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Факторы риска падений у пациентов с артериальной гипертензией
Факторы риска падений у пациентов с артериальной гипертензией
Ховасова Н.О., Наумов А.В., Ткачева О.Н., Мороз В.И. Факторы риска падений у пациентов с артериальной гипертензией. Системные гипертензии. 2019; 16 (4): 45–51. DOI: 10.26442/2075082X.2019.4.190649
Systemic Hypertension. 2019; 16 (4): 45–51.
DOI: 10.26442/2075082X.2019.4.190649
________________________________________________
Systemic Hypertension. 2019; 16 (4): 45–51.
DOI: 10.26442/2075082X.2019.4.190649
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Падения – важная многофакторная проблема пожилых людей, которая ассоциирована с серьезными осложнениями, потерей функциональной автономности, инвалидизацией и смертью. Одно из частых коморбидных состояний у лиц пожилого возраста – это артериальная гипертензия (АГ), которая, в свою очередь, увеличивает риск падений.
Цель. Изучить факторы риска падений у пациентов с АГ.
Материалы и методы. Обследованы 155 пациентов гериатрического отделения с наличием хотя бы 1 падения, случившегося в течение последнего года: 133 (85,8%) женщины (75,29±8,31 года) и 22 (14,2%) мужчины (79,14±4,64 года). У пациентов с АГ оценивались риск падений и факторы риска падений.
Результаты. У 148 (95,5%) пациентов имелась АГ. Наиболее распространенными факторами риска АГ у лиц пожилого возраста явились атеросклероз и снижение физической активности. У всех пациентов наблюдались поражения органов-мишеней различной тяжести. В 25,7% случаев отмечены цифры артериального давления (АД) вне целевых значений. 18 (12,2%) пациентов получали гипотензивную терапию нерегулярно. В среднем при поступлении в стационар пациенты получали 2,06±0,63 гипотензивного препарата. Частота падений у пациентов с АГ составила 2,59±2,2, 2 и более падений случилось у 91 (61,5%) человека. По шкале самооценки риска падений 131 (88,5%) пациент имел высокий риск падений. Высокий риск падения в стационаре (по шкале Морсе) был выявлен у 63 (42,6%) пациентов. Наиболее распространенными факторами риска падений у пациентов с АГ были ранее случившиеся падения в анамнезе, сенсорный дефицит, нарушения равновесия, остеоартрит. Результаты комплексной гериатрической оценки демонстрируют, что у пациентов с АГ при АД ниже целевых показателей в сравнении с целевыми и даже высокими цифрами АД отмечается более высокая распространенность старческой астении, хуже показатели функционального статуса, выше частота падений и высокого риска падений по шкале Морсе.
Заключение. Наиболее распространенные факторы риска падений у пациентов с АГ – случившиеся ранее падения в анамнезе, сенсорный дефицит, нарушения равновесия, остеоартрит. Для пациентов с АГ низкое АД является предиктором высокого риска падений и худшего прогноза. При уровне АД ниже целевого отмечается более высокая распространенность старческой астении и хуже показатели функционального статуса, что является плохим прогностическим признаком для людей пожилого возраста.
Ключевые слова: падения, переломы, пожилые люди, инвалидизация, смертность, артериальная гипертензия, ортостатическая гипотония.
Aim. To study the risk factors for falls among patients with AH.
Materials and methods. Examined 155 patients of geriatric department with the presence of at least one fall in the last year: 133 (85.8%) women (75.29±8.31 years) and 22 (14.2%) men (79.14±4.64 years). Risk of falls and risk factors of falls were assessed in patients with AH.
Results. 148 (95.5%) patients had AH. The most common risk factors for hypertension in the elderly were atherosclerosis and decreased physical activity. Target organ lesions of varying severity were observed in all patients. In 25.7% of cases, BP figures outside the target values were noted. 18 (12.2%) patients received hypotensive therapy irregularly. On average, at admission, patients received of 2.06±0.63 anti-hypertensive drug. The frequency of falls in patients with hypertension made up 2.59±2.2, two or more falls happened in 91 persons (61.5%). According to the self-assessment risk of falls scale 131 (88.5%) patients had a high risk of falls. A high risk of falling in hospital (on the Morse scale) was identified in 63 (42.6%) patients. The most common risk factors for falls in patients with AH were previous falls in anamnesis, sensory deficit, imbalance, osteoarthritis. The CGA results demonstrate that patients with hypertension with blood pressure below the target values in comparison with the target and even high numbers of blood pressure have a higher prevalence of frailty, worse indicators of functional status, higher incidence and high risk of falls on the Morse scale.
