The concept of reference value in geriatrics

In order to ascertain with certain certainty the predominant role of one or several mechanisms, the intervention of additional factors in the natural development of the aging process, it is necessary to cite the characteristic of functional changes occurring in the body's basic systems as they age. At the same time, it is necessary to take into account a number of peculiarities and conventions that arise when assessing the quantitative characteristics of age-related changes.

To objectify the detection of physiological and pathological values ​​of the results of laboratory tests, they are compared with control( reference) values, that is, with the values ​​obtained by the same methods in healthy individuals in the same population. Although the boundaries of age norms sometimes cover a wide range, they nevertheless define the ontogenesis of its main stages - formation, maturity and extinction. This implies the existence of an age standard for each age period and each population, that is, a consistent change in the norm. Unlike the period of formation, at the stage of extinction it is much more difficult to determine the boundaries of the "norm", since there are no sharp transitions between the elderly and senile ages. Therefore, the boundaries of the "norm" are very conditional.

In addition, the use of such a concept of "reference" values ​​for aging is limited. The problem is that the values ​​obtained from middle-aged people are used as reference values ​​for evaluating the results of analyzes of older people. Thus, on the one hand, the wrong "control" group is elected, and on the other hand, the notion of "reference value-norm-health" is not always preserved.

It should be noted that if for a young or middle-aged person the disease is an exception to the rule, then in the elderly people there is a reverse situation. Such a concept as a "fully healthy elderly person" should be considered an exception rather than a rule. Therefore, the control values ​​of laboratory indicators in the elderly do not necessarily coincide with the normal values ​​in young and middle-aged people.

However, the definition of the norm for the elderly is a necessary point of reference for practical medicine in terms of choosing specific preventive and curative measures.

Perspective approaches based on a regular assessment of the dynamics of laboratory indicators of an individual for life, or from the age of 30-35 years. The results of laboratory studies of an individual, obtained with a certain periodicity, are the best reference values. In order to follow the age dynamics in a person, any test that marks a systematic age-related change in any structure or function of the body is perfectly acceptable.

Currently, there is another approach to solving this problem - the introduction in clinical practice of the concept of an idealized "single norm" - the magnitude of the characteristics of the state of homeostatic systems of the organism at the age of 20-25 years. By the age of 20-25 the body's growth is coming to an end. In this period, mortality from all major diseases is minimal, therefore it seems optimal to adopt the indicators characteristic of this age, for the rate, if a person during this period has no diseases. In this regard, the optimal one should be considered the norm that is characteristic of every person in 20-25 years;it can be conditionally designated as an ideal norm. This is the starting point from which the path to age-related pathology begins, and that ideal, to the maintenance of which it is necessary to strive. Apparently, this approach should be considered the most optimal, as it allows to identify early manifestations and leading mechanisms of aging and thereby control this process.