An increasing senior population requires improvements in geriatric care. Elderly patients are prone to various age-related diseases combined with geriatric symptoms. In such cases, medical treatment involves collaboration between doctors of different specializations, nurses, social workers, and care professionals. To make such collaboration as efficient as possible, appropriate professional training and a regulatory framework for interaction, along with well-defined medical care algorithms, are necessary.

The slowing phenotype, which is widespread among geriatric patients, is a variant of unhealthy aging that conceptually links the physical, cognitive, and emotional status of the patient. The development of simple and accessible diagnostic algorithms and further study of this phenotype are of paramount importance for understanding the mechanisms of its progression and developing the most effective therapeutic strategies for correction.

OBJECTIVE: to study the prevalence of cognitive dysfunction (CD), depression, and the slowing phenotype among patients with sarcopenia and sarcopenic obesity (SO) and to assess the clinical and functional relationships between these clinical manifestations and dyspnea in the study cohort.

MATERIALS AND METHODS. In a cross-sectional observational study of 227 geriatric patients divided into four comparative groups (with sarcopenia, with SO, with obesity without sarcopenia, control group without sarcopenia and obesity), the frequency of CD, depression, dyspnea, and the slowing phenotype was studied. The McNaught and Kane scale was used to identify cognitive impairment. Depression was assessed using the Geriatric Depression Scale (GDS-15). The Modified Medical Research Council (mMRC) and Borg scales were used to interpret the severity of dyspnea.

RESULTS. The mean age of the study participants was (76.48 ± 6.94) years, with a predominance of female subjects (73.57 %). Among patients with sarcopenia and sarcopenic obesity, the greatest number of individuals with cognitive deficit, depression, and the slowing phenotype were identified. Patients with dyspnoea were found to be numerically and more severely predominant in the sarcopenic obesity and non-sarcopenic obesity groups. Statistically significant relationships were established between sarcopenia and cognitive dysfunction (c² = 27.34; p < 0.001; С = 0.38 — average relationship), and between sarcopenia and depression (c² = 10.82; p = 0.002; С = 0.24 — average relationship). The present study found a statistically significant correlation between dyspnoea and depression (r = 0.20; p = 0.049), fatigue (r = 0.33; p = 0.008) and average relationship with obesity (c² = 7.85;  p = 0.006; C = 0.27). Conversely, obesity was not associated with cognitive dysfunction or depression.

CONCLUSION.  Among patients with sarcopenia and sarcopenic obesity, there is a high frequency of cognitive dysfunction, depression, and the slowing phenotype, which represents the most unfavorable prognostic variant of aging. Indirectly, dyspnea in such patients can aggravate the condition due to the negative impact on fatigue, physical function, and depression.

Cognitive disorders are one of the most significant problems for elderly and senile people. Particular attention should be paid to the diagnosis of early pre-dementia stages of cognitive impairment: subjective and subtle cognitive decline and mild cognitive impairment. The review presents current concepts of classification of pre-demential forms of cognitive decline, their diagnosis, and therapeutic approaches to managing patients with these disorders. Non-pharmacological methods for managing patients with initial forms of cognitive declines are discussed. The importance of cognitive training, physical activity, and socialization for such patients is highlighted. When considering drug therapy for pre-demetial cognitive impairment, the safety profile of medications is discussed, especially in the elderly population, where it is important. Finding safe and well-tolerated medications for elderly patients remains a priority for specialists. The possibility of using Prospekta in the management of patients with early cognitive decline is being considered.

Osteoporosis is one of the most significant medical problems, especially in the context of global population aging. With increased life expectancy, the number of elderly patients with this pathology is growing, which has significant medical and socio-economic consequences. Osteoporosis is characterized by a decrease in bone mineral density, which significantly increases the risk of fractures, especially in older age groups. These pathological changes not only worsen the quality of life of patients, but also lead to increased healthcare costs and increase the social burden.

BACKGROUND. Osteoarthritis (OA) is a major medical and social problem in modern society, as it is the leading cause of impaired mobility, loss of independence, and disability. Sarcopenia, which often coexists with OA, minimizes the effectiveness of non-pharmacological treatment programs for osteoarthritis. There is considerable clinical interest in the efficacy of symptomatic slow-acting drugs (disease-modifying agents), focused on the clinical manifestations of sarcopenia.

OBJECTIVE. To evaluate changes in muscle strength and function during therapy with a bioactive concentrate derived from small marine fish in patients with chronic nonspecific musculoskeletal pain and probable sarcopenia.

MATERIALS AND METHODS. A single-center, open-label, prospective, phase IV comparative post-marketing study was designed to assess changes in muscle strength and function during treatment with a bioactive concentrate derived from small marine fish in 60 geriatric patients with probable sarcopenia and chronic nonspecific musculoskeletal pain.

RESULTS AND DISCUSSION. During therapy, an increase in muscle strength was observed in both the intervention and control groups. Handgrip strength increased by 44.3 % over 2 months in the intervention group (from  14.7 kg to 21.2 kg), compared with a 5.9 % increase in the control group. Over the observation period, «Timed Up and Go» decreased by 40.6 % in the intervention, with most patients reaching the reference value compared to a 22.9 % reduction in the control. Gait speed increased by 6.5 % in the first month versus 2.4 % in the second month in the intervention. Pain reduction reached 83.1 % in the group after 2 months, compared to 22.8 % in the control (p = 0.02).

CONCLUSION. The inclusion of a bioactive concentrate from small marine fish in the comprehensive management of pain exacerbations in patients with chronic nonspecific musculoskeletal pain and probable sarcopenia resulted in a greater reduction in pain compared to the control group. Under pain control conditions, indicators of muscle strength were significantly improved in the group receiving the bioactive concentrate compared to those in the control group.

BACKGROUND. One of the most common age-related conditions is atrial fibrillation (AF). The development of AF in geriatric patients leads to the inevitable prescription of additional medications: anticoagulants and means to control rhythm or frequency. This situation often leads to polypharmacy and an increased risk of dangerous adverse events, which is especially unfavorable for patients with frailty and pre-frailty. In addition, despite the treatment of AF according to clinical recommendations, emergency treatment for such patients remains quite frequent.

OBJECTIVE. Analysis of the reasons for seeking emergency care for geriatric patients with AF and evaluation of the effectiveness of measures carried out at the prehospital stage.

MATERIALS AND METHODS. The study, performed in real clinical practice by an on-site emergency team, involved 36 patients with paroxysmal AF. According to the results of screening using the «Age is not a hindrance» questionnaire, patients were divided into 3 groups: 18 patients without frailty-syndrome (FS) (50 %), 9 patients with pre-frailty syndrome (PFS) (25 %), 9 patients with FS (25 %). The reasons for seeking emergency care were identified, the completeness and adherence to previous therapy were assessed, and outcomes were analyzed. Frequency comparisons were performed using the chi-square test.

RESULTS. The geriatric care was previously available to all patients with FS. In patients with PFS and in patients without FS, screening of the FS was performed for the first time. The causes of treatment in 75 % of cases were palpitations and heart failure, in 16.7 % of cases ― arterial hypertension (systolic pressure above 180 mmHg), in 8.3 % of cases ― arterial hypotension, accompanied by weakness and dizziness. The patient groups had no significant differences in the reason for seeking emergency care (p = 0.287). Increased symptoms of heart failure were significantly more often observed in patients with PFS (44.4 %) and patients with FS (88.8 %), and were not detected in patients without FS (p = 0.036). All patients with AF were prescribed standard therapy before seeking emergency treatment, including rhythm control drugs (propafenone or amiodarone) and oral anticoagulants (apixaban, rivaroxaban). Nevertheless, 16.7 % of the patients without FS took acetylsalicylic acid instead of anticoagulants. The incidence of decreased adherence to treatment in patients without FS was 16.7 %, in patients with PFS ― 66.7 %, while in patients with FS ― 11.1 % (p = 0.048). The restoration of sinus rhythm at the prehospital stage was achieved only in patients without FS in 33.3 % of cases, an adequate reduction in heart rate was achieved in 66.7 % patients without FS, in 33.3 % of patients with PFS and in 16.7 % of patients with FS (p = 0.026). In 33.3 % of cases, patients with FS were hospitalized due to the ineffectiveness of pre-hospital treatment, and in 66.6 % of cases due to the detection of symptoms of decompensation of concomitant chronic heart failure. Overall, the hospital admission rate for patients with paroxysmal AF was 33.3 %.

CONCLUSION. The most common reason for geriatric patients with paroxysmal atrial fibrillation seeking emergency care is insufficient rhythm control. Prehospital therapy was effective mainly in patients without frailty-syndrome, when sinus rhythm restoration was achieved in 33.3% of cases. Hospitalization was necessary in 33.3% of cases due to the ineffectiveness of prehospital measures or as a result of decompensation of heart failure, which was observed mainly in patients with frailty-syndrome. Patients with pre-frailty turned out to be the least committed group to treatment. It is possible that some of them may have signs of dementia, which makes it difficult to take medications, and are subject to a more in-depth examination by the geriatric service.

BACKGROUND. The Russian government has set itself an ambitious goal – to significantly increase both the duration and quality of life of citizens, paying special attention to the older generation. The promotion and comprehensive support of active longevity is becoming a key area of government policy. The essence of this strategy is to maximize the involvement of older people in work and social life, which, in turn, has a positive effect on their physical and psychological condition. Voronezhstat data for 2024 indicate that pensioners make up an impressive 42 % of the population of the Voronezh Region. This figure clearly demonstrates the scale of the task facing the regional authorities to ensure a decent life and social adaptation of the older generation.

OBJECTIVE. To determine the effectiveness of a recovery program for 65-year-old women with sarcopenic obesity.

MATERIALS AND METHODS. The study involved 60 people selected according to certain criteria. The studied patients were classified according to the presence or absence of sarcopenic obesity. To analyze the effectiveness of rehabilitation intervention, two groups were formed: experimental and control. For 6 months, the participants of the experimental group, in addition to traditional treatment, underwent a rehabilitation program developed at the N. N. Burdenko State Medical University. The program included physical exercises, dosed according to the condition and functional capabilities of the patients, as well as a high-protein diet (1.0 g/kg/day). The Sports Complex (SC) of the N. N. Burdenko VSMU, as part of the program for the rehabilitation of the elderly, offers a course of 10 thematic classes organized in a scientifically based manner for this category of patients. Classes lasting 60 minutes are held 2 times a week for 6 months in a certain sequence. On the first day, a group is formed and an introductory lecture is held. Participants are explained the principles of the program, rules of conduct, individual wishes are taken into account. A medical examination is conducted by a doctor to identify health problems. The day ends with an introductory complex of therapeutic gymnastics and an introduction to the psychologist. The second session starts with therapeutic gymnastics and continues in the phytobar with a discussion of physiological changes in old age with basic recommendations. The third day includes therapeutic gymnastics in the gym and a talk on the prevention of aging of the musculoskeletal system, as well as an introductory chiropractic procedure. The fourth day includes a session in the swimming pool and discussion of the basics of proper nutrition and modern diets, principles of healthy lifestyle. The fifth session - discussion of techniques and performance of breathing exercises and inhalations. The sixth day - exercise machines, discussion about skin care and anti-cellulite massage, doctor's examination. The seventh session - dosed walking and a talk about its role in longevity. Eighth session - Nordic walking and a talk about its principles, pros and cons, a session with a psychologist. The program is completed by a walk in nature (ninth day) and a relaxation complex of therapeutic gymnastics (tenth day).

