBHaR ,ll1lR CTpaHl,I B uenoM, H3yttanaCb B 40 pa3nHttHLIX paHOHax <l>HH- JIRH,QHH. Cpe,DH o6cne.noBaHHJ,IX 01,rno 1950 ttenoBeK B B03paCTe 65 neT H crap!de, CxeMa o6cne.noeaHHR mu..( e eo3pacre 65 neT H CTapooe noKa3atta Ha PHC, 1, a pacnpe.neneHHe 91'00 BLIOopKH no nony H nRTHneTHHM B03paCTJ-ILIM rpyrmaM, TaKJte KaK H yttacTHe o6cne.no- BaHHJ,IX B HHTepBbkl O COCTOIU-IHH 3.llOpc)BbR, npe.ncTaBneHLt B TaCl.n. 1. 19 PHc . 1. CxeMa Hccne,noeaIDtR Bb!OopKa: 1950 oOcne,noeaHHlolX HIITEPBbD O CXJCrOIIHHH 3Jl()P0Bbll ----- H£llHUHJICl(OE OBCm;QOBAIBIE 65 neT <l>A3A KJ111Hlf4EO<All O<Pl1HlfHI'A--+ <l>A3A TaOJIHua 1. Pacnpe,nenei-rne a1,1CiopKH no nony H nRTHJleTHHM Bo3paCTHblM rpynnaM, a TaK:11e no Y'{acnuo B HHTepBbm O COCTORHHH 3,DOpoBbff My;iK'IHHbl J. eHblHliLI Bo3paCTHaR rpynna lfHcno Ko9Cl><l>HUHeHT lfHcno KQ9¢<J>HUHeHT y'laCTHR (%) Y'{acrHJI (%) 65-69 293 95,6 432 94,0 70-74 209 95,7 359 95,3 75-79 121 95,0 255 96,1 80-84 61 100,0 139 94,2 85-89 20 95,0 42 92,9 90-94 5 (80,0) 11 81,8 95-99 0 3 66,7 HHTepBbm O COCTORHHH 3,DOPQBbff co BceMH JlHUaMH, BK~ qeHJ-11,JMH B BblCioPKY, npoao,m-mH Me,m-n .. MHCKHe cecrpw cnyir;OW oCiblecTBeHHOro 3,QpaBOOxpaHeHHR Ha ,DOMY y oCicne.QYeMWX HnH B yqpe:11,neHHRX, r,ne OHH HaXO,llHJlHCb Ha ne'leHHH. 3TH HHTepBbm npoBO,llHJlHCb 3a O,DHy - blecTb He,DeJlb ,no oOcne,noBaHHR B nepe,nBHllHOH KJIHHHKe. Ko9Cl><l>HUHeHT Y'{aCTHR B HHTepBb~ 0 COCTORHHH 3,DOPQBbff COCTaBJlRJJ 96,2% ,IVlR BCeA BWCiopKH H 95,1% B rpynne cTapt11e 65 neT. 20 nocne HJ-ITepm,10 0 COCTORHHH 3,00poBbR npOBO.l]HJlOCb Me.[U,1- 1..0iHCl<Qe oOcne.ooBaHHe ,onR c6opa HCXO,llHl,IX .[lattHb(X O Ka~OM qenoBeKe, pentcTpaUHH CHMllTOMOB H CKPHH11Hra BblOOPKH Ha B03MOm,'IO naTonorn10. CTeneHb yqaCTHR B ~3e CKpHHHHra BO BpeMR oOcne.ooaaHHR COC'I'aBnRna 90% .[lnR BCeH Bbl0oPKH H 80, 8% cpe.[U,1 JIHU B B03paCTe 65 neT H CTapllle (85,3% MY~HH H 78,2% 1teHhOfH) • Jbrua, y KOTOpblX B npouecce CKPHHHHra 6blna BblRBneHa B03MOltHOCTb naTOJJOntH, npHrnalllaJIHCb noBTOPHO ,onR KJIHHHqec- KOrQ o6cne.ooBaHl1R cnyCTR ,DBa - qen1pe MeCRllcl. UenRMH KJTHHH'lecKoro o6cne.noeattHR RBnRnHCb: no.oTBep;,;.neHHe HaJIHqHR KaKoro-n1-160 HapyrueHHR; ycTaHoaneHHe ,llHarH03a; onpe.oeneHHe creneHH <f>YHKUHoHanbHOro orpaHHqemm; H oueHKa nOTpe6HOCTH B neqeHHJ.1 H pea6HJlHTal..lHl-f. H3 Tex, KTO npHHRn yqacTHe B CTa,runi CKPHHHHra, 75% H3 o61nero ql-fCna H 83, 9% JlHU B B03paCTe 65 neT H CTaprue 6h1JlH np1-1rna1J1em1 .nnR npoae.oeHHR 3Toro .nonoJU-IHTenbHOro o6cne.ooaa- HHR. l<o:3<M>HUHeHTbl yqacniR B 3TOH ~3e o6cne,ooBaHHR COCTa- BHJIH 92,3% H 88,4% COCYrBeTCTBeHHo • .IlaHHb1e O pacnpocrpaHeHHOCTH cep,oe'IHO-Cocy )lHCTblX 3a6o- neaaHHH, apTePl-fanbHOO rnnepTeH3HH, H111eMl-fqecKOH 6one3HH cep.oua, cep,oe'IHOO He,OOCTaTO'IHOCTH H cocy)lHCTblX 3a6oneBaHHH ronoBHOro M03ra no nRTHneTHHM B03paCTHblM rpynnaM noKa3aHbl B Ta6n. 2. l<aK H cne.ooea.no 01tH.[laTb, pacnpocrpaHeHHOCTb cep- ,oe'IHOO He,OOCTaTO'IHOCTH C B03paCTOM YBeJIHql-fBaeTCR • .IlattHble o pacnpocrpatteHHOCTH XpottHqecKoro 6poHXHTa, 9MCf'H3eMbt nerKHX H TY6ePKYne3a np1-1ee.nem1 e Ta6n. 3. 9TH LD-1<1>Phl HeBenHKH H 3Haql-fMblX pa3~ Me;,;Jly nRTHneTHHMH B03paCTHblMH rpynnaMH He OTMeqeHo. HecMOTpR Ha TO, 'ITO ¢YHKUHOHanbHble OrpaHl-fqeHHR, Ha6Jll()- .oa1C111HecR y nolU1JlblX, 3aqacTYIO 6hlBalOT Bb13BaHbl KaK HeCK0]1bKHMH 3a6oneBaHHRMH, TaK H CaMHM CTapeHHeM, CYilleCTBYIOT H HeKOTO- pt,le <f>YHKUHOttanbHble orpaHHtieHHR, o6ycnoeneHm1e c ep,oe'-U-lo- cocy )lHCTLIMH H pecnHpaTOPHblMH 3a6oneBaHlfflMH. 