[The prevalence of osteoarthritis and its association with geriatric syndromes in people over 65: data from the Russian epidemiological study EVKALIPT].

BACKGROUND: Osteoarthritis (OA) in elderly and senile patients is not only common, but also one of the main diseases affecting the duration of active life, its quality, the appearance of addictions and loss of autonomy. Data on the relationship between OA and geriatric syndromes (GS) in our country are extremely scarce. AIM: To estimate the prevalence of OA and to analyze its associations with HS in persons aged 65 years. MATERIALS AND METHODS: The study included 4308 people (30% of men) aged 65 to 107 years, living in 11 regions of Russia. The patients were divided into 2 groups: with OA (n=2464) and without OA (n=1821). All patients underwent a comprehensive geriatric assessment. RESULTS: The prevalence of OA was 57.6%. With age, the frequency of OA increased significantly. According to the results of a comprehensive geriatric assessment, patients with OA had lower walking speed, the sum of points on the Bartel, Lawton scales and a short battery of physical functioning tests and higher the sum of points on the geriatric scale of depression and the age is not a hindrance scale. Patients with OA rated the quality of life and health status lower and higher the intensity of pain syndrome. Patients with OA were more likely to use any assistive device, with the exception of a wheelchair. In patients with OA, the most common HS were chronic pain syndrome (92%), senile asthenia syndrome (64%), basic (66%) and instrumental (56%) dependence in everyday life, cognitive impairment (62%), probable depression (51%) and urinary incontinence (50%). Univariate regression analysis showed that OA is associated with a 1.23.0-fold increase in the risk of a number of GS and a 28% decrease in the risk of malnutrition. CONCLUSION: OA is widespread in the elderly population. The presence of OA is associated with a number of GS associated with loss of autonomy.

[The clinical status and treatment options for osteoarthritis in patients with frailty].

Aging is an independent risk factor for the development of many diseases and geriatric syndromes. Osteoarthritis (OA), as the most common joint disease in the elderly, can be attributed to age - associated conditions. And the most significant geriatric syndrome, which dramatically affects the management and prognosis of an elderly, is frailty. The review provides current information on the prevalence of OA and frailty, their clinical and prognostic significance, and also shows the mutually aggravating role of these two conditions. The difference between non - and medication management of patients with OA and frailty is emphasized.

[Comprehensive personalized protocol for the prevention of repeated falls in elderly and senile patients]. / Kompleksnyi personifitsirovannyi protokol profilaktiki povtornykh padenii u patsientov pozhilogo i starcheskogo vozrasta.

OBJECTIVE: To study evaluation of the effectiveness of a comprehensive personalized protocol for the prevention of repeated falls in elderly and senile patients. MATERIAL AND METHODS: Over the course of one year, 300 patients aged 60 and older who suffered two or more falls during the year were observed. Patients of group 1 (n=100) were recommended a comprehensive personalized protocol for the prevention of repeated falls, the observance of which was regularly monitored; patients of group 2 (n=100) received standard recommendations for the prevention of falls upon discharge from the hospital, the observance of which was not actively monitored; patients of group 3 (n=100) were observed by a therapist on an outpatient basis. Primary endpoints: frequency of falls, death from any cause; secondary endpoints: the frequency of fractures, the frequency of hospitalizations for any reason. RESULTS: In group 1, after a year, the frequency of falls decreased by 5 times (100% vs. 21%, p<0.0001), in groups 2 and 3 - by 38% (p=0.013) and 81% (p<0.001). There was no significant decrease in the number of all fractures in any group, but in group 3, the frequency of vertebral fractures increased during the year (p=0.029). Statistically significant positive dynamics of indicators characterizing the geriatric status has been established: walking speed, values on the basic activity scale, a short nutrition assessment scale, the results of the drawing hours test have increased, the intensity of pain has decreased. No one died in group 1, unlike 5 patients in group 2 and 8 in group 3 (p=0.011). CONCLUSION: The use of a comprehensive personalized protocol for the prevention of repeated falls can reduce the number of complications in elderly and senile patients.

[Falls and pathology of the musculoskeletal system in the older age groups]. / Padeniia i patologiia kostno-myshechnoi sistemy v starshikh vozrastnykh gruppakh.

BACKGROUND: Fall in the elderly is considered as a geriatric syndrome, which increases the risk of new falls, decreases physical functioning and autonomy and is associated with other geriatric syndromes. One of the most common risk factors for falls is the pathology of the musculoskeletal system, including osteoarthritis, sarcopenia, osteopenia and osteoporosis, as well as chronic pain. AIM: To characterize diseases of the musculoskeletal system in elderly patients with falls. MATERIAL AND METHODS: The study included 289 patients (mean age 75,8±7,9 years, 224 women) who underwent falls during the last year. All patients had polymorbid pathology (mean number of diseases 5,13±2,3, the Charlson index 5,63±1,8 points). All patients underwent general clinical studies, a comprehensive geriatric assessment, X-ray examination of the joints, dual-energy X-ray absorptiometry. RESULTS AND CONCLUSION: The risk of falls assessed with a self-assessment scale as 7,45±3 points had 90,3% of patients, 34,6% of patients had the high hospital risk of falls. All patients had aggravated geriatric status (on average 7 geriatric syndromes). Among the risk factors for falls, one of the most common was the condition associated with the pathology of the musculoskeletal system: chronic pain (84,7%), physical inactivity (56,1%), disorders of balance (60,2%) and gait (35,9%), the use of mobility aids (30,4%), orthopedic pathology (9,7%) and vitamin D deficiency (86,1%). Osteoarthritis prevailed (75,8%) among nosological forms. One hundred and forty-two (64,8%) patients had pain in the joints, the duration of pain was 6,2±5,6 days, the pain intensity was 47,2±20,7 mm on a visual analogue scale and 106,3±112,3 points by WOMAC. The neuropathic component was diagnosed on DN4 scale in 34 (23,9%) patients. Dynapenia was detected in 109 (37,7%) patients, and sarcopenia in 28 (25,6%) of them. The risk of osteoporotic fractures was 17,4±7,9%. The significantly higher incidence of dynapenia, insufficiency and deficiency of vitamin D and a higher risk of osteoporotic fractures was observed in 289 patients with falls compared to 213 people without falls.

