Senile asthenia syndrome is an age–related pathology characterized by a decrease in physical and functional activity, a deficiency of adaptive and restorative capabilities of the patient. Typical clinical manifestations include malnutrition and muscle mass, a tendency to falls, decreased motor activity, cognitive disorders of varying severity. In the diagnosis, a leading role is assigned to a special geriatric study, the senile asthenia index. The treatment is based on normalization of the diet, increased physical activity, improvement of systemic metabolism and symptomatic therapy.
ICD 10
R54 Old age
General information
Senile asthenia syndrome (SAS) or “senile fragility” is a widespread condition among elderly and senile people. The total incidence in the population ranges from 4 to 58 per 100,000 people. Among the population aged 65 years and older, pathology is observed in 10-13%. The condition preceding it (preasthenia) is found in more than 48% of representatives of this age category. Among people over the age of 85, senile asthenia is detected in 85% of the total number of people. In elderly people staying in nursing homes, the incidence rate is higher – from 50 to 55%. SAS is somewhat more often diagnosed among women, the ratio between men and women is 1:1.5-1.7 cases.
Causes
Senile asthenia syndrome is the result of a number of age–related changes occurring in the body. It is not an obligatory component of the aging process, but rather an unfavorable variant of its development. The isolated influence of one or two risk factors rarely leads to the formation of SAS. As a rule, the occurrence of pathology is due to a combination of the following circumstances:
- Chronic diseases. The most significant are oncological pathologies, endocrinopathies (diabetes mellitus), arterial hypertension, residual effects after a stroke (dysphagia, hemiparesis or hemiplegia), dementia and depressive disorders. This can also include polypragmasia, which is characteristic of elderly people.
- Lifestyle. The probability of developing and the degree of severity of “senile fragility” directly depends on the level of physical activity of a person, the quality of rest, compliance with the rules of personal hygiene, the nature of nutrition and the presence of bad habits.
- Socio-economic factors. According to statistics, SAS is more often detected in people living in unfavorable housing conditions (often in rural areas), having a low level of education, poor financial situation. The incidence is higher among divorced, single people, widows and widowers.
Pathogenesis
The pathogenesis of senile asthenia syndrome is based on three leading factors that create “vicious circles”: malnutrition (malnourishment), muscle mass deficiency (sarcopenia), a decrease in physical activity along with a metabolic index. Malnutrition is caused by several changes at once: an age-related decrease in the oral cavity, a lack of taste sensitivity to food and the development of the “rapid saturation” syndrome, which significantly reduces appetite and the volume of absorbed food. All this leads to skeletal muscle atrophy, body weight deficiency and restriction of physical activity.
Age-related sarcopenia develops as a result of an increase in subclinical inflammation and oxidative stress in combination with malnutrition. This becomes a trigger factor for osteopenia, reducing the susceptibility of tissues to insulin and inhibiting natural metabolic processes. The latter, in combination with the restriction of physical activity, is the result of the previous two syndromes. Against the background of somatic diseases typical for the elderly, all these three factors lead to dysfunction of internal organs and systems, including cognitive disorders.
With senile asthenia syndrome, it is customary to note target organs that suffer more than others as a result of the above-mentioned changes. The first of them is the musculoskeletal system, hypotension and hypotrophy of skeletal muscles are observed, violations of its thermoregulation, a decrease in the level of metabolism. On the part of the immune system, deficiencies in the synthesis of immunoglobulins of classes A, G and interleukin-2 are detected, combined with an increase in the level of proinflammatory cytokines. Changes in neuroendocrine structures consist in a decrease in the secretion of somatotropic and sex hormones, insulin-like factor-1 and vitamin D. Because of this, the tone of the sympathetic part of the autonomic nervous system increases, insulin resistance and steroid dysregulation worsen.
Classification
In medical practice, the condition of elderly people who are at risk of senile asthenia syndrome is classified into several forms. The existing options depend on the presence of somatic pathologies, physical activity and functional capabilities. For systematization, the classification of the Canadian Working Group on Health and Aging Research CSHA 2009 is used, which includes the following state options:
- Preserved health. Elderly people who lead an active lifestyle, have high motivation and are not limited in physical activity.
- Good health. People with organic diseases in the stage of persistent remission, slightly reducing the functional capabilities of a person.
- Successfully treated chronic diseases. There are symptoms of chronic pathologies that are satisfactorily controlled by the prescribed therapy, but significantly worsen the functional state.
- Senile transformation. It is accompanied by an intermittent course of the “senile fragility” syndrome, in which frequent exacerbations are observed, somatic diseases in the decompensation stage with a pronounced decrease in functional capabilities are detected.
- A light form of SAS. It is characterized by a moderate decrease in the possibilities of physical activity while maintaining full self-service. Meets 0.1-0.2 ISA points.
- Moderate SAS. A person needs regular, long-term outside care. According to the ISA scale, it corresponds to 0.2-0.4 points.
- Heavy SAS. It is characterized by a pronounced restriction of motor activity, the need for constant careful care. The ISA is 0.4 points or more.
