This document is a clinical guideline on malnutrition in elderly and senile patients, developed by experts from the Russian Association of Gerontologists and Geriatricians, the National Association of Clinical Nutrition and Metabolism, the Union of Nutritionists, Nutritionists, and Food Industry Specialists. The Scientific and Practical Council of the Ministry of Health of the Russian Federation approved the document in December 2020. Clinical recommendations are aimed at geriatricians who provide assistance in outpatient and inpatient conditions, general practitioners, general practitioners, nutritionists, anesthesiologists-resuscitators, clinical pharmacologists, and rehabilitologists.

The document outlines the principles of screening, diagnosis of malnutrition syndrome, approaches to managing, preventing, and rehabilitating patients with malnutrition, and organizing medical care for this category of persons and criteria for quality control of its provision.

On behalf of EVKALIPT study.

Objective: to evaluate prevalence of age-related and chronic non-infectious diseases, senile asthenia and other geriatric syndromes in subjects aged ≥65 years old and to analyze their influence on general health and functional status.

Methods: 4308 subjects (30% males) aged from 65 to 107 years (mean age 78±8 years), who live in 11 Russian regions, were examined. They were divided in 3 groups by age: 65–74, 75–84 and ≥85 years. All subjects passed comprehensive geriatric assessment in 2 stages: 1) questioning based on a specially designed questionnaire; 2) physical examination.

Results: age increase is associated with decrease of anthropometric parameters (height, weight, body mass index), decrease of diastolic blood pressure, increase of pulse blood pressure and deterioration of social-economic status of elderlies (increase of those who out lived their partners, living alone and in institution/ nursing home, single (no partners) and disabled subjects; decrease in proportion of married and still working ones, subjects with university degree and higher income).

Conclusion: Russian EVKALIPT study protocol and basic characteristics of participants are summarized in the article.

Abstract Introduction. Recently studies showed that a persons aged 65 years and older with body mass index (BMI) ≥ 25 kg/ m² have the same or lower risk of mortality than older adults with a normal BMI.

Objective: to investigate the relationship between baseline body mass index (BMI), total skeletal muscle mass (SMM), muscle strength and all-cause mortality in the Russian population.

Methods. The Crystal study is a prospective cohort study of a random sample of people aged 65 years and older.

The total follow-up period was 9 years. Main parameters: BMI, nutritional status, anemia, C-reactive protein, skeletal muscle mass (SMM), functional status, depression, dementia and non-communicable diseases.

Results. Participants with BMI ≥ 25 kg/m² had a 34,6% lower risk of all-cause mortality during 5 years of follow-up and a 36,8% lower risk during 9 years of follow-up, regardless of nutritional status, chronic comorbidities, and functional status. This association was linked with higher SMM in participants with BMI ≥ 25 kg/m². After adjusting for all our covariates, higher SMM, but not BMI, was associated with a 7,4% decrease in mortality during the 5-year follow-up.

Conclusion. It is necessary to consider qualitative indicators of body composition, such as SMM and fat percentage during assessing the impact of BMI on mortality. The higher SMM is an independent factor associated with a 7,4% decreasing the risk of all-cause mortality over 5 years of follow-up in the population of people aged 65 years and older.

Introduction. At present, doctors in all disciplines are facing an increasing problem of chronic kidney disease (CKD) management. It is particulary relevant for screening and treatment of aged patients, because they suffer from CKD most frequently. This is due both to physiological age characteristics and kidney disease risk factors of these patient’s category.

Aim. To provide an analysis of the main causes and risk factors of CKD in elderly patients.

Materials and methods. Analysis of outpatient charts of patients aged 55–90 with multiple chronic diseases observed in the local health service in Moscow, which is the base of the Department of Outpatient Therapy, RNRMU.

Results. We analyzed the most significant risk factors of CKD and their frequency, the indications of this syndrome in the formulation of diagnosis, the prescription of drugs, providing nephroprotective strategy.

