Senile Asthenia Research Articles

Bariatric surgery in elderly patients

BACKGROUND: Bariatric surgery is indicated to patients with morbid obesity and aged 18–60 years. In older aged patients, such surgery can also be taken into consideration, however, the procedure of selecting the patients is not included into the clinical recommendations, which determines the topicality of the research. AIM: To establish a protocol for surgical treatment of morbid obesity in patients older than 60 years. METHODS: The research included 800 patients operated during the period of 2018–2023 at the Federal State Budgetary Institution “Federal Scientific and Clinical Center” of the Federal Medical-Biological Agency of Russia due to the presence of morbid obesity, of which 38 had an age of 61 and older. All the patients underwent only two types of surgery — laparoscopic longitudinal resection and laparoscopic Roux gastric bypass surgery. All the patients of the older age group underwent personalized selection for surgical treatment, screening procedures were arranged in order to detect the senile asthenia syndrome and, retrospectively, to stratify them using the GeriBari prognostic scale. During one year of follow-up, the remote results were assessed in all the patients along with the quality of life. RESULTS: There were no postoperative complications in the older age group, the 30-day mortality was 2.6% (1 patient has died from the complications of the coronaviral infection). The weight loss was found to be significantly less in the older age group (61 and older) comparing to the main group of patients (18–60 years): for laparoscopic longitudinal resection — 55.5% versus 73%, respectively (р=0.01), for laparoscopic Roux gastric bypass surgery — 58% versus 77.5% (р=0.0008). The remission of type 2 diabetes was achieved in 70.6% of the patients of the older age group. The quality of life among the patients of the older age group, even with the slight decrease of the excess body weight, was significantly better 12 months after surgery. CONCLUSION: Among the elderly patients with morbid obesity, it is possible to perform bariatry surgeries safely and effectively when following the proposed protocol.

Determination of the frequency and influence of senile asthenia syndrome on older patients' treatment results in urgent abdominal surgery

Abstract. Modern demographic data indicate a constant increase in the quantity older people in the general population structure. With age, the body is affected by many factors that lead to senile asthenia syndrome. The study is devoted to the evaluation of the influence of senile asthenia syndrome on older patients' treatment in emergency abdominal surgery for improvement. Materials and methods of the study. Examination and evaluation of the treatment results of 161 (100.0%) patients was based on the Municipal non-commercial enterprise "City Hospital of Emergency and Rapid Medical Care". In the first part of the group, 81 (50.3%) patients were diagnosed with cholelithiasis (CHD) and acute cholecystitis. The second part of the group of 80 (49.7%) patients was diagnosed with perforation of a stomach or duodenal ulcer. All patients were examined and operated urgently. Senile asthenia syndrome was assessed using the Edmonton Freil scale [11]. Markers of senile asthenia were: total protein, albumin, somatotropic hormone and interleukin 6. Results: It was established that hypoproteinemia with a total protein level indicators of 61.35 (55.00; 70.00) g/l, p = 0.0009, U = 1224.0 and dysproteinemia was determined in the main study group. The albumin level in the main group is also significantly reduced - 29.75 (24.70; 35.70) g/l, p = 0.0072, U = 2268.0. The level of somatotropic hormone was considerably lower in the main group 0.89 (0.12, 1.28) mlU/l compared to the comparison group 2.40 (0.33, 3.96) mlU/l, p = 0.0030, U = 2248.5. This indicated the presence of sarcopenia syndrome. The interleukin 6 level in both study groups exceeded the norm. A significant increase in the frequency and mortality of postoperative complications was determined in the group of asthenia patients. Conclusions. The frequency of senile asthenia syndrome was 50.3% among patients in emergency abdominal surgery. The Edmonton Freil scale can be a quick and effective method of diagnosing senile asthenia syndrome in emergency abdominal surgery. _________________________________________________________________________________________ Keywords: senile asthenia; sarcopenia; malnutrition; somatotropic hormone; interleukin 6

