Senile Patients Research Articles

Benefits and risks of revascularization in senile coronary artery disease patients: is there any optimal choice?

There has been an increase in the population of elderly patients with coronary artery disease (CAD) in recent years. Elderly and, especially, senile patients typically have comorbid conditions, multivessel coronary artery disease and coronary calcification, which make treatment more challenging. The available data from evidence-based medicine is not enough to determine the best treatment strategies for elderly patients, because large randomized clinical trials usually do not include elderly individuals with severe comorbidities. In the presented case, an 80-year-old patient with severe calcification and multivessel coronary artery disease experienced recurrent dissection of the left anterior descending artery (LAD) and stent thrombosis of the left main coronary artery (LMCA) during the second phase of percutaneous coronary intervention, which required the implantation of 8 stents and administration of glycoprotein IIb/IIIa inhibitors, leading to the clinical manifestation of gastrointestinal bleeding. An important feature of the presented case was the necessity to implant a large number of stents, which is a risk factor for restenosis. Various issues are discussed in this case, including the choice of optimal management strategy for an 80-year-old patient with multivessel coronary artery disease. Physicians had to make difficult decisions to achieve a balance between potential benefit and risk. In order to improve the management of elderly patients, further research is needed, as well as the accumulation and discussion of clinical data.

Efficacy of acupuncture or moxibustion in treating senile insomnia compared with a control group: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to assess the efficacy of acupuncture or moxibustion therapy in senile insomnia patients. A comprehensive literature search was conducted using 7 electronic databases to identify randomized controlled trials reported on the use of acupuncture or moxibustion therapy in insomnia. The time frame was set from database establishment to March 11, 2023. The RevMan (version 5.3) and STATA (version 17.0) software were used to evaluate the quality of the included randomized controlled trials and perform a meta-analysis. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Subgroup analysis was performed based on different intervention methods. The I2 statistic was used to assess heterogeneity among studies. A total of 20 studies conducted between 2007 and 2022 were included, involving 1677 patients with senile insomnia. In terms of efficacy, acupuncture or moxibustion alone was significantly better than western drugs (RR = 1.12; 95% CI, 1.06-1.20), acupuncture combined with drugs was better than drugs alone (RR = 1.20; 95% CI, 1.12-1.29), and acupuncture combined with cognitive behavior therapy intervention (CBT-I) was significantly better than CBT-I alone (RR = 1.52; 95% CI, 1.07-2.17). In terms of Pittsburgh Sleep Quality Index scores, acupuncture or moxibustion alone was more effective than western drugs (MD = -1.82; 95% CI, -2.37 to -1.26), acupuncture combined with drugs was more effective than drugs alone (MD = -3.10; 95% CI, -4.25 to -1.95), and acupuncture was significantly more effective than sham acupuncture (MD = -4.18; 95% CI, -5.85 to -2.51) and psychological intervention (MD = -3.54; 95% CI, -4.33 to -2.75) in improving sleep quality. This meta-analysis revealed that acupuncture or moxibustion alone or combination with other therapies(drugs, CBT-I or psychological intervention) has high clinical efficacy and can improve the sleep quality of patients with senile insomnia. However, further well-designed studies are warranted to verify these findings.

Predicting the overall survival of patients with chronic lymphocytic leukemia in the dynamics of the disease

Relevance. The high prevalence of chronic lymphocytic leukemia (CLL) in elderly and senile patients of the European population dictates the need to find a publicly available solution to the problem of prognosis in this cohort of patients. Previously, a relationship was established between the survival of patients with CLL and the value of the glomerular filtration rate (GFR) at the time of diagnosis. The purpose of the study: to assess the relationship of GFR with the survival of CLL patients in the course of the disease. Materials and methods: 207 patients (98 men and 109 women) aged 45 to 80 years with CLL A-C according to Binet and known overall survival were studied. Annually from the 1st to the 5th year of the course of the disease, the maximum value of the patient's GFR was taken into account according to the CKD-EPI formula. The data was processed by data mining using a logical classification algorithm. Results. With a GFR value of more than 76 ml/min/1.73 m2 during the first year of the disease, more than 75 ml/min/1.73 m2 during the second year of the disease, more than 70 ml/min/1.73 m2 during the third year of the disease, more than 68 ml/min/1.73 m2 during the fourth and fifth years of the disease, the patient will overcome the calculated parameters of the median survival for the corresponding stage of CLL according to Binet. Otherwise, the overall survival of the patient will be less than the calculated median survival according to Binet. This article provides illustrative clinical examples. Conclusion. It was found that the value of GFR in CLL patients gradually decreases with the course of the disease, however, the value of this parameter in the dynamics of the disease can be considered as a significant factor in predicting the survival of patients with CLL. Based on the results, an application for an invention No. 2023108368 was filed.

