Within the framework of the life trajectory paradigm, factors of poor health in older age may include ethnicity, as well as migration history of an individual. Estonia, with a large share of the Russian population, is a good example to analyze the impact of migration and changes in the ethnic environment on health throughout the life course. The purpose of the study is to assess differences in self–rated health of the older population (50+) living in Estonia and Russia, and identify reasons for these differences. The empirical basis of the study was data of the SHARE survey conducted in Estonia in 2010-2011 and the SAGE survey conducted in Russia in 2007-2010. The sample includes urban population aged 50+ in private households: 2,655 Estonians living in Estonia, 1,478 Russians living in Estonia, and 2,446 Russians living in Russia. The tested ordinal regression models show that the native-born in Estonia have a 39% higher chance of rating their health as good compared to Russians in Estonia, which is associated with differences in educational level in the population aged 50-64, while in the population aged 65+ it is associated with differences in living standards between the native-born and immigrants of the first and subsequent generations. At the same time, Russians from Russia are 70% (population aged 50-64) or 60% (population 65+) less likely to rate their health as good, which is related to the lifestyle and loneliness. Russians aged 65+ in Estonia who moved to the country at the age of 25+ have the same chances. The study negatives the healthy migrant effect identified in young immigrants, and also indicates health behavior and poor quality of social connections as possible reasons for poor health of the older Russian residents.

BackgroundIn migration and health research, the healthy migrant effect has been a common finding, but it usually pertains to specific contexts only. Existing findings are inconsistent and inconclusive regarding the cognitive functioning of the (aging) foreign-origin population relative to the populations of their host and sending countries. Moreover, this comparison is an understudied design setting.ObjectiveWe analyze the outcomes and associations of cognitive functioning outcomes of the non-institutionalized middle-aged and older population, comparing the Russian-origin population in Estonia with Estonians in Estonia and Russians in Russia in a cross-sectional design. We aim to estimate the (long-term) effects of migration on cognitive functioning in later life, contextualizing the findings in previous research on the healthy migrant effect.Data and methodsWe use data from face-to-face interviews conducted within the SHARE Estonia (2010–2011) and SAGE Russia (2007–2010) surveys. Respondents aged 50+ living in urban areas were grouped by self-identified ethnicity, including 2,365 Estonians, 1,373 Russians in Estonia, and 2,339 Russians in Russia (total N = 6,077). Cognitive functioning was measured using a 25-percentile cut-off threshold for the results of two cognition outcomes - immediate recall and verbal fluency - and the odds of impairment were estimated using binary logistic regression.ResultsRussian men and women living in Estonia have significantly higher odds of impairment in immediate recall than Estonian men and women, though they do not differ from Russians in Russia in the final adjusted models. The differences between all groups are non-significant if age at migration is considered. There are no significant differences between the groups in verbal fluency.ConclusionContrary to the commonly found healthy migrant effect, the middle-aged and older foreign-origin population in Estonia fares initially worse than the native population in the immediate recall outcome, but does not differ from their sending country population, possibly due to Russia’s higher mortality rate and therefore the selective survival of healthier people. Different results depending on the cognitive functioning outcome suggest that migration may affect temporary memory more than crystallized knowledge. However, there are no differences between the groups if defined based on age at migration, which suggests that the age profile differences explain most of the groups’ differences in cognitive functioning.

Aim to assess the frequency of disability in instrumental activities of daily living (IADLs) and to analyze its associations with other geriatric syndromes in persons aged 65 years. Material and methods. The study involved 4,308 people (30% male) living in 11 regions of the Russian Federation, aged 65 to 107 years (average age 78 8 years). The majority (60%) of participants were examined in a polyclinic, every fifth in a hospital (20%) or at home (19%), 1% in nursing homes. All patients underwent a comprehensive geriatric assessment, including an assessment of instrumental activities of daily living on the Lawton scale. Results. Among the elderly, a high (54%) prevalence of dependence in IADLs was revealed, and with increasing age, this indicator increased significantly, reaching 82% in people over 85 years old. In patients with disability in IADLs, the frequency of all geriatric syndromes, except orthostatic hypotension, was higher, of which the most common were chronic pain syndrome (90%), frailty (80%), dependence in basic activities of daily living (ADLs) (78%), cognitive impairment (75%), probable depression (63%) and urinary incontinence (54%). One-factor regression analysis showed that the presence of disability in IADLs increases the chances of detecting other geriatric syndromes by 1.65.9 times. Conclusion. The results of the EUCALYPT epidemiological study demonstrate a high prevalence of dependence in IADLs among the Russian population. The study also gives an idea of the relationship of dependence in IADLs with various geriatric syndromes.