Symptoms
Clinical manifestations of SAS can be combinations of a large number of different variants of geriatric syndromes. The primary symptoms form gradually. The most common signs of a pathological condition are general weakness, malaise, unreasonable fluctuations in body temperature, decreased or complete loss of appetite, unintentional loss of body weight at a rate of at least 4.5 kg in 12 months. Muscle weakness is accompanied by a noticeable decrease in physical capabilities, general slowness, walking disorders and falling syndrome.
Elderly people may notice insomnia, loss of previous interests, memory impairment, constant depressive mood and abnormally cold attitude towards others. Less often there are more pronounced cognitive impairments up to dementia. In some patients, urinary incontinence and hearing loss are detected, visual acuity decreases. In severe cases, the patient completely loses the ability to self-care and needs constant outside help.
Diagnostics
In the examination of patients with a preliminary diagnosis of SAS, several approaches are used at once: the determination of the index of “senile fragility”, traditional clinical and laboratory studies and a comprehensive geriatric examination. All of them are complementary and are conducted simultaneously. Often, patients with senile asthenia syndrome seek medical help for other somatic diseases, which is why not only neurologists, but also family doctors, other therapeutic specialists, less often surgical specialists, can be engaged in primary diagnosis.
The traditional diagnostic program includes anamnesis collection, physical examination, general clinical laboratory tests (blood test, blood lipid spectrum, liver markers) and basic hardware diagnostic methods (chest x-ray, ECG, ultrasound of “problem” areas). After identifying the signs corresponding to the syndrome of “senile fragility” according to the results of the above-mentioned examination program, it is advisable to resort to a specific diagnosis. It is implemented by specialized geriatric examination (SGE), which uses standardized scales IADL, MMSE, MNA and Bartel index. When determining indicators, the following parameters are usually used:
- Collecting patient data. It implies clarifying the quality of life, housing conditions, family status and the need for hospitalization in specialized social hospitals.
- General condition and presence of diseases. It consists in the identification of geriatric syndromes characteristic of SAS, their differentiation with manifestations of acute or chronic somatic pathologies.
- Functional parameters. The study of gait for its stability and the presence of senile changes, assessment of the potential of functional capabilities based on additional questionnaires.
- Mental indicators. Identification of mental disorders related to the aging process by type of cognitive or depressive disorders, dementia. When living in social institutions – identification of the syndrome of maladaptation of the nursing home, the syndrome of violence against the elderly and chronic stress.
- Social status. Clarification of relationships with family, social status, study of housing conditions and their safety, solving the issue of the need for assistance from social services.
Confirmation of the preliminary diagnosis and determination of the severity of the SAS is carried out using the Senile Asthenia Index (ISA) or the “fragility” index. There are 6 parameters in its structure, which are evaluated in points. These include subjective self-assessment of the level of health, the presence of somatic pathologies from the provided list (strokes, coronary heart disease, arthrosis, diabetes mellitus, COPD, hypertension, and others), an objective assessment of the functional state according to a number of criteria, BMI, determination of muscle strength based on the results of dynamometry, the ability to walk fast.
Treatment
The purpose of the treatment carried out with SAS is to preserve or restore the ability to self–care and functional capabilities, to improve the quality of life. The main emphasis is on outpatient forms of patient management. There is no universal therapeutic program for this pathology. Specific tactics are developed taking into account the existing symptoms and syndromes. Based on the clinical situation, the following items are included in the treatment program:
- Correction of the diet. The norm of calories consumed per day for an elderly person is about 1,500-1,700 kcal. With SAS, it rises to 3,000 kcal / day with a multiplicity of meals from 4 times. An important parameter is the amount of protein consumed. It should be at least 1 g per 1 kg of body weight per day, but not more than 100 g / day.
- Pharmacotherapy. It is mainly represented by symptomatic agents and drugs that improve metabolism in organs and tissues. The latter include vitamin D and group B, omega-3 fatty acids, dietary supplements, and rarely enteral mixtures. In the presence of anxiety-depressive disorders, serotonin reuptake inhibitors are prescribed. At the same time, the use of a large number of pharmacotherapeutic agents (polypragmasia) and high doses of medications are avoided.
- Kinesiotherapy. It is selected individually, taking into account the general condition of the patient and concomitant pathologies. The preferred directions are aerobic activities, physical therapy with the gradual inclusion of strength exercises, training simulating movements from daily activity.
Prognosis and prevention
The presence of senile asthenia syndrome is an unfavorable prognostic criterion. According to statistics, at the stage of preasthenia, the risk of death over the next 5 years is 20%, while with severe SAS it can reach 45%. Often, without timely correction of the transformation, after 3-5 years, it is transformed into an expanded SAS. Prevention consists in timely treatment of somatic disorders, control over medication intake and minimizing the impact of other potential etiological factors.
To prevent the syndrome of “fragility”, it is customary to use a special algorithm that includes control over meals, compliance with adequate physical activity, prevention of atherosclerosis, avoidance of social isolation, elimination of pain syndromes, regular performance of special sets of physical exercises and annual medical examinations to determine the functional state.