This review outlines the key points from the clinical guidelines «Sarcopenia in Elderly Patients», covering definition, epidemiology, clinical features, diagnostic approaches, and treatment strategies. The information is intended to help individuals manage patients aged 60 years or older with a focus on muscle health.

BACKGROUND. FRAX® is a key tool for fracture risk stratification in osteoporosis. In Russia, both online calculators and paper charts are available, but their comparability has not been studied. Offline settings, remote areas, and high patient flow make paper charts a practical alternative, yet their reliability is uncertain.
OBJECTIVE. To assess the concordance between 10-year fracture probabilities calculated using the online FRAX® calculator and paper-based FRAX® charts developed for the Russian population.
MATERIALS AND METHODS. This cross-sectional study included 161 patients (65.2% women) aged ≥50 years who were referred for DXA. Ten-year probabilities of major osteoporotic fractures (MOF) and hip fractures were calculated using two methods (online and paper charts), based on bone mineral density or body mass index (BMI). Correlation, regression, Bland–Altman analysis, and agreement on intervention thresholds were performed.
RESULTS. No statistically significant differences were found (p > 0.05). The correlation ranged from ρ = 0.927 to 0.957 (p < 0.001) with R^² = 84–90%. The highest Cohen's kappa value was observed for the MOF risk using BMI (k = 0,749). The false-positive intervention threshold rate was 4.9–5.3%.
CONCLUSION. Paper-based FRAX® charts show high concordance with the online calculator and can serve as a reliable alternative when internet access is limited or for large-scale screening.

BACKGROUND. Older adults with multiple comorbidities often have limitations in their daily activities due to the development of geriatric syndromes, such as frailty, malnutrition, and falls. The level of functional activity decreases significantly [1]. The approach to improving functional activity in these patients involves implementing multicomponent programs, including physical exercise [2]. However, there is no consensus among specialists on the effectiveness, structure, and duration of these interventions for multimorbid weakened elderly patients.
OBJECTIVE. To evaluate the structure of individual multicomponent rehabilitation programs based on the results of a comprehensive geriatric assessment of multimorbid patients aged 60 and older with frailty syndrome.
MATERIALS AND METHODS. The study was conducted at the Russian Gerontology Research and Clinical Center (RGNCC) of the N. I. Pirogov Russian National Research Medical University. Individual multicomponent programs were analyzed based on the results of comprehensive geriatric assessment (CGA) in patients with multimorbidity and frailty. The study included 299 patients, 79% of whom were women. The median age was 75 years (70; 81). All patients underwent CGA with functional and neuropsychological testing to identify geriatric syndrome (GS). Based on the CGA results, individualized geriatric rehabilitation (GR) programs were developed for each patient. These programs consist of 22 exercises, ranked by intensity in five levels, ranging from less intense (level 1) to more intense (level 5), with a specified number of repetitions and sets: 9 anaerobic exercises, one aerobic (cardiovascular) exercise (walking), five balance exercises and seven stretching exercises. Individualized long-term intervention programs also include recommendations on nutrition, cognitive training, use of walking aids and correction of any deficiencies identified during CGA.
RESULTS. In the structure of functional deficits, mobility impairments and the risk of falls, according to the results of the Brief Battery of Physical Functioning Tests (BBPFT) and the «Stand up and go» test, 39.0% of patients were identified. The majority of these patients (88.4%) showed a decrease in muscle strength in the upper limbs and a decrease in functional status, including instrumental activity in 47.9% of cases, dependency in everyday life for 43.1%, cognitive impairment for 33.4%, risk of depression for 24.1%, sleep disorders for 44.6%, polypharmacy for 47.3%, chronic pain syndrome for 78.8%, malnutrition for 20.9%. The most common chronic noncommunicable diseases were hypertension (93.0%), cerebrovascular accidents (47.2%), chronic kidney disease (49.8%), osteoarthritis (41.5%), coronary heart disease (29.4%), and type 2 diabetes mellitus (27.4%). Almost every fifth patient has a history of stroke. In 58% of patients, the duration of exercise did not exceed 30 minutes per day. Based on the identified goals and deficiencies, rehabilitation programs were developed for functional activity using adapted physical exercises, considering the level of physical activity (100% of cases), cognitive training (43.6%), and correction of the psychoemotional state (depression, insomnia, 77.8%), nutrition (29.8%) and fall prevention (77.8%).
CONCLUSION. Elderly and very old patients form a heterogeneous group with a variety of comorbidities, requiring an individualized approach to selecting rehabilitation programs. Comprehensive geriatric rehabilitation programs, developed based on the results of comprehensive geriatric assessments, address the fullest possible range of needs for patients with frailty.

