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Nursing Protocol: Oral Health in Older Patients 护理协议:老年患者的口腔健康
Pub Date : 2023-11-15 DOI: 10.37586/2686-8636-3-2023-203-204
O. N. Tkacheva, N. V. Sharashkina, N. Runikhina, Y. Kotovskaya
In the presented article, the authors consider the problem of oral care for older patients with functional or cognitive impairments. This protocol outlines the process for assessing the oral cavity on patient’s admission and at each shift, explaining how to  inform the therapist of  any abnormalities when evaluating the oral health condition, and how to determine the extent to which oral care can be managed by the patient himself or herself. When providing oral care, measures are taken to prevent aspiration.
在这篇文章中,作者考虑了有功能障碍或认知障碍的老年患者的口腔护理问题。该方案概述了在病人入院时和每次换班时对口腔进行评估的过程,解释了在评估口腔健康状况时如何将任何异常情况告知治疗师,以及如何确定口腔护理在多大程度上可以由病人自己进行。在提供口腔护理时,要采取措施防止吸入。
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引用次数: 0
The Influence of Chronic Diseases on Motoric Cognitive Risk Syndrome Development 慢性疾病对运动认知风险综合征发展的影响
Pub Date : 2023-11-15 DOI: 10.37586/2686-8636-3-2023-195-202
A. Turusheva, E. Frolova
Introduction. Motoric cognitive risk (MCR) syndrome is a syndrome characterized by cognitive complaints or mild cognitive impairment (MCI) identified during tests and accompanied by slow gait but without dementia or autonomy decline. The concept of MCR is relatively new, and its natural course has not been sufficiently studied to date.Objective. To estimate the prevalence of MCR, factors contributing to the risk of its development and the impact on mortality.Methods. A prospective cohort Crystal study, random sample of individuals aged 65 and older. The total follow-up period was 9 years. Evaluation covered: gait speed, the Mini-Mental State Examination, chronic disease, blood pressure, lab tests.Results. To diagnose the motor cognitive risk syndrome, the value of the gait speed was used, corresponding to the 2nd and 3rd quartiles — from 0.75 to 0.4 m/s. MCR was diagnosed in 16.7%. Type 2 diabetes was associated with an increased incidence of MCR [OR (95% CI) 7.275 (1.520–34.829)]. With an increase in systolic blood pressure (SBP) for every 30 mm Hg. the probability of detecting motoric cognitive risk syndrome increases by 6 times [OR (95% CI) 5.796 (1.388–24.200)]. After adjusting for sex, age, presence of type 2 diabetes, and blood pressure level, the addition of each component of the motoric cognitive syndrome increases the risk of all-cause death over 9 years of follow-up by 35% [HR (95% CI) 1.348 (1.001–1.814)].Conclusion. The main chronic diseases associated with the development of MCR were type 2 diabetes and arterial hypertension. MCR is associated with a higher risk of mortality in older age, even with a slight decrease in gait speed. Gait speed within the 2nd and 3rd quarter may be a component of motoric cognitive risk syndrome.
导言运动性认知风险(MCR)综合征是指在测试中发现认知症状或轻度认知障碍(MCI),并伴有步态缓慢,但无痴呆或自主能力下降的综合征。MCR 的概念相对较新,其自然病程迄今尚未得到充分研究。估计 MCR 的发病率、导致其发病风险的因素以及对死亡率的影响。一项前瞻性队列晶体研究,随机抽样对象为 65 岁及以上的老年人。随访期共计 9 年。评估内容包括:步速、迷你精神状态检查、慢性病、血压、实验室检查。为了诊断运动认知风险综合征,使用了步速值,对应于第二和第三四分位数--0.75 至 0.4 米/秒。16.7%的人被诊断为运动认知风险综合征。2型糖尿病与MCR发病率增加有关[OR (95% CI) 7.275 (1.520-34.829)]。收缩压(SBP)每升高 30 毫米汞柱,发现运动性认知风险综合征的概率就会增加 6 倍[OR (95% CI) 5.796 (1.388-24.200)]。在对性别、年龄、是否患有 2 型糖尿病和血压水平进行调整后,运动性认知风险综合征的每个组成部分都会使 9 年随访期间的全因死亡风险增加 35% [HR (95% CI) 1.348 (1.001-1.814)]。与运动性脑损伤相关的主要慢性疾病是 2 型糖尿病和动脉高血压。即使步速略有下降,MCR 也与老年期较高的死亡风险相关。第二和第三季度的步速可能是运动认知风险综合征的一个组成部分。
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引用次数: 0
Features of Oncoscreening and Detection of Precancerous Diseases of the Oral Mucosa and the Vermillion Border of the Lips in Older and Oldest Old Patients 老年患者和高龄患者口腔黏膜和嘴唇朱缘癌前病变的筛查和检测特点
Pub Date : 2023-11-14 DOI: 10.37586/2686-8636-3-2023-176-182
M. Abramova, I. V. Zolotnitsky, V. G. Mamatsashvili, V. V. Parshkov, N. O. Kopaneva, A. A. Alekseeva
The article presents data on the incidence of oncological and precancerous diseases and cancer of the oral mucosa and the vermillion border of the lips in older, oldest old and long-livers (144 patients), being the patients of A.I. Yevdokimov Moscow State University of Medicine and Dentistry all of them underwent clinical examination and treatment at Therapeutic Dentistry and Oral Mucosa Diseases Department. Also, a review of the scientific literature and the regulatory framework for the management of patients, their routing and medical examination (506 sources of literature) was carried out. The tactics for the management of older patients with precancerous diseases and cancer of the oral mucosa and the vermillion border of the lips are analyzed.