Parameters of left ventricular deformation in elderly and senile patients with aortic stenosis after transcatheter implantation of the aortic valve

Aim: To evaluate the parameters of left ventricle (LV) myocardial deformation (longitudinal, circular and radial) in patients with symptomatic severe aortic stenosis (AS) with preserved LV ejection fraction after transcatheter aortic implantation valve (TAVI) in the early postoperative period.Material and Methods. The study included 31 patients after TAVI out of 69 with symptomatic severe AS. Echocardiography (EchoCG) using two-dimensional speckle tracking technology was performed before TAVI and in the early postoperative period (within 5 ± 1,7 days).Results. There were no significant differences in the analysis of deformation parameters before TAVI and in the early postoperative period. There was a tendency to increase the longitudinal deformation of the LV, including the longitudinal deformation of the basal, middle and apical segments in individual patients. The longitudinal deformation of the left atrium did not change after TAVI.Conclusion. There were no significant changes in deformation parameters in elderly and senile patients with severe AS and preserved LV ejection fraction and with reduced LV deformation (longitudinal, circular and radial) after minimally invasive TAVI in the early postoperative period. There is a tendency to increase the global longitudinal deformation of the LV.

The results of hemostasis assessment using thromboelastography in patients with COVID-19

All currently existing studies of the hemostasis system in COVID-19 using thromboelastography (TEG) were performed on the delta strain of SARS-CoV-2, while there is no information in the literature on conducting such studies in patients infected with the current omicron strain.Research objective. To determine the state of the hemostasis system in hospitalized patients with COVID-19 (omicron strain) using TEG. To assess the relevance of existing guidelines on anticoagulant therapy.Materials and methods. TEG was performed in 93 hospitalized patients with COVID-19 aged 1 to 88 years, of which 66 patients (group 1) on the first day and 27 patients (group 2) – on the second day. For comparison with the parameters of healthy volunteers, a sample of 30 people was formed. Data analysis was performed using the Statistica, version 12 (StatSoft, USA). To compare the independent variable in more than two samples, a multivariate ANOVA analysis of variance was performed with the calculation of the Kruskal-Wallis test. To assess the relationships between continuous variables, the Spearman direct linear correlation coefficient (r) was determined.Results. 53% of patients had hypocoagulation, 31% had normocoagulation, and 16% had hypercoagulation. Elderly patients (61 [26–72]) more often have developed hypocoagulation. Young patients (24.5 [7–37]) more often have developed hypercoagulation. Routine methods for assessing hemostasis did not reflect its true state. Higher levels of fibrinogen (4.5 [5.8–4] g/l) and D-dimer (1.28 [0.5–2.77] µg/ ml) were observed in patients from the group with normocoagulation. Was revealed a statistical tendency towards an increase in the level of amylase when there was an increase in the coagulation properties of the blood.Conclusion. With the current course of COVID-19 and early admission of non-severe patients to the hospital, normocoagulation and hypocoagulation predominate. Elderly and senile patients are not recommended to prescribe anticoagulants without TEG. It is necessary to specify the recommendations for prescribing anticoagulants to hospitalized patients. For the diagnosis of hemostasis disorders expand application of TEG.

Deep learning-based companion robot on senile dementia patients

BackgroundThere are currently at least 50 million dementia patients worldwide, and this number is expected to reach 152 million by 2050, of which about 60-70% will be Alzheimer’s patients. The companion robot based on deep learning is a product of the development of artificial intelligence technology, which is of great significance to the physical and mental health of the elderly, so it is used in the research on the treatment of Alzheimer’s patients.Subjects and Methods100 patients with Alzheimer’s disease in a hospital were selected for the study, and 50 patients were randomly divided into experimental group and control group. In the experiment, 50 patients with Alzheimer in the experimental group used a companion robot based on deep learning for auxiliary treatment while carrying out daily treatment. The control group of 50 patients did not receive any adjuvant therapy in addition to daily treatment. After three months of treatment, the study used the 3D-CAM and the mini–mental state examination (MMSE) to collect the treatment status of all patients, and used the SPSS23.0 statistical software to statistically analyze the collected data.ResultsAfter statistical analysis, the results of the two groups were obtained. The scores of 3D-CAM and MMSE in the experimental group were significantly higher than those in the control group and the difference was statistically significant.ConclusionsCompanion robots based on deep learning are helpful in the treatment of Alzheimer’s patients. They can improve the therapeutic effect and have certain social value.AcknowledgementThe Fundamental Research Funds in Heilongjiang Provincial Universities (No.135309356); Qiqihar University Young Teachers’ Scientific Research Initiation Support Program (No.2012k-M17).

