Электронный научный журнал

Research actuality.  Cerebrovascular disorders present a serious medico-social problem all over the world. Discirculatory encephalopathy remains among the most common diseases diagnosed in elderly patients. At  present time health-related quality of life is a frequently used criteria to examine patient’s condition and treatment efficiency. However, no research with comparative analysis of different kinds of in-hospital treatment as an elderly patients’ with discirculatory encephalopathy quality of life formation factor in up-to-day literature.

The aim of our research: the comparative analysis of different kinds of in-hospital treatment as an elderly patients’ with discirculatory encephalopathy quality of life formation factor.

Material and methods. The research was based on Belgorod municipal hospital №1and Belgorod veterans’ hospital. A group of 30 patients from 60 to 74 years was selected in each hospital (median age in municipal hospital was 68,8 ± 3,2 years, in veterans’ hospital 75,5 ± 2,5 years). For quality of life examination we used sf-36 questionnaire which has eight scaled scores; the scores  are weighted sums of the questions in each section.  Scores range from 0  to 100 Lower scores mean more disability, higher scores mean less disability. The sections are: Vitality, Physical functioning, Bodily pain, General health perceptions, Physical role functioning, Emotional role functioning, Social role functioning, Mental health. The  statistical validity was approved by Student criterium.

In addition we studied clinic-epidemic peculiarities of elderly persons in care homes in comparison with non-organised persons. Patients were divided in two groups. The first included 307 non-organised individuals with median age of 72,5+1,3  years who spent all their time at home. This part of study was based on  Belgorod municipal polyclinic №1. The other  group included 305 elderly people with median age of 72,1+1,2 years living in Shebekino and New Oskol care houses.

Table 1.

Medico-social characteristic of elderly persons with chroic cerebrovascular insufficiency in care houses and at home

Results and discussion.

The quality of life analysis found valid difference in all criteria between groups of municipal and veterans’ hospitals.

Physical functioning.

There were no significant differences in this scale between patients of municipal (44,2 pts) and veterans’(44,5 pts) hospitals on admission. By the end of treatment both groups demonstrated positive dynamics, but the growth in veterans’ hospital group was more significant than in municipal hospital (20,3 ± 18,6 and  14,4 ± 9,9 pts respectively). The post-hospital period presented serious differences in two groups. The municipal hospital group presented decrease of scale by 16,8 ± 7,7 pts, while the veterans’ hospital group still had growth by 3,1 ± 13,9 pts.

Social role functioning

On admission the veterans’ hospital group was scaled significantly lower (18.6 pts) than the municipal hospital group (39.5 pts). By the end of treatment both groups demonstrated positive dynamics, but the growth in veterans’ hospital group was more significant than in municipal hospital (54,0 ± 20,2 and  2,9 ± 11,8  pts respectively). The post-hospital period presented scale decrease in both groups, but in the veterans’ hospital group it  was more significant than in the municipal hospital group (9,7 ± 19,3 and   2,9 ± 20,6 pts respectively).

Bodily pain.

This scale demonstrated severe decrease on admission, more prominent in the veterans’ hospital group (34,1 pts) than  in the municipal hospital group (40.7 pts).

By the end of treatment both groups demonstrated positive changes. The growth in veterans’ hospital group was more significant than in municipal hospital (34,9 ± 22,2  and  8,0 ± 14,2 pts respectively). The post-hospital period presented scale decrease in both groups, but in the municipal hospital group it  was more significant than in the veterans’ hospital group (5,2 ± 12,5 and   2,4 ± 19,6 pts respectively).

General health perceptions

This scale demonstrated almost equal decrease for both groups on admission(41.9 pts for the veterans’ hospital group and 42.3 pts for the municipal hospital group)

By the end of treatment both groups demonstrated positive changes. The growth in veterans’ hospital group was more significant than in municipal hospital (13,5 ± 16,6   and  11,5 ± 9,1 pts respectively). The post-hospital period presented serious differences in two groups. The municipal hospital group presented decrease of scale by 11,5 ± 9,4 pts, while the veterans’ hospital group still had growth by 1,5 ± 15,9  pts.

