What is primary: frailty or sarcopenia? (literature review)

Среди множества гериатрических синдромов несомненно одно из первых мест занимают старческая астения и саркопения. Несмотря на широкое их освещение в современной научной медицинской литературе, до сих пор актуальным остается вопрос о взаимосвязи этих гериатрических синдромов. Какой из вышеуказанных синдромов является первичным, а какой - вторичным? Они конкурируют между собой, взаимно отягощают друг друга, не зависят один от другого либо же объединены общими патологическими механизмами? Рассмотрению этих вопросов посвящен данный обзор литературы. Among the many geriatric syndromes, undoubtedly, one of the first places is, in other words, the leading positions are occupied by frailty and sarcopenia. Despite their wide coverage in the modern scientific medical literature, the question of the relationship of these geriatric syndromes with each other is still relevant. Which of the above syndromes is primary and which is secondary? Do they compete with each other, mutually burden each other, do not depend on each other, or are they united by common pathological mechanisms? This literature review is devoted to these issues.

Current issues of disability and rehabilitation of elderly and senile patients with lower limb loss due to vascular pathology

Большинство пациентов с ампутационным дефектом нижних конечностей являются гражданами пожилого возраста с высокой ко- и полиморбидностью, наличием нескольких гериатрических синдромов, что неблагоприятно влияет на прогноз, снижает реабилитационный потенциал, в ряде случаев приводит к развитию сердечно-сосудистых осложнений, ампутации второй конечности, тяжелой инвалидизации и высокой послеоперационной летальности. Ключевым звеном процесса реабилитации инвалидов с культей нижней конечности является обеспечение их функциональным протезом. В статье приведен анализ заболеваемости, первичной инвалидности в период 2015-2019 гг., гендерных, возрастных и клинических характеристик пациентов, проживающих в Санкт-Петербурге, которым выполнена ампутация нижней конечности вследствие сосудистой патологии. Установлено, что отсутствует информация о выживаемости пациентов после проведения ампутации в различные сроки постгоспитального периода в Санкт-Петербурге. Выявлен выраженный дисбаланс между количеством выполняемых ампутаций нижних конечностей ежегодно и количеством обращений инвалидов в бюро медико-социальной экспертизы для обеспечения техническими средствами реабилитации и направлением на первичное протезирование, реабилитацию. The majority of patients with amputation defect of the lower extremities are elderly citizens with high co- and polymorbidity, the presence of several geriatric syndromes, which adversely affects the prognosis, reduces the rehabilitation potential, in some cases leads to the development of cardiovascular complications, amputation of the second limb, severe disability and high postoperative mortality. The key link in the rehabilitation process of disabled people with a lower limb stump is to provide them with a functional prosthesis. The article provides an analysis of morbidity, primary disability in the period from 2015 to 2019, gender, age and clinical characteristics of patients living in St. Petersburg who underwent amputation of the lower limb due to obliterating artery diseases is presented. It was found that there is no information on the survival rate of patients after amputation at various times of the post-hospital period in St. Petersburg. We have identified a pronounced imbalance between the number of lower limb amputations performed and the number of applications of disabled people to the bureau of medical and social expertise for providing technical means of rehabilitation and referral to primary prosthetics.

Depressive Symptoms and Malnutrition are Associated with Other Geriatric Syndromes and Increase Risk for 30-Day Readmission in Hospitalized Older Adults: A Prospective Cohort Study

Background: Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods: Consecutive admissions of patients >65 years to a general medical department were recruited over 15 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for intermediary events including poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results: We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) patients. Depressive symptoms (OR 1.55, 95% CI 1.15-2.07), malnutrition (OR 1.59, 95% CI 1.14-2.23), higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P<0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR=1.62, 95% CI 1.22-2.16), had poor oral intake (OR=1.35, 95% CI 1.02-1.79) and functional decline during admission (OR=1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty, delirium, cognitive impairment and poor oral intake during hospitalization (P<0.05). In minimal adjustment set identified by DAG, depressive symptoms (OR=1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was attenuated after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR=1.40, 95% CI 0.99-1.98, P=0.06). Conclusion: The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

Epidemiology, diagnosis, and assessment of diabetes mellitus in the elderly population: a purposive review

