Multimorbidity is defined as the coexistence of more than one chronic disease and is frequently associated with heart failure (HF), particularly in cases with a preserved left ventricular ejection fraction (EF). It is considered a heterogeneous clinical syndrome, especially among elderly individuals with an impaired functional and physical status. It is particularly prevalent in  females and in  individuals with arterial hypertension, obesity, diabetes mellitus, atrial fibrillation, ischemic heart disease and chronic kidney disease. Comorbidity and frailty are important determinants of HF outcomes and significantly impact quality of life. In today's ageing society, multimorbidity is the norm rather than the exception, posing a challenge to physicians who must treat HF and its associated diseases simultaneously. HFpEF results from many factors, including involutional changes in the body due to ageing. The most common cause of its development is diastolic dysfunction. The pathophysiological mechanisms of HFpEF include low-intensity chronic inflammation contributing to microvascular endothelial dysfunction and oxidative stress, which promote pathological left ventricular (LV) remodelling and the progression of diastolic dysfunction. The wide range of non-specific symptoms, concomitant diseases and frailty complicate the diagnosis of heart failure and the selection of an effective therapy. Disease-modifying therapy, diuretics and innovative anti-inflammatory drugs are modern approaches to managing elderly multimorbid patients with HFpEF.

BACKGROUND. Improving treatment adherence in elderly patients with hypertension remains an important challenge in modern cardiology. One promising approach is the use of remote monitoring technologies.

OBJECTIVE. The objective of this study was to evaluate the feasibility of remote monitoring and its impact on adherence to blood pressure measurement and data transmission via a chatbot in patients with hypertension over 65 years of age.

MATERIALS AND METHODS. This open-label, randomized, controlled trial included 95 patients aged ≥65 years who were randomized into 2 groups: 1) remote monitoring (RM) (n = 50; median age 70 years; 27 % men) and 2) control (n = 45; median age 71 years; 40 % men). The RM group utilized remote monitoring, which included daily patient surveys via a chatbot in a messenger. In case of systolic blood pressure (SBP) decrease <100 mm Hg, a questionnaire to assess symptomatic hypotension was also offered. In the control group, patients were observed on an outpatient basis without the use of remote monitoring. The observation period was 3 months. The criteria for assessing the effectiveness of the intervention were adherence to filling out the chatbot (assessed by counting the number of completed questionnaires during the entire observation period) and SBP level.

RESULTS. After 3 months, 45 patients in  the UN  group and 45  patients in  the control group completed the study. An increase in SBP above 150 mm Hg during home measurement was significantly more frequent in the control group (UN 6 (13 %); control group 20 (44 %); p = 0.001). The absolute reduction in SBP in both groups was statistically significant. In the UN group, the absolute reduction in SBP was 7.5 mm Hg (p < 0.001), in the control group 5 mm Hg (p = 0.003). Adherence to the chatbot and blood pressure data transmission for more than 50 % of the observation time was observed in 43 patients (95 %), and more than 75 % in 27 patients (60 %). Symptomatic hypotension was observed in 22 patients (49 %) in the remote monitoring group.

CONCLUSION. Digital platforms for remote monitoring can be effective in hypertension management, promoting increased engagement in the treatment process in patients over 65 years of age. Patient adherence for more than 50 % of the observation time via messenger was 95 %.

Prognostic value of erythropoietin in elderly and senile patients with heart failure and anemia

OBJECTIVE: to study the prognostic value of erythropoietin (EPO) levels in elderly and senile patients with chronic heart failure (CHF) and anemia.

MATERIAL AND METHODS. EPO levels in blood serum were determined once in 105 patients with CHF and anemia aged 65 to 90 years. The follow-up period was 24 months. The primary endpoint was death from all causes. The adequacy of endogenous EPO production was assessed by the ratio «observed EPO / predicted EPO» (O/P), calculated on the basis of EPO and hemoglobin levels in patients of the control group with iron deficiency anemia without CHF – [HR 1.004 ± 0.004 [95 % CI; (0.919–1.080)]. The value of O/P < 0.9 was considered insufficient production of EPO, O/P > 1.1 – excessive, O/P = 1.0 – adequate. The Kaplan – Meyer method was used to compare survival rates depending on the value of O/P levels of EPO. Regression analysis of proportional hazards of Cox was used to assess the effect of the value of O/P levels of EPO on the risk of death.

