BACKGROUND: The concept of frailty suggests the potential reversibility of this syndrome. Research indicated that geriatric rehabilitation programs aimed at maintaining mobility and functional independence reduce the frequency of repeated hospitalizations.

AIM: To study the specifics of geriatric status to assess the potential effectiveness of rehabilitation programs in improving mobility and functional independence.

MATERIALS AND METHODS: A subgroup analysis was conducted based on the data obtained in the open prospective study «POSTSCRIPTUM» (Protocol of Geriatric Rehabilitation in Patients Aged 60 Years and Older Living in Moscow Boarding Houses or Nursing Homes). The analysis included 465 patients (82% women, mean age 78.6 ± 7.6 years). For the analysis, patients were divided into two groups depending on whether there was an improvement in the Short Physical Performance Battery (SPPB) score of at least 1 point following the rehabilitation program: groups «ΔSPPB ≥ 1» and «ΔSPPB < 1», respectively. A comparative analysis of baseline parameters and the dynamics of comprehensive geriatric assessment (CGA)results were performed upon completing the 21-day geriatric rehabilitation programs. Patients with a baseline maximum SPPB score («SPPB = 12», n = 112; 43%) were excluded from the analysis.

RESULTS: The «ΔSPPB ≥1» group included 202 (43%) patients, and the «ΔSPPB < 1» group included 263 (57%) patients. After excluding patients with SPPB = 12 from the analysis set, the proportion of patients in the «ΔSPPB ≥1» group was 57.3%. At baseline, the comparison groups did not differ in gender, body mass index, education level, marital status, prevalence of noncommunicable diseases or CGA results. The mean age was 78.7 ± 6.74 years in the «ΔSPPB ≥1» group and 81.2 ± 8.32 years in the «ΔSPPB < 1» group (p < 0.01). Both groups showed positive dynamics in the results of the Montreal Cognitive Assessment (MoCA) test, GDS-15, Insomnia Severity Index, and VAS scales. However, intergroup comparison revealed no differences in these indicators. The groups differed in dynamometry results: in the «ΔSPPB ≥1» group, they improved from 16.7 ± 6 kg to 18.0 ± 6.2 kg between Visits 1 and 2, p < 0.001 (intergroup delta comparison p < 0.001).

CONCLUSION: The subgroup analysis results indicate that the effectiveness of rehabilitation depends not only on baseline demographic and clinical characteristics but also on the initial geriatric status as determined by CGA. Comprehensive 21-day geriatric rehabilitation programs tailored to CGA results are effective in improving mobility, muscle strength, psychoemotional state, and sleep quality. However, the rate and magnitude of the effect on various domains may vary among patients with different baseline statuses.

INTRODUCTION. A personalized approach to the rehabilitation of patients with coronary heart disease (CHD) and concomitant musculoskeletal disorders (MSDs) is becoming increasingly relevant, especially for older patients. The number of patients with comorbidities is significantly related to age. Older people tend to experience slowly progressive pathological conditions, they gradually develop several diseases, particularly chronic ones, and their ability to compensate and adapt is reduced.

OBJECTIVE: To analyze modern methods of cardiac rehabilitation for this group of patients.

MATERIALS AND METHODS: Three types of analysis (quantitative, qualitative and structural) were used to conduct the scientometric analysis of a personalized approach in the rehabilitation of patients with CHD and concomitant MSDs.

RESULTS: The findings from the indicate that conventional cardiac rehabilitation programs often fail to produce satisfactory results for patients with concomitant conditions. Alternative modalities, such as aquatic exercise, Nordic walking, and personalized resistance training, have been shown to be highly effective and safe. A multidisciplinary approach and tailored exercise prescription are crucial components for successful rehabilitation, particularly in older individuals with age-related concomitant conditions.

DISCUSSION: The findings of a comprehensive scientometric analysis, which includes quantitative, qualitative, and structural analysis, support the significance of a personalized approach to rehabilitation for patients with coronary heart disease (CHD) and comorbid musculoskeletal disorders (MSDs). However, a limitation of the review is the absence of randomized controlled trials that evaluate the effectiveness of personalized rehabilitation programs based on scientometric analysis for patients with CHD and MSDs. Most studies included in the review had small sample sizes and short follow-up periods.

CONCLUSION: Further research is required to explore new rehabilitation options, develop and validate tools for assessing the functional status of comorbid patients, and compare the efficacy of various individualized rehabilitation techniques, taking into consideration the age-related changes and specific characteristics of older individuals (the interaction of several factors such as age, somatic diseases, polypragmasia, social maladaptation).