RESULTS. In the experimental group of patients suffering from sarcopenic obesity, statistically significant changes in anthropometry and quality of life were found after the rehabilitation course. There was a significant decrease in weight (from 90.1 kg to 84.2 kg; p < 0.001) and body mass index (BMI) (from 32.8 kg/m² to 30.9 kg/m²; p < 0.001). At the same time, after rehabilitation measures, there was a noticeable increase in absolute (from 14.8 kg to 16.2 kg; p < 0.001) and relative (from 16% to 22%; p < 0.001) muscle mass, as well as the MMI/BMI ratio (from 0.459 to 0.583; p < 0.001). The assessment of quality of life revealed a significant decrease in the overall score, which indicates an improvement in various aspects of life in these patients. Statistically significant changes in anthropometric indicators and quality of life assessment were also recorded in patients of the experimental group without sarcopenic obesity. There was a marked decrease in body weight (from 80.0 kg to 74.9 kg; p = 0.001) and BMI (from 28.2 kg/m² to 25.3 kg/m²; p < 0.001

 CONCLUSION. Regular physical activity, especially of an aerobic nature, stimulates the mechanisms of muscle tissue repair. In addition to building muscle mass, they have a positive effect on the functioning of the heart and blood vessels of the brain, which is especially important for overweight people.

The study was conducted to assess the quality of life of elderly and senile patients with arterial hypertension (AH); for this purpose, the results of using the European Quality of Life Questionnaire (EQ-5D-3L) and the Hospital Anxiety and Depression Scale (HADS) for these patients were studied.  It was found that, compared with patients without hypertension, patients with hypertension have more difficulties in daily life and higher levels of anxiety and depression.  At the outpatient stage of management of patients in the older age group with hypertension, conduct a survey using EQ-5D-3L and HADS and, after evaluating its results, add measures to the rehabilitation program to correct the physical and mental components of quality of life, which will further avoid complications of hypertension and increase the life expectancy of patients with this disease.

BACKGROUND.  In our country, the aging of the population is characterized by an increase in the number of residents over the age of able-bodied and an increase in life expectancy. It is noted that about 80 % of the older generation suffer from polymorbid chronic pathology. Most often, 1 patient over the age of 60 has more than 4 chronic diseases and the need for medical care increases.

Hypertension is one of the most common diseases of the cardiovascular system with complications that cause disability and premature mortality, especially in the older age group of patients. Hypertension not only has high risks of complications, but also leads to a decrease in the quality of life of patients, worsening their psychological and physical condition. Specific questionnaires can be used to assess one specific category of quality of life (physical or mental condition). or to assess the quality of life for a certain disease. Based on the results of the survey of patients with hypertension, it is possible to introduce measures to correct the psychological and physical components of quality of life into the programs of preventive measures during dispensary supervision.

OBJECTIVE. To evaluate the quality of life of elderly and senile patients with hypertension based on the results of surveys using the EQ-5D-3L and HADS questionnaires.

MATERIALS AND METHODS. The object of the study was 120 patients over 65 years old with hypertension who signed an informed consent to data processing in the framework of a scientific study (the main group), and 40 patients of the same age group who did not suffer from hypertension (the control group). All study participants underwent physical and laboratory examinations. Additionally, all patients were surveyed using the EQ-5D-3L and HADS questionnaires.

RESULTS. As a result of the study, it was revealed that 65+ patients suffering from hypertension are more likely to be overweight or obese compared to the control group.

The use of questionnaires in the study allowed us to establish the following facts.

Patients with hypertension are more likely than the control group to experience difficulties in daily life and increased levels of anxiety and depression.

Thus, 26.6 % of AH sufferers have 8–10 points on the anxiety scale (0 % in the control group); more than 10 points ― 7.6 % (0 % in the control group). The fact of a more frequent occurrence of depression in patients with hypertension has been recorded: 16.5 % have 8–10 points (0 % in the control group).

This suggests that these patients need a correction of their psychoemotional state.

In addition, it was found statistically significantly (p < 0.05) that patients with combined pathology (CHD + AH or DM + AH) are more likely to have difficulty walking. This is significantly related to the presence of pain or discomfort during movement. Thus, it is confirmed that patients with polymorbid pathology have a reduced quality of life component. A survey of patients with hypertension showed that with a significant degree of probability (p < 0.001), walking difficulties are closely correlated with age.

The data from the results of the study in the group of older women suffering from hypertension showed that in the female cohort of such patients, as well as in the general group, a significant (p < 0.05) relationship was established between the severity of abdominal obesity (waist circumference > 88 cm) and the risk of cardiovascular diseases.

CONCLUSION. Based on the results of the study, it is recommended to conduct an EQ-5D-3L and HADS questionnaire at the outpatient stage of patient management and, after evaluating the results, add measures to correct the physical and mental components of quality of life to rehabilitation programs.

With the information obtained as a result of the patient survey, it is possible to correct the diet, daily routine, patient behavior, as well as pharmacorrection and, as a result, optimize the quality of life, which will further avoid complications of hypertension and increase the life expectancy of patients with this disease.

BACKGROUND. Progressive limitation of life activity with aging is largely associated with the development of sarcopenia, a geriatric syndrome characterized by decreased muscle strength and mass, requiring timely correction to maintain functional independence and quality of life in older people.

OBJECTIVE: to assess the severity of sarcopenia in older men and women to assess their potential for achieving active longevity.

MATERIALS AND METHODS. The object of the study was a random sample of 120 patients (30 men and women of elderly and senile age, mean age - (77.3 ± 2.5) years) who went to the medical prevention departments of polyclinics in Kursk to undergo annual medical examination. Kursk to undergo annual medical examination. All patients were evaluated by carpal dynamometry to judge whether the muscle strength of both arms was preserved or decreased, and the strength index (SI) was calculated, reflecting its percentage relation to body weight. A brief questionnaire was administered to the study participants using the SARC-F screening questionnaire to determine the individual probability of SP development in points, indirectly reducing the potential for achieving active longevity.

Statistical analysis of the results was carried out by descriptive statistics methods; normality of distribution was established by the Shapiro-Wilk test at p < 0.01; reliability of differences between the studied indicators was assessed by Student's test at p < 0.05. The strength and direction of the relationship between the studied characteristics was determined on the basis of the Pearson correlation coefficient.

RESULTS. Screening assessment with the SARC-F questionnaire revealed probable SP in 64% of the respondents, and in 36% of the examined patients - its absence. In elderly women, self-assessed SP was significantly higher than in men of similar age ((5.5 ± 0.4) points vs. (4.60 ± 0.25) points; p < 0.05). The left and right hand dynamometry values in women were (10.7 ± 1.5) kg and (12.8 ± 1.6) kg, respectively, while in their male peers they were significantly higher: (26.3 ± 2.4) kg and (27.5 ± 2.7) kg, respectively (p < 0.001). The SI in women was significantly lower than in men ((14.6 ± 2.2) % vs. (25.2 ± 2.1) %; p < 0.001), which indirectly confirmed the more pronounced degree of their physical limitations and, consequently, their greater need for assistance.

The expression of SP in the elderly subgroup, assessed by the questionnaire method in points, was found at a higher level than in the elderly group; no gender differences were revealed. According to the results of dynamometry, left and right arm strength in women was significantly lower than in men ((4.3 ± 1.2) kg vs. (16.2 ± 1.5) kg and (6.1 ± 1.3) kg vs. (19.3 ± 2.1) kg, respectively), as well as SI ((5.5 ± 1.4) % vs. (18.7 ± 2.0) %) (p < 0.001).

Comparison of SI values between subgroups of elderly and elderly patients confirmed similar differences (p < 0.001) in favor of younger patients.

In the group of men and women over 75 years of age, strong inverse correlations were found between the SP index and dynamometry (r = -0.70 and r = -0.63; p < 0.01), indicating a significantly pronounced relationship between age-related changes in the muscular system and limitations of vital activity. In representatives of the elderly group, these correlations were smaller (r = -0.43 and r = -0.38; p < 0.05), which may serve as a predictor of relative compensation for the functional decline in muscle strength with moderately pronounced structural changes in them against the background of aging, thereby indicating the preservation of the potential to achieve active longevity, provided that the optimal diet and exercise regimen is followed.

CONCLUSION. The greatest severity of involutional sarcopenia, established in elderly women, confirms a higher probability of developing their functional dependence, serves as a predictor of a high risk of adverse medical and social consequences. Measures aimed at slowing the development and progression of age-associated sarcopenia will serve as the basis for achieving both individual and population-wide active longevity.

The number of elderly people is projected to increase, which increases the need for strategies to prolong a healthy life. Regular physical activity can prevent many age-related diseases, including cardiovascular diseases, diabetes, and cognitive impairment. It has a positive effect on key biomarkers of aging: it enhances antioxidant protection, suppresses inflammation, preserves telomere length and improves blood lipid profile. However, the exact molecular and cellular mechanisms of this beneficial effect require further research.

BACKGROUND. The average life expectancy in developed countries is projected to reach 80 years, which will lead to an increase in the proportion of the elderly population to a quarter of the world's population by 2050. At the same time, the duration of a healthy life lags behind the general one, increasing the period of disability. Strategies for improving healthy longevity include regular physical activity that can prevent or reduce the severity of many age-related chronic diseases, such as coronary heart disease, chronic heart failure, type 2 diabetes, COPD, osteoporosis, depression, and dementia. At the same time, the pathophysiological mechanisms of this effect remain insufficiently studied.

OBJECTIVE. Analysis of scientific data on the relationship of physical activity with biomarkers of age-related diseases

MATERIALS AND METHODS. An analytical review of the scientific literature over the last decade devoted to methods for assessing the impact of physical activity on biomarkers of age-associated physiological changes and age-related diseases has been conducted. The analysis was performed using electronic databases (PubMed, UpToDate) and an Internet search engine (Google Scholar) for keywords: physical activity, aging, the elderly, biomarkers, age-related diseases.

RESULTS. Physical activity affects a number of markers of aging that reflect the state of the body. The sensitivity of tissues to insulin improves, and the risk of type 2 diabetes mellitus decreases. There is a decrease in the concentration of free radicals and an increase in antioxidant protection. A decline in inflammatory cytokine levels was observed in response to regular physical activity. The practice of physical activity has been demonstrated to contribute to the maintenance of optimal telomere length by modulating the process of cellular aging. Telomerase activity increases, thereby preventing telomere shortening. A decline in LDL and triglyceride levels is observed. The level of the stress hormone cortisol decreases. The concentration of dehydroepiandrosterone, which has anti-aging effects, increases. The level of neurotrophic factor (BDNF) increases, which is important for maintaining cognitive function. Homocysteine and C-reactive protein levels decrease, which reduces the risk of neurodegenerative diseases. These markers indicate that physical activity affects various pathophysiological mechanisms of age-related diseases.

CONCLUSION. Regular physical activity reduces the likelihood of many chronic diseases, such as heart disease, metabolic disorders, and osteoporosis. Despite the obvious benefits, the mechanisms of influence of physical activity have not been sufficiently studied. Physical activity slows down cellular aging, affecting the rate of telomere shortening, and causes epigenetic changes that enhance the expression of genes providing antioxidant protection. In addition, physical activity reduces the severity of inflammation, improves mitochondrial function, activates autophagy, and increases the production of myokines. These processes are confirmed by the connection between physical activity and various biomarkers of aging.

