[The analysis of problems of supporting long-term nursing of individuals who lost their ability to self-care in Russia]

The article presents results of research study intended for identifying degree of cognitive impairment in elderly citizen residing in conditions of institution of stationary social support. The study was conducted in a multidisciplinary rehabilitation institution of social services. The obtained results confirmed necessity to organize primary preventive work and permitted to test program of correctional classes with elderly people having cognitive impairments. The comparative analysis of results of primary and control diagnostics testifies that efficiency of corrective impact depends on degree of cognitive impairment and beginning time of correctional work. The early correction of cognitive abnormality of light and moderate degree is the most successful. It actualizes issues of timely diagnosis of cognitive abnormalities in elderly people and necessity to develop activities of primary prevention of dementia.

[The improvement of cognitive rehabilitation of persons of older and senile age]

The article presents results of study of patients of elderly age within the framework of pilot project on the basis of the geriatric department of the State Budget Institution of the Rostov Oblast "The Hospital for War Veterans". The specially questionnaire was developed with participation of the charitable foundation "Memory of Generations" and the public movement "Medics-Volunteers". The social hygienic characteristics of studied contingent was analyzed. The statistical processing of obtained data was carried out considering subjective status of patients.

[Comparative analysis of the results of anterior decompression-stabilization techniques in the treatment of degenerative stenosis of the cervical spine in elderly patients: a retrospective study.]

The purpose of the study was to compare the clinical and radiological efficacy of 2-level anterior cervical discectomy and fusion (ACDF) and 1-level anterior cervical corpectomy and fusion (ACCF) in the treatment of two-segment degenerative stenosis of the cervical spine in elderly patients. The retrospective study included 74 elderly patients (over 60 years old), two cohorts were identified: the 1st (n=38) - patients who underwent staged 2-level ACDF; the 2nd (n=36) - patients operated on using the technique of 1-level ACCF. For comparative analysis, we used general information about patients (gender, age, body mass index, physical status according to ASA), characteristics of surgical interventions (time of surgery, volume of blood loss), features of the postoperative period, clinical data, radiological outcomes, and the presence of complications. Analysis of the results was carried out in a minimum period of 36 months. As a result, it was found that 2-level ACDF in the treatment of two-segment degenerative stenosis of the cervical spine in older patients is associated with less blood loss and the level of local pain syndrome. At the same time, better clinical outcomes and fewer revision interventions after 1-level ACCF were recorded in the long-term postoperative period.

[Problems of choosing hypoglycemic therapy in elderly patients (literature review).]

Type 2 diabetes mellitus is one of the most common non-infectious diseases in the world. Among people with type 2 diabetes, patients of the older age group predominate: 60,5% of all patients are over 65 years old, and the peak prevalence is at the age of 65-69 years. The treatment of this pathology in elderly patients has certain features, which is associated with a high level of polymorbidity in these patients. Therapy for type 2 diabetes should be aimed not only at compensating the level of glycemia, but also at treating and preventing complications of diabetes, and improving the quality of life of patients. The choice of hypoglycemic therapy should take into account the effect of drugs on the cardiovascular system and kidney function, as well as the risk of hypoglycemia, which is more common in older people and affects the cognitive function of such patients. This review discusses the possibilities of using various groups of antidiabetic drugs in elderly and old patients.

[Risk factors for low functional activity in people 80 years and older.]

The global aging of the population continues in the world, therefore, the extension of functional and cognitive independence in the elderly, senile and centenarians is a priority goal of the healthcare systems of all states. The aim of the study was to identify risk factors for low functional activity in senile people. The study included 122 people aged 80 years and older (mean age 84,74±2,98 years). Complaints were collected from all participants; history; anthropometric indicators, handgrip strength, functional activity using the SPPB battery of tests, body composition were determined. It was found that men aged 80 years and older showed better functional performance than women. Gender, age, and the number of drugs taken were significant predictors of functional activity. Patients at the age of 80 years and older with normal functional activity had better anthropometric parameters, body composition, and hand grip strength. Depression and osteoarthritis were more common in older people with low functional activity.