BACKGROUND: The primary goal of rehabilitation after a femoral fracture surgery in patients with osteoporosis is to reduce the risk of disability and mortality, which is highest in the first months after the fracture.

AIM: To develop, scientifically justify, and evaluate the effectiveness of virtual reality and mechanotherapy technologies in the rehabilitation of patients with osteoporosis after surgical treatment of femoral fractures.

MATERIALS AND METHODS: The study included 98 patients aged 59 to 84 years who had undergone osteosynthesis or hip joint endoprosthetics for osteoporosis-related femoral fractures within 6 to 12 weeks before enrollment.

RESULTS: The study results indicate that the new medical rehabilitation program leads to an increase in the total Harris Hip Score (p = 0.034) and maximum hip extension strength (p = 0.041) after 12 days, improved gait speed and biomechanics, with increased right leg stride length after 12 days (p = 0.036) and reduced step width after 60 days (p = 0.22), faster pain syndrome regression, and better physical functioning.

CONCLUSION: In patients with osteoporosis who underwent surgical treatment for proximal femoral fractures, the new medical rehabilitation program involving mechanotherapy, virtual reality, and sensor-based treadmill training with biofeedback improves hip joint function recovery compared to standard rehabilitation programs.

BACKGROUND. Chronic pain syndrome in dorsopathy is a common geriatric syndrome diagnosed in 65% of patients aged 60 to 75 years. It impairs the quality of life in older adults and leads to anxiety and depressive disorders due to persistent symptoms [22]. This necessitates introducing non-pharmacological rehabilitation methods into the treatment plan for this group of patients. It will help avoid polypharmacy and its cumulative side effects and improve patients’ functional abilities, self-care, and capacity for daily and occupational activities.

AIM. To scientifically substantiate the effectiveness of rehabilitation measures for chronic lower back pain syndrome in elderly and senile patients with dorsopathy using non-pharmacological treatment methods, in particular therapeutic physical exercises, physiotherapy, individualized orthopedic support, etc.

MATERIAL AND METHODS. The study included 120 patients diagnosed with deforming dorsopathy, with a mean age of 67.1 (66.8; 67.4) years, of whom 71 (59%) were female. The patients were divided into two groups: the main group (n=66) and the control group (n=54). The main group of elderly patients received continuous year-round treatment focusing on non-pharmacological methods (therapeutic physical exercises, individualized orthopedic corrections, physiotherapy, etc.). In contrast, the control group received treatment once every six months, mainly focusing on pharmacotherapy as the basis of treatment. Rehabilitation effectiveness was evaluated before and after treatment (after one calendar year) using the  EQ-5D-5L quality of life questionnaire, a visual analog scale for pain, assessments of general motor activity, self-care skills, ability to perform work, emotional and volitional characteristics, and the severity of main somatic complaints.

RESULTS. This study showed the effectiveness of continuous year-round use of non-pharmacological treatment methods (including dosed physical activity tailored to disease periods as a foundation) supplemented by medication when necessary during acute phases. The results indicate that consistent use (throughout the calendar year) of kinesitherapy, individualized foot orthotics, and physiotherapy (if clinically necessary) significantly improves the somatic status of patients, (reduces the need for pain relief medication, lessens dependence on constant assistance, improves quality of life, and positively affects emotional and volitional qualities, such as mood and initiative).

CONCLUSION. The preventive introduction of the proposed therapeutic methods could help primary care physicians and neurologists to alleviate pain symptoms faster, improve the quality of life in this cohort of patients, and reduce the frequency of hospitalizations, which is of significant economic importance for healthcare system as a whole.

BACKGROUND. Avascular necrosis of the femoral head (AVN) is a severe progressive and disabling clinical entity affecting relatively young and working-age individuals, leading to the patient’s disability and a sharp decrease in their physical and social activity.This condition characterized by the death of osteocytes in the loaded area of the femoral head. Osteonecrosis is a condition that results from impaired local blood flow, which can be caused by a variety of factors. Thes e include trauma, surgical procedures, hip dysplasia, inflammatory conditions, blood clotting disorders, use of glucocortic oid medications in the treatment of other conditions, and the effects of radiation or chemotherapy. However, during the period 2021–2023, cases of avascular necrosis of the femoral head in patients who had undergone COVID-19 treatment began to be reported in the medical literature. The authors have pinpointed three potential factors that could contribute to this condition: the utilization of glucocorticoids, vasculitis, endothelialitis, and thrombotic angiopathy, as well as the osteonecrotic impact of the COVID-19. To date, the gold standard treatment for advanced aseptic necrosis of the femoral head is total hip replacement surgery. The proportion of patients in this group ranges from 10% to 12% of all endoprosthetic implant recipients.