Ergospirometry is used to assess the perioperative prognosis in patients of different age groups, and traditionally, the indicators recorded on the peak of the exercise are evaluated. Achieving peak values during the study may be difficult for people over 60 years old with comorbid pathology, and therefore it is important to study the dynamics of the subthreshold values recorded during stress testing and the dynamics of their changes. A retrospective analysis of clinical and anamnestic data and ergospirometry parameters was performed in 100 patients (mean age (68,0 ± 2.6) year) who underwent planned lobectomy for stage II lung cancer. The following ergospirometry indicators were prognostically significant in relation to the risk of perioperative complications: the level of oxygen consumption and energy consumption at all stages of ergospirometry, starting from the adaptation stage; the dynamics of a decrease in cardiac output in the first minutes of exercise; the level of the anaerobic threshold; index of respiratory reserve at all stages of the study.

BACKGROUND. The ergospirometry technique is used to assess exercise tolerance, differential diagnosis of shortness of breath, detection of previously unverified pathology of the cardiovascular and respiratory systems, assessment of the patient's preoperative status and rehabilitation measures. The presence of frailty and associated geriatric syndromes is considered an unfavorable prognostic factor, but the degree of their influence requires clarification. At the same time, it is necessary to take into account that adaptive reserves and, as a result, the ability to maintain homeostasis under the influence of a stressful factor are individual. In this regard, along with the presence of frailty syndrome, age-related viability must be taken into account. The value of ergospirometry for older people lies in the simultaneous assessment of a large number of parameters of the cardiorespiratory link and the metabolic profile under standardized load conditions. To determine the perioperative prognosis, parameters such as the level of oxygen consumption at the peak of exercise and at the anaerobic threshold, and the ventilation carbon dioxide equivalent are traditionally evaluated. Achieving peak values during the study may be difficult for people over 60 years old with comorbid pathology, and therefore it is important to study the dynamics of the subthreshold values recorded during stress testing and the dynamics of their changes.

OBJECTIVE. Identification of the features of physiological reactions during cardiorespiratory stress in elderly people.

MATERIALS AND METHODS. A retrospective analysis of clinical and anamnestic data and ergospirometry indicators of patients examined at the oncological department No. 4 (thoracic department) of St. Petersburg A.P. Pavlov First State Medical University was carried out. The criteria for inclusion in the study were: elderly age, the availability of comprehensive geriatric assessment data, the possibility of performing ergospirometry on a bicycle ergometer according to a standardized ramp exercise protocol, the absence of absolute contraindications to performing exercise testing, and the availability of voluntary informed consent to conduct the study. A total of 100 people were included in the study, the average age was (68.0 ± 2.6) year (84 men, 16 women). All patients were admitted to the department as planned due to the presence of stage II lung cancer in order to perform a planned lobectomy operation. An assessment of the presence of chronic somatic pathology, a comprehensive geriatric assessment, preoperative ergospirometry, and an analysis of the features of the perioperative period were performed.

RESULTS. Frailty syndrome was detected in 39 % of patients, and prefrailty was observed in 29 % of the subjects. All patients had hypertension, 28% had ischemic heart disease, and 64 % had COPD. Patients with frailty syndrome showed lower values characterizing the level of oxygen consumption (p = 0.02) and energy consumption (p = 0.05) at all stages of ergospirometry, starting from the stage of adaptation (pedaling without load) compared with patients without frailty. In patients with frailty and prefrailty, there was a decrease in cardiac output by 15–25 % at the initial stage of the study (in the first minutes of exercise), more pronounced in the presence of frailty, which did not correlate with clinical and anamnestic data on the presence of coronary artery disease or clinically significant chronic heart failure. There was also an earlier achievement of the anaerobic threshold in patients with frailty syndrome with patients with prefrailty (p = 0.02) and patients without these geriatric syndromes (p = 0.0006). The load level to achieve the anaerobic threshold was (42.5 ± 4.6) W, (56.2 ± 3.4) W and (62.3 ± 2.9) W, respectively.

Nonfatal complications associated with surgery were reported in 14 % of patients, and no deaths were observed. The analysis of ergospirometry results revealed a statistically significant increase in the level of the respiratory reserve index at each stage of the study in all patients with perioperative complications (sensitivity of this parameter was 66.7–91.7 %, specificity was 64.2–88.0 %, depending on the stage of exercise).

CONCLUSION. The indicators recorded at the initial stages of ergospirometry may have significant prognostic value for assessing the adaptive potential of the body of elderly patients.

The effect of a combination of glutamyl-cysteinyl-glycine disodium and bedaquiline on the treatment of multidrug-resistant tuberculosis in rabbits of different ages was studied. Combination therapy improved the condition of animals, reduced inflammation and the size of lesions in the lungs, especially effective in elderly individuals. The data obtained emphasize the importance of taking into account the patient's age when prescribing anti-tuberculosis therapy.

BACKGROUND. The high incidence of tuberculosis and the difficulties of its treatment in older people are an urgent problem of phthisiatry and geriatrics. The growing drug resistance of mycobacteria and an increase in immunodeficiency diseases lead to the search and development of new medicines. Disodium glutamyl-cysteinyl-glycine has shown high efficacy as a means of preventing and treating secondary immunodeficiency conditions associated with radiation, chemical and infectious factors. Being a structural analog of oxidized glutathione, disodium glutamyl-cysteinyl-glycine has high bioavailability, modulating effect on intracellular processes of thiol metabolism, promotes initiation of cytokine system, activation of phagocytosis. The drug glutamyl-cysteinyl-glycine disodium is approved for use in pulmonary tuberculosis, but age-associated effects have not been studied.

OBJECTIVE. Evaluation of age-associated effects of glutamyl-cysteinyl-glycine disodium in combination with bedaquiline in multidrug-resistant tuberculosis in rabbits

MATERIALS AND METHODS. Three groups of 25 rabbits each with standard laboratory conditions were formed.: 1st ― young animals (1 year old), body weight ― 1,000–1,200 g; 2nd ― middle-aged animals (4 years old), body weight ― 1,700–1,900 g; 3rd ― elderly animals (7 years old), body weight ― 2,000–2,300 g. Three subgroups were identified in each age group: 1st (n = 5) ― infection control (infected animals without treatment); 2nd (n = 10) ― treatment control (infected animals receiving only bedaquiline); 3rd (n = 10) ― main (infected animals receiving bedaquiline + glutamyl-cysteinyl-glycine disodium). Thus, nine subgroups were formed: 1.1 ― a subgroup for the control of infection of young animals; 2.1 ― a subgroup for the control of infection of middle-aged animals; 3.1 ― a subgroup for the control of infection of elderly animals; 1.2 ― a subgroup for the control of treatment of young animals; 2.2 ― a subgroup for the control of treatment of middle-aged animals; 3.2 ― a subgroup for the control of treatment of elderly animals; 1.3 ― the main subgroup of young animals; 2.3 ― the main subgroup of middle-aged animals; 3.3 ― the main subgroup of elderly animals. Infection was carried out intravenously with a clinical strain of M. tuberculosis with multiple drug resistance. Treatment began on the third day after infection with bedaquiline and glutamyl-cysteinyl-glycine disodium. The condition of the animals, physical activity, food and water intake, and weight dynamics were monitored. CT scans of the lungs and hypersensitivity reaction tests were used. The data was processed using a package Statistica 7.0.

RESULTS. Monitoring the condition of the animals 6 weeks after infection allowed us to obtain the following results.

Young rabbits (1 year old). Infection control ― poor condition, low activity, low consumption of food and water. Treatment control ― satisfactory condition, good activity, normal diet and drink. The main subgroup is in excellent condition, maximum activity, increased intake of food and water.

Middle-aged rabbits (4 years old). Infection control ― poor condition, decreased activity, low intake of food and water. Treatment control ― satisfactory condition, good activity, increased intake of food and water. The main subgroup is in good condition, high activity, moderate intake of food and water.

Elderly rabbits (7 years old). Infection control is a critical condition, severe loss of activity, minimal intake of food and water. Treatment control ― satisfactory condition, good activity, sufficient intake of food and water. The main subgroup is satisfactory condition, average activity, and average food and water intake. In the first 3 weeks after infection, an increase in body weight was noted in all subgroups, in the 4th and 5th weeks, against the background of a clear decrease in these indicators, an increase in the average weight of animals in the main subgroups was observed in the infection control and treatment control subgroups. In response to intradermal administration of a sample with a tuberculosis recombinant allergen (Diaskintest) 18 days after inoculation of mycobacterium tuberculosis in intact experimental animals, a negative reaction was noted, and in all model rabbits a positive test result was recorded in the form of erythema with a size of (18.50 ± 1.49) mm (p < 0.0001), which indicated the presence of sensitization and confirmed the development of the tuberculosis process.

CT scans of the chest organs of animals from the infection control subgroups (subgroups 1.1, 2.1, 3.1) in all three age groups studied showed the presence of large polycyclic infiltrates of heterogeneous density in the upper lobes of the lungs, most likely of a specific nature. At the same time, in the group of elderly animals, pathophysiological changes formed faster and were more pronounced. CT scans of the thoracic organs of animals from the treatment control subgroups (subgroups 1.2, 2.2, 3.2) in all three age groups studied showed the presence of small foci of infiltration in the lungs with areas like frosted glass around the periphery. At the same time, the observed changes in the groups of middle-aged and elderly rabbits were more pronounced and had a longer duration with a tendency to chronicle the pathological process. CT scans of the thoracic organs of animals from the main subgroups (subgroups 1.3, 2.3, 3.3) in all three age groups studied showed the presence of focal infiltrative changes in the lungs of low intensity, which are less pronounced than in animals from the treatment control subgroups of the corresponding age groups. After infection, small focal shadows in the subpleural regions of the lungs, corresponding to the primary foci of infection, were observed in young rabbits. In middle-aged and elderly rabbits, more extensive infiltrates and focal shadows were detected, occupying significant areas of the lung. In elderly rabbits, signs of active inflammation with the presence of exudate in the alveoli were observed. An increase in the size of the intrathoracic lymph nodes, especially bronchopulmonary and tracheobronchial, was observed in rabbits of all age groups studied. The rabbits' body weight was unstable throughout the experiment. The changes depended on age and treatment regimen. Computed tomography of the lungs confirmed the formation of tuberculous changes of varying severity depending on age and treatment. In general, the treated animals showed better health, activity, and appetite compared to the untreated ones.

CONCLUSION. The results obtained confirm the presence of an inflammatory process in animals in the infection control subgroups of all ages. Inflammatory changes were also observed in the main subgroups and treatment control subgroups, and they were more pronounced in the latter. Computed tomography of the lungs in the main subgroups showed less pronounced focal infiltrative changes compared with the comparison subgroups, which indicates the potentiating effect of glutamyl-cysteinyl-glycine disodium. The study demonstrates the potential of this substance in combination with bedaquiline and opens up prospects for its inclusion in tuberculosis treatment regimens, including age-related aspects.

