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Elderly and senile people often suffer from cognitive impairment. One of the significant issues that develop as the severity of cognitive impairment increases is dysphagia. The article addresses various causes of dysphagia and ways to manage it. Due to the high prevalence of dysphagia in cognitively reduced patients, selecting therapy for cognitive disorders is often challenging. Since patients with dysphagia have difficulties taking solid dosage forms (DF) – tablets and capsules, alternative DFs are being discussed. In particular, studies of the positive effect on the cognitive status of Cereton and the use of its different DFs are presented, allowing for optimal therapy in various situations. The novel DF of Cereton, an oral solution, is convenient for use in patients with dysphagia.

Diabetes self-management education (DSME) is an essential part of effective and safe treatment of chronic conditions such as diabetes mellitus (DM). Though the data on DSME effectiveness in elderly are limited, all patients should be educated regardless of age. The form of learning and education program may vary depending on the clinical situation and the patient’s characteristics. Age-related problems, so-called geriatric syndromes, determinant heterogeneity of elderly diabetic population. Geriatric syndromes should be taken into account to choose proper treatment goals and optimal education programs. Functional dependency, cognitive decline, depression, sarcopenia, malnutrition and polypharmacy seems to be most important in the education context. The development of geriatric education program with a broad focus on solving both diabetic and age-related problems and its implementation on a wider range of institutions may be useful to improve diabetes self-management education of elderly in clinical practice. It is also necessary to initiate clinical studies to evaluate DSME effectiveness in elderly not only from the generally accepted diabetological criteria, but also considering its impact on age-related problems.

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.

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

The administration of oral anticoagulants in elderly patients with geriatric syndromes such as senile asthenia syndrome, falls and high risk of falls, dementia, polymorbidity, polypharmacy are discussed in the article. The evidence base for the anticoagulants taking in patients with atrial fibrillation aged ≥75, ≥80, ≥85 and ≥90 years, in patients with atrial fibrillation and various geriatric syndromes, as well as in elderly patients with venous thromboembolic complications and frailty syndrome is presented. Most studies indicate significant advantages of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban) over the vitamin K antagonist warfarin in elderly patients with geriatric syndromes. An updated version of the FORTA consensus document, which aims to optimize the prescription of medicines for the elderly, is also presented. Apixaban has a FORTA-A safety class and is the safest oral anticoagulant in elderly patients.

Aging is an independent risk factor for the development of many diseases and geriatric syndromes. Osteoarthritis (OA), as the most common joint disease in the elderly, can be attributed to age - associated conditions. And the most significant geriatric syndrome, which dramatically affects the management and prognosis of an elderly, is frailty. The review provides current information on the prevalence of OA and frailty, their clinical and prognostic significance, and also shows the mutually aggravating role of these two conditions. The difference between non - and medication management of patients with OA and frailty is emphasized.

Coronary heart disease is the leading cause of death worldwide. Over the past few decades, life expectancy has increased, which has led to an aging population in developed countries, so the average age of patients with acute coronary syndrome (ACS) has steadily increased in recent decades. The inclusion of elderly and senile patients in randomized clinical trials does not reflect the age-related association of these diseases. However, antithrombotic therapy and interventional treatment are the basis of treatment in patients with ACS of any age, including the elderly. For older patients, there may be a mismatch between chronological and biological age. The question of how close the treatment of elderly patients with ACS is to the level of current recommendations and whether it is possible to apply them unconditionally in this group of patients does not have a definite answer. Current recommendations and the underlying randomized clinical trials are focused on any one disease, whereas in the elderly in most cases multimorbid pathology occurs. In general, elderly patients with ACS should be treated using the same methods as younger patients, however, the presence of comorbid diseases in an elderly patient naturally increases the risk of complications, makes the patient’s prognosis heavier, significantly affects treatment tactics, limits the possibility of using conventional approaches when choosing a drug therapy.

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.