BACKGROUND. Frailty and related nutritional disorders are highly prevalent among older adults, especially in inpatient settings [1, 2]. The Mini Nutritional Assessment (MNA) is a validated tool that enables not only screening of nutritional status but also a more detailed evaluation of risk factors for developing malnutrition [3].
OBJECTIVE — to conduct a comprehensive evaluation of nutritional parameters in patients aged 60 years and older residing in care homes and geriatric centers in Moscow, to detail responses across MNA domains, to identify correlations with functional, psychoemotional and clinical parameters, and to propose targets for dietary interventions.
MATERIALS AND METHODS. A multicenter prospective study (within the first phase of the «POSTSCRIPTUM» clinical trial) included 792 patients aged 60 years and older (mean age 76.8 ± 8.2 years, 68% women) with indications for geriatric rehabilitation. Nutritional assessment was performed using the full version of the MNA [3]. Based on the total score, patients were divided into two groups: «normal» (MNA ≥24, n = 636) and «at risk of malnutrition» (MNA < 24, n = 156). A comparative analysis of responses to each of the 18 MNA items was carried out, along with correlation analysis between the MNA score and age, body mass index (BMI), functional independence (Barthel Index, Lawton Index), physical performance (Short Physical Performance Battery, SPPB), muscle strength (handgrip dynamometry), cognitive status (Montreal Cognitive Assessment (MoCA), depression (15-item Geriatric Depression Scale, GDS-15), pain (Visual Analogue Scale, VAS score), insomnia (Insomnia Severity Index, ISI), polypharmacy, and frailty screening (score on the «Age Is Not a Hindrance» scale).
RESULTS. The proportion of patients at risk of malnutrition was 19.7%. Statistically significant differences between groups were found across most MNA domains (p < 0.001). The following factors were significantly more frequent in the malnutrition-risk group: appetite decline (46.8% moderate and 1.3% severe), weight loss over the preceding 3 months (43.6%), mobility limitations (5.8%), acute stress/disease (69.2%), neuropsychological problems (overt dementia or depression —15.4%), polypharmacy (80.8%), pressure ulcers (2.6%), inadequate meal frequency (30.1%), protein-rich food deficit (3.2% with 0–1 markers), insufficient fluid intake (13.5% < 3 cups), low self-perceived nutrition quality (2.6% «insufficient», 26.3% «do not know»), self-rated health «not good» (41.0%), and reduced mid-upper arm circumference (3.2%) and calf circumference (5.8%). Correlation analysis demonstrated a weak positive association between MNA scores and the Barthel Index (r_s = 0.26) and SPPB (r_s = 0.27), a weak-to-moderate negative association with GDS-15 (r_s = –0.31), and weak negative associations with frailty screening (r_s = –0.28) and pain (r_s = –0.24).
CONCLUSION. Malnutrition risk was identified in every fifth patient. Moderate appetite decline, weight loss, neuropsychological problems, polypharmacy and poor self-rated health were widespread among patients at risk of malnutrition. Insufficient protein and fluid intake was also statistically significant. Rank correlation analysis showed a strong relationship between poor nutritional status and depressive symptoms, while other statistically significant associations were less strong, emphasizing the multifactorial nature of nutritional status among older adults. This should be taken into account when diagnosing and treating malnutrition, especially focusing on depression, physical activity and pain. Dietary targets for correction are proposed based on the study's limitations, and the results may be useful for developing nutritional support protocols for geriatric care facilities in Russia.