21 N N TaOmrua 2. PacnpocrpaHeHHOCTb .moOwc cep,ne<n-10-cocy.IIHCThlX 3a00.11eaaHHH (MKB, KO.llbl 390-458) H BallHeHil!He no.m<aTerOpHH cpe,nH nollWlhlX RO MTHJleTHHM B03paCTHhlM rpynnaM 3aooneBaHHR Bo3paCTHaR nJOO~e cep.ne<n-10- ApTepHa.JlbHaR HmeMH'lecKaR Cep,ne<n-1a11 cocy,noB rpynna lb-iCJJO cocy.IIHCTble nmePTett3HR oone3Hb He,nOCTaTO<n-!OCTb I"OJlOBHOI"O 3a00.11eBaHHR cep.aua M03I"a M03I"a (%) ( % ) (%) ( % ) (%) 65-69 686 43, 7 21,7 12,5 16,3 5 ,0 70-74 543 48,3 22,8 12,2 23,6 4,8 75-79 360 59,4 20,8 11,9 38,6 5,6 80-84 192 54,2 18,2 8,9 37,5 7,8 85-89 58 60,3 6,9 12,1 37,9 5,2 90-99 15 66,7 6,7 13,3 60,0 6,7 N w TaOmnla 3. Pacnpoc-rpa.HeHHOCTb JDOOwc pecnHpaTOPHWC 3aOoJleBaHMH (MKB, KO.In,I 011-012, 460-519) H BamiefllIHe no.m<aTeropHH y nOKH11WC no MTHJieTHHM B03paCTHblM rpynnaH Bo3paCTHaJ'I JboCioe pecmtpaTopHoe XpoliH'lecKHH 3M¢H3eMa Ty0epKYne3 rpynna 4Hcno 3aOoJleBaHHe OpoHXHT nencHX nerKHX (%) (%) (%) (%) 65-69 686 9,8 1,9 3,2 0,9 70-74 543 9,4 2,8 2,0 0,6 75-79 360 6,4 1,1 1,4 0,6 SQ-84 192 6,8 1,0 2,6 0,5 85-89 58 1,7 0,0 0,0 0,0 90-99 15 6,7 6,7 0,0 0,0 CHHllteHHe Tpy.nocncco6HOCTH BCJJe,IlCTBHe HapY111eHHR !WHKUHH onopHO-.IlBHraTem,Horo annapaTa ,OHCKYCCHH, KOTOPLle PaCio'laR rpynna npoBena no .naHHOH TeMe, orpaHH'IHBaJIHCb B CCHOBHOM peBMaTlfllecJ<HMH 3aoo11eBa- HHRMH, H B HeKOTOpoH creneHH TaKJte cep,netmo-cocy.QHCTLIMH H HeBpo11OrH'lecKHMH Cione3HRMH. OrpaHH'leHHe ¢YHKUHH onopHo-,nauraTem,Horo annapaTa CJ<a- 3LIBaeTcR Ha cnocoOHOCTH .IlaHHOro qe11OBeKa BLITTOJlHRTb onpe,ne- 11emn.1e .neHCTBHR, CBR3aHHLle C nepe,llBHllteHHeM KaK caMOro ceOR, TaK H npe,llMeTOB c MecTa Ha MecTO (ICIDH, crp. 161 ). I'JJaB- HOe BHHMaHHe y,neJJReTCR TpeM MOMeHTaM: a) CHJUeHHIO cnccoOHOCTH XO,llHTb (T40-45) - xo,llbOa, nepeceqeHHe HepoBHOH MeCTHOCTH, no,n'.l,eM no JJecTHHUe H npeo.noneHHe .npyrux npenRTCTBHH, a TaK•e Oer; 0) npHKOBLIBalClllHM K MeCTy CHH)l';eHHRM cnocoOHOCTH (T46-47) - cHHir;eHHIO cnocoOHOCTH nepeMelllaTbCR, BKJllO'laR cnocoOHOCTb JlOUITbCR B nocTem, HJ1H ca,QHTbCR Ha CTY n H BCTaBaTb C nocreJJH HJJH co c-ryna, BXO.QHTb B aBToOyc H BLIXO.DHTb H3 Hero, a TaKir;e BLle3,lll>I K MecTaM OT,lll>IXa H pa3BneqeHHH; B) .IlPYirlM cHHir;eHHRM JlOKOMOTOPHOH cnocoOHOCTH (T48-49), BKnJO'-laR no,llHHMaHHe H nepeHOCKY TRJtecTeH. K OCHOBHLIM KJJaccaM HapY111eHHH, CBR3aHHYM C orpamNeHHeM ¢YHJ<l.{HH onopHO-,llBHraTeJil,HOro annapaTa, OTHOCRTCR: a) HapY111eHHR BHYTpeHlMX opraHOB (H61), r.ne npoOneMa CBR3aHa C ¢YHKUHeH KaKOO-Jll,100 KOHe'IHOCTH (HanJ:liMep, B pe3ym,TaTe 3aCio11eBaHHR nepH¢ePH'-lecKHX cocy.noB) HJJH opraHH3- Ma B uenoM (npH 3aooneBaHHH oprattoB KpoBooOpabieHHR H11H ,lll>IXaHHR); 0) HapyweHHR cKeneTa (H?l-79), KY.Ila BXO,llRT ,IlBa OCHOBHLIX THna JlOKaJII,HLJX Hapyt11eHHH: Te, KOTopble RBMIOTCR MexaHH'leCKHMH, BLl3BaHHLIMH orpaHH'-leHHeM ,llBHJ'(eHl-fR (KaK HaflPHMep, npH peBMaTH'-lecKHX 3aCioneBaHHRX) HJJH OTCYTCTBHeM KaKOH-JIHOO qaCTH ( aM11YTaJ.lHR); H Te, KOTopLle CBR3aHLI C ynpaBneHHeM KaKOH-Jl}!OO KOHe'IHOCTblO, B 'laCTHOCTH napaJIHt{ H .npyrne 3aTpy.nHeHHR npH BLIHOJJHeHHH .IlBHraTeJII,HOH ¢YHKI.UiH; 24 B) oOtnHe, cettcopHL1e H ,opyrHe ttapy'ldemm ( H90-94, 96. 3 H 98-99), BKJllO'laR He,oep•aHHe MO'IH, qpe3MepHyJO no,IlBep•eH- HOCTb TpaBMaM, HeKOTOPble MeTaOoJIH'lecKHe HapYllleHWI, OOJib B cnHHe H TaKHe COCTORHHR, KaK rattrpeHa. 8 Ta6n. 4 noKa3aHN K~HUHeHTbl OOJ)alllemm 3a KOHCY m,- Tat.OieH K Bpa'laM oO~eH npaKTHKH B Coe.mmeHHOM KoponeBCTBe, crpYfIJlliP()BaHHble no OCHOBHLIM CHCTeMaM opraHH3Ma. TaM TaK•e npHBe,oeHL1 qe-nipe ~eHIJJHe npH'Ollibl orpaHHt1eHHR <l>YHKUHH onopHO-.OBHraTeJlbl-iOro armapaTa. XOTR 3TH .oaHHL1e H He HCt1ep- rn1BaIOtnHe, OHH .[leHCTBHTenbHO CBH.[leTenbCTByJOT, 'ITO npHBO.IlRlllHe K cmaeHHJO Tpy.oocnocoOHOCTH COCTORHHR COCTaBJlRIOT ropa3.no 0oJiblllytO 'laCTb Bcex •anoO I CBR3aHHblX C KOCTHO-Mb(ble'IHOH CHCTeMOO, qeM 3TO HMeeT MeCTO B OTHObleHHH KaKOH-nH6o H3 .opyrHX CHCTeM. TaKHM o0pa30M, oOHapy;,iumaeTCR TO OOCTOR- TenbCTBO, 'ITO peBMaTH'leCKHe 3aOoneBa.HHR RBnRIOTCR rnaBHOH npH'OlliOO <l>H3H'lecKHX HapyweHHH, OOYCJlOBnHBaR nO'ITH nonOBHHy TaOJlHUa 4. KoHcy11bTaJ.111H c Bpa'la>4H o0111el nJ)al<THKH ( pacnpe.aene tme no CH=eMaN opraHH3Ma, OTBeTCTBel-OiWN 3a OCHOBHWe KJlaCCW orpaJ-ONeH.HR .aaHraTe.JlbHMX ¢,Yffl(I..OM) CHCTeMa opra.HH3Ma H COOTBeTCTBYJOblee HHBaJ1M.llH3HP)'l(lllee COCTOIIH>te (o COOTBeTCTBHH C py0PffKa>4H HKB, 8-A nepecMOTp) CH=eMa !9:!2B000paa,eHWt 3aOo11eBaHHR nepH<l>ePHAHw.x cocy.aoo (np>tO.rn«eHHo