Falls in old and senile age is one of the main geriatric syndromes that determine the prognosis of a patient's life and autonomy, regardless of the consequences. According to experts, 33% of people 65 years of age and older have a history of falls, with 50% of them falling more than once a year. The prevalence of falls depends on the environment of older person: falls rate is more than 10 times higher for older people in nursing homes and hospitals than in those living at home. For people 65 years of age and older, falls is the most common cause of injury and the leading cause of death due to traumatic injury. Falls are closely related to other geriatric syndromes. It is important to understand that falls are preventable. Falls prevention is an integral part management of older and senile patients management.

Fractures of the proximal femur are a severe, life-threatening injury with enormous social, medical and economic consequences. Even with a well-organized system of medical care, up to 12-17% of patients die within the first year after injury, and the long-term risk of death doubles. Specially designed population-based studies in the Russian Federation have shown a high incidence of hip fractures in patients at the age of 50 and older. However, there is currently no unified system of medical care organization for all regions of Russia, which allows hospitalization and operation of patients with hip fractures during the first hours after trauma. Hip fracture in an elderly person is an absolute indication for the hospitalization. However most patients have severe comorbidities, osteoporosis, an increased risk of falls and mortality because of any reason. The main surgical treatments for hip fractures include osteosynthesis of the fracture or hip arthroplasty. It is well known that after the occurrence of any fragility fracture the risk of subsequent fractures increases by 2-3 times. To ensure the continuity of patient management, provide prescription of anti-osteoporotic drugs and long-term follow-up of patients it is necessary to manage them within the special Fracture Liaison Services (FLS). The article is devoted to the organization of medical care in patients of older age groups who have received hip fractures. A review of modern approaches to the treatment and organization of care for elderly patients with hip fractures is based on the methodological recommendations «Complex measures aimed at preventing falls and fractures in the elderly» developed in the framework of the federal project «The Older Generation», the draft national clinical guidelines «Fractures of the proximal femur», as well as the results of our own research.

Falls predict functional status declines in old age and institutionalization. Among the causes of the falls are sensory deficits, cognitive impairment, chronic diseases such as cardiovascular, endocrine diseases, musculoskeletal system pathology, the use of sedatives, antihypertensive drugs, neuroleptics and diuretics, as well as external causes, including inappropriate aids. The optimal diagnostic method in this case is a comprehensive geriatric assessment, which allows for focused history taking, detailing the circumstances of the fall, identification of risk factors and assessment of consequences, the gait and balance testing, determination of the lower limbs and joints functions are hold in the course of CGA along with orthostatic test that detects sensory deficits. Additional measures of mandatory recommendations should be a discussion of rational nutrition, with an emphasis on adequate intake of protein with food and fluids as prevention.

Objective. Evaluation of influence on mortality, life expectancy and related costs in the Russian Federation of methodical changes in the organizing surgical treatment of proximal femur fracture (PFF).

Material and methods. The mathematical modeling methods were applied for evaluation of impacts, related to methodical changes in the organizing surgical treatment of PFF, including the calculation of life expectancy. It is assumed, that 95% of all patients over 60 years old with PFF would receive a surgical treatment. Calculations were perform in 3 stages: calculation of death causes, related to PFF, calculation of life expectancy change in population and calculation of direct and indirect medical and non-medical costs and social assistance for patients with PFF.

Results. Mortality rate from PFF in model is decreased by 51%, which is equal to 55 648 saved lives. Life expectancy indicator increases by 0.3 annually during the transition to new methods of surgical treatment for the patients with PFF. Number of disabled patients is decreasing by 74 179 people annually. Taking into account all the effects, revealed in the modeling, the financial savings are estimated at 12.3 billion rubles or 32% of current expenditures from all funding sources on treatment and social assistance of patients with PFF.

Conclusion. Implementation of this new approach to surgical treatment of patients over 60 years old with PFF shows a positive influence on dynamic of demographical indicators of population in general. Despite changes in structure of expenses and increase direct medical costs, new approach in surgical care will lead to a major cost reduction as well as significant improvement of treatment results for geriatric patients with PFF.

Background. To reduce the number of osteoporotic fractures in the world in recent years, — Fracture Liaison Service has been created. Since 2019, the development of a register of patients included in the Secondary Fracture Prevention named «Prometheus» has begun in Russia.

Materials and methods. An information system for storing, searching and processing information has been created, and a registration card has been developed. Six FLS participate in the register management. As of 10.03.2021, data on 387 patients were introduced in the register.

