The present document developed by the Russian Association of Gerontologists and Geriatricians represents the Clinical guidelines on chronic pain in older and senile patients. The Clinical guidelines were endorsed by Scientific Council of the Ministry of Health of the Russian Federation in December 2020.
Clinical guidelines are focused on geriatricians providing medical care in outpatient and hospital settings, general practitioners, and physiotherapists.
The document sets out the pain syndrom screening and diagnosis principles in older patients, management and treatment approaches in patients with chronic pain, as well as the prevention, rehabilitation, medical care organization issues and quality control criteria for its provision in this category of persons.

The high incidence of back pain in older people, its effect on quality and duration of life, and insufficient effectiveness of existing treatment methods determine the need to search for methods of back pain treatment that will reduce inflammatory and degenerative changes and the pain syndrome itself. The review analyzes the epidemiology, pathogenesis, current methods of pharmacotherapy for back pain, the role of genetic changes and biomarkers of chronic pain, discusses current prospects for the use of targeted therapy for the treatment of chronic nonspecific back pain based on pathogenetic mechanisms (genetic changes, aseptic inflammation, immune disorders, disorders of chondrogenesis, etc.).

Currently the number of older people with chronic rheumatic diseases is increasing. Distinctive features of this population are the increased risk of cardiovascular and infectious diseases, tumours, as well as iatrogenic complications, while this group of patients is rather heterogeneous. On the one hand, modern biological and targeted synthetic drugs, provide new, previously inaccessible, treatment options; on the other hand, their use is associated with risk of side effects. In this review specifics of prescribing immunosuppressive drugs in older patients with rheumatoid arthritis and spondyloarthritis has been analyzed. An effective and safe approach to the use of these drugs in older people can be based on a comprehensive interdisciplinary approach, taking into account geriatric characteristics of the patients.

The article discusses the directions of marketing in the field of healthcare, the essence of medical marketing, analyzes the distinctive features of marketing of medical tourism in older age. Based on the data from the literature and the results of our own research, the article concludes that marketing in medical tourism in the Russian Federation is in its infancy, a purposeful and consistent work is required to develop this area.

Aim. To assess the geriatric and somatic status of older patients with falls.
Materials and methods. The study included 655 patients (81% of them women) with the age of 75.1±8.2 years hospitalized in geriatric departments. Depending on whether they experienced falls, the patients were divided into two groups: group 1 (332 people, 50.7%) consisting of patients who experienced at least one fall in the current year and group 2 (323 people, 49.3%) consisting of patients who did not experience any falls. The patients underwent general clinical tests and comprehensive geriatric assessment.
Results. Half of the hospitalized patients over the age of 60 experienced falls, and among patients without a fall experience 50.8% had a high risk of falls. As a result of falls 246 (74.1%) patients suffered from bruises and abrasions of soft tissues, 36 (10.8%) patients had fractures of various localizations, 6 (1.8%) patients had traumatic brain injury (TBI). Patients of both groups were diagnosed with an average of 5 diseases while there were no differences in the nosological structure among patients of both groups. As a result of the performed comprehensive geriatric assessment patients with falls were significantly more often diagnosed with frailty, dementia, depression, visual impairment, gait and balance disorders as well as orthostatic reactions.

The emergence and spread of COVID-19 infection has set health professionals the task of providing recovery and rehabilitation programs after pneumonia for patients of different age groups.
The paper presents the survey results of older people after COVID-19-related pneumonia before and after one- and two-component medical rehabilitation programs.
The rationality of using the proposed hypobaric chamber adaptation technique for elderly patients at the outpatient and home stages of medical rehabilitation, the effectiveness of which increased in combination with the appointment of cytoflavin, is shown.
An increase of Stange test was found when combined hypobaric adaptation and kinesiotaping of the posterior arch of the diaphragm in order to create a breathing pattern in the examined group of patients. The conducted stabilometric study showed an increase in the stability of older patients after a course of hypobaric chamber adaptation.

Osteoporosis and sarcopenia are age-associated diseases of the musculoskeletal system. Osteosarcopenia, the presence of osteopenia/osteoporosis and sarcopenia. The prevalence of osteosarcopenia in older adults with failing was 37% and associated with higher rate of death. Diagnosis of osteosarcopenia consists of describing medical history of fractures, providing x-ray of the spine (if it is needed) and bone densitometry, calculation of Fracture Risk Assessment Tool (FRAX), evaluating muscle strength, mass, function. The most common exam which is used to measure bone mineral density (BMD) is dual-energy x-ray absorptiometry (DXA or DEXA). Screening using the FRAX is recommended in all postmenopausal women and mеn over 50 in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis in patients with fragility fracture of large bones of the skeleton. Diagnosis of sarcopenia is consist of measures for three parameters: muscle strength, muscle quantity/quality and physical performance as an indicator of severity. Muscle strength can be measured with carpal dynamometry. Muscle mass can be evaluated dual-energy X-ray absorptiometry (program «Whole body»). Muscle function can be evaluated with short physical performance battery (SPPB) tests. In this article described algorithm of diagnosis of osteosarcopenia.

