Влияние старческой астении на исходы и тактику ведения пациентов пожилого и старческого возраста в условиях интенсивной терапии (обзор)

Цель обзора — оценить влияние старческой астении на исходы критических состояний у пациентов пожилого и старческого возраста, обобщить существующие подходы к их ведению в отделении реанимации и интенсивной терапии (ОРИТ). 
Материалы и методы. В обзор включили 65 публикаций из баз PubMed, Google Scholar, Cochrane Library, eLIBRARY.RU. Поиск осуществляли по ключевым словам «старческая астения», «пожилой пациент в интенсивной терапии», «лечение пациентов пожилого и старческого возраста», «критические состояния пожилого возраста», «иммуностарение», «когнитивный дефицит», «саркопения». 
Результаты. Рассмотрели процессы, входящие в понятие «старческая астения» (СА); инструменты оценки тяжести СА; выделили факторы физиологического старения, влияющие на течение основного заболевания пациентов пожилого и старческого возраста в ОРИТ; показали особенности подхода к их лечению. 
Заключение. Значительное влияние на тактику ведения исследуемой когорты пациентов ОРИТ оказывают такие факторы физиологического старения, как изменения гормональной регуляции, иммунностарение, саркопения, изменение когнитивной функции. Следует также учитывать сопутствующие заболевания, особенности приема лекарственных препаратов и статус мобильности. Наличие СА приводит к увеличению летальных исходов среди пациентов ОРИТ пожилого и старческого возраста по сравнению с пациентами без астении. Рекомендуется проводить лечение силами мультидисциплинарной команды, уделять внимание роли семьи и лечебном процессе, а также поддерживать желание и приверженность пациента к проводимому лечению. 

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