Conclusion. The most common risk factors for falls among patients with AH are previous falls in anamnesis, sensory deficit, imbalance, osteoarthritis. For patients with hypertension, low blood pressure is a predictor of high risk of falls and a worse prognosis. When blood pressure is below the target, there is a higher prevalence of frailty and worse indicators of functional status, which is a poor prognostic sign for the elderly.
Цель. Изучить факторы риска падений у пациентов с АГ.
Материалы и методы. Обследованы 155 пациентов гериатрического отделения с наличием хотя бы 1 падения, случившегося в течение последнего года: 133 (85,8%) женщины (75,29±8,31 года) и 22 (14,2%) мужчины (79,14±4,64 года). У пациентов с АГ оценивались риск падений и факторы риска падений.
Результаты. У 148 (95,5%) пациентов имелась АГ. Наиболее распространенными факторами риска АГ у лиц пожилого возраста явились атеросклероз и снижение физической активности. У всех пациентов наблюдались поражения органов-мишеней различной тяжести. В 25,7% случаев отмечены цифры артериального давления (АД) вне целевых значений. 18 (12,2%) пациентов получали гипотензивную терапию нерегулярно. В среднем при поступлении в стационар пациенты получали 2,06±0,63 гипотензивного препарата. Частота падений у пациентов с АГ составила 2,59±2,2, 2 и более падений случилось у 91 (61,5%) человека. По шкале самооценки риска падений 131 (88,5%) пациент имел высокий риск падений. Высокий риск падения в стационаре (по шкале Морсе) был выявлен у 63 (42,6%) пациентов. Наиболее распространенными факторами риска падений у пациентов с АГ были ранее случившиеся падения в анамнезе, сенсорный дефицит, нарушения равновесия, остеоартрит. Результаты комплексной гериатрической оценки демонстрируют, что у пациентов с АГ при АД ниже целевых показателей в сравнении с целевыми и даже высокими цифрами АД отмечается более высокая распространенность старческой астении, хуже показатели функционального статуса, выше частота падений и высокого риска падений по шкале Морсе.
Заключение. Наиболее распространенные факторы риска падений у пациентов с АГ – случившиеся ранее падения в анамнезе, сенсорный дефицит, нарушения равновесия, остеоартрит. Для пациентов с АГ низкое АД является предиктором высокого риска падений и худшего прогноза. При уровне АД ниже целевого отмечается более высокая распространенность старческой астении и хуже показатели функционального статуса, что является плохим прогностическим признаком для людей пожилого возраста.
Ключевые слова: падения, переломы, пожилые люди, инвалидизация, смертность, артериальная гипертензия, ортостатическая гипотония.
________________________________________________
Aim. To study the risk factors for falls among patients with AH.
Materials and methods. Examined 155 patients of geriatric department with the presence of at least one fall in the last year: 133 (85.8%) women (75.29±8.31 years) and 22 (14.2%) men (79.14±4.64 years). Risk of falls and risk factors of falls were assessed in patients with AH.
Results. 148 (95.5%) patients had AH. The most common risk factors for hypertension in the elderly were atherosclerosis and decreased physical activity. Target organ lesions of varying severity were observed in all patients. In 25.7% of cases, BP figures outside the target values were noted. 18 (12.2%) patients received hypotensive therapy irregularly. On average, at admission, patients received of 2.06±0.63 anti-hypertensive drug. The frequency of falls in patients with hypertension made up 2.59±2.2, two or more falls happened in 91 persons (61.5%). According to the self-assessment risk of falls scale 131 (88.5%) patients had a high risk of falls. A high risk of falling in hospital (on the Morse scale) was identified in 63 (42.6%) patients. The most common risk factors for falls in patients with AH were previous falls in anamnesis, sensory deficit, imbalance, osteoarthritis. The CGA results demonstrate that patients with hypertension with blood pressure below the target values in comparison with the target and even high numbers of blood pressure have a higher prevalence of frailty, worse indicators of functional status, higher incidence and high risk of falls on the Morse scale.
Conclusion. The most common risk factors for falls among patients with AH are previous falls in anamnesis, sensory deficit, imbalance, osteoarthritis. For patients with hypertension, low blood pressure is a predictor of high risk of falls and a worse prognosis. When blood pressure is below the target, there is a higher prevalence of frailty and worse indicators of functional status, which is a poor prognostic sign for the elderly.
Полный текст
Список литературы
1. Soriano TA, DeCherrie LV, Thomas DC. Falls in the community-dwelling older adult: a review for primary-care providers. Clin Interv Aging 2007; 2 (4): 545–54.
