The Clinical Management of Deconditioned Patient

The current study was designed to investigate the clinical management of deconditioned patients. In the current study, we investigate the clinical manifestations of deconditioned patients. A subacute functional deficiency was determined when getting up from a supine position and developing tachycardia with an increase in heart rate by 30 or more per minute for 10 minutes. This study included 172 elderly patients aged 65 to 74 years. The average age of the patients was 69.2+2.2 years. There were 102 men and 70 women in the study. These patients were registered at the dispensary with the therapists of outpatient clinics after an infectious disease. Within 6 months after the treatment, a comprehensive geriatric assessment of patients was performed. All patients were divided into four groups depending on the indicators of motor activity, which in the framework of this study was the criterion of the adaptive function of the body and viability. Patients with normal motor activity indicators did not have the decondition and were designated as a control group. Patients with the decondition did not have normal indicators of motor activity. The obtained results were processed statistically. According to the results of our study, it was noted that the assessment of the six months after the treatment showed heterogeneity of patients from a functional point of view with a homogeneous somatic structure. Six months after the treatment, out of 172 people, 45 people (26.2%) had normal motor activity indicators (39-40 points); according to the questionnaire "Assessment of motor activity in the elderly", the average score was 39.6+0.2; 42 people (24.4%) had mild motor activity disorders (34-38 points), the average score was 36.1+0.4; moderate disorders (21-33 points) were registered in 47 people (27.3%), the average score was 27.9+2.1; significant motor activity disorders (0-20 points) occurred in 38 people (22.1%), the average score was 13.2+1.4. The fall syndrome was characteristic of those patients with the decondition who demonstrated moderate and significant motor activity disorders 6 months after the treatment. In particular, in people with significant motor activity disorders, there was a decrease in muscle strength in the lower extremities by 48.3+3.2% and in the upper extremities - by 27.1+3.1% (P<0.05). As a result of the presence of the decondition, an unfavorable cascade of geriatric syndromes is formed in the form of an increase in the level of situational anxiety from 21.9-24.8 to 58.4-75.3 points on the Spielberger-Hanin scale, a deterioration in morale with an increase in the severity of depression from 5.8-6.0 to 11.0-14.9 points, a decrease in the quality of sleep on the ten-point visual analog scale from 8.3-8.4 to 5.2-5.7 points on the Beck scale, an increase in the proportion of patients at risk of developing malnutrition syndrome from 4.8-6.7% to 46.8-68.4%, the development of the fall syndrome, which, in turn,, it is a predictor of the development of dinapenia in the form of a decrease in the strength of the upper extremities by 22.7-27.1%, a decrease in the strength of the lower extremities by 29.6-49.6%, with a faster rate of decrease in the strength of the lower extremities compared to the upper extremities by 1.8 times, which, accordingly, reduces the rehabilitation potential. Clinical manifestations of the decondition in elderly patients were such geriatric syndromes as anxiety, depression, cognitive decline, sleep disorders, hypomobility, dinapenia, risk of developing malnutrition syndrome and falls syndrome.

[Aging foot syndrome: patients screening and routing.]

The article proves that when providing medical and social care to patients of older age groups, it is advisable to pay attention not only to the patients' somatic and geriatric status, but also to perform screening of local geriatric syndromes that affect the patients' functional status, such as, in particular, aging foot syndrome. Implementation of rehabilitation treatment measures that we propose allows to maintain the patients' mobility level and consequently their general functional capability level and quality of life.

Progressive multifaceted approach to the management of geriatric patients with cardiac arrhythmias

Aim. To develop a progressive multifaceted approach to the management of geriatric patients with cardiac arrhythmias.

Material and methods. The study was carried out in 2 stages. The study sample consisted of 262 elderly and senile people (mean age, 69,5±1,1 years). There 145 elderly (mean age, 68,4±1,2 years) and 117 senile patients (mean age 74,4±1,3 years). We analyzed medications used for six months in geriatric patients with arrhytmias and senile asthenia (SA) and without it. The combined strategy of management of geriatric patients with arrhytmias and SA was tested.

Results. SA is most common in geriatric patients who are taking drugs such as class I a, b, c antiarrhythmics, class V antiarrhythmics (cardiac glycosides), diuretics (torasemide, furosemide), and statins. This indicates the need to avoid polypharmacy and to adjust the treatment of geriatric patients with cardiac arrhythmias in accordance with Beers criteria. Presented study revealed that in patients with SA, the total antioxidant activity is reduced, which indicates the need to restore antioxidant defence to such patients. A combined strategy has been developed for the management of geriatric patients with cardiac arrhytmias and SA.