RESULTS. In patients with CHF and anemia, the average EPO level was (35.900 ± 2.537) mIU/ml [8.46; 154.00]. According to the obtained ratio of O/P levels of EPO, 59 % of patients showed signs of excessive production of EPO (O/P > 1.1), 18 % – insufficient production (O/P < 0.9) and adequate – in 23 % (O/P = 1.0). The Kaplan – Mayer method showed significantly higher mortality in patients with O/P > 1.1 than in patients with O/P < 0.9  and O/P = 1 (p = 0.00418). The analysis of proportional hazards of Cox revealed an effect on the risk of death of the ratio O/P > 1.1 at the trend level in a single-factor analysis [HR 0.947 (95 % CI; 0.893–1.004), p = 0.069] and significant in a multifactorial [HR 0.924 (95 % CI; 0.859–0.994), p = 0.034].

CONCLUSION. Elderly and senile patients with CHF and anemia are characterized by marked variability in EPO levels, while there may be excessive, insufficient or adequate EPO production. The prognostic value of O/P levels of EPO as a marker of the discrepancy between the degree of anemia and the actual production of EPO was revealed, while the O/P value >1.1 indicates an unfavorable prognosis, since it correlates with an increased risk of death.

BACKGROUND. Falls are considered to be one of the most common causes of injuries and fatal accidents due them among elderly people. Falls can be especially dangerous for elderly people who live alone. The analysis of  the risk factors of  falls and geriatric status of  lonely senior citizens gives an  opportunity to  estimate the possibility of application of modern technical devices contributing to manage the risks of falls and to improve the quality of rendering assistance to the mentioned category of patients.

OBJECTIVE: To analyse the risk factors of falls and to study certain indicators of geriatric status in elderly and senile people living alone who happen to be participants of the project called «Emergency button. Prevention of falls in elderly people living alone in the Nizhny Novgorod region».

MATERIALS AND METHODS. Smart watches for elderly people, the capabilities of which allow patients to press a button on the side panel and make a phone call to a relative (or a social worker) were purchased with grant funds. During the project implementation, 100 elderly individuals living alone and 51 high-risk patients (average age 75 ± 9.5 years) were provided with smart watches, and risk factors for the syndrome were studied in  them through basic and instrumental daily activity.

RESULTS. Taking into consideration the elderly individuals living alone and participating in the project included in the study, it was found that the most common risk factors for falls were: previous history of falls, fear of falling, abnormal gait, urinary incontinence, and others. Furthermore, a high prevalence of decline in instrumental and basic activities was observed.

CONCLUSION. Elderly individuals living alone with a high risk of  falls who were included in  the study often exhibit dependence on  external assistance and multiple factors contributing to  falls. This situation justifies the use of smartwatches with emergency call buttons (as confirmed by actual use by project participants) and highlights challenges in  their use, as well as  the need for monitoring by relatives or social workers to ensure proper application of the technology.

BACKGROUND. The increasing prevalence of chronic diseases with age makes the management of elderly patients a major challenge in modern medicine. In patients with coronary heart disease (CHD), concomitant musculoskeletal disorders (MSD) are common, reducing exercise tolerance and limiting the effectiveness of standard cardiac rehabilitation programs. This highlights the importance of personalized rehabilitation approaches. Promising methods include Nordic walking (NW) and Arm Crank Ergometry (ACE), which can be adapted for patients with impaired lower-limb function.

OBJECTIVE is to evaluate the dynamics of exercise tolerance and functional mobility in patients with CHD and MSDs during standard and personalized rehabilitation programs involving NW and ACE.