2. Ferrer A, Formiga F, Sanz H et al; OCTABAIX Study Group. Multifactorial assessment and targeted intervention to reduce falls among the oldest-old: a randomized controlled trial. Clin Interv Aging 2014; 9: 383–93.
3. Imhof L, Naef R, Wallhagen MI et al. Effects of an advanced practice nurse in-home health consultation program for community-dwelling persons aged 80 and older. J Am Geriatr Soc 2012; 60 (12): 2223–31.
4. Fuller GF. Falls in the elderly. Am Fam Physician 2000; 61 (7): 2159–68, 2173–4.
5. Ministry of Health, Labour and Welfare. The Outline of the Results of the National Livelihood Survey. Available online: https://www8.cao.go.jp/kourei/whitepaper/w-2018/html/zenbun/s1_2_2.html (accessed on 4 April 2019).
6. Mizukami S, Arima K, Abe Y et al. Falls are associated with stroke, arthritis and multiple medications among community-dwelling elderly persons in Japan. Tohoku J Exp Med 2013; 231 (4): 299–303.
7. Web-based Injury Statistics Queryand Reporting System (WISQARS) website. https://www.cdc.gov/
injury/wisqars/. 2016. Accessed November 8, 2017.
8. Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged 65 years United States, 2014. MMWR Morb Mortal Wkly Rep 2016; 65 (37): 993–8.
9. Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. J Am Geriatr Soc 2011; 59 (1): 148–57.
10. Costa-Dias MJM, Ferreira PL. Fall risk assessment tools. Rev Enferm Ref 2014; IV (2): 153–61.
11. Oliveira RM et al. Strategies for promoting patient safety: from the identification of the risks to the evidence-based practices. Esc Anna Nery 2014; 18 (1): 122–9.
12. Pasquetti P, Apicella L, Mangone G. Pathogenesis and treatment of falls in elderly. Clin Cases Miner Bone Metab 2014; 11: 222–5.
13. Mizukami S, Arima K, Abe Y et al. Falls are associated with stroke, arthritis and multiple medications among community-dwelling elderly persons in Japan. Tohoku J Exp Med 2013; 231 (4): 299–303.
14. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47: 30–9.
15. Fortin M, Bravo G, Hudon C et al. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005; 3: 223–8.
16. Kenny RA, Richardson DA, Steen N et al. Carotid sinus syndrome: A modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol 2001; 38: 1491–6.
17. Falcão RMM, Costa KNFM, Fernandes MDGM et al. Risk of falls in hospitalized elderly people. Rev Gaucha Enferm 2019; 40 (spe): e20180266. DOI: 10.1590/1983-1447.2019.20180266
18. Kaufmann H. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clin Auton Res 1996; 6: 125–6. DOI: 10.1007/BF02291236.
19. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021–104. DOI: 10.1093/eurheartj/ehy339
20. Tinetti ME, Han L, Lee DS et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014; 174 (4): 588. DOI: 10.1001/jamainternmed.2013.14764
21. Corrao G, Mazzola P, Monzio Compagnoni M et al. Antihypertensive medications, loop diuretics, and risk of hip fracture in the elderly: a population-based cohort study of 81,617 Italian patients newly treated between 2005 and 2009. Drugs Aging 2015; 32: 927–36.
22. Kjeldsen SE, Stenehjem A, Os I et al. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets. Blood Press 2016; 25: 333–6.
23. Perez-Castrillon JL, Martin-Escudero JC, Alvarez Manzanares P et al. Hypertension as a risk factor for hip fracture. Am J Hypertens 2005; 18: 146–7.
24. Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019; 16 (1): 6–31. DOI: 10.26442/2075082X.2019.1.190179
[Chazova I.E., Zhernakova Ju.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019; 16 (1): 6–31. DOI: 10.26442/2075082X.2019.1.190179 (in Russian).]
25. White DK, Neogi T, Nevitt MC et al. Trajectories of gait speed predict mortality in well-functioning older adults: the Health, Aging and Body Composition study. J Gerontol A Biol Sci Med Sci 2012; 68 (4): 456–64. DOI: 10.1093/gerona/gls197
2. Ferrer A, Formiga F, Sanz H et al; OCTABAIX Study Group. Multifactorial assessment and targeted intervention to reduce falls among the oldest-old: a randomized controlled trial. Clin Interv Aging 2014; 9: 383–93.
3. Imhof L, Naef R, Wallhagen MI et al. Effects of an advanced practice nurse in-home health consultation program for community-dwelling persons aged 80 and older. J Am Geriatr Soc 2012; 60 (12): 2223–31.