Gerontology is the field of study that focuses on understanding the patterns of aging; it has experienced significant growth since 2016, when the World Health Organization introduced the «Decade of Healthy Aging» initiative. The undeniable success of modern medicine can be seen in the growing numbers of youngest-old, middle-old, and oldest-old individuals. The collective contribution of scientists, physicians, healthcare professionals, social workers, and, directly, patients to maintaining the health of individuals over the age of sixty needs to be supported and multiplied.
THE OBJECTIVE of the study was to determine the awareness and knowledge of specific issues in age-associated medicine among outpatient clinic service physicians and their patients in the Moscow Region.
MATERIALS AND METHODS. A simultaneous paired survey was conducted over a span of 12 days, beginning on October 2 and ending on October 13, 2023, with participation from 435 primary care physicians and 603 patients in the Moscow Region. In order to gather information about their education and training in geriatrics, as well as their intentions to receive further training and knowledge of regulatory documents, their own opinion about the role and structure of geriatric services, experts were asked to complete an electronic questionnaire.
RESULTS. The interviews included 603 patients, gender ratio 2:1 (66.8% women, 33.2% men). Age structure: patients less than 60 years old — 41.3%, 60–70 years old — 34.5%, 70–80 years old — 16.3%, 80–85 years old — 5.3%, 85–90 years old — 1.3%, over 90 years old — 1.3%. Over the past year, 172 people received inpatient treatment for all reasons, which amounted to 48.7% of the total number of older respondents, and more than 50% of them were hospitalized two or more times during the last year. 38.6% of older and oldest-old respondents define their health as «satisfactory», 8.2% noted a low level of their health. 30.2% are under outpatient observation in the clinic. Among people over 60, 85% of respondents had never consulted a geriatrician. Among the patients participating in the study, 16.4% were dissatisfied with medical care, while 63.8% were satisfied with the current state of medical institutions. According to the survey, older and elderly patients are aware of what aspects are included in the concept of a healthy lifestyle and adhere to it. Thus, 68.9% regularly exercise, 27.1% do not drink alcohol at all, and 31.1% sharply limit alcoholic drinks, 59.8% of patients add fresh fruits and vegetables to their diet daily.
CONCLUSIONS. The findings of this study indicate that the feeling of old age is not determined by one's passport age. The Moscow region is also experiencing a deficiency in geriatrics experts, resulting in inadequate consultations for patients requiring geriatric care. Additionally, neither doctors nor patients expect changes in well-being and treatment after consultations with geriatricians. Patients need consultation with doctors much less frequently than doctors themselves assume. Currently, cardiologists, neurologists and endocrinologists are most in demand for the management of older patients.

OBJECTIVE: to study the effect of elevated levels of IL-6 on the risk of death in elderly and senile patients with chronic heart failure (CHF) and anemia.
MATERIALS AND METHODS. After discharge from the hospital, 145 patients aged 65 to 90 years with CHF of functional class II–IV (NYHA) against the background of coronary heart disease (CHD) were observed for up to 24 months: 105 patients with CHF and anemia and 40 patients with CHF without anemia. The control group (CG) consisted of 30 patients with CHD without CHF and anemia. The primary endpoint is death from cardiovascular and non-cardiovascular causes. Upon admission, the levels of IL-6 and N-terminal brain-promoting natriuretic peptide (NT-proBNP) were examined once in patients. Kaplan – Meyer survival curves were used to estimate the mortality rate, and Cox proportional hazards regression analysis was used to assess the effect of IL-6 on the risk of death.
RESULTS. In the CHF group with anemia, the average IL-6 level was (9.54 ± 0.67) pg/ml, which is significantly higher than in the CHF group without anemia (6.93 ± 0.97) pg/ml (p = 0.004) and in KG (0.95 ± 0.07) pg/ml (p = 0.000). The Kaplan – Meyer survival analysis revealed a higher mortality rate of patients in the CHF group with anemia than in the CHF group without anemia (p = 0.00186), as well as in the CHF group with anemia — a higher mortality rate of patients in the 4th quartile range (QR) of IL-6 levels (12.5–39.4 pg/ml), than in 1QR (1.10–5.00 pg/ml) (p = 0.04022). Univariate regression analysis in the CHF group with anemia revealed a significant effect of IL-6 on the risk of death from cardiovascular and non-cardiovascular causes in 4QR patients [1.087 (1.007–1.174), p = 0.033], which remained in the multivariate regression analysis after correction for covariates significant for prognosis: age [1.088 (1.005–1.178), p = 0.037] and hemoglobin levels [1.086 (1.006–1.173), p = 0.036], but did not persist after correction for NT-proBNP [1.031 (0.931–1.143), p = 0.556].
CONCLUSION. To assess the prognosis in elderly and senile patients with CHF and anemia, it is advisable to study IL-6 in addition to NT-proBNP as a marker of a high risk of death from cardiovascular and non-cardiovascular causes.