[A new screening method for the diagnosis of sarcopenia in people 65 years and older.]

Diagnosis of sarcopenia is difficult due to the limitations of measuring muscle mass, which requires specialized equipment. Simple screening tools can be useful in general practice. The aim of the study was to develop a new screening method for diagnosing sarcopenia based on risk factors and biomarkers of the disease. The study included 230 people over 65 years and older (70 men and 160 women, median age 75 [68; 79] years) examined in a medical institution in St. Petersburg. Sarcopenia was diagnosed according to the updated consensus of the European Working Group on Sarcopenia 2 (EWGSOP2, 2018). When constructing a mathematical model, such indicators as the number of falls, BMI, fatigue, and the level of C-reactive protein in the blood serum had the greatest diagnostic significance of sarcopenia. The calculations showed high sensitivity - 91,4%, specificity - 88,7% and accuracy - 89,9% of the screening method for diagnosing sarcopenia in people 65 years and older.

[COVID-19, neuroCOVID-19 and cognitive impairment in elderly and old patients (literature review).]

The new coronavirus infection COVID-19 causes damage to many organs and systems, is a multi-organ disease. Many researchers are studying the relationship of the new coronavirus infection with polymorbid pathology, frailty, sarcopenia. The SARS-CoV-2 virus has the property of neurotropism, therefore, olfactory, taste disorders, as well as cognitive impairments can join the spectrum of clinical manifestations and consequences of the disease. Alzheimer's disease is the most common cause of dementia in the world. It is of interest that there is a link between the coronavirus infection and the development of cognitive impairment, including Alzheimer's disease.

The medical demographic characteristic of group of citizen injured in road accidents on the Federal Highway

The role of citizen of elderly age in road accidents on the Federal Highway was principally passive since passengers of vehicles predominated (p<0,0001). The most of victims of elderly age (66,7%) suffered of combined lesions. Considering gender of victim, presence of ethanol in blood at the moment of hospitalization, the role of victim of road accident and degree of severity of lesions in citizen of elderly age was in overall higher than in citizen of able-bodied age up to 2.3-2.9 points according ISS scale. The established medical demographic characteristics of victims of elderly age condition necessity of development of differentiated approaches to their medical care support, planning of measures of population prevention of medical sanitary aftermaths of road traumatism.

[Intraoperative and early postoperative risk factors of development of acute cerebrovascular accident after coronary artery bypass grafting in the elderly age.]

The article presents data on the problem of ischemic heart disease, surgical myocardial revascularization, as well as the risk of developing acute cerebrovascular accident (ACVA) in elderly patients with coronary artery bypass grafting (CABG). The authors conducted a study to identify risk factors for the development of stroke in elderly patients. Predictors of ACVA development in the operational and early postoperative periods were identified. It has been proven that the time of extubation, an increase in PCO2 levels, and hyperlactatemia are reliable intraoperative and early postoperative predictors of stroke in elderly patients with CABG. The practical significance of the study lies in the application of its results to predict the development of perioperative stroke in elderly patients with CABG.

[Postoperative cognitive dysfunction in elderly patients after aorta-coronary bypass under conditions of artificial blood circulation.]

In patients undergoing open myocardial revascularization under cardiopulmonary bypass (CB), one of the complications is cognitive dysfunction. The aim of the work is to study the effect of intraoperative lactic acidosis, anemia and the duration of myocardial anoxia on the change in cognitive status with the help of FAB after coronary artery bypass grafting (CABG) with CB. The negative impact of lactic acidosis on cognitive status in patients after CABG has been proven. The relationship between the decrease in hemoglobin concentration during surgery and the negative dynamics of cognitive changes in the postoperative period (R=0,41; p=0,021) was determined. A negative effect of prolonged myocardial anoxia during surgery on the dynamics of cognitive functions of patients was revealed. Thus, the above indicators may be markers of the formation of postoperative cognitive dysfunction in patients undergoing CABG with CB.

