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2TERRITORIAL-GEOGRAPHICAL ASPECTS, PHARMACOEPIDEMIOLOGY AND PREVENTIVE CHARACTERISTICS OF THE ORIGIN, CLINICAL COURSE AND COMPLICATIONS IN THE GERONT POPULATION (LITERATURE REVIEW)
1Mamasoliev N.S., 2Sirodjiddinov K.B., 3Nishonova N.A., 4Mamasolieva Sh.A.
1,2,3,4Andijan State Medical Institute, Uzbekistan https://doi.org/10.5281/zenodo.13685183
Abstract. In the given article the origin, clinical course and complications of comorbidity in the GERONT population, regional-geographical aspects, pharmaco-epidemiological and preventive features were analyzed by authors showing the relevance and necessity of the research topic. Most studies usually conclude that drugs can increase the risk of fatal complications or toxicity in the gerontpopulation with iatrogenic multimorbidsyndrome. Gerontialpatients always require "majority" observation by relatives or medical personnel, especially in the presence of comorbid diseases. This requires improvement of the system of epidemiological, preventive and pharmaco- epidemiological observation of the gerontological population.
Keywords: epidemiological, preventive and pharmaco-epidemiological monitoring of comorbidity; population in gerontology; iatrogenic drug.
Relevance and importance of the research. It is important to suggest that the influence of risk factors on the occurrence and development of comorbidity is more clearly seen from the literature review. In clinical studies, the main attention is paid to the diagnostic, screening-clinical pharmaco-epidemiological characteristics and the basics of comorbidity prevention in gerontians. It can be said that in the gerontian population, the regional and geographical prevalence of comorbidity in routine clinical practice is underestimated. Based on this, it can be suggested that the true prevalence of comorbidity (determined only in epidemiological studies) is higher than the generally accepted indicator. Clip IT. et al. (2013) studied the comorbidity of iron deficiency in chronic heart failure in 1506 people from Poland, Spain and the Netherlands. Such comorbidity was detected in 50% of clients. The prognostic value of iron deficiency is confirmed. In the presence of this factor, the incidence of "endpoints" due to heart failure increases two fold [23].
Besides that, Jacob S. et al. (2019) studied 2223 patients with chronic heart failure in a retrospective cohort study in Austria. Endpoints (death, heart transplantation) in combination with comorbidity of anemia in SUE were detected in 62% of patients, with anemia - in 37% frequency [21].
Definitely, in comorbidity, the issue of pharmacotherapy occupies a special place. In order to coordinate and provide therapy for the gerontological population, several algorithms for reducing the risk of polypharmacy have been developed and recommended for practice by researchers and scientific societies abroad and in Russia [15; 29]. To prevent the risk of polypharmacy in the gerontological population, it is recommended to use the following questionnaires and algorithms: "Method of Optimization of Prescription" [13], "Structured Collection of anamnesis of taking medications Guestiommaire" [14], "Palliative approach to solving the problem of polypharmacy in elder patients" [8], the ASV scale [Anticholinergic
cognitive load] [31], the Index of Expediency of Treatment [18], AGS [2] and the START/STOPP criteria [28].
The available data indicate that most researchers studying gerontologists should always consider non-drug treatment first.
It is known to everyone that a study by K. Turnheim (2004), in which the author asked the question of gerontological age, is it necessary to use a pharmacological drug at all or is there a need for it? - the question is posed crosswise [34]. Different systemic diseases contribute to comorbidity in a characteristic and differential manner, and with age it varies and takes a leading place.
According to Yardaniar A. et al (2000), polypharmacy/polypharmacotherapy can be one of the factors worsening the course of diseases in the gerontological age population, in particular the course of comorbid diseases [35].
Due to the suggestions by Benjamin E.J. et al (2019), the abandonment of the "pill for every disease" principle for gerontological patients, strict control over the treatment process with a multidisciplinary (team) approach, addition of over-the-counter drugs and dietary supplements, limitation of the number of doctors who prescribed drugs confirmed that it is appropriate to follow the rules as much as possible [6].
