COVID‑19 continues demonstrating possible complications after recovery. One of these complications is avascular osteonecrosis, which can lead to bone destruction and patient disability. Cases of the development of osteonecrosis associated with coronavirus infection were widely reported during and after the SARS epidemic in 2003. They also appear to be common in COVID‑19 infection. All patients who have recovered from COVID‑19 infection, especially who received glucocorticoids, are threaten of osteonecrosis development.We describe a case of bone necrosis in a healthy young woman without additional risk factors with a mild course of COVID, who received a short course of glucocorticoids.This is the first described case of COVID‑induced osteonecrosis in our country, although due to the large‑scale use of glucocorticoids, there are probably more such cases. Early diagnosis is important to prevent disease progression. Therefore, clinical alertness is necessary in all patients with COVID‑19.

The review is dedicated the interconnection between neurodegenerative diseases, chronic pain and gut microbiota’s structure and function. The gut microbiota’s role in gut-brain axis, neuroimmune interaction is considered. The modern data about gut dysbiosis in Alzheimer disease, Parkinson disease, osteoarthrosis, neuropathic pain in COVID infection, muscular-skeletal pain in fibromyalgia, irritable bowel syndrome et cetera are provided. The gut microbiota’s modification by means of pre and probiotics in combination with medicines and diet modification can be used for the treatment of chronic pain and dementia. © T.M. MANEVICH.

Delirium is an acute, life-threatening condition manifested by disturbance in consciousness, attention and cognition, which has a multifactorial genesis, severe consequences and commonly seen in older and senile people inpatient. Clinical experience in domestic practice shows that delirium diagnosis in older and senile patients is often missed, and its signs may be considered as manifestations of other diseases, while the state of delirium is often perceived only as an alcohol withdrawal. The article presents a clinical protocol developed and based on the firsthand experience and modern ideas by a multidisciplinary team of the Russian Gerontology Research and Clinical Centre, in which the delirium in older and senile people is considered as a geriatric syndrome. The article shows the latest diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the main diagnostic tools are given — Confusion assessment method (CAM), diagnostic and differential diagnostic algorithms; clinical subtypes, management tactics, non-drug and drug approaches to treatment, as well as principles for the prevention of geriatric delirium are described.

Background . The prevalence of chronic pain syndrome in general population of older adults in the Russian Federation is unknown. Aim . To study the prevalence and features of chronic pain syndrome in subjects aged ≥65 years. Materials and methods . There were examined 4308 subjects (30% males) aged from 65 to 107 years (mean age 78±8 years), living in 11 regions of the Russian Federation, who were divided into 3 age groups (65–74 years, 75– 84 years and ≥85 years). All participants underwent a comprehensive geriatric assessment consisted of two stages: 1) questioning based on a specially designed questionnaire; 2) physical examination. The «Chronic pain» module of questionnaire included: 1) questions concerning the presence, localization, character and frequency of chronic pain syndrome, as well as the frequency of taking analgesics; 2) self-assessment of pain intensity on a visual-analogue scale at the moment of examination and for the previous week; 3) DN4 questionnaire to detect neuropathic pain. Results . The prevalence of chronic pain syndrome was 87.2%, including 83.8% in subjects aged 65–74 years, 87.7% — 75–84 years, 91.1% — ≥85 years (p for trend <0.001). In women, chronic pain was detected more often than in men (90.2% vs. 80.2%; p<0.001). The most frequent localization of pain syndrome were large joints (75%), back (68%) and head (64%). The prevalence of different types of pain was as follows: nociceptive — 67.3%, neuropathic — 21.2%, nociplastic — 11.4%. With age, the frequency of detection of neuropathic pain increased (from 18.9% in patients aged 65–74 to 23.8% in patients ≥85 years; p for trend = 0.013), nociplastic, on the contrary, decreased (from 13.8% to 9%; p for trend = 0.001), and nociceptive — remained unchanged (67.3% in patients aged 65–74, 67.6% — 75–84 years, 67.2% — ≥85 years; p for trend = 0.974). In patients with neuropathic pain, more severe manifestations of pain syndrome were revealed: they were more likely to experience pain of any localization with a large number of pain zones/areas, they had a higher frequency and intensity of pain syndrome, and they were more likely to take analgesics and noted limitations in daily life due to pain. Conclusion . In the EVKALIPT study, for the first time, domestic data on the prevalence and features of chronic pain syndrome in subjects aged ≥65 years in the general population was obtained.

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.