[The alteration of the structure of mortality of endocrine system diseases, nutrition disorders and metabolic disturbances in individuals of able-bodied age and older in conditions of pandemic]

The elderly age and endocrine diseases are among death risk factors at contamination with new coronavirus infection. To reply the question of how the influence of these risk factors is summing up, differences were determined concerning patterns of changes in structure of mortality of endocrine system diseases, nutrition disorders and metabolic disturbances in individuals of able-bodied age and older against the background of COVID-19 pandemic. on the basis of information from the Moscow database of deaths of endocrine system diseases, nutrition disorders and metabolic disturbances, the changes in contribution of individual diseases to the death causes structure in 2019-2021 were analyzed. The groups of individuals of able-bodied age and older were compared. It was established that in both groups rate of indicating SARS-CoV-2 virus infection as concomitant disease decreased while rate of indicating concomitant diseases at death of COVID-19 increased. The group differences in changes of structure of death causes were established in 2021. The percentage of undetermined forms of diabetes and obesity in structure of death causes increased in the elderly, while in individuals of able-bodied age increased. The percentage of obesity as concomitant disease of death of COVID-19 in individuals of able-bodied age increased and did no change were detected in the elderly group. The input of poly-glandular dysfunction as consequence of old infection into mortality is five times higher among individuals of able-bodied age. On the basis of received results, assumption was made SARS-CoV-2 virus contamination ruinously affects development of pathological process under endocrine diseases regardless of age, while age affects spreading of endocrine diseases and degree of resistance to development of infectious process directly. The differences in patterns of changes of structure of death causes of population of able-bodied age and older are associated with low quality of diagnostics of death causes in individuals of elder age groups.

[The modern methods of evaluation of implementing personalized programs of prevention of age-associated diseases]

The development of preventive programs targeting specific groups of consumers of medical social services having age-related health and lifestyle characteristics is one of the most prospective methods to improve quality of medical care of the elderly and senile patients. The previously developed by Russian and foreign scientists programs of personalized prevention of age-related diseases make it possible to organize target groups of patients seeking medical services in both state and private health care organizations to be screened for conditions of medical and social significance from the point of view of preventive medicine. This permits to achieve a real integration of various components of preventive care that improves health of elderly and senile patients in terms of morphofunctional indices of patient's physical status, quality of life, degree of independence, and, as a result, quality and scope of implementation of preventive programs for elderly population. Therefore, the development of the basics of personalized programs preventing age-related diseases in elderly population is actual.

[The particular medical social problems of individuals of elderly and senile age as exemplified by the Rostov Oblast]

The article analyzes dynamics of main indices of disability in population older than able-bodied age in the Rostov Oblast. The trend of decreasing of scope of examinations of individuals of the mentioned age group, including decreasing the number of first and iteratively recognized as the disabled, against the background of increasing in the population structure of percentage of individuals older than able-bodied age. At the same time, increasing of accumulated disability was established in the studied category of population.

[Age-associated features of the development of fibrosis and inflamaging in patients with arterial hypertension and ischemic stroke.]

The article deals with the development of fibrosis and immune inflammation in patients with arterial hypertension and acute ischemic stroke in old age. The aim of the study was to study age-associated features of the concentration of fibrosis markers (metalloproteinase-9, tissue inhibitor of matrix metalloproteinases-1, their ratio MMP-9/TIMP-1), immune inflammation (TNF-α, IL-1β, INF-γ) in patients with arterial hypertension and ischemic stroke (AI). The study included 86 patients with arterial hypertension (AH) of the 2nd degree, of which 42 were middle-aged (53±5 years) and 44 elderly (66±5 years). The control group consisted of 22 elderly patients with AH without a history of AI. The criteria for inclusion in the study are patients with hypertension who were admitted to the hospital in the acute period of the first cerebral stroke. It was found that in elderly patients with hypertension with AI, the indicators of inflamaging and fibrosis markers were significantly higher than in middle-aged people. The level of IL-1ß was 31,7% higher (p<0,01), TNF-α by 55,7% (p<0,001), INF-γ by 36,6% (p<0,01), the level of MMP-9 was 46,4% higher (p<0,01), TIMP-1 by 21,2% (p<0,01), MMP-9/TIMP-1 by 19,6% (p<0,01) in the elderly compared to middle-aged patients with hypertension and acute AI. Thus, it was found that patients with arterial hypertension and ischemic stroke have violations of the processes of inflamaging, synthesis and degradation of the extracellular matrix, especially pronounced in old age.

