COMPREHENSIVE GERIATRIC ASSESSMENT OF LARGE JOINTS IN OSTEOARTHRITIS OF THE KNEE AND HIP JOINTS IN THE ELDERLY

COMPREHENSIVE GERIATRIC ASSESSMENT OF LARGE JOINTS IN OSTEOARTHRITIS OF THE KNEE AND HIP JOINTS IN THE ELDERLY

Kamariddin Khisomov

Orthopaedic surgeon, Researcher of Department of Orthopaedic surgery at the Academy of Postgraduate Education of Federal Сlinical Research Center of Specialized Types of Medical Care and Medical Technologies,

Russia, Moscow

Vyacheslav Ondar

Dr. Sci. (Med.), Professor at the Department of Orthopaedic surgery at the Academy of Postgraduate Education of Federal Сlinical Research Center of Specialized Types of Medical Care and Medical Technologies,

Russia, Moscow

Aleksandr Akhpashev

Ph.D. of Medical Sciences, Head of Department of Orthopaedic surgery at the Academy of Postgraduate Education of Federal Сlinical Research Center of Specialized Types of Medical Care and Medical Technologies,

Russia, Moscow

КОМПЛЕКСНАЯ ГЕРИАТРИЧЕСКАЯ ОЦЕНКА БОЛЬНЫХ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА С ОСТЕОАРТРОЗОМ КРУПНЫХ СУСТАВОВ

ABSTRACT

Background: Musculoskeletal disorders in elderly patients require special attention as it leads to disability, which subsequently worsens the life quality. Consequently, a comprehensive geriatric assessment in elderly patients with gonarthrosis and coxarthrosis is an actual topic today. The aim of the study: To investigate the development of geriatric syndromes in gonarthrosis and coxarthrosis in geriatric patients using a comprehensive geriatric assessment. Materials and methods: The study clinical properties of gonarthrosis and coxarthrosis was carried out for 50 groups of older and senile patients, including 25 elderly patients and 25 senile patients. The study of clinical features was carried out using scales for assessing geriatric status. Statistical processing of research data was carried out. Results: Establushed that elderly patients with gonarthrosis and coxarthrosis are less prone to disturbances in stability and gait than in senile patients. In the elderly, depression is less likely to occur, the probability of cognitive impairment is low, the slight dependence on strangers in everyday life, the reduced development of malnutrition syndrome, which distinguishes the life quality of elderly from senile patients. Conclusion: In elderly age, osteoarthritis of the knee and hip joints is accompanied by a smaller change in the age-related state, namely, the decrease of life quality is less pronounced and accounts for approximately 12% of the total. Comprehensive geriatric assessment helps to identify age-related conditions in both elderly and senile people. And timely reveals deviations in the geriatric status, which in the future makes it possible to prescribe a set of preventive and therapeutic measures in advance.

Keywords: osteoarthritis, gonarthrosis, coxarthrosis, elderly age, senile age, comprehensive geriatric assessment.

Introduction. One of the important tasks in contemporary geriatrics is to ensure the preservation of functional activity in geriatric patients throughout their lifespan [2, p. 39; 4, p. 796; 3, p. 146]. Elderly individuals undergo various age-related changes in the body, which can affect the quality of active life due to the emergence of geriatric syndromes and predisposition to them, regardless of pre-existing conditions. In most cases, geriatric syndromes can be prevented through appropriately selected and provided therapeutic and preventive care. To identify the pathologies that accumulate in the bodies of patients, comprehensive measures are required [4, p. 796; 5, p. 77]. From this perspective, musculoskeletal diseases have significant social importance as they are highly prevalent and lead to a variety of complaints that are likely to restrict the individual's life activity [6, p. 102]. Osteoarthritis of the knee and hip joints (OAKH) is a frequently observed musculoskeletal disorder in older people. This pathology is characterized by pronounced local signs, especially pain, decreased joint range of motion, which affect the social activity status of patients and predispose them to falls and increased isolation from the surrounding environment [7, p. 61; 8, p. 315; 9, p. 93]. Comprehensive geriatric assessment (CGA) represents a complex of diagnostic and analytical measures. Its goal is not only to conduct traditional nosological examination of pathologies in patients but also to analyze the social condition of the patient and the impending decrease in life activity from the perspective of physiological status observed in gerontological patients. The main goal of CGA is to search for and detect geriatric asthenia, which is a common problem in geriatrics [1, p. 45; 10, p. 176]. One of the most common age-related phenomena is geriatric asthenia (GA), which leads to a gradual decline in body activity indicators. With GA, gait speed decreases, physiological functioning declines, body mass decreases, and muscle weakness and decreased work capacity are observed [6, p. 102; 14, p. 366; 11, p. 2378]. Geriatric asthenia is considered a fundamental concept in contemporary geriatrics that requires prevention of its formation and, if it progresses, the involvement of medical and social support measures to socialize the patient [4, p. 796; 14, p. 688]. Therefore, in gerontological patients with OAKH, geriatric syndromes such as GA often develop. The study of GA remains a relevant topic in current research [12, p. 15; 13, p. 213].