РЕГИОНАЛЬНЫЙ МОНИТОРИНГ ФАКТОРОВ РИСКА РАЗВИТИЯ ХРОНИЧЕСКИХ НЕИНФЕКЦИОННЫХ ЗАБОЛЕВАНИЙ ПОСЛЕ ПЕРЕНЕСЕННОГО COVID-19

Annotation. Chronic non-communicable diseases (NCD) represent a major public health problem in recent decades. NCD kill 41 million people annually, accounting for 74% of all deaths worldwide. WHO predicts that the total number of deaths from NCD will rise to 55 million by 2030 unless drastic measures are taken. Cardiovascular disease, cancer, chronic respiratory disease and diabetes are the four leading causes of premature mortality among NCD. Multimorbidity affects 65% of people over 65 years of age, requiring more patient-centred and complex models of care. The aim of the study was to conduct regional monitoring of risk factors for chronic noncommunicable diseases in geriatric patients. Outpatient charts of 152 patients aged 60 years and older who had undergone COVID-9 and had undergone an in-depth adult check-up were used for the study. The average age of the patients who underwent the dispensary was 70.0±5.7 years. Questionnaire survey of 152 patients aged 65 years and older to identify NCD and senile asthenia showed that the highest proportion of patients had risk factors for cardiovascular diseases - 63.2%, osteoporosis - 40.8%, GI diseases - 28%, senile asthenia - 27% and polypragmasia - 20.4%. 32.2% of respondents noted a decrease in memory, perception of material, impaired comprehension, loss of ability to distribute time, 30.9% experienced a decrease in mood, loss of energy, depressive state, 24.3% each experienced vision and hearing problems that impair the quality of life, and 22.4% of persons over 65 experienced difficulty in walking. Based on the results of the study, data collection modules based on the STEPS system were identified for the step-by-step assessment of risk factors for the development of chronic non-communicable diseases, and a model for a comprehensive approach to improving the health of citizens aged 60 years and older, who have the highest risk of developing NCD, was proposed.

Assessment of the Level of NT-proBNP in Patients with Arterial Hypertension Aged 80 Years and Older, Depending on the Presence of Heart Failure and Senile Asthenia Syndrome

Objectives. To evaluate the informativeness of the N-terminal brain-promoting natriuretic peptide (NT-proBNP) for the diagnosis of chronic heart failure (CHF), depending on the presence of senile asthenia syndrome (SSA) in patients with arterial hypertension (AH) 80 years and older.Materials and Methods. 320 patients with hypertension, depending on the presence of CHF and SSA, were divided into groups: group 1A — patients with hypertension, SSA and CHF (n=84), group 1B — patients with hypertension, SSA without CHF (n=77), group 2A — patients with hypertension, CHF without SSA (n=84), group 2B — patients with hypertension without CHF and without SSA (n=75). The CSA was identified by the questionnaire “Age is not a hindrance”. The level of NT-proBNP was determined in blood serum by enzyme immunoassay. ROC analysis was used to determine the threshold value of markers.Results. In patients with hypertension and SSA without CHF, the concentration of NT-proBNP in the blood is 2.3 times higher (p=0.003) compared with patients with hypertension without SSA and without CHF, which indicates the effect of SSA on the level of NT-proBNP. In patients with hypertension and CHF without SSA, the level of NT-proBNP is 4.3 times higher compared with patients with hypertension without SSA and without CHF (p<0.001), in whom the concentration of NT-proBNP was noted below the threshold level (106.2 pg/ml). In patients with hypertension and SSA and CHF, the highest concentrations of NT-proBNP were recorded, which are 2.9 times (p<0.001) higher than in “fragile” patients with hypertension without CHF and 1.5 times higher than in “strong” patients with hypertension and CHF (p<0.001). A new threshold level of NT-proBNP has been calculated for the diagnosis of CHF in patients with hypertension and SSA aged 80 years and older — 365.9 pg/ml.Conclusion. For the diagnosis of CHF in patients with hypertension 80 years and older without CSA, the NT-proBNP marker is informative, since, according to the data obtained, its level did not depend on the age of the patients. When using NT-proBNP to detect CHF in patients with hypertension and SSA 80 years and older, the calculated threshold marker level (365.9 pg/ml) should be used, since in these patients the concentration of NT-proBNP is increased, regardless of the presence of CHF.

Optimization of cholecystectomy timing during staged treatment of acute cholecystitis in elderly and senile patients with cholecystostomy

Aim. To determine optimal timing for laparoscopic cholecystectomy in elderly and senile patients with cholecystostomy.Materials and methods. Treatment results of 37 patients aged 60 years and over at different terms after cholecystostomy formation were analyzed. The degree of senile asthenia, concomitant diseases, technical features of surgical aid, dynamics of the postoperative period, as well as morphological features of inflammatory changes in the gallbladder wall were assessed.Results. Pre-asthenia was detected in 12 (32%) patients, mild senile asthenia – in 14 (38%) patients, and moderate senile asthenia – in 11 (30%) patients. Polymorbidity was determined in all patients, with 23 patients having four or more diseases. In 3 (8%), 15 (40.5%), 15 (40.5%), and 4 (11%) cases, laparoscopic cholecystectomy was performed 3–9 days, 10–30 days, 2–6 months, and 6 months or more (1 conversion) after cholecystostomy.Conclusion. In elderly and senile patients, laparoscopic cholecystectomy performed 10–30 days after cholecystostomy is optimal, safe, and affordable. Radical intervention in this period is not associated with technical difficulties. Reduced terms of external drainage of the gallbladder contribute to improving the elderly patient’s quality of life and their social adaptation, while shortening the period of postoperative recovery. When planning surgical interventions in a patient over 60 years old, account should be taken of comorbidities, polypragmasy, and senile asthenia.