BACKGROUND. Malnutrition is a prevalent and clinically significant condition among long-livers, associated with increased vulnerability, functional decline, and adverse health outcomes. Conventional screening tools, such as questionnaires, may be limited in individuals aged 90 and older due to cognitive and physical impairments. This highlights the importance of objective laboratory-based assessment in this population.
OBJECTIVE: to identify laboratory biomarkers associated with malnutrition and weight loss in long-livers
MATERIALS AND METHODS. This study included 3,869 long-livers aged 90 and above. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), and a comprehensive laboratory panel included markers of inflammation, protein metabolism, hormonal status, and micronutrients. A subset of participants underwent follow-up to assess changes in body weight. Non-parametric tests and the Boruta algorithm were used to identify key predictors. The ethics committee (№ 30 24.12.2019) reviewed the study. The statistical analysis was performed using R version 4.4.0.
RESULTS. Malnutrition or its risk (MNA ≤ 11) was identified in 78.6% of long-livers. These individuals exhibited significant changes in laboratory parameters: lower levels of albumin, total protein, hemoglobin, leptin, 25(OH) D, and IGF-1, and higher levels of C-reactive protein (CRP), NT-proBNP, and ferritin (p < 0.001). Boruta analysis highlighted albumin, total protein, hemoglobin, and leptin as the strongest predictors of malnutrition. A change in IGF-1 was consistently observed both in malnourished participants and those with progressive weight loss, regardless of initial nutritional status.
CONCLUSIONS. Laboratory screening provides valuable insights into the metabolic profile of malnutrition in long-livers, reflecting systemic inflammation, protein-energy deficiency, and diminished anabolic reserve. IGF-1 may serve as a sensitive indicator of early catabolic processes. Laboratory-based assessment is an effective and practical tool when questionnaire-based methods are limited or inapplicable.

OBJECTIVE. To identify and discuss the causes of death among the elderly in the four regions of the Russian Federation, using medical death certificate (MDC) data.
MATERIALS AND METHODS. A total of 114,402 deaths of people aged 75 years or older from diseases (ICD-10 codes I–XVIII and XXII) were selected from electronic databases of regional medical information and analysis centers in four regions of the Russian Federation for the year 2023. Of these, 45,988 died in Moscow (40.2%), 43,249 in the Moscow region (37.8%), 13,309 in Novosibirsk region (11.6%), and 11,856 in Kemerovo region (10.4%).
RESULTS. The structure of the underlying causes of death (OCD) from diseases by ICD-10 classes in 4 regions has significant differences (p < 0.0001). The share of diseases of the circulatory system (DCS) was 71.6% in Moscow, 47.7% in the Moscow region; 70.8% in the Novosibirsk region and 50.9% in the Kemerovo region. The share of deaths from malignant neoplasms (MN) was 18.7% in Moscow; 9.9% in the Moscow region; 14.9% in the Novosibirsk region and 14.1% in the Kemerovo region; diseases of the nervous system — 0.2%; 22.2%; 2.9% and 15.5%, respectively. The fourth rank place in the Moscow region (4.8%) and Kemerovo region (6.2%) was occupied by diseases of the endocrine system (0.2% in Moscow and 1.1% in the Novosibirsk region). The share of acute forms of ischemic heart disease (ICD-10 code groups I21–I24), stroke (I60–I64) and ruptured aneurysm or aortic dissection in the structure of the PPS was 9.7% in Moscow; 12.3% in the Moscow region; 8.8% in the Novosibirsk region and 12.9% in the Kemerovo region. The share of codes probably associated with chronic cognitive impairment and/or dementia (from 3 classes of diseases) accounted for 33.2% in Moscow, 30.8% in the Moscow region, 14.0% in the Novosibirsk region and 26.7% in the Kemerovo region. The CSD codes in any place of the ICD-10 were indicated in 83.0% of cases in Moscow and 85.2% in the Moscow region; in the Novosibirsk region — 85.6%, and in the Kemerovo region — 87.3%, with 98.0% of the MCCs indicating more than one 4-digit ICD-10 code.
CONCLUSIONS. Despite significant differences in the structure of causes of the death, chronic pathology predominates in all four regions, with a high proportion of deaths associated with cognitive impairment. The causeof-death statistics for those aged 75 and older are not sufficiently objective, with underdiagnosis of some diseases and overdiagnosis of others, as well as a high frequency of using codes for unspecified causes of death or those not recommended for use in mortality statistics.