Visual Outcomes of Phacoemulsification in Senile Cataract Patients in Purworejo Indonesia

Purpose: There was still limited study about the success rate of phacoemulsification in Indonesia, although it has been widely used. This study aimed to assess the visual acuity based on the characteristics of patients with senile cataract who underwent phacoemulsification. Study Design: Descriptive observational. Place and Duration of Study: Panti Waluyo Hospital, Purworejo from January to November 2019. Methods: This included 58 senile cataract patients (70 eyes) who underwent phacoemulsification. Basic patient characteristics such as: age, gender, cataract stages, comorbidity and pre- and postoperative visual acuity were taken from medical records. The visual acuity was measured pre-and postoperatively using Snellen Chart. The data were analyzed using a descriptive analysis method. Results: There were 23 men and 35 women who underwent phacoemulsification during the study period. Seventy six percent were 60 – 74 years old. Eighty percent had immature cataract. Half of the patients did not have any comorbidity of diabetes mellitus or hypertension. There were 45 (64.3%) eyes with moderate to severe visual impairment (vision 6/18 – ≥ 3/60) and 25 (35.7%) eyes with blindness (vision < 3/60). The postoperative vision of 57 eyes (81.4%) improved to a good outcome. Thirteen eyes (18.6%) were categorized as borderline outcome. No eyes were reported to have poor outcome post-surgery. Conclusion: The postoperative visual acuity of cataract patients who underwent phacoemulsification was classified as good outcome (81.4%) and borderline outcome (18.6%). In this study, there was no poor visual outcome found.

Approaches to predicting life expectancy in elderly coronary artery disease patients with comorbid conditions

The aim of the study was to develop a model for predicting the probability of survival up to 80 years of age for elderly and senile patients with coronary artery disease (CAD) and concomitant conditions. Materials and methods. A retrospective data analysis of elderly and senile CAD patients who were observed in the period 1997–2019 and died from a cardiovascular event. Results. Using binary logistic regression analysis, a model of the survival probability up to 80 years in CAD patients with comorbid conditions has been developed. The overall accuracy of the model was 83.12 % (χ2 = 6.70, p < 0.05), and the predictive accuracy of the model (AUC = 0.853, 95 % CI 0.802–0.896) was sufficiently high and adequate to use in clinical practice. Odds ratio has shown a greater contribution of arterial hypertension and diabetes mellitus to reduced probabilities of surviving to the age of 80, a less significant contribution – of chronic obstructive pulmonary disease and dyslipidemia. Conclusions. The developed model for predicting the survival probability up to 80 years for older age group patients with coronary artery disease and comorbid conditions can be used to evaluate the effectiveness and correct medical and preventive measures.

Retracted: To Analyze the Influencing Factors of Senile Coronary Heart Disease Patients Complicated with Frailty Syndrome.

[This retracts the article DOI: 10.1155/2022/7619438.].

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).

Ways to improve the organization of dental treatment and preventive measuresin the elderly and senile people

Background. The purpose was to develop ways to improve the organization of dental treatment and preventive measures for the elderly and senile people. Materials and methods. The study involved 578 patients aged 60 to 89 years. At stage I, a dental examination was performed followed by an assessment of the dental status and at stage II, after examination by internists, somatic status was evaluated. Results. The presence of comorbid or multimorbid conditions in the elderly and senile patients leads to complicated course of major dental diseases that requires long-term treatment and rehabilitation with considerable financial costs. To address this challenge, we offered a multidisciplinary individualized approach to the examination of each patient. To this end, we have developed a road map for a dental еlderly рatient. Conclusions. High clinical effect in carrying out treatment and preventive measures was ensured by improvement of their organization, which consisted in the application of multidisciplinary approach with involvement of dentists of related specialties and internists in providing dental care to the elderly and senile patients.