The article details a group of individuals with aseptic necrosis of the femoral heads, who contracted COVID-19 in 2021– 2022 and underwent total hip replacement surgery in 2023–2024 During the early and late post-operative periods, the patients underwent medical rehabilitation at the second and third stages, in a specialized department, following their personalized treatment plan.

AIM. The article aimed to determine the tactics and outcome of medical rehabilitation in patients suffering from avascular necrosis of the femoral heads, who have undergone total hip replacement surgery, taking into account the assessment of rehabilitation prognosis, the use of physical and medical rehabilitation methods.

MATERIALS AND METHODS. The study involved 174 patients from the medical rehabilitation department of the Clinical Hospital of the INC SB RAS who had hip endoprosthesis implants, with 46 of them presenting with aseptic necrosis of the femoral heads. 46 individuals contracted COVID-19 between 9 and 13 months prior to their operation. They received standard laboratory tests, general therapy, and orthopedic evaluation, as well as assessments of physical activity, integrated rehabilitation, and the Harris scale. According to the medical rehabilitation scale, patients are classified as category 4–5. All performed studies of the level of vitamin D in the blood serum. All received physiotherapeutic procedures, exercise therapy, igloreflexotherapy, mechanotherapy, hip contracture management in the apparatus of passive and active mobilization of the hip and knee joints, training in the correct weight distribution on stabilloplatform. In addition, the medical rehabilitation fragment included combined osteoprotective therapy: ibandronic acid 3 mg/3 ml (bonviva) 1 times per 3 months (for 9–15 months), alphacalcidol 0.5–1 μg per day (alpha D3-Teva), dipyridamol 75 mg per day (curantil) 10 days, nimesulide 100 mg 2 times on the day of 10 days. Following individual testing by a medical psychologist, the Ortorent Cognitive apparatus underwent correction to improve psychological well-being and prevent disorders. Statistical methods of processing the obtained results were carried out. The study was approved by the Biomedical Ethics Committee of the Irkutsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences (Extract from Meeting No. 74-2 of 30.01.2023). A positive opinion of the Russian Academy of Sciences No. 1022040600618-4.3.2.10 of 09.01.2023 was received for the study

CONCLUSION. As a result of medical rehabilitation of patients suffering from aseptic necrosis of the femoral heads, who underwent implantation of hip endoprostheses, pain syndrome was relieved, locomotor function was optimized, contracture of the operated hip joint was significantly reduced, physical activity was expanded, laboratory tests of peripheral blood were improved.

INTRODUCTION. The aging of the population and the resulting increased proportion of older patients with chronic, non-communicable diseases represent one of the greatest challenges for the healthcare system in many countries. At the same time, a high level of medical care, including transportation, must be guaranteed for older people. This makes it crucial to research both organizing challenges associated with the development of well-functioning processes directly at the medical facility and accessibility when receiving medical care.

OBJECTIVE. To research the main variables affecting organizational and medical access barriers for patients who are over working age in the Russian Federation.

MATERIAL AND METHODS. In the present work we used the questionnaire survey method with a questionnaire consisting of three blocks and 89 questions. The statistical analysis of the data was carried out using the programs Statistica for Windows Version 10.0, Stata and R-Studio. The Pearson test of agreement (Chi-criterion) was used to compare the distributions of qualitative characteristics. A generalized linear model with a logit link function was used to test the hypothesis about the influence of individual respondent characteristics on the probability of falling into quartiles. To test the hypothesis about the influence of individual sociodemographic factors on the probability of getting into the top 25% of the distribution based on the mean of the scores, a generalized linear model with a logit function of the relationship was used.

RESULTS. A total of 3,942 respondents took part in the survey. All persons older than working age faced some obstacles in obtaining medical care, and the prevalence of problematic situations ranged from 12.5% (problems with movement due to the inconvenient location of the practice) to 74.3% (absence the right specialist and the need to see another one). medical organization). Factors that influence the severity of the barriers are described (living in rural areas, presence of financial problems and low social integration, older age).