[The role of inflammation in the development of post-stroke depression in elderly patients.]

The aim of the study was to study the role of cytokines, the ratio of neutrophils and lymphocytes in the development of post-stroke depression in elderly patients. The study included 110 patients with acute ischemic stroke, including 60 middle-aged people (52±5 years) and 50 elderly people (66±4 years). The control group consisted of 20 middle-aged people without a history of stroke. After 3 months of follow-up, post-stroke depression (PSD) developed in the elderly in 28 patients (56%), in the middle age in 26 patients (43,3%). Patients with ischemic stroke in the elderly who developed PSD were significantly older (7,9%, p<0,05), more often had arterial hypertension (12,4%, p<0,05), the level of glucose was 16,1% higher (p<0,05), triglycerides by 14% (p<0,05), LDL-C by 12,8% (p<0,05). In middle age, patients with post-stroke depression had a body mass index higher by 8,1% (p<0,05), a glucose level by 9,6% (p<0,05), triglycerides by 10,9% (p<0,05), LDL-C by 9,7% (p<0,05) than patients without PSD. Elderly patients with ischemic stroke and PSD had higher levels of cytokines - IL-1β was 35,4% higher (p<0,01), TNF-α by 27% (p<0,01), INF-γ by 18% (p<0,01) than in patients without PSD. In elderly patients with PSD, the ratio of neutrophils and lymphocytes (N/L) is 46% (p<0,001) higher than in patients without PSD. In the elderly, in the presence of PSD, the N/L ratio was 50% (p<0,001) higher than in the same middle-aged group. Thus, in elderly patients with ischemic stroke, the level of inflammatory markers may have a prognostic value in the development of post-stroke depression.

[Low-pressure pneumoperitoneum with abdominal elevation in laparoscopic radical prosta-tectomy in elderly patients with a localized form of prostate cancer.]

Prostate cancer is an actual problem among males of older age groups, while the concomi-tant premorbid background of this category of patients often leads to the development of postopera-tive complications using the standard surgical method. The article presents the results of using low-pressure pneumoperitoneum with anterior abdominal wall lifting for laparoscopic radical prostatec-tomy in elderly patients with a localized form of prostate cancer. Convincingly shown that the use of low-pressure techniques pneumoperitoneum with lifting anterior abdominal wall ensures satis-factory operating field, obtains stable indicators of operational monitoring and allow to reduce the duration of the operation, as well as reduce the duration of hospitalization and incidence of postoperative complications.

[Prevalence of mental retardation among the elderly in Northwestern Federal District.]

In a single-stage observational study, the dynamics of indicators of prevalence and incidence of mental retardation in persons aged 60 years and older in the North-Western Federal district was studied. It was found that in the diagnostic structure of the prevalence of mental disorders of older people in the northwestern Federal district in 2018, the share of mental retardation is 2,9%. Among all patients with mental retardation, the proportion of elderly people in the regions of the northwestern Federal district ranges from 1,9 to 7,6%. From 2016 to 2018 in the northwestern Federal district, the increase in the prevalence of mental retardation of the elderly due to the cumulative effect was 9,6%, and the decrease in the incidence rate was 26,5%. Cases of primary diagnosis of mental retardation in older people may be due to migration factors and diagnostic errors. A more thorough assessment of the clinical picture of cognitive disorders in elderly patients and accurate follow-up of diagnostic criteria is required.