Study of senile astheny markers against the background of acute inflammatory process in elderly and senile patients in emergency abdominal surgery

The aim of our work was to determine the influence of the acute inflammatory process on the diagnostic value of markers of senile asthenia in emergency abdominal surgery. Material and methods. The basis of the work included 92 (100.0 %) patients, the average age in the entire group was 72.0 ± 2.3 years. All patients were divided into three groups: group A – 32 (34.8 %) patients with acute surgical pathology and confirmed senile asthenia syndrome. The group included 15 (16.3 %) patients with acute cholecystitis and 17 (18.5 %) with perforation of a gastric or duodenal ulcer. Group B included 30 (32.6 %) people with acute surgical pathology, which was statistically comparable in terms of the number of surgical diagnoses to group A, but without asthenia. To determine the reliability of the inflammatory process influence on markers of senile asthenia, we formed group C – 30 (32.6 %) patients without acute surgical pathology, but with the syndrome of senile asthenia. Based on the literature analysis, we selected markers of malnutrition syndrome: total protein, albumin and cholesterol levels, and the marker of sarcopenia – somatotropic hormone. Results. Based on the comparison of the obtained results, we found a decrease in the level of total protein in groups A and C, which was not significantly different, p = 0.2519, U = 372.0. Whereas when comparing groups, A and B, a significant decrease was found in the group of patients with asthenia (A) – p = 0.0009, U = 224.0. The same data were obtained when comparing the level of albumin; in groups A and C the level of albumin was reduced but did not differ significantly between groups – p = 0.1932, U = 361.5, whereas comparing groups with senile asthenia syndrome (group A) and without it (group B), a significant difference was found – p = 0.0072, U = 268.0. When determining the cholesterol level, we did not find a significant difference between the groups with asthenia (A and C) – p = 0.0614, U = 323.0, as well as between the groups with asthenia and without asthenia with acute inflammation (A and B) – p = 0.01646. It was determined that the level of somatotropic hormone in the groups with asthenia (A and C) was equally low – p = 0.9646, U = 466.5, while when comparing the group with and without asthenia (A and B), a significant decrease in this hormone was found in group A – p = 0.0030, U = 248.5. Conclusions. The absence of acute inflammatory process influence on the diagnostic value of the studied markers of senile asthenia in the groups was determined. When comparing the results between group A (acute surgical pathology + senile asthenia syndrome) and group B (acute surgical pathology without senile asthenia syndrome), a significant decrease in the level of total protein, albumin, and somatotropic hormone was revealed, p = 0.0009, p = 0.0072 and p = 0.0030, respectively, while when comparing groups with asthenia (A and C) no significant difference was found, p = 0.2519, p = 0.1932 and p = 0.9646. The level of total cholesterol cannot be used as a marker for the diagnosis of senile asthenia in emergency abdominal surgery, as there are a significant number of factors that directly affect the results of the diagnosis. Comparison of the results of the groups with asthenia and without asthenia on the background of acute inflammatory process (A and B) showed no significant difference, p = 0.1646. The same negative results were obtained when evaluating groups with asthenia (A and C) – p = 0.0614.

Features of geriatric status in patients with arterial hypertension and coronary heart disease (review)

Background: Among the geriatric syndromes associated with the pathology of the cardiovascular system, in particular arterial hypertension (AH) and coronary heart disease as one of the causes of their occurrence, researchers call the syndrome of falls, senile asthenia syndrome (SAS), depression and cognitive impairment. The listed reasons indicate the relevance of their study and the implementation of preventive measures to reduce the prevalence in conceptual terms. The aim of the study: To analyze the geriatric status in patients with arterial hypertension and coronary heart disease, which will allow creating a plan for preventive measures to reduce the prevalence of geriatric syndromes in patients with arterial hypertension and coronary heart disease. Materials and methods: The analysis of the literature data on the geriatric status of patients with arterial hypertension and coronary heart disease published over the last decade was carried out: PubMed, Elibrary, Scopus. Results: Analysis of literature sources has shown that in the age cohort of senile persons, the prevalence of falls syndrome occurs in almost every second person, while 15-30% is in the group of 60-74 years. It has been shown that in predicting non-fatal complications with existing hypertension in geriatric patients with SAS, the pulse rate, systolic pressure, and laboratory parameters should be taken into account. The prevalence of depressive symptoms in patients with hypertension and coronary heart disease with various geriatric syndromes in different populations of countries ranges from 0.5 to 73.0% and its frequency depends on the diagnostic method used by the researchers. Despite the heterogeneity of the available information, it is indicated that depression occurs on average in 26.8% of AH patients with geriatric syndromes. Cognitive impairments were observed in 60.0% of AH and coronary heart disease patients with geriatric syndromes, and they develop due to the fact that in patients over 65 years of age, previous drug treatment has been ineffective for many years. Conclusion: The collected data may make it possible to create a plan for preventive measures to reduce the prevalence of geriatric syndromes in patients with arterial hypertension and coronary heart disease. Further research in this area will improve the quality of life of this population, which accounts for a significant proportion of hospitalizations and outpatient visits.