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

A review of the use of comprehensive geriatric assessment and its components in oncology is introduced. The evidence base for the increasing incidence of cancer in the elderly worldwide also presented. The management of older adults with cancer is challenging. Comprehensive Geriatric Assessment (CGA) has been shown by many authors to be a strong predictor of adverse events in geriatric oncology patients. CGA is recommended in oncology practice for many reasons: to identify health problems not usually detected in routine oncologic screening, to perform non-oncologic interventions, and to modify the cancer treatment plan. Comprehensive geriatric assessment is the gold standard in geriatric oncology for identifying patients at high risk for adverse outcomes and optimizing cancer treatment and overall management. Nevertheless, it can be stated that the final point in the search for evidence-based and effective frailty assessment tools in the practice of geriatric oncology has not yet been reached. It is concluded that the development of new scales and index scores, as well as the application of the CGA model in general, can provide adequate care for elderly cancer patients.

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.

Background: Fall in the elderly is considered as a geriatric syndrome, which increases the risk of new falls, decreases physical functioning and autonomy and is associated with other geriatric syndromes. One of the most common risk factors for falls is the pathology of the musculoskeletal system, including osteoarthritis, sarcopenia, osteopenia and osteoporosis, as well as chronic pain., Aim: To characterize diseases of the musculoskeletal system in elderly patients with falls., Material and Methods: The study included 289 patients (mean age 75,8±7,9 years, 224 women) who underwent falls during the last year. All patients had polymorbid pathology (mean number of diseases 5,13±2,3, the Charlson index 5,63±1,8 points). All patients underwent general clinical studies, a comprehensive geriatric assessment, X-ray examination of the joints, dual-energy X-ray absorptiometry., Results and Conclusion: The risk of falls assessed with a self-assessment scale as 7,45±3 points had 90,3% of patients, 34,6% of patients had the high hospital risk of falls. All patients had aggravated geriatric status (on average 7 geriatric syndromes). Among the risk factors for falls, one of the most common was the condition associated with the pathology of the musculoskeletal system: chronic pain (84,7%), physical inactivity (56,1%), disorders of balance (60,2%) and gait (35,9%), the use of mobility aids (30,4%), orthopedic pathology (9,7%) and vitamin D deficiency (86,1%). Osteoarthritis prevailed (75,8%) among nosological forms. One hundred and forty-two (64,8%) patients had pain in the joints, the duration of pain was 6,2±5,6 days, the pain intensity was 47,2±20,7 mm on a visual analogue scale and 106,3±112,3 points by WOMAC. The neuropathic component was diagnosed on DN4 scale in 34 (23,9%) patients. Dynapenia was detected in 109 (37,7%) patients, and sarcopenia in 28 (25,6%) of them. The risk of osteoporotic fractures was 17,4±7,9%. The significantly higher incidence of dynapenia, insufficiency and deficiency of vitamin D and a higher risk of osteoporotic fractures was observed in 289 patients with falls compared to 213 people without falls.

Anemia in older patients can be seen as a geriatric syndrome that impairs quality of life, functional status, reduces autonomy, and affects prognosis. Anemia is associated with other geriatric syndrome such as frailty, sarcopenia, falls and fractures, vitamin D deficiency, dementia and others. Iron deficiency anemia is the most common. Most often in older persons, the causes of its development are chronic blood loss and malnutrition. Laboratory criteria confirming iron deficiency anemia are hemoglobin reduction, microcytosis, low serum iron and ferritin. This is the basis for the administration of iron preparations, among which two- and threevalent ones are isolated. Trivalent iron preparations are most preferred in older patients because they have better tolerance and less frequency of side effects with comparable efficacy with divalent preparations.

Aging is an independent risk factor for the development of many diseases and geriatric syndromes. Osteoarthritis (OA), as the most common joint disease in the elderly, can be attributed to age - associated conditions. And the most significant geriatric syndrome, which dramatically affects the management and prognosis of an elderly, is frailty. The review provides current information on the prevalence of OA and frailty, their clinical and prognostic significance, and also shows the mutually aggravating role of these two conditions. The difference between non - and medication management of patients with OA and frailty is emphasized.