Согласованное мнение экспертов по проблемам недержания мочи у пациентов пожилого и старческого возраста

Согласованное мнение экспертов по проблемам недержания мочи у пациентов пожилого и старческого возраста

Experience of teaching doctors the principles of rational pharmacotherapy on the example of patients with a fall in a hospital

The postgraduate education of doctors in the principles of rational pharmacotherapy, conducted on the educational program «Polypragmasia in a therapeutic and preventive organization: a problem and a solution» of 36 academic hours, allowed to reduce the total number of simultaneously prescribed medications in elderly patients of a cardiological profile in a gerontological hospital (the number of medications received by patients older than 75 years before and after training, respectively 9.48±2.6 vs 7.12±1.9, p<0.001). A decrease in polypragmasia contributed to a decrease in the frequency of suspected unforeseen serious adverse reactions, which included falls associated with taking medications. The simultaneous introduction of Safety Protocols, Standard Operating Procedures for identifying patients at high risk of falling and conducting incident analysis led to the analysis of each case of an elderly and senile patient falling in a hospital and a review of the treatment received.

Risk of Macular Toxicity After Intra-Cameral 1mg/0.1 ml Cefuroxime for Endophthalmitis Prophylaxis in Phacoemulsification Cataract Surgery

The world's leading culprit of preventable blindness is cataracts. For numerous decades, postoperative endophthalmitis has instilled terror as a potential complication of cataract surgery. Objective: To determine the frequency of retinal toxicity in terms of transient macular edema following using per-operative intracameral cefuroxime 1mg/0.1ml for endophthalmitis prophylaxis. Methods: A Descriptive case series was done at LRBT Eye Hospital, Lahore, from 15th Dec 2020 to 14th Jun 2021. A total number of 118 senile cataract patients were included. After cataract surgery, an intracameral 1 mg injection of cefuroxime was given to each patient. The optimally corrected visual acuity and macular thickness at the center of the retina on OCT were assessed postoperatively at week 1. If they were found to be elevated, it was labeled as retinal toxicity. Data were collected on data collection proforma. Results: The average age of the participants was 59.68 ± 5.28 years. Mean visual acuity before and after surgery was 2.01 ± 0.74 and 1.92 ± 0.94, respectively. Mean central macular thickness before and after surgery was 241.08 ± 4.73 and 248.74 ± 5.86 µm, respectively. There were 71 (60.17%) male and 47 (39.83%) female patients. There were 42 (35.59%) farmers, 40 (33.90%) job holders, 05 (4.24%) business people, and 31 (26.27%) non-working patients. Retinal toxicity was found in 54 (45.76%) patients. Conclusions: Intracameral injection of cefuroxime sodium can result in transient macular edema and retinal toxicity. In this study, retinal toxicity occurred in 45.8% of patients undergoing phacoemulsification.

Study of level of malondialdehyde and total antioxidant capacity (TAC) in human lens epithelial cells of diabetic and senile cataract patients

Study of level of malondialdehyde and total antioxidant capacity (TAC) in human lens epithelial cells of diabetic and senile cataract patients

Perioperational management of elderly and senile patients based on a comprehensive geriatric assessment for endoprosthetics of large joint

Introduction. Due to the changing age structure of the world’s population, an increase in the number of geriatric patients undergoing endoprosthetics of large joints is to be expected in the future. Age-related frailty and existing comorbidities pose problems for the entire treatment team.The aim of the study was to determine the effectiveness of comprehensive geriatric management of elderly and senile patients before and after endoprosthetic of the hip and knee joints.Materials and methods. An analysis of publications on the use of comprehensive in endoprosthetic of large joints in elderly and senile patients with osteoarthritis was performed. Searched in the electronic databases and libraries Web of Science, Conchrane library, PubMed, eLibrary using the search words: comprehensive geriatric assessment.Results and discussion. There is an increasing incidence of large joints endoprosthetic in orthogeriatric patients with osteoarthritis. Anaesthesia and arthroplasty in this group of patients is an important issue, as well as ensuring immediate postoperative mobilization of the patient. An individualized patient preparation plan for surgical intervention and postoperative management, aimed at preventing the development of transient cognitive impairment and other complications associated with geriatric status, in particular falls, is a necessary organizational element of treatment.Conclusion. A comprehensive geriatric assessment plays a crucial role in the perioperative introduction of geriatric patients for endoprosthetic of large joints. Timely identification of geriatric patients during the preoperative phase eliminates risk factors.