Adipocines and longevity: connections and paradoxes

Adipose tissue is an active endocrine organ that regulates energy homeostasis throughout the body by releasing hundreds of biologically active substances called adipokines. Dysregulation of adipokines is a key feature of insulin resistance with the development of metabolic syndrome and type 2 diabetes mellitus, which is an age-dependent pathology. In turn, dysregulation of adipokines and insulin resistance are associated with the development of metabolic deficiency and senile asthenia syndrome in older age groups. Previous studies have shown that the absence of insulin resistance and low prevalence of diabetes among centenarians are metabolic prerequisites for increased lifespan, suggesting a possible role for adipokine homeostasis in healthy longevity. Among numerous adipokines, adiponectin is considered a protective factor, showing a negative correlation with major metabolic disorders associated with age and obesity, and a positive association with life expectancy and insulin sensitivity among centenarians. Despite all the apparent protective effects of adiponectin, large-scale epidemiological studies have revealed the opposite aspect of adiponectin as a predictor of all-cause mortality and cardiovascular disease in patients with heart failure as well as kidney disease. In this review, the clinical significance of adiponectin is considered in centenarians from the point of view of the development of the main geriatric syndrome - senile asthenia, as well as cardiovascular risk and mortality.

Comprehensive Geriatric Assessment of Older and Oldest-Old Patients in the Perioperative Period. Russian Gerontology Research and Clinical Centre Experience

With the aging population, the significance of preoperative diagnostics and optimizing the treatment of surgical patients with frailty syndrome is gaining momentum. For such patients a comprehensive geriatric assessment (CGA) is carried out to clarify the severity of frailty and the individual characteristics of the geriatric status [1]. The results of this assessment are used to stratify the risk in the postoperative period and to determine targeted interventions for the correction of geriatric syndromes [2]. The introduction of new geriatric technologies during hip and knee replacement in weakened older patients needs scientific justification and confirmation of effectiveness.Objective: to test the method of complex geriatric management of older and oldest-old patients before and after surgical interventions in the provision of planned inpatient orthopedic care (knee and hip arthroplasty).Materials and methods: the study involved two groups of older and oldest-old patients with frailty: 50 patients, average age 69.2 ± 6.0 years [60 to 87 years] with gonarthrosis and 50 patients, average age 67.6 ± 5.5 years [60 to 81 years] with coxarthrosis. At the prehospital stage, patients were diagnosed with frailty, in accordance with the clinical recommendations of «Senile asthenia» [3]. Upon admission to surgical treatment, a CGA was performed, including indicators of basic (Barthel Activities of daily living Index, Barthel scale [4]) and instrumental activity (The Instrumental Activities of Daily Living Scale, IADL scale [5]), nutrition assessment (Mini Nutritional assessment, MNA scale [6]), cognitive functions (The Montreal Cognitive Assessment, MOCA test [7]), depression (Geriatric Depression Scale, GDS-15 scale [8]), as well as quality of life (A Visual Analogue Scale, EQ-VAS scale [9]), multimorbidity and polypragmasia. An individual plan of perioperative management was drawn up.Results. A comparative analysis demonstrated statistically significant improvements in functional status (based on the Barthel scale), cognitive status (based on the MOCA test), nutritional status (based on the MNA scale) and quality of life (based on the EQ-VAS scale) 12 months after surgical intervention in groups of patients after knee and hip replacement. In the group of patients after hip replacement, there was also an improvement in the quality of life of patients 12 months after surgery. The assessment and dynamics of indicators in functional and cognitive status within the control group were not carried out, which makes it difficult to compare the results. However, there was a reduction in hospital stay for patients using geriatric approaches compared with previously used surgical care in the control group.Conclusion: the management of patients with frailty in the perioperative period with the use of CGA allows for preventive measures aimed at maintaining functional, psycho-emotional status. Individual characteristics of the state of psychoemotional and functional status in older and oldest-old patients may not be considered during the traditional preoperative risk stratification and increase the risks of adverse outcomes of surgical treatment, duration of hospital staying and repeated hospitalizations.

