Indira Omarova

Introduction: Population ageing increases the demand for long-term care (LTC) and systematic functional assessments within primary health care (PHC). This study aimed to describe the prevalence of functional dependence among older adults receiving LTC at the PHC level in Aktobe, Kazakhstan, and to examine differences in geriatric screening indicators.Methods: This cross-sectional observational study included 216 adults aged 60 years and older receiving LTC or regular dispensary follow-up from March to May 2024. Functional independence was assessed using the Barthel Index. Additional screening tools included FRAIL for frailty, MNA for nutrition, SARC-F for sarcopenia risk, Mini-Cog for cognitive status, and FRAX for fracture risk. Statistical analysis was conducted using Jamovi 2.6.Results: Complete or severe functional dependence was identified in 140 participants (64.8%), while 76 (35.2%) exhibited moderate or mild dependence with a mean sample age of 80.0 ± 7.44 years. No significant differences between groups were found for age, BMI, or high FRAX fracture risk which was 82.4% total (p=0.608). However, statistically significant differences were observed for positive frailty screening with 82.1% in complete/severe versus 98.7% in moderate/mild groups (p<0.001), malnutrition risk (56.4% vs 71.1%, p=0.035), sarcopenia risk (8.6% vs 77.6%, p<0.001), and potential cognitive impairment (32.1% vs 46.1%, p=0.043).Conclusion: Functional dependence is highly prevalent (64.8%) among older adults receiving LTC at the PHC level in Kazakhstan. The Barthel Index serves as a practical, standardized tool for ADL assessment, supporting care planning and nursing-patronage stratification. Due to the cross-sectional design, these findings reflect clinical associations rather than direct causal relationships.

Aim: Oligoprogressive disease (OPD) has emerged as a clinically relevant and common scenario in oncology, reflecting progression in a limited number of metastatic sites while systemic therapy continues to control the majority of disease. Despite its increasing recognition, the definition, diagnostic approach, and management of OPD remain poorly standardized. Methods: A multidisciplinary expert panel from Kazakhstan and international faculty, including ten medical oncologists, radiation, and surgical oncologists, participated in a structured survey. The questionnaire consisted of 15 items divided into three domains: definition of OPD, diagnostic evaluation, and treatment strategies. Responses were analyzed, and consensus was defined as ≥ 70% agreement, relative agreement as 50–69%, and lack of consensus as < 50%. Results: Consensus was reached that OPD is defined as progression in a limited number of lesions while other sites remain controlled, regardless of lesion size or localization. No consensus was achieved regarding the maximum number of progressive lesions, with experts divided between “≤ 5 lesions” and “any number amenable to local therapy.” Imaging with CT or PET-CT was considered sufficient. Biopsy and molecular testing were recommended only in selected contexts. Systemic therapy continuation during OPD was endorsed if effective, with strong support for local therapy, particularly stereotactic ablative radiotherapy (SBRT/SABR). Divergence remained regarding the management of repeat OPD. Conclusions: This Kazakhstan Cancer Society consensus defines the fundamental clinical features of OPD and provides practical recommendations for diagnosis and treatment. Comparison with international guidelines reveals broad alignment on systemic continuation and local therapy, as well as persistent variation regarding lesion number, biopsy, and repeat OPD management.

In the recent years, the accelerating global demographic shift toward population aging has been accompanied by a marked increase in the prevalence of neurodegenerative disorders, notably Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, and multiple sclerosis. Among emerging approaches, dietary interventions targeting the gut–brain axis have garnered considerable attention, owing to their potential to modulate key pathogenic pathways underlying neurodegenerative processes. This review synthesizes current concepts in precision nutrition and elucidates neurohumoral, immune, and metabolic regulatory mechanisms mediated by the gut microbiota, including the roles of the vagus nerve, cytokines, short-chain fatty acids, vitamins, polyphenols, and microbial metabolites. Emerging evidence underscores that dysbiotic alterations contribute to compromised barrier integrity, the initiation and perpetuation of neuroinflammatory responses, pathological protein aggregations, and the progressive course of neurodegenerative diseases. Collectively, these insights highlight the gut microbiota as a pivotal target for the development of precision-based dietary strategies in the prevention and mitigation of neurodegenerative disorders. Particular attention is devoted to key bioactive components such as prebiotics, probiotics, psychobiotics, dietary fiber, omega-3 fatty acids, and polyphenols that critically participate in regulating the gut–brain axis. Contemporary evidence on the contribution of the gut microbiota to the pathogenesis of Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis is systematically summarized. The review further discusses the prospects of applying nutrigenomics, chrononutrition, and metagenomic analysis to the development of personalized dietary strategies. The presented findings underscore the potential of integrating precision nutrition with targeted modulation of the gut–brain axis as a multifaceted approach to reducing the risk of neurodegenerative diseases and preserving cognitive health.

