Elderly patients represent a specific risk group in diagnostic procedures using contrast media (CM). With increasing life expectancy and a growing elderly population, the need for diagnostic procedures using CM is rising. However, scientific information on the specific use of CM in this group remains limited. This review analyzes available data on the pharmacokinetic characteristics of contrast media in older individuals and examines key risks associated with their use in this patient group. The analysis indicates that older patients are more susceptible to contrast media side effects. Accordingly, the review explores key aspects of optimizing CM use in older patients, emphasizing an individualized approach for patients over 65 years of age. The review demonstrates the need for further research to improve understanding of the specific features of RCP use in elderly patients, which will optimize the diagnostic process and increase the safety of examinations.
BACKGROUND. Frailty and related nutritional disorders are highly prevalent among older adults, especially in inpatient settings [1, 2]. The Mini Nutritional Assessment (MNA) is a validated tool that enables not only screening of nutritional status but also a more detailed evaluation of risk factors for developing malnutrition [3].OBJECTIVE — to conduct a comprehensive evaluation of nutritional parameters in patients aged 60 years and older residing in care homes and geriatric centers in Moscow, to detail responses across MNA domains, to identify correlations with functional, psychoemotional and clinical parameters, and to propose targets for dietary interventions.MATERIALS AND METHODS. A multicenter prospective study (within the first phase of the «POSTSCRIPTUM» clinical trial) included 792 patients aged 60 years and older (mean age 76.8 ± 8.2 years, 68% women) with indications for geriatric rehabilitation. Nutritional assessment was performed using the full version of the MNA [3]. Based on the total score, patients were divided into two groups: «normal» (MNA ≥24, n = 636) and «at risk of malnutrition» (MNA < 24, n = 156). A comparative analysis of responses to each of the 18 MNA items was carried out, along with correlation analysis between the MNA score and age, body mass index (BMI), functional independence (Barthel Index, Lawton Index), physical performance (Short Physical Performance Battery, SPPB), muscle strength (handgrip dynamometry), cognitive status (Montreal Cognitive Assessment (MoCA), depression (15-item Geriatric Depression Scale, GDS-15), pain (Visual Analogue Scale, VAS score), insomnia (Insomnia Severity Index, ISI), polypharmacy, and frailty screening (score on the «Age Is Not a Hindrance» scale).RESULTS. The proportion of patients at risk of malnutrition was 19.7%. Statistically significant differences between groups were found across most MNA domains (p < 0.001). The following factors were significantly more frequent in the malnutrition-risk group: appetite decline (46.8% moderate and 1.3% severe), weight loss over the preceding 3 months (43.6%), mobility limitations (5.8%), acute stress/disease (69.2%), neuropsychological problems (overt dementia or depression —15.4%), polypharmacy (80.8%), pressure ulcers (2.6%), inadequate meal frequency (30.1%), protein-rich food deficit (3.2% with 0–1 markers), insufficient fluid intake (13.5% < 3 cups), low self-perceived nutrition quality (2.6% «insufficient», 26.3% «do not know»), self-rated health «not good» (41.0%), and reduced mid-upper arm circumference (3.2%) and calf circumference (5.8%). Correlation analysis demonstrated a weak positive association between MNA scores and the Barthel Index (rs = 0.26) and SPPB (rs = 0.27), a weak-to-moderate negative association with GDS-15 (rs = –0.31), and weak negative associations with frailty screening (rs = –0.28) and pain (rs = –0.24).CONCLUSION. Malnutrition risk was identified in every fifth patient. Moderate appetite decline, weight loss, neuropsychological problems, polypharmacy and poor self-rated health were widespread among patients at risk of malnutrition. Insufficient protein and fluid intake was also statistically significant. Rank correlation analysis showed a strong relationship between poor nutritional status and depressive symptoms, while other statistically significant associations were less strong, emphasizing the multifactorial nature of nutritional status among older adults. This should be taken into account when diagnosing and treating malnutrition, especially focusing on depression, physical activity and pain. Dietary targets for correction are proposed based on the study's limitations, and the results may be useful for developing nutritional support protocols for geriatric care facilities in Russia.