Asthenic disorders correction with Recognan

Asthenia, asthenic syndrome, asthenic condition, asthenic reaction, asthenic disorders are terms that describe the state of «impotence». Fatigue that occurs against the background of habitual physical or intellectual stress for a person, and persists after rest, is asthenia. For people of the older age group, the term senile asthenia syndrome is used. Asthenia manifests itself with increased fatigue and exhaustion, mood instability, increased irritability, sleep disorders. Asthenic conditions manifest themselves along with a decrease in physical activity, increased cognitive and mental fatigue. Asthenic syndrome (AS) are considered as an integral part of cardiovascular diseases (CVD), as one of the manifestations of cerebrovascular pathology. Senile asthenia syndrome (SAS) is a geriatric syndrome characterized by an age-associated decrease in the physiological reserve and functions of many body systems, including cognitive functions. One of the drugs that has a positive effect on the severity of AS and improves the state of cognitive functions is the domestic drug Recognan (citicoline). The effectiveness of Recognan in the treatment of AS in patients with CVD, SAS, and post-COVID asthenia has been shown. It is recommended to prescribe Recognan orally at 500 mg / day for 30 days. Recognan has a nootropic and antiasthenic effect.

Assessment of senile asthenia syndrome using the Frailty and Edmonton frail scales in elderly and senile patients who underwent emergency abdominal surgery

The aim of the work was to compare the effectiveness of the assessment of senile asthenia syndrome using the Frailty and Edmonton Frail scales in elderly and senile patients undergoing emergency abdominal surgery.
 Materials and methods. The study included 80 patients aged 60 to 89 years with a diagnosis of acute calculous cholecystitis. A correlation was determined between asthenia and the severity of the patient’s condition according to the P-POSSUM scale, the peak value of the increase in the risk of postoperative complications and mortality occurs in patients with a sum of points >32, p = 0.012. The syndrome of senile asthenia using the Edmonton Frail scale was detected in 30 (37.5 %) patients, according to the Frailty scale – 32 (40.0 %), U = 3120.0, p = 0.7862.
 Results. The main advantage of the Edmonton Frail scale is the examination time of 22 ± 3 min, while with the Frailty scale 360 ± 22 min (U = 24.5, p < 0.0001). Based on the assessment of the severity of the condition using the P-POSSUM scale, we determined a direct correlation of average strength between the presence of asthenia and the number of points: Edmonton Frail subgroup A – rs = 0.81, p = 0.000001. The same results, respectively, on the Frailty scale – rs = 0.78, p = 0.000004. The frequency of complications increases significantly in the category of patients with asthenia, which is confirmed by both the Edmonton Frail scale – 23.3 % (U = 605.0, p = 0.0087), and the Frailty scale – 21.9 % (U = 632.0, p = 0.0150).
 Conclusions. The frequency of detection of senile asthenia syndrome using the Edmonton Frail and Frailty scale in patients was equivalent (U = 3120.0, p = 0.7862). The Edmonton Frail scale is more convenient to use in urgent situations, and the mean time to diagnose asthenia using it was 22 ± 3 min, while the complete diagnosis using the Frailty scale took 360 ± 22 min (U = 24.5, p < 0.0001).
 A significant increase in the frequency of postoperative complications was determined in the category of patients with asthenia, confirmed both by the Edmonton Frail scale – 23.3 % (U = 605.0, p = 0.0087), and by the Frailty scale – 21.9 % (U = 632.0, p = 0.0150).

Assessment of risks of using local anesthetics in surgical practice in elderly patients

The consequence of the demographic aging of the population is an increase in the surgical pathology of the elderly. Local anesthetics (LA) play an important role in providing anesthetic care to this category of patients. Features of pharmacokinetic processes in the elderly, including the processes of absorption, distribution, metabolism, and excretion, underlie the change in the pharmacodynamic effects of LA. Elderly patients are at a higher risk of adverse reactions. This is due to physiological changes associated with the aging process, as well as patients’ comorbidity. Patients suffering from the senile asthenia syndrome, cardiovascular diseases, and impaired function of the excretory organs have the highest risks.

