The paper introduces clinical guidelines on frailty that have been developed by the Russian Association of Gerontologists and Geriatricians. These guidelines are specifically designed to assist geriatricians, internists, general practitioners, family physicians, and other healthcare specialists who work with adult patients. Within the paper, there are screening instruments, diagnostic tools, and treatment options provided for individuals with frailty. Additionally, the paper also includes information on prevention, rehabilitation, and medical care organization for this cohort of patients.

The first part of the article discusses the issues of preoperative bowel preparation in older and oldest-old patients, with a particular emphasis on the safest drugs. The second part of the article presents the problem of chronic constipation as a geriatric syndrome, including a description of age-associated changes in the structure and function of colon, causes of constipation and features of correction in geriatric practice.

The population of older and oldest-old individuals is increasing at a rapid pace, leading to a notable proportion of this age group requiring surgical procedures due to multimorbidity. It is known that, compared with young people, patients over 60 have a whole set of factors, such as decreased physiological functions, the presence of several concomitant diseases, polypharmacy, cognitive dysfunction and specific geriatric syndromes, which may lead to a higher risk of postoperative complications and prolonged recovery. Therefore, an integrated multidisciplinary approach on management is necessary for this group of patients, but the use of such an approach is currently rare. The purpose of this document is to review the literature, summarize current recommendations, and provide a set of expert recommendations to assist practicing geriatricians, surgeons, anesthetists, and allied health professionals.

Dementia is one of the main challenges to modern society. According to estimated data, as of 2019, there were 1.949.811 people living In Russia with dementia of various etiology. At the same time, there have been no large epidemiological studies of dementia in the Russian Federation. The article provides an overview of the available data on the epidemiology of cognitive impairment (CI) In Russia given from various sources. Not only estimated, but also available clinical data were analyzed. In general, the obtained prevalence values for CI are comparable to global values. Thus, in an epidemiological study of people over 60 years of age in a separate district of Moscow, the prevalence of dementia was 10.4%, Alzheimer's disease 4.5%. A study of outpatients aged 60 years and older showed a high prevalence of both dementia and non-dementia CI at general medical appointments (incidence of dementia 7.8%, MCI 49.6%). It has been shown that the problem of non-dementia CI is already relevant in people of pre-retirement age (the prevalence of non-dementia CI in patients 55-64 years old is 36.8-44.8%). Unique data obtained in a population of institutionalized centenarians (prevalence of dementia 69%), as well as data on the relationship of CI with both somatic and demographic factors are presented.

Aging is a natural process with varying effects. As we grow older, our bodies become more susceptible to aging-associated diseases. These diseases, individually or collectively, lead to the formation of distinct aging phenotypes. Identifying these aging phenotypes and understanding the complex interplay between coexistent diseases would facilitate more personalized patient management, a better prognosis, and a prolonged lifespan. Many studies distinguish between successful aging and frailty. However, this simple distinction fails to reflect the diversity of underlying causes. In this study, we sought to establish the underlying causes of frailty and determine the patterns in which these causes converge to form aging phenotypes. We conducted a comprehensive geriatric examination, cognitive assessment, and survival analysis of 2,688 long-living adults (median age = 92 years). The obtained data were clustered and used as input data for the Aging Phenotype Calculator, a multiclass classification model validated on an independent dataset of 96 older adults. The accuracy of the model was assessed using the receiver operating characteristic curve and the area under the curve. Additionally, we analyzed socioeconomic factors that could contribute to specific aging patterns. We identified five aging phenotypes: non-frailty, multimorbid frailty, metabolic frailty, cognitive frailty, and functional frailty. For each phenotype, we determined the underlying diseases and conditions and assessed the survival rate. Additionally, we provided management recommendations for each of the five phenotypes based on their distinct features and associated challenges. The identified aging phenotypes may facilitate better-informed decision-making. The Aging Phenotype Calculator (ROC AUC = 92%) may greatly assist geriatricians in patient management.

Despite the increase in the number of older and oldest old patients with cancer, the tactics of their treatment are often suboptimal while the doctor-patient relationship model tends to be paternalistic. Insufficient knowledge in the field of geriatric care among health care providers dealing with cancer patients along with the low representation of older patients in research lead to their vulnerability to both «over- and under-treatment». There is ample evidence to support the superiority of comprehensive geriatric assessment in identifying frail patients at risk of poor outcomes compared to conventional clinical assessment or traditional oncology tools. Planning therapy taking into account the geriatric status and preferences of the patient, allows us to add the best results and satisfaction of aging patients with oncological diseases.