The elderly population with diabetes mellitus is rapidly growing worldwide and has become a major social burden with significant impact on health and economics. This social category requires considerations that are not traditionally associated with diabetes mellitus management. Several epidemiological studies have shown that the prevalence of diabetes mellitus increases with advancing age. According to the recent International Diabetes Federation (IDF) published data, the number of people with diabetes mellitus among those 65 and over has reached 136 million (19.3%) with more frequent diabetes mellitus complications and co-morbidities compared to the young counterparts. Cardiovascular complications are the leading cause of death and the quality of life is strongly impacted by geriatric syndromes such as poor vision, dementia and functional dependence. The elderly diabetic population is classified into three categories; the robust, the fragile and the patient at the end of life. In practical terms, they can also be classified into two categories: the autonomous patients and the dependent patients, requiring support and assistance. Keywords: diabetes mellitus, elderly, epidemiology, geriatric syndromes, geriatric evaluation.

The role of exercise and physical activity on aging-related diseases and geriatric syndromes

Aging is a complex process of physiological and social changes that leads to various diseases. The number of elderly people in the world is increasing dramatically and it should be noted that rapid population aging represents a major public health burden. On the other hand, providing an appropriate and low-cost approach to control and prevent complications such as chronic diseases, physical dysfunction, and the geriatric syndrome is necessary. Also, numerous studies have shown that participation in physical activity and exercise training reduces the incidence of dysfunctional capacity, cardiovascular and metabolic disease, as well as the premature death rate in older adults. After plenty of precise observations about the role of exercise on aging-related diseases and geriatric syndromes articles, the benefits of exercise and physical activity in older adults will be more tangible. Therefore, the first purpose of the present review was to investigate the mechanisms of PA and exercises that are involved in the prevention of aging-related diseases and GS using current evidence (from 2015 onwards). Also, the purpose of this study was to provide an exercise guideline (aerobic and resistance training) based on recent evidence (from 2015 onwards). El envejecimiento es un proceso complejo de cambios fisiológicos y sociales que conduce a diversas enfermedades. El número de personas de edad avanzada en el mundo está aumentando drásticamente y cabe señalar que el rápido envejecimiento de la población representa una importante carga para la salud pública. Por otro lado, es necesario brindar un enfoque adecuado y de bajo costo para controlar y prevenir complicaciones como enfermedades crónicas, disfunción física y síndrome geriátrico. Además, numerosos estudios han demostrado que la participación en la actividad física y el entrenamiento físico reduce la incidencia de disfunciones, enfermedades cardiovasculares y metabólicas, así como la tasa de muerte prematura en los adultos mayores. Después de muchas observaciones precisas sobre el papel del ejercicio en los artículos sobre enfermedades relacionadas con el envejecimiento y síndromes geriátricos, los beneficios del ejercicio y la actividad física en los adultos mayores serán más tangibles. Por lo tanto, el primer propósito de la presente revisión fue investigar los mecanismos de actividad física y ejercicios que están involucrados en la prevención de enfermedades relacionadas con el envejecimiento y síndrome geriátrico utilizando la evidencia actual (de 2015 en adelante). Además, el propósito de este estudio fue proporcionar una guía de ejercicio (entrenamiento aeróbico y de resistencia) basada en evidencia reciente (de 2015 en adelante).

PECULIARITIES OF GERIATRIC STATUS OF PATIENTS WITH AGE-AGE MACULAR DEGENERATION

В пожилом возрасте вследствие иволютивных процессов и соматической патологии происходит ухудшение гериатрического статуса и преждевременное старение. Присоединение зрительного дефицита, вызванного возрастной макулярной дегенерацией, еще в большей cтепени снижает функциональную активность пациентов. Цель исследования - изучение особенностей гериатрического статуса пациентов с возрастной макулярной дегенерацией. На базе офтальмологического центра проведено обследование свыше 200 пациентов с возрастной макулярной дегенерацией. Контролем служили пациенты с отсутствием данной офтальмологии. Всем пациентам выполнено комплексное офтальмологическое и гериатрическое обследование, включающее оценку зрительных функций и основных клинических гериатрических синдромов. В ходе исследования установлено, что возрастная макулярная дегенерация статистически значимо ухудшает гериатрический статус пациентов по таким позициям как личностная и ситуативная тревожность синдром гипомобильности, ограничения в бытовой активности по шкале Гронингена. У пациентов с возрастной макулярной дегенерацией гериатрический статус отягощен также синдромом полиморбидности, представленным преимущественно артериальной гипертензией, ишемической болезнью сердца, сопутствующий офтальмологической патологией. Среди пациентов пожилого возраста с возрастающей макулярной дегенерацией статистически значимо выше распространённость. Все это указывает на важность оценки гериатрического статуса для его корреляции In old age, due to evolutive processes and somatic pathology, there is a deterioration in geriatric status and premature aging. The addition of visual deficit caused by age-related macular degeneration further reduces the functional activity of patients. The aim of the study was to study the features of the geriatric status of patients with age-related macular degeneration. On the basis of the ophthalmological center, more than 200 patients with age-related macular degeneration were examined. Patients with the absence of this ophthalmology served as control. All patients underwent a comprehensive ophthalmological and geriatric examination, including an assessment of visual functions and the main clinical geriatric syndromes. In the course of the study, it was found that age-related macular degeneration statistically significantly worsens the geriatric status of patients in such positions as personal and situational anxiety, hypomobility syndrome, limitations in everyday activity according to the Groningen scale. In patients with age-related macular degeneration, the geriatric status is also aggravated by polymorbidity syndrome, represented mainly by arterial hypertension, ischemic heart disease, concomitant ophthalmic pathology. Among elderly patients with increasing macular degeneration, the prevalence is statistically significantly higher. All this points to the importance of assessing geriatric status for its correlation

