Clinical portrait of elderly outpatient


DOI: https://dx.doi.org/10.18565/therapy.2024.3.41-51

Larina V.N., Kudina E.V., Shcherbina E.S., Mikhailusova M.P., Orlov D.A., Kladovikova O.V.

1) N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow; 2) Diagnostic Clinical Center No. 1 of the Department of Healthcare of Moscow
Abstract. The increase in the cohort of elderly people throughout the world leads to a revision of the approach to medical care provision, taking into account body involutional changes.
The aim: to assess the incidence of multimorbidity, geriatric syndromes and their correlations in patients who are taking medical care at an outpatient basis.
Material and methods. Open, cross-sectional study included 371 patients (61.7% females) aged 60–93 years, observed by a general practitioner in medical consulting room for patients of older age groups with multiple chronic diseases. Clinical and laboratory parameters were analyzed, screening for senile asthenia was performed using “Age is not a hindrance” questionnaire.
Results. The average age of studied patients was 73 (68; 80) years, most of them were elderly (58.8%) and female (61.7%) persons, having more than three (70.89%) diseases. The most common disease was arterial hypertension (95%). Diabetes mellitus and obesity had 42 and 39% of them, respectively. Geriatric syndromes occurred in 80.86% of patients: decreased hearing and vision (71%), sleep disturbances (56%) and movement disorders (48%), urinary incontinence (27%) and falls during the year (20%). Factors associated with frailty were osteoarthritis (odds ratio (OR) 2.56; 95% confidence interval (CI): 1.33–4.89; p = 0.005), myocardial infarction in anamnesis (OR 3.43; 95% CI: 1.78–6.62; p = 0.001), chronic kidney disease (OR 1.91; 95% CI: 1.00–3.65; p = 0.050), female gender (OR 4.23; 95% CI: 1.73–10.31; p = 0.002). The cut-off value for the age at which the likelihood of senile asthenia developing increases was 75.5 years (95% CI: 0.68–0.85).
Conclusion. Among outpatients aged 60 years and older, elderly female patients and persons with complex pathology are predominating. Arterial hypertension, diabetes mellitus and obesity are leading diseases in the structure of multimorbidity, hearing and vision loss, sleep disturbances and mobility problems are existing among geriatric syndromes. Chronic kidney disease, history of myocardial infarction, and osteoarthritis are associated with senile asthenia, especially in females, as well as at the age of 75.5 years and older, when the probability of senile asthenia developing is highest.
Keywords: multimorbidity, senile asthenia, geriatric syndromes, elderly age, outpatients
Read entire article

Literature

1. World Health Organization. Global health and aging. 2011. URL: https://www.who.int/ageing/publications/global_health.pdf (date of access – 02.04.2024).


2. World Health Organization. Noncommunicable diseases country profiles 2018. 2018.


URL: https://www.who.int/publications/i/item/9789241514620 (date of access – 02.04.2024).


3. World Health Organization. World health statistics 2021: Monitoring health for the SDGs, sustainable development goals. 2021. URL: https://iris.who.int/bitstream/handle/10665/342703/9789240027053-eng.pdf?sequence=1 (date of access – 02.04.2024).


4. Панова Е.А., Серов В.А., Шутов А.М. с соавт. Полипрагмазия у амбулаторных пациентов пожилого возраста. Ульяновский медико-биологический журнал. 2019; (2): 16–22. (Panova E.A., Serov V.A., Shutov A.M. et al. Polypharmacy in elderly outpatients. Ul’yanovskiy mediko-biologicheskiy zhurnal = Ulyanovsk Medico-Biological Journal. 2019; (2): 16–22 (In Russ.)).


https://doi.org/10.34014/2227-1848-2019-2-16-22. EDN: QYQLCB.