owpaaeHHWe UJ<¢pal"1 .D.1111 aTeJ)OCIUlepo3a, 440) PecrtHP3T2£HaR C>t=eMa xpoHH'lecKHl1 OpoHXHT H 3M~H3eMa (491-492) CKenentCrMWlde'OiM CHCTeNa H C()e.QHHHTeJlbHall TKaHb o=eoaPTPQ3 (713.0-713.2) HeeoHaR C>t=ewa H oeraHW ~o=o H>tcyJlhT ( 3aOo11eoa1me cocy.aoo ro1100HOro M03ra, 43o-438) Bee Oone3HH H COCTORHWI He1<cnopue COCTOfU-IWI, rtpHBO.nRllCHe K HHBaJlM.QHOCTH ( nOK33aHW BWDJe) nauweHTW, OOpab:laQdHecR 3a KOt•tcyflbTal.01eA (o 003pa=e 65 neT H =apDJe) Ha 1000 uaceneHH.A 230 15 197 46 157 89 113 32 668 182 OJX)ue1rr OT OOrnero 'IHCJla 34 8 30 25 24 49 17 18 100 100 HC'TO'IIIHl<I Office of Population Censuses and Surveys (6). 25 TaJ<HX HapyrueHHH y JIHU neHcHoHHoro HJIH Oonee craproero eo3pacra (oOruee 'Olcno cTpa.[laKJJtHX 9TiiMH 3aOoneeaHHRMH He noKa3aHo e TaCin. 5) . .llnR Toro t1ToOb1 .naHHhle , npHee.neHHbre e TaCin. 4 H 5, BocnpHI-IHMaJIHCb B COOTBeTCTByKJJteM KOHTeKcre, cne,eyeT ecnoM- HHTb, 'ITO H3 ecero ttaceneHHR Coe,nHHeHHoro Koponeecrea (no oueHKe 1979 r. 55,9 MJIH. t1enoeeK) 17,3% (9,7 MJIH.) HaXO- .nRTcR B B03pacTe, npeBblbla1<111eM neHCHOHHblH (60 neT .n.mt l(eHblHH H 65 neT .OM MYJK'IHH). TaJ<HM o0pa30M, Ha nporRJKeHHH O,llHOro ro.aa npHMepHO 1,9 MJIH. nolKHJ!blX oOpamalOTCR K ceoeMY epaqy C>CxiteA npaKTIIKH no noeo,ey JKanoO, OTHOCRbtHXCR I< CKeneTHO- t,l,lble'IHOH CHCTeMe. PeaJ<I.IHR Ha 9TO Bpa'leH oOlneA npaKTHl<H HOCHT pa3nH'U-ll,IH XapaKTep, nOCJ<OJibKY Ha KOHcyJibTaJ.OiID I< cneUHanHCTaM OHH HanpaBrunoT MeHblllYID qacn, 0o1IbHblX (1/5) peBMaTOnorH'leCKHMH 3aOoneeaHHRMH, 'leM 9TO HMeeT MecTO B cpeJIHeM ,ll]lR ecex Oone3HeA H COCTORHHH (1/3). C .npyroA CTOpDHbl, peUH.nHBHPYIQJOfe H CSonee TRJKeJlble BOCila.mtTeJlbHble 3aOoneeaHHR, TaKHe, KaK apTPOOaTIIH, npHBO,[lRT K OoJibb!eMY 'O!Cny oOparueHHH K epaqy Ha O.DHH cnyt.laH HI< C5o1ll,ldeMY, 'leM e cpe,nHeM, 'lHCny KOHCYJibTaUHA (25%) Ha .DOMY y Oom,ttoro, t1eM e 1<aCiHHeTe epaqa. no1.Hnble mrua t1ame crpa.nam peeMaTH'lecJ<HMH 3aOoneea- HHRMH. no BCeM Oone3HRM H COCTORHHRM y JU,fll BCex B03paCTOB TOJibKO 12,3% oOpameHHH 1< epaqy .nenaeTCR JIHU?MH CTapme neHcHoHHoro eo3pacTa. COOTBeTCTBYKJJtlffl no1<a3aTe1Ib .ll1lR ecex peBMaTH'leCKHX 3aCSo11eeaHHH COCTaBMeT 17,8%1 B ,naHHoA rpynne Ha .DOJJID aPTponaTJffl npHXO.DHTCR 41,9%. B TaOn. 5 Oo- nee no.npo0HO noKa3aHa CBR3b Mel(,[ly B03paCTOM H l<OJJH'leCTBOM oOpameHHA K epa'laM no CYr,[leJlbHblM J<aTeropHRM peBMaTH'lecJ<HX CSone3HeH. .llaHHb1e, npHBe,neHHble B TaCiJIHue, CBHJ]eTeJlbCTByIDT 0 3aMeTHblX pa3J1H'OIRX H O Be.llYlJleH ponH pa3JJH'IHblX <l>OPM apTPH- Ta. 803 MOJKHO, 9TH UH<l>Pbl RBMIOTCR 3aHHJKeHHblMH, nOCJ<OJibl<Y noJKHJ1ble MeHee Cl<nOHJ-lbl oOparuaTbCR I< Me.DHUHHCl<HM cnyJKoaM, 'leM 9TOro MOJKHO CibinO Obi OlKH,[laTb, HecMOTPR Ha HX OoJiblllYID 3aCSone- eaeMOCTb. B TaCin. 6 no1<a3aHbl Te 1<aTeropHH Oone3HeA, 1<0Top1,1e t1ame ecero npHBO,[IRT I< CHHl(eHHID Tpy.nocnocoOHOCTH y noUU!blx. ApTponaTHH, XCYrR H Bbl3blBalOT HaHOonee TRl(enyID HHBaJIH,llHOCTb, RBJIRJOTCR He e,nHHCTBeHHblMH peBMaTH'lecl<HMH 3aOoneBaHHRMlf, npHBO.nRlllHMH K HapymeHHRM <l>YHKUHAJ TeM He Mettee B KOnH'lecT- BeHHOM OTHOlleHHH OHH .DOMHHHJ)YIOT• Cpe.DH aPTponanrn CSonee 26 TaOJtHUa 5. CBR3b Me~y B03paeTOM H qHeJJOM o6pa1I1eHHH K Bpaqy o0111eil npaKTHKH ( K09<fxln•n.n-ieHT oopal!leHHR 0oJlbHLIX Ha 1000 HaeeneHHR) 1<09<Jxl)HUHeHT OO!)ableHHR Oom,HblX K Bpaqy l<aTeropHR Ha 1000 HaeeneHHR peBMaTHqecKHX 3aOoneaclIDIA Bee B03paCTbl 0-14 15-44 45-64 65-74 APTponanrn 34 2 14 62 io5 BoJIH B em1He H peBMaTH3M MRrKHX TKaHeil 55 6 65 87 64 PaCT.RlleHHR H .ne<f>oPMauHH 31 19 42 32 20 75+ 114 45 15 HCTOqttHK: Office of Population Censuses and Surveys (6). T.RllenyJO Hl-lBaJlH.[lHOCTb oObl'IHO Bbl3blBaeT peBMaTOH.QHLIH apTPHT (PA), qeM OCTeoaPTpo3 (OA), npeHMyblecTBeHHO nOTOMy, qTo OH qa111e nopallaeT OoJlb111ee qHcnO eyCTaBoB, npHqeM H3MeHeHHR B HHX HOC.RT, KaK npa1mno, Oonee .QecTPYKTHBHblH xapaKTep. TeM He MeHee epe.nH HaeeneHHR B uenoM q3ble aeero BcTpeqaeTC.R HMeHHO OA. TaKHM o0pa30M, epe.QH JIHU, y KOTOPblX CHHllteHHe Tpy.nocnocoOHOCTH Bbl3BaHO aPTPHTOM, Be.ltYb!HM 3aooneBaHHeM .RBJJ.ReTC.R OA noqTH B 3/4 cnyqaeB, a PA - TOJlbKO B 1/8. 