INTRODUCTION: Surgical treatment in patients aged 75 years and older is associated with a high risk of intraand postoperative complications, leading to a significant number of cancellations of planned procedures. The cancellation of elective surgeries in elderly patients is a complex medical and organizational issue that has a negative impact on patients, medical institutions, and healthcare systems.
OBJECTIVE: The aim of this study is to conduct a retrospective analysis of the reasons for cancellations of elective orthopaedic surgeries in patients 75 or older.
MATERIALS AND METHODS: We analyzed the medical records of 109 patients scheduled for knee or hip arthroplasty in 2024. We reviewed the reasons for surgery cancellations in this cohort.
RESULTS: Of the 109 planned surgeries in patients aged 75 and older, 55 (51%) were performed. Among the reasons for cancellations, clinical factors predominated, driven by high comorbidity: coronary artery disease, anemia, obesity, atrial fibrillation, oncological diseases, and other concomitant conditions. In some cases, the decision to cancel the surgery was related to the success of conservative therapy or a recent acute respiratory infection. Organizational reasons, primarily long waiting times, as well as episodes with unclear circumstances, also accounted for a significant proportion. Medico-social factors were represented by patient refusal due to fear of surgical intervention, or the inability to provide postoperative care. During follow-up, about half of the previously cancelled interventions were subsequently performed; however, a significant portion remained unrealized.
CONCLUSIONS: Every second planned surgical intervention for patients aged 75 years and older was canceled. The key risk factors for cancellation include comorbidities as well as organizational barriers. It is necessary to conduct a comprehensive geriatric assessment in order to optimize preoperative patient preparation and minimize risks, as well as improve patient flow in elective surgery.

Elderly patients represent a specific risk group in diagnostic procedures using contrast media (CM). With increasing life expectancy and a growing elderly population, the need for diagnostic procedures using CM is rising. However, scientific information on the specific use of CM in this group remains limited. This review analyzes available data on the pharmacokinetic characteristics of contrast media in older individuals and examines key risks associated with their use in this patient group. The analysis indicates that older patients are more susceptible to contrast media side effects. Accordingly, the review explores key aspects of optimizing CM use in older patients, emphasizing an individualized approach for patients over 65 years of age. The review demonstrates the need for further research to improve understanding of the specific features of RCP use in elderly patients, which will optimize the diagnostic process and increase the safety of examinations.

Population aging leads to a steady increase in the prevalence of cognitive impairment (CI) and dementia, posing a significant medical and social challenge. This article reviews current concepts on the etiology and pathogenesis of CI in elderly and senile patients, highlighting the key roles of oxidative stress, mitochondrial dysfunction, and inflammaging. Special attention is given to the diagnosis and differentiation of non-dementia cognitive disorders (subjective, mild, and moderate cognitive impairment), which can be stabilized or even reversed with timely detection and risk factor correction. The necessity of a comprehensive, multidisciplinary approach to managing these patients is substantiated, encompassing the optimization of comorbidity treatment, non-pharmacological interventions, and targeted pharmacotherapy. The importance of using multimodal drugs, such as ethylmethylhydroxypyridine succinate (Mexidol), which exhibit antioxidant, antihypoxic, and membrane-stabilizing effects, is emphasized. Evidence shows that incorporating Mexidol into complex therapy contributes to the improvement of cognitive functions, enhances patients' quality of life, and slows down the progression of vascular cognitive disorders. This is confirmed by data from randomized clinical trials and reflected in current clinical guidelines.

