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This article presents the incidence of geriatric syndromes in patients with chronic heart failure 65 years of age and older, depending on cognitive status. At the Russian gerontological center, 149 people with confirmed chronic heart failure were selected according to the European criteria of 2021. In this sample, 50,3% of patients had mild cognitive impairment, and 17,5% had severe cognitive impairment. With age, the incidence and severity of cognitive impairment increased. Among patients with cognitive impairment, there were more patients with reduced basic and instrumental activities of daily living, with a high risk of malnutrition and malnutrition, frailty and patients with hearing loss. Also, as cognitive functions declined, the median score of the Barthel and Lawton index, the mini nutritional assessment, the short physical performance battery, the Lubben social network scale decreased, and the median of the Morse fall risk scale and the geriatric depression scale increased. The presence of hearing loss was associated with a 3,6-fold increase in the odds of being diagnosed with cognitive impairment, and the presence of frailty syndrome, basic dependence in daily life, or the risk of malnutrition by a 2,4-fold increase.
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Actividades Cotidianas , Disfunción Cognitiva , Evaluación Geriátrica , Insuficiencia Cardíaca , Humanos , Anciano , Femenino , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/psicología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/complicaciones , Masculino , Evaluación Geriátrica/métodos , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/diagnóstico , Federación de Rusia/epidemiología , Anciano de 80 o más Años , Fragilidad/epidemiología , Fragilidad/psicología , Fragilidad/fisiopatología , Fragilidad/diagnóstico , Desnutrición/epidemiología , Desnutrición/diagnóstico , Desnutrición/psicología , Desnutrición/fisiopatología , Enfermedad Crónica , Incidencia , Pérdida Auditiva/epidemiología , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/psicología , Pérdida Auditiva/fisiopatología , Síndrome , Evaluación NutricionalRESUMEN
The number of elderly and senile patients who are in need of surgical care delivery is growing steadily year over year. This category of patients is characterized by comorbidity, polypragmasy and high prevalence of geriatric syndromes including loss of autonomy, malnutrition and cognitive impairments that increase the risk of developing perioperative complications. Management of these patients at all stages requires a comprehensive multidisciplinary approach. Nevertheless, there is no uniform understanding of solution of this problem at present. Determination of consensus on certain issues using the Delphi method will allow to gather and unite expert opinions. In this regard, the working group formulated the main points of management of elderly and senile patients before, during and after surgical treatment and conducted a cross-sectional analysis of experts' opinions.
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Evaluación Geriátrica , Humanos , Anciano , Evaluación Geriátrica/métodos , Consenso , Anciano Frágil , Técnica Delphi , Fragilidad/complicaciones , Femenino , Masculino , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Grupo de Atención al Paciente/organización & administración , Atención Perioperativa/métodos , Atención Perioperativa/normas , Estudios TransversalesRESUMEN
OBJECTIVES: Delirium is common during acute infection in older patients and is associated with functional decline. Geriatric rehabilitation (GR) can help older patients to return to their premorbid functional level. It is unknown whether delirium affects GR outcomes in patients with acute infection. We evaluated whether delirium affects trajectories of activities of daily living (ADL) and quality of life (QoL) recovery in GR after COVID-19 infection. DESIGN: This study was part of the EU-COGER study, a multicenter cohort study conducted between October 2020 and October 2021. SETTING AND PARTICIPANTS: Participants were recruited after COVID-19 infection from 59 GR centers in 10 European countries. METHODS: Data were collected at GR admission, discharge, and at the 6-week and 6-month follow-ups. Trajectories of ADL [using the Barthel index (BI)] and QoL [using the EuroQol-5 Dimensions-5 Level (EQ-5D-5L)] recovery were examined using linear mixed models. RESULTS: Of the 723 patients included (mean age 75.5 ± 9.9 years; 52.4% male), 28.9% had delirium before or during GR admission. Participants with delirium recovered in ADL at approximately the same rate as those without (linear slope effect = -0.13, SE 0.16, P = .427) up to an estimated BI score of 16.1 at 6 months. Similarly, participants with delirium recovered in QoL at approximately the same rate as those without (linear slope effect = -0.017, SE 0.015, P = .248), up to an estimated EQ-5D-5L score of 0.8 at 6 months. CONCLUSIONS AND IMPLICATIONS: Presence of delirium during the acute phase of infection or subsequent GR did not influence the recovery trajectory of ADL functioning and QoL.