4aC'l'O'I'a COCTO.RHHH, npHBO.Q.RblHX K HaH6onee T.RllenOMy CHtt- JleHHIO Tpy.nocnocoOHOCTH, e B03paCTOM yB~aeTC.R; oco6eH- HO y.R3BHMbl CaM!,le cTapb1e (B B03pacTe 75 JJeT H CTapwe). l<poMe Toro, onIOCHTeJJbHa.R .QOJJ.R lleHblHH cpe.QH JJHU C HapY111e- HH.RMH Bblllle B CTaJ)blHX B03paCTHWC rpynnax, qTo OTpallaeT OOl!IYIO Oonee paHHlOIO CMePTHOCTb MylltqHH. E.miHCTBeHHblH KJJacc 3aOone- BclIDIA, KOTOpblH He Bbl3blBaeT nOBblllleHHR HapY111eHHH y Myll'UiH, 9TO pecmtpaTopHb1e 3aOoneBaHH.R, B03MOJIHO, Bcne.ncTBHe Oonee 27 N CD TaOJll.lua 6. HeKoropwe npH'lH!ibl CHHJtE!HHR TPYJJOCnOCo0HOCTH y nollW!WX 0CHOBHoe 3aOoneBal01e Ap-rponanm - OCTeoaPTPQ3 Bone3HH KpoBOOOpameHHR Pec:rtHpaTOpHWe 3aOoneBaHW1 TpaBMa HHcyJ!bT ICE: <XCro.RIDUI noeo3paCTHOH K0:3(jxj)HUHeHT 3aOoneeaeMOCTH (Ha 1000 HaceneHH11) 16+ 65+ 65-74 75+ 22,1 90,2 75,6 116, 7 18,7 79,5 64,9 106,0 10,9 43,1 38,6 51,3 7,6 23,7 24,9 21,4 6,3 16,3 10,5 26,6 3,3 13,7 10,2 20,1 75,6 265,6 216,4 354,3 HC'I'O'IHHK: Harris, A. I. (17). npoueHT ecex Jll.lU C HapymeHHIUIH, y npoueHT KO'rOpt,IX HMeeT MecTO nOJIJ.l.llWX :,;eHIIIHH TID:enaJ! HHBaJIKIIHOCTb C HapymeHHRMH 65-74 75+ 80 17 25 80 12 25 64 10 20 43 7 14 58 12 24 57 54 58 66 15 26 BLICOf<OO cMef)THOCTH Oo.rn,Hl,IX; HO .nai,;e npH 3TOM <JaCTOTa cny<Jaee TRllenoro cmaeHHR TPY.OOCnocoCiHOCTH, Bbl3BaHHoro 9THMH COCTORHHRMH, BLllde cpe,DH nolrnJiblX (TaCin. 7). TaOroma 7. HeKOTopb1e npH'OfHl,I TR;,,;enoro cHHi,;eHHR TPY .nocnocoOHOCTH y no;,mni,1x 0cHOBHoe 3aOoneeaHHe AprponaTHH - OCTeoaprpo3 Bone3HH CHCT€Ml,I KJ)OBooCipallleHHR PecnHpaTOpHl,le 3aooneaaHHR TpaeMa 1-iHcyJtbT BCE COCT051HH51 noao3paCTHOH KOS(fxt)HUHeHT TR)!;eJlOro CHH)f;€HHR Tpy.nocnocoOHOCTH (Ha 1000 HaceneHHR) 65-74 75+ 12,9 29,2 7,8 26,5 3,9 10,3 1,7 3,0 1,3 6,4 5,5 11, 7 32,5 92,1 1-iCTO'IHHK: Harris, A.I. (7). UeHHOCTb ,naHHJ,DC O pacnpocTpaHeHHOCTH 3aOoneaaHHH, KaK Te, KOTopwe npe,llCTaeneHJ,I B TaCin. 6, COCTOHT B OCHOBHOM e TOM, '-!TO OHH .nam- BOOMO;'ltHOCTb BblRBHTI, Tex, KTO no.neepi,;eH PHCKY BO3HHKHOBeHHR Oonee cepb€3Hl,IX pacCTpoHCTB. O,nttaKo, '-!TO KacaeTCR nOTpeCiHOCTH B oCicnyllGfBaHHH Ha TpeTH'Il-lOM ypoBHe, TO HMeHHO CTpa.naKIJtHe TMenblM (H O'-1€Hl, TR)f;enblM) 29 CHHJl'.eHHeM TPY.IlOCnocoOHOCTH 1-fYllt,IlaJOTCR B MaKCHMaJibHOM BHHMa- HHH , CooTBeTCTBYKlltHe ,IlaHHhle npHee,neH1>1 B TaOn. 7. H3 TeX, KTO nepeHec HHcyJibT , Oo11ee qeM y nonOBHHl>I HMeK>TCR cepbe3HJ,le HaPYllleHHR, HapY111eHHR, c1<a3b1BaKlltHecR Ha ynpaeneHHH opraHH3- MOM ( T, e. Heepo11onf\lec1<He COCTORHHR) , oOt,l'IHQ npHBO,llRT I< Mal<CHMaJlbHOMY CHHllteHJ-110 TPY ,nocnocoOHOCTH Y OollbHl,IX ,DaJle TOr,na, KOr,na CTenem, HapY111eHHR npHMepHO COO'l'BeTCTByeT TOH, .l<OTOpaR MOllteT HaOmo,naTbCR npH ,npyrHX 3aOo11eeaHHRX, 00 9TOM ceH.[leTenbcTeyeT npeo011a.naHHe Heel?011ornqec1<HX 3aOo11eeaHl-lA cpe.m,t TeX, KTO 1-fYJK,[laeTCR B yxo.ne Ha .nc>MY HJ1H B cneLU1aJIH3H- poBa.HHOM Y'lJ)ellt,lleHHH, 00 yR3BHMOCTH nOltHnblX roeopHT TO o0cTORTellbCTBO, 'ITO H3 Tex, l<TO CTpa,naeT TRJle.nJ,IM CHHJleHHeM TPY.IlOCllOCOOHOCTH He3aBHCHMO OT ero npH'IHHbl, 44% HaXO,ll.RTCR B cneLU1anH3HpoBa.HH1,1X yqpellt,IleHHRx, Tor,na Kai< aHano~ noKa- 3aTe1Ib cpe,IlH TeX, KTO He ,IlOCTHr neHCHOHHoro B03paCTa, co- CTaenReT TOJibKO 11% (8). O,IlHOH H3 cneLU1¢H'lec1<HX npo011eM, OTHOCRlllHXCR I< e1<e.neTHO- Ml,111Je'IHOH CHCTeMe RBnRJOTCR nepenoMbl bleAl<H Oe,npa. BepoRTHOCTb BO3HHl<HOBeHHR TaKoro nepenoMa 0yJ<Ba1IbHO Y.IlBa.HBaeTCff C 1<alt,QblM npolltHTl>IM nRTHJJeTHeM, Ha'IHHaR C B03paCTa 65 JJeT H CTapble y 11HU oOoero no11a, a K 85 ro.naM npHMepHo 2% J1eH111HH H 1% MY1t'4HH nonyqaioT nepe11OM meHJ<H Oe.npa eJKero,IlHo (9). HMeHHo 9TH nepe- 11OMb1, no BCeH EepoRTHOCTH, COCTaBnRIOT 3Ha"-UfTe1IbffYIO 'laCTb H3 oOblero 'IHcna TpaeMaTH'lecJ<HX HapY111el-{}ffl, noKa3aHHoro e TaOn. 6 H 7. 