Aging is the risk factor for developing cancer — approximately 60 % of cancer occurs in people 65 years or older. Treatment planning that takes into account the patient's geriatric status and preferences helps achieve better outcomes and patient satisfaction. Conducting a comprehensive geriatric assessment and developing

an individualized care plan during the preparation and treatment stages of cancer, as well as post-surgery, radiation therapy, and/or chemotherapy, helps reduce the risk of complications and maintain patients' quality of life. Due attention should be paid to prehabilitation tools, which focus on improving the patient's physical condition, optimizing nutrition, cognitive interventions, reducing stress and anxiety, and correcting anemia and other comorbidities. Measures included in prehabilitation programs have a synergistic effect: interventions that may not produce significant clinical results individually, when combined, provide significant improvements in the postoperative period. The lack of clinical trials in cancer patients aged 75 years and older is a common problem worldwide. The importance of a comprehensive multidisciplinary approach to managing these patients should be emphasized to improve overall survival, quality of life, and reduce the risk of potential complications.

The necessity of organizing geriatric medical care in primary healthcare is driven by the increasing elderly population, the rise in chronic non-communicable diseases, and the prevalence of frailty and other geriatric syndromes among older adult patients. Elderly patients with chronic non-communicable diseases and geriatric syndromes place a considerable additional strain on primary healthcare, particularly on therapeutic services and paramedic's office. There is also a high demand for long-term care among this population. The methodological recommendations facilitate the integration of preventive approaches and strategies for identifying and addressing geriatric syndromes into primary healthcare. Implementing these recommendations will enhance the quality of life for older adult patients, alleviate the burden on primary healthcare services, reduce patients' dependence on external assistance, and decrease unplanned visits to clinics and adverse outcomes.

Relevance. An increase in the number of centenarians leads to a greater spread of geriatric syndromes, leaving both the pathogenesis of these diseases and the risk factors for their development in this age group poorly understood. At the same time, the risk of disease is often associated with socio-economic factors that were realized at a much earlier age, for example, with the level of education received.

The objective of the study. Study of the relationship between the educational level of centenarians and the risk of developing geriatric syndromes.

Materials and methods. The open-ended observational study included 658 individuals aged 90 years and older living in Moscow and the Moscow Region, both in institutionalized and non-institutionalized settings, who gave written voluntary consent to participate. All participants underwent a comprehensive geriatric assessment, as well as a history of socioeconomic status. The Mann-Whitney nonparametric test (for quantitative variables), the Chi-square test, and Fisher's exact test (for categorical variables) were used for the intergroup comparison. Borut's algorithm was used to select the most significant variables. Logistic regression models have been built to account for multifactorial risk.

Results. Individuals with primary education had a 2.6 times higher risk of dementia compared to those with higher education (p = 0.010), and participants with secondary education had a 1.9 times higher risk compared to participants with higher education (p = 0.021). Primary education was associated with a lower risk of chronic pain syndrome (OR 0.395; 95% CI: 0.16–0.95; p = 0.037), compared with those with an average and higher level. Primary education is associated with a 3.4–fold reduction in the risk of polypragmasia (OR 0.294; 95% CI: 0.12–

0.68; p = 0.005). The presence of primary education was associated with orthostatic hypotension (OR 2.217; 95% CI: 1.05–4.77; p = 0.039).

Conclusion. The results indicate a relationship between the level of education and dementia, chronic pain syndrome, orthostatic hypotension and polypragmasia. A higher level of education acts as a protective factor against dementia and orthostatic hypotension, and an elementary level of education protects against polypragmasia and chronic pain syndrome.

The aging of the population is an inevitable but predictable process in modern society, both in the Russian Federation and worldwide. With increasing life expectancy, there is a significant increase in conditions and diseases related to frailty and aging. Cognitive decline is one of the most common problems in geriatric practice. However, the detectability of this syndrome remains quite low, preventing the initiation of timely therapy and, as a result, the prevention of the development of dementia in the elderly and senile.