The article presents a clinical case of recovery from COVID-19 of a 101-year-old patient who has been living in a nursing home and disabled for four years. Medical history of the patient includes more than 5 chronic diseases. Senile asthenia, fall syndrome and cognitive impairment are predominant among the main geriatric syndromes. Coronavirus infection caused by the COVID-19 virus was complicated by polysegmental pneumonia. The presented clinical case confirms the possibility of recovering not only older and senile patients, but also centenarians. For a good outcome of the disease, timely diagnosis and correct therapy are required.

This article describes a clinical case of a patient with chronic pain syndrome on the background of osteoarthritis, with a history of joint replacement. The reason for hospitalization was a fall, after which a constant pain syndrome persisted and a neuropathic component joined, which the patient could not stop with anything.
As a result of a comprehensive geriatric assessment, the patient was diagnosed with frailty and the following geriatric syndromes: mild dependence on outside help, chronic pain syndrome, balance disorders, falls, stress urinary incontinence. Non-drug methods of treatment and complex therapy (gabapentin + B vitamins + uridine) and antiosteoporetic therapy were recommended, against which the intensity of the pain syndrome decreased to a mild degree (according to the VAS scale of 2 points at the time of discharge) and a decrease in neuropathy copatterns was noted.

Locomotive syndrome is a geriatric syndrome that corresponds to the model of autonomy loss and the emergence of addictions due to pathology of the musculoskeletal system with a heavy medical and social burden. Combination of musculoskeletal system diseases, including osteoarthritis, osteoporosis, dorsopathy, sarcopenia, neuropathy, together with impaired physical functioning are the clinical characteristics of locomotive syndrome. Only comprehensive programs, including pain treatment, the risk of osteoporetic fractures, prevention of falls, correction of sarcopenia, physical training, psychotherapeutic methods, etc., can increase the mobility of patients with locomotive syndrome and help reduce addictions in older age.

Aim. To assess the presence or absence of indications for taking acetylsalicylic acid (ASA), as well as the safety of therapy among centenarians according to clinical guidelines.
Materials and methods. The study included 81 patients (71 women and 10 men). Inclusion criteria: patients 95 years and older (mean age 98.3 ± 1.89) receiving combination therapy, including ASA. In the study, the patients' history data on concomitant diseases and pharmacotherapy were assessed, a comprehensive examination (complete blood count (CBC), echocardiography) was performed. In our work, the results of these studies were analyzed, and statistical calculations were performed.
Results. From the total number of patients included in the study, 41.9% regularly take ASA (n=34). In 41.7% (n=14) were taken as secondary prevention of cardiovascular events (the presence of a documented history of cardiovascular disease). According to current recommendations, 58.3% (n=20) of patients had no indications for a prescription. During the analysis among patients for whom according to clinical guidelines ASA therapy was not recommended, groups were identified in which the risk of gastrointestinal bleeding (GIB) was increased: 30% (n=6) patients had a history of gastric ulcer or duodenal ulcer, 20% (n=4) took drugs from the group of non-steroidal anti-inflammatory drugs, 25% (n=3) of patients had thrombocytopenia. In 4 (15.6%) patients from these subgroups, several factors simultaneously increase gastrointestinal bleeding risk.
Conclusions. From the total number of patients included in the study and prescribed with ASA, more than half had no indications for therapy; the vast majority of this group had additional risk factors for GIB development. At the same time, a quarter of all participants had indications, but therapy was not prescribed. Summarizing all of the mentioned above, before prescribing and continuing treatment with ASA, clinicians should analyze the therapy's feasibility and safety.

The article analyzes the features of the activities of entrepreneurs of pre-retirement and retirement age. In the course of IT application spheres analysis in medicine it was revealed that information technologies are an integral part of healthcare. They are applied at all levels of management and health care delivery. Yet the dentistry is the most interesting and promising direction.

Pain syndrome in older patients requires a number of diagnostic and therapeutic measures that are not always performed in everyday clinical practice, especially in older patients. Regularly assessing of chronic pain and organizing adequate care measures is an essential task when older patients nursing. Nurses who are most in contact with patients can play a leading role in screening and ensuring timely corrections.