Conclusion. CKD is one of the most frequent pathologies in the elderly. An analysis of the outpatient charts showed that the main causes of CKD among patients in this age group were not kidney diseases but comorbide pathology, primarily arterial hypertension. These patients also had high frequency of diabetes mellitus, hyperlipidemia, obesity. Not all patients have been identified with CKD in the structure of diagnosis, which could influence the correct tactics for treating related diseases. Nephroprotective therapy was also not fully available to patients. Current recommendations can be used by primary health-care doctors in practice.54

Aim. The aim of our study was to verify the effectiveness of the innovative IntelligenceGym training in improving cognitive abilities in the elderly.

Material and methods. We developed an original training method that requires interaction between motor and cognitive functions. In our study 123 women and 89 men, aged 68–76 were examined. The inclusion criteria were Mini-Mental State Examination (MMSE) scores of 23 to 25 at inclusion, autonomy in walking, medical certification to participate in light physical activity. We have proposed to the participants to attend IntelligenceGym training one hour twice a week for 24 weeks. Cognitive performance was assessed before and after intervention included MMSE, Forward and Backward Digit Span Test, Rey’s Auditory Verbal Learning test (RAVLT), TMT-A, TMT-B. Moreover, motor performance was tested by using the Time Up and Go (TUG) test.

Results.The cognitive assessment after IntelligenceGym training showed statistically significant improvement in all the scores tested (t-test performed). The results showed that participants of the IntelligenceGym training had particularly improved performance in Digit Span, MMSE and TMT-B tests and also improvements in motor TUG test.

Conclusion. These findings indicate that the IntelligenceGym training is an efficient tool to improve cognitive performance in older adults with borderline or mild cognitive deficiency.

Aim. To analyze the factors associated with the development of chronic heart failure (CHF) in older age and to evaluate possible approaches to managing outpatients.

Material and methods. The search for domestic and foreign publications in Russian and international systems (PubMed, eLibrary, Medscape, etc.) for the last 0.5–15 years has been carried out. The analysis includes articles from the peer-reviewed literature.

Results. During aging, a number of structural changes and changes at the cellular level occur in the cardiovascular system, predisposing to the development of myocardial dysfunction, which explains the variety of manifestations of heart failure and the prevalence of preserved left ventricular ejection fraction (LVEF). Involutional functional and morphological changes in organs and systems form multimorbidity and nonspecificity of clinical symptoms and signs. «Cross symptoms» of frailty and CHF often complicate the timely diagnosis of the heart failure. Medications used for the treatment of CHF in older and younger patients are similar, but when choosing a specific drug, caution should be exercised in the group of the most vulnerable patients: over the age of 85, in the first two weeks after discharge from the hospital and in the presence of frailty.

Conclusion. Based on the available results of studies, it is necessary to be alert of primary care physicians regarding the presence of CHF with preserved LVEF in  older persons with multimorbidity and geriatric syndromes. The therapeutic strategy for CHF older patients is complex and involves an individualized approach, depending on the clinical situation.

Individuals age >65 years old are the fastest expanding population demographic throughout the developed world. Consequently, more aged patients than before are receiving diagnoses of impaired renal function and nephrosclerosis. In this review, we examine these features of the aged kidney and explore the various validated and putative pathways contributing to the changes observed with aging. Senescence or normal physiologic aging portrays the expected age-related changes in the kidney as compared to chronic kidney disease (CKD) in some individuals. The microanatomical structural changes of the kidney with older age include a decreased number of functional glomeruli from an increased prevalence of nephrosclerosis (arteriosclerosis, glomerulosclerosis, and tubular atrophy with interstitialfibrosis), and to some extent, compensatory hypertrophy of remaining nephrons. Among the macroanatomical structural changes, older age associates with smaller cortical volume. There is reason to be concerned that the elderly are being misdiagnosed with CKD. In addition to the structural changes in the kidney associated with aging, physiological changes in renal function are also found in older adults, such as decreased glomerular filtration rate, vascular dysautonomia, altered tubular handling of creatinine, reduction in sodium reabsorption and potassium secretion, and diminished renal reserve. These alterations make aged individuals susceptible to the development of clinical conditions in response to usual stimuli that would otherwise be compensated for in younger individuals, including acute kidney injury, volume depletion and overload, disorders of serum sodium and potassium concentration, and toxic reactions to water -soluble drugs excreted by the kidneys. Additionally, the preservation with aging of a normal urinalysis, normal serum urea and creatinine values, erythropoietin synthesis, and normal phosphorus, calcium and magnesium tubular handling distinguishes decreased GFR due to normal aging from that due to chronic kidney disease.