BACKGROUND. In the modern world, life expectancy is increasing, which leads to an increase in the number of elderly people. The problems of maintaining and promoting health, a rational lifestyle, and improving the functional capabilities of the elderly and senile are relevant to society as a whole. The choice and use of longevity technologies must be personalized, taking into account the characteristics of human health, lifestyle, and take into account genetic and epigenetic factors. In the Republic of Karelia, one of the causes of serious health disorders of the population is a deficiency of trace elements. The analysis of the elemental status and the development of corrective programs are of key importance in the elderly and senile for the prevention of diseases associated with deficiency and imbalance of trace elements.

OBJECTIVE. The purpose of the study is to study the content of macro- and microelements in the body of residents of the older age group in various regions of the Republic of Karelia in order to further develop recommendations for correcting the deficiency.

MATERIALS AND METHODS. To assess the elemental composition of the body, the composition of trace elements in the hair was analyzed using atomic emission and mass spectrometry methods. All hair samples were collected and subjected to sample preparation according to the requirements of the International Atomic Energy Agency and the methodological recommendations of the Federal Center for State Sanitary and Epidemiological Supervision of the Russian Federation. A specially designed questionnaire with personal data was filled out for each subject. The results were compared with the reference values of this age group in the middle zone of Russia.

RESULTS. As a result of the research, a high prevalence of diselementosis was revealed among the examined. Most of the respondents were at risk ("pre-disease"). Calcium deficiency was the most common. Such a frequency of Ca deficiency may be associated with hypo- and vitamin deficiency D, which is a consequence of the prolonged exclusion of UV rays from the skin during the shortened daylight hours ("light starvation") in the autumn-winter period in the northern territories of our region. Deficiencies of magnesium, copper, iodine, zinc, selenium, and cobalt were also found in this sample. In addition, some of the respondents noted the presence of mercury and lead in their hair. Toxic elements (mercury and lead), which normally should not be in the human body, can come from water, food or air, which may be due to a high level of industrial pollution.

CONCLUSION. A study of the elemental composition of hair in this sample of elderly people living in the Republic of Karelia has shown that the data obtained differ significantly from the reference values typical for residents of central Russia. The work highlights the importance of monitoring the micronutrient status for the health of the population of the northern territories and the need for an interdisciplinary approach to solving this problem. Based on the data obtained, a personalized mineral complex was developed for elderly and senile residents living in Karelia, which includes calcium, magnesium, zinc, selenium, cobalt, copper and iodine.

BACKGROUND.  Arterial hypertension is, on the one hand, a disease requiring lifestyle changes, constant drug therapy, which worsens the quality of life of patients, and, on the other, an independent risk factor for the development of chronic non–communicable diseases. The greatest importance in determining the life expectancy of patients with hypertension is the complex effect of age-mediated rearrangements of organs and systems and the long-term damaging effects of blood pressure.

The importance of arterial hypertension as a factor determining the duration and quality of life is undeniable, but insufficient attention remains to the individual components of the external and internal environment that determine the course of hypertension.

OBJECTIVE. Analysis of the impact of certain medical and social factors on the average life expectancy of older patients with arterial hypertension in the Kursk region.

MATERIALS AND METHODS. The study material includes outpatient cards (form 025/y) of 449 deceased patients with hypertension (2014–2024). Of these, 117 from Kursk and 73 from the Kursk region in 2014–2019, 158 from Kursk and 101 from the Kursk region in 2020–2024. Analysis of the results ― MicrosoftExcel 2010.

RESULTS. The main indicator is the life expectancy of patients with hypertension served in multidisciplinary urban polyclinics for the period 2020–2024 reached (69.74 ± 0.97) year, that is, lower than in 2014–2019, when it was (72.12 ± 1.07) year. Similar changes in life expectancy can be traced in rural areas, where the observed patients received medical care mainly in outpatient clinics. So for the period 2020–2024. It was (68.42 ± 1.29) year, and in 2014–2019 it was (71.64 ± 1.26) year. Such unfavorable trends are determined by the complicated course of COVID-19 in older people and the antiepidemic limitations of preventive measures.

The influence of coronavirus infection can also be traced in the assessment of life expectancy with hypertension. So in 2020–2024 in Kursk it was (11.07 ± 0.52) year and in the Kursk region ― (9.13 ± 0.79) year. Which is lower than the values of the previous calendar period ― (14.38 ± 0.61) year and (13.82 ± 0.73) year, respectively.

Effective follow–up in 2020–2024 was only 47.24 % for the city of Kursk, 43.75 % for the Kursk region, that is, significantly lower than the values of the pre-epidemic period ― 84.06 % and 73.56 %, respectively.

The extremely negative aspects were the lack of recommendations on lifestyle changes in 2020–2024 in 46.18 % of cases in Kursk and 25.3 % in the Kursk region.

There is a similar trend in assessing involvement in regular health school attendance: in the period 2014–2019, the figure reached 22.45 % for urban residents and even higher ― 30.28 % ― among residents of the Kursk region. In 2020–2024 ― 10.8 % and 9.73 % in the city of Kursk and the Kursk region.

A positive trend has been noted over the past two years in the Kursk region as a whole ― the intensification of dispensary monitoring and patient involvement in health schools, but it is too early to assess the effectiveness of these trends.

CONCLUSION. Thus, the unsatisfactory restructuring of indicators characterizing life expectancy in the region was largely determined by the anti-epidemic limitations of COVID-19, when the quality and volume of preventive measures were significantly reduced due to the reorientation from prevention to treatment of urgent conditions.

BACKGROUND. The School of Health is an organizational form of group preventive counseling (ICD 10, Z70–Z76), hygienic education and upbringing, which is a comprehensive medical preventive service. The implementation of educational programs for patients of the older age group is a promising part of the formation of a healthy lifestyle, prevention of polypragmasia, improvement of quality of life and other aspects of a rational approach to the personification of medical care for elderly patients.

OBJECTIVE. To analyze the experience of conducting educational events in a hospital and polyclinic; evaluate the effectiveness of patient education at different stages of medical care; to determine the learning factors of different groups of patients and to identify the problems of effective interaction in learning groups.

MATERIALS AND METHODS.

1. Questionnaire-Patient feedback reviews.
2. Educational modules on nosological profiles.

RESULTS. Schools for citizens with various chronic diseases or with a high risk of developing them are a mandatory component of the second stage of dispensary examination of the adult population and dispensary monitoring of citizens of the second and third health groups (Order of the Ministry of Health of the Russian Federation of April 27, 2021, No. 404n, "On Approval of the Procedure for Preventive Medical Examination and Dispensary Examination of Certain Groups of the Adult Population").

It is recommended to conduct schools on the basis of the department (office) of medical prevention for adults or Health Centers. In addition, the introduction of health schools in a round-the-clock hospital is an important tool for creating continuity of education for patients at different stages of medical care. Educational modules in the hospital and in the polyclinic carry a different information load.

An analysis was conducted of the experience of health schools in the context of the 24-hour inpatient clinic of the Clinical Hospital for Veterans and the outpatient clinic of the hospital of the Institute of Scientific and Research Center of the Siberian Branch of the Russian Academy of Sciences. The patient underwent a four-month hospitalization, during which time they were treated in a medical facility. The study population comprised 127 patients from the older age group, with an average age of 76.7 years. Among the total sample of participants, 84 of the subjects were female, while 43 of the subjects were male. A total of 18 lectures, 27 seminars, and 4 master classes were conducted. In the polyclinic, 77 women and 23 men (average age 73.2 years) were trained. 22 lectures, 8 seminars, and 3 masterclasses were held. The topics of lectures and seminars are devoted to the prevention of non-communicable diseases. 120 feedback questionnaires from patients after participating in educational modules in the hospital and 94 outpatient questionnaires were analyzed.

CONCLUSION. According to the results of the conducted research, based on the questionnaire, it was established:

1. The issues of rational use of medicines, organization of proper nutrition in diabetes mellitus and gastrointestinal infarction, and prevention of falls are of the greatest interest to patients of the older age group both in the hospital and in the polyclinic.
2. Seminars in small groups and masterclasses are recognized as the most effective forms of training.
3. The features of the organization of educational events are identified – poor perception of lecture material due to hearing impairment in elderly patients, rapid exhaustion of attention due to cognitive deficits.
4. The most promising forms of improving educational activities in medical organizations are:

• Working in small groups
• Individual talks and trainings
• Mandatory visualization
• Visual handout
• The delivered voice of the doctor Simple speech in short phrases
• The duration of the review part is no more than 20 minutes
• Repeating key phrases for memorization
• Enough time for questions and answers
• Involving middle staff in the organization of lessons
• Choosing a comfortable room
• Speaker 's patience

BACKGROUND. Vascular age is considered as an additional criterion for the progression of cardiovascular disease and cardiovascular aging. Arterial hypertension contributes to the development of cognitive impairments that go beyond the age norm.

OBJECTIVE. Evaluation of the correlation relationship between vascular age and manifestations of moderate cognitive impairment in patients with arterial hypertension.

MATERIALS AND METHODS. The study included 30 patients with stage 1 and 2 arterial hypertension, 12 men, 18 women, aged 67 to 70 years. All patients underwent clinical, laboratory and instrumental examination in accordance with clinical recommendations. Based on the modified SCORE table, vascular age was calculated taking into account gender, age, smoking status, blood pressure and total serum cholesterol levels. The presence of manifestations of moderate cognitive impairment was assessed using the self-assessment questionnaire. A score of more than 45 points allowed us to suspect cognitive impairment. Moderate cognitive impairment was objectively assessed by conducting a minimal neuropsychological study on the ability to remember and repeat words before and after the Clock test.

RESULTS. In all patients, the vascular age was higher than the chronological age. The average chronological age was (62.4 ± 11.6) year, the average vascular age was (68.7 ± 10.6) year. The predominance of vascular age over chronological age varied from 2 to 10 years and was directly proportional to the duration of arterial hypertension (r = 0.64). Cognitive impairment, according to the memory self-assessment test, was detected in 11 patients (36.6 %). The average score of the memory self-assessment test was 38.39. The indicator of this test correlated with the vascular age indicator (r = 0.65). Objective assessment confirmed moderate cognitive impairment in 7 patients (23.3 %). According to the minimal neuropsychological examination, they were unable to reproduce previously memorized words, and 4 of them had noticeable deviations in the position of the hands or numbers on the clock face in the drawing. In these patients, the vascular age exceeded the chronological age by 7–10 years.

CONCLUSION. The obtained results showed that arterial hypertension can lead to the development of cognitive deficit. The influence of risk factors for arterial hypertension, which reflects the vascular age indicator, and an increase in the duration of arterial hypertension is associated with the likelihood of developing mild cognitive impairment.

BACKGROUND. A standardized approach to the use of a dual drug combination in the treatment of arterial hypertension (AH) as a first step, with subsequent possible transition to a three-component combination, shows that approximately 50 % of patients require a triple combination. The use of this strategy leads to an increase in the time to achieve blood pressure (BP) control, and a possible decrease in patient adherence to the prescribed treatment.

OBJECTIVE. To evaluate the effectiveness of blood pressure control using a strategy of triple antihypertensive therapy as a restart antihypertensive therapy.