文章介绍了老年、高龄和长寿患者(144名)的肿瘤和癌前疾病以及口腔粘膜和嘴唇朱缘癌的发病率数据,这些患者都是莫斯科国立叶夫多基莫夫医学和牙科大学的患者,他们都在牙科和口腔粘膜疾病治疗科接受了临床检查和治疗。此外,还对科学文献和患者管理规范框架、患者路线和医疗检查(506 篇文献资料)进行了审查。分析了管理患有口腔黏膜和嘴唇朱缘癌前病变和癌症的老年患者的策略。
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引用次数: 0
Aspects and Problems of Local Anesthesia in Older Patients: State of the Question 老年患者局部麻醉的各个方面和问题:问题现状
Pub Date : 2023-11-14 DOI: 10.37586/2686-8636-3-2023-183-187
E. V. Velichko, Yu. L. Vasil’ev, S. A. Rabinovich, T. D. Babich, O. P. Dashkova, L. A. Zavodilenko
Dental care is one of the types of medical care most demanded by various age groups of  patients. In the process of human aging, pathological and dystrophic changes develop in all organs and tissues, including the tissues of the maxillofacial region, which increases the need for patients to contact various specialists. Older and oldest-old often have several chronic somatic diseases and age-related mental characteristics, for the treatment of which several groups of drugs are used simultaneously. In geriatric dentistry, anesthesia should be applied taking into account polypharmacy, somatic and cognitive health. When deciding on a dosing regimen and assessing the risks of local anesthesia, it is important to consider not only the length of each visit to the dentist but also the total number of visits required to achieve dental health.
牙科治疗是各年龄段患者需求量最大的医疗服务之一。在人体衰老过程中,所有器官和组织都会发生病理和萎缩性变化,包括颌面部组织,这就增加了患者与各种专科医生联系的必要性。老年人和高龄老人往往有几种慢性躯体疾病和与年龄有关的心理特征,为治疗这些疾病,需要同时使用几组药物。在老年牙科应用麻醉时,应考虑到多种药物、躯体和认知健康状况。在决定用药方案和评估局部麻醉的风险时,不仅要考虑每次看牙医的时间,还要考虑实现牙齿健康所需的看牙医的总次数。
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引用次数: 0
Managing Older and Oldest-Old with Frailty in Outpatient and Inpatient Clinics of Moscow (Treatment Algorithm Based on CGA Rresults) 莫斯科门诊和住院诊所对老年和高龄体弱患者的管理(基于 CGA 结果的治疗算法)
Pub Date : 2023-11-14 DOI: 10.37586/2686-8636-3-2023-188-194
A. V. Trukhanov, N. Runikhina, A. A. Reshetova, O. N. Tkacheva, Y. Kotovskaya, N. V. Sharashkina
The article is aimed at improving the management of older and oldest-older in outpatient and inpatient medical facilities of Moscow. Represented algorithm of therapeutic and preventive measures allows the geriatrician, in accordance with CGA domains and possible clinical situations, to timely and efficiently draw up  a patient management plan based on the results of CGA and current clinical guidelines.