Treatment of osteoarthritis, as the most common pathology of the musculoskeletal system, presents certain clinical difficulties in comorbid patients. The frequent combination of osteoarthritis (OA) and cardiovascular diseases (CVD), diabetes mellitus type 2 and other cardiometabolic pathologies raises questions about the safety of pain relievers in the presence of chronic kidney disease (CKD). Safe treatment for chronic pain syndrome implies an informed decision about the risks / benefits of using any analgesic intervention. Particular attention should be paid to the decision on the appointment of non-steroidal anti-inflammatory drugs (NSAIDs). An alternative strategy for the treatment of joint pain in patients with CKD may be the use of chondroitin sulfate prescription form. Particular attention should be paid to the possibility of using the parenteral form of the drug, which has reliable evidence, faster onset of the clinical effect of analgesia, with a potential protective effect on the structure of joint tissues.

The main measures to prevent the spread of the COVID-19 virus in long-term institutions for elderly people should be based on the principle of social distancing and on limiting direct physical contact between older residents and their families. In this regard, the system of nursing care for the elderly residents of long-term care institutions is forced to reorganize in order to provide residents and their families with adequate quality care, while ensuring infection safety.

The article presents the current criteria for clinically reliable and clinically possible Parkinson's disease; the role of paraclinical methods in diagnosis is discussed.

The number of old and very old people is increasing every year. Geriatric population is considered as the most growing age group. By different estimations about 60% of medicines are prescribed to patients of 65 and older. In the same time this age group is underrepresented in clinical trials. Participation of elderlies in clinical trials is really actual now and requires further development form regulatory authorities, drug manufactures and investigators. This review summarizes actual international guidelines on clinical trials in geriatric population.

Errors during research can occur not only at the stage of planning, data collection and statistical analysis, but also at the stage of filling in spreadsheets. In most cases they can be easily corrected, otherwise results may be distorted. These errors can be categorized into invalid format and input errors. In the first case, the mixing of the absence of data and the zero values is especially dangerous, since it can lead to systematic errors: overestimation (if the zero values are filled in as the absence of data) or underestimation (if the absence of data is filled in as zero values) of the mean or the prevalence. Input errors are most often random, and their effect decreases with increasing sample size, but for the better analysis they should also be corrected as much as possible. The article provides an algorithm that allows you to find input errors and correct them before statistical analysis.

Malnutrition is a common geriatric syndrome, which often undiagnosed, leads to impaired physical and mental functioning and patient prognosis. Geriatric patients admitted to hospital with acute and subacute conditions and pain syndrome are in an especial risk zone. The article presents a clinical case of the development and correction of malnutrition in an 84-year-old patient with aseptic necrosis of the femoral head. Risk factors and existing approaches to the management of patients with malnutrition are discussed.

The prevalence of sensory deficits in older patients is high and is associated with falls, cognitive impairment, depression, functional impairment, disability, and mortality. Regularly assessing sensory systems and organizing adequate care measures is an essential task of nursing elderly patients. Nurses who are most in contact with patients can play a leading role in screening for sensory impairments and ensuring timely corrections.