This review outlines the key points from the clinical guidelines «Sarcopenia in Elderly Patients», covering definition, epidemiology, clinical features, diagnostic approaches, and treatment strategies. The information is intended to help individuals manage patients aged 60 years or older with a focus on muscle health.
Population aging and the increasing prevalence of arterial hypertension (AH) have led to an epidemic of cognitive impairment and dementia. AH is a key modifiable risk factor that triggers a cascade of pathophysiological changes: cerebrovascular remodeling, blood-brain barrier (BBB) dysfunction, and neuroinflammation. Analysis of current data demonstrates that angiotensin II receptor blockers (ARBs), particularly telmisartan, possess unique neuroprotective properties due to their high affinity for AT1R and their ability to activate PPARγ. This provides anti inflammatory and antioxidant effects, as well as improved cerebral blood flow. Calcium channel blockers (CCBs), such as amlodipine, complement this effect by improving regional perfusion and reducing oxidative stress. The combination of telmisartan and amlodipine ensures not only stable blood pressure control and reduced variability but also multi-channel protection of the neurovascular unit.
Gerontology is the field of study that focuses on understanding the patterns of aging; it has experienced significant growth since 2016, when the World Health Organization introduced the «Decade of Healthy Aging» initiative. The undeniable success of modern medicine can be seen in the growing numbers of youngest-old, middle-old, and oldest-old individuals. The collective contribution of scientists, physicians, healthcare professionals, social workers, and, directly, patients to maintaining the health of individuals over the age of sixty needs to be supported and multiplied.THE OBJECTIVE of the study was to determine the awareness and knowledge of specific issues in age-associated medicine among outpatient clinic service physicians and their patients in the Moscow Region.MATERIALS AND METHODS. A simultaneous paired survey was conducted over a span of 12 days, beginning on October 2 and ending on October 13, 2023, with participation from 435 primary care physicians and 603 patients in the Moscow Region. In order to gather information about their education and training in geriatrics, as well as their intentions to receive further training and knowledge of regulatory documents, their own opinion about the role and structure of geriatric services, experts were asked to complete an electronic questionnaire.RESULTS. The interviews included 603 patients, gender ratio 2:1 (66.8% women, 33.2% men). Age structure: patients less than 60 years old — 41.3%, 60–70 years old — 34.5%, 70–80 years old — 16.3%, 80–85 years old — 5.3%, 85–90 years old — 1.3%, over 90 years old — 1.3%. Over the past year, 172 people received inpatient treatment for all reasons, which amounted to 48.7% of the total number of older respondents, and more than 50% of them were hospitalized two or more times during the last year. 38.6% of older and oldest-old respondents define their health as «satisfactory», 8.2% noted a low level of their health. 30.2% are under outpatient observation in the clinic. Among people over 60, 85% of respondents had never consulted a geriatrician. Among the patients participating in the study, 16.4% were dissatisfied with medical care, while 63.8% were satisfied with the current state of medical institutions. According to the survey, older and elderly patients are aware of what aspects are included in the concept of a healthy lifestyle and adhere to it. Thus, 68.9% regularly exercise, 27.1% do not drink alcohol at all, and 31.1% sharply limit alcoholic drinks, 59.8% of patients add fresh fruits and vegetables to their diet daily.CONCLUSIONS. The findings of this study indicate that the feeling of old age is not determined by one's passport age. The Moscow region is also experiencing a deficiency in geriatrics experts, resulting in inadequate consultations for patients requiring geriatric care. Additionally, neither doctors nor patients expect changes in well-being and treatment after consultations with geriatricians. Patients need consultation with doctors much less frequently than doctors themselves assume. Currently, cardiologists, neurologists and endocrinologists are most in demand for the management of older patients.