本文旨在改善莫斯科门诊和住院医疗机构对老年人和高龄老人的管理。治疗和预防措施的算法使老年病医生能够根据 CGA 领域和可能出现的临床情况,及时有效地制定基于 CGA 结果和当前临床指南的患者管理计划。
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引用次数: 0
Forming a Modern Therapeutic Resource for Geriatric Dentistry 形成老年牙科的现代治疗资源
Pub Date : 2023-11-13 DOI: 10.37586/2686-8636-3-2023-157-167
V. Trezubov, R. Rozov, M. Mishnev, Yu. . Parshin
Background. The special status and position of older and oldest old in the therapeutic, diagnostic, and preventive activities of a dentist lead to a firm conviction of an urgent necessity and expediency of creating a new medical specialization — geriatric dentistry.Aim. Based on many years of clinical experience and scientific research, including extensive use of high-tech oral prosthetics for older adults, to make the first attempt at creating an optimal therapeutic resource for a new medical specialization — geriatric dentistry.Materials and methods. Examination and prosthetics were performed on 645 patients aged 60 to 85 years old, with various types of implantable prostheses in the period o 3 to 7 years after their implantation. In addition, 903 implantable prostheses and 3287 of their artificial supports (implants) were also examined.Results. The mean age of patients who visited the orthopedic dentistry department for dental prosthetics was 64.72 ± 6.8 years old. As the main method of rehabilitation of older patients’ masticatory and speech apparatus, we have used implant-supported prosthesis with its digital transformation. Most of the patients underwent reasonably radical oral cavity preparation for prosthetics. The original state retention of the tissues of the implant bed ranged from 78.04 to 100%. At the same time, fixed structures of implantable prostheses were characterized by higher indicators. The preservation of the implants was from 96.8 to 100%, depending on the observation period.Conclusion. The high values of implant and prosthesis retention rates, good condition of the peri-implant mucous membrane and bone in remote periods after prosthetics, as well as a high level of patient satisfaction and significantly higher achieved level of their quality of life, along with high medical and economic efficiency of the method, allow us to consider it a promising standard of geriatric dentistry. Thus, a modern therapeutic, or rather, rehabilitation, resource for effective pre-prosthetic preparation and implant prosthesis has been developed and justified, which is the optimal approach in geriatric dentistry.
背景。老年人和高龄老人在牙医的治疗、诊断和预防活动中的特殊地位和作用,使我们坚信创建一个新的医学专业--老年牙科--的紧迫性和必要性。基于多年的临床经验和科学研究,包括广泛使用高科技口腔修复技术为老年人服务,首次尝试为新的医学专业--老年牙科--创建最佳治疗资源。对 645 名 60 至 85 岁的患者进行了检查和修复,这些患者在植入各种类型的植入式修复体 3 至 7 年后接受了修复。此外,还对 903 个植入式假体及其 3287 个人工支架(植入物)进行了检查。到牙科矫形科就诊的患者平均年龄为(64.72 ± 6.8)岁。作为老年患者咀嚼和语言装置康复的主要方法,我们使用了数字化改造的种植体支持修复体。大多数患者都进行了合理的口腔修复前准备。种植床组织的原始状态保持率从 78.04% 到 100% 不等。同时,植入式修复体的固定结构也有较高的指标。根据观察时间的不同,种植体的保存率从 96.8% 到 100% 不等。种植体和修复体的高保留率、修复后远期种植体周围粘膜和骨质的良好状态、患者的高满意度和生活质量的显著提高,以及该方法的高医疗和经济效益,使我们可以将其视为一种有前途的老年牙科标准。因此,一种有效的修复前准备和种植修复的现代治疗(或者说是康复)资源已经被开发出来并得到证实,这是老年牙科的最佳方法。
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引用次数: 0
The Nutritional Status and Oral Health: A New Look at the Problem 营养状况与口腔健康:问题的新视角
Pub Date : 2023-11-13 DOI: 10.37586/2686-8636-3-2023-168-175
A. Turusheva, E. Frolova, V. Trezubov, R. Rozov, M. Y. Kabanov
Introduction. According to research, the condition of the oral cavity in older adults is one of the risk factors for the development of malnutrition; however, even with complete loss of teeth, malnutrition does not develop in all patients.Objective. The aim of our study was to evaluate the prevalence of malnutrition in patients with tooth loss and the factors associated with a reduced risk of developing malnutrition in them.Methods. Epidemiological study of the EVCALIPT random sample of individuals aged 65 years and older (n=396). Main study parameters: oral health assessment questionnaire, non-communicable chronic disease, nutritional assessment using the Mini Nutritional assessment, comprehensive geriatric assessment, blood count test.Results. The prevalence of malnourishment does not depend on the number of remaining teeth and the use of dentures or implants (p>0.05). The main independent factors affecting the risk malnutrition in patients with oral frailty are complaints about difficulty with mastication [OR (95% CI) 2.100 (1.100–4.010)] and pronunciation of words [OR (95%CI) 2.203 (1.007–4.816)]. Maintaining high rates of grip strength [OR (95% CI) 0.314 (0.167–0.590)] and absence of depression [OR (95% CI) 0.408 (0.196–0.846)] are associated with a reduced risk of malnutrition in patients with oral frailty.Conclusion. The fact of the absence of teeth or prostheses / implants does not lead to an increase in the risk of malnutrition in older adults. Complaints about mastication and words pronunciation difficulties are more significant contributors to the risk of malnutrition in this age group. High rates of grip strength and the absence of depression in patients with impaired chewing of food and pronunciation of words are associated with a diminished risk of malnutrition.