THE OBJECTIVE of the study is to identify the relationship between the severity of cognitive impairments and the manifestations of geriatric syndromes in elderly and senile individuals residing in the city of Arkhangelsk.

MATERIALS AND METHODS. A cross-sectional study was conducted on a random sample (n = 114) among elderly and senile citizens living in Arkhangelsk and receiving geriatric care in an outpatient department. Respondents were examined by a comprehensive geriatric assessment in accordance with geriatric domains. To identify cognitive decline syndrome, the questionnaire of the Short Mental Status Assessment Scale (MiniMental State Examination, hereinafter MMSE) was used. Statistical analysis comprised the Mann — Whitney U test, Pearson’s chi-squared (χ²) test, and Spearman’s rank correlation coefficient.

THE RESULTS of the study revealed the presence of cognitive impairment syndrome in 71.9 % of elderly and senile individuals residing in Arkhangelsk. A relationship between cognitive impairment syndrome and manifestations of geriatric syndrome was established, predominantly in women. In women, cognitive decline was significantly associated with sensory deficit syndrome (hearing and vision loss), chronic pain syndrome, senile sarcopenia, impaired activities of daily living, and depression. Therefore, early detection and treatment of these geriatric conditions can help prevent cognitive decline and development of dementia in older adults.

INTRODUCTION. As we age, the prevalence of chronic heart failure (CHF), frailty (FA), and geriatric syndromes (GS) increases.

THE OBJECTIVE OF THE STUDY. To study the frequency of detection of frailty and other geriatric syndromes in patients with CHF 65 years and older, their associations with the characteristics of CHF and their significance for prognosis.

MATERIALS AND METHODS. From March 2021 to March 2023, 150 patients 65 years and older with established

CHF were examined on the basis of the RGRCC FGAU RNRMU N. I. Pirogov. GS was assessed using a comprehensive geriatric assessment. A year later, information was received about the onset of the endpoints. The statistical analysis was performed using the IBM® SPSS® Statistics program.

RESULTS. 150 patients were examined, 53.3% women (n = 80), average age (77.7 ± 7.4) years. Moderate cognitive impairment or dementia was detected in 67.33%, probable depression in 46.5%, risk of malnutrition in 29.33%, malnutrition in 6%, high risk of falls in 25.33%, dependence from outside help in 56.67%, decreased instrumental activity in 49.33%, falls in 33.3% patients. The frequency of occurrence of GS did not depend on the ejection fraction (EF). A correlation was established between NT-proBNP levels, clinical assessment scores, and several geriatric scales. Univariate analysis identified several variables associated with an unfavorable outcome. The strongest associations were found with indicators of functional status (malnutrition according to MNA, dependency assessed by Barthel and Lawton scales), laboratory markers (NT-proBNP, iron levels), and echocardiographic parameters (right ventricular size, tricuspid regurgitation gradient).

CONCLUSION: In elderly patients with chronic heart failure (CHF), a combination of geriatric and cardiological factors—such as malnutrition, loss of autonomy, iron deficiency, elevated NT-proBNP levels, right ventricular enlargement, and tricuspid regurgitation gradient—may be associated with an unfavorable prognosis. The multifactorial contribution of CHF and geriatric syndromes (GS) to the clinical status of elderly and aged patients underscores the necessity of an individualized treatment approach in this population.

BACKGROUND. The aging of the visual organ and other sensory systems is a key medical and social problem, as it leads to a decrease in quality of life, functional dependence and an increased burden of disease.

OBJECTIVE. Cataracts develop due to the accumulation of oxidative damage to the lens and disruptions in its biochemical composition. Age-related macular degeneration is associated with the accumulation of drusen, oxyinflammation, and immune mechanisms leading to pigment epithelial atrophy. Glaucomatous neurodegeneration is caused by optic nerve damage, excitotoxicity, mitochondrial dysfunction, and oxidative stress. Diabetic retinopathy is characterized by vascular and inflammatory changes, exacerbated by accelerated cellular aging. Dry eye syndrome is associated with dysfunction of the lacrimal and meibomian glands, as well as age-related decline in antioxidant defenses. The mechanisms of presbycusis and presbynasalis are also discussed.