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C'1'l)aJla.QIIK peBMaTINeCIOOtH saOolleBaHHlucH , c J)llalpe.QeJleHKeN no 110spacry 4~ 12,50 (4>T.CT.) 65-74 7,63 (4>T.CT . ) 7S+ 5,47 (4>T . CT . ) a Jleq,exn&, 3aTPY.IIHIIDIHe 0pHeffHpOIIK)' 0 MemDIHe saHHllan.o! C1lcii ~ . He ~ - 0 8emNHKw Mettee l\ npHpa!IHHBalJTO'I K ffYJ'II). B He 11KJIINeHW JlHl.la , Y KOTOpWX HlleeTO'I O'feta, ffl&ellllJI HKBalllUIHOCTl,. r HCICIIO'fall TeX, KTO 11 oOoNltwx yCJ1011HllX He -= JIQMallHHIIM .QeJlallH • HCTO'fHHI<: Woo d & Badley ( 16). - "Hcrn.rrLIBaeT JtH 9TOT qenoBeK TPY.llHOCTH npH opHeHTHJ)O- Ba.HHH B CBoeM OKP~eHHH'? .RBJIReTCR JtH 9TOT ttenoeeK lJ)H3HtleCKH He3aBHCHMLIM npH BMnOJU-feHHH noBCe.llHeBHWC lJ>YHl<LIHA'? H T.,II. 0) Bonee cnollteH cyMMapHh&\ Oann 9THX TPex rnaeHblX pa3,IlenOB KJJaCCHlJ)HKauHH I, 0, H HJ OHH npe,IICTaBJlFDOT ce>Oo\ Ha,IlelltHl,IH MeXaHH3M, KOTOpwl rapaHTHPyeT, 'ITO onpe,I1eneHHMe KnaccM npoOneMM He OCTaJ-IYTCR BHe noJIR 3peHHR. YttaCTHe CJIHIIIKON Oonbmoro tlffcna cneuHaJIHCTOB CBff3aHO C TµeBOllHrn TeH,Ileffi.{Hai K orpaHH\leHHOMy BocnpHRTHJO, Bcne,IICTBHe qero Bann.re acneKTl,l 9<1XJ)eKTHBHOCTH BMn011HeHHR Oo111,Hl,IM Heo0XO,[IHM!,IX lJ)yHKUHH H HaOJDO,llaJOlJtHXCR y Hero HapymeHHA He npHHHMaJOTCR BO BHHMaHHe, nocKOJlbKY HX 3attaCTyJO C'lHTaJOT HaXO.IlffblHMHCR 3a npe,IlenaMH TOH HJtH HHOi cneUJ,faltl,HOCTH. TeM He MeHee npoOne- MaMH naUJ,feHTOB ,llOnlltHJ,1 3aHHMaT1,CII Bee cneuHaJIHCTW. PeaKUWI He ,IIOnlltHa Or'pa.HH'IHBaTl,CII 11JX)H3B01lbHl,IMH paMKaMH Tei\ HJlH HHrn .QHCUHnJIHHl,l. 9-ra Oonee MHPOKM KOHUem.tHR oco0eHHO Heo0XO- ,IIHMa e oODlliHe, r.r1e nolltHJWe HHBanH,lll,I 3at1aCTy10 no.I1.I1ePEfflaJOT KOHTaKT TOJlbKO CO cneUJ,faJIHCTaMH KaKoro-TO 0.llHOf"O J'1POCl)HJ'lff. B) HaKoHeu, cyineCTByeT cxeMa oueHKH cTeneHH cma:eHHR TPY.IIOCnoco01-K>CTH no e.mrnrn MKane (ICIDH, CTP• 175), no.IIP()O- HO noKa3MBalOlllaff ueJtH Hee B03NOJUfOCTH BMe!llaTe1lbCTBa, a HMeHHO, npe,IIYflpell.IleHHe cm«eHHR TPY.nocnoco0HOCTH, yeenH'{e- HHe HMeJOlllHXCR B03MOJUfOCT9%, ,IIOOOJU-feHHe H 3aMetty. no He.QO- CMOTPY O.QHH Knacc OMn nponyineH Ha mKane QlleHKH cma:eHHR TPY.IIOCnocoOHOCTH ICIDH. Pe'lb H.IleT O cnyqaruc, KOr.Qa \leJJOBeK MOllteT BbITTOnHIITb TY HJtH HHylO lJ)yHKUHJO HJlH BecTH ceOR onpe,Ile- neHHblM o0pa30M Oe3 KaKHX-nHOo 3aTPy.llHeHHA, HO TOJlbKO Heo0Wl- HLIM HJtH aHOMaJlbHl,IM nyTeM. npHMeHHTeJlbHO K 9TOMy KJ1accy CHH- llteHHR Tpy.r1ocnocoOHOCTH COOTBeTCTBy!Oblaff UeJlb ,IIOnlUfa COCTOIITb B yBe.nJNeHHH B03MOlUfOCTeA H, TaKHN o0pa30M, 9TOT KJlaCC .IIOn- llteH OblTb noMellleH Mellt.IIY CYJnecTByI(XltHMH nyl{J(TaMH mKam.r OH 1, O.llHaKO .IIJlR Toro, t1To0M COXpaHHTb conOCTaBHMOCTb C ..QJ)yrHMH nOJlb30BaTe.TlflMH b!KaJlhl ICIDH, npe,ll11araeTCR noKa 9TOT KJ1acc o0<>3HattaTb HeHcnOJtb3yeMrn UJ-flJ)~ 7. npH oueHKe lJ)H3HtlecKoro OKP~eHHR \leJJOBeKa H HaxO.IlffblHX- CR Bero pacnopRlleHHH pecypcoB cne.nyeT HCOOJtb30BaT1, CHCTe- MaTif'rnbJH H H30HpaTe.JlbHblH nO.IIXO.II, nOCJ<OJlbKY OHH MOryT BJtHIITb Ha BbIOop BMemaTeJlbCTBa. 3HatteHHe TµeOoBaHHA H11H OrpaJ-IH'te- HHA lJ)H3HtleCKOr'O OKp~eHHR OTpaJ[eHO B CTPYKTYJ)e KnaccHlJ)HKa- UHH CHHJl(eHHff -rpy,llOcnocoOHOCTH (ICIDH, CTp. 37). BMemaTenb- CTBO MOllteT HOCHTh pa3.11),ftO{Ui XapaKTep - OT npe,IIOCTaeneHHR 54 BCOOMoraTeJlbHOro Cpe,QCTBa ,ll11R nepe.nmu:eHHR ,no H3MeHeHHR nonHTHKH JlJ)OeKTHJX)BaHHR ropo.noB. PecypcLr, KOTOp1,1e HeoOxo- ,llHMO oueHHTb, MOI"yT Ob1Tb COI..OiaJlbHblMH H.l1H JUNHblMH. npH nno- XOM 9KOHOMff'.lecKOM nonoKel-001 nauHeHTa MOKeT nOTpeOoBaTbCR Ha3ttatteHHe eNy neHCHH no HHBaJIH.llHOCTH. Bamtoe 3HatteHHe HMetoT e111e TPH acneKTa. nepBLIA 3aK- ruot1aeTCR B TOM, 'ITO BO MHOrnx cnyqaruc npH OUeHKe cHJaeHHR Tpy.nocnocoOHOCTH HCXO,JlRT H3 roro, 'ITO ecJ1H Ta HJJH HHaR $YHJ(l..tHff orpaHHttetta, ee KaKHM-TO o0pa3OM cne.nyeT Boccratto- BH'n>. 