MATERIALS AND METHODS. The study included 165 patients with grade 2-3 hypertension and high or very high cardiovascular risk, aged 65 to 75 years, who did not regularly use antihypertensive drugs. Group A consisted of 96 patients with hypertension who were prescribed a dual antihypertensive combination as first-step therapy, including drugs from four first-line classes (angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), calcium antagonists (CCBs), diuretics), with subsequent dose titration and possible addition of a third drug if the target BP level was not achieved. Group B included 69 patients with similar hypertension parameters who had previously taken dual antihypertensive therapy and noted its ineffectiveness (provided that no drugs were taken regularly during the last month). Office blood pressure monitoring was performed every 2-4 weeks; the dynamics of daily blood pressure parameters were assessed after 2 and 3 months.

RESULTS. Of the 96 patients in Group A, the target BP level with two-component therapy was achieved in 29 patients (30.2%). Effective BP control during the 2nd step of therapy with the addition of the third drug was achieved in another 59 patients in Group A (61.4%). In Group B, a faster achievement of the target BP level was observed. Already after 1 month of therapy in the restart three-component therapy group, the achievement of the target BP was observed in 40 patients (70.2%), which was accompanied by more significant dynamics of most daily BP parameters, whereas in Group A after 1 month of therapy, only 10 (16.9%) patients achieved the target BP, the rest were at the stage of dose and treatment strategy adjustment.

CONCLUSION. The use of a restart triple drug combination in patients indicating lack of blood pressure control when using two antihypertensive drugs in the past demonstrated a rapid rate of achieving target blood pressure levels and achieving early positive dynamics of daily blood pressure parameters. In patients with predictors of ineffective dual antihypertensive therapy, it is possible to shorten the first step with an early transition to a triple antihypertensive combination in order to achieve effective blood pressure control in the shortest possible time.

BACKGROUND. Hypodynamia is an important risk factor for the development of many diseases, and a sedentary lifestyle leads to aggravation of cardiovascular and respiratory pathology. The most accessible and effective method of physical rehabilitation for patients with cardiovascular and broncho-obstructive pathology at home, as well as safe in terms of orthopedic risk and the risk of cardiovascular complications, is dosed walking. However, studies devoted to the study of the effectiveness of blood pressure control, quality of life in comorbid patients using regular physical training, in particular, dosed walking, are currently few in number.

OBJECTIVE. To study the effect of dosed walking in addition to standard treatment in patients with hypertension and COPD on achieving blood pressure control.

MATERIALS AND METHODS. A total of 85 patients diagnosed with stage 2 hypertension, grade 1-2, risk III (high), COPD GOLD 2, group B were examined. The average age of the patients was (67.90 ± 1.06) years. In addition to drug therapy, dosed walking was added to the patients of group A. Patients of group B received drug therapy only. All patients underwent clinical, laboratory and instrumental examination methods in accordance with clinical recommendations, as well as a daily study of blood pressure indicators, depressive disorders were assessed using the Beck scale and quality of life indicators using the SF-36 questionnaire at the beginning of treatment, after 6 weeks and 6 months.

RESULTS. With the systematic use of physical rehabilitation methods (dosed walking) for patients with hypertension and COPD in addition to standard drug therapy, a more effective reduction in the frequency of complaints, improvement in quality of life, normalization of blood pressure, heart rate, lipid profile, and a decrease in the frequency of depression are observed. In the group of patients performing physical training, the long-term results confirmed the highest effectiveness of the treatment, with 91.1 % of patients achieving the target blood pressure level. Higher adherence to the therapy was also noted, with 93.3 % of patients continuing to perform physical training.

CONCLUSION. It is advisable to include dosed walking in the medical rehabilitation program of comorbid patients in addition to standard drug therapy in order to achieve blood pressure control, improve quality of life and increase patient adherence to regular antihypertensive therapy.

Fractures represent a significant socioeconomic burden worldwide. In chronic kidney disease, the incidence of fractures is five times higher than in the general population, with this disparity being particularly pronounced in advanced stages of renal dysfunction and among elderly patients. Hip fractures are four times more common in dialysis patients compared to the general population. In our prospective study, we analyzed mineral and bone disorder parameters in elderly patients with CKD, assessed FRAX calculator prognostic data in this patient cohort, and identified the most significant predictors of fracture development. The obtained data will be used to finalize the design of an information system for remote assessment of fracture risk over the next three years.

BACKGROUND. Mineral and bone disorders (MBD) are one of the leading complications in elderly patients with chronic kidney disease (CKD).

OBJECTIVE. To assess the three-year dynamics of mineral and bone disorders in patients with chronic kidney disease.

MATERIALS AND METHODS. The study included 50 patients with a mean age of (67.4 ± 1.6) year. For each patient, the 10-year fracture risk was assessed at baseline and after 3 years, along with comprehensive laboratory and instrumental examinations. Statistical analysis was performed using SPSS Statistics 22 software.

RESULTS. The overwhelming majority of patients had CKD stages 3–5 (76 %). The following CKD-MBD manifestations were recorded: secondary hyperparathyroidism, vitamin D deficiency/insufficiency across all CKD stages, and hyperphosphatemia predominantly in CKD5. Three patients had fracture history, 3 women experienced early menopause, and 4 patients received glucocorticoids for >3 months. Diabetes mellitus was the leading comorbidity (n = 21; 42 %). Osteoporosis was present in every third CKD patient (n = 15; 30 %). In the study cohort, 18 patients (n = 18; 36 %) required therapeutic intervention: native and active forms of vitamin D, calcium supplements, phosphate binders, bisphosphonates, and human monoclonal IgG2 antibody. During the three-year follow-up period, 7 patients (n = 7; 14 %) were lost to follow-up due to death: severe internal organ dystrophy resulting from intoxication caused by septic process (n = 1; 2 %), multiple organ failure (n = 3; 6 %), circulatory failure (n = 2; 4 %), and suicide (n = 1; 2 %). Additionally, 8 patients (n = 8; 16 %) experienced low-energy fractures. However, three years earlier, the FRAX scale had predicted fracture development within the next 10 years for only 4 of our patients (n = 4; 8 %). The recorded incidence of osteoporosis also increased by 12 %. Timely initiation of therapy could have prevented fracture development in the study group during the three-year observation period. The performed ROC analysis established the necessity of conducting both FRAX® and bone densitometry in elderly CKD patients, as their combined use enables effective identification of fracture risks and osteoporosis in patients with chronic kidney disease. Furthermore, the obtained results of factor analysis allowed identification of the most significant predictors of fracture development in CKD, while cluster analysis grouped these parameters into distinct categories.

CONCLUSION.

1. Osteoporosis by DXA was detected in every third elderly patient with CKD (n = 15; 30 %).
2. Only 8 % of CKD patients had a high 10-year fracture risk according to FRAX®. The values remained comparable after three years.
3. Despite the low 10-year fracture risk predicted by FRAX®, every sixth CKD patient (n = 8; 16 %) experienced a low-energy fracture during the 3-year follow-up.
4. The obtained data will be used to develop an information system for fracture risk assessment in elderly CKD patients within the next three years.
5. CKD patients require adequate anti-osteoporotic therapy to prevent the onset and progression of MBD.

BACKGROUND. Stenosis of the aortic valve is the most common heart disease that requires surgical intervention. A feature of this vice is a long asymptomatic period. After decompensation, five-year survival in these patients without surgery decreases to 1–5%.

OBJECTIVE. Assessment of the effectiveness and safety of transcatheter implantation of the aortic valve with critical aortic stenosis in senile patients compared to patients under 75 years of age.

MATERIALS AND METHODS. The team of authors analyzed the results of 72 transcate implant operations of aortic valve in patients with critical aortic stenosis performed in the Clinical Hospital №1for the period from 2015 to 2024. All patients were divided into 2 groups depending on age. The first group included 39 patients over 75 years old (the average age of patients is (80,69 ± 3,80) year). For comparison, a control group of 33 patients under 75 years old was formed (the average age was (66,18 ± 6,17) year).

RESULTS. In all patients of the studied group in the postoperative period, there was a significant decrease in the maximum gradient on the aortic valve to the reference values of the residual gradient on the aortic valve with (83, 54 ± 24, 55) mm Hg up to (19,78 ± 5,75) mm Hg. In the comparison group, a decrease in the gradient of systolic pressure on the aortic valve was observed from (89,58 ± 30,76) mm Hg to (20,75 ± 6,95) mm Hg. It should be noted a reliable increase in left ventricular ejection fraction on average by 2,7% (p <0,05) immediately after the valve implantation in patients of both groups. Additionally, a statistically significant decrease in pulmonary artery systolic pressure by (7±4) mm Hg was noted, which reduced the proportion of patients with pulmonary hypertension by 10% in patients in the main group and by 33% in patients under 75 years of age. In the early postoperative period in patients of both groups, a decrease in hemoglobin was observed (on average by 19,64 g/l in the main and 16,22 g/l in group 2), red blood cells (by 0,62*10 ¹²/l and 0,51*10 ¹²/l). At the same time, there was a slight decrease in the level of creatinine and the increase in the glomerular filtration rate in both groups, which indicates an improvement in the function of the kidneys after the correction of the aortic defect. This indicates the success of the operation and the achievement of clinical goals immediately after the intervention. In total, one person in a group over 75 years old died in the analyzed contingent of patients (2,5% mortality). The total number of complications was often found in senile patients (the installation of pacemaker 10% vs. 9% of cases, bleeding 10% vs. 3%, rhythm disorders 59% vs. 47%, atrial fibrillation 16% vs. 6%).

CONCLUSION. Transcatether implantation of the aortic valve is an effective and safe treatment for aortic stenosis in patients with high and moderate risk of surgical intervention, including senile people, being a worthy alternative to the classical «open» surgery. A decrease in the number of complications can be achieved by using more modern prosthesis models that allow safe and, if necessary, multiple repositioning of the prosthesis.

BACKGROUND. Activation of inflammation in the periodontium is inextricably linked with systemic processes in the body, accompanied by an inflammatory response. One of these conditions is excess body weight, which in most cases is accompanied by the development of insulin resistance and hyperleptinemia. The adipose tissue hormone leptin, in conditions of insulin resistance, promotes the activation of inflammation, changes in cytokine regulation.

OBJECTIVE. To study the relationship between the clinical state of periodontal tissues, immunological indicators of systemic inflammation and leptin levels in men with generalized periodontitis in combination with excess body weight.

MATERIALS AND METHODS. The study involved 96 men aged 65–75 years with generalized periodontitis associated with excess body weight. The control group included 33 healthy individuals, the comparison group included 32 patients with generalized periodontitis. A clinical examination was performed, and serum leptin was determined by ELISA; interleukins IL-1 β, IL-4, IL-6, TNF-α, and secretory IgA were determined in oral fluid.

RESULTS. A strong positive correlation was established between the leptin level and the periodontal indices, the content of IL-6 and TNF-а in the oral fluid (r = 0.72 and r = 0.71, respectively, at p < 0.01). The correlation between the leptin level and the content of IL-4 in the oral fluid was strongly negative (r = −0.7). The correlation between the leptin level and the content of IL-1β and secretory IgA in the oral fluid was moderately positive (r = 0.64; p < 0.01) and moderately negative (r = −0.49; p < 0.01), respectively.

CONCLUSION. The identified correlation relationships indicate an imbalance in the cytokine system that develops under conditions of hyperleptinemia, which is accompanied by a decrease in the effectiveness of local immunity and activation of inflammation.