MATERIALS AND METHODS. A prospective single-center study was conducted involving 84 patients with CHD and osteoarthritis of the knee and/or hip joints. The mean age of the patients was (66.3 ± 10.4) years. Participants were randomized into three groups: Group 1 (n = 30, NW), Group 2 (n = 24, ACE), and a control group (n = 30, standard rehabilitation). Each program lasted 2 weeks with 3 sessions per week (30 minutes each). Effectiveness was evaluated using the 6-Minute Walk Test (6MWT), ACE Test, and 10-Meter Walk Test (10MWT). Statistical analysis employed the Wilcoxon signed-rank test and Kruskal – Wallis H-test, followed by post-hoc analysis where appropriate; significance level p < 0.05.

RESULTS. All groups demonstrated significant improvement in all functional tests (p < 0.001). The improvement rates in 6MWT and ACE test were higher in personalized groups compared to  the control group (p < 0.05). No statistically significant difference was found between NW and ACE programs. For the 10MWT, significance was not achieved (H = 5.4; p = 0.067).

DISCUSSION. The findings confirm the effectiveness of personalized rehabilitation programs utilizing NW and ACE. All groups showed significant enhancement in exercise tolerance (p < 0.001), with greater progress in personalized programs (p < 0.05). The most pronounced improvement was observed in the ACE group, though the difference between NW and ACE was not statistically significant (p = 1.0). For the 10MWT, intergroup differences did not reach statistical significance (p = 0.067), which may be attributable to the test’s limited sensitivity to short-term aerobic interventions (NW and ACE).

CONCLUSION. Personalized rehabilitation programs incorporating NW and ACE improve exercise tolerance in patients with CHD and MSDs, demonstrating superiority over standard approaches. Both methods showed comparable efficacy, supporting their integration into clinical rehabilitation practice.

BACKGROUND. In patients over 60 years of age, senile asthenia (SA), the main geriatric syndrome, may be the background for tuberculosis. The development of SA is accompanied by a decrease in physical and functional activity, adaptive and restorative reserves of the body, which makes the elderly vulnerable to infectious diseases, including tuberculosis.

OBJECTIVE. To study the features of detection and diagnosis of respiratory tuberculosis in patients with senile asthenia over the age of 60 in 2018–2024.

MATERIALS AND METHODS. A retrospective prospective cohort study wasconducted, which included 301 patients over 60 years of age with newly diagnosed respiratory tuberculosis in 2018–2024 in the Yaroslavl and Kostroma regions. The diagnosis of tuberculosis in all patients was carried out using clinical, laboratory, and instrumental examination methods generally accepted in phthisiology. All patients were screened for SA using the «Age is not a hindrance» questionnaire; asthenia was recorded with a score of 5 or more (Senile asthenia. Clinical guidelines, 2018, 2024). The patients were divided into two groups: 51 patients with SA in the first group, 250 patients without SA in the second group.

RESULTS. The time frame for detecting tuberculosis from the moment of contacting the general medical network to the diagnosis was more than one month in 59.1 % of patients over 60 years of age. In most cases (44.8 %), tuberculosis was detected by internists in the general treatment network (GTN) when patients complained of intoxication and bronchopulmonary disorders that had been bothering them for more than 3 weeks. In the group of patients with SA, disseminated (52.3 %) and infiltrative (31.3 %) forms prevailed, and tuberculosis of the bronchi (8.3 %) and tuberculosis of the bronchi (8.3 %) also occurred. Classical radiological signs of pulmonary tuberculosis in patients over 60 years of age werefound in 90.8 % of cases. Patients with SA were more likely to have a negative Mantoux test result with 2 TE than among patients without SA (39.2 % and 64.0 %; p <0.01). The ELISPOT test (T-SPOT.TV) was positive in 100% of cases.

CONCLUSIONS. In patients over 60 years of age with SA, there is a late diagnosis of tuberculosis. Tuberculosis is  detected mainly by  complaints of  the development of  widespread, disseminated processes against the background of reduced immune reactivity. It is advisable to include computed tomography of the chest organs, sputum analysis for Mycobacterium tuberculosis by molecular genetic methods, microscopy and culture, as well as immunological tests for tuberculosis using the ELISPOT method in the algorithms for diagnosing tuberculosis in patients over 60 years of age.