5. Kernick D., Chew-Graham C.A., O’Flynn N. Clinical assessment and management of multimorbidity: NICE guideline. Br J Gen Pract. 2017; 67(658): 235–36.


https://doi.org/10.3399/bjgp17X690857. PMID: 28450343. PMCID: PMC5409424.


6. Ларина В.Н., Самородская И.В., Глибко К.В. с соавт. Комплексная патология: терминология, оценка тяжести состояния пациентов и возможный подход к их ведению. Клиническая геронтология. 2019; 25(1–2): 49–57. (Larina V.N., Samorodskaya I.V., Glibko K.V. et al. Complex pathology: Terminology, assessment of the severity of patient’s condition and possible approach to the management of patients. Klinicheskaya gerontologiya = Clinical Gerontology. 2019; 25(1–2): 49–57 (In Russ.)).


https://doi.org/10.26347/1607-2499201901-02049-057. EDN: YXZNZR.


7. Оганов Р.Г., Симаненков В.И., Бакулин И.Г. с соавт. Коморбидная патология в клинической практике. Алгоритмы диагностики и лечения. Кардиоваскулярная терапия и профилактика. 2019; 18(1): 5–66. (Oganov R.G., Simanenkov V.I., Bakulin I.G. et al. Comorbidities in clinical practice. Algorithms for diagnostics and treatment. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2019; 18(1): 5–66 (In Russ.)).


https://doi.org/10.15829/1728-8800-2019-1-5-66. EDN: YXKKAP.


8. Soley-Bori M., Ashworth M., Bisquera A. et al. Impact of multimorbidity on healthcare costs and utilisation: A systematic review of the UK literature. Br J Gen Pract. 2021; 71(702): e39–e46.


https://doi.org/10.3399/bjgp20x713897. PMID: 33257463. PMCID: PMC7716874.


9. Кобалава Ж.Д., Конради А.О., Недогода С.В. с соавт. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020; 25(3): 149–218. (Kobalava Zh.D., Konradi A.O., Nedogoda S.V. et al. Arterial hypertension in adults. Clinical guidelines 2020. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020; 25(3): 149–218 (In Russ.)).


https://doi.org/10.15829/1560-4071-2020-3-3786. EDN: TCRBRB.


10. Недогода С.В., Барыкина И.Н., Саласюк А.С. Национальные клинические рекомендации по ожирению: концепция и перспективы. Вестник Волгоградского государственного медицинского университета. 2017; 1): 134–140. (Nedogoda S.V., Barykina I.N., Salasyuk A.S. National clinical recommendations for obesity: concept and prospects. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta = Bulletin of Volgograd State Medical University. 2017; (1): 134–140 (In Russ.)).


https://doi.org/10.19163/1994-9480-2017-1(61)-134-140. EDN: YHQTDF.


11. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. (WHO/NMH/NHD/MNM/11.1). 2011. URL: https://iris.who.int/bitstream/handle/10665/85839/WHO_NMH_NHD_MNM_11.1_eng.pdf?sequence=22 (date of access – 02.04.2024).


12. KDIGO 2012 clinical practice guidelines for the evaluation and management of chronic kidney disease. Kidney Int. 2013; 3(1): 1–163.


https://doi.org/10.1038/kisup.2012.48.


13. Клинические рекомендации. Падения у пациентов пожилого и старческого возраста. Общероссийская общественная организация «Российская ассоциация геронтологов и гериатров», Общественная организация «Российская ассоциация по остеопорозу». 2021. Доступ: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/059/120/original/9.Падения_у_пациентов_пожилого_и_старческого_возраста_2021.pdf?1641888379 (дата обращения – 02.04.2024). (Clinical guidelines. Falls in elderly and senile patients. Russian Association of Gerontologists and geriatricians, Russian Association for Osteoporosis. 2021. URL: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/059/120/original/9.Падения_у_пациентов_пожилого_и_старческого_возраста_2021.pdf?1641888379 (date of access – 02.04.2024) (In Russ.)).