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Actividades Cotidianas , COVID-19 , Delirio , Calidad de Vida , Recuperación de la Función , Humanos , Anciano , Masculino , Femenino , Anciano de 80 o más Años , Europa (Continente) , SARS-CoV-2 , Estudios de Cohortes , Evaluación GeriátricaRESUMEN
Aim To evaluate the incidence of iron deficiency (ID) in men and women with chronic heart failure (CHF) and to compare clinical and functional indexes in patient with and without ID depending on the gender.Material and methods An additional analysis of the study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)" was performed. The study included 498 (198 women, 300 men) patients with CHF, in whom, in addition to iron metabolism, the quality of life and exercise tolerance (ET) were studied. 97 % of patients were enrolled during their stay in a hospital. ID was defined in consistency with the European Society of Cardiology (ESC) Guidelines. Also, and additional analysis was performed according to ID criteria validated by the morphological picture of the bone marrow.Results ID was detected in 174 (87.9 %) women and 239 (79.8 %) men (p=0.028) according to the ESC criteria, and in 154 (77.8 %) women and 217 (72.3 %) men (p=0.208) according to the criteria validated by the morphological picture of the bone marrow. Men with ID were older and had more severe CHF. They more frequently had HF functional class (FC) III and IV (63.4 % vs. 43.3 % in men without ID); higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and lower ET. HF FC IIIâincreased the probability of ID presence 3.4 times (p=0.02) and the probability of HF FC IVâ13.7 times (p=0.003). This clinical picture was characteristic of men when either method of determining ID was used. In women, ID was not associated with more severe CHF.Conclusion Based on the presented analysis, it is possible to characterize the male and female ID phenotypes. The male ID phenotype is associated with more severe CHF, low ET, and poor quality of life. In females of the study cohort, ID was not associated with either the severity of CHF or with ET.
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Insuficiencia Cardíaca , Deficiencias de Hierro , Humanos , Femenino , Masculino , Calidad de Vida , Prevalencia , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Enfermedad Crónica , FenotipoRESUMEN
The prevalence of older people in Russian population increases rapidly. Therefore, the concept of healthy aging is becoming crucial in Russia and all over the world, and thus disability prevention is one aspect of this issue. Aim: To assess a possible association between geriatric syndromes, comorbidities, and mortality rate among frail patients who receive home medical care in Moscow. Materials and methods: The study included 450 patients with home medical care provided by the State Budgetary Healthcare Institution "Diagnostic Center No. 3 of the Moscow Health Department" from June 2019 to April 2021. Physical health, functional, cognitive, social and emotional statuses were evaluated by comprehensive geriatric assessment (CGA). The mortality rate after 1 year was assessed. Results: The all-cause case mortality rate in patients during the observation period was 22.4%. There was no difference in age and comorbidities in survivors and deceased patients, but the latter group had more geriatric syndromes. The association between risks of mortality and anemia and some geriatric syndromes, such as malnutrition and hearing impairment, total dependence (Barthel index less than 60) was observed.
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Aim To evaluate the prevalence of iron deficiency (ID) in Russian patients with heart failure (HF).Material and methods Iron metabolism variables were studied in 498 (198 women, 300 men) patients with HF. Data were evaluated at admission for HF (97â%) or during an outpatient visit (3â%). ID was determined according to the European Society of Cardiology Guidelines.Results 83.1â% of patients had ID; only 43.5â% of patients with ID had anemia. Patients with ID were older: 70.0 [63.0;79.0] vs. 66.0 years [57.0;75.2] (p=0.009). The number of patients with ID increased in parallel with the increase in HF functional class (FC). Among patients with ID, fewer people were past or current alcohol users (p=0.002), and a greater number of patients had atrial fibrillation (60.1 vs. 45.2â%, p=0.016). A multiple logistic regression showed that more severe HF (HF FC) was associated with a higher incidence of ID detection, whereas past alcohol use was associated with less pronounced ID. An increase in N-terminal pro-brain natriuretic peptide (NT-proBNP) by 100âpg/ml was associated with an increased likelihood of ID (odds ratio, 1.006, 95â% confidence interval: 1.002-1.011, p=0.0152).Conclusion The incidence rate of HF patients is high in the Russian Federation (83.1â%). Only 43.5â% of these patients had anemia. The prevalence of ID in the study population increased with increases in HF FC and NT-proBNP.
