The paper introduces clinical guidelines on frailty that have been developed by the Russian Association of Gerontologists and Geriatricians. These guidelines are specifically designed to assist geriatricians, internists, general practitioners, family physicians, and other healthcare specialists who work with adult patients. Within the paper, there are screening instruments, diagnostic tools, and treatment options provided for individuals with frailty. Additionally, the paper also includes information on prevention, rehabilitation, and medical care organization for this cohort of patients.

Studying the frailty in  patients with atrial fibrillation (AF) is  essential given the high prevalence of  AF and the escalating risk of strokes and bleeding as individuals age.

AIM: to evaluate the effect of frailty on the risk of the sum of thromboembolic events and bleedings in patients with AF aged 60 years and older receiving anticoagulants.

MATERIALS AND METHODS. This fragment from the single-center prospective REGATTA-2 register (Register of  long-term Antithrombotic therapy -NCT043447187) included 455 patients with AF  ≥ 60 years for whom it  was possible to assess the signs of frailty on three scales Groningen Frailty Index, FRAIL and «Age is not a hindrance». During the follow-up (median of 6 years), the sum of thromboembolic events and bleedings were taken into.

RESULTS. Frailty according to the Groningen Frailty Index and FRAIL scales were detected in 29.7% and 31.8%, using the «Age is not a hindrance» scale — in 9.5% of patients. The most common syndromes were emotional and cognitive disorders, fatigue and limited mobility. According to  the ROC analysis, all three scales used had predictive value in relation to the risk of the sum of thromboembolic events and bleedings. Independent predictors (Cox proportional risks model) of sum of thromboembolic events and bleedings are Groningen Frailty Index ≥ 4 (HR=1.8) and «Age is not a hindrance» ≥ 3 (HR=1.6).

CONCLUSION. Frail patients with atrial fibrillation have an  increased risk thromboembolic events and bleedings; therefore, they need personalized monitoring and treatment regimen.

BACKGROUND. According to the United Nations, by 2050, it is expected that every sixth inhabitant of our planet will have crossed the threshold of 65 years. This indicates an urgent need to identify the main barriers that arise when providing medical care in order to improve the process of organizing medical services for people over working age.

AIM. To study the characteristics of psychological and communication barriers (problems in defining the model of the doctor-patient relationship) in the Russian Federation when providing medical services to people over the working age, with the aim of developing recommendations based on these findings to eliminate these obstacles.

MATERIALS AND METHODS. In this study, a questionnaire was used, consisting of three blocks and 89 questions. The data were analyzed using Statistica 10, Stata, and R-Studio programs. The Pearson’s chi-square test was used to compare categorical variable distributions. A generalized linear model was used to test the impact of individual characteristics on the outcome variable. The Mann-Whitney U and Kruskal-Wallis tests were used to analyze differences between samples with abnormal distributions.

RESULTS. A total of 3,942 individuals participated in the survey. Among the study participants, the most prevalent psychological barrier to engaging with the healthcare system was fear of visiting a medical facility associated with the potential for detecting new illnesses or worse outcomes (66.6%). Approximately half of respondents indicated that this could serve as a reason for not seeking medical attention (52%). The most commonly reported communication barriers included the need for assistance in understanding doctor’s prescriptions (27.7%), difficulty understanding doctor’s speech due to hearing problems (18.5%), the frequent use of incomprehensible terminology by doctors (25.7%), and approaching problems in a formal manner or not delving deeply enough (24%)

CONCLUSION. The research conducted will allow us  to make managerial and organizational decisions in  a more purposeful and reasonable manner, in  order to  create a  trustworthy environment, improve the quality of  doctorpatient communication, and provide necessary psychological support during medical care for people over working age.

Bendopnea, a recently described new symptom of dyspnea that occurs during trunk flexion, and the bending oxygen saturation index (BOSI) are of interest for further research and application in geriatric practice.

OBJECTIVE: The aim of this study was to investigate the incidence of bendopnea in geriatric patients with varying body composition, including obesity, sarcopenia, and sarcopenic obesity.

MATERIALS AND METHODS. The bendopnea symptoms and the BOSI were studied in  a cross-sectional, observational study involving 100 individuals of advanced age with sarcopenia or sarcopenic obesity as well as control groups with obesity or no sarcopenia/sarcopenic obesity. Bendopnea was defined as dyspnea occurring after 30 seconds of transverse trunk flexion in a seated position of patient. Simultaneously, the BOSI was calculated by subtracting the oxygen saturation values before and after the bendopnea test, using pulse oximetry.

RESULTS. The average age of the participants was 76.16 ± 7.71 years, with women accounting for the majority (72%). The group with sarcopenic obesity showed the highest number of  positive bendopnea symptoms (65.38%), with statistically significant differences compared to the group with sarcopenia (26.92%) (p = 0.01); the group with obesity without sarcopenia (30.77%) (p = 0.01) and the control group (22.73%) (p < 0.001), respectively. The bendopnea was most commonly reported in patients actively experiencing dyspnea, with higher scores on the Borg dyspnea scale and severity on the Modified Medical Research Council (mMRC) scale. These patients also had lower grip strength, higher waist circumferences, and body mass index. No statistically significant differences were found when comparing the BOSI indices of patients with and without positive bendopnea.

CONCLUSION. Bendopnea may be a promising additional diagnostic tool for dyspnea in older patients. Given its high incidence in sarcopenic obesity, further studies are required to assess its prognostic value in this category of older patients.