14. Клинические рекомендации. Старческая астения. Общероссийская общественная организация «Российская ассоциация геронтологов и гериатров». Рубрикатор клинических рекомендаций Минздрава России. 2020. ID: 613. Доступ: http://cr.rosminzdrav.ru/schema/613_1 (дата обращения – 02.04.2024). (Clinical guidelines. Senile asthenia. Russian Association of Gerontologists and Geriatricians. Rubricator of clinical recommendations of the Ministry of Healthcare of Russia. 2020. ID: 613. URL: http://cr.rosminzdrav.ru/schema/613_1 (date of access – 02.04.2024) (In Russ.)).


15. Полуэктов М.Г., Бузунов Р.В., Авербух В.М. с соавт. Проект клинических рекомендаций по диагностике и лечению хронической инсомнии у взрослых. Неврология и ревматология. Приложение к журналу Consilium Medicum. 2016; (2): 41–51. (Poluektov M.G., Buzunov R.V., Averbukh V.M. et al. The draft of clinical guidelines for diagnosis and treatment of chronic insomnia in adults. Nevrologiya i revmatologiya. Prilozheniye k zhurnalu Consilium Medicum = Neurology and Rheumatology. Supplement to the journal Consilium Medicum. 2016; (2): 41–51 (In Russ.)). EDN: YOSOMH.


16. Siah K.W., Wong Ch.H., Gupta J., Lo W. Patterns of multimorbidity. 2021.05.13.21256888. medRxiv.


https://doi.org/10.1101/2021.05.13.21256888. Preprint.


17. Ntiyani N., Letamo G., Keetile M. Prevalence of and factors associated with hypertension, diabetes, stroke and heart attack multimorbidity in Botswana: Evidence from STEPS 2014 survey. PLoS ONE. 2022; 17(3): e0265722.


https://doi.org/10.1371/journal.pone.0265722. PMID: 35324986. PMCID: PMC8947240.


18. Feldman K., Stiglic G., Dasgupta D. et al. Insights into population health management through disease diagnoses networks. Sci Rep. 2016; 6: 30465.


https://doi.org/10.1038/srep30465. PMID: 27461860. PMCID: PMC4962032.


19. Андреенко Е.Ю., Лукьянов М.М., Якушин С.С. с соавт. Ранняя кардиоваскулярная мультиморбидность в амбулаторной и госпитальной практике: возрастные характеристики и медикаментозное лечение пациентов (данные регистров РЕКВАЗА и РЕКВАЗА-КЛИНИКА). Кардиоваскулярная терапия и профилактика. 2020; 19(5): 195–203. (Andreenko E.Yu., Lukyanov M.M., Yakushin S.S. et al. Early cardiovascular multimorbidity in out- and in-patient care: Age characteristics and medication therapy (data from the REKVAZA and REKVAZA-CLINIC registries). Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2020; 19(5): 195–203 (In Russ.)).


https://doi.org/10.15829/1728-8800-2020-2672. EDN: WHYVPX.


20. Pati S., Swain S., Metsemakers J. et al. Pattern and severity of multimorbidity among patients attending primary care settings in Odisha, India. PLoS One. 2017; 12(9): e0183966.


https://doi.org/10.1371/journal. pone.0183966. PMID: 28910309. PMCID: PMC5598947.


21. Голованова Е.Д., Титова Н.Е., Филиппова Ю.М., Баженова Д.С. Заболеваемость долгожителей-ветеранов Смоленской области. Кардиоваскулярная терапия и профилактика. 2019; 18(3): 57–61. (Golovanova E.D., Titova N.E., Filippova Yu.M., Bazhenova D.S. The disease incidence of long-lived veterans of the Smolensk region. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2019; 18(3): 57–61 (In Russ.)).


https://doi.org/10.15829/1728-8800-2019-3-57-61. EDN: DRBGLO.