Comparison of the cost and quality of life in psychoneurological residential institutions and in assisted living accommodation was carried out as part of the study aimed at creating a financial and economic model of life arrangements, social services and assistance to the citizens with mental disabilities, having various degrees of need for outside help, in assisted living accommodation of small groups of disabled people in an ordinary urban or rural environment, and comparing it with an inpatient form of social service. The results of the comparison have shown a high socio-economic efficiency of assisted living in comparison with living in psychoneurological residential institutions. With greater satisfaction with the quality of life of the users, the financial and economic costs of the assisted living accommodation are comparable to the cost of inpatient social services. At the same time, the modernization of psychoneurological residential institutions may require more resources than the organization of assisted living

Summary Osteoporosis is associated with almost all geriatric syndromes (GSs), and the occurrence of osteoporosis in patients over 65 years of age increases by 1.2–2.5 times. Early diagnosis of osteoporosis and GSs is very important. Additional programs should be adopted by the state to introduce information about the possibilities of working with elderly patients. Purpose To analyze associations of osteoporosis with geriatric syndromes in patients aged 65 years and older in the Russian Federation. Methods A total of 4308 patients (30% men) aged 65–107 years were examined and distributed into 3 age groups (65–74 years, 75–84 years, and 85 years and older). All patients underwent a comprehensive geriatric assessment. In the “Falls and risk of falls” module, the number and circumstances of falls over the previous year were analyzed, as well as the history of fractures. The presence of osteoporosis was determined based on medical records. Physical examination included anthropometric measurements and standard enquiry, short physical performance battery (SPPB), dynamometry, measurement of gait velocity, Mini-Cog test, and orthostatic test. Results A total of 507 patients (11.8%) had evidence of osteoporosis; indications of low-energy fractures in history were recorded in 739 (17.3%) patients. Patients with osteoporosis were older, shorter, and predominantly women; had a lower body weight and a higher Charlson comorbidity index; and took more drugs. Patients with osteoporosis had lower gait velocity, hand grip strength, Barthel index value, and scores of the Lawton instrumental activities of daily living scale, the MNA (Mini Nutritional Assessment) short-form, and the SPPB. Osteoporosis is associated with almost all geriatric syndromes (GSs), and the occurrence of osteoporosis in patients over 65 years of age increases by 1.2–2.5 times. Conclusions Osteoporosis is associated with almost all GSs. The association of osteoporosis with advanced GSs aggravates the condition of these patients. Early diagnosis of osteoporosis and GSs is very important. Additional programs should be adopted by the state to introduce information about the possibilities of working with elderly patients: early detection and correction of osteoporosis.

BACKGROUND:A low hemoglobin level in older adults impairs cognitive ability and functional status and associates with risk of falls and fractures, sarcopenia, malnutrition, depression, frailty, and decreased autonomy. Epidemiological data on the anemia prevalence in the geriatric population in our country is not available.AIM:To assess the prevalence of anemia and analyze its associations with geriatric syndromes (GS) in subjects aged 65 years.MATERIALS AND METHODS:4308 subjects (30% of men) aged 65107 years, living in 11 regions of the Russian Federation, were examined and divided into age groups (6574 years, 7584 years and 85 years). All the participants underwent a comprehensive geriatric assessment and determined hemoglobin level.RESULTS:The anemia prevalence in older adults was 23.9%. It has been shown that with an increase in age per 1 year, the risk of anemia detection increases by 4%. The incidence of anemia was higher in males than females (28.1% versus 22.1%; p0.001). In most cases, anemia was mild. The results of a comprehensive geriatric assessment show that patients with anemia had lower hand grip force, Barthel Index, the sum of points on Lawton instrumental activities of daily living scale, Mini Nutritional Assessment scale, the Mini-Cog test and higher the sum of points on the Geriatric Depression Scale (GDS-15) and the Age Is No Barrier scale. Patients with anemia were more likely to use hearing aids, absorbent underwear, and assistive devices during movement. Patients with anemia had a higher incidence of all GS, except for orthostatic hypotension and chronic pain syndrome. The presence of GS is associated with an increased risk of anemia by 1.33.4 times.CONCLUSION:EVKALIPT study obtained domestic data on the prevalence of anemia in older patients and examined its associations with other GS.

The health of a population is an important indicator of the general well-being of the population, and it has its practical significance, as it determines the costs of providing care, and social and medical assistance for the elderly. The study presents an assessment of healthy life-expectancy indicators of people over age 65 based on the results of the Russian epidemiological study EVCALIPT and a comparison of this results with data from other surveys in Russia and European countries.

Aging creates demand for the integration of health and social services, as it ensures more timely response and better satisfaction of patients' needs for treatment and care and helps to contain the growth of costs of the services. The research aims at assessing the current level of integration of health and social services for the elderly in Russia. List of possible integration mechanisms that may coordinate work provision of services to the elderly was elaborated. Analysis of the regulatory framework and interviews with leaders and workers of health and social care in three Russian regions (Oryol Oblast, Karelia and North Ossetia) was carried out to determine the existing and implementing forms of integration and to assess the level of integration and barriers to its increase. The current level of integration of social and medical services in Russia seems to be low. In recent years, there has been a transition from a strict division of responsibility of departments to an integrated system, but the parameters of the transition have not been sufficiently developed. Significant barriers to integration (administrative, legal, financial, and related to staffing) exist. The results of the study can be used in work of federal and regional authorities to improve health care, social services and long-term care for the elderly, and by commercial and non-profit social service organizations.

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.

