The population of older and oldest-old individuals is increasing at a rapid pace, leading to a notable proportion of this age group requiring surgical procedures due to multimorbidity. It is known that, compared with young people, patients over 60 have a whole set of factors, such as decreased physiological functions, the presence of several concomitant diseases, polypharmacy, cognitive dysfunction and specific geriatric syndromes, which may lead to  a higher risk of  postoperative complications and prolonged recovery. Therefore, an integrated multidisciplinary approach on management is necessary for this group of patients, but the use of such an approach is currently rare. The purpose of this document is to review the literature, summarize current recommendations, and provide a  set of  expert recommendations to  assist practicing geriatricians, surgeons, anesthetists, and allied health professionals.

With the aging population, the significance of preoperative diagnostics and optimizing the treatment of surgical patients with frailty syndrome is gaining momentum. For such patients a comprehensive geriatric assessment (CGA) is carried out to clarify the severity of frailty and the individual characteristics of the geriatric status [1]. The results of this assessment are used to stratify the risk in the postoperative period and to determine targeted interventions for the correction of geriatric syndromes [2]. The introduction of new geriatric technologies during hip and knee replacement in weakened older patients needs scientific justification and confirmation of effectiveness.

Objective: to test the method of complex geriatric management of older and oldest-old patients before and after surgical interventions in the provision of planned inpatient orthopedic care (knee and hip arthroplasty).

Materials and methods: the study involved two groups of older and oldest-old patients with frailty: 50 patients, average age 69.2 ± 6.0 years [60 to 87 years] with gonarthrosis and 50 patients, average age 67.6 ± 5.5 years [60 to 81 years] with coxarthrosis. At the prehospital stage, patients were diagnosed with frailty, in accordance with the clinical recommendations of «Senile asthenia» [3]. Upon admission to surgical treatment, a CGA was performed, including indicators of basic (Barthel Activities of daily living Index, Barthel scale [4]) and instrumental activity (The Instrumental Activities of Daily Living Scale, IADL scale [5]), nutrition assessment (Mini Nutritional assessment, MNA scale [6]), cognitive functions (The Montreal Cognitive Assessment, MOCA test [7]), depression (Geriatric Depression Scale, GDS-15 scale [8]), as well as quality of life (A Visual Analogue Scale, EQ-VAS scale [9]), multimorbidity and polypragmasia. An  individual plan of  perioperative management was drawn up.

Results. A  comparative analysis demonstrated statistically significant improvements in  functional status (based on  the Barthel scale), cognitive status (based on the MOCA test), nutritional status (based on the MNA scale) and quality of life (based on the EQ-VAS scale) 12 months after surgical intervention in groups of patients after knee and hip replacement. In the group of patients after hip replacement, there was also an improvement in the quality of life of patients 12 months after surgery. The assessment and dynamics of indicators in functional and cognitive status within the control group were not carried out, which makes it difficult to compare the results. However, there was a reduction in hospital stay for patients using geriatric approaches compared with previously used surgical care in the control group.

Conclusion: the management of  patients with frailty in  the perioperative period with the use of  CGA allows for preventive measures aimed at  maintaining functional, psycho-emotional status. Individual characteristics of  the state of psychoemotional and functional status in older and oldest-old patients may not be considered during the traditional preoperative risk stratification and increase the risks of adverse outcomes of surgical treatment, duration of hospital staying and repeated hospitalizations.

Background. Life expectancy is  increasing around the globe. However, chronological age is  not the best indicator of  health. For a  more accurate assessment of  body condition throughout life, in  general, and aging, in  particular, and identify potential points of geroprotective intervention, a specialized tool is needed. A tool that could prove beneficial is a biological age calculator, utilizing a range of biomarkers to analyze the degree of functional preservation of the body. Many existing biological age calculators are limited by a small number of parameters to analyze and sensitivity to use in a specific population.

Aim. Large-scale studies to create a mathematical model for calculating biological age based on the Russian population have not previously been carried out. In 2022, the RUSS-AGE study was launched to create biochemical, cognitive and microbiotic calculators of biological age and determine possible points of geroprotective interventions.

Materials and methods. The study intends to  enroll at  least 3,500 participants and analyze more than a  hundred biomarkers using laboratory tests, questionnaires, neurocognitive and functional testing, and collection of anthropometric and physical indicators.

Results. Currently, the recruitment of participants is supported by a government grant under the Priority 2030 program. By November 2023, 510 participants had been enrolled in the study.

Conclusion. Further statistical processing of the information received and the development of prototypes of biological age calculators are planned.

Background. Oldest old are the fastest growing age group in Russia. The prevalence of depression increases with age and occurs more commonly among oldest old compared to lower age groups. At the same time, the frequency of depression and its association with geriatric syndromes in institutionalized oldest old is poorly studied.

Aim. To  assess the frequency of  depression, the presence and nature of  its associations with other geriatric syndromes in persons aged ≥90 years, who live in long term care facilities (LTCF).