Novel coronavirus SARS-CoV-2 infection (COVID-19) is a dangerous disease for older adults. Preventive measures in this population should involve three groups of measures: 1) prevention of infection; 2) prevention of functional decline and geriatric syndromes, including social support; 3) control of chronic comorbidity. Older adults are common to present with atypical COVID-19 symptoms, and mildness of symptoms (no fever, cough, shortness of breath) does not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, that is why it is screening should be widely implied. Risk of malnutrition resulting in sarcopenia increases during the hospitalization, especially if mechanical ventilation required, and promotes frailty progression and decreases quality of life after the discharge from the hospital. Geriatric assessment is an important component of the decision making process in the management of older adults. Full version was published as Tkacheva O.N., Kotovskaya Yu.V., Aleksanyan L.A., Milto A.S., Naumov A.V., Strazhesko I.D., Vorobyeva N.M., Dudinskaya E.N., Malaya I.P., Krylov K.Yu., Tyukhmenev E.A., Rozanov A.V., Ostapenko V.S., Manevich T.M., Shchedrina A.Yu., Semenov F.A., Mkhitaryan E.A., Khovasova N.O., Yeruslanova E.A., Kotovskaya N.V., Sharashkina N.V. Novel coronavirus infection SARS-CoV-2 in elderly and senile patients: prevention, diagnosis and treatment. Expert Position Paper of the Russian Association of Gerontology and Geriatrics. Cardiovascular Therapy and Prevention. 2020; 19(3): 2601. DOI: 10.15829/1728-8800-2020-2601

Increasing life expectancy of the world’s population is accompanied by increasing number of elderly patients with dementia. According to various studies, the prevalence of pain syndrome in elderly patients with dementia ranges from 35.3% to 63.5%. The review represents data on the epidemiology, clinical manifestations, methods of diagnosis and treatment of pain syndrome in patients with dementia. Medicinal and non-pharmacological methods of pain relief are discussed.

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.

Background. Osteoarthritis (OA) in elderly and senile patients is not only common, but also one of the main diseases affecting the duration of active life, its quality, the appearance of addictions and loss of autonomy. Data on the relationship between OA and geriatric syndromes (GS) in our country are extremely scarce. Aim. To estimate the prevalence of OA and to analyze its associations with HS in persons aged 65 years. Materials and methods. The study included 4308 people (30% of men) aged 65 to 107 years, living in 11 regions of Russia. The patients were divided into 2 groups: with OA (n=2464) and without OA (n=1821). All patients underwent a comprehensive geriatric assessment. Results. The prevalence of OA was 57.6%. With age, the frequency of OA increased significantly. According to the results of a comprehensive geriatric assessment, patients with OA had lower walking speed, the sum of points on the Bartel, Lawton scales and a short battery of physical functioning tests and higher the sum of points on the geriatric scale of depression and the age is not a hindrance scale. Patients with OA rated the quality of life and health status lower and higher the intensity of pain syndrome. Patients with OA were more likely to use any assistive device, with the exception of a wheelchair. In patients with OA, the most common HS were chronic pain syndrome (92%), senile asthenia syndrome (64%), basic (66%) and instrumental (56%) dependence in everyday life, cognitive impairment (62%), probable depression (51%) and urinary incontinence (50%). Univariate regression analysis showed that OA is associated with a 1.23.0-fold increase in the risk of a number of GS and a 28% decrease in the risk of malnutrition. Conclusion. OA is widespread in the elderly population. The presence of OA is associated with a number of GS associated with loss of autonomy.

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.).

Objective: to assess the structure and influence of chronic pain (CP) on the functional status of patients with geriatric syndromes.Patients and methods. The study included 370 geriatric patients who were divided into two groups. Group A included 300 patients (mean age 75.1±8.25 years) with CP, and group B – 70 subjects of comparable age (75.1±7.75 years) without CP. All study participants were found to have polymorbidity: the Charlson index was 5.55±1.59 points in group A and 5.56±1.64 points in group B (p=0.963). All patients underwent a comprehensive geriatric assessment (CGE) to determine the functional status and diagnose geriatric syndromes.Results and discussion. According to the CGE data, senile asthenia syndrome was detected in 127 (42.3%) patients with CP and in 20 (28.6%) patients without CP (p=0.035). The average number of geriatric syndromes in group A was 7.06±2.68, in group B – 5.2±1.8 (p<0.001).Group A patients differed from those without CP in a significantly higher degree of dependence in daily life (Bartel index) and a lower score on the Physical Performance Battery.Conclusion. Patients with CP have poorer physical functioning and a greater degree of dependence on others in their daily life. When planning the most effective complex strategies for the treatment and prevention of CP exacerbations, it is necessary to take into account the functional status of elderly patients.

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.

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.