CONCLUSION. Aging of sensory systems is a multifactorial process that forms a wide range of age-associated diseases. A comprehensive combination of clinical, molecular, and computational approaches opens new possibilities for personalized diagnostics, early detection, and the development of targeted anti-aging strategies aimed at preserving visual function and improving quality of life in the elderly population.

A literature review was conducted to study the experience of different countries in addressing the issues of medical care for the elderly and adapting healthcare systems to the needs of an aging population.

BACKGROUND. In Russia, as in the rest of the world, there is currently a trend towards an aging population, with an increasing proportion of people over the age of retirement and a longer life expectancy. The increasing demand for healthcare services among older adults with age-related conditions places a strain on the healthcare system, and it is crucial to consider this when making decisions about healthcare provision to adapt the healthcare system to the needs of this age group.

OBJECTIVE: Studying the international experience of organizing medical care for the elderly in different countries around the world.

MATERIAL AND METHODS. The work uses the analytical research method and content analysis. The material was prepared based on the search for information in databases: eLIBRARY.RU — scientific electronic library, PubMed, digital scientific library CyberLeninka, Scopus, MSD Reference (Global Medical Knowledge), materials of the United Nations (UN) and the World Health Organization (WHO), data from official Internet resources, and literary sources about the organization of assistance to the elderly and senile in different countries of the world. In total, more than 350 sources were found that address various aspects of providing medical care to the elderly, of which 55 sources were selected that are relevant to the study and meet the 10-year search depth.

RESULTS. The aging of the population is one of the features of the current demographic situation. Elderly people have their own health characteristics due to the increasing number of chronic diseases and require special measures to maintain their health, which in turn requires the adaptation of healthcare systems in order to improve medical care and services. As the aging of the population becomes an increasingly pressing issue, one of the main challenges for healthcare systems around the world is to provide high-quality and accessible medical care to elderly patients.

DISCUSSIONS. This review examines the organization of medical care for the elderly and senile in the current realities in various health systems of the world and studies and systematizes the existing models of geriatric care in various national health systems. Based on the analysis of publications by international authors, the most promising areas of development of medical care for the elderly have been identified, which have the potential for integration regardless of the existing organizational model.

CONCLUSIONS. Models of organizing medical care for the elderly vary from country to country, depending on the economic, social, cultural, and other characteristics of each country, and are characterized by continuous processes of structural transformation. The most effective models of care for older adults are based on the principles of a comprehensive, interdisciplinary approach, as well as the interaction between healthcare and social services systems. Based on the analysis of existing global experience, the development of human resources, structural changes with a focus on strengthening the coordinating role of primary care and developing outof-hospital care, the introduction of telemedicine technologies, and a shift in the patient-doctor relationship towards empowering patients in health management are considered promising vectors for optimizing the healthcare system in an aging population.

The article addresses the issue of treating arterial hypertension (AH) in patients with orthostatic arterial hypotension (OH). For many years, it was believed that treating AH might increase the risk of developing OH in elderly and senile patients. However, an increasing body of evidence-based data indicates that more intensive antihypertensive therapy regimens, achieving lower target blood pressure levels, are associated with a reduced risk of developing OH. The article discusses these sources in detail. It provides information about the pathophysiological mechanisms underlying the development of OH, as well as approaches to its diagnosis in clinical practice. The problem of selecting optimal antihypertensive therapy for patients with OH is examined. The article also addresses the issue of treating AH in the presence of OH in elderly patients with frailty syndrome. Expert opinions on the examination and treatment strategies for patients with AH and OH, as reflected in modern clinical guidelines, are presented in the article.

