[Therapeutic effects of medical rehabilitation in patients suffered from coronary heart disease with lower limb amputation]. / Lechebnye effekty meditsinskoi reabilitatsii bol'nykh ishemicheskoi bolezn'yu serdtsa s amputatsiei nizhnikh konechnostei.

Disabled persons, who have undergone lower limb amputation (LLA) due to obliterating atherosclerosis, are a special group among patients with coronary heart disease (CHD). In the developed countries, 25-35% of patients was performed high LLA in the first year of critical ischemia, ant the number of interventions is steadily increasing. The development of personalized medical rehabilitation programs (MR) for such patients is relevant. OBJECTIVE: To scientifically substantiate the therapeutic effects of MR in patients with CHD and LLA. MATERIAL AND METHODS: The research design was a prospective cohort comparative study of MR therapeutic effects. The research subject was a change of physical activity tolerance (PAT) in patients during the implementation of recommended MR programs. The study object was 102 patients aged from 45 to 74 years. All patients were distributed by the random numbers method. The examined sample of patients was divided into two clusters. The first cluster consisted of 52 patients with CHD and LLA: study group included 1 - 26 patients, who were performed MR (kinesitherapy, manual mechanokinesitherapy, breathing exercises) and comparison group consisted of 1 - 26 patients, who were performed the preparation to prosthetics). The second cluster included 50 patients with CHD (study group consisted of 2 - 25 patients, who were performed MR and pharmacotherapy, and comparison group consisted of 2 - 25 patients, who were performed only pharmacotherapy). Clinical, instrumental and laboratory methods of examination were used in the research, as well as indicators of psychophysiological status and life quality, subjected to adequate statistical analysis. RESULTS: Dosed physical activities improve clinical and psychophysical statuses, as well as life quality of patients with CHD and LLA, increase contractility and optimize diastolic myocardial function, raise PAT, improve central and intracardial hemodynamics levels, neurohumoral regulation and lipid metabolism. The efficacy of personalized MR programs for patients with CHD and LLA is 88%, and standardized programs is 76%. The determinants of MR efficacy are base PAT values, as well as indicators of myocardial contraction and diastolic function. CONCLUSION: The MR in patients with CHD and LLA forms obvious cardiotonic, vegetative correcting and lipid lowering healing effects.

[Clothing and footwear for the elderly and senile: recommendations for the formation of a special wardrobe.]

According to WHO, the number of elderly and senile people by 2050 will amount to more than 2 billion people. The period 2020-2030 is designated by WHO as the «Decade of Healthy Aging¼ with a program according to which healthy aging is designed to delay the dependence of this age group on outside help, to promote their long healthy life. Such a statement of the problem indicates an understanding of the relevance of the development of functionally comfortable and aesthetically designed clothing and footwear designs that provide this contingent with independence in self-service and contribute to their successful longevity. The purpose of the study is to substantiate recommendations for the development of clothing and footwear designs, the formation of a wardrobe for elderly and senile people to facilitate the process of self-service and movement. A questionnaire has been developed, with the help of which an examination by specialists and a survey of 60 patients aged 60-87 years who underwent social rehabilitation in the clinic of the 1Federal Scientific Center for Rehabilitation of Disabled People named after G.A.Albrecht. Information was obtained about the diseases of these patients, about the limitations in self-service and mobility, preferences in choosing standard designs of clothing and shoes, claims and wishes for their characteristics in the aspect of self-service. The main recommendations on the compilation of a wardrobe for the elderly and senile age have been developed and formulated, the need for the development of functionally new forms and designs of both clothes and shoes to create for the elderly and senile the convenience of using these products, hiding morphological defects and deformations (figures and feet) and at the same time meeting the aesthetic requirements of fashion and personal preferences has been substantiated the user. The rehabilitation effect of using functionally new forms and designs of these products is to provide self-management of clothing and footwear for patients with significantly pronounced diseases, functional disorders, defects and deformations of the musculoskeletal system, that is, to reduce their dependence on outside help in the process of self-service and movement.

[Rheumatic polymyalgia is a rarely diagnosed, but often occurring disease in elderly patients.]

Verification of the diagnosis of rheumatic polymyalgia at the reception of a general practitioner, geriatrician presents significant difficulties due to the lack of pathognomonic signs of the disease. The «calling card¼ of the disease is a combination of severe pain in the proximal muscle groups in combination with a high acute inflammatory response.