Oldest old are the fastest growing age group in most countries of the world, including the Russian Federation. Disability and institutionalization in oldest old is associated with an increased risk of cognitive impairment. The relationship between cognitive status and other geriatric syndromes has not been studied sufficiently in institutionalized oldest old.Objective. To assess the relationship between cognitive status and geriatric syndromes in persons ≥ 90 years, who live in long term care facilities (LTCF).Material and methods. The study involved patients aged ≥ 90 years, who were examined in the LTCF of Moscow. All patients underwent a neuropsychological examination, which included Mini-mental State Examination (MMSE), Frontal Assessment Battery (FAB), 5-word test, clock-drawing test and verbal fluency. A comprehensive geriatric assessment was carried out for all the subjects. To diagnose the frailty, we used the Short Physical Performance Battery (SPPB). The Bartel index was used to assess performance of activities of daily living. Instrumental activities of daily living were assessed using the Lawton scale. Nutritional status was assessed based on the Mini-Nutritional Assessment. The pain intensity syndrome was assessed by visual analogue scale. To detect dinopenia we used dynamometry with manual dynamometer. Statistical data analysis was performed using the statistical program SPSS 23.0 (SPSS Inc., USA). Fischer’s two-sided accurate test was used for two groups comparison. The relationships between the variables were evaluated using binary logistic regression with calculation of the odds ratio (OR) and 95% confidence interval (CI).Results. Dementia was diagnosed in 69% of patients. According to multivariate analysis, sensory defi ciency (OR 4.23; CI 95% 1.96–9.09; p < 0.001), malnutrition (OR 2.68; CI 95% 1.10–6.52; p = 0.030), fecal incontinence (OR 4.37; CI 95% 2.14–8.90; p < 0.001), frailty (OR 4.23; CI 95%; 1.96–9.09; p < 0.001) are associated with the presence of dementia; an increase in age for every 1 year correlates with an increase in the chances of having dementia by 15%. Urinary incontinence and chronic pain syndrome were noted in more than half of oldest old, constipation syndrome and falls syndrome were detected in more than a third of the subjects, and more than 2/3 of oldest old had dinopenia.Conclusion. The majority of institutionalized oldest old suffer from dementia, while an increase in the chances of having it is associated with frailty, sensory deficiency, malnutrition and an increase in the age of oldest old.

A comprehensive geriatric assessment is the main diagnostic tool in the work of a geriatrician, which is also necessary for drawing up an individual plan for managing an older patient. A distinctive feature of the geriatric approach is a holistic perception of all the needs of an older person — not only medical, but also functional, social. The main goals of the CGA (comprehensive geriatric assessment) are to improve diagnostics, optimize treatment, and enhance the functional state and quality of life, including living conditions, the use of health-care services, and planning long-term support for older adults. Based on the results of the CGA, a comprehensive approach is being developed to provide assistance to older patients, which should help restore their independence, the ability to self-care, improve the quality of life through various targeted rehabilitation measures, as well as optimize healthcare costs, reduce risks, improve prognosis and increase life expectancy of the older patients.

