Despite the increase in the number of older and oldest old patients with cancer, the tactics of their treatment are often suboptimal while the doctor-patient relationship model tends to be paternalistic.

Insufficient knowledge in the field of geriatric care among health care providers dealing with cancer patients along with the low representation of older patients in research lead to their vulnerability to both «over- and under-treatment». There is ample evidence to support the superiority of comprehensive geriatric assessment in identifying frail patients at risk of poor outcomes compared to conventional clinical assessment or traditional oncology tools. Planning therapy taking into account the geriatric status and preferences of the patient, allows us to add the best results and satisfaction of aging patients with oncological diseases.

In order to reduce the risk of falls and fractures in older patients, promoting a healthy lifestyle and ensuring adequate calcium, vitamin D and protein intakes in their diet is of particular importance. When combined with regular exercise and avoiding bad habits such as alcohol and smoking, bone quality improves significantly.

Osteoporosis treatment certainly includes the first line in the development and prevention of fractures in older adults, but diet optimization is an equally important component of treatment. This article presents results of the most relevant research to date on the characteristics of nutrition with a decrease in high bone density.

Introduction: the lack of comprehensive screening programs for colorectal cancer detection in oldest-old steadily leads to an increase in the diagnostic interval (DI), i.e. the time from the patient’s first presentation of complaints until diagnosis and treatment. At the same time, worsening the general somatic condition and developing the decompensation of concomitant diseases. Thus, patients with long-term DI need additional measures while preparing for surgery; the preoperative bed-day increases.

Purpose of the study: to evaluate the impact of the diagnostic interval on the short-term results of II and III stages right colon cancer treatment in geriatric patients.

Materials and methods: a retrospective multicenter study was conducted at the surgical facilities of Sechenov University from 2006 to 2015. The study included patients aged over 75 who have undergone surgical treatment of II and III stages right colon cancer. The control group comprised patients with CRC diagnosis in the period from 0 to 6 months; the studied group involved patients with a diagnostic interval over than 6 months.

Results and conclusions. Analysis of the results revealed that patients older than 80 years had a longer diagnostic interval, which is statistically significant (p<0.001). Prolongation of the diagnostic interval for more than 6 months has shown a decrement in the polymorbidity indicators and operational and anesthetic risk compared with DI≤6 months (p=0.001, p=0.039). Polymorbidity, in particular cardiovascular diseases decompensation, affected the indicators of operational and anesthetic risk on the ASA scale, which were significantly higher in the study group (p=0.039). High level of polymorbidity required a longer preoperative preparation in the studied group, which is statistically significant in comparison with the control group (p=0.018). Statistically significant differences in early postoperative complications rate in both groups were not revealed. 30 and 90 day mortality rates were similar in the studied and control groups (p=0.225, p=0.353). The study has also shown that diagnostic interval (DI) have no effect on the prevalence of II and III stages comparing with the control group (p=0.315).

Background. The Short Physical Performance Battery (SPPB) is considered a standard screening test for frailty, however certain conditions it requires are frequently inaccessible.

Aim. To develop Hospital Rapid Geriatric Assessment Scale (HRGAS) and to evaluate its diagnostic value in frailty screening.  

Materials and methods. 408 sequentially hospitalized patients (23% male) aged 60–95 (median 73) years were examined using our specially designed algorithm (HRGAS) that includes 9 items: 1) age; 2) Mini-Cog test; 3) short depression assessment; 4) dynamometry; 5) falls in the past year; 6) mobility; 7) self-feeding ability; 8) urinary incontinence; 9) body mass index. The results were scored from 0 to 3 for age and from 0 to 2 for all other items. Minimum score sum is 0, maximum — 19. Assessment time was approximately 5 minutes. As control SPPB was used for frailty screening. The HRGAS results were compared with SPPB. 

Results. Based on SPPB, frailty rate was 46,3%, pre-frail — 26%, robust — 27,7%. HRGAS score was ranged from 0 to 14 (median 4, IQR 2–6) and negatively correlated to SPPB score (rS = -0,63; p<0,001). For frailty detection (SPPB score 0–7), ROC-analysis showed AUC 0,815 (95% CI 0,774–0,856), p<0,001, cut-off value ≥5, sensitivity 67,2%, specificity 81,3%, positive prognostic value (PPV) 76,5%, negative prognostic value (NPV) 74,2%, diagnostic accuracy 74,8%. For robust detection (SPPB score 10–12), ROC-analysis showed AUC 0,805 (95% CI 0,761–0,849), p<0,001, cut-off value ≤2, sensitivity 55,8%, specificity 84,1%, PPV 57,3%, NPV 83,2%, diagnostic accuracy 76,2%.  

Conclusion. We developed HRGAS and calculated its cut-off values to identify and rule out frailty syndrome: score 0–2 by HRGAS indicate robust, score 3–4 — pre-frail and score ≥5 — frail patients.

Background. Cognitive decline is one of leading contributors to the loss of independence in older adults. Therefore, early diagnosis and detection of  potentially modifiable cognitive disorders is  a significant challenge for modern geriatrics.

Aim. To assess the relationship between cognitive impairment and presence of leukoareosis through neuroimaging in older adults.

Materials and methods. General population cohort study of  102  patients aged 60–98  years treated at  The St. Petersburg Hospital for War Veterans between September and December 2019. Cognitive assessment (The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE)), depression (The Geriatric Depression Scale), sleep complaints, subjective cognitive decline, computed tomography (CT) scan.

Results. The studied patients were divided into two groups: with the presence of  leukoareosis (n=59) and without leukoareosis (n=43). Patients with leukoareosis had significantly lower total MoCA scores. They performed significantly worse in  domains of  visual–structural skills and attention. As  for MMSE, patients with leukoareosis also performed significantly worse in  repeating a  sentence and descending subtraction task. There was no  statistically significant difference in GDS scores between the two groups. However, patients with leukoareosis significantly more frequently considered their lives less fulfilling and their memory worse. They also abandoned most of their former interests.

Conclusion. If  leukoareosis is  detected on  CT scans, it  is necessary to  evaluate cognitive functions; the presence of leukoareosis in patients was associated with an increased risk of cognitive disorders and depression.

In this article, the authors discuss the issue of supporting family care among older and oldest old; the matter is considered an urgent challenge in geriatrics. The work focuses on assessing the quality of care for older individuals at home, as well as providing support to their family members. The protocol gives an idea of the role of a caregiver, which is carried out through the interaction between family members during the process of distributing family roles. The issue of home care is being discussed, considering the maintenance of the patient’s highest possible functional status along with healthy nutrition, hygiene and symptom management.

In the article presented, the authors discuss the problem of providing high-quality medical care to older patients with cancer. The work focuses on examining patient based on a comprehensive geriatric assessment (CGA), including urgent situations related to a malignant neoplasm. The protocol provides an overview of hypercalcemia, tumor disintegration syndrome, spinal cord compression, neutropenia. The issue of educational necessity for nurses caring for patients with cancer is discussed.

The article discusses the characteristics of medical assistance organization based on interdepartmental interaction with social protection structures when implementing a Long-Term Care System. A model of interdepartmental interaction is presented, aimed at identifying individuals potentially requiring Long-Term Care services. The principle of data exchange is described, the example of patients' vital signs monitoring by care assistants is given.