This is the first issue of Russian Journal of Geriatric medicine published under supervision of Russian Association of gerontologists and geriatricians.

The paper represents clinical guidelines on frailty, developed by Russian Association of gerontologists and geriatricians. The guidelines are dedicated to geriatricians, internal medicine specialists, general practitioners, family doctors and other specialists, dealing with adult patients. The paper includes screening and diagnostic tools and treatment options for patients with frailty, along with prevention, rehabilitation and medical care organization in this cohort of patients.

To assess the appropriateness of prescribed drugs according to the STOPP/START criteria of elderly patients with type 2 diabetes mellitus (T2DM) in the endocrinology department of a multi-speciality hospital.

Medical records of 136 patients ≥65 years old with T2DM hospitalized in the endocrinology department of  the multi-speciality hospital (Moscow, Russia) were analyzed according to  the «STOPP/START» criteria.

The analysis of  prescription leaflets has identified 30 potentially not recommended drugs (46 patients [33,8%]), the use of which should be avoided in certain clinical situations. Also the analysis has identified 175 medications that should be considered for elderly patients with certain conditions (89 patients [65,4%]). The most frequent identified STOPP criteria were: «Glibenclamide or chlorpropamide or glimepiride with T2DM» (23,3%); «Non-steroidal anti-inflammatory drug (NSAID) with history of peptic ulcer disease or gastro-intestinal bleeding, unless with concurrent histamine H2 receptor antagonist, proton pump inhibitors or misoprostol» (13,3%) and «NSAID with estimated glomerular filtration rate 20–50 ml/min/1.73m2» (3%). The most frequent START criteria were: «Statin therapy with a documented history of coronary, cerebral or peripheral vascular disease, where the patient’s functional status remains independent for activities of daily living and life expectancy is >5 years» (25,1%); «Сlopidogrel with a documented history of cerebral or peripheral vascular disease» (18,9%); «Aspirin with a documented history of atherosclerotic coronary disease in patients with sinus rhythm» (18,3%).

In  patients ≥ 65 years old with T2DM potentially not recommended drugs are often administrated and there are no prescriptions for some appropriate drugs required in certain clinical settings. The findings give evidence of the need to optimization of pharmacotherapy in elderly and senile patients with T2DM. This adaptation will improve the patients’ quality of  life and avoid wasteful spending.

The long-livers of Moscow: functional, cognitive and emotional status. Aim: To evaluate the functional, cognitive and emotional state of long-livers for determining the amount of necessary assistance from social services and medical personnel.

Methods: According to  the register of  super-long-livers of  Moscow, 82 people aged from 95 to 105 years were recruited. Participants looked around at home. When visiting, the comprehensive geriatric assessment were performed for each paitent, including an  assessment of  the overall level of physical and instrumental activity, mental status and cognitive functions. The following questionnaires were used for the assessment: a  brief scale of  mental status assessment (MMSE), a  geriatric scale of  depression, the Barthel index (activity in  everyday life), IADL (assessment of instrumental activity), to assess the quality of life, a visual assessment scale (VAS) was used.

Result: The study showed that, on average, people who reached or were approaching the 100th anniversary had a high level of instrumental (15.6 +/–5.4) and daily activity (72 +/–27.8). In general, no significant decrease in cognitive functions (21.8 +/–5.6) and emotional level (6.3 +/–4.1) was detected in the study participants.

Conclusion: The first data showed the uniqueness and fragility of  people in  this age group. Future work using a similar integrated and multidimensional approach is necessary for a better understanding of aging processes and risk factors worsening the condition of patients, ensuring an increase in the number of centenarians with a high level of life satisfaction.

Considering the increasing amount of elderly people in Russia and in the world, an active study of arterial hypertension in this group is an actual and clinically demanded task. The strategic direction defining treatment tactic in such patients, especially over 80 years old, is the determination of their functional status and of the presence of frailty syndrome, which is not synonymous with comorbidity and is not an obligatory early aging companion, but specifies the need for a personalized approach in the treatment of hypertension, even the complete abolition of antihypertensive drugs if needed. The review presents data on the prevalence and clinical features of hypertension in the older age group and presents a digest of the latest European and Russian clinical guidelines about this topic. Special attention is paid to “fragile” patients from the point of view of evidence-based medicine. The influence of different combinations of antihypertensive drugs on cardiovascular events, mortality and cognitive potential is also explained.

Aim: To evaluate the functional, cognitive and emotional state of long-livers for determining the amount of necessary assistance from social services and medical personnel.

Vascular aging is associated with increased arterial stiffness, vascular remodeling, and increased pulse wave propagation rate. This process can be accelerated by cumulative exposure to various factors that damage the arterial wall: arterial hypertension, hyperglycemia, dyslipidemia, smoking, etc. At present, there is no convincing evidence of the preferential effect of certain components of metabolic syndrome that have the greatest impact on the acceleration of vascular aging in older patients. In  this regard, a  non-interactive study was conducted to  calculate vascular age and compare it with passport age in patients over 65 years of age with metabolic syndrome (MS) and obesity, assessing the greatest contribution to vascular ageing in a given age group of different MS components. The study showed that at different age periods MS components have different specific weights in the formation of early vascular aging.

Anemia is  a common clinical and laboratory syndrome, complicating many somatic diseases. Of particular importance is the reduction of hemoglobin in patients with cardiovascular diseases. Anemia increases both the frequency and prognosis of cardiovascular disease. The article presents a  typical clinical case of  an elderly patient with chronic heart failure and normocytic anemia, presents the algorithm of management and tactics of treatment of anemia.

Due to the steady aging of the population the social situation to need for reforms has been identified, including a starting a state system of long-term medical care and monitoring at home for patients 65 years and over in Russia last years. The article includes the role, social significance and status for implementation of home medical patronage according the main tasks and priorities towards a decade of healthy ageing of WHO.

The provision of home-based primary care in the framework of social protection for elderlies provides to use a typing system for organize targeted assistance for the seniors and persons with disabilities in  Russia. By  analogy, typing of  patients is  envisaged and is  being developed for conducting medical home nursing.

The typing model for long-term medical support of old patients has their own characteristics, from the risk factors and the “philosophical approach” through the end of  the multidisciplinary medical team formation and the need for vaccination.

Hospitalized older adults are at risk of malnutrition. Nurses should carefully assess and monitor the nutritional status of the older hospitalized patient so that appropriate nutrition-related interventions can be implemented in timely fashions.

Elderly patients are at risk of malnutrition due to dietary, economic, psychological and physiological factors. Older people are at risk of developing malnutrition. This condition or the risk of its development is observed in 39–47% of hospitalized elderly patients. The use of the Mini-Nutritional Assessment (MNA) is recommended to identify malnutrition or the risks of its development. The MNA scale takes into account the diet, patient mobility, BMI, the dynamics of weight loss, psychological stress, acute diseases, dementia and other mental features of the patient.

Management plan of a patient with malnutrition: monitoring the implementation of the recommendations of a dietitian, clinical pharmacologist, and other specialists who determine the patient’s nutrition, ensuring adequate supply of nutrients, clinical nutrition (artificial nutrition, special nutritional support, parenteral, enteral nutrition, or a combination thereof), oral administration dietary supplements.

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