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Fibrilación Atrial , Insuficiencia Cardíaca , Deficiencias de Hierro , Anciano , Fibrilación Atrial/complicaciones , Biomarcadores , Estudios Transversales , Femenino , Insuficiencia Cardíaca/complicaciones , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico , Fragmentos de PéptidosRESUMEN
PURPOSE: To compare the effect of 12 months of treatment with moxonidine or bisoprolol on telomerase activity (TA) and parameters characterizing the arterial wall state in postmenopausal women with arterial hypertension (AH) and osteopenia. METHODS: An open-label randomized study with 114 postmenopausal women with hypertension and osteopenia; pulse wave velocity (PWV), intima-media thickness (IMT), and TA were analyzed initially and after 12 months of therapy with moxonidine (n = 57) or bisoprolol (n = 57). RESULTS: Both medications effectively lowered blood pressure (BP) in both groups. After 12 months, the moxonidine group showed a significant increase in TA by 45.5% (from 0.87 to 1.15; p < 0.001), in contrast to the bisoprolol group, where TA decreased by 14.1% (from 0.89 to 0.74; p = 0.001). Within 12 months, in the moxonidine group, PWV decreased by 1.9% (from 10.35 ± 2.56 to 10.05 ± 2.29 m/s; p = 0.039), and in the bisoprolol group it increased by 5.8% (from 10.36 ± 2.47 to 11.26 ± 2.60 m/s; p < 0.001). In the moxonidine group, IMT increased by 3.5% on the right and 1.4% on the left, in the bisoprolol group - by 5.7% on the right and 4.2% on the left. CONCLUSION: A 12-month treatment with moxonidine but not with bisoprolol in postmenopausal women with AH and osteoporosis was associated with a decrease of arterial stiffness seen as statistically significantly reduced PVW and with increased TA.
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Bisoprolol , Enfermedades Óseas Metabólicas , Hipertensión , Telomerasa , Femenino , Humanos , Antihipertensivos/farmacología , Bisoprolol/farmacología , Enfermedades Óseas Metabólicas/complicaciones , Enfermedades Óseas Metabólicas/tratamiento farmacológico , Grosor Intima-Media Carotídeo , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Moscú , Posmenopausia , Análisis de la Onda del Pulso , Telomerasa/efectos de los fármacosRESUMEN
Senile asthenia syndrome (SAS) is a geriatric syndrome characterized by age-associated decline of the physiological reserve and function in multiple systems, which results in higher vulnerability to effects of endo- and exogenous factors and a high risk of unfavorable outcomes, loss of self-sufficiency, and death. Generally, SAS is observed in elderly patients with comorbidities. In cardiovascular diseases, SAS is associated with a poor prognosis, including a higher incidence of exacerbation and death both during acute events and in chronic disease. However, SAS is often not taken into account in developing diagnostic and therapeutic programs for managing elderly patients with cardiovascular diseases (CVD). This article analyzes available scientific information about SAS, algorithms for SAS diagnosis, and the scales that may be useful in developing individual plans for management of elderly patients with CVD.
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Enfermedades Cardiovasculares , Geriatras , Anciano , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Testimonio de Experto , Evaluación Geriátrica , Humanos , Federación de Rusia/epidemiologíaRESUMEN
In recent years, more and more works have appeared that with age, classic risk factors that negatively affect the prognosis (cardiovascular diseases) lose their influence on life expectancy. The study aimed to assess the influence of cardiovascular diseases and their risk factors and structural and functional characteristics of the heart on three-year survival in people 95 years and older. The study involved 69 patients 95 years and older (98±1,9 years), 61 (88,4%) were women. After 36 months, data were obtained on the participants' status of life: 25 (36,2%) were alive, and 44 (63,8%) died. Based on the regression analysis results, it was determined that risk factors and history of cardiovascular diseases were not associated with 3-year survival. With a 3-year follow-up, the risk of death increases three times with a decrease in diastolic blood pressure less than 75 mm/Hg, 7,8 times with a decrease in left ventricular ejection fraction below 62%, and 4,9 times with an increase in the end-diastolic size of the right ventricle by more than 2,9 cm.
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Enfermedades Cardiovasculares , Insuficiencia Cardíaca , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Femenino , Humanos , Pronóstico , Factores de Riesgo , Volumen Sistólico , Función Ventricular IzquierdaRESUMEN
A hypertensive crisis is a sudden increase in blood pressure (BP) to an individually high level associated with clinical symptoms and target organ damage, in which BP must be reduced immediately. Since 2018 in Europe and since 2020 in Russia, an uncomplicated hypertensive crisis is recommended to be considered as a part of malignant (uncontrolled) arterial hypertension. The clinical picture of increased BP in elderly patients is characterized by nonspecific symptoms even in target organ damage. Management of this group of patients requires a physician to know the patient's comorbidities and the drugs taken on a regular basis to minimize development of side effects of the administered drugs and their undesirable interaction with the chronic therapy.