Evaluation of the effect of chronic pain on the functional and physical status of patients in older age groups

Objective: to assess the structure and influence of chronic pain (CP) on the functional status of patients with geriatric syndromes.Patients and methods. The study included 370 geriatric patients who were divided into two groups. Group A included 300 patients (mean age 75.1±8.25 years) with CP, and group B – 70 subjects of comparable age (75.1±7.75 years) without CP. All study participants were found to have polymorbidity: the Charlson index was 5.55±1.59 points in group A and 5.56±1.64 points in group B (p=0.963). All patients underwent a comprehensive geriatric assessment (CGE) to determine the functional status and diagnose geriatric syndromes.Results and discussion. According to the CGE data, senile asthenia syndrome was detected in 127 (42.3%) patients with CP and in 20 (28.6%) patients without CP (p=0.035). The average number of geriatric syndromes in group A was 7.06±2.68, in group B – 5.2±1.8 (p<0.001).Group A patients differed from those without CP in a significantly higher degree of dependence in daily life (Bartel index) and a lower score on the Physical Performance Battery.Conclusion. Patients with CP have poorer physical functioning and a greater degree of dependence on others in their daily life. When planning the most effective complex strategies for the treatment and prevention of CP exacerbations, it is necessary to take into account the functional status of elderly patients.

Prevalence of Oropharyngeal Dysphagia and Risk of Pneumonia, Malnutrition, and Mortality in Adults Aged 60 Years and Older: A Meta-Analysis

<b><i>Introduction:</i></b> Oropharyngeal dysphagia (OD) is a serious health condition associated with poor survival and quality of life in adults aged 60 years and older. Comprehensive assessment and management of OD could lead to better and improved health outcomes for older adults. Therefore, we performed the first meta-analysis to determine the pooled prevalence of OD and risk of pneumonia, malnutrition, and mortality. <b><i>Methods:</i></b> Databases including Ovid-MEDLINE, Web of Science, Embase, PubMed, Cochrane, and CINAHL were searched up to January 2021. Data analysis was conducted using logistic-normal for prevalence rate and DerSimonian-Lard random-effects models for outcomes and associated factors of OD, providing odds ratio (OR) and corresponding 95% confidence interval (CI). <b><i>Results:</i></b> The pooled prevalence of OD in 39 studies with 31,488 participants was 46% associated with higher pooled OR for risk of pneumonia 2.07 (95% CI, 1.58–2.72), malnutrition 2.21 (95% CI, 1.43–3.41), and mortality 2.73 (95% CI, 1.62–4.60). Geriatric syndromes including fecal incontinence 6.84 (4.955–9.44), immobility syndrome 6.06 (5.28–6.96), pressure ulcers 4.02 (2.46–6.56), sarcopenia 3.10 (1.89–5.09), urinary incontinence 2.75 (1.81–4.19), frailty 2.66 (1.16–6.13), delirium 2.23 (1.73–2.87), and falls 1.47 (1.19–1.81) and comorbidities including dementia 3.69 (2.36–5.78) and stroke 1.92 (1.47–2.52) were associated with OD. <b><i>Conclusion:</i></b> Early identification and management of OD should consider geriatric syndromes and neurogenic comorbidities to prevent malnutrition and pneumonia and reduce mortality in adults aged 60 years and older.