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Hospital Rapid Geriatric Assessment Scale — a new diagnostic tool for frailty screening 医院老年快速评估量表——一种新的衰弱筛查诊断工具
Pub Date : 2023-07-20 DOI: 10.37586/2686-8636-2-2023-111-120
N. Vorobyeva, I. Malaya, G. Semochkina, Y. Kotovskaya, N. Sharashkina, N. Runikhina, O. Tkacheva
Background. The Short Physical Performance Battery (SPPB) is considered a standard screening test for frailty, however certain conditions it requires are frequently inaccessible.Aim. To develop Hospital Rapid Geriatric Assessment Scale (HRGAS) and to evaluate its diagnostic value in frailty screening.  Materials and methods. 408 sequentially hospitalized patients (23% male) aged 60–95 (median 73) years were examined using our specially designed algorithm (HRGAS) that includes 9 items: 1) age; 2) Mini-Cog test; 3) short depression assessment; 4) dynamometry; 5) falls in the past year; 6) mobility; 7) self-feeding ability; 8) urinary incontinence; 9) body mass index. The results were scored from 0 to 3 for age and from 0 to 2 for all other items. Minimum score sum is 0, maximum — 19. Assessment time was approximately 5 minutes. As control SPPB was used for frailty screening. The HRGAS results were compared with SPPB. Results. Based on SPPB, frailty rate was 46,3%, pre-frail — 26%, robust — 27,7%. HRGAS score was ranged from 0 to 14 (median 4, IQR 2–6) and negatively correlated to SPPB score (rS = -0,63; p<0,001). For frailty detection (SPPB score 0–7), ROC-analysis showed AUC 0,815 (95% CI 0,774–0,856), p<0,001, cut-off value ≥5, sensitivity 67,2%, specificity 81,3%, positive prognostic value (PPV) 76,5%, negative prognostic value (NPV) 74,2%, diagnostic accuracy 74,8%. For robust detection (SPPB score 10–12), ROC-analysis showed AUC 0,805 (95% CI 0,761–0,849), p<0,001, cut-off value ≤2, sensitivity 55,8%, specificity 84,1%, PPV 57,3%, NPV 83,2%, diagnostic accuracy 76,2%.  Conclusion. We developed HRGAS and calculated its cut-off values to identify and rule out frailty syndrome: score 0–2 by HRGAS indicate robust, score 3–4 — pre-frail and score ≥5 — frail patients.
背景。短物理性能电池(SPPB)被认为是虚弱的标准筛选测试,然而它所要求的某些条件通常是无法达到的。目的:编制医院老年快速评估量表(HRGAS)并评价其在衰弱筛查中的诊断价值。材料和方法。采用我们特别设计的算法(HRGAS)对408例年龄在60-95岁(中位73岁)的连续住院患者(23%男性)进行了检查,该算法包括9个项目:1)年龄;2) Mini-Cog试验;3)短期抑郁评价;4)测力法;(五)过去一年下跌;6)流动性;7)自馈能力;8)尿失禁;9)体重指数。年龄得分从0到3,其他项目得分从0到2。分数总和最小为0,最大为- 19。评估时间约为5分钟。作为对照,采用SPPB进行衰弱筛查。将HRGAS结果与SPPB结果进行比较。结果。基于SPPB,虚弱率为46.3%,虚弱前期为26%,健壮期为27.7%。HRGAS评分范围为0 ~ 14(中位数为4,IQR为2 ~ 6),与SPPB评分呈负相关(rS = -0,63;p < 0001)。对于脆弱检测(SPPB评分0-7),roc分析显示AUC为0.815 (95% CI为0.774 - 0.856),p< 0.001,临界值≥5,敏感性67.2%,特异性81.3%,阳性预后值(PPV) 76.5%,阴性预后值(NPV) 74.2%,诊断准确性74.8%。对于稳健检测(SPPB评分10-12),roc分析显示AUC为0,805 (95% CI为0,761-0,849),p<0,001,临界值≤2,敏感性55.8%,特异性84.1%,PPV为57.3%,NPV为83,2%,诊断准确性76.2%。结论。我们开发了HRGAS,并计算了其临界值来识别和排除虚弱综合征:HRGAS评分0-2分表示强壮,评分3-4分表示虚弱前期,评分≥5分表示虚弱患者。
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引用次数: 0
White Matter Hyperintensities According to Neuroimaging Analysis, Cognitive Impairment and Emotional Disorders: Is There a Link? 根据神经影像学分析,白质高强度,认知障碍和情绪障碍:有联系吗?
