Добавил:
ivanov666
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Comprehensive geriatric assessment from theory to practice. Study aid
.pdf
Federal State Budgetary Educational Institution
of Higher Education «Samara State Medical University»
of the Ministry of Healthcare of the Russian Federation
S.V. Bulgakova, E.V. Treneva, D.P. Kurmaev
COMPREHENSIVE GERIATRIC ASSESSMENT:
FROM THEORY TO PRACTICE
Study aid
Recommended by the Coordinating Council for the Field of education
“Health and Medical Sciences” as a study aid for use in educational institutions
implementing basic professional educational programs of higher education
in specialty programs 31.05.01 “Medical practice”
Protocol № 067 dated February 16, 2023, meeting of the Expert Commission on Working
with Educational Publications (hereinafter referred to as ECU) of the Federal State
Autonomous Educational Institution of Higher Education First Moscow State
Medical University named after I.M. Sechenov Ministry of Healthcare
of the Russian Federation (Sechenov University).
Registration number of the review: 2092 EKU dated February 16, 2023
Moscow
IPR Media
2025
UDC 616-053.9
BBK 57.4
B92
Authors:
Bulgakova S.V. — Doctor of Medical Sciences, Associate Professor,
Head of the Department of Endocrinology and Geriatrics,
Samara State Medical University of the Ministry of Health of Russia;
Treneva E.V. — Candidate of Medical Sciences, Associate Professor,
Associate Professor of the Department of Endocrinology and Geriatrics,
Samara State Medical University of the Ministry of Health of Russia;
Kurmaev D.P. — Candidate of Medical Sciences,
Assistant of the Department of Endocrinology and Geriatrics,
Samara State Medical University of the Ministry of Health of Russia
Reviewers:
Ilnitsky A.N. — Doctor of Medical Sciences, Professor,
Head of the Department of Therapy, Geriatrics and
Anti-Aging Medicine of the Academy of Postgraduate Education
of the FSBI FNCC FMBA of Russia;
Ushakova S.E. — Doctor of Medical Sciences, Professor,
Head of the Department of Polyclinic Therapy and Endocrinology
of the FSBEI HE IvGMA of the Ministry of Health of Russia
Bulgakova, Svetlana Viktorovna.
B92 Comprehensive geriatric assessment: from theory to practice : study aid /
S.V. Bulgakova, E.V. Treneva, D.P. Kurmaev ; Samara State Medical
University. — Moscow : IPR Media, 2025. — 153 p. — Text : electronic.
ISBN 978-5-4497-3961-2
The study aid describes in detail the definition, goals, indications and a step-by-step
algorithm for conducting a comprehensive geriatric assessment with a description of the methods and
emphasis on interpreting the results obtained. The aid contains test tasks and situational tasks for
knowledge self-control.
The study aid is intended for students of medical universities and has been prepared in
accordance with the requirements of the current Federal State Educational Standard for Higher
Education of a specialist in the specialty “General Medicine” and the work program of the discipline
“Gerontology and Geriatrics”, approved by the Central Committee of the Federal State Budgetary
Educational Institution of Higher Education of the Samara State Medical University of the Ministry
of Health of Russia. The study aid was approved by the Central Committee of the Federal State
Budgetary Educational Institution of Higher Education of the Samara State Medical University of the
Ministry of Health of Russia.
Educational electronic publication
Approved and recommended to the publishing
by the Central Coordination Academic Council,
Samara State Medical University (protocol № 2 of 10/12/2022)
ISBN 978-5-4497-3961-2 © Bulgakova S.V., Treneva E.V.,
Kurmaev D.P., 2025
© Samara State Medical University, 2025
© LLC Company “IPR Media”, 2025
Educational publication
Bulgakova Svetlana Viktorovna
Treneva Ekaterina Vyacheslavovna
Kurmaev Dmitry Petrovich
Editor Yu.V. Semenova
Technical editor, computer layout A.A. Balakireva
Cover by Ya.A. Kirsanov, S.S. Siziumova, photobank Freepik
Signed for use 25.11.2024. Data volume 6 Mb.