It should be taken into consideration that the issue of reducing the risk of pharmacotherapy in the gerontological age population, mainly in clients with a comorbid background, was also raised by foreign researchers, for example Steenman M. et al. [33], Curtis A.B. et al. [11], Meschiari K.A. et al. [27], Di P.A. et al. [12], Burshtein B. et al [9] and Khan M.A. et al. [22], and they gave separate recommendations on this matter. For example, it is from them that the reference to international clinical guidelines comes, which should not be used as a "Chinese wall" in the gerontological population.
In addition, the mentioned sources give unambiguous conclusions about the reduction of the risk of pharmacotherapy against the background of cardio comorbidity in the gerontological and geriatric population: 1) the risk of comorbidity in CKD after 60 years is 77.2% (in men) and 78.2% (in women), from 80 years - 89.3% and increases to 91.8%; 2) geronts sharply increase the risk of developing heart failure, arrhythmias (mainly atrial fibrillation) and arterial hypertension; 3) against the background of cardio comorbidity, the main pathogenetic factors that cause and aggravate CKD are enhanced (inflammatory markers and the level of oxidative stress, apoptosis, the aging process of cardiomyocytes, degenerative processes, interleukin-6, a-tumor necrosis factor, S-reactive protein), firstly, cardiac pathologies, for example, increase the frequency of UCI and secondly, their risk with aging of the elderly. As a result of comorbidity in CKD (for example, atherosclerotic diseases), the following diseases are observed with high frequency in the gerontological population: hypertension (85.6% and 80.0% are observed in women and men), CKD (from 15 to 100 thousand people), myocardial infarctions are taken into account (from 11.5% and 4.2% of men and women), ventricular fibrillation (10.0%) and strokes (up to 23.5%) [9; 22; 25; 26]. Another factor that should be taken into account or considered important in the treatment of comorbid conditions in the gerontological population is that studies often show that this population has a relatively low level of fear of drugs (addiction to the drug) and adherence to pharmacotherapy. According to the scientific results presented by Haynes RB, MacDonald H. et al. (2002), Bloom BS. (2001) and Benner J.S. et al. (2002), more than 50% of elderly people of
gerontological age do not adhere to the prescribed pharmacotherapy for chronic (comorbid) diseases [5;7;19].
It is important to suggest that Kronish I.M., Dieffenbach M.A., Edmondson D.E. et al. (2012) convincingly confirm that one of the main reasons for the fear or anxiety about drug addiction (DA) in gerontological patients is the formation of a completely erroneous idea that the drug used necessarily causes specific problems. In addition, gerontological age and gerontology-related memory loss, cognitive impairment, fear and hearing loss and, of course, comorbidities and obligations are to respond to medications [24].
According to Anderson L.J. and others [4] and Sergi G. et al. [32], one of the reasons for the increase in the number of comorbid diseases among the gerontological population and among the elderly in general is a complex pharmacotherapy regimen. According to the scientific findings presented with co-authors Griberg R.N. [17] and Claxton A.J. [10], the percentage of fulfillment of pharmacotherapeutic obligations and the associated problems of geriatric-gerontological comorbidity increases with an increase in the frequency of DD intake: while taking the drug once a day - 73-79%, twice a day of drinking - 69-70%, three times a day of drinking - 52-65%, four times a day of drinking - 42-51%. The confirmation of negative effects as a risk factor for comorbidity (a total of 15 cases), as well as polypharmacotherapy, was reliably reported and confirmed by the following researchers: Alosco M.L. et al. [1], Herringer C. et al [20], Al Sheikh S. et al [3], Rode D. et al [30] and Gelled V.F. et al [16].
Conclusion. Thus, most studies conclude that drugs can increase the risk of fatal complications or toxicity in the gerontial population with iatrogenic multimorbid syndrome. Gerontial patients always require "most" monitoring by relatives or medical personnel, especially in the presence of comorbid diseases. This requires improvement of the system of epidemiological, preventive and pharmacoepidemiological monitoring of the gerontial population.
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