ПЕРСПЕКТИВЫ ПРИМЕНЕНИЯ МЕТОДОВ НАУЧНОЙ МУЗЫКОТЕРАПИИ И АРТ-ТЕРАПИИ ПАЦИЕНТАМ ПОЖИЛОГО ВОЗРАСТА В УСЛОВИЯХ САНАТОРНО-КУРОРТНОГО ЛЕЧЕНИЯ

This article is devoted to the prospects of applying scientific music therapy as psychophysiological assistance to elderly and senile people during their stay in a sanatorium-resort institution. The issues of the psychosomatic status of elderly and senile patients and the possible consequences of psychosomatic disorders, as well as the possibility of using scientific music therapy in the treatment of psychosomatic diseases and other health disorders are discussed. The article presents a description of receptive and active methods of scientific music therapy, as well as methods of music and art therapy in the framework of treatment, rehabilitation and rehabilitation in sanatorium conditions. The expediency and necessity of active introduction and application of scientific music therapy technologies to elderly patients in the conditions of sanatorium treatment is substantiated.

Surgical Treatment of Fractures of the Trochanteric Zone of the Femur in Older Patients

Summary. Treatment of fractures of the trochanteric zone of the femur in the elderly still remains one of the problems that need further study.
 Objective: to analyze clinical application of internal osteosynthesis for fractures of the trochanteric zone in older and senile patients.
 Materials and Methods. The results of treatment of 102 older patients with fractures of the trochanteric region of the femur were analyzed. All patients were treated surgically using a proximal femoral nail antirotation (PFNA); the indicators at the inpatient stage of treatment and long-term consequences up to 3 years after treatment were analyzed using improved standards for evaluating the quality of treatment of injuries and diseases of the organs of movement and resistance with modification.
 Results and Discussion. Analyzing the treatment of 102 patients with fractures of the trochanteric region type A1, A2, A3 according to the AO classification, it was found that surgical treatment with the use of PFNA proves its effectiveness due to minimally invasive access, minimal intraoperative blood loss, a short time of surgical intervention, and the possibility of early activation of patients and provides low rates of postoperative complications and mortality.
 Conclusions. 1. The conducted clinical study allows us to confirm the effectiveness of the PFNA system in the surgical treatment of older patients with fractures in the trochanteric zone in a trauma hospital. 2. In older patients with fractures of the trochanteric zone of the femur, PFNA osteosynthesis allows restoring the function of the hip joint in 54.6% (55% СІ 85.4-55.8) of cases. 3. PFNA can be recommended as a priority in the treatment of older patients with fractures of the trochanteric region of the femur in a trauma hospital.

The efficacy and safety of apixaban: what has changed in 12 years of its use in real clinical practice?

This review examines the position of apixaban among other direct oral anticoagulants in patients with atrial fibrillation (AF) and venous thrombosis in randomized clinical trials and real clinical practice. Since the advent of apixaban, many studies of real clinical practice (RCP) and meta-analyses have appeared. RCP studies have fully confirmed the efficacy and safety of apixaban. Now we have data that au pixaban is equally effective and safe in elderly and senile people and younger patients, as well as in patients with reduced creatinine clearance. The efficacy and safety of apixaban has been confirmed in patients with AF with the presence of diseases of several vascular basins, in patients with AF and angina, including acute coronary syndrome, treated by coronary artery stenting and conservatively. An important property of apixaban is safety, which can be traced in almost all studies, which made it possible to successfully apply it in people with a high risk of bleeding, namely in patients with active cancer and venous thrombosis. Thus, RCP studies in patients with AF, including the elderly and senile patients with chronic kidney disease, many concomitant diseases, as well as patients with VTEC, confirmed the results of randomized clinical trials of apixaban. The drug appears to be an effective and at the same time the safest anticoagulant. The safety image of Apixaban which has become noticeable in all RCTs (in patients with atrial fibrillation, VTEC, including patients with active cancer) was confirmed both in real clinical practice studies and meta-analyses, and allowed it to be successfully used in the category of patients which are at highest risk for bleeding.

The modified resistance index in elderly and senile patients with chronic kidney disease and cardiovascular comorbidity

The modified resistance index in elderly and senile patients with chronic kidney disease and cardiovascular comorbidity