[Osteoarthritis and geriatric syndromes]. / Osteoartrit i geriatricheskie sindromy.

AIM: To study the geriatric status of patients with osteoarthritis (OA) older than 60 years depending on the severity of frailty. MATERIAL AND METHODS: The study included 201 patients with OA (mean age 75.84±8.09 years). The patients were divided into 3 groups: patients without frailty, patients with prefrailty and patients with frailty. Along with clinical examination, the risk of falls, pain intensity, the Charlson comorbidity index and the number of geriatric syndromes were calculated. RESULTS AND CONCLUSION: With the increase of frailty, the number of patients experiencing difficulties in movement increases. The physical activity of the patients gradually reduces with the appearance of prefrailty and significantly reduces in OA. At the same time, there is the increase in dependence on outside help, the decrease in IADL and walking speed. The most common geriatric syndromes in patients with OA are sensory deficits, chronic pain syndrome and falls. The neuropathic component of pain is diagnosed in every tenth patient with OA without frailty and in every third patient with OA and frailty. In light of results obtained in the study, the authors suggest detailed recommendations for treatment of patients.

[The place of chondroitin sulfate and glucosamine sulfate in osteoarthritis pain therapy: a practical view from evidence-based medicine]. / Mesto khondroitina sul'fata i gliukozamina sul'fata v terapii boli pri osteoartrite.

Osteoarthritis is one of the leading causes of a chronic pain in elderly people. Old and very old age in itself is a risk factor of a comorbidity, which often limits the therapy specified in clinical recommendations. First of all, it concerns NSAID. In such situations, priority is given to chondroitin sulfate (CS) and glucosamine sulfate (GS) having the anti-inflammatory properties comparable with effects of NSAID. CS and GS also promote the delay in progression of degenerative processes and restoration of the structure of cartilaginous tissue. The drugs of CS and GS groups are Chondroguard and Sustaguard Artro having the considerable evidence-based efficacy and safety and also a polymodality of effects in patients with a combination of osteoarthritis and socially important diseases (atherosclerosis, diabetes mellitus type 2, oncological diseases) and also geriatric syndromes (sarcopenia) and aging in general.

[Chronic pain in patients older than 60 years: a view of the geriatrics]. / Khronicheskaia bol' u patsientov starshe 60 let: vzgliad geriatra.

AIM: To analyze the geriatric status of patients with chronic pain. MATERIAL AND METHODS: One hundred and sixteen patients of a geriatric unit, aged 75.66±7.98 years (110 women, 94.8%), were studied. All patients underwent general clinical examination and complex geriatric assessment, on the results of which geriatric syndromes were identified. Characteristics of pain syndrome (cause, intensity, localization) are described. RESULTS: Chronic pain syndrome is identified in 85 (73.3%) patients. Most often pain is localized in large joints (n=44 (51.76%)) and back (n=50 (58.8%)). The intensity of pain was higher in patients with moderate dependence in daily activities compared to those with mild dependence (p<0.05). Pain intensity is associated with the degree of impairment of physical functioning (p<0.05). Patients with chronic pain have more geriatric symptoms (6.8±2.8). More syndromes (9.11±2.37) are identified in patients with marked impairment of physical functioning. The reduction of muscle strength is observed in 45.9% patients with- and 9.7% patients without chronic pain syndrome. The velocity of pace is 0.59 m/s and 0.71 m/s, respectively. CONCLUSION: The high prevalence of chronic pain in patients of a geriatric unit is shown. The intensity of pain iss higher in patients with moderate dependence in daily activities compared to those with mild dependence. Pain intensity increases with the reduction of patient's physical functioning. Patients with chronic pain more often have dynapenia and significantly lower velocity of pace that indicates the poor outcome in elderly patients.

[Microsurgical elimination of foot soft tissue defects with free vascularized flaps]. / Mikrokhirurgicheskoe ustranenie defektov miagkikh tkaneí stopy svobodnymi vaskuliarizirovannymi loskutami.

The results of 40 microsurgical transplantations of complex flaps in 37 patients with cicatricial-ulcerous foot deformations are analysed. The surgery was indicated in cicatricial soft tissues defects, unhealing trophic ulcers, inability to use local tissues for plastic surgery. The scapular flap was used in 34 cases, thoraco-dorsal flap in 5 cases, deltoid flap in 1 case. It was necessary to increase the square of the scapular flap in case of a vast cicatricial soft tissue defect of the talocrural joint and dorsal surface of the foot and the sole. A special expander was used for this purpose. The importance of ultrasound methods for evaluation of the vessels supplying the sole, as well as the state of the microvascular anastomoses in postoperative period is stressed. The long-term results were followed up for 1.5 to 5 years in 29 of 37 patients. The good results was noted in 18 patients, satisfactory in 7 patients, complications (unhealed trophic ulcers) in 4 patients. The complications were caused by calcanel tuber deformation with osteophyte, osteomyelitis, inradically removed scars.