LLC Company “IPR Media”
8 800 555 22 35 (toll-free within Russia)
E-mail: sales@iprmedia.ru
4
TABLE OF CONTENTS
ABBREVIATIONS .................................................................................... 5
INTRODUCTION ...................................................................................... 6
1. Biological chronological aging .............................................................. 10
2. Gerontology and geriatrics in the Samara region:
past, present and future............................................................................... 20
3. Comprehensive Geriatric Assessment: A Background.......................... 39
4. Comprehensive Geriatric Assessment:
Concept, Purpose, Methods ........................................................................ 43
5. Steps for conducting a comprehensive geriatric assessment ................. 52
6. Assessment of motor activity in elderly and senile people ................... 77
7. Scale for assessing instrumental functional activity in everyday life .... 79
8. Syndrome of frailty ................................................................................ 86
APPENDIX ............................................................................................... 96
CONTROL TASKS................................................................................ 116
BIBLIOGRAPHY .................................................................................. 146
5
ABBREVIATIONS
ADL — activity in daily life
AMPK — adenosine monophosphate-activated protein kinase
CAVI — cardio-ankle vascular index
IADL — instrumental activity in everyday life
DNA — Deoxyribonucleic acid
mTOR — mechanical target of rapamycin
CGA — Comprehensive Geriatric Assessment
UN — United Nations Organization
Samara State Medical University — Samara State Medical University
TMK — telemedical consultations
6
INTRODUCTION
The study aid is intended for students of medical universities and has
been prepared in accordance with the requirements of the current federal
state educational standard for higher education of a specialist in the
specialty “General Medicine” and the work program of the discipline
B1.B.65 “Gerontology and Geriatrics”, approved by the Central
Committee of the Federal State Budgetary Educational Institution of
Higher Education of the Samara State Medical University of the Ministry
of Health of Russia dated June 23, 2021, aimed at developing the
following competencies:
PC-2 Ability and readiness to conduct a patient examination in order
to establish a diagnosis; PC-4 Ability and readiness to draw up a treatment
plan for a disease, prescribe medications, medical devices, clinical
nutrition, non-drug treatment in accordance with current medical care
procedures, clinical guidelines, followed by an assessment of efficacy and
safety; PC-5 Ability and willingness to implement and monitor the
effectiveness of the patient's medical rehabilitation, including individual
rehabilitation programs, prescribe sanatorium treatment, assess the
patient's ability to work. Student should:
1) know: the principle of action of drugs, medical devices and
therapeutic nutrition, indications and contraindications for their use,
possible adverse events and complications during treatment, clinical
guidelines for the use of drugs, medical devices, therapeutic nutrition, their
mechanisms of action; indications and contraindications for prescription,
complications during use; principles of providing palliative medical care;
2) be able to: draw up a plan for prescribing drug, non-drug therapy
and therapeutic nutrition taking into account the diagnosis, individual
needs and age of the patient in accordance with modern clinical guidelines
(treatment protocols) and assess the effectiveness of the prescribed
therapy, prescribe drug and non-drug therapy, therapeutic nutrition taking
into account the individual needs and age of the patient, diagnosis, clinical
7
picture in accordance with current clinical guidelines, protocols, standards
and procedures for the provision of medical care; explain the rules for
taking medications and conducting non-drug therapy;
3) master: the rules of a personalized approach to treating a patient
with various pathologies, polymorbidity, limited physical abilities and
taking into account age, skills of interaction with medical specialists, other
medical workers and family members of a sick person when providing
palliative care to a sick person.
By 2050, the number of older people aged 65 and over worldwide is
expected to rise from 8.5 % to almost 25 %. As the population ages, the
concept of frailty becomes more relevant to healthcare delivery. The
concept of frailty (weakness, frailty) was introduced into the literature of
geriatric medicine almost three decades ago as a method of understanding
and defining the complex health conditions of the elderly. Frailty is
defined as a clinical syndrome due to age-related biological changes that
determine its physical characteristics and ultimately adverse outcomes.
Initially, frailty syndrome was conceptualized as a condition that precedes
disability, but it can also be described as coexisting with disability.
Phenotypic weakness, proposed by Fried and his colleagues, considers the
syndrome of frailty as a biological syndrome of a decrease in physiological
reserves. This leads to a decrease in adaptive capacity, causing
vulnerability to stressors, which leads to the physical manifestations of
frailty syndrome. Fried proposed to measure five parameters, namely,
muscle weakness as assessed by hand grip strength, reduced walking
speed, general weakness as assessed by self-reported fatigue, and physical
inactivity with estimated energy expenditure as assessed by a physical
activity questionnaire, and unintentional loss of weight. The syndrome of
frailty was set on the basis of a decrease in 3 out of 5 indicators. However,
due to the evaluation of only a limited number of parameters, it became
necessary to develop more informative tests with the definition of various
body functions.
