Indicators of geriatric status in the postoperative period in patients included in rehabilitation programs

With progressive population aging, maintaining the functional independence of older adults, especially in surgical patient groups, is becoming increasingly important [1].

Mobility is a critical component for performing basic daily activities in older adults. Studies have shown the significance of assessing mobility indicators for predicting disability in older age [2, 3], even in older patients with preserved functional capacities [4].

Restoring mobility during and after hospitalization is very important for maintaining physical activity, social participation, and autonomy [5, 6].

AIM: To evaluate the geriatric status of patients included in rehabilitation programs after planned orthopedic operations (knee and hip joint replacement).

MATERIALS AND METHODS: The study included 100 patients, evenly distributed between groups with knee and hip joint replacement surgeries. At the pre-hospital stage, patients were screened for frailty syndrome according to the clinical guidelines for «Frailty Syndrome» [7]. Based on the results, the patients were divided into two groups: with and without frailty syndrome. Upon admission for surgical treatment, a Comprehensive Geriatric Assessment (CGA) was conducted, including basic activity indicators (Barthel Activities of Daily Living Index [8]), instrumental activity indicators (The Instrumental Activities of Daily Living Scale [9]), nutrition assessment (Mini Nutritional Assessment (MNA)), cognitive functions (MiniMental State Examination [10]), depression (Geriatric Depression Scale, GDS-15 [11]), and quality of life (EQ-VAS [12]). During the outpatient period, the CGA was repeated 12 months after surgical treatment. Rehabilitation programs included general recommendations for physical activity of at least 150 minutes per week, with an emphasis on aerobic exercise for patients with frailty syndrome.

RESULTS: The mean age of patients with gonarthrosis was 69.2±6.0 years; the mean age of patients with coxarthrosis was 67.6±5.5 years. In the group of patients 12 months after knee joint replacement and complex rehabilitation programs, there was a slight but statistically significant improvement in functional status, cognitive status, nutritional indicators, quality of life. Among patients with gonarthrosis and frailty syndrome, functional activity indicators remained stable for 12 months after surgery; with significant improvement in MMSE scores (baseline: 26.5±3.0; at 12 months: 28.8±2.2, p < 0.05) and quality of life (baseline: 58.6±12.4; at 12 months: 67.4±10.3, p < 0.05). In the group of patients 12 months after hip joint replacement and complex rehabilitation programs, statistically significant improvements were observed in functional status, cognitive status, nutritional indicators, quality of life, and Geriatric Depression Scale scores. Among patients with coxarthrosis and frailty syndrome, there were significant improvements in functional status (Barthel Index, baseline: 91.1±14.7; at 12 months: 97.9±8.0, p < 0.05), mobility (Timed Up and Go Test, baseline: 16.92±7.14; at 12 months: 8.45±5.51 seconds, p < 0.05), MMSE (baseline: 27.9±2.0; at 12 months: 29.6±0.6, p < 0.05), quality of life (baseline: 60.4±13.7; at 12 months: 83.6±8.6, p < 0.05), and depression scores (GDS-15, baseline: 4.4±3.0; at 12 months: 2.0±1.5, p < 0.05) after one year of surgical treatment and rehabilitation.

CONCLUSION: Recommendations for physical activity and mobility contribute to maintaining functional activity during the first year after knee and hip replacement surgery in initially frail elderly patients.

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