Pub Date : 2023-07-20 DOI: 10.37586/2686-8636-2-2023-121-126
A. A. Govorushina, S. Minakova, A. Kalmykova, A. Turusheva, T. A. Bogdanova
Background. Cognitive decline is one of leading contributors to the loss of independence in older adults. Therefore, early diagnosis and detection of  potentially modifiable cognitive disorders is  a significant challenge for modern geriatrics.Aim. To assess the relationship between cognitive impairment and presence of leukoareosis through neuroimaging in older adults.Materials and methods. General population cohort study of  102  patients aged 60–98  years treated at  The St. Petersburg Hospital for War Veterans between September and December 2019. Cognitive assessment (The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE)), depression (The Geriatric Depression Scale), sleep complaints, subjective cognitive decline, computed tomography (CT) scan.Results. The studied patients were divided into two groups: with the presence of  leukoareosis (n=59) and without leukoareosis (n=43). Patients with leukoareosis had significantly lower total MoCA scores. They performed significantly worse in  domains of  visual–structural skills and attention. As  for MMSE, patients with leukoareosis also performed significantly worse in  repeating a  sentence and descending subtraction task. There was no  statistically significant difference in GDS scores between the two groups. However, patients with leukoareosis significantly more frequently considered their lives less fulfilling and their memory worse. They also abandoned most of their former interests.Conclusion. If  leukoareosis is  detected on  CT scans, it  is necessary to  evaluate cognitive functions; the presence of leukoareosis in patients was associated with an increased risk of cognitive disorders and depression.
背景。认知能力下降是老年人丧失独立性的主要原因之一。因此,早期诊断和发现潜在的可改变的认知障碍是现代老年病学面临的重大挑战。通过神经影像学评估老年人认知功能障碍与白斑病之间的关系。材料和方法。2019年9月至12月期间在圣彼得堡退伍军人医院接受治疗的102名60-98岁患者的一般人群队列研究。认知评估(蒙特利尔认知评估(MoCA),迷你精神状态检查(MMSE)),抑郁(老年抑郁量表),睡眠抱怨,主观认知能力下降,计算机断层扫描(CT)扫描结果。研究患者分为两组:有白质瘤(59例)和无白质瘤(43例)。白斑患者的MoCA总评分明显降低。他们在视觉结构技能和注意力方面的表现明显更差。在MMSE测试中,白质硬化患者在重复句子和降序减法任务中的表现也明显较差。两组患者GDS评分差异无统计学意义。然而,患有白斑病的患者更频繁地认为他们的生活不那么充实,记忆力更差。他们也放弃了大部分以前的兴趣。如果在CT扫描中发现白质硬化,有必要评估认知功能;患者出现白斑病与认知障碍和抑郁的风险增加有关。
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引用次数: 0
Nutrients and Dietary Patterns for Osteoporosis 骨质疏松症的营养和饮食模式
Pub Date : 2023-07-19 DOI: 10.37586/2686-8636-2-2023-92-104
E. Ivannikova, E. Dudinskaya, O. Tkacheva
In order to reduce the risk of falls and fractures in older patients, promoting a healthy lifestyle and ensuring adequate calcium, vitamin D and protein intakes in their diet is of particular importance. When combined with regular exercise and avoiding bad habits such as alcohol and smoking, bone quality improves significantly.Osteoporosis treatment certainly includes the first line in the development and prevention of fractures in older adults, but diet optimization is an equally important component of treatment. This article presents results of the most relevant research to date on the characteristics of nutrition with a decrease in high bone density.
为了减少老年患者跌倒和骨折的风险,促进健康的生活方式并确保在饮食中摄入足够的钙、维生素D和蛋白质尤为重要。如果与定期锻炼和避免吸烟、酗酒等不良习惯相结合,骨骼质量会得到显著改善。骨质疏松症的治疗当然包括老年人骨折的发展和预防的第一线,但饮食优化是治疗的一个同样重要的组成部分。这篇文章介绍了迄今为止最相关的研究结果,关于营养与高骨密度降低的特征。
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引用次数: 0
At the turn of geriatrics and oncology: state of the problem 在老年病学和肿瘤学的交汇处:问题的现状
Pub Date : 2023-07-19 DOI: 10.37586/2686-8636-2-2023-86-91
V. S. Ostapenko, R. Absalyamov
Despite the increase in the number of older and oldest old patients with cancer, the tactics of their treatment are often suboptimal while the doctor-patient relationship model tends to be paternalistic.Insufficient knowledge in the field of geriatric care among health care providers dealing with cancer patients along with the low representation of older patients in research lead to their vulnerability to both «over- and under-treatment». There is ample evidence to support the superiority of comprehensive geriatric assessment in identifying frail patients at risk of poor outcomes compared to conventional clinical assessment or traditional oncology tools. Planning therapy taking into account the geriatric status and preferences of the patient, allows us to add the best results and satisfaction of aging patients with oncological diseases.