Conclusion. The combined strategy of managing older patients with arrhytmias and SA helped to improve the geriatric status, prevent SA, and increase antioxidant defence. A significant improvement in the quality of life was noted, in particular, in relation to the mental and psychological well-being.

[Effect of pharmacotherapy on collagen metabolism in patients with heart failure with middle range ejection fraction of senile age.]

Of particular interest is the study of the mechanisms of development of chronic heart failure, especially with middle range ejection fraction (HFmrEF). In conditions of HF, the significance of the development of myocardial fibrosis increases many times, leading to irreversible dysfunction, which contributes to the further progression of HF. Atrial fibrillation is an additional factor contributing to systolic dysfunction of the left ventricle. The purpose of this study was to study the effect of beta-blockers on changes in fibrosis markers in senile patients with HF, including those with AF. 104 patients with HF, coronary disease of functional class II were examined according to the classification of NYHA, the average age was 78,4±3,2 years. After 12 months, we found a significant decrease in the level of matrix metalloproteinase-type 1, -type 9 (MMP-1, MMP-9), tissue inhibitor MMP-1 (TIMP-1), as well as the ratio of MMP-1/TIMP-1, MMP-9/TIMP-1 in senile patients with HF, including those with atrial fibrillation who took nebivolol as a beta-blocker. While in patients who took bisoprolol, no significant changes in the studied parameters were detected (except for MMP-9). Changes in collagen metabolism cause the restoration of myocardial function after therapy with the beta-blocker nebivolol in patients with chronic heart failure with an middle range ejection fraction, including atrial fibrillation. Serum markers of collagen turnover can serve as a non-invasive method for documenting and monitoring both the degree and mechanisms of myocardial fibrosis in patients with HF, coronary disease, including in the presence of AF.

[Prevention of disoders of activity which associated with the risk of dynapenia and sarcopenia by combined aerobic-anaerobic training.]

The article presents the data of the study of different models of aerobic and anaerobic exercise in 208 elderly people (89 men and 119 women), which were divided into three groups. The 1st group (control) received standard recommendations of the doctor on the regime of physical activity (daily walks of at least 30 minutes). The 2nd group in addition to the standard recommendations received training in the form of Nordic walking with the regime of classes twice per week for 60 minutes. The 3rd group in addition to the standard recommendations received combined aerobic exercise in the form of Nordic walking twice per week for 60 minutes + anaerobic exercises with a frequency of training twice per week for 30 minutes. It was found that the best results of the increase in total activity, improved gait and stability, as well as increased muscle strength were achieved in the 3rd group of patients. Such, combined aerobic-anaerobic exercise can be recommended as a program of geriatric prevention of disorders associated with the risk of dynapenia and sarcopenia.

[Bio-psycho-social model of energizing care of the elderly and senile age at home.]

Due to the introduction of new medical technologies, there is an increase in the number of people, including the elderly and senile age, who have extended their lives, but who need constant care from medical and social services at home. In the study of age differences of biological needs in home care, it was found that for middle-aged people the greatest difficulties and contribution to the reduction of quality of life brought insufficient nutrition, limited independence in the performance of household manipulations due to joint damage, pain and other biological causes, as well as hypothermia syndrome compared with elderly and senile age. For people of older age groups was characterized by the need to bridge the lack of communication; enhancing the role of the family in the implementation of care; increased confidence in caregivers; increased availability of medicines; and increased availability of religious services. Developed on the basis of identified age-based determinants of quality of life, the original model of the bio-psychosocial activating care for the geriatric contingent of patients at home, the difference from traditional approaches is the use of activating kinesitherapy and cognitive exercises, contributes to the achievement of a higher level of functionality and independence of the geriatric patient, which is accompanied by improving the quality of life.

[The geriatric status in patients with the breast cancer in the conditions of comorbidity.]

The article represents the results of a comparative analysis of the geriatric status, the Charlson comorbidity index and the geriatric variant of the cumulative illness rating scale for geriatrics (CIRS-G) in patients of different age groups with breast cancer, considering the concomitant pathology (CHF). It was revealed that the age classification of the WHO is more valid in determining the somatic and geriatric status of women with breast cancer. Also the evaluation of the severity of geriatric syndromes is given. It was revealed that the malnutrition syndrome and cognitive impairment syndrome are more expressed in people of middle age and elderly with breast cancer As well the importance of detecting both frailty and comorbidity is determined with the aim of increasing the accuracy of prediction of adverse events of treatment.