22. Дедов И.И., Шестакова М.В., Майоров А.Ю. с соавт. Алгоритмы специализированной медицинской помощи больным сахарным диабетом под редакцией И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. 9-й выпуск. Сахарный диабет. 2019; 22(S1–1): 1–144. (Dedov I.I., Shestakova M.V., Mayorov A.Yu. et al. Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 9th edition. Sakharnyy diabet = Diabetes Mellitus. 2019; 22(S1–1): 1–144 (In Russ.)).


https://doi.org/10.14341/DM221S1. EDN: LDOTJF.


23. Ryan B.L., Bray J.K., Shariff S.Z. et al. Beyond the grey tsunami: A cross-sectional population-based study of multimorbidity in Ontario. Can J Public Health. 2018; 109(5–6): 845–54.


https://doi.org/10.17269/s41997-018-0103-0. PMID: 30022403. PMCID: PMC6964436.


24. Башкова И.Б., Бусалаева Е.И., Тарасова Л.В. Анализ тактики ведения пациентов с остеоартритом врачами первичного звена. Терапия. 2022; 8(7): 102–109. (Bashkova I.B., Busalaeva E.I., Tarasova L.V. Analysis of tactics of management of patients with osteoarthritis by primary care physicians. Terapiya = Therapy. 2022; 8(7): 102–109 (In Russ.)).


https://doi.org/10.18565/therapy.2022.7.102-109. EDN: RHQDXP.


25. Ларина В.Н., Барт Б.Я., Карпенко Д.Г. с соавт. Полиморбидность и ее связь с неблагоприятным течением хронической сердечной недостаточности у амбулаторных больных в возрасте 60 лет и старше. Кардиология. 2019; 59(S12): 25–36. (Larina V.N., Bart B.Ya.,


Karpenko D.G. et al. Polymorbidity and its association with the unfavorable course of chronic heart failure in outpatients aged 60 years and older. Kardiologiya = Cardiology. 2019; 59(S12): 25–36 (In Russ.)).


https://doi.org/10.18087/cardio.n431. EDN: CDIVKK.


26. Ларина В.Н., Барт Б.Я., Распопова Т.Н. Хроническая сердечная недостаточность и остеопороз. Кардиология. 2013; 53(6): 76–84. (Larina V.N., Bart B.Ya., Raspopova T.N. Chronic heart failure and osteoporosis. Kardiologiya = Cardiology. 2013; 53(6): 76–84 (In Russ.)). EDN: QMEWCN.


27. Ховасова Н.О., Наумов А.В., Ткачева О.Н., Мороз В.И. Гериатрический портрет пациента с синдромом падений. Российский журнал гериатрической медицины. 2021; (3): 344–30. (Khovasova N.O., Naumov A.V., Tkacheva O.N., Moroz V.I. Geriatric portrait of patient with falls. Rossiyskiy zhurnal geriatricheskoy meditsiny = Russian Journal of Geriatric Medicine. 2021; (3): 344–350 (In Russ.)).


https://doi.org/10.37586/2686-8636-3-2021-336-342. EDN: RNBDLY.


28. Boyd C.M., Leff B., Wolff J.L. et al. Informing clinical practice guideline development and implementation: Prevalence of coexisting conditions among adults with coronary heart disease. J Am Geriatr Soc. 2011; 59(5): 797.


https://doi.org/10.1111/j.1532-5415.2011.03391x. PMID: 21568950. PMCID: PMC3819032.


29. Morley J.E., Vellas B., van Kan G.A. et al. Frailty consensus: A call to action. J Am Med Dir Assoc. 2013; 14(6): 392–97.


https://doi.org/10.1016/j.jamda.2013.03.022. PMID: 23764209. PMCID: PMC4084863.


30. Lee J.S.W., Auyeung T.-W., Leung J. et al. Transitions in frailty states among community-living older adults and their associated factors. J Am Med Dir Assoc. 2014; 15(4): 281–86.


https://doi.org/10.1016/j.jamda.2013.12.002. PMID: 24534517.