尽管老年和高龄癌症患者的数量有所增加,但他们的治疗策略往往是次优的,而医患关系模式往往是家长式的。处理癌症患者的卫生保健提供者在老年护理领域的知识不足,以及老年患者在研究中的代表性低,导致他们容易受到“过度治疗和治疗不足”的影响。有充分的证据表明,与传统的临床评估或传统的肿瘤学工具相比,综合老年评估在识别有不良预后风险的虚弱患者方面具有优势。计划治疗考虑到患者的老年状态和偏好,使我们能够增加老年肿瘤疾病患者的最佳结果和满意度。
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引用次数: 0
Diagnostic Interval for Oldest-Old Patients with II–III Stage Right Colon Cancer 老年II-III期右结肠癌患者的诊断间隔
Pub Date : 2023-07-19 DOI: 10.37586/2686-8636-2-2023-105-110
P. Tsarkov, V. M. Nekoval, I. Tulina, V. Balaban
Introduction: the lack of comprehensive screening programs for colorectal cancer detection in oldest-old steadily leads to an increase in the diagnostic interval (DI), i.e. the time from the patient’s first presentation of complaints until diagnosis and treatment. At the same time, worsening the general somatic condition and developing the decompensation of concomitant diseases. Thus, patients with long-term DI need additional measures while preparing for surgery; the preoperative bed-day increases.Purpose of the study: to evaluate the impact of the diagnostic interval on the short-term results of II and III stages right colon cancer treatment in geriatric patients.Materials and methods: a retrospective multicenter study was conducted at the surgical facilities of Sechenov University from 2006 to 2015. The study included patients aged over 75 who have undergone surgical treatment of II and III stages right colon cancer. The control group comprised patients with CRC diagnosis in the period from 0 to 6 months; the studied group involved patients with a diagnostic interval over than 6 months.Results and conclusions. Analysis of the results revealed that patients older than 80 years had a longer diagnostic interval, which is statistically significant (p<0.001). Prolongation of the diagnostic interval for more than 6 months has shown a decrement in the polymorbidity indicators and operational and anesthetic risk compared with DI≤6 months (p=0.001, p=0.039). Polymorbidity, in particular cardiovascular diseases decompensation, affected the indicators of operational and anesthetic risk on the ASA scale, which were significantly higher in the study group (p=0.039). High level of polymorbidity required a longer preoperative preparation in the studied group, which is statistically significant in comparison with the control group (p=0.018). Statistically significant differences in early postoperative complications rate in both groups were not revealed. 30 and 90 day mortality rates were similar in the studied and control groups (p=0.225, p=0.353). The study has also shown that diagnostic interval (DI) have no effect on the prevalence of II and III stages comparing with the control group (p=0.315).
引言:由于缺乏全面的高龄人群大肠癌筛查方案,导致诊断间隔(DI),即从患者首次出现主诉到诊断和治疗的时间不断增加。同时,使一般躯体状况恶化,并发疾病失代偿。因此,长期DI患者在准备手术时需要额外的措施;术前卧床时间增加。本研究目的:评价诊断间隔时间对老年患者ⅱ期和ⅲ期右结肠癌治疗短期疗效的影响。材料与方法:2006 - 2015年在谢切诺夫大学外科医院进行回顾性多中心研究。该研究包括75岁以上接受过II期和III期右结肠癌手术治疗的患者。对照组为0 ~ 6个月诊断为结直肠癌的患者;研究组包括诊断间隔超过6个月的患者。结果和结论。分析结果显示,80岁以上患者的诊断间隔较长,差异有统计学意义(p<0.001)。与DI≤6个月相比,延长6个月以上的诊断间隔在多病指标、手术和麻醉风险方面有所降低(p=0.001, p=0.039)。多发病,特别是心血管疾病失代偿影响ASA评分的手术和麻醉风险指标,研究组的这两项指标明显高于对照组(p=0.039)。研究组多病发生率高,术前准备时间较对照组长,差异有统计学意义(p=0.018)。两组术后早期并发症发生率差异无统计学意义。研究组和对照组的30天和90天死亡率相似(p=0.225, p=0.353)。研究还表明,与对照组相比,诊断间隔(DI)对II期和III期的患病率没有影响(p=0.315)。
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引用次数: 0
Heart failure clinic: the role of nurses 心衰门诊:护士的作用
Pub Date : 2023-04-06 DOI: 10.37586/2686-8636-1-2023-63-66
K. Eruslanova, I. Malaya, Y. Kotovskaya
Heart failure is one of the most common cardiovascular conditions with a steadily increasing incidence. Management of  such patients only by  general practitioners and cardiologists make it  impossible to  provide high-quality medical care. To ensure multidisciplinary monitoring of heart failure patients in many countries, including Russia, heart failure clinics are actively developing. Specially trained nursing staff play a particular role in the implementation of the clinics’ purposes. Working at Heart Failure Clinic requires advanced training, which in turn determines the priority for the development of  new educational programs and expanding the competencies of  nursing staff in  our country. This article describes the foreign experience of nursing staff in outpatient monitoring of patients with heart failure.
