Comorbid patient with arterial hypertension: difficulties in diagnosis and treatment

The problem of comorbidity becomes especially relevant in the conditions of demographic aging of the population. In recent years the number of studies devoted to diagnostic and treatment features of comorbidities, especially in elderly and senile patients, has increased. In spite of this fact, until now there are no clear recommendations for the management of comorbidities in the therapeutic practice.The article is devoted to the presentation and discussion of a clinical case of a comorbid patient with arterial hypertension. The stages of the performed diagnostic search with verification of the clinical diagnosis and the tactics of the prescribed pharmacotherapy are presented. On the basis of the presented data it is shown that exacerbation of one of the chronic diseases of the patient’s general comorbid background may significantly increase the severity of the general pathology and in its turn will determine the prognosis and influence the treatment tactics. The complexity of this case is that the patient has chronic single kidney disease in the stage of chronic renal failure. In analysing this case, it is also important to note the difficulties in the choice of drug therapy, as this situation poses significant limitations in the use of many drugs. This is a challenge that every clinician faces on a daily basis, regardless of clinical experience and medical knowledge. Only a multilevel approach will enable comprehensive medical and social care to be organised for patients with co-morbidities with chronic diseases, provide follow-up not only during exacerbations but also during remissions, contribute to the prevention of exacerbations and complications, which will consequently improve prognosis and quality of life.

Sarcopenia and nutritional support for elderly and senile patients

Демографическое старение населения приводит к значительному увеличению доли лиц пожилого и старческого возраста как на амбулаторном, так и стационарном этапах лечения. За последнее десятилетие средний возраст основного контингента больных в отделениях реанимации и интенсивной терапии составляет более 65 лет, с тенденцией к увеличению, что предопределяет стратегию более тщательной оценки подходов к проведению лечебных мероприятий с учетом полиморбидности и функциональных возможностей пациентов старших возрастных групп как в период пребывания в стационаре, так и на дальнейших этапах восстановления и реабилитации. Известно, что в целом длительность пребывания в отделениях интенсивной терапии пожилых пациентов значительно выше, а результаты лечения и реабилитации достоверно ниже, чем у более молодых. Это связано с сочетанием целого ряда факторов: коморбидности/полиморбидности пациентов пожилого и старческого возраста, снижения функциональных резервов организма, синдрома старческой астении, главными составляющими которого являются саркопения, недостаточность питания. Связь старческой астении с увеличением длительности госпитализации, снижением физической активности, развитием функциональных дефицитов, увеличением риска падений, переломов и смертности достаточно хорошо изучена, однако в рутинной клинической практике оценке нутритивного статуса, диагностике недостаточности питания и решению проблемы недостаточности питания пациентов с синдромом старческой астении и саркопении уделяется недостаточное внимание, несмотря на известные факты о взаимосвязи недостаточности питания, снижения массы скелетных мышц, в том числе их силы или функции с неблагоприятным исходами заболевания. В амбулаторном этапе, кроме малоподвижного образа жизни, развитию и прогрессированию саркопении часто способствуют наличие тяжелого заболевания, сопровождающегося системным воспалением, метаболическая резистентность, нутритивная недостаточность и депрессия, характерные для данной категории больных. Современные подходы к лечению пациента пожилого и старческого возраста подразумевают проведение регулярной оценки нутритивного статуса и консультирование по вопросам рационального питания с внедрением методов нутритивной поддержки в комплексную программу ведения пожилого пациента наряду с основными лечебными и реабилитационными мероприятиями с целью замедления прогрессирования синдрома астении и саркопении. Demographic aging of the population leads to a significant increase in the proportion of elderly and senile people, both at the outpatient and inpatient stages of treatment. Over the past decade, the average age of the main contingent of patients in intensive care and intensive care units is more than 65 years, with a tendency to increase, which predetermines the strategy for a more thorough assessment of approaches to treatment measures, taking into account polymorbidity and functional capabilities of patients of older age groups, as the period of stay in hospital, and at further stages of recovery and rehabilitation. It is known that, in general, the duration of stay in intensive care units for elderly patients is much longer, and the results of treatment and rehabilitation are significantly lower than that of younger patients. This is due to a combination of a number of factors: comorbidity/polymorbidity of elderly and senile patients, decreased functional reserves of the body, senile asthenia syndrome, the main components of which are sarcopenia, and malnutrition. The relationship of senile asthenia with an increase in the duration of hospitalization, a decrease in physical activity, the development of functional deficits, an increase in the risk of falls, fractures and mortality is well understood, however, in routine clinical practice, assessing nutritional status, diagnosing malnutrition and solving the problem of malnutrition in patients with senile asthenia syndrome and Insufficient attention is paid to sarcopenia, despite the known facts about the relationship of malnutrition, a decrease in skeletal muscle mass, including their strength or function, with unfavorable outcomes of the disease. In the outpatient phase, in addition to a sedentary lifestyle, the development and progression of sarcopenia is often facilitated by the presence of a severe illness accompanied by systemic inflammation, metabolic resistance, nutritional deficiency and depression characteristic of this category of patients. Modern approaches to the treatment of an elderly and senile patient imply a regular assessment of the nutritional status and counseling on rational nutrition with the introduction of nutritional support methods into a comprehensive management program for an elderly patient, along with basic treatment and rehabilitation measures in order to slow the progression of asthenia and sarcopenia syndrome.