Osteoarthritis is one of the leading causes of a chronic pain in elderly people. Old and very old age in itself is a risk factor of a comorbidity, which often limits the therapy specified in clinical recommendations. First of all, it concerns NSAID. In such situations, priority is given to chondroitin sulfate (CS) and glucosamine sulfate (GS) having the anti-inflammatory properties comparable with effects of NSAID. CS and GS also promote the delay in progression of degenerative processes and restoration of the structure of cartilaginous tissue. The drugs of CS and GS groups are Chondroguard and Sustaguard Artro having the considerable evidence-based efficacy and safety and also a polymodality of effects in patients with a combination of osteoarthritis and socially important diseases (atherosclerosis, diabetes mellitus type 2, oncological diseases) and also geriatric syndromes (sarcopenia) and aging in general.

Aim: To analyze the geriatric status of patients with chronic pain., Material and Methods: One 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., Results: Chronic 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., Conclusion: The 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.

Aim: To study the geriatric status of patients with osteoarthritis (OA) older than 60 years depending on the severity of frailty., Material and Methods: The study included 201 patients with OA (mean age 75.84±8.09 years). The patients were divided into 3 groups: patients without frailty, patients with prefrailty and patients with frailty. Along with clinical examination, the risk of falls, pain intensity, the Charlson comorbidity index and the number of geriatric syndromes were calculated., Results and Conclusion: With the increase of frailty, the number of patients experiencing difficulties in movement increases. The physical activity of the patients gradually reduces with the appearance of prefrailty and significantly reduces in OA. At the same time, there is the increase in dependence on outside help, the decrease in IADL and walking speed. The most common geriatric syndromes in patients with OA are sensory deficits, chronic pain syndrome and falls. The neuropathic component of pain is diagnosed in every tenth patient with OA without frailty and in every third patient with OA and frailty. In light of results obtained in the study, the authors suggest detailed recommendations for treatment of patients.

Aim: to assess the prevalence of some geriatric syndromes and their association with high risk of cardiovascular complications (RCVC) among elderly women., Material and Methods: We examined 72 women aged 69-77 years with cardiovascular diseases. Examination included laboratory and echocardiography assessment, dual-energy X-ray absorptiometry, 6-min walk test, assessment of psycho-emotional status using Mini-mental State Examination (MMSE) questionnaire. Frailty was defined as three or more of the following: weight loss, low physical activity levels, MMSE less or equal 23 points, weakness (chair stand test>10 sec), history of multiple falls. Follow up was 7.3 (5.5-7.8) months., Results: High CVR was found in 70.8% women: in 59.1% women aged 65-74 years and in 89.3% - aged more or equal 75 years, =0.006. Osteoporosis (OP) was found in 51.3% women aged 65-74 and in 90.5% - aged more or equal 75 years, =0.024; MMSE was 27 (24-28) vs 24 (20-26) points, respectively, =0.008. The geriatric syndrome of frailty was found in 13.6% women aged 65-74 and in 64.3% - aged more or equal 75 years. Frailty was associated with high CVR (odds ratio [R] 7.2, 95% confidence interval [CI] 1.5-34.2, =0.013), chronic kidney disease (CKD, R 18.9, 95%CI 5.2-20.2, <0.001), P (R 4.5, 95%CI 1.3-15.8, =0.019), history of myocardial infarction (MI, R 6.8, 95%CI 2.2-20.8, =0.001), greater age (R 6.0, 95%CI 2.1-17.5, =0.001)., Conclusion: High CVR was prevalent among greater age women what could be explained by prevalence of chronic heart failure, atrial fibrillation, CKD. Prevalence of frailty was 13.6 and 64.3% among women aged 65-74 and more or equal 75years, respectively. It was significantly associated with high CVR, OP, PMI, CKD.