3'ro coBep111eHHo Heo0R3aTeJlbHO. MHorne npe.nOCTaBnRe- Mble (5oJibHJ,IM BCllOMOraTe.llbHble Y~CTBa TaK H He HCnO.llb3yJOT- CR, nOCKOJlhKY TO, 'ITC cneUHa.n:HCT MOKeT C'OITaTb HapymeHHeM, KOTOpOe Tpe0yeT netteHHR, .nnR caMoro Oo.llbHoro RBnReTCR JtHlllb He3Ha'IHTe.llbHblM Hey.noOcTBOM, C KOTOPblM OH r'OTOB CKOpee CMH- PHTbCR, tteN m.rraTbCR ero npeo.noneTb. no9TOMy oueHKa .no~a OhlTb Oonee TO'IHal H H3OHJ)ciTeJlbHOO, BblRBJlRR Te HapymeHHR, KOTop1,1e Bamn.r .nnR BH.QOB Oo.llbHoro Ha Oy.Qyblee Hero oOpa3a KH3HH, H y.ne,JVIR MeHbllle BHHMaHHR .npyrHM TPY.IlHOCTRM. BTOpoe - 9TO TO, 'ITC BceBO3MOllOible JlH'IHble aTPHOYTbl, TaKHe, KaK non, B03paCT, o0pa3OBaHHe, CeMeHHble oOc'I'ORTe.llI::r- CTBa (B TOM 'IHcne CeMeHHoe nono•eHHe), KHJlHIJlHble ycnoBHR H po.n 3aHIITHA, HecoMHeHHO B.llHRIOT Ha YTPaTY TPY.nocnocoOHOCTH (cOUHaJlNfylO He.l1QC'l'aTO'IHOCTb). npe.nnpHJOtMa.n:HCb CHCTeMant- tteCKHe YCWllifl ,ll11R cC'>opa no.noOHWC cee.nettHA, O.IlffaKO nOCKOnI::r- KY 9TH YCHJJHR npeTeH,[lytOT Ha BCeoOl>eMJU<lllHH xapaKTep, OHH MOI"yT OblTl, oOpetteHW Ha Hey,naqy. XOTR He cne.nyeT npeHeOpe- raTb HHKaKHMH HMelOlllHMH OTHObleHHe K .neny MOMeHTaMH, CYJJtecT- BeJ-DiYlO porn, Hrpal)T J1Hbll, Te acneKTbl, KOTOplJe onpe.ne.nRJOT CTe- neHb cmmeHHR TPY.nocnocoOHOCTH ttenoBeKa, H HMeHHO HX HeoC'>- XO,QHMO npHHHMaTb BO BHHNaHHe npH OUeHKe pecypcoB H $H3Httec- KOro OKpyKeHHR. TaKHM o0pa3OM, no,noOHble AaHHhle MOllHO paCCMaTPHBaTb KaK HCXO.llffYE HH¢opMauHJO ,ll11R ue.n:eA oueHKH H HMeHHO HX B3aHMOCBR3b C HHBanH.IlHOCTblO .no.n:KHa Haxo.mrrbCR B ueHTPe BHHMaHHR. 3'ro oOCToRTeJlbCTBO nomBep-.naeT •enaTe.n:I::r- HOCTb H30HJ)ciTeJlbHoro no.nxo.na K peblemoo npoOneM (B npcrrHBO- nono.KHOCTb IIIHJ)OKOMY no.nxo.ny, •e.n:aTeJlbHOMY npH oueHKe npoOneM). HaKOHeu, Heo0XO.QHMO OTMeTH'n> 3HatfeHHe anbTepHanmHblX nepcneKTHB. KOHUemnm "narpe0HOCTH B HHTepBane", BbUlBH- ffYTaR Isaacs & Neville, OWJa Hcnom,3OBaHa .nnR onpe.ne.n:eHHR 55 creneHH ¢H3H'tecKo\ He3aEIHCHMOCTH Y JIHU C }'TpaTOO Tpy.QOCnO- ~HOCTH (COUHaJlbHGI He,llOCTaTO'IJ-IOCTl:,10). 3Ta KOffi..lernuffl CBR- 3imaeT Me.,lly ~ KaJ< 'JaCTOTY B03HHJ<HOBeffltR nO'rpeOHOCTeR, TaJ< H HX HeoTnOJIHOCTI,. ConOCTaElbTe, HanpHMep, narpeOHOCTb nOOTH B TYaneT (KpHTH'tecKK\ HHTepBan} C nOTpeOHOCTblO B no- MOlllH npH e,lle HJlH O,lleBaHHH (KOpO'rKWi HHTepBan}. 3TOT MeTO.ll HaMHOro npeBOCXO,llHT Oonee npoH3BOJlbHhle pa31IH'IHR, KaK, HanpH- Mep, Te, KOTOp1,1e OCHOBLIBaJOTCR Ha .llJIHTe.TlbHOCTH nePHO.lla, BO BpeMR KOTOporo -rpeOyeTCR nOMOll[b, HJlH Ha xapaJ<Tepe TPY.IIHOC-- TEM, BCTpe'laJOlllHXCR npH BLln01DieHHH OT.lleJlbHWC <J>yHKU~ • npoeepKa npHrO,llHOCTH ICIDH HHHHcrepcTBO 3.flpaBOOxpaHeHHR H 3a.JQHTW OKP}'IallllteA cpe.m,, HH,IlepnaH,llOB e KOHUe 1978 r. npHIIIJIO K BLIBO.flY, 'ITO OTCyTCTBHe o0blenpHHRTGI CHCTeMLI onpe,lleneHK\ H KnaccHCJ>HJ<a.I.01H B oOnacnt HHBanH,llHOCTH cepbe3HO 3aTPy,llHReT perHCTpaUHII HHBaJlH,QOB H npoee,lleHHe cpaBHHTeJll,Hl,IX HccneJlQeaHK\. HeCK011bKO pa.Hbble, e 1978 r., OWJa C03.naHa PaOo'laR rpynna no KJJaCCH¢HKauHH H KO,llHpoBaHHJO C uem,io nO,llrO'rOBKH CnpaBOtOtHJ<a no CYJl1E!C'l'ByJObla% HOMeHKnaTYJ)e H KO.JlHpoBaHHIO B oOnacrH 3.flpaBOOXpaHeHHRJ npH 9TOM OblJIO npHHRTO pebleHHe O Heo0XO,llHMOCTH C03.llaHHR HeOorn:r b1HX nowpynn no KOHKpeTHblM TeMaM. 0.IIHa H3 TaJ<HX no.nrpynn 3aHHManaCb npo(5neMoo HHBamf,llHOCTH. Ha nporRieHHH 1980 r. OHa paOO'rana no TJ)eM OCHOBHLIM HanpaBneHHRM: - yCTaHOBneHHe Melt,llyHapo,llHLIX KOHTaJ<TOBJ - nepeBO.ll ICIDH Ha rOJUlaH,llCKWi R3LIKJ H - opraHH3a.J..Offl paOo'JeR KOH¢epel-ll.lHH 3aHHTepecoeamn,oc nHU H nareIB.lHaJibHLIX nam,3oeaTeneA KnaccHCJ>HKaJ..01H. ,llnn TOro 'JTo01,1 oOner'IHTb nepeeo.ll, OWlH ycrattoenemr KOH- TaKTLI c B03 H c OCHOBHLIM aEITOpoM ICIDH. Ha paCCMO'rpeHHe pa- Oo'JeH KOH¢epeJ-ll.lHH OWi npe,llCTaElneH rtpe.llBapHTe.Tll:JihlA TeKCT ne- peBO,lla, H crano RCHO, 'ITO Heo0XO,llHMO peblHTb uenwA PR.Q npaK- TH'tecKHX npo(5neM H npeo,llOneTb MHOro TPY.IIHOCT9%, ~e 'JeM ICIDH MOJKHO Oy,lleT HcnOnb30BaTb B peaJlbHGI oOC'I'aHOBKe. 