Aim: to assess the efficacy and safety of ixekizumab in the treatment of ankylosing spondyloarthritis (AS) and psoriatic arthritis (PA) in real clinical practice. Patients and Methods: this retrospective study included patients with AS and PA who received ixekizumab therapy from February 2021 to April 2022. Disease activity was evaluated every 3–6 months, using BASDAI and ASDAS scores for AS and DAPSA и PASI scores for PA. C-reactive protein (CRP) served as a serologic marker of disease activity. Results: the analysis included the data received for 27 patients, of whom 10 persons had AS and 17 — PA. The safety of treatment was assessed in all patients, and the data of 9 AS and 16 PA patients were included in the analysis of the treatment efficacy. In the AS group (4 males and 5 females), the median age at the therapy initiation was 34 [32; 41.5] years and in the PA group (11 males and 6 females — 40 [32.5; 48.5] years. Failure or intolerance of the standard therapy was reported in all patients. Prior to ixekizumab treatment, most patients did not receive targeted therapies. Of 27 patients, 4 received genetically engineered biological drugs / targeted synthesized drugs which failed to achieve remission / low disease activity. In the AS group, the elevated levels of CRP were revealed in 7 (77.8%) patients, ASDAS demonstrated the presence of disease activity in all patients. According to BASDAI, disease activity was recorded in 7 (77.8%) cases. During the treatment, there was a downtrend in the percentage of patients with high disease activity as shown by ASDAS and BASDAI scores, as well as in the percentage of patients with elevated levels of CRP, while the BASDAI values were statistically significant (p=0.031). In the PA group, elevated CRP levels were reported in 62.5% of patients, and DAPSA scores represented moderate of high activity in 75.0% of patients. As a result of the treatment, there was a decrease in the percentage of patients with higher DAPSA scores and elevated CRP levels, but the changes did not achieve statistical significance. Side effects were reported in 7.4% of patients, but there were no serious adverse events. Conclusion: acording to our data ixekizumab has shown efficacy and safety in the treatment of PA and AS in real clinical practice. KEYWORDS: ixekizumab, real clinical practice, psoriatic arthritis, ankylosing spondyloarthritis, genetically engineered biological drugs. FOR CITATION: Meshkov A.D., Ostapenko V.S., Pykhtina V.S. The efficacy and safety of ixekizumab in the treatment of spondyloarthritis under the conditions of real clinical practice. Russian Medical Inquiry. 2023;7(3):137–143 (in Russ.). DOI: 10.32364/2587-6821- 2023-7-3-137-143.

Background: GR with implementation of additional geriatric rehabilitation stage has been shown in a number of studies to be efficient in daily functional activities as well as in reducing hospital readmissions and mortality. However, better integration of geriatric care models into clinical practice requires further investigations. Aim : to assess the influence of geriatric rehabilitation on functional activity. Methods : рrotocol POSTSCRIPTUM suggests Multicentral Prospective Study on different protocols for Geriatric Rehabilitationл in Moscow boarding houses or nursing homes. The study consists of 21-days period of active treatment based on the results of complex geriatric assessment and 12-months follow-up period. The study enrolls patients aged 60 years and older, who have indications for geriatric rehabilitation. Conclusion : POSTSCRIPTUM — the 1st Russian study on efficacy of geriatric rehabilitation programs that based on complex geriatric assessment.

Introduction . Oldest old are the fastest growing age group in most countries of the world, including the Russian Federation. A signifi cant part of oldest old are feel lonely, need care and live in long term care facilities (institutionalized). Disability and institutionalization are associated with an increased risk of cognitive impairment in oldest old. The cognitive status in this group has been studied insuffi ciently in Russia. Determination of diagnostic standards for cognitive functions assessment scales in oldest old is important both for clinical practice and for scientifi c research. Objective : to evaluate cognitive functions and to determine diagnostic value for various psychological tests in persons aged ≥ 90, who live in long term care facilities (LTCF). Material and methods . The persons aged ≥ 90 years that live in LTCF (boarding houses or nursing homes) in Moscow were examined. All patients passed neuropsychological examination, which included Mini-mental State Examination (MMSE), Frontal Assessment Battery (FAB), 5-word test, clock-drawing test and verbal fl uency tests. In addition, original questionnaire was used for cognitive impairment screening. Results . Dementia was found in 69% of oldest old, who live in LTCF; frontal dysfunction in 89.1% and “hippocampal type” of memory disorders in 57.5%. The results of phonemic verbal fl uency test were normal in 6.7% only and of semantic verbal fl uency test in 8.1%. For diagnosis of dementia in institutionalized subjects sensitivity of MMSE ≤ 23 points was 97% and specifi city was 90.9%. For the FAB optimal sensitivity/specifi city ratio (98/83.7%) was at score of ≤ 14. The clock-drawing test sensitivity for dementia was 91.9% and specifi city was 69.7% at total score ≤ 6 . Conclusion . Institutionalized persons aged ≥ 90 years have a high prevalence of dementia. The above mentioned tests can be used for oldest old examination. Further studies of the relationship of cognitive impairment with other geriatric disorders in oldest old are needed.

Older inpatient with diabetes mellitus is highly vulnerable to acute diabetes complications. Awareness-raising program for nursing staff is aimed to shed the light on risk factors and thereby reduce diabetic complications frequency, and to implement clear algorithm of actions to cope complications when they occur minimize consequences for the patient and the clinic.

