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1DYNAMICS OF SENILE FRAILTY SYNDROME DEVELOPMENT IN THE ASPECT OF PHYSIOLOGY
Kamalova Z.M.
Tashkent Pediatric Medical Institute https://doi.org/10.5281/zenodo.13624231
Abstract. The given article presents the data of the literature analysis on aspects of the study of senile fragility syndrome, which are of great importance for physicians, especially from a theoretical point of view.
Keywords: fragility syndrome; manifestations of vascular dementia; bones; asthenia; heart; hypertension; musculoskeletal system; immune system; central nervous system; endocrine system.
It is important to suggest that senile asthenia syndrome or "fragility" syndrome is manifested by age-related changes in the body. These changes primarily affect the musculoskeletal, immune, central nervous and endocrine systems.
Among the most common symptoms of senile asthenia are: weakness; slowness; weight loss of more than 4.5 kg per year without diets; deterioration of memory and analytical abilities; hearing and vision loss; depressive states; impaired sensitivity; urinary incontinence.
Definitely, the "fragility" syndrome is often complicated by manifestations of vascular dementia, when an elderly person begins to confuse numbers and dates, loses orientation in his own apartment, loses important social skills and the ability to self-care.
The development of senile asthenia is due to the physiological characteristics of people 65+: it can't be completely prevented; however, it is possible and necessary to minimize the symptoms and manifestations.
The attention should be paid to: a balanced diet in accordance with age, helping to prevent atherosclerosis, diabetes, constipation. A specialist will help you create a diet; physical activity as recommended by a doctor - therapeutic exercise, Nordic walking, exercise. Moderate activity in everyday life - washing dishes, cleaning, cooking, playing with grandchildren; giving up bad habits - drinking alcohol and smoking; social activity, pleasant communication, communications. Social isolation of the elderly person should be avoided, painkillers should be taken if necessary. It is important not to allow the elderly person to endure pain, prevent infectious diseases.
It is important to visit a geriatrician regularly, 1-2 times a year, as well as specialists recommended by him, to undergo examination - ECG, fluorography, blood and urine tests and others.
This is necessary for early diagnosis of age-related changes, as well as monitoring the dynamics of previously identified symptoms and manifestations.
An unfavorable variant of aging is frailty - an age-associated syndrome, the main clinical manifestations of which are general weakness, slowness and / or unintentional weight loss. Frailty syndrome (FAS) is accompanied by a decrease in physical and functional activity, as well as adaptive and restorative reserves, which leads to increased vulnerability of patients to the development of dependence on others, limited ability to respond to external and internal stressors, to adverse medical and functional outcomes.
Population aging is a global demographic phenomenon of the 20th - 21st centuries and has a significant impact on the planning of political, economic and social spheres of life in many countries. The increase in life expectancy and the aging of the population of our country also makes its own adjustments to the organization of medical care for elderly and senile patients.
This problem is especially relevant for Moscow - life expectancy at birth in the capital is higher than in the country as a whole. Thus, in 2016, this indicator in Moscow was 77.08 years, exceeding the corresponding national indicator by more than 5 years. Urbanization is an unstoppable social phenomenon and an irreversible trend that is studied from different perspectives; such as urban planning, transport, industrial context, employment and health. Gradually, healthcare systems are being brought into line with the needs of older people, the foundation is being created and the human resources necessary for long-term comprehensive care are being provided, ageism is being combated and the global network for cities and communities focused on older people is being expanded.
According to Lenzi A. (2019), it is necessary to focus on improving mental and physical well-being for everyone at any age. It is obvious that increasing the duration and good quality of life is associated with a reduction in preventable mortality from non-communicable diseases. Improving the health and quality of life of older people is especially relevant. It is projected that by 2050, approximately 16% of the world's population will be over 65 years of age. There is a comprehensive restructuring of the age and sex structure of the human population, which is accompanied by social, economic, medical, and psychological changes in society. Current demographic changes, which some call the fourth stage of the demographic transition, suggest that the number of older people will only increase over time. There is an increasing burden on the working-age population, social and pension funds, and the healthcare system.
According to the European Union (EU) report on ageing, the demographic profile of the European population will change dramatically in the coming decades, with the proportion of older people increasing. The percentage of EU citizens aged over 65 is projected to increase from 18% to 28% by 2060; the proportion of those aged over 80 is projected to increase from 5% to 12% over the same time period. The proportion of older people will become much larger, increasing from 19% to 29% of the population, while the proportion of people aged 80 and over will increase from 5% to 13%, becoming almost the same as the young population in 2070. As a result, the old-age dependency ratio (people aged over 65 compared to those aged 15-64) is projected to increase from 29.6% to 51.2% in the EU as a whole. Of particular interest is the 16 progressive aging of the elderly population, with an exponential increase in cohorts over 80 years of age and a doubling of the elderly dependency index, which will increase from 28.8% (according to 2015 data) to 51.0% by 2080.