Diseases of the digestive system are widely represented in modern society and tend to increase in frequency among the elderly. The aim of the study was to assess the prevalence of symptoms and established diagnoses of digestive system diseases in the elderly and senile age. 106 patients were examined: 77 (72.6 %) women and 29 (27.4 %) men aged 65 to 92 years; the median age was 77 years. All subjects were examined for symptoms and medical history of digestive diseases, medical history of drugs, screening for frailty, malnutrition, and depression, and an analysis of outpatient cards for the previous 5 years. The most common gastrointestinal symptoms in the elderly were epigastric pain (33.0 %) and epigastric burning (30.2 %), bloating (33.9 %), and constipation (28.3 %), and frequent heartburn (20.8 %). Less common symptoms included loose stools (17.9 %) and pain in the mesogastrium and hypogastrium (16.9 %). Only 33.0 % of respondents were diagnosed with a digestive disease. The underdiagnosis of digestive diseases may be due to the infrequent use of esophagogastroduodenoscopy and liver tests. 52.8 % of respondents reported taking medications for gastrointestinal symptoms, often without a doctor's prescription, particularly proton pump inhibitors, antispasmodics, and non-optimal classes of laxatives. Symptoms of digestive disorders, including constipation and gastric or colon resection, increase the risk of frailty and malnutrition.

BACKGROUND. Cognitive impairment represents a growing global health challenge due to population aging and the increasing prevalence of chronic non-communicable diseases. Early stages of cognitive decline, including subjective cognitive decline and mild cognitive impairment, are considered the most promising therapeutic window for preventive intervention.

OBJECTIVE. To summarize expert opinions regarding the potential role of omberacetam (Noopept®) in early prevention and management of cognitive impairment.

MATERIALS AND METHODS. The article presents the resolution of an expert council meeting involving specialists in geriatrics, neurology, psychiatry, and internal medicine. Current evidence from experimental and clinical studies on the mechanisms of action and clinical efficacy of omberacetam was analyzed.

RESULTS. Omberacetam demonstrates multimodal neuroprotective effects, including stimulation of neurotrophic factors (BDNF and NGF), antioxidant activity, modulation of glutamatergic neurotransmission, and improvement of neuronal plasticity. Clinical studies have shown improvements in memory, attention, executive functions, and quality of life in patients with mild and moderate cognitive impairment of vascular, traumatic, and other origins. CONCLUSION. According to expert consensus, omberacetam may be considered as part of a complex therapeutic strategy for patients with early cognitive impairment, vascular risk factors, asthenic conditions, and organic CNS disorders. Further multicenter randomized clinical studies are required to strengthen the evidence base and evaluate the potential inclusion of omberacetam in clinical recommendations for the prevention and management of cognitive impairment.

Against the backdrop of the rising global prevalence of overweight and the established link between obesity, activation of the renin-angiotensin-aldosterone system (RAAS), and hypertension, selecting an antihypertensive agent capable of targeting the common pathogenetic pathways of these conditions is critical for comorbid patients. This article analyzes the therapeutic potential of telmisartan, a highly selective angiotensin II receptor blocker with unique pharmacokinetic properties. Due to its pronounced lipophilicity, the drug ensures effective blockade of tissue RAAS, which accounts for its high organoprotective activity. Particular attention is given to the specific mechanism of telmisartan as a partial agonist of peroxisome proliferator-activated receptor gamma (PPAR-γ). This property allows the drug to function as a metabolic modulator: promoting adipose tissue redistribution, reducing visceral fat area, lowering triglyceride levels, and improving insulin sensitivity. The presented data lead to the conclusion that the use of telmisartan is a pathogenetically justified and rational choice for treating comorbid patients with concomitant hypertension and obesity as well as cardiovascular-renal-hepatic-metabolic syndrome, enabling the achievement of target blood pressure levels while simultaneously correcting metabolic disturbances.