4. Fuller GF. Falls in the elderly. Am Fam Physician 2000; 61 (7): 2159–68, 2173–4.
5. Ministry of Health, Labour and Welfare. The Outline of the Results of the National Livelihood Survey. Available online: https://www8.cao.go.jp/kourei/whitepaper/w-2018/html/zenbun/s1_2_2.html (accessed on 4 April 2019).
6. Mizukami S, Arima K, Abe Y et al. Falls are associated with stroke, arthritis and multiple medications among community-dwelling elderly persons in Japan. Tohoku J Exp Med 2013; 231 (4): 299–303.
7. Web-based Injury Statistics Queryand Reporting System (WISQARS) website. https://www.cdc.gov/
injury/wisqars/. 2016. Accessed November 8, 2017.
8. Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged 65 years United States, 2014. MMWR Morb Mortal Wkly Rep 2016; 65 (37): 993–8.
9. Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. J Am Geriatr Soc 2011; 59 (1): 148–57.
10. Costa-Dias MJM, Ferreira PL. Fall risk assessment tools. Rev Enferm Ref 2014; IV (2): 153–61.
11. Oliveira RM et al. Strategies for promoting patient safety: from the identification of the risks to the evidence-based practices. Esc Anna Nery 2014; 18 (1): 122–9.
12. Pasquetti P, Apicella L, Mangone G. Pathogenesis and treatment of falls in elderly. Clin Cases Miner Bone Metab 2014; 11: 222–5.
13. Mizukami S, Arima K, Abe Y et al. Falls are associated with stroke, arthritis and multiple medications among community-dwelling elderly persons in Japan. Tohoku J Exp Med 2013; 231 (4): 299–303.
14. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47: 30–9.
15. Fortin M, Bravo G, Hudon C et al. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005; 3: 223–8.
16. Kenny RA, Richardson DA, Steen N et al. Carotid sinus syndrome: A modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol 2001; 38: 1491–6.
17. Falcão RMM, Costa KNFM, Fernandes MDGM et al. Risk of falls in hospitalized elderly people. Rev Gaucha Enferm 2019; 40 (spe): e20180266. DOI: 10.1590/1983-1447.2019.20180266
18. Kaufmann H. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clin Auton Res 1996; 6: 125–6. DOI: 10.1007/BF02291236.
19. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021–104. DOI: 10.1093/eurheartj/ehy339
20. Tinetti ME, Han L, Lee DS et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014; 174 (4): 588. DOI: 10.1001/jamainternmed.2013.14764
21. Corrao G, Mazzola P, Monzio Compagnoni M et al. Antihypertensive medications, loop diuretics, and risk of hip fracture in the elderly: a population-based cohort study of 81,617 Italian patients newly treated between 2005 and 2009. Drugs Aging 2015; 32: 927–36.
22. Kjeldsen SE, Stenehjem A, Os I et al. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets. Blood Press 2016; 25: 333–6.
23. Perez-Castrillon JL, Martin-Escudero JC, Alvarez Manzanares P et al. Hypertension as a risk factor for hip fracture. Am J Hypertens 2005; 18: 146–7.
24. Chazova I.E., Zhernakova Ju.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019; 16 (1): 6–31. DOI: 10.26442/2075082X.2019.1.190179 (in Russian).
25. White DK, Neogi T, Nevitt MC et al. Trajectories of gait speed predict mortality in well-functioning older adults: the Health, Aging and Body Composition study. J Gerontol A Biol Sci Med Sci 2012; 68 (4): 456–64. DOI: 10.1093/gerona/gls197
2. Ferrer A, Formiga F, Sanz H et al; OCTABAIX Study Group. Multifactorial assessment and targeted intervention to reduce falls among the oldest-old: a randomized controlled trial. Clin Interv Aging 2014; 9: 383–93.
3. Imhof L, Naef R, Wallhagen MI et al. Effects of an advanced practice nurse in-home health consultation program for community-dwelling persons aged 80 and older. J Am Geriatr Soc 2012; 60 (12): 2223–31.
4. Fuller GF. Falls in the elderly. Am Fam Physician 2000; 61 (7): 2159–68, 2173–4.
5. Ministry of Health, Labour and Welfare. The Outline of the Results of the National Livelihood Survey. Available online: https://www8.cao.go.jp/kourei/whitepaper/w-2018/html/zenbun/s1_2_2.html (accessed on 4 April 2019).
6. Mizukami S, Arima K, Abe Y et al. Falls are associated with stroke, arthritis and multiple medications among community-dwelling elderly persons in Japan. Tohoku J Exp Med 2013; 231 (4): 299–303.
7. Web-based Injury Statistics Queryand Reporting System (WISQARS) website. https://www.cdc.gov/
injury/wisqars/. 2016. Accessed November 8, 2017.
8. Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged 65 years United States, 2014. MMWR Morb Mortal Wkly Rep 2016; 65 (37): 993–8.
9. Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. J Am Geriatr Soc 2011; 59 (1): 148–57.
10. Costa-Dias MJM, Ferreira PL. Fall risk assessment tools. Rev Enferm Ref 2014; IV (2): 153–61.
11. Oliveira RM et al. Strategies for promoting patient safety: from the identification of the risks to the evidence-based practices. Esc Anna Nery 2014; 18 (1): 122–9.
12. Pasquetti P, Apicella L, Mangone G. Pathogenesis and treatment of falls in elderly. Clin Cases Miner Bone Metab 2014; 11: 222–5.
13. Mizukami S, Arima K, Abe Y et al. Falls are associated with stroke, arthritis and multiple medications among community-dwelling elderly persons in Japan. Tohoku J Exp Med 2013; 231 (4): 299–303.
14. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47: 30–9.
15. Fortin M, Bravo G, Hudon C et al. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005; 3: 223–8.
16. Kenny RA, Richardson DA, Steen N et al. Carotid sinus syndrome: A modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol 2001; 38: 1491–6.
17. Falcão RMM, Costa KNFM, Fernandes MDGM et al. Risk of falls in hospitalized elderly people. Rev Gaucha Enferm 2019; 40 (spe): e20180266. DOI: 10.1590/1983-1447.2019.20180266
18. Kaufmann H. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clin Auton Res 1996; 6: 125–6. DOI: 10.1007/BF02291236.
19. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021–104. DOI: 10.1093/eurheartj/ehy339
20. Tinetti ME, Han L, Lee DS et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014; 174 (4): 588. DOI: 10.1001/jamainternmed.2013.14764
21. Corrao G, Mazzola P, Monzio Compagnoni M et al. Antihypertensive medications, loop diuretics, and risk of hip fracture in the elderly: a population-based cohort study of 81,617 Italian patients newly treated between 2005 and 2009. Drugs Aging 2015; 32: 927–36.
22. Kjeldsen SE, Stenehjem A, Os I et al. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets. Blood Press 2016; 25: 333–6.
23. Perez-Castrillon JL, Martin-Escudero JC, Alvarez Manzanares P et al. Hypertension as a risk factor for hip fracture. Am J Hypertens 2005; 18: 146–7.
24. Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019; 16 (1): 6–31. DOI: 10.26442/2075082X.2019.1.190179
[Chazova I.E., Zhernakova Ju.V. on behalf of the experts. Clinical guidelines. Diagnosis and treatment of arterial hypertension. Systemic Hypertension. 2019; 16 (1): 6–31. DOI: 10.26442/2075082X.2019.1.190179 (in Russian).]
25. White DK, Neogi T, Nevitt MC et al. Trajectories of gait speed predict mortality in well-functioning older adults: the Health, Aging and Body Composition study. J Gerontol A Biol Sci Med Sci 2012; 68 (4): 456–64. DOI: 10.1093/gerona/gls197
________________________________________________
2. Ferrer A, Formiga F, Sanz H et al; OCTABAIX Study Group. Multifactorial assessment and targeted intervention to reduce falls among the oldest-old: a randomized controlled trial. Clin Interv Aging 2014; 9: 383–93.
3. Imhof L, Naef R, Wallhagen MI et al. Effects of an advanced practice nurse in-home health consultation program for community-dwelling persons aged 80 and older. J Am Geriatr Soc 2012; 60 (12): 2223–31.
4. Fuller GF. Falls in the elderly. Am Fam Physician 2000; 61 (7): 2159–68, 2173–4.
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Авторы
Н.О. Ховасова*1,2, А.В. Наумов1,2, О.Н. Ткачева1,2, В.И. Мороз2
1ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2ОСП «Российский геронтологический научно-клинический центр» ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*natashahov@mail.ru
Olga N. Tkacheva1,2, Victoriya I. Moroz2
1Pirogov Russian National Research Medical University, Moscow, Russia;
2Russian Clinical and Research Center of Gerontology of Pirogov Russian National Research Medical University, Moscow, Russia
*natashahov@mail.ru
1ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2ОСП «Российский геронтологический научно-клинический центр» ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*natashahov@mail.ru
________________________________________________
Olga N. Tkacheva1,2, Victoriya I. Moroz2
1Pirogov Russian National Research Medical University, Moscow, Russia;
2Russian Clinical and Research Center of Gerontology of Pirogov Russian National Research Medical University, Moscow, Russia
*natashahov@mail.ru
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