[The influence of hearing and vestibular impairments on cognitive function in elderly people.]

Cognitive function is a complex brain function that is important in the cognition of the reality and connecting with it. It has a complicated reflex basis, arises from external factors exposure, improves by growing up and learning till its maximum and declines in the elderly age. For several years it was believed that cognitive function drop is connected with ageing processes of the whole organism. However, the results of the latest studies show that it can be affected by many factors. Two of the most influencing factors are hearing and vestibular efficiency. Moreover, hearing and vestibular normalization can even improve the cognitive function. Unfortunately, studies, that describe the role of hearing and vestibular function in the cognitive sphere, are extremely rare. That is why further research is very important, especially in the rehabilitation tactics. For elderly patients with severe-to-profound hearing loss cochlear implantation is the optimal rehabilitation method. However, ear surgery can lead to such complication as vestibular dysfunction. That is why preoperative diagnostics and postoperative care are very important for preventing cognitive impairments.

[Legal Regulation of Hospital-Substituting Aspects of Social Services for Elderly and Disabled Citizens at Home.]

The article presents information about a significant number of people older than working age, disabled people and recipients of social services in stationary form and about the unfavorable forecast of the number of people older than 65 years for 2024 and 2030 in the Russian Federation, which determines the need for legal regulation of their lifestyle issues with respect for human rights to lead an independent lifestyle. The authors present an analysis of the federal and regional legal framework in terms of determining the circumstances under which a citizen is recognized as needing social services, the participation of local self-government bodies and subordinate organizations in the provision of social services, the implementation of social support, the introduction of hospital-substituting social service technologies. The article discusses the trends and ways to improve the legal regulation of social services for elderly and disabled citizens at home from the perspective of the introduction of hospital-substituting elements.

[Current issues of disability and rehabilitation of elderly and senile patients with lower limb loss due to vascular pathology.]

The majority of patients with amputation defect of the lower extremities are elderly citizens with high co- and polymorbidity, the presence of several geriatric syndromes, which adversely affects the prognosis, reduces the rehabilitation potential, in some cases leads to the development of cardiovascular complications, amputation of the second limb, severe disability and high postoperative mortality. The key link in the rehabilitation process of disabled people with a lower limb stump is to provide them with a functional prosthesis. The article provides an analysis of morbidity, primary disability in the period from 2015 to 2019, gender, age and clinical characteristics of patients living in St. Petersburg who underwent amputation of the lower limb due to obliterating artery diseases is presented. It was found that there is no information on the survival rate of patients after amputation at various times of the post-hospital period in St. Petersburg. We have identified a pronounced imbalance between the number of lower limb amputations performed and the number of applications of disabled people to the bureau of medical and social expertise for providing technical means of rehabilitation and referral to primary prosthetics.

[Assessment of barriers in people with disabilities with ophthalmopathology and varying degrees of sensory impairment to substantiate the list of support services they need and social protection measures in different areas of life.]

The assessment of barriers in persons older than working age with visual impairment was carried out using the International Classification of Functioning, Disabilities and Health to substantiate the list of necessary support services. An increase in the absolute number of people in older age groups objectively leads to an increase in the number of citizens experiencing difficulties in solving medical, social and psychological problems. Analysis of the results of the study showed that a significant part of people, due to impaired visual functions, experience limitations and barriers in physical environment, emotional sphere, family relationships with close and distant relatives. When assessing environmental barriers that interfere with the full-fledged life of persons with visual impairments, the presence of restrictions in sections D4 «Mobility¼, D5 «Self-service¼, D6 «Household life¼ was revealed. The presence of barriers and restrictions indicates the need to implement social protection measures, including rehabilitation, the need to adjust the list of support services. The use of the International Classification of Functioning, Disability and Health will determine the barriers faced by a disabled person due to visual impairment in various spheres of life and provide targeted assistance, support and assistance, to ensure the objectivity and sufficiency of social protection measures for each disabled person, on a scientific basis.

[Nordic walking in an integrated approach to improving the quality of life of the elderly.]