BACKGROUND. Impaired balance, gait speed, and movement speed are among the leading geriatric syndromes affecting the quality of life in older adults. Sensory deficits in elderly patients include visual and hearing impairments. Sensory and physical impairments are considered potentially modifiable factors that may improve prognosis and influence other health domains in aging individuals.

However, the interplay between these geriatric syndromes remains understudied. There is also evidence that certain ophthalmic diseases may serve as markers of geriatric syndromes. To implement a geriatric approach, it is essential to understand how physical status parameters may change in the presence of sensory organ pathologies, particularly the eyes.

OBJECTIVE. To study the association between certain geriatric syndromes and ocular pathologies in elderly patients.

MATERIALS AND METHODS. We analyzed 481 medical records (Form 003-u) of patients admitted to the Arkhangelsk Veterans' War Hospital between 2019 and 2023 (mean age: (80.96 ± 0.24) years old). All patients underwent a Comprehensive Geriatric Assessment (CGA), including evaluations of gait speed, balance, nutritional status (MNA scale), functionality (Barthel Index), the Timed Up and Go (TUG) test, and fall risk assessment (Morse Fall Scale). Criteria for geriatric syndromes were based on the 2021 Clinical Guidelines for Frailty in Old Age. An ophthalmologist examined all patients using standard diagnostic methods. Ophthalmic diagnoses were recorded as «present» or «absent».

Statistical analysis included frequency distribution and Pearson’s chi-square test, processed using Stata.

RESULTS. The most common ocular pathologies in the study cohort were glaucoma (27.9%), cataract (74.5%), and retinal angiosclerosis (96.7%). Uncorrected vision was prevalent in 52.4% of patients. Sex-based associations revealed:

– Visual acuity impairment (equal in men and women, slightly better in men).

Glaucoma (3.5 times more frequent in women).

No other statistically significant sex-linked ophthalmic associations were found.

Ocular diseases showed significant correlations with geriatric syndromes:

• Glaucoma increased the likelihood of slow gait speed by 74%.
• Cataract worsened gait speed by 82%.
• Secondary retinopathy increased the prevalence of slow gait by 115%.
• Uncorrected refractive errors were associated with 77% worse TUG test results (adjusted for sex and age).
• Uncorrected bilateral vision impairment correlated with a higher fall risk (TUG test).
• Patients with uncorrected vision had a 51% higher risk of falls.

No significant associations were found between ophthalmic pathologies and balance impairments.

• Glaucoma increased the risk of malnutrition by 82%, while secondary retinopathy raised it by 84%.

CONCLUSION. These associations can inform personalized rehabilitation programs in geriatric practice and support the integration of geriatric principles into ophthalmic care.

In the context of global population aging, ensuring the availability and quality of healthcare services for the elderly is becoming relevant. Digital healthcare, including pharmaceutical services, opens up new opportunities to improve their quality of life. The purpose of the study is to study the experience of using digital pharmaceutical services by the elderly and identify the factors influencing this. A sociological survey among the elderly and pharmaceutical workers showed that 46.0 % of respondents have an average level of comfort when using applications, but only 7.7 % actively use pharmaceutical services. The main problems are delivery delays and technical failures. Most respondents are willing to learn how to use these services. The study is aimed at developing recommendations for improving the availability and quality of digital pharmaceutical services for the elderly.

BACKGROUND. In the context of global population ageing, the availability and quality of healthcare for older people are becoming increasingly important. Digital healthcare, including pharmaceutical services, offers new opportunities to improve their quality of life by allowing them to receive healthcare services and information at home. The COVID-19 pandemic has highlighted the need for digital technologies in healthcare. However, there is a lack of research on older people’s perception and use of these technologies.

OBJECTIVE. To study the experience of using digital pharmaceutical services by older people and identify influencing factors. The study analyzes the needs of older people in digital health and the willingness of pharmacists to interact with them.

MATERIALS AND METHODS. A sociological survey of elderly people and pharmaceutical workers was conducted using two questionnaires to assess awareness of digital pharmaceutical services, their use and satisfaction with services. Quantitative and qualitative data analysis were used.

RESULTS. The study identified the main barriers and obstacles that older people face when using digital pharmaceutical services. Thus, 46.0 % of respondents rated their comfort level when using applications as average, while only 7.7 % of respondents over 60 regularly use pharmaceutical services and applications. 30.7 % of respondents used mobile applications to order medicines, which indicates their demand. Among the difficulties encountered when working with pharmaceutical services and applications, respondents noted delays in delivery or cancellation of orders, as well as technical problems. Most survey participants (61.5 %) expressed a willingness to learn how to work with pharmaceutical services, ready to spend more than 30 minutes on this. The survey analyzed the role of pharmaceutical workers in the process of adaptation of older people to new technologies. The results of the study can form the basis for developing recommendations to improve the accessibility and quality of digital services in the pharmaceutical field for older people.

CONCLUSION. Digital pharmaceutical services have the potential to improve access to healthcare and enhance the quality of life of older people. However, their effective use requires overcoming low awareness and emerging challenges. Improving the availability and effectiveness of services contributes to healthier and more active ageing.

BACKGROUND. Statistics have recently shown a tendency towards an increase in the number of stroke patients, most often with consequences such as speech disorders, which occur in 30–40 % of the total number of patients, manifested by aphasia and dysarthria. In this regard, the urgent problem of gerontology is the recovery of speech in aphasia. The most common variants of aphasia that require the participation of a speech therapist include acoustic-gnostic, acoustic-mnestic, and semantic forms of it. Taking into account the age of the patients and concomitant diseases (chronic cerebral ischemia, hearing loss, impaired cognitive functions, decreased mood), most of them fail to achieve the desired positive correction results due to lack of motivation for rehabilitation.

OBJECTIVE. The aim of the research was to study the results of speech therapy rehabilitation in elderly and senile patients who were in the gerontological center (GC) «Ekaterinodar».

MATERIALS AND METHODS. Materials and methods. Since June 2024, a speech therapist has been employed at GC Ekaterinodar, who, in the direction of internists and/or geriatricians of the center, conducted a speech therapy consultation, which took into account the results of an initial examination by a medical psychologist to fill out a psychological passport indicating the cognitive and emotional sphere, the characteristics of socialization, and the character of the patient. A total of 15 patients (7 men, 8 women, average age (73.4 ± 2.3) years) with aphasia underwent corrective and rehabilitation work. In all cases, aphasia was a consequence of a stroke from 6 months to 10 years ago. The following types of aphasia were identified: gross sensorimotor (4 patients), acoustic-gnostic (3 patients), total (3 patients), acoustic-mnestic (4 patients) and afferent motor aphasia of moderate severity (1 patient). Different techniques developed by Russian scientists were used to correct aphasia (M. M. Shcherbakova, S. V. Kotov and others), an individual lesson plan was drawn up.

Age-related memory changes and the level of education were taken into account in each individual case. In the acoustic-gnostic form, work was carried out with global reading, the selection of semantic distortions, and the subject relationship of the word. In this group of patients, such techniques as solving crosswords, selecting synonyms, antonyms for words, and retelling the text were used. The speech therapy correction plan for the semantic form of aphasia included the analysis of schematic pictures, and in the case of a mild disorder, the identification of cause–and-effect relationships, the selection of prepositions, the solution of logical problems, and the correction of grammatical errors. In the acoustic-mnestic form, the basis of classes was visual perception, which was supplemented, depending on the severity of the violations, by creating sentences from individual words, solving mathematical exercises, and identifying logical errors in the presented text. In addition, all patients underwent elements of creative therapy, speech therapy massage, articulatory gymnastics, classes with teachers and psychologists. Statistical data processing was carried out using nonparametric criteria.

RESULTS. The results of the study. A total of 442 individual speech therapy sessions were conducted. Control studies have shown that after 3–6 months of individual speech therapy exercises combined with psychological exercises, all 15 patients showed positive dynamics of speech contact of varying degrees of severity against the background of an improvement in their psychological state.

CONCLUSION. Conclusions. Speech therapy work to overcome aphasia in elderly and senile people in social entities in synergy with psychologists allows achieving positive results and increasing social adaptation.

BACKGROUND. The method of low-frequency magnetolaser therapy for elderly and senile patients is extensively applied in the early recovery period after an acute cerebral circulatory disorder (ACCD) of ischemic genesis. This is due to the fact that under the influence of the low-intensity energy of optical quantum generators, reparative processes are stimulated, micro- and macrocirculation in the cerebral vascular network and in the general bloodstream is improved along with the rheological properties of blood, the state of oxygenation and metabolism in biological tissues. 

OBJECTIVES. To apply the method of laser irradiation onto biologically active points and determine the effectiveness and tolerability of the method for elderly and senile patients.

MATERIALS AND METHODS. The study involved 188 patients aged 65 to 82 years in their early recovery period after an ACCD of ischemic genesis. The exposure was performed by the «Ricta 04/4» device 3–4 weeks after the acute disease period.

Each patient received daily treatments on biolocically active points located in the 4th intercostal space at the edge of the sternum, subclavian, supraclavicular, suboccipital fossa, frontal and temporal regions, paravertebral on both sides of the VII cervical vertebra. Additionally, the elbow bends or hamstring fossae of paretic limbs were irradiated individually every other day.

The exposure frequency was 5 Hz and 50 Hz with the exposure time of 1 minute per zone. The number of biologically active points per session is 6. The course of treatment consists of 10–12 sessions. The method was combined with drug therapy and exercises in the physical therapy room.

RESULTS. An increase in the volume of movements in the paretic limbs, a decrease in spasticity, a decrease in pain, increased stress tolerance, improved reading comprehension, writing and pronunciation skills, enhanced communication and self-service skills, relieved or decreased headaches and dizziness, and improved emotional status. In addition, good tolerability of the laser irradiation treatment should be noted.

CONCLUSION. The use of this technique for elderly and senile patients during the early recovery period after an ACCD provides an increase in the effectiveness of rehabilitation due to significant activation and regeneration of cognitive and motor disorders.

BACKGROUND. Mucosal cysts of the fingers of the hand are tumor-like formations considered as a complication of osteoarthritis.

The aim of the work is to analyze errors in the diagnosis and treatment of patients over 60 years of age with mucosal cysts of the fingers of the hand to improve treatment results.

MATERIALS AND METHODS. The study included 75 patients aged 60 years and older. The diagnosis included clinical and anamnestic examination, radiography and ultrasonography. According to the medical history, the patients were divided into 2 groups: the first group consisted of patients who came to the clinic first; the second group consisted of patients with recurrent mucosal cysts. All patients underwent surgical procedures: excision of the osteophyte of the phalanx, skin grafting of the skin defect. Evaluation of surgical treatment results was performed 2, 6, 12 months according to radiography, VAS, QuickDash questionnaire, volume of movements in the distal interphalangeal joint.

RESULTS. Analysis of the initial treatment of patients in the second group (with relapses of the disease) according to the profile of specialists and the type of care provided. It was established that patients with relapses underwent manipulations (cyst piercing, thermal effects, removal of thinned skin above the cyst) or operations without excision of the osteophyte of the phalanx and plasty of the skin defect after excision of the cyst. A full-fledged examination at the treatment stage allowed all patients to confirm the diagnosis and identify the presence of osteophyte of the affected phalanx of the finger.