Modern Approaches to Diagnostics and Correction of Aging Biomarkers

From the biomedicine point of, view ageing is a natural process, characterized by a gradual decrease in the physiological integrity and adaptive abilities of the body, leading to a violation of its functions and an increase in the risk of death with age. Demographic aging of the population is a serious socio-economic problem, both in Russia and around the world. The main cellular and molecular signs of aging include genome instability, telomere shortening, epigenetic alterations, impaired proteostasis, impaired nutrient recognition, mitochondrial dysfunction, cellular aging, the stem cell pool depletion and changes in intercellular interaction, extracellular matrix rigidity, as well as activation of retrotransposons and chronic inflammation. For these reasons, in modern healthcare, preventing premature aging and treating age-related diseases is becoming a priority task. This review presents modern approaches to the quantitative assessment of the aging process using aging biomarkers as functional parameters reflecting the biological organism age at the molecular, cellular, and organismal levels. This work also considers the actual non-drug and drug interventions allowing to slow down the development of age-associated pathological processes, allowing you to increase the quality and duration of life.

Characteristics and Prognoses of Long-Term Home Care Patients

With demographic aging, many older adults require home medical care. Although home-based primary care is promoted in the United States and Japan, there is insufficient evidence about it. We aimed to study the characteristics and prognoses of long-term home care patients. We prospectively registered 151 patients, estimated to receive physician home visits for more than six months, in a clinic in Chiba, Japan, in 2020. The mean (±SD) age was 83.9±10.0 years and ranged from 31 to 102 years. Most patients were men (60.3%) and aged 65 years or above (95.3%). We investigated clinical information, the Edmonton Symptom Assessment System Revised Japanese version (ESAS-r-J), Dementia Assessment Sheet in Community-based Integrated Care System 21 items (DASC-21), EuroQOL 5 dimensions 5-level (EQ-5D-5L) every six months, and the incidence of hospital admission, death, and patient transportation by ambulance. The most frequent diagnoses were dementia (31.1%), bone and articular diseases (17.2%), cerebrovascular diseases (11.9%), organ failure (9.3%), and neurological diseases (9.3%). Most patients (78.2%) showed more than 30 points on the DASC-21, suggesting cognitive impairment. Worse wellbeing, drowsiness, tiredness, anxiety, depression, and pain were the most prevalent symptoms. EQ-5D-5L index values were distributed around–0-0.2 and 0.4-0.7. During the first three months of physician home visits, 21.9% of patients had hospital admissions, 12.5% of them died, and 11.7% required hospital transportation by an ambulance. In this study, most long-term home care patients suffered from cognitive impairment. In addition to receiving care for daily life, these patients require intensive medical management.

International Migration of the Older Generation: Global and Russian Trends

The subject of this research is the international migration of the elderly (global and Russian trends). This topic is of particular relevance due to the fact that the elderly people make up 17% of international migrants (2019). In addition, older migration is at the intersection of four demographic “megatrends” - population aging, migration, population growth and urbanization. In addition, the international emigration of elderly Russians is practically not studied in the domestic literature. The hypothesis of the study is the assumption of the aging of international migration flows in accordance with the trend of demographic aging. Research method - secondary data analysis. The main empirical base is the data of the UN and Rosstat. Global statistics show that while the number of older migrants has increased, the proportion of older people has not changed. Thus, the hypothesis was not confirmed, which gives grounds to draw the following conclusion: migration lags behind aging. This is due to the weak mobilization and adaptive potential of the older generation. Russian statistics make it possible to single out 4 thousand people over the working age who moved abroad in 2019 (not including the CIS countries). The most popular destinations are Germany, Georgia. In conclusion, it examines the risks (negative impact on the labor potential of the country, etc.) and opportunities (rejuvenation of the age structure, reduction in age discrimination) for Russia in the context of the emigration of the elderly population. Analysis of the existing indices of active longevity showed the absence of migration as an indicator of activity, which significantly distorts this index. The direction of future research is to study the migration of Russian pensioners in the countries of Southeast Asia and China.