心力衰竭是最常见的心血管疾病之一,发病率稳步上升。只有全科医生和心脏病专家才能管理这类患者,因此无法提供高质量的医疗服务。为了确保包括俄罗斯在内的许多国家对心力衰竭患者进行多学科监测,心力衰竭诊所正在积极发展。受过专门训练的护理人员在实现诊所宗旨方面发挥着特别的作用。在心力衰竭诊所工作需要高级培训,这反过来又决定了发展新教育计划和扩大我国护理人员能力的优先事项。本文介绍国外护理人员对心衰患者进行门诊监护的经验。
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引用次数: 0
The relevance of the use of cardiopulmonary exercise testing (CPET) in elderly and senile patients 心肺运动试验(CPET)在老年和老年患者中的应用
Pub Date : 2023-04-06 DOI: 10.37586/2686-8636-1-2023-44-53
O. N. Tkacheva, Y. Kotovskaya, N. Runikhina, E. Alimova, M. S. Arefieva, K. Eruslanova, A. V. Rozanov
Cardiopulmonary exercise testing is  a study that provides both prognostic and diagnostic information about the state of the cardiovascular, respiratory systems and metabolic processes allowing us to determine how these systems contribute to a decrease in exercise tolerance. A large number of clinical studies using this method have shown its safety and diagnostic value. However, due to  insufficient education among doctors and little experience, CPNT is currently not widely used in diagnostics, especially in the geriatrics. This review of available literature over the last 10 years is devoted to the relevance of the use of cardiopulmonary exercise testing in older and oldest older patients, the essence and methodology of the study, possible changes in indicators in patients with frailty, chronic heart failure, and diseases of the bronchopulmonary system.
心肺运动测试是一项研究,它提供了关于心血管、呼吸系统和代谢过程状态的预后和诊断信息,使我们能够确定这些系统是如何导致运动耐受性降低的。大量临床研究表明该方法具有安全性和诊断价值。然而,由于医生的教育不足和经验不足,CPNT目前并未广泛用于诊断,特别是在老年病学中。本文回顾了过去10年的文献,主要探讨心肺运动试验在老年人和老年患者中的应用,研究的本质和方法,虚弱、慢性心力衰竭和支气管肺系统疾病患者的指标可能发生的变化。
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引用次数: 0
Algorithm for managing older patients with syncope based on the guidelines of the European Society of Cardiology «Syncope» published in the Russian Journal of Cardiology in 2019 根据2019年发表在《俄罗斯心脏病学杂志》上的欧洲心脏病学会《晕厥》指南管理老年晕厥患者的算法
Pub Date : 2023-04-06 DOI: 10.37586/2686-8636-1-2023-67-74
O. Tkacheva, Y. Kotovskaya, K. Eruslanova, E. Alimova
Syncope is a short-term transient loss of consciousness associated with a decrease or cessation of blood supply to the brain. Syncope is one of the causes of falls in older patients, leading to increased hospitalizations and deaths. There is  an  increased  susceptibility to  syncope  with advancing  age and sometimes it  occurs with no  identifiable cause. Orthostatic hypotension, carotid sinus syndrome, neuromediated syncope, structural heart disease, and cardiac arrhythmias are the common contributors to  syncope in  older adults. Given the high risk in  this group of  patients, a structured and integrated approach to the management of older patient with syncope is required. Implementing the algorithm for the management of such patients allows us to evaluate the syncope cause, assess the risk and choose the optimal treatment for older patients.