8 'JHcnO nareHUHaJlbHLIX OOnb30BaTeneR BXO,llRT 00:be,llHHeHHaR Me,llH- UHHCKaR ~a, KOTOpaR xarena 01,1 HcnOJib30BaTb ee B Ue.nRX perHCTpaUHH B CBR3H C OCYb!eC'rBneHHeM 3aKOHa O MaTepHaJtbHOM oOecne'leHHH npH oObteR HHBanH,llHOCTH (3TO'r 3aJ<OH KacaeTCR CTpaxOBaHHR HaceneHHR Ha cnY'faH HeTPY.llOClloco0HOCTH)1 56 Uempam,Hoe CTaTHcrlNeo<Oe OIOpo, KOTOpoe paccMaTPHBaeT B03- MOltHOCTb BKJllOqeHHJI HH,llHKaTopa 3~0poBbR B CBOH 0630P HHTep- BblO O COCTORHHH 3~opOBbR f a TaKlte pa3nlNHLre yqpe!l,lleHHR, 3aHHMaKIIIHeCR peaOKmiTauHeli, KOTopbre HaMepeBalOTCR BBeCTH perHCTP peaOHJniTauHH. CTanO RCHO, 'ITO npHMeHHTeJlbHO K perHCTPY HeoOXO.llHMO Oy~eT COOTBeTCTBYKIIIHM o0pa30M H3MeHHTb He TOJlbKO ICIDH, HO TaKlte MJ<B H Me!PYHapo~HylO KnaccH¢HKaUHIO npoue,nyp B Me,llHUHHe (MKllM) (13). TeM BpeMeHeM (51,1na pa3pa- 60TaHa ¢opMa BOnpocHHKa ~R npoBe~eHHR peaOHnHTaUHOHHoro ,IIHeBHOro netteHHR. OH BKnl()t{aeT 0oJtblllyJO ttaCTb nepettHR CHHlteHHH Tpy~ocnocoOHOCTH H3 ICIDH no ~Y3HatJHLIM pyOpHKaM. OHH crpynnHpoBaHbl cne~KIIIHM o0pa3oM: HapYbJeHHe cnocoOHOCTH BblllOJIH1ITb OOBCe,llHeBHble ~ena; - COUHaJlbHble aHOManHH; H KOMMYHHKaTHBHble HapYbJeHHR. 4eTBepTaR rpynna Oy~eT npHMeHRTbCR ~ paHHero oOHapy1teHHR nOTeHUHaJlbHLIX ~e¢eKTOB y ~eTcli Mna.Illllero B03paCTa. OcTalOTcR O.DHaKO qenipe BallHJ,1e npooneMb1. 1. npoesneMbl, cBR3aHHb1e c caMoH KnaccH¢HKauHcli, BKnl()t{aJOT: KPHTH'tecKHe 3aMetJaHHR OTHOCHTeJlbHO rpynnHpoBaHHR, MeTo~a pa3MeMeHHR nyHKTOB B nepe'-IHRX I HD H He~ocTaTOtJHO no~OHOH cJ)opMbl nepetJHR H; KpHTHqeCKHe 3aMetJaHHR OTHOCHTenbHO ICIDH co CTOpoHbl Tex, KTO paOOTaeT co MKaJlOH oueHKH CTeneHH ncHXono- rnqecKHX HapYbJeHHH H co MKanOO oueHKH cmuteHHR TPY- ~ocnocoOHOCTH npH ¢YHKUHOHaJlbHblX OCHX03aX; OTcyTCTBHe TOqffOro OOHCaHHR H KpHTepHeB npH KO,IIHpO- BaHHHJ H 57 58 He,llOCTaToqHoe noHHMaHHe CBR3H Mell(,Qy HapYlJleHHRMH, CHHJlteHHeM TPY .nocnocoOHOCTH H YTpaTC::lt TPY .nocnocoO- HOCTH ( COUHaJlbHOO He.nOCTaTOqffQCTI,I()) • 2. npo011eMb1, CBR3aHH1>1e C npaKTHqecKHM npHMeHeHHeM MJ<HCTCH, BKJl)()qaJOT HeoOXO,DHMOCTb e: PYKOBO.DCTBe no ee npHMeHeHHIO H B HHCTPYKUHH no KO,llHpoBaHHIO; ueHTpanH30BaHJ-IOH npo¢eccHOHaJ!bHOH no,nrOTOBKe Ka.npoe ,DJlR paOon,1 c ICIDH; pa3pa0oTKe CTaH,IlaµTH3HJX)BaHHOH HCTOPHH Oone3HH; pa3paOoTKe KPHTepHeB ,DJlR cocraeneHHR 3aJIBKH o0 oocne.noeamrn ycnoeHH m3HH ceMbHJ H Ha3HaqeHHH PYKOBO,DHTeJlR paOonl Ha,[l KnaccKJ)HKfilU,feH. 3. 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B TeX CJlY'laRX, KOr,lla 3TO B03MO;ntO, oueHKY noTpeOHOCTeH H pecypcoB noEUDro '-lenOBeKa cne.QyeT npoBO)lHTb B npHBbl'-lHNX ,llJ1R Hero ycnoBHRX, a He B KnHffHtlecKOO oOCTaHOBKe, nOCKOJlbKY y0e)lHTe.11l,HO noKa3aHo, '-lTO TO'-lHaR oueHKa nyqme Beere ,llOCTHraeTCR B 3HaKOMOM OKp~eHHH. 14. ,llJtl'I roro '-ITOON oueHl1Tb, npaBHJlbHO a.npecoBaTb H cpaB- HHTb B03.lleHCTBHe aJlbTepHaTHBHLIX BNemaTeJibCTB H oOecne'-lHTb onpe,lleneHHe HX pe3yJ1bTaTOB, cne,llyeT npHMeHRTb TaKyJO CHCTe- MY, KOTOpaJI ON TO'-lHO OtUfCLlBana BMeruaTeJlbCTBO no ero KOHl<'- peTHhlN KOMnOHeHTaM. 3To OTHOCHTCR KaK K npo¢HnaKTH'-lecKHM MepaM, npHMeHReMLlN B OTHObleHHH Hel-UiBamt.nOB, TaK HK CTpaTe- rHRN BMelda.TeJlbCTBa, npoBO,llHMblM C uenblO ne'-leHHR, HK CTpaTe- rHRM yxo,lla 3a HHBaJU-f.QaMH. 15. 4To0N OT,llaBalt ,llOJWHoe TOO po.11H, KOTOPYIO Hr'palOT cpe,llCT- ea MaCCOBOO HH<J)opMatlHH e pacnpoc:rpaHeHHH cpeJlH nollUiJlblX cee- ,llel-D-IA O TON, '-lTO KacaeTCR HX CaMHX, B ocoOeHHOCTH B OTHOme- HHH UenH 11 3.QOpoBbe ,llJ1R Bcex K 2000 r'O.Qy 11 , HaUHOHanbHNe npa- BHTeJibCTBa, paBHO 1<aK H B03, npHBneKanH Cpe,llCTBa MaCCOBOO HHcJ)oPMatlHH Beer.Ila, KOr,lla 3TO B03MOllHO, B Ka'-leCTBe PaBHO- npaBHLVC napniepoB, a He CTopol-UiHX HaOJDO,llaTeneH npH npoBe,lle- HHH MeponpHRTHA, HanpaBneHHblX Ha ,llOCTHieHHe 3THX ueneA. 65 B ar~o hleHJrn I CIDH Pa6o'laR rpynna npHHRJla cne,nyio1111-1e peKOMeH,llaUHH: 16. rocy.napcTBa-qneHbl ,llOMHhl C03,llaBaTb ycnOBHFI .DnFf oOcro11- TeJII,HhlX ,llHCKyccl-Gi B C(X)TBeTCTBYKlllcli oOcTfil!OBKe, nOCBf!llleHJ-lblX <!JyH,llaMet-ITaJil,HhlM KOHUent..IHRM, H pa3paCian1BaTb COOTBeTCTBY1()1lJYIO TepMHHOJlOrHIO ,ll1lFI KaJIUIOH CTpa.Hbl. 17. rocy.napcTBa-qneHbl .11O11:un.1 cnocoCx:TBOBan, H3yqeHHIO npaK- TH'lecKoro npHMeHeHHR I CIDH, 'IToOLI BblRBHTb ee cnaO1>1e H CJ.tJII,- Hhle CTOpoHl>I. 18. rocy.napcTBa-q11eH1>r .nom,;Hh1 npH3BaTb Bee opraHH3aI.