介绍。研究表明,老年人的口腔状况是发生营养不良的风险因素之一;然而,即使牙齿完全脱落,也并非所有患者都会发生营养不良。我们的研究旨在评估缺牙患者中营养不良的发生率,以及降低他们发生营养不良风险的相关因素。对 EVCALIPT 随机抽样的 65 岁及以上老年人(n=396)进行流行病学研究。主要研究参数:口腔健康评估问卷、非传染性慢性病、使用迷你营养评估进行的营养评估、老年病综合评估、血细胞计数测试。营养不良的发生率与剩余牙齿数量、假牙或种植体的使用无关(P>0.05)。影响口腔虚弱患者营养不良风险的主要独立因素是咀嚼困难的主诉[OR (95%CI) 2.100 (1.100-4.010)]和单词发音[OR (95%CI) 2.203 (1.007-4.816)]。保持较高的握力[OR (95%CI) 0.314 (0.167-0.590)] 和无抑郁[OR (95%CI) 0.408 (0.196-0.846)] 与口腔虚弱患者营养不良的风险降低有关。没有牙齿或修复体/种植体不会导致老年人营养不良的风险增加。咀嚼抱怨和语言发音困难是导致这一年龄组营养不良风险的重要原因。咀嚼食物和发音有障碍的患者握力强、无抑郁,与营养不良风险降低有关。
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引用次数: 0
Nursing protocol: malignant tumours in older patients 护理方案:老年恶性肿瘤患者
Pub Date : 2023-07-21 DOI: 10.37586/2686-8636-2-2023-130-131
O. Tkacheva, N. Sharashkina, N. Runikhina, Y. Kotovskaya
In the article presented, the authors discuss the problem of providing high-quality medical care to older patients with cancer. The work focuses on examining patient based on a comprehensive geriatric assessment (CGA), including urgent situations related to a malignant neoplasm. The protocol provides an overview of hypercalcemia, tumor disintegration syndrome, spinal cord compression, neutropenia. The issue of educational necessity for nurses caring for patients with cancer is discussed.
在本文中,作者讨论了为老年癌症患者提供高质量医疗服务的问题。这项工作的重点是基于全面的老年评估(CGA)来检查患者,包括与恶性肿瘤相关的紧急情况。该方案提供了高钙血症,肿瘤解体综合征,脊髓压迫,中性粒细胞减少症的概述。探讨护理癌症患者的护士教育必要性问题。
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引用次数: 0
Long-Term Care: Medical Service Delivery 长期护理:医疗服务提供
Pub Date : 2023-07-21 DOI: 10.37586/2686-8636-2-2023-132-137
A. V. Rozanov, E. S. Cherepanova, K. A. Barannikova, S. P. Svishcheva, V. Samorodov, A. V. Perestoronina, A. N. Sysoeva, A. V. Kashin
The article discusses the characteristics of medical assistance organization based on interdepartmental interaction with social protection structures when implementing a Long-Term Care System. A model of interdepartmental interaction is presented, aimed at identifying individuals potentially requiring Long-Term Care services. The principle of data exchange is described, the example of patients' vital signs monitoring by care assistants is given.
本文讨论了在实施长期照护制度时,基于部门间互动与社会保障结构的医疗救助组织的特点。提出了一个跨部门互动的模型,旨在识别可能需要长期护理服务的个人。阐述了数据交换的原理,并给出了护理助理监测患者生命体征的实例。
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引用次数: 0
Nursing Protocol: Supporting Family Caregivers 护理规程:支持家庭照顾者
Pub Date : 2023-07-21 DOI: 10.37586/2686-8636-2-2023-127-129
O. Tkacheva, N. Sharashkina, N. Runikhina, Y. Kotovskaya
In this article, the authors discuss the issue of supporting family care among older and oldest old; the matter is considered an urgent challenge in geriatrics. The work focuses on assessing the quality of care for older individuals at home, as well as providing support to their family members. The protocol gives an idea of the role of a caregiver, which is carried out through the interaction between family members during the process of distributing family roles. The issue of home care is being discussed, considering the maintenance of the patient’s highest possible functional status along with healthy nutrition, hygiene and symptom management.
在本文中,作者讨论了支持家庭照顾老年人和最年长的老人的问题;这一问题被认为是老年病学的一个紧迫挑战。这项工作的重点是评估老年人在家的护理质量,以及为其家庭成员提供支持。该协议给出了看护者角色的概念,这是在分配家庭角色的过程中通过家庭成员之间的互动来实现的。目前正在讨论家庭护理问题,考虑到维持病人尽可能高的功能状态以及健康的营养、卫生和症状管理。
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引用次数: 0
期刊
Russian Journal of Geriatric Medicine
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