Objective: To investigate the occurrence of geriatric syndromes in gerontological patients with osteoarthritis of the knee and hip joints (OAKH) when applying comprehensive geriatric assessment (CGA).

Materials and Methods. Clinical features of gonarthrosis and coxarthrosis were investigated in 50 gerontological patients, including 25 elderly patients (mean age 74.3±0.7 years) and 25 older adult patients (mean age 62.2±0.6 years). Clinical assessment scales designed to identify geriatric syndromes and evaluate geriatric status were used. The inclusion criteria were as follows: patients with third and fourth stage OAKH (according to the Kellgren radiological classification of osteoarthritis); presence of memory impairment without cognitive function impairment; absence of severe compensatory comorbidities; age range of 60 to 90 years for both males and females, with indications for planned primary total endoprosthetic replacement; provision of signed informed consent by patients to undergo CGA with subsequent follow-up over a specified period (12 months). The exclusion criteria were as follows: patients with first and second stage OAKH, cognitive impairments hindering contact with the subjects; severe decompensated pathology; voluntary refusal of the patient to participate in the study; patients under 60 years of age; patients with severe comorbidities.

To study and analyze the course of osteoarthritis in elderly patients, we applied CGA and identified important disease progression indicators. With the use of CGA, we assessed the following scales: gait and stability assessment scale; protein-energy deficit assessment scale; Confusion Assessment Method for the Intensive Care Unit (CAM-ICU); geriatric depression scale; Barthel Index for functional activities; psychosocial assessment scale; European Quality of Life-5 Dimensions (EQ-5D) protocol.

Statistical analysis was performed to assess the differences between the two groups using various statistical methods. Evaluation systems for repeated measurements, such as paired t-test, repeated measures ANOVA, Friedman ANOVA, and Wilcoxon-Mann-Whitney test for non-normally distributed data, were employed. Quantitative variables were presented as mean values with standard deviation, while qualitative variables were presented as percentages and sample sizes. Student's t-test was used for comparing quantitative variables, and Fisher's exact test and z-test were utilized for analyzing proportions and qualitative variables. Data entry was performed using electronic spreadsheets (Excel), and mathematical and statistical data analysis was conducted using the software "Statgraphics plus for Windows," version 7.0.

Results and Discussion. In 100% of cases (50 patients), surgical interventions were performed, including total primary knee joint replacement using cemented fixation endoprostheses and total primary hip joint replacement using cemented and cementless fixation. Anesthesia management included regional spinal-epidural anesthesia. Medication therapy was administered according to the standards of care for joint replacement procedures. Risk assessment for the development of transient cognitive impairments based on comprehensive geriatric assessment (CGA) was conducted during the perioperative period.

Results of Comprehensive Geriatric Assessment (CGA) at baseline and during follow-up are presented in Table 1.

Table 1.

Dynamics of CGA Results

Assessment of protein-energy deficiency syndrome risk. The survey revealed that nutritional status in elderly patients was characterized by lower values compared to older adults, resulting in their inclusion in the group of patients at risk for developing protein-energy deficiency syndrome (total score between patients was 16.3±0.1, p<0.05). However, older adult patients had a normal total score for nutritional status (22.4±0.2), which would not impact the exacerbation of symptoms in osteoarthritis of the knee and hip.

Assessment of Transient Cognitive Impairment (CAM-IC). Upon determining the total score, it was found that in older adult patients, it was significantly higher (p<0.05) compared to elderly patients, indicating a lower degree of cognitive impairment in older adult patients with osteoarthritis of the knee and hip. The total scores were 27.7±0.3 and 22.8±0.2, respectively.