Vitality

The vitality scale scoring educed  the decrease up to 38.9 pts for the municipal hospital group and 46.3 pts for the veterans’ hospital group. Treatment leaded to growth both in the municipal hospital group (14,7 ± 9,8 pts) and the veterans’ hospital group (19,2 ± 13,4 pts). The post-hospital period presented scale decrease in both groups, but in the municipal hospital group it  was much more significant than in the veterans’ hospital group (24,7 ± 9,7 and   2,1 ± 13,8 pts respectively).

Social role functioning

This  scale scoring was  reduced  to 52.6 pts for the municipal hospital group and 50.6 pts for the veterans’ hospital group. Treatment leaded to growth both in the municipal hospital group (24,8 ± 15,6 pts) and the veterans’ hospital group (24,0 ± 20,4 pts). But in the post-hospital period the veterans’ hospital group demonstrated the dramatic fall of the scale by 30,7 ± 14,2, while in the municipal hospital group it  remained almost the same – the reduction was only by 0,2 ± 19,0  Emotional role functioning

On admission the veterans’ hospital group was scaled 45.2 pts , the municipal hospital group 36.3  pts. By the end of treatment both groups demonstrated positive dynamics, the growth in veterans’ hospital group was almost  the same  as in the municipal hospital (33,3 ± 29,2 and  35,5 ± 19,5  pts respectively). The post-hospital period presented scale decrease in both groups, but in the veterans’ hospital group it  was more significant than in the municipal hospital group (34,4 ± 10,1 and   4,3 ± 19,2)

Mental health

On admission the veterans’ hospital group was scaled 53.6 pts, the municipal hospital group 36.4  pts. By the end of treatment both groups demonstrated positive dynamics, the growth in veterans’ hospital group was 21,1 ± 17,8, in the municipal hospital 17,8 ± 14,1. The post-hospital period presented scale decrease in both groups, but in the veterans’ hospital group it  was more significant than in the municipal hospital group (13,7 ± 9,2  and   6,4 ± 12,0)

The clinic-epidemiology of desadaptation syndroms in elderly persons with cerebrovascular insufficiency in care houses.

The acquired results present that elderly persons with chronic cerebrovascular insufficiency in care houses more frequently than thosr who live at home present borderline mental disorders – anxiodepressive and emotionally labile syndromes; gastrointestinal malfunction -  irritable colon; sense organ disorders - sensorineural hearing loss, cataract; other diseases - benign prostatic hyperplasia, teeth problems.

Table 2

The quantity of elderly persons with cerebrovascular insufficiency who significantly more often present other diseases.

The analysis of main geriatic disadaptating syndroms revealed that dizziness, falls, hearing and vision  loss were much more common in care houses residents than among those who lived at home p<0,05.

Table 3

Main geriatic disadaptating syndroms among care houses residents and non-organised elderly persons with chronic cerebrovascular insufficiency.

Conclusions:

1. Patients who were observed before hospitalization in a specialized geriatric policlinics had higher scores in emotional role functioning, mental health, vitality  scales and lower – in physical role functioning than those who visited municipal policlinics
2. Hospital treatment increased the quality of life by all scales. The most noticeable changes occurred in emotional role functioning, mental health, physical role functioning, social role functioning and general health perceptions. On retirement from geriatric hospital the most significant changes were found in physical role functioning scale, probably due to the absence of physical work during the hospital treatment.
3. Treatment in a specialized geriatric hospital provides not only formation, but also the long-time stabilization of higher quality of life level in elderly patients with discirculatory encephalopathy
4. Elderly patients in care houses experience such geriatic disadaptating syndromsas falls, dizziness, hear and vision loss more often than non-organized.

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