31. Collard R.M., Boter H., Schoevers R.A. et al. Prevalence of frailty in community-dwelling older persons: A systematic review. J Am Geriatr Soc. 2012; 60(8): 1487–92.


https://doi.org/10.1111/j.1532-5415.2012.04054.x. PMID: 22881367.


32. Zucchelli A., Vetrano D.L., Marengoni A. et al. Frailty predicts short-term survival even in older adults without multimorbidity. Eur J Intern Med. 2018; 56: 53–56.


https://doi.org/10.1016/j.ejim.2018.06.012. PMID: 29950278.


33. Peng Y., Zhong G.C., Zhou X. et al. Frailty and risks of all-cause and cause-specific death in community-dwelling adults: A systematic review and meta-analysis. BMC Geriatrics. 2022; 22(1): 725.


https://doi.org/10.1186/s12877-022-03404-w. PMID: 36056319. PMCID: PMC9437382.


34. Chang S.-F., Lin P.-L. Frail phenotype and mortality prediction: A systematic review and meta-analysis of prospective cohort studies. Int J Nurs Stud. 2015; 52(8): 1362–74.


https://doi.org/10.1016/j.ijnurstu.2015.04.005. PMID: 25986959.


35. Hanlon P., Nicholl B.I., Jani B.D. et al. Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493737 UK Biobank participants. Lancet Public Health. 2018; 3(7): e323–e332.


https://doi.org/10.1016/S2468-2667(18)30091-4. PMID: 29908859. PMCID: PMC6028743.


36. Ларина В.Н., Рунихина Н.К., Барт Б.Я. с соавт. Риск развития сердечно-сосудистых осложнений и гериатрические синдромы у женщин пожилого и старческого возраста. Кардиология. 2017; 57(3): 58–64. (Larina V.N., Runikhina N.K., Bart B.Ya. et al. Risk of cardiovascular complications and geriatric syndromes among elderly women. Kardiologiya = Cardiology. 2017; 57(3): 58–64 (In Russ.)).


https://doi.org/10.18565/cardio.2017.3.58-64. EDN: YHWRSB.


37. Shrauner W., Lord E., Nguyen X.-M. et al. Frailty and cardiovascular mortality in more than 3 million US Veterans. Eur Heart J. 2022; 43(8): 818–26.


https://doi.org/10.1093/eurheartj/ehab850. PMID: 34907422. PMCID: PMC9890630.


38. Veronese N., Cereda E., Stubbs B. et al. Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis. Ageing Res Rev. 2017; 35: 63–73.


https://doi.org/10.1016/j.arr.2017.01.003. PMID: 28143778. PMCID: PMC6047747.


About the Autors

Vera N. Larina, MD, Dr. Sci. (Medicine), professor, head of the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova St.
E-mail: larinav@mail.ru
ORCID: https://orcid.org/0000-0001-7825-5597
Ekaterina V. Kudina, MD, PhD (Medicine), associate professor of the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova St.
ORCID: https://orcid.org/0000-0002-9547-078X
Ekaterina S. Shcherbina, MD, resident of the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova St.
ORCID: https://orcid.org/0000-0001-8619-8123
Marina P. Mikhailusova, MD, PhD (Medicine), associate professor of the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova St.
ORCID: https://orcid.org/0000-0003-0271-6726
Denis A. Orlov, MD, PhD (Medicine), assistant at the Department of polyclinic therapy of the Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova St.
ORCID: https://orcid.org/0000-0002-0994-8880
Olga V. Kladovikova, MD, acting as a chief physician for organizational and methodological work of Diagnostic Clinical Center No. 1 of the Department of Healthcare of Moscow. Address: 117485, Moscow, 29/2 Miklouho-Maklaya St.
ORCID: https://orcid.org/0000-0001-7977-5850


Similar Articles

Back to Content

Бионика Медиа