Coronavirus disease 2019 (COVID-19) has caused significant morbidity and mortality worldwide. Convalescents often experience a chronic condition known as long COVID-19. The relationship between SARS-CoV-2 infection and skeletal muscle damage has sparked significant interest within the global medical community. Sarcopenia is a severe complication of the acute and long-term phases of the disease. Comprehensive rehabilitation is necessary to restore strength, muscle mass, and skeletal muscle function in patients after they have had the disease. The prevention and treatment of sarcopenia necessarily include various types of physical exercise. Patients should undergo rehabilitation after a comprehensive geriatric assessment to identify frailty syndrome, carried out by a team of medical specialists under the guidance of a geriatrician. Several authors propose comprehensive physical rehabilitation strategies to restore physical function, including aerobic and/or strength training and breathing exercises. Some types of physical exercise can be performed by patients in severe conditions while lying supine in bed. Telemedicine offers greater accessibility by avoiding physical contact and enabling engagement with a multidisciplinary team of specialists. It allows for remote consultations with patients in remote areas and eliminates the risk of infection. This literature review examines the main mechanisms of sarcopenia development after a SARS-CoV-2 infection and methods for skeletal muscle rehabilitation in geriatric patients.

The PRISm spirometry pattern remains a significant challenge for clinicians due to an incomplete and inconsistent understanding of its interpretation. Nevertheless, a substantial body of evidence has been amassed, suggesting that the identification of a forced expiratory volume in one second (FEV1) / forced vital capacity (FVC) ratio ≥70 % (Gaensler index) and FEV1 <80 % during the evaluation of respiratory function can be regarded as a predictor of an unfavourable prognosis for diverse patient categories. Recent studies have demonstrated a close pathogenic relationship between PRISm and the aging process, thus allowing for the consideration of this pattern as a marker of age-associated changes or biological age of the bronchopulmonary system.

Objective: The present study aims to accumulate and analyse information on the PRISm spirometry pattern, with a view to determining its potential as a diagnostic sign for assessing the state of the respiratory system in relation to age.

Materials and methods. A comprehensive review of the most pertinent and substantial publications concerning the PRISm problem in recent years was conducted. The article presents key information about potential etiological factors of this spirometry pattern, pathomorphological signs, and discusses pathogenic relationships of PRISm with the aging process.

Conclusion. Spirometry remains one of the most informative methods for diagnosing bronchopulmonary diseases; however, the identification of the PRISm pattern, which is not included in  the usual classifications of respiratory system pathology, is not given due attention in real clinical practice. The association between aging and the potential for restoring normal respiratory function in individuals with PRISm introduces new avenues for scientific research in the field of geriatrics, particularly with regard to the development of therapeutic strategies.

Disorders of the musculoskeletal system pose a major medical and social problem for older people. The clinical phenomenon of locomotive syndrome (LS) is observed in senile asthenia (SA) and is a key feature of degenerative and inflammatory joint diseases. This article is a critical analysis of the literature on LS from the perspective of geriatrics and arthrology. It highlights that traditional methods for diagnosing joint diseases don't fully consider a key clinical and prognostic aspect: the patient's actual physical abilities, which directly affect their quality of life and level of independence. Currently, there is a growing need to develop comprehensive clinical assessment methods focused on functional indicators and early detection of joint diseases in elderly patients with osteoarthritis (OA) and SA.

Objective of the review. Critical analysis of existing approaches to the diagnosis of sarcopenia in elderly patients with osteoarthritis and to identifying directions for future research.

Atherosclerotic cardiovascular diseases (ASCVD) account for nearly half of all deaths in the Russian Federation. In a considerable number of cases, elderly patients have concomitant ASCVD and type 2 diabetes mellitus (T2DM), with ASCVD being the primary cause of death in patients with T2DM. The presence of shared risk factors and the presence of close pathophysiological relationships among these diseases suggests the potential for therapeutic action on both T2DM and ASCVD simultaneously. The therapeutic approach for type 2 diabetes mellitus (T2DM) in elderly patients with atherosclerotic cardiovascular disease (ASCVD) is a complex task due to changes in the functional and psychosocial status of patients, comorbidities, and polypharmacy. Therefore, the selection of therapeutic interventions for these patients requires an individualized approach. Presently, the selection of hypoglycemic medications is informed by their impact on cardiovascular outcomes and the safety profile with respect to hypoglycemia, a consideration of particular significance for elderly and senile patients. The review methodically analyzes current literature data on drugs for the treatment of elderly patients with ASCVD and T2DM, providing a concise overview of the mechanisms of action and the evidence base for their efficacy and safety. The objective of this information is to facilitate treatment decisions for patients with T2DM and ASCVD, including elderly and geriatric patients, within the context of routine clinical practice.