Cognitive dysfunction is one of the most common disorders in the elderly and senile age. There are currently 57 million people with dementia worldwide.Objective: to assess cognitive functions, to understand the prevalence of cognitive impairment (CI) and to analyze their associations with socioeconomic, demographic and anthropometric factors and geriatric syndromes in people aged ≥65 years.Patients and methods. Subjects living in 11 regions of the Russian Federation took part in the EVKALIPT epidemiological study. The inclusion criterion was age ≥65 years. Participants were divided into three age groups (65–74 years, 75–84 years, and ≥85 years) according to the protocol. All patients underwent a comprehensive geriatric assessment, comprising a specially designed questionnaire and physical examination. Cognitive functions were assessed using the mini-Cog test. The study included 3545 patients (of which 30% were males) aged 65 to 107 years.Results and discussion. According to the data obtained in our study, CI was detected in 60.8% of the subjects, and severe disorders – in 19.9% (0 or 1 point according to the mini-Cog). Patients with CI had a lower socioeconomic status. One-way regression analysis showed that the risk of CI increased by 10% with increasing age for every 1 year but did not depend on the sex of the subjects. Associated with increased CI risk also were: living alone (by 28%), living in a nursing home (by 90%), widowhood (by 2.2 times) or absence of a partner (by 2.2 times), underweight (by 2.9 times) and normal body weight (by 1.6 times), disability (by 54%), primary (by 4.8 times) and secondary (by 75%) education, bad economic conditions (by 95%). On the contrary, the presence of overweight and obesity reduced the risk of CI by 14 and 24% respectively, living in a family – by 24%, having a spouse – by 55%, divorce – by 29%, having a job – by 73%, higher education and a scientific degree – by 55 and 59%, medium and good economic conditions – by 38 and 52%, respectively. In patients with CI, the incidence of all geriatric syndromes was higher.Conclusion. The frequency of CI among elderly patients was higher compared with data from other studies. The EVKALIPT study was the first to obtain national data on the prevalence and characteristics of CI in persons aged ≥65 years in the general population.

The main symptoms of osteoarthritis (OA) are pain and dysfunction of the joints. Neuropathic pain (NP) occurs in more than half of patients with OA, it is refractory in nature and is the cause for seeking medical advice more frequently, poor quality of life and disability.Objective: to evaluate the frequency of NP and its relationship with geriatric syndromes (GS) in patients with OA aged 65 years and older. Patients and methods. The subanalysis of the study EVKALIPT included 2286 patients with OA and chronic pain syndrome. All patients underwent a comprehensive geriatric assessment (CGA) and diagnostics of NP using the DN4 questionnaire.Results and discussion. The prevalence of NP in patients with OA was 22.7%. Patients with OA and NP more often experienced pain of any localization with a large number of tender points, they had a higher frequency and intensity of pain syndrome, they more often took analgesics and noted limitations in daily life. When conducting a correlation analysis, correlations of medium strength were found between the sum of scores according to DN4 questionnaire and the pain intensity assessment on a numerical rating scale at the time of examination (r=0.26; p<0.001) and in the previous 7 days (r=0.29; p<0.001). CGA data in patients with OA and NP demonstrated worse geriatric status and a higher incidence of GS. The most common GSs were basic (81%) and instrumental (64%) dependence in everyday life, senile asthenia (70%), urinary incontinence (69%), depression (69%) and cognitive impairment (67%). Multivariate analysis showed that, in addition to age, the presence of NP was independently associated with sensory deficits, depression, falls, urinary incontinence, and bedsores (odds ratio 1.77–2.49). Patients with NP were more likely to use mobility aids, absorbent underwear, and orthotics.Conclusion. NP was diagnosed in 22.7% of OA patients aged 65 years and older. Such patients have worse functional status, they are more often diagnosed with a number of GSs.

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.

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.

Aim. To study the prevalence of geriatric syndromes and assess their relationship with senile asthenia in persons aged ³65 years living in Russian regions with different demographic, climatic and socio-economic characteristics.Material and methods. We examined 664 patients aged 65-107 years (mean age, 79±9 years; men, 25%) living in Moscow (n=365) and Voronezh (n=299). All patients underwent a comprehensive geriatric examination, which consisted of two stages: a survey with original questionnaire and an objective examination.Results. The prevalence of senile asthenia was 66,4%, including 47,4% in people aged 65-74, 71,1% — 75-84 years, and 82,8% — ³85 years (p for trend <0,001). Senile asthenia was associated with age (odds ratio (OR), 2,36; 95% confidence interval (CI), 1,89-2,93; p<0,001) and female sex (OR, 1,52; 95% CI 1,06-2,18; p=0,024). Patients with senile asthenia had a lower socioeconomic status. Also, close associations of senile asthenia with other geriatric syndromes (dementia, depression, vision and hearing impairment, incontinence, falls, high risk of falls, functional decline, failure to thrive) with OR from 1,32 to 7,22 were revealed.Conclusion. The first results of the EVCALIPT study indicate a high incidence of senile asthenia in persons aged ³65 years and its close association with other geriatric syndromes and socio-economic factors.