Education of values: Marketizing the aging population in urban China

In this article, I examine some of the marketing and sales strategies at Gardenview, a newly established eldercare company that ran a few residential eldercare facilities in Nanjing, China. There, like elsewhere in urban China, the projected aging demography was mobilized to push for an industrialization (chanyehua)—marketization and professionalization—of eldercare, transforming ideas and experience of eldercare by putting forward a new set of knowledge of aging. To this end, I first ground the rising eldercare industry in the transitioning paradigm of conceptualizing China’s population from population control to demographic aging. Then I explore ethnographically how Gardenview participated in the eldercare industry in a rapidly aging China. In particular, I look at the floorplans and the marketing stories as devices of the education of values—as prices, the good and desirable, and differentiators—to understand the social, economic, and ethical dynamics instigated by a transitioning demography. These values, as I show, are crucial in linking everyday life and choices with the paradigmatic shift of China’s population. Finally, I discuss how understanding the very processes of marketing and sales as an education of values could shed further light on what anthropologist Michael Fischer calls “literacies of the future” as a socially and economically elaborated and contested world of an aging China.

The impact of migration processes on the labor market in the Republic of Moldova

Economic transformations in recent years have produced changes in the social structure, as well as profound demographic changes, which have contributed to demographic aging and declining working age populations. Changes in the structure of the population, accompanied by migration have led to a reduction in the number of people employed, as well as to changes in the structure of employment. The study reveals that the socio-economic situation in the country, the imperfect evolution of the labor market, the diffifculty of securing a decent paying job, have put a signififi cant part of the population on the path of labor migration, which for many has become a necessity rather than a choice. At the same time, the remittances transferred in favor of individuals have become the only source of income for many households. All the above issues are current and, therefore, represent the topic of this research. The research was performed using comparative analysis methods, aided by graphs. Based on the results of this research, certain conclusions and recommendations were developed in order to promote a system of measures aimed at reducing labor migration, by applying sustainable socioeconomic development programs, which would contribute to the creation of new jobs.

Social Assistance in the Conditions of Population Aging: Comparative Analysis of Domestic and Foreign Experience

Since the second half of the twentieth century, humanity has increasingly begun to face the contradictory consequences of population aging. In our country, various practices of social assistance to aging citizens have also begun to expand, primarily related to their medical, social and material support, provision of social services at home, which were an alternative to living and servicing in homes for the elderly and disabled. It was during these years that the system of social assistance to the older generation (first of all, the lonely, those with chronic diseases and those in need of outside help), which is currently functioning, was laid. However, the domestic model was quite different from the foreign ones. Nevertheless, it made it possible to support various groups of people of late age and to develop certain socio-political approaches in the context of demographic aging.

Population Aging Tendencies in Islamic Countries Between 1950-2020: A Geographical Assessment

In the contemporary world, population aging and the factors affecting population aging are among the topics of interest of policymakers and planners in any country. Knowledge of this situation will help to regulate and even advance substantial population programs. This study aimed to investigate the trend of the demographic aging index in Islamic countries based on the analysis of survival history. The research method was descriptive-analytical, a type of applied research, and methods of collecting documentary information. The United Nations Population Database (1950 to 2020) was used for data collection. In the present study, 57 countries were grouped and studied in ten geographical areas. The statistical method used is survival history analysis. Data were analyzed using Stata statistical methods and non-parametric methods of estimating the survival function of the Kaplan-Meier method, Nelson-Aalen estimator, and the semi-parametric model of Cox’s proportional risk. Based on the results, it was found that the fertility index has a downward trend in the ten regions of the Islamic world. In contrast, the indicators of old age (with low acceleration) and life expectancy have an increasing trend. The probability of aging has a negative relationship with the total fertility rate and a positive correlation with life expectancy. Estimates of the survival function and cumulative risk for nine of the ten geographical regions (barring the Southern European region) of the Islamic world in 2020 indicate that the probability of aging in these regions is not significantly different. Likewise, the rate of entry into the aging phase does not differ significantly between the same geographical areas. Nevertheless, with the current trend of life expectancy and the reduction of fertility, many of these countries are likely to face the aging crisis in the coming years.

Stereotyping in Robotic Care: An Ethical Analysis of Vulnerabilities Among Older People in Digitalized Care Settings

"In light of demographic aging, the change of familial care arrangements, and the lack of skilled caretakers, robotic systems are increasingly discussed as a possible solution for eldercare. Sociopsychological research indicates that the ensuing human-robot interaction involves the same social categories as human-human interaction, e.g., gender, age and ethnicity. Indeed, these categories and related stereotypical markers are even strategically used in technology development to increase the acceptance and efficiency of robotic systems. Especially in vulnerable groups such as older people, however, such stereotyping strategies can be a reason for new vulnerabilities in digitalized care settings and cause serious moral problems that need critical reflection. In our contribution, we provide a systematic ethical analysis of stereotyping in robotic eldercare. Starting from the conceptual distinction between agency-based and harm-based conceptions of vulnerability, we explore potential moral issues and conflicts in the implementation of stereotypical care robots for older people and detect particularly serious challenges regarding users’ autonomy and wellbeing. Against this backdrop, we propose and discuss possible solutions like the explanation, neutralization or queering of care robots. Thus, we contribute to the theoretical conceptualization of older people’s vulnerabilities in increasingly digitalized care settings and draw conclusions for ethically sensitive technology development in eldercare. "