[The main indices of functioning of the centers of social support of citizen of elderly age and disabled persons in Russia]

The main causes of aging of the population are decreasing of birth rate, increasing of life expectancy, increasing of mortality rate of population of able-bodied age. The continuing aging of population results in increasing of number of elderly people requiring social and medical care. The role of social service institutions is increasing. The purpose of study is to assess activities of the division's centers of social services to elderly age and disabled citizen in the Russia for 2007-2017. The article presents analysis of the indices of functioning of the centers of social support of elderly population and disabled persons in the Russian Federation. In 2007-2017 in the conditions of aging of population most of the indices of divisions of the centers of social support of elderly population and disabled persons decreased except social rehabilitation divisions and divisions of social service at home. The methods. The normative documents regulating activity of the centers of social services and their structural divisions are investigated. The indices of functioning of divisions centers of the social support of elderly population and disabled persons such as day care, temporary residence, social and rehabilitation services, social services at home, specialized social and medical services at home, urgent social services in Russia, were analyzed according to the Federal State Statistics Service (Rosstat) for period of 11 years. The analytical and statistical methods were used. Conclusion. In the Russian Federation, the last decade has been characterized by significant increase in the total proportion number of persons over working age (from 20,8 to 25,0%). At the same time, decreasing of indices of functioning of divisions of temporary residences, day care, specialized divisions of social and medical services at home, urgent social services divisions, reduction in the number of social workers centers of social services to elderly age and disabled citizens was established.

[The organization of medical nurse support of patients of elderly age in geriatric practice]

In recent years, the concept of nursing process has been actively introduced. It is especially important in geriatric practice, where the issues of nursing support prevail over those in the young and middle age. There are forms of organization of care, where it is the average medical staff is leading in the provision of medical care (hospices, nursing care hospitals, homes for the elderly, etc.). In these conditions, the responsibility of nurses in making and implementing medical decisions in the event of emergency conditions increases.

[Prevention of cognitive dysfunction in elderly cancer patients operated on the pelvic organs in conditions of multimodal anesthesia]

The aim of the study was to evaluate the impact of various variants of multimodal anesthesia on the cognitive functions of elderly patients after surgical interventions on pelvic organs, the development of preventive measures for POCD.

MATERIAL AND METHODS

A study was conducted in 76 elderly patients aged 62 to 84 years with an increased risk of developing POCD. Of these, 46 women and 30 men. Patients were divided into two groups, depending on the type of anesthesia. The 1st group consisted of 37 patients who had low-flow anesthesia with sevoflurane combined with epidural analgesia. 2^nd - 39 patients who had anticipated multimodal analgesia on the basis of systemic administration of lidocaine, sulphate magnesia, verapamil. In each group, patients are divided into subgroups - the main (O) and control (K). In the main subgroups anesthetics were supplemented with 20 ml. Cytoflavin, administered 20-25 minutes before the end of surgery and on the 1-3 days of the perioperative period. Cognitive functions were assessed by standardized scales: Mini Mental State Examination (MMSE), Montreal Cognitive Evaluation Scale (MoCA), Frontal Assessment Batteries (FAB). The level of anxiety and depression was determined by the hospital scale of anxiety and depression (HADS).

RESULTS

At oncological patients of advanced age in 52.5% of cases there is a moderate degree of cognitive impairment. In the perioperative period, in the study groups, when using different variants of multimodal anesthesia, there is an equivalent transient decrease in cognitive functions by 12.5 and 12.8%. The use of cytoflavin can reduce the manifestation of POCD from 1-day perioperative period, improve the cognitive status of patients.

CONCLUSION

In cancer patients of advanced age, cognitive impairment is observed, aggravated after surgical treatment, regardless of the variant of multimodal anesthesia. Protection by Cytoflavin allows to restore the cognitive functions of elderly cancer patients, reduce the manifestations of POCD.

[Features of dental rehabilitation of elderly patients after treatment of maxillofacial neoplasm.]

The purpose of this study is a comparative analysis of the effectiveness of the use of dental trays-transformers for the manufacture of prosthetic designs for elderly patients with acquired microstomia. Was conducted a clinical study of 12 hemimaxillectomy patients from 60 to 72 years. The 1st group included 6 patients with acquired microstomia, impressions of the jaws were obtained with dental trays-transformers. The 2nd group includes 6 patients who have less traumatic oral opening, they were removed with standard dental trays. The group of clinical control consisted of 6 patients with partial absence of maxillary teeth, who needed to prosthetic dentistry. The results of the study indicate the effectiveness of the use of trays-transformers to impressions of the jaw in elderly patients with restricted oral opening, as well as in patients with normal oral opening. Optimization of the stages of obturator prostheses allows to provide qualitative prosthetic care of patients with malignant neoplasms of the oropharyngeal region, which has a positive effect on the quality of life of elderly patients with acquired defects of the oropharyngeal region.