The article analyzes the results of the impact of an integrated approach to lifestyle modification, including Nordic walking, rational nutrition and pharmacotherapy, on the quality of life of elderly people (average age 72,5±3,6 years). A significant improvement in the pain scale indicator of the MOS SF-36 was revealed after six months (p=0,001), which was also determined by the end of the year (p=0,0001). A tendency to improve the quality of life was revealed in the Minnesota Questionnaire after six months (p=0,0617). A significant improvement in the Minnesota Quality of Life Questionnaire was found after a year of applying this approach (p=0,0001). The relationship of improving quality of life indicators and a significant decrease in systolic blood pressure (p=0,0016) and diastolic blood pressure (p=0,0032) in elderly people after a one-year practice of an original approach to lifestyle modification is discussed.

[Age-related specifics or diseases and disability caused by digestive disorders among adults in Saint-Petersburg in 2013-2017.]

The paper presents the retrospective analysis of the structure and dynamics of diseases and disability caused by digestive disorders in Saint Petersburg citizens. The paper presents the results of the comparative analysis of disability among people of active working and pension ages living in Saint Petersburg, versus Russia's average 2013-2018 data. As a result, regularities and differences in the structure and dynamics of digestive disorders in people 18 years old and older, which manifested themselves in after-surgery complications, death rate, and disability rate. The results may be used as reference for making federal or regional-level decisions on developing the system for preventing and early diagnosis of digestive disorders and integrated rehabilitation of disabled persons.

[Influence of hearing decline on cognitive function in elderly and senier age patients and its assessment after cochlear implantation (literature review).]

The study of the effect of cochlear implantation on cognitive function is an urgent problem, since the world is increasing the population of elderly and senile people who, as a rule, have certain hearing impairments. Age-related hearing loss is one of the most common health problems associated with aging, affecting two-thirds of people over the age of 70. However, few adults are tested for hearing loss, and even fewer are being treated. It is known that hearing loss - the most common sensory deficit-forms the prerequisites for narrowing the range of cognitive functions in the elderly and can serve as a factor accelerating the progression of cognitive changes. We analyzed the available research on the effects of hearing loss and cochlear implantation on cognitive function. It was revealed that for the most part, they had a small sample, the results were not subjected to the necessary statistical analysis, and the tests used were not adapted for hearing impaired people. After analyzing different tests for assessing cognitive function, HI-MoCA and RBANS-H tests were selected, which are adapted for hearing impaired people, which will allow to reliably assess cognitive function in the pre- and postoperative period, as well as to trace the effect of cochlear implantation on cognitive function in postoperative period.

[Evaluation of the effectiveness of rehabilitation of elderly patients with metabolic syndrome, taking into account the provisions of International classification of functioning, disability and health.]

The article contains data on rehabilitation measures in elderly patients with metabolic syndrome. Individual-oriented treatment and rehabilitation programs implemented in primary health care allow to reliably reduce the severity and risk of progression of restrictions of life, increase the independence of patients The elderly, having metabolic syndrome, complicated the development of type 2 diabetes mellitus. It is proposed to assess the effectiveness of rehabilitation, taking into account the provisions of the International Classification of functioning, restrictions on life and health and by drawing up an individual geriatric profile.

[Clinical and experimental study of the peculiarities of cardiac activity disorders during poisoning by combustion products in persons of different age groups.]

The work is carried out to clarify the mechanisms of cardiac activity disorders and assess the severity of cardiotoxicity in acute poisoning by combustion products in the age aspect. 71 patients with severe carbon monoxide poisoning were examined. The comparison group consisted of 22 patients with acute severe opiate poisoning. The methodological basis of the clinical study was daily monitoring of ECG. The studies were performed in 1 and 3-4 days. Residual cardiac dysfunction was estimated at 12-14 days. The comparison group selected 14 patients with acute myocardial infarction at this stage. Pathomorphological changes were studied on the cadaveric material of 24 experimental animals exposed to carbon monoxide at a dose of 16 g/m3 for 5 minutes on 31 days from toxic injury. It is established that acute poisoning by combustion products leads to the development of severe electrophysiological disorders classifying cardiotoxic effect as severe or extremely severe. Expression of signs of cardiotoxicity is higher in middle-aged and elderly patients. In the outcome of the poisoning, all the victims have formed a toxic cardiomyopathy.

[Dynamics and structure of primary disability in persons of retirement age when applying to the Bureau of Medical and Social Expertise of Saint Petersburg from 2006 to 2017.]