晕厥是一种短暂的意识丧失,与大脑血液供应减少或停止有关。晕厥是老年患者跌倒的原因之一,导致住院和死亡人数增加。随着年龄的增长,晕厥的易感性增加,有时发生晕厥没有明确的原因。直立性低血压、颈动脉窦综合征、神经介导性晕厥、结构性心脏病和心律失常是老年人晕厥的常见原因。鉴于这组患者的高风险,需要一种结构化和综合的方法来管理老年晕厥患者。实施该算法对此类患者进行管理,使我们能够评估晕厥原因,评估风险,并为老年患者选择最佳治疗方案。
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引用次数: 0
POSTSCRIPTUM: Protocol of Geriatric Rehabilitation in Patients Aged 60 Years and Older Living in Moscow Boarding houses or Nursing homes. Protocol of Multicentral Prospective Study 附言:60岁及以上住在莫斯科寄宿公寓或养老院的患者老年康复方案。多中心前瞻性研究方案
Pub Date : 2023-04-06 DOI: 10.37586/2686-8636-1-2023-54-62
O. Tkacheva, N. Runikhina, I. Malaya, N. Sharashkina, V. S. Ostapenko, Y. Kotovskaya, A. G. Melia, E. Mkhitaryan
Background: GR  with implementation of  additional geriatric rehabilitation stage has been shown in  a number of  studies to  be efficient in  daily functional activities as  well as  in reducing hospital readmissions and mortality. However, better integration of geriatric care models into clinical practice requires further investigations.Aim: to assess the influence of geriatric rehabilitation on functional activity.Methods: рrotocol POSTSCRIPTUM suggests Multicentral Prospective Study on  different protocols for Geriatric Rehabilitationл in Moscow boarding houses or nursing homes. The study consists of 21-days period of active treatment based on the results of complex geriatric assessment and 12-months follow-up period. The study enrolls patients aged 60 years and older, who have indications for geriatric rehabilitation.Conclusion: POSTSCRIPTUM — the 1st Russian study on efficacy of geriatric rehabilitation programs that based on complex geriatric assessment.
背景:许多研究表明,实施额外的老年康复阶段的GR在日常功能活动以及减少住院再入院率和死亡率方面是有效的。然而,将老年护理模式更好地整合到临床实践中需要进一步的研究。目的:探讨老年康复对功能活动的影响。方法:采用多中心前瞻性研究方法对莫斯科寄宿公寓或养老院的老年康复患者进行不同治疗方案的研究。该研究包括21天基于复杂的老年评估结果的积极治疗和12个月的随访期。该研究招募了60岁及以上有老年康复指征的患者。结论:POSTSCRIPTUM -俄罗斯第一项基于复杂老年评估的老年康复计划疗效研究。
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引用次数: 0
Efficacy and safety of reperfusion therapy for ST-segment elevation myocardial infarction in patients older than 75 years 75岁以上st段抬高型心肌梗死再灌注治疗的疗效和安全性
Pub Date : 2023-04-06 DOI: 10.37586/2686-8636-1-2023-39-43
P. Duplyakova, T. Pavlova, D. Duplyakov
The review analyzes studies on  the efficacy and safety of  reperfusion therapy for ST-segment elevation myocardial infarction in patients over 75 years of age. Registers data on the positive impact of reperfusion treatments on outcomes in older patients hospitalized with STEMI are given. Particular emphasis is put on the need for prospective studies to determine the optimal tactics for managing older and oldest older patients with STEMI.
本文分析了75岁以上st段抬高型心肌梗死再灌注治疗的有效性和安全性研究。给出了再灌注治疗对老年STEMI住院患者预后积极影响的登记数据。特别强调需要进行前瞻性研究,以确定管理老年和老年STEMI患者的最佳策略。
{"title":"Efficacy and safety of reperfusion therapy for ST-segment elevation myocardial infarction in patients older than 75 years","authors":"P. Duplyakova, T. Pavlova, D. Duplyakov","doi":"10.37586/2686-8636-1-2023-39-43","DOIUrl":"https://doi.org/10.37586/2686-8636-1-2023-39-43","url":null,"abstract":"The review analyzes studies on  the efficacy and safety of  reperfusion therapy for ST-segment elevation myocardial infarction in patients over 75 years of age. Registers data on the positive impact of reperfusion treatments on outcomes in older patients hospitalized with STEMI are given. Particular emphasis is put on the need for prospective studies to determine the optimal tactics for managing older and oldest older patients with STEMI.","PeriodicalId":256357,"journal":{"name":"Russian Journal of Geriatric Medicine","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132307854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Russian Journal of Geriatric Medicine
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