Периоперационное ведение пациентов пожилого возраста остается одной из самых сложных задач современной анестезиологии. По сравнению с молодыми пациентами люди старше 60 лет имеют более высокий риск развития неблагоприятных послеоперационных исходов в результате связанного с возрастом снижения физиологических функций, наличия нескольких сопутствующих заболеваний, полипрагмазии, когнитивной дисфункции и специфических гериатрических синдромов, таких как старческая астения. Более четверти этой категории больных имеют хронические заболевания сердечно-сосудистой, нервной, эндокринной систем, органов дыхания, кроветворения, пищеварения, опорно-двигательного аппарата, нередко их сочетание. Возрастная инволюция обменных процессов, уменьшение реактивности и адаптационной способности пожилого организма, наряду с хирургическим, часто большим по объему и травматичности, повреждением, существенно увеличивают риск периоперационных осложнений и летальности. В методических рекомендациях даны определения понятий пожилого и старческого возраста и представлены основные характеристики возрастных изменений, влияющих на проведение анестезии и интенсивной терапии у этого контингента больных. Указаны ведущие клинические симптомы и синдромы, наиболее важные для прогнозирования неблагоприятного течения периоперационного периода, в том числе старческая астения, нутритивная недостаточность, когнитивная дисфункция. Отдельно представлены методики оценки функциональной активности и риска падений. Особое внимание уделено принципам диагностики, лечения и профилактики респираторных, сердечно-сосудистых осложнений и послеоперационного делирия. Описаны основы периоперационного ведения и подходы к выбору метода анестезии у пациентов старшей возрастной группы в зависимости от особенностей хирургических вмешательств и характера сопутствующей патологии.

The present article discusses the perioperative management issues in patients with frailty and other geriatric syndromes focusing mainly on the prevention and correction of malnutrition, ESPEN practical guidelines: Clinical Nutrition in cancer. The concept of prehabilitation is described — a multimodal strategy that is implemented from the moment of diagnosis to surgical treatment, aimed at enhancing postoperative outcomes, which elements have a synergistic effect. The clinical case of 62-year-old female patient prehabilitation with a long-term underweight, prefrailty, sarcopenia, osteoporosis and developed because of a transverse colon tumor malnutrition syndrome is given.

Perioperative management of elderly patients remains one of the most difficult tasks of modern anesthesiology. Compared with younger patients, people over 60 years of age have a higher risk of developing adverse postoperative outcomes, as a result of age-related decline in physiological functions, the presence of several concomitant diseases, polypragmasia, cognitive dysfunction and specific geriatric syndromes, such as frailty. More than 25 % of this category of people have several chronic diseases of the cardiovascular, nervous, endocrine, hematopoietic, musculoskeletal systems, respiratory, digestive and other systems. In the process of aging, there is also a decrease and some perversion of metabolic processes, a decrease in the reactivity of the body. All of the above, along with the surgical intervention, increases the risk of postoperative complications and perioperative mortality. The recommendations present the definition of the category of elderly and senile patients, provide information about age-related changes in their body that affect anesthesia and intensive care. The main clinical syndromes and symptoms useful in predicting the unfavorable course of the perioperative period are indicated, including frailty, nutritional insufficiency, sarcopenia and cognitive dysfunction. Methods for assessing functional activity and the risk of falls are given separately. Attention is paid to the causes, diagnosis, prevention and treatment of delirium, cardiovascular, respiratory complications. The principles of choosing the method of anesthesia and management of the perioperative period in elderly and senile patients, depending on the features of interventions and concomitant pathology, are described.

High blood pressure is a risk factor for cardiovascular morbidity and mortality, as well as cognitive decline and loss of autonomy in the elderly and old age. Randomized clinical trials (RCTs) in populations of older patients living at home with low comorbidity and preserved autonomy indicate the benefit of lowering elevated blood pressure in patients over 80 years of age. Older patients with senile asthenia, loss of autonomy and other geriatric problems were excluded from RCTs, and observational studies in these groups of patients indicate an increase in morbidity and mortality with lower blood pressure and antihypertensive therapy. Obviously, in very elderly patients, a universal strategy for the treatment of arterial hypertension cannot be applied due to the significant heterogeneity of their functional status. The geriatric approach to the management of arterial hypertension in older patients involves an assessment of the functional status, the presence of senile asthenia, and the degree of autonomy for the choice of antihypertensive therapy tactics.

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.

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.

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