Need to determine the residual concentrations of direct oral anticoagulants in patients with atrial fibrillation undergoing transcatheter implantation of the aortic valve

Introduction. Lengthening the period of direct oral anticoagulant (DOAC) withdrawal before intervention is not allowed. Chronic kidney disease (CKD), impaired liver function, extremely low or high body mass, chronic heart failure (CHF), and age > 90 years can increase blood DOAC levels. DOAC therapy does not require routine laboratory monitoring. However, there are coagulation tests that can be used to detect the presence of a drug in blood. Duration of DOAC discontinuation and the appropriateness of assessing residual anticoagulant concentrations before intervention with a high bleeding risk in a special category of patients is to be defined.Aim. To measure residual concentrations of anticoagulants and their association with perioperative bleeding risk in patients with AF using DOACs in blood samples collected immediately before TAVI.Materials and methods. The 94 patients with atrial fibrillation (AF) included in the study were characterized by senile age, a high risk of thromboembolic complication (ТС), many comorbidities, and a high prevalence of senile asthenia. The apixaban and rivaroxaban concentrations were measured according to the value of anti-Xa activity and control plasmas with normal levels of coagulation factors (Diagnostica Stago, France).Results. The median time of DOAC withdrawal before TAVI was 60 hours [47.5; 72]. However, the DOAC concentration exceeded 30 ng/ml in 1/5 patients (19.2%), and stage 3 or more CKD was more common in these patients. Our study showed the relationship between DOAC concentration and the duration of DOAC withdrawal period. However, the relationship between DOAC concentration and bleeding that occurred in the perioperative period could not be found. Patients with signs of CKD were older and had a lower BMI as compared to patients without CKD.Conclusion. Our data showed the relationship between the DOAC concentration and the duration of DOAC withdrawal period. No relationship was found between DOAC concentrations and bleeding.

ИНТЕРЛЕЙКИН-6 – МАРКЕР СУБКЛИНИЧЕСКОГО ВОСПАЛЕНИЯ У БОЛЬНЫХ ИБС В СТАРЧЕСКОМ ВОЗРАСТЕ И ДОЛГОЖИТЕЛЕЙ

Introduction. Interleukin-6 is a cytokine involved in the regulation of immune reactions, in the processes of hematopoiesis and inflammation. Levels of interleukin-6 in the blood correlate with the development of senile asthenia. Aim. The study aim was to determine the blood concentration of interleukin-6 and to evaluate the relationship of this cytokine with a number of pathological conditions in very old and centenarians with coronary artery disease. Material and Methods. 128 patients were enrolled in the cross-sectional study of interleukin-6 in very elderly patients and centenarians with coronary artery disease: 94 with coronary artery disease – in the study group, 34 without coronary artery disease – in the control group. The mean age of study patient was 88.3+5.3 years (76 to 98 years). Serum interleukin-6 concentrations (N<7.0 pg/ml) were determined by enzyme-linked immunosorbent assay. Results and discussion. Elevated interleukin-6 levels were found in 45.3% of patients. Mean interleukin-6 concentration was 8.2+6.3 (1.5-36.2) pg/ml. In patients with coronary artery disease mean interleukin-6 concentration reached 9.0 pg/ ml, in the control group – 5.8 pg/ml (p=0.001). Significantly higher interleukin-6 levels were found in patients with heart failure – 11.2 and 6.6 pg/ml, respectively (p=0.00005). Among patients with hyperuricemia mean interleukin-6 values reached 10.8+4.8 pg/ml. Positive correlations were found between interleukin-6 level and leukocytes count (r=0.29; p=0.002), neutrophils count (r=0.37; p=0.00002) and tumor necrosis factor-α (r=0.39; p=0.007). In patients with elevated interleukin-6 level lower Barthel index (70.7 and 80.7, respectively, р=0.003) and IADL scale (3.4 and 5.0, respectively, р=0.0002) values were observed. Conclusion. In patients with chronic coronary artery disease in very old age and centenarians an increase level of interleukin-6 is often found. Higher levels of interleukin-6 are associated primarily with heart failure and hyperuricemia.

CLINICAL AND NEUROLOGICAL PARAMETERS IN SENILE ASTHENIA SYNDROME

Asthenia senile syndrome is coded R54 in the International Classification of Diseases (ICD-10). Today, the prevalence of this syndrome among elderly people worldwide is 13%, while the prevalence of "senile preadjustment syndrome" is 50%. With an unfavourable course, without early treatment and rehabilitation, senile prehospital syndrome develops into senile asthenia after 4-5 years. This syndrome is a key concept of modern gerontology.