BACKGROUND. The growing global aging population increases the demand for innovative solutions in geriatric medicine to address complex health challenges. AI offers promising tools for enhancing care, but faces unique challenges in this area.

OBJECTIVE. To evaluate the potential of  AI to  enhance diagnosis, monitoring and care for elderly patients in geriatric medicine and to identify key challenges to its implementation.

MATERIALS AND METHODS. A systematic review was conducted according to PRISMA guidelines. Literature searches were conducted in PubMed, Scopus and RSCI databases (2020-2025), using keywords related to AI and geriatrics. Studies focused on clinical applications of AI in patients aged 60 years and over were included. After removing duplicates and irrelevant publications from 1,243 records, 50 studies were analyzed. The quality of the studies was assessed using the AMSTAR-2 and the Newcastle-Ottawa scales.

RESULTS. AI demonstrates high efficacy in early diagnosis of dementia (up to  90  % accuracy), osteoporosis (89 %), and cardiovascular diseases (91 %), as well as in monitoring falls (92 %) and nutritional status (90 %). Key challenges include ethical concerns (privacy, algorithmic bias), limited technology access (40 % in rural areas), and insufficient staff training (only 30 % of geriatricians are AI-proficient).

CONCLUSIONS. AI holds transformative potential for geriatric medicine but requires adaptation to the unique needs of older adults, development of ethical and technical standards, and enhanced training programs for healthcare professionals. This review underscores the need to integrate AI as part of a person-centered care ecosystem.

Individuals with subjective cognitive decline (SCD) who experience cognitive complaints are considered to have cognitive abilities within the age-appropriate range based on cognitive tests and to have no significant mental, neurological, or somatic disorders affecting cognitive function. SCD in older adults is considered an early marker of severe cognitive impairment in neurodegenerative diseases such as Alzheimer's disease. This review discusses the sociodemographic characteristics of SCD and examines the relationship between subjective assessment and objective measures of cognitive function. Although individuals with SCD may not exhibit clinically significant cognitive deficits, increasing evidence suggests subtle cognitive and neurobiological differences compared to healthy older adults of the same age. The relationship of SCD to the concept of cognitive fragility is discussed: reversible cognitive fragility is essentially SCD and is considered important for intervention and the potential prevention or delay of dementia. In the elderly, SCD is associated with impairments in their daily lives, problems, and difficulties with social participation. Currently, increasing attention is being paid to the treatment of patients with SCD, but pharmacological treatments are not the treatment of choice. The association of asthenic symptoms and cognitive impairments warrants the prescription of medications that provide a comprehensive psychostimulant and nootropic effect. In this context, having Prospekta in a physician's repertoire may be useful for the treatment of cognitive impairment and asthenia.

Overactive bladder (OAB) is urinary urgency, with or without urinary incontinence, usually with increased daytime frequency and nocturia. M-cholinoblockers remain the drug of choice in the treatment of OAB, and beta3-agonists are used at high risk development of cognitive impairment due to anticholinergic load. The objective of our work is to evaluate the efficacy and safety of trospium chloride in elderly patients with OAB refractory to mirabegron (beta-3-agonist). After 24 weeks, 16 out of 22 patients (aged from 65 to 80 years) had positive results and continued treatment, which was 72.7 %. At the same time, 12 patients used a dose of 45 mg and 4 patients 60 mg of trospium chloride. The reasons for interruption of treatment were insufficient efficacy in 2 patients and side effects in 4 patients (dry month – 1, constipation – 2 and residual urine – 1). It is important to note that none of the patients have been observed to have deterioration of cognitive function. Thus, we conclude that trospium chloride is a reliable M-cholinoblocker for the treatment of OAB, including elderly patients at risk of developing CNS dysfunction as a result of anticholinergic load.