CONCLUSION. Radiography and ultrasonography are informative research methods. The treatment of mucosal cysts is an operation involving the repair of a skin defect with local tissues after excision of the cyst and removal of the osteophyte.

BACKGROUND. The most common causes of falls are balance disorders, gait disorders, decreased muscle strength, visual acuity and cognitive functions, chronic diseases and the use of psychotropic drugs. Falls are common among the elderly population: their frequency varies from 15 to 30 %, increases with the age of patients and reaches 50 % in 80-year-olds.

OBJECTIVE. The study of the main parameters of impaired motor activity in elderly patients - wards of social inpatient institutions of the Kyrgyz Republic.

MATERIALS AND METHODS. The object of the study was elderly and senile people (65 years and older), wards of the Nizhne-Serafimovsky social inpatient institution for the elderly and people with disabilities (hereinafter referred to as SII). Criteria for the inclusion of patients in the study: the age of patients aged 65 years and older. Exclusion criteria: age less than 65 years, severe and extremely serious condition. 55 people were examined, 31 men (56.4 %), 24 women (43.6 %). The average age of the subjects was (72.40 ± 6.93) year.

A specialized geriatric examination (SGE) was performed using the computer program «Optimization of geriatric care depending on the degree of senile asthenia». In our study, of all the parameters of the SGE, the main focus is on identifying the degree of mobility and assessing the degree of independence in everyday life.

RESULTS. In our study, impaired general motor activity was observed in 41 ((74.50 ± 5.77) %) patients. However, violations of stability parameters were more pronounced, which were detected in 51 ((92.70 ± 8.13) %) and walking parameters in 48 ((87.30 ± 6.82) %) patients. The degree of moderate impairments prevailed in only one parameter of general sitting stability (69.00 ± 5.43%, in contrast to gross impairments ― 31.00 ± 2.81%; p < 0.05).

In other parameters, gross impairments were more pronounced than moderate impairments: in standing with closed eyes, (63.60 ± 4.16) % vs. (41.1 ± 3.4) %; p < 0.05; in backward bending stability, (56.40 ± 5.26) % vs. (38.20 ± 4.56) %; p < 0.05.

A one-year study of a continuous sample of patients aged 65 and older showed that the main geriatric syndromes among the patients of a social inpatient institution are violations of the general parameters of stability and walking. The disorders identified in the study contributed to the high dependence of patients on outside help: 76.4% of patients were dependent to varying degrees.

CONCLUSION. A comprehensive geriatric assessment to identify the main geriatric syndromes, followed by mandatory correction in wards of a social inpatient institution aged 65 years and older, should become an integral part of the organization of medical care aimed at solving the problems of elderly and senile patients.

The study of age-associated diseases is an integral component of modern medicine. In the conducted study, diagnostic phase angle limits for the detection of presarcopenia in patients with type 2 diabetes mellitus (T2DM) were determined. Early detection of sarcopenia in patients with T2DM helps to increase the duration and quality of their life.

BACKGROUND. Sarcopenia, like T2DM, not only is an age-associated disease, but is also recognized as a complication of T2DM. According to the results of studies by domestic scientists, phase angle (PA) parameters can be used for diagnostically significant decrease in muscle mass during bioempidansometry, but diagnostic limits for the diagnosis of presarcopenia are not presented. At the same time, the phase angle is an integral index of the processes occurring in the human body.

OBJECTIVE. To compare FS values depending on the presence of presarcopenia and to define diagnostic limits of FS for the diagnosis of presarcopenia in patients with T2DM.

MATERIALS AND METHODS. A one-stage single-centre cross-sectional study of patients over 60 years of age hospitalized in the endocrinology department of Buyanov State Clinical Hospital due to decompensation of T2DM was performed. During hospitalization, the SARC-F questionnaire was used to detect sarcopenia syndrome, patients with more than 4 points were included in the main stage of the study to detect sarcopenia according to the EWGSOP 2 consensus.

Statistical processing was performed using the SPSS Statistics 23 software package.

RESULTS. During the study period, 232 patients were examined, of whom 147 (63% of the total number of patients; 35 men (24%) and 112 women (76%); average age ― (70 ± 8) years) participated in the study; presarcopenia was detected in 87 people (59% of the study population). In patients with presarcopenia the mean FA was lower than in patients without signs of sarcopenia, the values were (7.05 ± 2.37)⁰ and (8.50 ± 1.59)⁰, respectively (p = 0.0001). The area under the ROC curve corresponding to the relationship between presarcopenia prognosis and phase angle was 0.714 ± 0.044 with 95 % CI: 0.627–0.800. The obtained model was statistically significant (p < 0.001). The threshold value of FA at the cut-off point was 6.61⁰. A high risk of presarcopenia was predicted at FA equal or lower than this value. The sensitivity and specificity of the method were 80.0 % and 62.1 %, respectively.

CONCLUSION. The study demonstrates that patients with presarcopenia have a prognostically significant decrease in FA, which makes it possible to diagnose sarcopenia in patients with T2DM at early stages, before the body's muscle reserves are exhausted, and to carry out its timely correction.

The endoscopic picture of 357 patients of different ages with peptic ulcer of the stomach or duodenum was analyzed. Age-related features were revealed: an increase in the proportion of women among patients with this nosology, an increase in the number of cases of multiple ulcers, mainly among women, an increase in the frequency of gastric localization of ulcers, an increase in the size and timing of scarring of ulcers.

BACKGROUND. Elderly and senile patients make up a significant proportion of patients with peptic ulcer disease. The clinical picture of their disease is not always standard, an atypical course is often found, there is no seasonality, and severe pain syndrome. Sometimes an ulcer of the stomach or duodenum turns out to be an accidental finding during an endoscopic examination. Studying the endoscopic features of peptic ulcer of the stomach and duodenum in the elderly will help to develop clear algorithms for the diagnosis of this pathology, taking into account the age-specific nosology.

OBJECTIVE. Identification of endoscopic features of gastric and duodenal ulcer in elderly and senile patients.

MATERIALS AND METHODS. The analysis of 357 case histories of patients with peptic ulcer of the stomach and duodenum was carried out. The patients were divided by age into four groups: I ― young age, II ― mature age, III ― elderly age, IV ― senile age. The diagnosis of peptic ulcer disease in all cases was confirmed by endoscopic examination. The number of patients with multiple and single ulcerative defects, the localization of ulcerative lesions, the area and duration of scarring of ulcerative defects in patients of different ages were studied.

RESULTS. The ratio of men and women included in the study in different age groups was: 3.2 : 1 among young people; 2.1 : 1 among mature patients; 1.8 : 1 among elderly patients; 1.3 : 1 among senile patients. As the age increases, the relative number of women with peptic ulcer disease, increased, which does not contradict the literature data. The percentage of patients with gastric ulcer localization was higher (p < 0.001) in elderly and senile patients compared with younger patients (42 % and 14 %, respectively), which is consistent with the literature data.

The most common multiple ulcerative defects occurred when the process was localized on the anterior and posterior walls of the duodenal bulb, somewhat less often in the pylorus and in the lower third of the small curvature of the stomach. The percentage of women with multiple ulcerative defects in relation to the total number of women with peptic ulcer disease was higher (p < 0.01) than the same indicator for men, that is, multiple ulcers were more common in women. This may be due to the more frequent use of nonsteroidal anti-inflammatory drugs by women and the development of NSAID gastropathy, which is characterized by a multiplicity of ulcerative lesions. When comparing the size of ulcerative defects in patients with multiple ulcers, a tendency was found to decrease the number of patients with small ulcers and increase the number of patients with large ulcerative defects as the age of patients of both sexes increased (p < 0.001). As the age of the subjects increased, patients of both sexes with long-term scarring of ulcerative defects were more common (p < 0.001).

CONCLUSION. As the age of patients increased, the ratio of men and women changed towards an increase in the proportion of women, there was a tendency towards an increase in gastric localization of ulcers, a multiplicity of ulcers, especially in elderly women, an increase in the size of ulcers, and an increase in the number of patients with long-term scarring of ulcerative defects.

The demographic situation in the Kyrgyz Republic leaves no doubt that caring for older people is a pressing issue and a huge medical and social problem.

OBJECTIVE. Тo assess the state and development prospects of the gerontological service and to study the level of geriatric care for the population of the country.

MATERIALS AND METHODS. Legislative, regulatory documents and materials from open sources have been studied since 1991. Using the example of Bishkek and Nizhne-Serafimovsky social inpatient institutions, the health status was analyzed and 442 wards were examined.

RESULTS. According to the National Statistical Committee, the total population of the republic at the beginning of 2019 was 6,389,500 people. Of these, the rural population was 4,215,900 people, and the urban population was 2,173,600 people. About 500,000 citizens, or almost one in eight residents of the republic, are older than working age. The number of men over working age (63 years and older) was about 150,000 people (4.7% of the male population), and women (58 years and older) — more than 349,000 people (10.8% of the female population). This means that the number of women in this age group exceeded the number of men by 200,000, or 2.3 times. There have been some successes in the development of gerontological services: the Kyrgyz Republic became a member of the international gerontological network AgeNet International (2005), and the law “On Elderly Citizens in the Kyrgyz Republic” (2011), and an Action Plan to Improve the Quality of Life of Older Citizens for 2019–2025 (dated August 30, 2019) was approved. Despite these successes, the republic's gerontological services do not meet the modern challenges of an aging population, and problems related to geriatric care remain: there are no geriatricians, no geriatric clinics, no geriatric centers, geriatric medical care for the elderly is not provided at the proper level, and residents of social inpatient facilities remain under-examined.

CONCLUSION. The Kyrgyz Republic needs to create a single coordinating body for the gerontological and geriatric services, which will be responsible for its work and development. In order to develop the gerontology service, achieve health and quality of life indicators for the elderly, it is necessary to develop collaborative scientific research and improve specialized training in geriatrics. Coordinated actions of the healthcare and social protection system are needed to help provide the elderly and senile population of the country with highly specialized medical and medical-social care, which will undoubtedly have an impact on prolonging their active longevity.

BACKGROUND. Geriatric syndromes are fairly common clinical conditions in the elderly that do not fall into certain categories of diseases. Recently their list has expanded to include senile frailty, sarcopenia, anorexia, and cognitive impairment.

OBJECTIVE. To identify the prevalence of senile asthenia syndrome in the wards of social inpatient institutions in the southern regions of the Kyrgyz Republic using a screening questionnaire.

MATERIALS AND METHODS. Our work was carried out in social inpatient institutions of the Kyrgyz Republic. During the study, geriatric status was determined in 206 patients at these institutions. The first group of the study consisted of 144 elderly patients (60 to 74 years old), and the second group consisted of 62 elderly patients (75 to 90 years old). Using the computer program “Optimization of care in geriatrics depending on the degree of senile asthenia”, the main geriatric syndromes such as motor disorders, balance parameters, cognitive impairment; frequency and risk of malnutrition syndrome were studied. Factors related to morale and the degree of independence of the elderly in everyday life were also studied.

RESULTS. Symptoms of senile asthenia (Table 1) of various degrees were found in (95.6 ± 1.4) % of patients (n = 197); asthenia was not detected in (4.4 ± 1.4) % of subjects (n = 9). Moderate asthenia was the most common, found in (25.2 ± 3.0) % of the subjects (n = 52). Mild and severe cases had a high frequency of (24.3 ± 2.9) %; p ≥ 0.05) (n = 50) each. Senile preasthenia accounted for (15.0 ± 2.4) % of cases, (p < 0.01), (n = 31); severe asthenia accounted for (6.8 ± 2.1) % of cases, (p < 0.01), (n = 14).