Materials and methods. The study involved 351 men and women aged 90 years and older permanently residing in the LTCF of Moscow. Depression was ascertained with the Geriatric Depression Scale. (GDS-15). All the subjects underwent a  comprehensive geriatric assessment. To  diagnose the frailty, we  used the Short Physical Performance Battery (SPPB). The Bartel index was used to  assess performance of  activities of  daily living. Instrumental activities of  daily living were assessed using the Lawton scale. Nutritional status was assessed based on the Mini-Nutritional Assessment (MNA). To detect urinary and fecal incontinence, a scale of activities of daily living (Bartel index) was used, which contains relevant questions. Constipation syndrome was diagnosed in the presence of less than 3 bowel movements per week. An orthostatic test was performed to detect orthostatic hypotension. The presence of falls, sensory deficits, chronic pain and drug therapy were also assessed.

Results. Depression was diagnosed in 67.2% of oldest old. A higher incidence of depression was found in women (77.5% vs. 68.7%; p=0.074). Only 2.73% of oldest old with depression received antidepressants. The presence of chronic pain (OR 1.89; 95% CI 1.16–3.08; p=0.010), hearing deficiency (OR 2.20; 95% CI 1.29–3.74; p=0.004) and frailty (OR 5.33; 95% CI 2.56–11.12; pp<0.001) is independently associated with the presence of depression.

Conclusion. The study showed a  high incidence of  depression with insufficient therapy in  institutionalized oldest old. Independent risk factors of depression that are of practical importance for clinicians have been identified: frailty, hearing impairment and chronic pain syndrome.

Despite significant tactic’s improvements of perioperative management of patients undergoing non-cardiac surgery, there is still a high incidence of postoperative complications. So more accurate risk stratification is necessary before surgery in order to possibly reduce such risk. In addition to assessing the risk associated with surgery, the risk associated with the patient, which may be due to the presence of certain diseases, primarily cardiovascular, is also assessed. There are currently evidences of the validity of determining the level of biomarkers in the blood in certain groups of patients during operations not related to cardiac intervention, which makes it possible to clarify the scope of necessary diagnostic interventions in preparation for surgery, as well as to diagnose complications of heart disease in the postoperative period.

In  recent years, Russia has seen an  increase in  the proportion of  older patients receiving surgical care. In  the majority of cases, an older patient is burdened with multiple long-term conditions (MLTC) and geriatric syndromes. To improve the consensus clinical and / or functional outcomes after surgery, rehabilitation measures are required in the postoperative period. In this review, spanning the last 10 years, the value of rehabilitation programs for older and oldest-old patients was assessed. The clinical effectiveness of multidisciplinary rehabilitation measures in the postoperative period is analyzed.

Polypharmacy in geriatric patients is associated with an increased risk of adverse outcomes. Therefore, several instruments for prescription analysis and optimization can be used to enhance the safety and efficacy of pharmacotherapy in old age population. STOPP/START criteria is one of the most popular screening tools in the Russian Federation and abroad that list potentially inappropriate drugs for use in older patients (STOPP criteria) and potentially prescribed for certain clinical cases (START criteria). Two previous versions of the STOPP/START criteria were published in 2008 and 2015. Released in 2023, the newest (third version) demonstrates the evolution of evidence-based pharmacotherapy for older and oldestold patients, featuring 133 STOPP and 57 START criteria. Expanding the base of STOPP/START criteria should support optimization of prescriptions and reducing ADRs risk in older patients. This article introduces translation of STOPP/START criteria, version 3.

The first part of  the article discusses the issues of  preoperative bowel preparation in  older and oldest-old patients, with a  particular emphasis on  the safest drugs. The second part of  the article presents the problem of  chronic constipation as a geriatric syndrome, including a description of age-associated changes in the structure and function of colon, causes of constipation and features of correction in geriatric practice.

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is a common condition in older man. Uroselective a1a-adrenoceptor (AR) antagonists tamsulosin and tamsulosin modified release (OCAS) are the most frequently prescribed medications for the men with LUTS due to BPH. Both tamsulosin and tamsulosin OCAS improve the patients disease-specific quality of life, reduce IPSS by approximately 30–40% and increase Qmax by approximately 20– 25%. The high selectivity of tamsulosin to α1А-adrenoceptor and slow release system OCAS provide a minimal vasodilating effect and correspondingly low risks of falls. These benefits are important in the treatment of LUTS in older men.

In this article, the authors discuss the principles of perioperative management of patients in the older age group with frailty syndrome. Most patients with frailty syndrome have several chronic diseases; associations of  frailty with cardiovascular diseases are known — arterial hypertension, coronary heart disease, chronic heart failure, as well as with diabetes mellitus, chronic kidney disease, diseases of the joints and lower respiratory tract, oncological diseases, which causes a higher risk of  complications in  the postoperative period and requires a  special approach in  the perioperative period. This protocol addresses the issues of preventing complications and preserving the patient’s autonomy after surgical treatment.