[Substantiation of the drug «Cytoflavin» application and cognitive-behavioral therapy in complex treatment of deforming coxarthrosis in elderly patients.]

The article presents the results of a study of the effectiveness of the addition of a standard course of conservative therapy to 104 patients of the older age group with coxarthrosis deforming the drug «Cytoflavin» and cognitive-behavioral therapy courses. It was found that such scheme increases the effectiveness of therapeutic interventions, which manifests itself as the improvement of the mental and physical components of quality of life by reducing pain and increasing the functionality of some of the affected hip. At the heart of positive clinical effect is a decrease in processes of inflammation and reduction of tension of regulatory processes in the organism.

[Megapolis medical rehabilitation system of elderly patients with severe cranio-cerebral injury.]

The capacities of systemic standard graded medical rehabilitation were assessed in 469 patients carried out surgical intervention for severe craniocerebral injury at Saint-Petersburg hospitals in 2010-2017. As a result of neurorehabilitation system introduction rates of infectious-inflammatory complications associated with physical inactivity were significantly decreased. An average length of stay at hospital was decreased from 34±5 to 23±4 days. At discharge from neurosurgical hospital the Barthel index of activities of daily living was 42±8 points. After inpatient rehabilitation course an average Barthel index was increased to 70±6 points. And after outpatient rehabilitation course an average Barthel index had reached 70±6 points.

[Features of fibrosis and disorders of the collagen metabolism of the interstitial matrix of the myocardium in patients with arterial hypertension and possibilities of their correction with sartname.]

Metabolic disorders of the interstitial heart and vessels matrix in hypertension develop due to chronic stretching of their walls. For estimation the involutive and hypertensive changes in interstitial matrix of the heart and vessels we have been examined 30 normotensive elderly women and 30 patients of same age with arterial hypertension (AH) II stage, as well as the possibility of their correction by valsartan and veroshpiron. The next parameters of investigation used: the volume fraction of interstitial collagen (VFIC) in myocardium, cardiovascular conjugation (CVC), serum concentrations of markers of systemic collagenogenesis - COL-1, TGF-β1, MMP-1, TIMP-1, Gal-3. CVC reflected the hard-elastic properties of the myocardium and arterial vessels, which was elevated in women with AH. A high intensity of LV myocardial fibrosis was revealed with a significant increase in the VFIC content in elderly patients with AH compared with normotensive patients. This is due to the increased activity of fibrosis markers. There was a decrease in their level after antihypertensive therapy, which proved its antifibrotic effect.

[Proliferative activity of paravasal connective tissue cells in the age aspect.]

The aim of the study was to investigate the age-related variability of the proliferative activity of fibroblasts of the paravasal connective tissue of the hollow and parenchymal organs of men corpses of the first period of mature age, elderly and senile age by detecting the expression of the Ki-67 protein (MIB-1 clone) and calculating the proliferation index. The results showed that in the first period of mature age, the proliferation index is almost at the same level in the paravasal tissue cells of the parenchymal and hollow organs of the digestive tract, while the fibroblasts of the paravasal tissue of the heart have the lowest proliferation activity among all the organs studied. With age, the intensity of cell proliferation decreases, moreover, at the age of more than 75 years, a distinct organ specificity is revealed. In cells of the paravasal tissue of parenchymal organs, proliferation index is characterized by minimal values among all studied organs. The cells of the paravasal tissue of hollow organs retain significantly greater proliferative activity in the senile, which is almost twice as large as the same parameter of the parenchymatous organs in this age group.

[Optimization of cognitive rehabilitation of elderly patient with motor disorders on the basis of modern digital technologies.]