Results. Among the included patients, 46.25% received a fracture of the proximal femur, 20.41% — of the vertebral bodies and 16.80% of the proximal humerus, the rest had fractures of other localizations. The risk of fractures was assessed in all patients. A high risk of major osteoporotic fractures according to FRAX was determined in 160 (43.24%) people. Two-energy X-ray absorptiometry (DXA) was performed in 152 (39.28%) patients, and osteoporosis was detected in 103 (67.76%), osteopenia — in 42 (27.63%) patients. The risk of falls was assessed in 100% of the included patients, and the risk of falls was determined to be high in 343 (88.63%) patients. Evaluation of various laboratory parameters to find the causes of secondary osteoporosis was performed in most patients. After consultation with the FLS doctor, anti-osteoporotic drugs were prescribed to 241 (64.27%) people. Among the rest, 70 (52.24%) patients had contra-indications and 31 (23.13%) people needed further examination.

Conclusions. Thus, the use of the register allows you to evaluate all the main sections of the organization of assistance within the FLS and compare them with international standards to identify «gaps» and improve the work of the service.

Background. In the Russian Federation, the prevalence of falls and fractures in older people in the general population is unknown. Single studies have been carried out on small samples (hospitalized patients, patients with diabetes mellitus etc.). Objective. To investigate history of low-energy fractures, frequency of falls in the past year and their associations with other geriatric syndromes (GS) in subjects aged ≥65 years.

Materials and methods. We examined 4308 subjects (30% of men) aged 65 to 107 years (mean age 78 ± 8 years) in 11 regions of the Russian Federation, who were divided into 3 age groups (65-74, 75-84 and ≥85 years old). All participants underwent comprehensive geriatric assessment, which consisted of two stages: 1) survey on a specially designed questionnaire; 2) physical examination.

Results. The frequency of falls over the past year was 30%, including 25,7% — in subjects aged 65-74 yrs, 29,8% — 75-84 yrs, 37,3% — ≥85 yrs (p for trend <0,001). Of these, 62% of participants fell 1 time, 38% — 2 times or more. With the same frequency, the subjects fell at home (41%) and on the street (42%), 17% of subjects fell both at home and on the street. A history of low-energy fractures was found in 17% of the participants, among which the most frequent (63%) were fractures of the radius. Univariate regression analysis with sex and age (as a discret variable) adjustment, where the falls in the past year were considered as the dependent variable, and GS as independent one, demonstrated that all GS were associated with falls in the past year with odds ratios (ORs) ranging from 1,25 to 3,13. Multivariate regression analysis with age and sex adjustment showed that independent predictors of falls were female gender (ORs 1,51; 95% confidence interval 1,26-1,82; р<0,001) and 6 GS (malnutrition, depression, urinary and fecal incontinence, chronic pain and dependence in instrumental activities in daily life) with a 1,3-2,4 times increase of falls risk.

Conclusion. In EVKALIPT study we firstly obtained the domestic data on the prevalence of falls and low-energy fractures history in subjects aged >65 years in the general population and studied associations between falls in the past year and other geriatric syndromes.

The article analyzes the results of treatment of gerontological patients with fractures of the proximal femur on the basis of legal documents adopted by the Ministry of Health of the Russian Federation; summarizes the clinical experience of treating patients with this pathology; indicates ways to improve the quality of emergency trauma care.

The world's population is aging rapidly, with increasing prevalence of many chronic diseases that are more common in older people. Osteopenia and osteoporosis are two chronic conditions often diagnosed in frail older patients, and both seem to be a significant public health burden. In Russia, osteoporosis (in accordance with the criteria of the World Health Organization) was detected in 33.8% of women and 26.9% of men aged 50 and over. Every minute in the country, 7 vertebral fractures happen, and every 5 minutes — a fracture of the proximal femur occurs. According to the latest data, about 34 million people in Russia are at high risk of developing low-energy fractures. The use of anabolic therapy in older patients with severe osteoporosis can achieve optimal results in the accumulation of bone mineral density and significantly reduce the risk of repeated low-energy fractures.

The comorbidity of osteoarthritis and cardiovascular disease is the most frequent and typical polymorbidity in older patients. The identity of risk factors, low intensity pathogenetic effect of systemic inflammation, dyslipidemia define a greater degree and progression of both osteoarthritis and cardiovascular diseases in patients with a combination thereof. There is a significant decline in physical functioning and loss of autonomy. There is a higher risk of cardiovascular mortality in osteoarthritis patients. Only comprehensive programs involving physical rehabilitation, nutraceutical support, and pharmaceutical substances of chondroitin sulfate and glucosamine sulfate can supply effective and safe treatment in patients with osteoarthritis and cardiovascular disease.

The prevalence of in-hospital falls varies depending on medical institution profile and department. According to various sources, the incidence of falls in intensive care units (ICU) is 2.3-7 falls per 1000 bed-days (a day spent by a person in the hospital). Assessment of fall risk in elderly patients shows that especially in case of deteriorating health, after transfer to another department, and when the fall has already happened, according to the protocol nurses will allow quickly identification of the problem and provide timely correction.