The paper represents clinical guidelines on frailty, developed by Russian Association of gerontologists and geriatricians. The guidelines are dedicated to geriatricians, internal medicine specialists, general practitioners, family doctors and other specialists, dealing with adult patients. This publication includes treatment options for patients with frailty.

The aim of this study was to research the prevalence of frailty and prefrailty and their relationship with chronic non-infectious diseases among outpatients in Moscow.

Methods. The study included 356 patients ≥65 years (mean age 74.9 ± 6.1), 80.4% (n = 286) were women. For identify frailty, the phenotype model and the deficit accumulation model were used. The chronic non-infectious diseases was detected by an anamnesis and evaluating medical records.

Results. Frailty and prefrailty according to the criteria of the phenotypic model were identified in 8.9% and 61.3% cases; according to the criteria of the deficit accumulation model – in 4.2% and 45.8% cases, resp. The average number of chronic non-infectious diseases was significantly higher in patients with frailty both  – by the phenotype model (4.0 ± 1.3 vs 2.8 ± 1.4) and by the deficit accumulation model (5.8 ± 0.9 vs 2.5 ± 1.2). Taking into account the influence of age, the risk of prefrailty according to the phenotypic model increases 2.7 times in the presence of chronic heart failure; according to the deficit accumulation model – 5.6 times in the presence of coronary heart disease, 4.2 times with in the joint diseases, 3.7 times with diabetes and 3 times with cancer.

Conclusion. А high prevalence of prefrailty among outpatients in Moscow 65 years and older, as well as a reliable relationship between frailty and prefrailty with the total number and individual chronic non-infectious diseases were revealed. It is important to take measures to prevent the development and progression of frailty among outpatients, having a potentially high prevalence of chronic non-infectious diseases.

In review article, we discuss the opportunity of use of one of the direct oral anticoagulants – apixaban – for prevention of stroke and/or systemic embolism in elderly patients with non-valvular a trial fibrillation. We consider results of randomized clinical trials of apixaban – ARISTOTLE and AVERROES, including the subgroups analysis in patients in the age of ≥75 years and ≥80 years – in ARISTOTLE, ≥75 years and ≥85 years – in AVERROES. These studies have shown that elderly patients had more benefit from apixaban administration than warfarin (in ARISTOTLE) or acetylsalicylic acid (in AVERROES). The results of two retrospective observational studies confirming the favorable profile of apixaban effectiveness and safety in elderly patients with a trial fibrillation in real clinical practice, and the main provisions of the consensus document FORTA, the purpose of which is to individualize treatment of elderly patients based on clinical characteristics of the patient, are also considered.

This review article deals with the topic of changes in bone tissue in the process of aging of the body. Adipogenesis and osteogenesis are affected at the molecular level, proteins and genes are described, in which somatic mutation can occur during the aging process, resulting in both minor changes and an active loss of bone mineral density. The factors that affect the change in bone mineral density mainly in the elderly, and existing drugs that can slow down osteoporosis are listed. Knowledge of the cellular and molecular mechanisms underlying the aging of bone tissue will contribute to the creation of targeted therapy for osteoporosis, which slows down bone aging and prevents falls and fractures in the elderly people.

Hip fractures are severe and life-threatening injuries with huge social, medical and economic consequences and a high mortality rate. The article is devoted to the organization of medical care in older patients group who received a hip fracture due to osteoporosis. Based on the experience of the Yaroslavl emergency medical care hospital n.a. N.V. Solovyov we analyze how the providing of medical care for these patients has changed over the past 10 years. A whole range of measures was introduced to ensure timely hospitalization, round-the-clock examination, availability of free metal structures, therapeutic support and early rehabilitation of patients. The result of these measures was the reduction in hospital mortality from 9.66% to 1.44%, the increase of operational activity from 71% to 92%, and the increase of the number of patients operated on within 48 hours from 0.3% to 82%. In addition, patients with low-energy fractures need implementing measures of falls prevention and prescription of the treatment for osteoporosis. These approaches help to reduce the frequency of further low-energy fractures and mortality of these patients. For this purpose, the secondary fracture prevention service (FLS) was created in this hospital. The service organized an active patients’ identification, fractures and falls risk assessment, prescription of osteoporosis therapy, recommendation of non-drug measures and physical training, and development of a plan for further monitoring of the patient. These approaches allowed to achieve high efficiency of the service: identification up to 97% in patients with fracture, prescription of drug therapy to 78% of patients. Thus, the introduction of a whole range of measures has significantly improved the quality indicators of medical care for patients with hip fractures.

Osteoporosis, falls and low-energy fractures have a high prevalence in elderly, which is increasing in the presence of diabetes mellitus type 2 (T2DM). Patients with T2DM have a low rate of bone metabolism, a pronounced change in bone microarchitecture. The use of trabecular bone score in evaluating of densitometry and the FRAX scale improves the sensitivity of the methods in patients with diabetes. Integrated approach is required in elderly patient with type 2 diabetes and includes assessment of geriatric status, diabetes status, correction of multiple complications of diabetes, carbohydrate metabolism, vitamin D deficiency, selection of the most effective hypoglycemic and anti-osteoporetic therapy and development of preventive and treatment methods aimed to reduce falls risk and fractures rate.

In this article, the authors consider the problem of delirium in the elderly and senile age, which is an actual geriatric syndrome in the world clinical practice. The paper focuses on the management of an elderly patient with delirium by secondary medical personnel. For this purpose, the geriatric nursing protocol «Set of measures to prevent the development of delirium in hospitalized elderly and senile patients» is provided, which is used in the clinical practice of the Russian Clinical and Research Center of Gerontology. The protocol provides an idea of the prevalence and relevance of delirium. The parameters for evaluating a patient with delirium, the nursing strategy, and the expected results from implementing the protocol are described. The necessary diagnostics for the scale are given, an important place is given to the prevention of delirium. The need to train nurses in diagnosis, prevention, and patient care is discussed.