Background/Objectives: Accurately assessing the independence level of older adults using useful assessment tools is an important step toward providing them with the necessary care while preserving their dignity. These tools allow older adults to receive effective, personalized home care, which improves their quality of life. This study aimed to clarify the current prevalence of severe and complete functional dependence and associated factors among Kazakhstan’s older adults aged >60 years. Methods: This cross-sectional study was conducted in several polyclinics and geriatric service care centers in two cities of Kazakhstan from March to May 2024. Functional status was assessed by the Barthel Index. We combined the selection into two categories: total dependency and severe dependency in the category “dependent”, and moderate dependency, slight dependency, and total independence in the category “active patients”. Results: Among the 642 older people in this study, 43.3% were dependent patients, and 56.7% were active patients. The odds of severe and total functional dependence are significantly higher for frail participants (adjusted odds ratio (AOR) = 2.96, 95% confidence interval (CI) [1.70, 5.16], p < 0.001) compared to those that are not frail; eleven times higher for those at home (AOR =11.90, 95% CI [5.77, 24.55], p < 0.001) than those in nursing homes; two times higher for participants with sarcopenia (AOR =2.61, 95% CI [1.49, 4.55], p < 0.001) compared to those with no sarcopenia; and three times higher for participants with high risk of fracture (AOR =3.30, 95% CI [1.94, 5.61], p < 0.001) compared to those with low risk. The odds of having severe and total functional dependence are significantly higher for participants with low dynamometry (AOR =1.05, 95% CI [1.03, 1.07], p < 0.001) compared to those with normal dynamometry. Conclusions: Old age, low dynamometry (for men ≤ 29 kg, for women ≤ 17 kg), frailty, being at home, high risk of fracture and osteoporosis, and sarcopenia were associated with increased risk of severe and total functional dependence.

Background and Objectives: The aim of this study is to categorize and combine (according to the source of biomaterial) biomarkers of frailty syndrome and identify challenges in research on these biomarkers by reviewing the current literature from the past five years. Methods: We systematically searching five electronic databases—PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Library—for citations from 1 January 2019 to 1 July 2024. We conducted a qualitative data synthesis and categorized the limitations by topics and subtopics. PROSPERO—CRD: 42024491369. Results: A total of 61 papers met the criteria for inclusion in this study. These studies included a total of 56,758 participants, and 1479 unique biomarkers. We categorized biomarkers such as blood, genetic, urinary, and salivary biomarkers. Our analysis identified three major categories of challenges: challenges related to study design, unclear pathophysiological mechanisms, and biomarker-specific challenges. Conclusions: This review underscores the extensive research into biomarkers associated with frailty syndrome, such as blood, genetic, urinary, and salivary biomarkers. However, significant challenges persist, including methodological inconsistencies, biomarker measurement variability, and a limited understanding of underlying mechanisms.

BACKGROUND: Coronavirus infection can negatively impact the mental and physical status of patients with chronic heart failure, exacerbating anxiety and depressive symptoms. These changes should be recognized and addressed promptly. AIM: The study aimed to evaluate the impact of COVID-19 on the mental and physical status of patients with chronic heart failure who were eligible for treatment in primary care settings. METHODS: The study included patients with chronic heart failure of various origins with or without a history of COVID-19. The physical and mental health of all patients was evaluated using three scales: the Sheehan Patient-Rated Anxiety Scale, the Beck Depression Inventory, and the Social Adaptation Self-Evaluation Scale. Eligible patients with COVID-19 were prescribed sertraline, a selective serotonin reuptake inhibitor antidepressant, based on results of a psychometric evaluation. RESULTS: Sertraline is shown to significantly improve anxiety disorder, particularly severe cases, in patients with chronic heart failure who have recovered from COVID-19. Sertraline was found to be even more clinically effective in the treatment of depression; it improved depressive symptoms in all study groups. Sertraline was found to affect cardiovascular parameters in patients with chronic heart failure after COVID-19. Sertraline decreased heart rate, thereby improving the course of chronic heart failure. In addition, the ejection fraction remained virtually unchanged in the short term, which indicates the efficacy and safety of sertraline. This supports the recommendation to add sertraline to the combined therapy for this patient group. CONCLUSION: The study confirms the significant impact of COVID-19 on the physical and mental status of patients with chronic heart failure. However, the agents used to treat these conditions may affect the cardiovascular system. Patients require a comprehensive treatment strategy that includes support for mental and physical health.

Indira Omarova, Assiya Akanova, Almagul Kurmanova, Gaukhar Kurmanova, Natalya Glushkova, Amina Seidanova, Kuatzhan Turysbekov. J Pharmacopuncture 2023;26:238-46. https://doi.org/10.3831/KPI.2023.26.3.238