Effect of senile asthenia syndrome on cardiovascular mortality within 12 months in patients over 70 years of age with myocardial infarction

Aim. This study aims to investigate the effect of senile asthenia syndrome (SAS) on the cardiovascular mortality risk within 12 months in patients over 70 years of age with myocardial infarction.Material and methods. We performed a retrospective study of 92 patients over 70 years of age with myocardial infarction, who agreed to participate. To detect senile asthenia syndrome, we used the questionnaire "Age is not a hindrance". We estimated the anamnestic data, and also laboratory and instrumental parameters. The follow-up period was 12 months. As an end-point, the onset of an adverse event — cardiovascular death was chosen. Statistical nonparametric methods, ROC analysis, Kaplan-Meier survival analysis (p<0,05) were used.Results. In 12 months, 19 patients (20,65%) met the end-point. The median (25%; 75%-quartile) of the numbers of points according to the questionnaire "Age is not a hindrance" was significantly higher in the group of dead patients than in the group without adverse outcomes — 4 (3; 5) and 2 (1; 4) points (p<0,001). When gaining 3 or more points according to the questionnaire "Age is not a hindrance", risk ratio of cardiovascular death within 12 months was 1,72; 95% confidence interval: 1,28-2,30 (p=0,001). In conduction of ROC analysis to predict adverse outcome when gaining 3 or more points according to the questionnaire "Age is not a hindrance", the area under the curve (AUC) was 0,78 (p<0,001), sensitivity — 89%, specificity — 60%.Conclusion. The risk of cardiovascular death within 12 months after myocardial infarction in patients over 70 years of age with SAS increases by 72%. The inclusion of the results from the questionnaire "Age is not a hindrance" into prognostic models, and the SAS estimation in this cohort of patients will improve the risk stratification.

Study on the effect of community legal consciousness health management on cognitive function of senile patients

BackgroundSenile asthenia is an old-age syndrome. Patients have increased vulnerability due to degenerative changes in the body and a variety of chronic diseases. Senile asthenia involves multiple bodily system functions of patients and is a pre-disease state. Its incidence shows an upward trend with the increase in the age. This study takes community health service as the breakthrough point to explore the role of community legal awareness health management in improving the cognitive function of elderly frail patients, hoping to provide references for improving the health level of elderly frail patients.Subjects and Methods660 elderly patients who were hospitalized at our hospital from June to December 2021 were selected as the study objects and were randomly divided into the management intervention group and the general group, with 30 cases each. Both groups of patients were given basic disease treatment and in-hospital rehabilitation guidance, while the management intervention group increased community legal awareness of health management services at community health service stations. The cognitive function of patients was evaluated by Mini Mental State Examination (MMSE). The senile weakness, cognitive function score, and quality of life of the two groups of patients were compared and analyzed.ResultsIt can be seen from the comparison of the cognitive function scores of the two groups of patients that the cognitive function level of the management intervention group is significantly higher than that of the conventional group. The cognitive function score of the management intervention group after treatment is 26.46±2.39 points, and that of the conventional group after treatment is 23.58±2.41 points. The difference between the two groups is statistically significant (P < 0.05). As shown in Table 1.Table 1.MMSE scores of two groups of patients before and after treatmentModeManagement intervention groupGeneral grouptPBefore treatment22.54±2.3722.56±2.291.305>0.05After treatment26.46±2.3923.58±2.416.398<0.05t6.4542.743--P<0.05>0.05--ConclusionsCarrying out community legal awareness health management services can effectively improve the cognitive function level of the elderly and weak patients, and promote the improvement of the quality of life of the elderly and weak patients. Publicizing legal awareness to the elderly and weak patients and carrying out community health and health management services can help the elderly and weak patients solve their life problems in time. Legal awareness management education with disease prevention and health education can promote cognitive function training and improvement of the elderly and weak patients.

FEATURES OF PROVIDING MEDICAL CARE TO ELDERLY AND SENILE CITIZENS

Currently, the state policy in the field of organization of medical care for elderly citizens is aimed at ensuring its quality, creating a system for monitoring the quality and volume of medical and diagnostic measures, further development of medical examination, prevention and rehabilitation, timely consultations of patients undergoing inpatient treatment, continuity in the treatment of patients at inpatient and outpatient stages. The article analyzes the necessary actions of doctors during a comprehensive geriatric examination. The characteristic symptoms and signs of senile asthenia, as well as its relationship with age-related diseases, are described.

Senile asthenia as a predictor of the severity of the perioperative period in elderly and senile patients