Table 1. Prevalence rate of senile asthenia syndrome of different degrees of severity

№

The severity of the syndrome

Prevalence (n = 206)

n, men

P ± m, %

1

No signs of senile asthenia

9

4,4 ± 1,4

2

Senile preasthenia gravis

31

15,0 ± 2,4

3

Mild asthenia

50

24,3 ± 2,9

4

Moderate asthenia

52

25,2 ± 3,0

6

Severe asthenia

50

24,3 ± 2,9

7

Severe asthenia

14

6,8 ± 2,1

Note: n is an absolute number, P ± m is the frequency of severity of senile asthenia syndrome.

The table was compiled by the authors based on their own data.

CONCLUSION. The medical contingent of the medical and sanitary unit of social inpatient institutions of the Kyrgyz Republic should take into account the results of our research when providing medical and sanitary care to the wards.

The relationship between the immune inflammatory index (SII) and sarcopenia in older patients, specifically in terms of muscle mass and relative strength, was assessed. The SII has shown promising predictive ability and high efficacy in identifying decreased muscle function among older individuals.

BACKGROUND. In elderly people, sarcopenia can lead to a decrease in functional activity and the ability to perform self-care activities, as well as an increased risk of falling. A general blood test is a common laboratory test that can be used to measure various components that can act as markers for inflammation. The SII index, which is calculated by multiplying the number of platelets by neutrophils and dividing by lymphocytes, is more accurate than C-reactive protein in predicting coronary heart disease. It can also effectively predict the development and progression of heart failure. However, the relationship between sarcopenia and the SII index has not yet been fully investigated.

THE OBJECTIVE OF THE STUDY ― to investigate the relationship between the inflammatory index SII (platelet-neutrophil ratio/lymphocyte count) and muscle mass and strength.

MATERIALS AND METHODS. The study included 65 elderly men with an average age of 70.4 ± 3.2 year. Sarcopenia was diagnosed using the EWGSOP criteria. The participants were divided into two groups: group 1 included 32 men with sarcopenia, and group 2 included 33 men without sarcopenia. The inclusion criteria were: the age of the patients was 60–74 years, and all stages of the study had been completed.

Muscle mass index (MMI) was determined by dividing muscle mass by body mass index (BMI). For men, an MMI below 0.789 was considered low. Grip strength was measured by squeezing a dynamometer in each hand 3 times for 5 seconds, and the average value was taken. The elbow was positioned at a right angle to the body. Relative Strength Index (RSI) was calculated by dividing dominant arm muscle strength by BMI.

Statistical analysis was performed using ROC analysis to evaluate MMI in predicting low muscle mass and strength risk. Spearman's correlation analysis was used to assess the relationship between SII, MMI, and muscle strength.

RESULTS. Patients with sarcopenia had a significantly higher BMI (p < 0.001, mean (32.03 ± 6.28) kg/m²) compared to those without sarcopenia (mean (25.98 ± 5.03) kg/m²). They also had lower BMI (mean 0.68 ± 0.09 vs 0.87 ± 0.06) and BMI (1.12 ± 0.17 vs 1.52 ± 0.23). An increase in BMI was associated with a decrease in RSI.

Patients without sarcopenia had lower platelet and lymphocyte counts. The SII value was significantly higher in patients with sarcopenia (548.36 ± 232.63) compared to those without (414.42 ± 205.25, p<0.001). The area under the ROC curve for SII predicting a decrease in BMI was 0.723 ± 0.054, indicating a 74.2% diagnostic effectiveness. For RSI, the area was 0.852 ± 0.035, indicating an 82.5% diagnostic efficiency. SII also maintained a significant negative correlation with IMM, both as a continuous and categorical variable.

CONCLUSION. The SII index has demonstrated reliable predictive ability and high efficiency in detecting decreased muscle function in elderly patients.

This article presents the results of radiofrequency ablation of atrial fibrillation in elderly and geriatric patients. A total of 151 patients were included in the study. The subjects were divided into two groups: Group 1 consisted of patients aged 65 to 75 years, while Group 2 included those over 75 years of age. The follow-up period lasted for 1 year.

BACKGROUND. According to the literature, the prevalence of atrial fibrillation (AF) in the population ranges from 1 % to 2 %. This frequency increases with age, from less than 0.5 % in individuals aged 40 to 50 years to 5 % to 15 % in those aged 80 years [1–8]. Considering the increase in life expectancy, we can also expect a rise in the number of elderly and senile patients with atrial fibrillation. [9–11, 22]. Given that pulmonary vein ostia isolation is the gold standard for treating this condition, there is a need for studies that reflect the profile of efficacy and safety of radiofrequency ablation for atrial fibrillation in patients within these age groups. [12–21].

OBJECTIVE. To investigate the efficacy and safety of pulmonary vein ostia isolation in elderly and geriatric patients.

MATERIALS AND METHODS. The study is retrospective in nature. It was conducted in 2022–2023 at the Pirogov University Russian Gerontological Scientific Clinical Center. The first group included 104 patients aged up to 75 years (42 men, 62 women, with a mean age of 62 years and a mean disease duration of 5.2 years). The second group comprised 47 patients over 75 years old (14 men, 33 women, with a mean age of 78 years and a mean disease duration of 8.2 years). Inclusion criteria for the study were: age over 18 years, indications for radiofrequency ablation of atrial fibrillation, symptomatic atrial fibrillation, and anticoagulant therapy for more than four weeks prior to the procedure. Exclusion criteria included any contraindications to surgical intervention. The primary efficacy endpoint was the absence of recorded atrial fibrillation lasting more than 30 seconds during the blind period (2 months). The secondary efficacy endpoint was the absence of atrial tachycardia, atypical atrial flutter, typical atrial flutter, atrial fibrillation after the blind period, death, stroke, or transient ischemic attacks (TIA). The assessment of the results was conducted using Holter monitoring and during clinic visits at 3, 6, and 12 months after the procedure. A significant portion of patients had paroxysmal atrial fibrillation, with 79 individuals in the first group (76 %) and 34 individuals in the second group (72 %). The most common comorbidity among patients in the first group was hypertension (97 patients, 93.27 %), followed by dyslipidemia (64 patients, 61.54 %). Chronic cerebral ischemia was observed in 48 patients (46.15 %), chronic heart failure in 46 (44.23 %), chronic kidney disease in 24 (23.07 %), diabetes mellitus in 14 (13.46 %), ischemic heart disease in 10 (9.62 %), and a history of stroke or TIA in 6 (5.77 %). Chronic obstructive pulmonary disease (COPD) was present in 5 patients (4.81 %), and post-infarction cardiosclerosis (PICS) in 4 (3.85 %). Implantation of a pacemaker due to sick sinus syndrome or atrioventricular block was performed prior to the study in 4 patients (3.85 %).

In the group over 75 years of age, hypertension and dyslipidemia were present in 43 patients (91.45 %), chronic cerebral ischemia in 32 (68.09 %), heart failure in 35 (74.45 %), kidney disease in 9 (19.15 %), diabetes mellitus in 9 (19.15 %), ischemic heart disease in 8 (17.02 %), and a history of stroke or TIA in 9 (19.15 %). COPD was diagnosed in 5 patients (10.64 %), and PICS in 3 (6.38 %). Pacemaker implantation was performed in 7 patients (14.89 %).

All patients underwent atrial isolation of the pulmonary vein orifices using a three-dimensional navigation system.

RESULTS. The duration of the surgery in the first and second groups was comparable: (56 ± 14) minutes and (49 ± 13) minutes (p < 0.05). Criteria for the isolation of the pulmonary vein ostia were achieved in all patients. No serious complications, such as hemopericardium, ischemic stroke, or atrial-esophageal fistula, were recorded. The efficacy during the blind period was 78.8 % (82 patients) in the first group and 81.4 % (34 patients) in the second group, with χ² = 1.648, p = 0.194. The efficacy after 1 year of follow-up was 75.9 % (79 patients) in the first group and 76.7 % (33 patients) in the second group, with χ² = 0.003, p < 0.05.

CONCLUSION. Radiofrequency ablation for atrial fibrillation in elderly and senile patients demonstrates a high profile of efficacy and safety. However, further studies are necessary to confirm this conclusion.

BACKGROUND. On an outpatient basis, a common problem in older patients is osteochondrosis of the spine. His treatment in geriatric patients often forces him to prescribe drugs with multiple undesirable side effects. Possible tools for their prevention are the STOP/START criteria and the modified index of rationality of drug use (Medicine Appropriateness Index ― MAI, 2012), which make it possible to assess the effectiveness and safety of the therapy.

OBJECTIVE. Assessment of the safety of drug therapy for spinal osteochondrosis in patients over 60 years of age using STOPP/START criteria and MAI.

MATERIALS AND METHODS.

A retrospective analysis of medication prescriptions in 315 case histories of elderly patients of day care centers in Kursk with spinal osteochondrosis (2015-2024) was performed. The age of the studied patients was (70.94 ± 0.86) years. To solve the research tasks, STOPP/START criteria and a modified index of the rationality of drug use (MAI, 2012) were used. Statistical analysis of the results ― Microsoft Excel 2010.

RESULTS. All the examined corresponded to the elderly age ― (70.94 ± 0.86) year. The subjects received multicomponent drug therapy. So they could use up to 10 medications at a time (the average number of medications per patient was 6.13 ± 0.19).

Traditional therapy for spinal osteochondrosis in day hospitals consisted of anti–inflammatory and analgesic components (corticosteroids (GCS) and nonsteroidal anti-inflammatory drugs (NSAIDs)) and muscle relaxants, more often of central action.

The greatest number of limitations in the treatment of osteochondrosis of the spine were found in non-selective NSAIDs. However, there was no adequate prevention of adverse side effects.

Thus, 23.83 % had chronic heart failure (CHF), however, measures and recommendations for the prevention of it and its exacerbations are not recorded in the medical documentation. The proportion of patients with hypertension was 47.99 %. At the same time, the appointment of anti-inflammatory therapy was carried out without proper monitoring of blood pressure levels, which, in turn, provoked episodes of blood pressure destabilization.

Despite the large number of undesirable side effects of anti-inflammatory therapy on the part of the kidneys, the glomerular filtration rate was not calculated in 81.54 %, which indicates an almost complete lack of prevention of kidney dysfunction.

MAI GCS reached the highest values ― 14.59 ± 0.21. The indices of non–selective NSAIDs MAI were also high ― 14.09 ± 0.12. In selective NSAIDs, this indicator is significantly lower ― 9.15 ± 0.16. The intermediate MAI values for centrally acting muscle relaxants are 11.18 ± 0.14.

CONCLUSION. The prescribed anti-inflammatory therapy for osteochondrosis of the spine was carried out without taking into account the pathology of the cardiovascular system and the functional state of the kidneys, creating all the prerequisites for exacerbating the course of concomitant pathology. Extremely high MAI values indicate defects in the safety assessment and underestimation of possible side effects and insufficient control of inter-drug effects and somatic pathology of aging patients. The identified shortcomings require wider implementation of restrictive lists in clinical practice.