DISCUSSION. The results obtained in this work are comparable to a number of studies conducted in the Russian Federation and worldwide.

CONCLUSION. Overcoming accessibility and organizational barriers requires management and organizational decisions on the part of regional health protection authorities, municipalities, and employees of medical organizations and social services.

AIM. This study aimed to evaluate risk factors of low medication adherence in outpatients aged 60 and over.

MATERIALS AND METHODS. A total of 224 participants aged 60 years and over were included in the study. The mean age was 71.2±6.6 years, with 129 (57,6%) being female. General clinical examination, probable frailty screening using the «Age is Not a Hindrance» questionnaire were performed. Medication adherence was assessed using the four-item Morisky Medication Adherence Scale.

RESULTS. Adherent and non-adherent patients were comparable in terms of age (p = 0,598), gender (p = 0,563), intake of drug groups, adherence to healthy lifestyle principles, concomitant diseases, with the exception of diabetes mellitus, which was more common (p = 0,037) among non-adherent patients. A negative correlation was established between adherence to treatment and probable frailty (r = −0,24, p < 0,001), diabetes mellitus (= −0,14, p = 0,032). Non-adherence to the treatment regimen was associated with probable frailty (OR 0.26, 95% CI 0.12–0.56; p < 0.001), and the absence of the frailty and diabetes mellitus was associated with high adherence to treatment (OR 4,58, 95% CI 1,24–16,87, p = 0.022).

CONCLUSION. Medication non-adherence was found in 38,8% outpatients aged 60 and over. Multimorbid older patients with probable frailty and diabetes mellitus have a high risk of non-adherence to treatment.

The Russian Federation is experiencing a continuous trend of rapid aging within society, with the older population projected to make up 28% by 2030. To reduce economic and social losses, a geriatric service has been introduced in the Russian Federation, focusing on maintaining the functionality of an older people. The functionality of older patients is evaluated using the Barthel Index based on comprehensive geriatric assessment. One of the most common geriatric syndromes is visual impairment. However, there is still no consensus on the role of vision pathology in the development of frailty.

OBJECTIVE. To assess the relationship between the function of the visual organ and the preservation of functionality according to the Barthel scale among older people.

MATERIALS AND METHODS. The article investigates the ophthalmic status of older people (n = 481) aged 75 and older, who were hospitalized for frailty in a geriatric hospital. The study assessed visual acuity using the Sivtsev — Golovin table and confirmed ophthalmological diagnoses. Older participants were categorized based on their level of functionality: severe loss (Barthel index less than 60) and preserved functionality (Barthel index 60 and above). Statistical analysis was conducted using logistic regression to determine the presence of any relationships

RESULTS. The study examined the relationship between patients' sex and age with visual acuity, leading ophthalmological diagnoses, and their connection to functionality (according to the Barthel index). The results showed significant associations between impaired functionality and cataracts (OR = 1.95, 95% CI 1.21–3.12), AMD (OR = 2.64, 95% CI 1.50–4.64), and refractive error (OR = 1.95, 95% CI 1.10–3.49).

CONCLUSION. The presence of multiple eye pathologies increased the likelihood of functionality loss in older patients. The study highlights the importance of implementing organizational solutions for managing older patients with vision problems and suggests a new approach for ophthalmologists to preserve functionality in older patients.

BACKGROUND. The role of insulin-like growth factor-1 (IGF-1) and its levels in aging have been established in clinical and experimental studies. Aging-associated geriatric syndromes underlie functional and adaptive decline in older patients. However, there is insufficient evidence that aging-associated decrease in circulating levels of IGF-1 is associated with geriatric syndromes, particularly in long-living adults. This study aimed to examine the associations between IGF-1 levels and geriatric syndromes in long-living adults.

METHODS. This cross-sectional study included nonagenarians recruited with the assistance of social services, nursing homes, geriatric centers, and other geriatric services. The participants underwent a comprehensive geriatric assessment, including medical history, geriatric scales, and questionnaires. Blood samples were collected, and IGF-1 levels were assessed using chemiluminescence. The study was approved by the ethics committee (Protocol № 30 dated December 24, 2019). Statistical analysis was performed using the R package (v. 4.2.2).

RESULTS. The study included 3,789 participants aged 90–107 (median age = 92) who met the inclusion criteria. The median IGF-1 level was 99.8 ng/mg (min: 30.8 ng/ml; max: 208 ng/ml). The intergroup analysis showed associations between IGF-1 levels and functional dependence, frailty, risk of falls, malnutrition, sarcopenia, and cognitive impairment. However, after adjusting for physical activity and BMI, a significant association was demonstrated only between IGF-1 levels and cognitive impairment.