Assessment of Depression. The evaluation of depression in elderly and older adult patients revealed the following changes: life satisfaction - 1.1±0.1 and 0.5±0.2; loss of interest - 1.2±0.2 and 0.3±0.1; emptiness - 1.0±0.3 and 0.4±0.2; boredom - 1.1±0.2 and 0.5±0.1; mood - 1.0±0.1 and 0.2±0.1; foreboding - 1.8±0.1 and 1.3±0.1; happiness - 1.7±0.2 and 1.3±0.2; social isolation - 1.9±0.1 and 1.4±0.1; memory problems - 1.0±0.2 and 0.5±0.1; suicidal thoughts - 1.9±0.1 and 1.6±0.2; worthlessness - 1.1±0.2 and 0.5±0.1; energy - 1.8±0.3 and 1.4±0.2; hopelessness - 1.9±0.2 and 1.3±0.1; with p<0.05 between the parameters of depression assessment results in gerontological patients. The analysis of the obtained results showed a higher prevalence of depression among older adult patients compared to elderly patients.

Assessment of Independence in Activities of Daily Living (Barthel Index). Comparative analysis of the independence questionnaire scores between gerontological patients yielded the following data: elderly patients (defecation - 8.8±0.2, urination - 9.7±0.1, personal hygiene - 9.6±0.2, toilet use - 9.0±0.1, eating - 9.6±0.3, moving within the bed - 9.8±0.2, mobility - 9.7±0.2, dressing - 9.8±0.2, stair climbing - 8.1±0.2, bathing - 8.8±0.1); older adult patients (defecation - 6.4±0.2, urination - 6.5±0.1, personal hygiene - 7.3±0.1, toilet use - 7.4±0.2, eating - 7.2±0.2, moving within the bed - 6.5±0.1, mobility - 6.1±0.2, dressing - 7.8±0.2, stair climbing - 4.0±0.1, bathing - 7.1±0.2); the overall score for elderly patients was 92.9±0.2 (mild dependence), while for older adult patients it was 66.3±0.2 (moderate dependence), with p<0.05 for the parameters analyzed between the groups. Based on the research results assessing the independence of gerontological patients in their daily activities, it was found that elderly patients require less assistance compared to older adult patients.

Assessment of Moral State. The moral state of elderly patients, which reflects an individual's attitude towards life, is characterized by significantly higher parameters compared to older adult patients - 42.0±0.3 and 38.8±0.2 units, with p<0.05 between the scores of elderly and older adult patients.

Assessment of Quality of Life (EQ-5D-3L). The questionnaire results revealed higher scores among elderly patients compared to older adult age group. The results of EQ-5D-3L questionnaire scores in elderly and older adult patients are as follows: mobility - 23.6±2.2 and 15.3±1.5 units; self-care - 34.1±4.2 and 29.3±3.9 units; pain/discomfort - 12.5±1.4 and 17.1±1.2 units; usual activities - 33.5±2.1 and 27.7±1.9 units; anxiety/depression - 28.3±3.3 and 20.3±3.7 units, with p<0.05 between the groups of elderly and older adult patients (Table 2).

Table 2.

Assessment of Quality of Life (EQ-5D-3L) over time.

Significant improvement in self-rated quality of life has been observed. Thus, the application of comprehensive geriatric assessment (CGA) in gerontological patients has revealed specific changes in the condition of patients with geriatric syndromes such as knee and hip disorders. Firstly, it has been identified that stability and gait are less affected in elderly patients with geriatric syndromes. Additionally, protein-energy malnutrition develops less frequently at this age, cognitive ability decline and dependency on external assistance are less prevalent, and there is a slight improvement in quality of life. Based on the aforementioned findings, a specialized approach to the treatment of gerontological patients is warranted, regardless of the subtle differences in geriatric status changes.

Conclusions:

1. Geriatric syndromes, particularly osteoarthritis and related conditions, manifest differently in elderly patients compared to those of advanced age. Specifically, there is a mild impairment in gait and stability, a lower incidence of protein-energy malnutrition, a lower likelihood of psychosocial and cognitive impairments, a modest level of dependence on assistance, and a minor overall decrease in quality of life by 12%.
2. The diagnosis of musculoskeletal disorders in gerontological patients requires the selection of an appropriate approach in comprehensive geriatric assessment (CGA) to timely identify comorbidities and geriatric status changes, which would facilitate the timely implementation of therapeutic and preventive measures.

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