COGNITIVE DYSFUNCTION AS A FACTOR RESTRICTING THE APPLICATION OF ACCELERATED REHABILITATION PROGRAMS FOR ELDERLY AND SENIOR PATIENTS IN OPERATIVE GYNECOLOGY

Glazkova O.; Shmeleva S.; Moskalenko R.; Ignatchenko O.; Romanova A.; Dubrovinskaya E.

doi:10.14529/jpps200203

O. L. Glazkova Russian Medical Academy of Continuing Professional Education, Moscow, Russian Federation glazkova-ol-le@yandex.ru
S. V. Shmeleva Moscow State University of Technology and Management named after K.G. Razumovsky, Moscow, Russian Federation http://orcid.org/0000-0003-0390-194X 89151479832@mail.ru
R. V. Moskalenko City Clinical Hospital named after S.P. Botkin, Moscow, Russian Federation botkinhospital@zdrav.mos.ru
O. Y. Ignatchenko City Clinical Hospital named after S.P. Botkin, Moscow, Russian Federation botkinhospital@zdrav.mos.ru
A. V. Romanova Russian State Social University, Moscow, Russian Federation http://orcid.org/0000-0002-7472-8235 Angelina.rom@mail.ru
E. I. Dubrovinskaya Russian State Social University, Moscow, Russian Federation http://orcid.org/0000-0001-6280-5590 deldongo@mail.ru

DOI: https://doi.org/10.14529/jpps200203

Keywords: women, gynecological pathology, cognitive dysfunction, FastTrack, anxiety, surgery, elderly and senile age

Abstract

Aim: to identify risk groups for the formation of cognitive dysfunction in elderly patients after gynecological operations. Research base: City Clinical Hospital named after S.P. Botkin, Moscow, Russian Medical Academy of Continuing Professional Education. The risk groups for the formation of cognitive dysfunction in elderly and senior patients after gynecological operations are determined. Hospitalization was carried out just before the operation, the postoperative hospital bed rest varied from 2 to 4 days. Where possible, the principles of FastTrack technology were applied in the perioperative period. Materials and methods. The study involved 60 elderly and senior female patients after menopause from the age of 50 to 85 years (75,2 ± 6,3 years), who underwent surgery under conditions of endotracheal anesthesia due to benign pathology (ovarian neoplasms, genital prolapse). The principles of FastTrack – an accelerated path in surgery were applied. Before the operation and on the 2nd day after the operation, testing was performed on the MMSE (Mini-mental State Examination) scale, as well as on the questionnaire to identify Spielberger-Hanin personal and reactive anxiety. Results. It has been proven that the frequency of postoperative cognitive dysfunction increases in proportion to the age of the patients and often depends on the type of anesthetic benefit and the severity of the operation. In the group of women aged from 50 to 60, no initial cognitive impairment was found, 18 % of patients after 60 years of age have cognitive impairment, and 5 % have mild dementia. The older the patient, the more cases of postoperative cognitive impairment develops/worsens, and high levels of anxiety remain. Early discharge in such cases can cause problems. Conclusion. In risk groups, especially in patients older than 70 years with signs of widespread atherosclerosis, cerebrovascular accidents, and a history of brain injuries, it is necessary to accurately identify signs of cognitive impairment and promptly involve a neurologist and clinical psychologist to correct them, which will significantly improve the postoperative period and reduce the anxiety level

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Author Biographies

O. L. Glazkova , Russian Medical Academy of Continuing Professional Education, Moscow, Russian Federation

Candidate of medical Sciences, associate Professor of the Department of obstetrics and gynecology

S. V. Shmeleva , Moscow State University of Technology and Management named after K.G. Razumovsky, Moscow, Russian Federation

Doctor of medical Sciences, Professor of the Department of psychology and pedagogy of professional education

R. V. Moskalenko , City Clinical Hospital named after S.P. Botkin, Moscow, Russian Federation

Obstetrician-gynecologist

O. Y. Ignatchenko , City Clinical Hospital named after S.P. Botkin, Moscow, Russian Federation

Obstetrician-gynecologist, head of the 22nd gynecological Department

A. V. Romanova , Russian State Social University, Moscow, Russian Federation

Candidate of psychological Sciences, associate Professor

E. I. Dubrovinskaya , Russian State Social University, Moscow, Russian Federation

Candidate of psychological Sciences, associate Professor

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