The main burden of care for the elderly falls on the shoulders of
primary care physicians. This is a natural situation that exists everywhere,
8
not only in Russia. However, the population of older people is
heterogeneous. Some need help with illnesses; others need more support
and social services. The current disconnect between geriatric care, primary
health care physicians and social services prevents effective
communication and continuity. How to identify older people in need of a
range of services? Who needs help first and how much? How to properly
allocate health resources? Who can most effectively identify the group of
most vulnerable older patients?
At the present stage of development of the geriatric service for these
purposes, a comprehensive assessment (CGA ) of the health status of
patients of older age groups (Comprehensive Geriatric Assessment) is
used. CGA is defined as a multidimensional, interdisciplinary diagnostic
process for determining the scope of care needed, planning it, and
improving the health of an older person. A comprehensive geriatric
assessment includes an interdisciplinary assessment of the state of somatic,
mental health, social relationships, and satisfaction with the quality of life.
Such an assessment is carried out in order to prolong the increase in
subjective well-being and active longevity of an elderly and senile person.
The leading strategies are improving diagnostics, optimizing
treatment, improving the functional state and quality of life, including
living conditions, using medical services, planning long-term support for
the elderly. The complex assessment process involves many measurable
indicators, usually forming four groups (domains, as they are called in
foreign literature). Indicators of physical health are data from a traditional
life history, physical examination, laboratory tests, criteria for the severity
of individual diseases. The next group of information describes the
functional status, using indicators such as activity in daily life (ADL),
instrumental activity in daily life (IADL), mobility, risk of falls, quality of
life. Mental health indicators are also assessed, among them, first of all,
the cognitive status and emotional state, and socio-economic factors,
including the presence of a family, relatives, financial situation, and the
safety of the place of residence. After analyzing the complex of these
indicators, a list of the needs of an elderly person is formed, measures are
9
determined to improve the quality of his life and support. A detailed
comprehensive assessment of the condition of an elderly person can be
performed at various stages of care and with the participation of various
services and specialists: in a hospital before a patient is discharged, in
nursing homes, in general medical practice. But wherever it is performed,
it is the basis of the geriatric service system, a single language for
communication, a starting point for referring patients to various medical
institutions and specialists, creating rehabilitation and treatment programs.
For a doctor, the most important goal of a comprehensive health
assessment will, of course, be to identify various symptoms and signs that
make it possible to establish a diagnosis or identify a particular disease, and
prescribe the appropriate treatment. For a social worker, the main goal will
be to clarify the need for various types of services that a social service can
provide. The patient himself may also have a need for a comprehensive
assessment of the state of health. It would be nice, starting this procedure, to
find out what the patient himself expects from it. Finally, an important task
of the integrated approach is to compare the results over time.
The manual provides a step-by-step algorithm for conducting a
comprehensive geriatric assessment with a description of the methods and
emphasis on interpreting the results.
10
1. BIOLOGICAL CHRONOLOGICAL AGING
Aging is the main risk factor for the development of cardiovascular
diseases, cardiovascular and cerebrovascular complications, which are the
main causes of death worldwide. Vascular aging entails structural changes
in the vascular wall, increased stiffness, which impair vascular function
and ultimately cause organ damage, predominantly the heart, brain, and
kidneys. Age-related arterial complications usually manifest clinically
after the fifth or sixth decade of life, but there is high individual variability
in the occurrence of vascular disease and associated mortality. Early
vascular aging is observed in patients with premature aging syndromes,
and, conversely, centenarians/supercentenarians demonstrate supernormal
(delayed) vascular aging. The understanding that people do not age at the
same rate has led to the concept of biological aging, also called functional
or physiological aging. In a progressively aging global population, it is
critical to identify the mechanisms that regulate biological vascular aging
in order to reduce its socioeconomic and medical burden.
Biomarkers reflecting the state of vascular aging are essential for the
early identification of people at high risk of developing cardiovascular
disease. To reduce morbidity and mortality in a population, biomarkers of
biological age in a population must be better than chronological age. In
addition, their quantification should be simple and safe, preferably with a
blood test or non-invasive imaging method. Biomarkers of biological age
described so far range from phenotypic and functional indicators to
molecular ones.
Molecular and cellular biomarkers of aging.
Aging can be defined at the molecular and cellular level by the
presence of 9 hallmarks, which include: genomic instability, telomere
shortening, epigenetic modifications, proteostasis, nutrient dysregulation,
mitochondrial dysfunction, cellular senescence, stem cell depletion, and
altered cell-to-cell communication. Some of these traits, such as telomere
shortening and epigenetic changes, are commonly used to estimate a
Соседние файлы в предмете [НЕСОРТИРОВАННОЕ]