[Bioinformatic investigation of the involvement of candidate genes of cytokines in the formation of large myomatous nodes in women with uterine cancer in older age groups]

The aim was to study bioinformatics involvement of candidate genes of cytokines in the formation of large fibroids in women with uterine cancer in older age groups. Genotyping of 15 molecular genetic markers cytokines was performed in 120 patients with uterine myoma with large myoma nodes and 107 patients with myoma nodes of small size. The study found that genetic risk factors for fibroids with large uterine fibroids are two combinations of genetic variants: G SDF-1, CC IL-1β, A RANTES (OR=5,56) and A RANTES with genotype CC IL-1β (OR=4,60). 12 of 15 polymorphic loci studied in various combinations (8 revealed significant combinations) have protective value in the formation of large fibroids with uterine cancer (OR=0,09-0,31).

[The investigation of blood cells of middle and old age in patients with bronchial asthma and chronic obstructive pulmonary disease by atomic force microscopy. Similarities and differences with the biological animal model]

The investigation of reactive changes of blood cells in such diseases as COPD or asthma in people of different age groups is the very difficult problem. Simulating the same conditions in animals that occur in humans with these diseases can serve as a reliable practical model. It is possible because the changes which take places at the cellular level in animals might reflect a similar trend in the human body.

[Clinical features of patients of older age groups with uterine myoma]

The study analyzed 301 patients with uterine cancer at the age of 45 years and older and 304 patients with uterine myoma 45 years. It was found that patients with uterine myoma of the older age group (45 and older) have the following clinical features: overweight and thus increased BMI these women, a lower percentage of a family history of uterine cancer, a smaller percentage of infertility, a greater number of pregnancies, births, medical abortions, the high prevalence of diseases of the cardiovascular system and pathology of the cervix, large size fibroids and as a consequence more common compartment syndrome adjacent organs by myoma nodes (disuric disorders).

[Preventive geriatrics vs anti-aging medicine]

The article presents the main modern ideas of the new interdisciplinary direction at the junction of aesthetic medicine, geriatrics and valeology - preventive geriatrics, or the anti-aging medicine. Describes its purpose, namely effective individual programs of prevention of the development and progression of chronic diseases and age-related conditions; the overview of the diagnostic methods used in preventive geriatrics, individualized prevention programs with proven efficacy is given. Substantiates the importance of preventive geriatrics (anti-aging medicine) as a discipline with its own scientific methodological tools, points of application, and presents prospects of scientific study.

[Musculoskeletal system as a target organ of a frailty processes]

Pathology of the musculoskeletal system is widespread in the population and is one of the most common diseases of patients in older age groups. The most significant of them are osteoporosis, osteoarthritis and sarcopenia. All three components separately, of course, lead to lower quality of life. In our work we show the mechanisms of interference of these states at each other, and their combined impact on the musculoskeletal system as a target organ processes senile asthenia. Osteoarthritis, osteoporosis, and sarcopenia, and especially their combination lead to hypomobility. Hypomobility under the influence of external factors is one of the leading syndromes potentiating aggravation processes senile asthenia. Thus, the mechanism of re-entry is triggered, and a vicious circle leading to fatal medical-social and social consequences. It is shown that changes in the musculoskeletal system should be considered as a single aging within senile asthenia, and all used and newly created medical and social rehabilitation and prevention programs should be integrated in nature.

[Morphological and mechanical peculiarities of erythrocytes and neutrophils from patients of different age groups with chronic obstructive pulmonary disease and asthma]

Modern scanning probe microscopy methods make possible to study the peculiarities of the cell response in chronic obstructive pulmonary disease and asthma, as well as to diagnose the severity of the diseases which is important in senile age, particularly.

[Morphofunctional characteristics of erythrocytes as target cells in the processes of early aging]

The article describes the morphofunctional characteristics of erythrocytes in clinical models of early aging (essential hypertension, coronary heart disease and diabetes mellitus) by the original clinical and cytomorphological material. It is shown that in the processes of aging and early aging following effects take places: the changing of the shape and size of cells, cell-cell interactions are broken, changing the elasticity of the cell membrane is changing too and cellular destruction is promoted.