A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.

The standard for the treatment of dementia in Alzheimer's disease (AD) is the use of basic medicines affecting the cholinergic and glutamatergic systems. The aim of the study was a comparative evaluation of combined treatment with an NMDA receptor antagonist akatinol memantine and donepezil — acetylcholinesterase inhibitor, compared with donepezil monotherapy in AD patients with mild dementia. Material and methods . The study included 35 patients with AD (average age 78.51 years old ± 6.08) at the stage of mild dementia. 35% of patients received donepezil monotherapy (alzepil), 65% of patients received donepezil and akatinol memantine combined treatment. The observation period was 12 months. During this period, the patients underwent a neuropsychological examination every 3 months. It included a Mini Mental State Examination, Frontal assessment battery, memory test with an assessment of immediate and delayed reproduction of «12 words», verbal fluency (phonetic and semantic), clock drawing test, Trial making test, part A. Results . In patients, who received the combined treatment, improvement was detected on almost all cognitive scales, in 3 months of the therapy. It continued to increase throughout the whole observation period. And, contrary-wise, in patients, who received monotherapy, only stabilization of cognitive status was manifested. Conclusion . The administration of combined treatment with akatinol memantine and donepezil to patients with AD at the stage of mild dementia during the period of 12 months, is more effective than donepezil monotherapy.

Cognitive disturbances are very frequent problems of the aged people. The review is dedicated to the modern methods of nonpharmacologic treatment of the predemention stage and mild dementia. There are data of reviews and meta-analysis of cognitive rehabilitation of the neurodegenerative and post-stroke cognitive disturbances. The mechanisms of brain neuroplasticity and the phenomenon of cognitive cerebral reserve are discussed. The relationship between effectiveness of the aerobic exercises and cognitive training is analysed and the influence of the hyppocamp blood supply on the cognitive reserve is also discussed.

A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.

AIMTo analyze the geriatric status of patients with chronic pain.MATERIAL AND METHODSOne hundred and sixteen patients of a geriatric unit, aged 75.66±7.98 years (110 women, 94.8%), were studied. All patients underwent general clinical examination and complex geriatric assessment, on the results of which geriatric syndromes were identified. Characteristics of pain syndrome (cause, intensity, localization) are described.RESULTSChronic pain syndrome is identified in 85 (73.3%) patients. Most often pain is localized in large joints (n=44 (51.76%)) and back (n=50 (58.8%)). The intensity of pain was higher in patients with moderate dependence in daily activities compared to those with mild dependence (p<0.05). Pain intensity is associated with the degree of impairment of physical functioning (p<0.05). Patients with chronic pain have more geriatric symptoms (6.8±2.8). More syndromes (9.11±2.37) are identified in patients with marked impairment of physical functioning. The reduction of muscle strength is observed in 45.9% patients with- and 9.7% patients without chronic pain syndrome. The velocity of pace is 0.59 m/s and 0.71 m/s, respectively.CONCLUSIONThe high prevalence of chronic pain in patients of a geriatric unit is shown. The intensity of pain iss higher in patients with moderate dependence in daily activities compared to those with mild dependence. Pain intensity increases with the reduction of patient's physical functioning. Patients with chronic pain more often have dynapenia and significantly lower velocity of pace that indicates the poor outcome in elderly patients.

Chronic pain among the elderly aged 60 years and above is one of the «big» geriatric syndromes, and has great prognostic significance in relation to cognitive, functional and physical status.The loss of muscle strength, mass (sarcopenia) is one of the important components of chronic pain syndromes in elderly patients. Pathological findings were demonstrated by own observation of 116 patients in the geriatric unit aged 75,667.98 years (110 women, 94.8%). Most patients had a combination of several geriatric syndromes, an average of which accounted for 6.6. Among them, there were falls - 72 (62.1%), chronic pain - 85 (73.3%), senile asthenia - 51 (43.9%), etc. In most cases, chronic pain was due to osteoarthritis. According to the dynamometry data, a decrease in muscle strength was found in 45.9% of cases, without chronic pain syndrome in 9.7% of cases among patients with chronic pain syndrome. Thus, prevalence rates of decreased muscle strength were higher in patients with chronic pain, than in patients without pain. In addition, a significantly lower walking speed was found, which indicates a poor prognosis in patients of older age groups.Sarcopenia and chronic pain treatment programs for elderly patients contain a number of evidence points: therapeutic exercises, adequate intake of calories and protein, vitamin D3, reduction of the number of drugs, chondroitin sulfate (Chondrogard), glucosamine sulfate (Sustagard Artro). This program, being multicomponent, should be long and regular.