The aim. To evaluate the effectiveness of the diagnosis of senile asthenia using the Edmonton Frail scale in emergency abdominal surgery and to determine its impact on the severity of the perioperative period. Materials and methods. The study included 81 patients with acute cholecystitis on the background of gallstone disease, who were assessed for senile asthenia using the Edmonton Frail scale. For the reliability of the obtained results, only patients who were urgently hospitalized to the surgical department with gynecology beds of the emergency hospital with clinical symptoms of acute cholecystitis were included. All patients received treatment in only one department and according to the standards and clinical protocols of this clinic. Based on the Edmonton Frail score, all patients were divided into two groups. The comparison group included 50 (61.7 %) patients who did not have senile asthenia. The main group included 31 (38.3 %) patients diagnosed with senile asthenia. Results. Surgical treatment in both groups was carried out on an urgent basis using total intravenous anesthesia with artificial lung ventilation. According to the type of surgical intervention in both groups, preference was given to minimally invasive methods. Laparoscopic cholecystectomy in the comparison group was performed in 49 (98.0 %) patients, and only one patient (2.0 %) was converted and operation continued from the mini-access. In the main group, all surgical interventions were performed by the laparoscopic method, U = 759.50, P = 0.8841. Analyzing the results of the duration parameters and the need for prolonged mechanical ventilation, it can be seen that it progressively increases in patients with asthenia: in the comparison group 61.50 (48.00; 75.00) minutes, and in the main 93.84 (60.00; 80.00), U = 513.50, P = 0.0112. Also, we noted that in patients with senile asthenia, the number of postoperative complications increases: in the comparison group, there were only 2 (4.0 %) postoperative complications, while in the main group – 7 (22.6 %), U = 556.00, Р = 0.0337. Summarizing the results, it can be seen that due to increase of the frequency of postoperative complications and increase of the need for prolonged artificial ventilation of the lungs, the length of hospital stay of patients with senile asthenia increased: in the comparison group it was 7.9 ± 2.2 days, and in the main group 9.7 ± 3.2 days, U = 530.50, P = 0.0177. Conclusions. In our opinion, the Edmonton Frail scale is effective in diagnosing the severity of senile asthenia in elderly and senile patients in emergency abdominal surgery due to its simplicity and speed of use. The overall severity of the condition, heart failure in patients with senile asthenia lead to increase in the duration of surgery and the total duration of artificial lung ventilation: in the comparison group 39.52 (30.00; 45.00) minutes, while in the main group 49.19 (35.00; 50.00) minutes, U = 482.50, P = 0.0046. The duration of mechanical ventilation also differed significantly, in the comparison group 61.50 (48.00; 75.00) minutes, and in the main – 93.84 (60.00; 80.00), U = 513.50, P = 0.0112. The severity of senile asthenia negatively affects the course of the perioperative period, the frequency of postoperative complications increases: 2 (4.0 %) patients in the comparison group, while in the main group of 7 (22.6 %) patients, U = 556.00, P = 0.0337 and, as a consequence, the duration of inpatient treatment increases: in the comparison group it was 7.9 ± 2.2 days, in the main – 9.7 ± 3.2, U = 530.50, P = 0.0177. Modification of the approaches to preoperative preparation and postoperative management of elderly and senile patients diagnosed with senile asthenia will reduce the frequency of postoperative complications and reduce the length of hospital stay.

Pharmacoepidemiological analysis of antihypertensive therapy in older age groups with senile asthenia syndrome

To conduct a pharmacoepidemiological study to determine the characteristics of antihypertensive therapy in older patients with senile asthenia syndrome (SSA) and compliance of this therapy with modern clinical recommendations. The study included 146 patients diagnosed with stage I-III hypertension who underwent inpatient treatment in the therapeutic department of the Krasnoyarsk Regional Hospital for War Veterans, the subjects were divided into two groups. The first group included 55 elderly patients (WHO, 2012) with hypertension and SSA. The second group included 35 elderly patients (WHO, 2012) with hypertension and SSA. The comparison group consisted of 56 patients aged 60 to 84 years with hypertension without SSA. Evaluation of the pharmacotherapy was carried out based on extracts from the medical histories of inpatient patients. The most commonly taken groups of antihypertensive drugs in patients of older age groups with hypertension and SSA according to the study are diuretics and β-blockers. Diuretics were taken by 88.6% of elderly patients and 83.6% of senile patients. The main combinations of antihypertensive drugs in patients with hypertension and SSA were: a two-component scheme of combination of an ACE inhibitor and a diuretic, a three-component scheme of combination of an ACE inhibitor, a β-blocker and a diuretic, four-component schemes of combination of an ACE inhibitor, a β-blocker, a calcium channel blocker and a diuretic, as well as a combination of an angiotensin II receptor blocker, a β-blocker, calcium channel blocker and diuretic with combined medications. The prescribed antihypertensive therapy in patients of older age groups with hypertension and SSA in most cases is represented by a combination of several drugs. Many patients take three-component antihypertensive therapy regimens. There were no statistically significant differences between patients of older age groups with hypertension and SSA, as well as patients of older age groups with hypertension without SSA. Therefore, it can be concluded that the presence of senile asthenia syndrome does not affect the tactics of treatment of hypertension and regardless of the presence or presence of SSA, patients receive the same hypotensive therapy, which contradicts existing clinical guidelines.