The adoption of the Strategy of Actions in the Interests of Senior Citizens in the Russian Federation until 2025, approved by the Government Order in 2016, indicates increased attention from the state to the problems of elderly and old people. The Strategy declares the need for scientific research in the field of geriatrics, which would allow planning the volume and nature of medical care for older people. In geriatric practice, the approach to assessing and managing patients is based on the diagnosis and correction of geriatric syndromes (GS) that develop in old age. The features of GS are their widespread prevalence and an increased likelihood of adverse outcomes - the formation of dependence on outside help, a decrease in the quality of life, an increased risk of hospitalization and death. Due to the presence of many risk factors involved in
the formation of GS, prevention of their development and correction is possible only using a multidimensional approach. The most common HS in outpatient practice include sensory deficits (reduced vision and hearing), cognitive disorders, depression, urinary incontinence, falls, malnutrition, and decreased mobility. Separately, there is the syndrome of frailty (SFA), which is closely related to other HS and characterizes a decrease in the general internal reserve of the body. The two most popular SFA models are the phenotypic model and the deficit accumulation model. However, in their classical form, they are not suitable for diagnosing SFA in everyday clinical practice due to their labor intensity. Short questionnaires have been developed for SFA screening in many foreign countries [11,12,13,14], but none of them have been validated in Russia.
As noted in the references, in recent decades there has been a rapid increase in the number of elderly patients, who have a high risk of cardiovascular complications. Advances in evidence-based medicine have significantly reduced morbidity and mortality in acute coronary syndrome (ACS), but these achievements have not improved the prognosis in elderly patients and long-livers. In this group of patients, the likelihood of using proven therapy, in particular invasive diagnostic and therapeutic interventions, is significantly lower, and therefore the risk of adverse outcomes remains high. The authors found that older age is associated with adverse outcomes in ACS. According to international registries, the proportion of people over 75 years of age among all patients with ACS is high, while in randomized clinical trials (RCTs), elderly patients and long-livers are underrepresented, which raises the question of the applicability of RCT results to patients with ACS over 75 years of age [7,8,9,10].
Further analysis of the literature showed that population aging is a global demographic phenomenon of the 20th - 21st centuries and has a significant impact on planning the political, economic and social spheres of life in many countries. The increase in life expectancy and the aging of the population of our country also makes its own adjustments to the organization of medical care for elderly and senile patients.
Domestic authors noted an interesting fact that this problem is especially relevant for Moscow - life expectancy at birth in the capital is higher than in the country as a whole. Thus, in 2016, this indicator in Moscow was 77.08 years, exceeding the corresponding all-Russian indicator by more than 5 years.
The adoption of the Strategy of Actions in the Interests of Senior Citizens in the Russian Federation until 2025, approved by the Government Order in 2016, indicates increased attention from the state to the problems of elderly and senile people. The Strategy declares the need for scientific research in the field of geriatrics, which would allow planning the volume and nature of medical care for older people.
Experts have confirmed that in geriatric practice, the approach to assessing and managing patients is based on the diagnosis and correction of geriatric syndromes (GS) that develop in old age. The features of GS are their wide prevalence and an increased likelihood of unfavorable outcomes - the formation of dependence on outside help, a decrease in the quality of life, an increased risk of hospitalization and death. Due to the presence of many risk factors involved in the formation of GS, prevention of their development and correction is possible only with the use of a multidimensional approach.
It was also noted in the literature that the most common GS in outpatient practice include sensory deficits (decreased vision and hearing), cognitive disorders, depression, urinary incontinence, falls, malnutrition, and decreased mobility. Separately, there is a syndrome of frailty
(SFA), which is closely related to other GS and characterizes a decrease in the general internal reserve of the body. The most popular are two models of SFA - phenotypic and deficit accumulation model. However, in their classical form, they are not suitable for diagnosing SFA in everyday clinical practice due to their labor intensity.
In foreign literature, it is noted that many GS remain undiagnosed by general practitioners. At the same time, there is evidence that the use of a set of measures developed on the basis of geriatric assessment can prevent a decrease in functional capabilities, reduce the risk of institutionalization, hospitalization and death of patients. Domestic authors also noted the fact that despite the ongoing demographic changes, the number of works devoted to the analysis of GS in Russia is small. The procedure for providing medical care in the geriatric profile, the need to identify SSA by district general practitioners was regulated at the legislative level. At the same time, to date, our country has not developed an algorithm for diagnosing SSA and selecting patients for consultation with a geriatrician, which could be used in the daily practice of primary health care physicians.
A special group for studying GS is elderly and senile patients who independently seek treatment at outpatient clinics. They are characterized, on the one hand, by a relatively high level of mobility and functional activity, on the other hand, by a potentially high level of comorbidity, which can influence the formation of SSA and other GS. The relationship between chronic non-communicable diseases (CNCDs) and SSA has been studied by many foreign researchers, but has been little studied in the Russian population of older patients.
Thus, at the end of the literature review, we can come to a consensus that aging is accompanied by an increase in morbidity and hospitalizations.
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