The necessity of organizing geriatric medical care in primary healthcare is driven by the increasing elderly population, the rise in chronic non-communicable diseases, and the prevalence of frailty and other geriatric syndromes among older adult patients. Elderly patients with chronic non-communicable diseases and geriatric syndromes place a considerable additional strain on primary healthcare, particularly on therapeutic services and paramedic's office. There is also a high demand for long-term care among this population. The methodological recommendations facilitate the integration of preventive approaches and strategies for identifying and addressing geriatric syndromes into primary healthcare. Implementing these recommendations will enhance the quality of life for older adult patients, alleviate the burden on primary healthcare services, reduce patients' dependence on external assistance, and decrease unplanned visits to clinics and adverse outcomes.
Falls in the elderly require close attention from specialists of various profiles due to their high frequency, association with severe injuries, and the risk of death, loss of autonomy. Falls determine the prognosis of life and are closely related to other geriatric syndromes. Falls in patients with osteoporosis increase the probability of fractures, in particular, hip fractures. Unjustified refusal of surgical treatment for elderly patients with hip fractures leads to death or loss of autonomy within a year after the injury. The lack of drug therapy for osteoporosis after surgical treatment of a fracture significantly worsens its results, leads to the risk of repeated fractures, and increases the burden on the healthcare system. The guidelines/methodological recommendations contain structured information on the organization of falls prevention, primary and secondary prevention of fractures from low-energy trauma related to osteoporosis, the organization of medical care for patients with hip fractures, and the infrastructure of medical and social care for elderly and senile patients. Their implementation at all stages of medical and social care will ensure healthy aging, preserve the quality of life and autonomy of the elderly.
Background Most population studies examining heart failure (HF) have been conducted in Western high-income countries (HICs), with limited comparable data from lower-income settings. Objectives The aims of this study were to describe differences in HF incidence and 30-day, 1-year, and 5-year case fatality rates among HF patients from countries at different income levels and in different global regions and to examine the impact of common and potentially modifiable risk factors for incident HF. Methods This analysis of the PURE (Prospective Urban Rural Epidemiology) study included 172,653 individuals from 25 HICs, upper middle-income countries (UMICs), lower middle-income countries (LMICs), and low-income countries (LICs) and 8 geographic regions of the world, followed for a median of 15 years. Age- and sex-standardized HF incidence, as well as 30-day, 1-year, and 5-year HF case fatality, were compared by income group and by geographic region. The population attributable fractions (PAFs) for incident HF related to 13 cardiometabolic, lifestyle, socioeconomic, environmental, and psychosocial risk factors were also estimated. Results The standardized rate of incident HF was 0.39 (95% CI: 0.36-0.41) per 1,000 person-years overall; the rate was highest in UMICs (0.58; 95% CI: 0.52-0.64), followed by HICs (0.36; 95% CI: 0.30-0.43), then LMICs (0.34; 95% CI: 0.30-0.38), and then LICs (0.26; 95% CI: 0.22-0.30). Among regions, the highest HF incidence was in sub-Saharan Africa (1.18; 95% CI: 0.95- 1.41) and Europe and Central Asia (0.86; 95% CI: 0.72-1.00) and lowest in South Asia (0.19; 95% CI: 0.15-0.22). Thirty-day case fatality was highest in LICs (59%) and lowest in HICs (11%); it was highest in South Asia (63%) and sub-Saharan Africa (63%) and lowest in North America (12%). Five-year case fatality after HF diagnosis was highest in LICs (77%) and lowest in HICs (28%); it was highest in South Asia (81%) and sub-Saharan Africa (75%) and lowest in North America (25%). More than 71% of the PAF for HF was attributable to the 13 modifiable risk factors studied, the largest being hypertension (PAF = 25%). Conclusions HF incidence and associated mortality vary substantially across countries at different levels of economic development and by geographic region. Hypertension is the largest population-level risk factor for HF globally. Preventive measures, early diagnosis, and access to guideline-directed medical therapy should be prioritized to reduce global disparities in HF incidence and mortality.
BACKGROUND:Few questionnaires with established measurement properties can globally measure sleep in preschoolers and sleep-related family practices. OBJECTIVE:To examine (1) concurrent validity of the SUNRISE parent questionnaire against an accelerometer for measuring sleep in preschoolers and (2) test-retest reliability of the questionnaire for sleep and related family practices. METHODS:Sleep was measured using the questionnaire and Actigraph GTX3+ accelerometer using a decision-tree algorithm and the Sadeh algorithm in 1737 preschoolers (4.4±0.6years) from 30 countries. Concurrent validity was examined using correlation analysis (duration, timing, and quality), paired t test or the Wilcoxon signed-rank test, Bland-Altman plot (duration, timing), and analysis of sensitivity, specificity, and accuracy (variability). Test-retest variability was examined for sleep and family practice variables in a subsample of 163 participants (4.3±0.6years) from eight countries. RESULTS:Questionnaire measures of sleep timing and duration were correlated with the accelerometer measures (r=0.43-0.75; p<.001). Although statistically significant mean differences were observed between questionnaire and accelerometer measures of sleep timing and duration variables, the difference in nighttime sleep duration had a small effect size (-14 min/d; Cohen's d=-0.2). The questionnaire was less able to provide adequate measurement for sleep quality and variability. High levels of reliability were observed for sleep (ICC=0.63-0.83; Kappa=0.53-0.62) and family practice (ICC=0.81-0.94; Kappa=0.73-0.86) variables. CONCLUSION:The SUNRISE questionnaire appears reliable in assessing preschooler sleep characteristics and related family practices, particularly in disadvantaged settings. It could be used in global surveillance of nighttime sleep duration and in studies examining associations of sleep timing and duration with health indicators in preschoolers.
BACKGROUND:Individual alcohol consumption depends on living conditions at different territorial and environmental levels. This study examined the influence of regional living conditions on individual alcohol consumption based on the results of a large Russian nationwide study (2012-2022). Study Design: A cross-sectional multicenter observational study. METHODS:Individual data from three stages of the Russian nationwide study, including the Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Regions of the Russian Federation (ESSE-RF1) (2012-2014), ESSE-RF2 (2017-2018), and ESSE-RF3 (2020-2022), were used for investigation. The study samples included 53,902 men and women aged 25-74 years from 31 regions. Individual data were combined with the annual values of four regional indices that characterize economic, demographic, social, and industrial environmental conditions. The analyzed outcomes included any alcohol consumption and binge drinking. RESULTS:The industrial development of regions was associated with an increased likelihood of any alcohol consumption (odds ratio [OR]: 1.66, 95% confidence interval [CI]: 1.59-1.72) and binge drinking (OR: 1.31, CI: 1.22-1.40). Improved economic (OR: 0.75, 95% CI: 0.72-0.78), demographic (OR: 0.73, 95% CI: 0.71-0.76), and social (OR: 0.55, 95% CI: 0.53-0.56) living conditions exhibited inverse associations with any alcohol consumption. Similar inverse associations of binge drinking were noted with the economic (OR: 0.84, 95% CI: 0.76-0.92), demographic (OR: 0.91, 95% CI: 0.85-0.98), and social (OR: 0.78, 95% CI: 0.73-0.82) indices. CONCLUSION:In general, our findings revealed the associations of alcohol consumption and binge drinking with the regional characteristics of living conditions.