(l,fJ.f B CBOe.H CTpaHe, KOTOpble npHMeHRIOT ICIDH, K TOMY, 'lTo01>1 OHH npe.no cTaBJlRJlH B03 cBe,lleHHR o ee 9¢<1>eKTHBHOCTH. 19. B rocy.napcTBax-qneHax HeoOXO.IlHMO npoBeCTH Hccne.noBa- HHR, B TOM •rncne H CHJJaMH MempaBHTeJil,CTBeHJ-lblX opraHH3a.I.ll-lA, nOCBRllleHHhlX pe3ym,TaTaM npHMeHeHHR H ynpo(lleHHIO ICIDH • 20. HeoOXO,llHMO pa3pa6oTaTb CHCTeMY KJlaCCH<!>HKauHH nmoB BMelJJaTeJil,CTBa, Y'JHTl>IBaR y'Tl.e cymecTBYKIIIYJO MKllM, BLIXO,llRlllYJO B C\JlHll(aHl!lee BpeMR KJlaccH¢HKaUHJO BcnoMoraTeJII,Hb(X yCTpoHCTB, no.nraroB11eHHy10 Mell(.nyHapo,llHoH opraHH3a.IlHeA no CTfil!,llaJ)TH3aJ.lHH (HCO ) H IC IDH. 21. HeoOXO,llHMO H3Y'-OITb MeTO,lll>I KJlaccH<!JHKaI.(l,fH npo011eM, C KO- T OPblMH CTanKHBalOTCR JllO,llH ( 3TO npe.nnottTHTeJII,Hee, tteM cocpe- ,llaTO'-OIBaTb BHHMaHHe Ha HMeKlltHXCR y HHX HapytdeHHJIX, cHHJl:eHHH TPY .nocnocoOHOCTH H T. ,ll. ), YBR3b1BaR 3TH MeTO.llbl C IC IDH . 66 OlHCDK JD,1TEPATYP1' I . /111 erna1io 11al classifica lion of impa1rmen1s. disabili1ies and handicaps: a ma nu a l o f classi fi ca ti o n rel a ting to the co nsequences o f disease . Gen- eva. Wo rld Hea lth O rga niza tio n . 1980 . 2. Regional s1ra1egy fo r a11aining health fo r all by the year 1000. Copen- hage n . W II O Regio na l O ffi ce fo r Euro pe. 1980 (unpublished d ocu- ment EU R/ RCJ0/ 8). 3. Repon of th e 1hir1y-fi rs1 session of !he Regional Commiuee fo r Europe. Cope nh age n . WII O Reg io na l O ffi ce fo r Euro pe , 1981 (unpublished docu ment EU R/ RC J l / 14 Ro:v . l). 4. Nursing and medicosocia/ 11 ·ork in the care of the elder/1•: repo rt o n a Conference . Co penhagen . WIIO Regio nal Office for Europe . 1')82 (EU RO Reports and Studies. No. 72). 5. • Alma-A ta /9 78: primary health care: rep ort o f th e Int erna ti o na l Co n- ference o n Primary Health Ca re . Ge neva , World ll ca llh O rga ni ,a- ti on. 1978 (Health for All Series. No . I) . 6. Office of Population Ce nsuses and Surveys. Morhidit_v statistics ji-0111 general pracltce. second na11011al s111dv /9 70-7 I. London, H. M. Sta - tionery Office. 1974 (Studies on Medi ca l a nd Popu latio n Subj ec ts. No . 26). 7. Harris, A.I. Handicapp ed and impaired in Great Britain, Part I . Lon- • do n. H.M. Stationery Office , 1971. 8. Wood, P.H.N. & Badley, E.M. An epidemio logica l appraisal of disable- ment. In: Bennett , A. E .. ed . Recent advances in community medicine. Londo n. Churchill Livingstone . 1978. 9 . . Knowelden, J. et al . Incid ence o f fr ac tures in perso ns over 35 yea rs o f age : report to the MR C Working Party o n frac tures in the elderl y. British journal of preventive and social medicine. 18: 130-141 ( I 964 ). 10. Baker, D.R. et al. Mental state and other prognostic factors in fem oral fractures of the elderly. Journal of the Royal College of General Prac- titioners, 28: 557-559 ( 1978). 11. Wood, P.H .N. & Badley, E.M. An epidemiological appraisal of bone and joint diseases in the elderly . In: Wright , V., ed . Medicine in old age: bone and joint disease. London . Churchill Livingstone, 1982. 12. Atkinson, R.C. & Schirrrln, R.M. Human memory, a proposed system and its control processes . In: Spence. K. W. & Spence . P .. ed . The psychology of learning and motivation. New York. Academic Press. 1968. 13. International classification of procedures in medicine. Geneva. Wo rld Health Organization. 1978. 67 OpHnoir.eHHe 1 AflbTEPHATiffi~ nnH BMEIIIATEnbCTBA HA rIEPBHYHOM, B'IDPH4HOM H TPE'I'HYHOM YPOBHE rIPH EOPbBE CO OIH~M TPY,llOCI10COBHOCTH 06otHe nonoir.eHHR npe,nynpeir..neHHe B03MOllHl,IX onacHOCTeH B OCHOBHOM 9TO RBnReTCR cfJYHJ<UHeH COUHaJlbHOH noJJHTHl<H H BKJllO'laeT cne.ny~ntHe MeponpHRTHR: yMeHbrueHHe MacruTaOa onaCHOCTH (HanpHMep, orpaHlNeHHe . 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