The article presents data on primary disability in elderly and able-bodied people and older than able-bodied (retirement) age as a result of the survey of citizens in the Bureau of Medical and Social Expertise of Saint Petersburg in the period 2006-2017. The features of the level, structure, dynamics and distribution by groups of disability in retirement age are reflected. There was a significant increase in the level of disability in 2007, with a progressive decline to 2011 and a gradual decline until 2017. During the study period, there was a redistribution of persons of a retirement age for the first time recognized as disabled by groups of disabilities - an increase in the proportion of individuals in Groups I and III of disability due to a decrease in II disability groups.

[THE DYNAMICS AND STRUCTURE OF INDICATORS OF SECONDARY DISABILITY DUE TO CEREBROVASCULAR DISEASES IN THE ELDERLY IN ST. PETERSBURG IN THE PERIOD 2005-2014].

The article presents data about secondary disability due to cerebrovascular diseases in the elderly based on results of examination in the Bureau of medical-social expertise of Saint Petersburg in the period from 2005 to 2014. Тhe analysis revealed a high proportion of the disabled elderly in the structure of disability due cerebrovascular diseases; and the growth of the share of people with disabilities elderly in the analyzed period.

[Analysis of indicators of primary disability due to cerebrovascular diseases in people of retirement age according to the results of medical and social examination in St. Petersburg].

The article presents data on the primary disability due to cerebrovascular disease in elderly patients based on the results of the survey in the Bureau of Medical and Social Expertise of Saint-Petersburg from 2005 to 2014. The analysis showed a reduction in the indicators of primary disability due to cerebrovascular disease and the increase in the share of persons with disabilities of the first and third groups in its structure.

[Factors significant for clinical-and-labor prognosis in elderly patients with ischemic heart disease after surgical myocardial revascularization].

Factors significant for clinical-and-labor prognosis in elderly patients with ischemic heart disease after surgical myocardial revascularization are considered. It is demonstrated that each level of the problem in consideration has its own significant factors. Besides, the most essential correlations between investigated factors are marked out. The results obtained would allow determining clinical-and-labor prognosis for patients with ischemic heart disease more correctly and develop the efficient programs aimed at their rehabilitation.

[Assessment of effectiveness of ischemic heart disease rehabilitation of elderly patients using six-minutes walking test].

The possibility to use the test with a six-minute walk to assess the effectiveness of long-term programs of rehabilitation, definite disability and severity of heart failure in middle-aged and elderly patients with coronary heart disease is discussed.

[Evaluation of the clinical, psychological and socio-environmental factors, affecting disability of elderly people undergoing surgical myocardial revascularization].

Factors significant for clinical-and-labor prognosis in elderly patients with ischemic heart disease after surgical myocardial revascularization are considered in the article. The authors demonstrate that for each level of the problem there are their own significant factors. Besides, the most essential correlations between investigated factors are marked out. The results obtained will enable to determine more correctly clinical-and-labor prognosis for patients with ischemic heart disease and develop their efficient rehabilitation programs. It is demonstrated that elderly patients have some features of vital activity restriction which are necessary to take into account while medical social expertise and rehabilitation program development.

[Analysis of disability resulting from cardiovascular disease patients of retirement age uptake bureau of medical and social examination in Saint-Petersburg].

The article demonstrate data on the primary and re-disability in the elderly, due to coronary artery disease and the results of expert assessment of citizens in the Bureau of Medical and Social Expertise of St. Petersburg from 2006 to 2012. The features of the level, structure, dynamics and distribution by disability groups in the retirement age are presented in comparison with the group of disabled people of the able-bodied age. During 7 year period of observation the consistent decline in the number of disabled people in both age groups was revealed. The increase in the number of the first and the third group disabled persons and the decrease in the number of people with second group of disability was found. The dynamics of disability in the retirement age group was greater than in the group of able-bodied age.

[Features of living activity limitations of elderly people with heart ischemic disease after surgical myocardial revascularization].

The article presents a comparative analysis of vital activity restriction in patients with coronary heart disease (CHD) after surgical myocardial revascularization in elderly and working age patients. It is demonstrated that elderly patients have some features of vital activity restriction, which is necessary to take into account in medical social expertise and rehabilitation program development.