CONCLUSION. Our study showed a significant association between IGF-1 levels and cognitive impairment. However, the detected associations require further analysis in prospective studies.

With progressive population aging, maintaining the functional independence of older adults, especially in surgical patient groups, is becoming increasingly important [1].

Mobility is a critical component for performing basic daily activities in older adults. Studies have shown the significance of assessing mobility indicators for predicting disability in older age [2, 3], even in older patients with preserved functional capacities [4].

Restoring mobility during and after hospitalization is very important for maintaining physical activity, social participation, and autonomy [5, 6].

AIM: To evaluate the geriatric status of patients included in rehabilitation programs after planned orthopedic operations (knee and hip joint replacement).

MATERIALS AND METHODS: The study included 100 patients, evenly distributed between groups with knee and hip joint replacement surgeries. At the pre-hospital stage, patients were screened for frailty syndrome according to the clinical guidelines for «Frailty Syndrome» [7]. Based on the results, the patients were divided into two groups: with and without frailty syndrome. Upon admission for surgical treatment, a Comprehensive Geriatric Assessment (CGA) was conducted, including basic activity indicators (Barthel Activities of Daily Living Index [8]), instrumental activity indicators (The Instrumental Activities of Daily Living Scale [9]), nutrition assessment (Mini Nutritional Assessment (MNA)), cognitive functions (MiniMental State Examination [10]), depression (Geriatric Depression Scale, GDS-15 [11]), and quality of life (EQ-VAS [12]). During the outpatient period, the CGA was repeated 12 months after surgical treatment. Rehabilitation programs included general recommendations for physical activity of at least 150 minutes per week, with an emphasis on aerobic exercise for patients with frailty syndrome.

RESULTS: The mean age of patients with gonarthrosis was 69.2±6.0 years; the mean age of patients with coxarthrosis was 67.6±5.5 years. In the group of patients 12 months after knee joint replacement and complex rehabilitation programs, there was a slight but statistically significant improvement in functional status, cognitive status, nutritional indicators, quality of life. Among patients with gonarthrosis and frailty syndrome, functional activity indicators remained stable for 12 months after surgery; with significant improvement in MMSE scores (baseline: 26.5±3.0; at 12 months: 28.8±2.2, p < 0.05) and quality of life (baseline: 58.6±12.4; at 12 months: 67.4±10.3, p < 0.05). In the group of patients 12 months after hip joint replacement and complex rehabilitation programs, statistically significant improvements were observed in functional status, cognitive status, nutritional indicators, quality of life, and Geriatric Depression Scale scores. Among patients with coxarthrosis and frailty syndrome, there were significant improvements in functional status (Barthel Index, baseline: 91.1±14.7; at 12 months: 97.9±8.0, p < 0.05), mobility (Timed Up and Go Test, baseline: 16.92±7.14; at 12 months: 8.45±5.51 seconds, p < 0.05), MMSE (baseline: 27.9±2.0; at 12 months: 29.6±0.6, p < 0.05), quality of life (baseline: 60.4±13.7; at 12 months: 83.6±8.6, p < 0.05), and depression scores (GDS-15, baseline: 4.4±3.0; at 12 months: 2.0±1.5, p < 0.05) after one year of surgical treatment and rehabilitation.

CONCLUSION: Recommendations for physical activity and mobility contribute to maintaining functional activity during the first year after knee and hip replacement surgery in initially frail elderly patients.

Lipoprotein (а) is able to initiate mechanisms of inflammation and create an atherogenic and thrombophilic condition due to its structural features. It is important to acknowledge that there are currently no standardized protocols for the regular monitoring of lipoprotein (а) levels in clinical settings, despite its relevance in assessing cardiovascular risk among older patients. Even in the absence of abnormal lipid profiles, there may still be thickening of the arterial walls and the formation of atherosclerotic plaque. The extent of atherogenicity, or plaque development, is directly linked to plasma levels of lipoprotein (а), which have a genetic basis.

This paper aims to review the role of lipoprotein (а) in low-grade inflammation and its pathogenic mechanisms in atherosclerosis, particularly in relation to elevated levels of this lipoprotein. The study will critically analyze the available literature on this topic to understand the potential role of lipoprotein (а) as a risk factor for atherosclerosis.