BACKGROUND. Cognitive impairment in older adults is a leading cause of functional decline and reduced quality of life, and it is driven by a combination of vascular, metabolic, and stress-related mechanisms. Omberacetam (Noopept) is a nootropic agent with a multimodal mechanism of action, whose clinical efficacy and safety have been evaluated in multiple studies. However, the available evidence has not been systematically summarized.
OBJECTIVE. To conduct a systematic review of clinical studies assessing the efficacy and safety of omeprazole in adults with cognitive impairment due to various etiologies, including non-dementia.
METHODS. This systematic review was conducted in accordance with the PRISMA-2020 guidelines. Literature searches were conducted using PubMed/MEDLINE, eLIBRARY.RU and manual searches of relevant Russian medical journals. Clinical studies involving adult patients who were treated with omberacetam at therapeutic doses and reported quantitative cognitive outcomes or safety data were included in the analysis. Risk of bias was assessed using the Cochrane Risk of Bias criteria. Due to the methodological and clinical heterogeneity of the studies, a metaanalysis was not conducted; results were analyzed qualitatively.
RESULTS. Eighteen clinical studies involving 1,279 patients were included, of whom 988 received omberacetam. The main clinical populations comprised vascular cognitive impairment, dyscirculatory encephalopathy, mild cognitive impairment, post-stroke, and post-traumatic cognitive disorders. Across all studies, omberacetam treatment was associated with improvement in cognitive performance assessed by global cognitive scales (MMSE, MoCA) and domain-specific neuropsychological tests. Improvements in MMSE scores ranged from +0.6 to +3.5 points depending on patient population and treatment duration. In comparative studies, omberacetam demonstrated efficacy comparable to or greater than piracetam and standard therapy. The drug showed a favorable tolerability profile; adverse events were generally mild, transient, and rarely led to treatment discontinuation.
CONCLUSIONS. The available clinical evidence indicates that omberacetam is effective in improving cognitive function in adults with non-dementia cognitive impairment and has a favorable safety profile. However, the predominance of open-label study designs highlights the need for further randomized, placebo-controlled trials with standardized cognitive endpoints.

Population aging and the increasing prevalence of arterial hypertension (AH) have led to an epidemic of cognitive impairment and dementia. AH is a key modifiable risk factor that triggers a cascade of pathophysiological changes: cerebrovascular remodeling, blood-brain barrier (BBB) dysfunction, and neuroinflammation. Analysis of current data demonstrates that angiotensin II receptor blockers (ARBs), particularly telmisartan, possess unique neuroprotective properties due to their high affinity for AT1R and their ability to activate PPARγ. This provides anti inflammatory and antioxidant effects, as well as improved cerebral blood flow. Calcium channel blockers (CCBs), such as amlodipine, complement this effect by improving regional perfusion and reducing oxidative stress. The combination of telmisartan and amlodipine ensures not only stable blood pressure control and reduced variability but also multi-channel protection of the neurovascular unit.

The article presents a case study of an 80-year-old patient with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM). This case demonstrates the importance of comprehensive examination in cases of unexplained heart failure in elderly patients, and illustrates the effectiveness of tafamidis treatment for patients over 80 years old. Transthyretin Amyloid Cardiomyopathy (ATTR-CM), is an infiltrative heart condition caused by the deposition of amyloid fibrils within the extracellular space of the myocardium. This condition leads to severe heart failure, which is often found in older patients and is frequently diagnosed at later stages due to comorbidities, masking symptoms under other conditions, and severe geriatric status. Without treatment, the prognosis for this condition is poor, with heart damage being the leading cause of death, and with an average survival time of only 3.6 years after diagnosis. Early diagnosis of ATTR-CM allows for timely initiation of pathogenetic therapy aimed at stabilizing the progression of the disease, improving the quality of life and reducing mortality.