The problem of cognitive dysfunction in modern gerontological aid goes to the leading positions, complicating treatment and rehabilitation of concomitant motor disorders. The current trend in recent years is the search and development of models of cognitive rehabilitation of elderly patients on the basis of digital technology with the ability to transfer the effect on the motor and mental sphere. The literature sources of the last 5-7 years describe dozens of methods of cognitive rehabilitation, including on the basis of computer games, which demonstrate the importance of these techniques not only in improving the cognitive abilities of patients, but also in Preservation of social adaptation and daily functioning. At the same time negligible attention is paid to the problem of application of digital technologies in rehabilitation of cognitive disorders in patients with motor disorders and possible transfer of effect between spheres. This study shows the application of the algorithm of action with the participation of electronic devices as cognitive rehabilitation with compensatory mechanism in comorbid patients with motor and moderate cognitive impairment.

[Atrial fibrillation as Risk Factor for Development of Cognitive Function Impairment and Dementia. Potential of Anticoagulant Therapy in Their Prevention]

This article presents an overview of data of Russian and foreign literature on possible associations between cognitive impairment and atrial fibrillation (AF). It includes modern classification of cognitive impairment, mechanisms of the effect of AF on cognitive functions and development of dementia, recommendations for the prevention of cognitive impairment in patients with AF. Special attention is paid to the assessment of cognitive status, and safe anticoagulant therapy, which is a priority in the prevention of cognitive impairment in patients with AF. Analysis of literature showed greater efficacy and safety of drugs from the group of Non-vitamin K Antagonist Oral Anticoagulants (NOAC), rivaroxaban in particular, in comparison with warfarin. Drugs from the NOAC group can be recommended for prevention stroke, cognitive impairment and dementia in elderly patients with AF.

[Involutive and hypertensive fibrosive transformation of the heart in formation of myocardial dysfunction and chronic heart failure.]

To assess the conjugation of involutive and hypertensive fibrotic transformation of the heart formation with myocardial dysfunction and chronic heart failure (CHF), 30 normotensive individuals and 60 elderly patients with arterial hypertension (AH) (mean age - 66±0,7 years) were examined by echo and dopplercardiography, estimation of the volume fraction of interstitial collagen (VFIC) in the myocardium, serum concentrations of markers of systemic collagenogenesis, using a six-minute walk test. A higher intensity of LV myocardial fibrosis was revealed with a significant increase in the VFIC content in elderly patients with AH compared with normotensive patients, which indicates the predominance of interstitial collagenogenesis over collagenolysis. The increased content of fibrous tissue in myocardial interstitium caused the development of unfavorable types of cardiac remodeling and the progression of diastolic dysfunction, negatively affecting the functional reserve of the circulatory system, as evidenced by negative correlations between the level of the VFIC and the results of a 6-minute walk test: weak in patients with I FC CHF, moderate strength in patients with AH with II FC CHF.

[Modern look at endovascular treatment bleeding the gastrointestinal tract in elderly patients.]

A literature review of the publications of foreign authors on the treatment of non-varicose bleeding from the upper gastrointestinal tract of elderly and senile patients is presented. The authors showed a modern view of the possibilities of endovascular hemostasis in comparison with a surgical operation with inefficiency of endoscopic hemostasis and characterized patients in whom it is possible this will be most effective.

[Evaluation of the effectiveness of rehabilitation of elderly patients with metabolic syndrome, taking into account the provisions of International classification of functioning, disability and health.]

The article contains data on rehabilitation measures in elderly patients with metabolic syndrome. Individual-oriented treatment and rehabilitation programs implemented in primary health care allow to reliably reduce the severity and risk of progression of restrictions of life, increase the independence of patients The elderly, having metabolic syndrome, complicated the development of type 2 diabetes mellitus. It is proposed to assess the effectiveness of rehabilitation, taking into account the provisions of the International Classification of functioning, restrictions on life and health and by drawing up an individual geriatric profile.

[Disability of elderly people due to hypertensive disease in the Russian Federation.]

The article presents the results of the analysis of the epidemiology of primary disability of the adult population in the Russian Federation for 12 years (2005-2016). During this period, 6.6 million elderly people (56,8% of the total number of people with disabilities) were recognized as invalids. The leading cause of disability in the structure of primary disability among elderly people is 68,5%. HD retains leading positions as the most important factor of disability of the population. Negative tendencies of primary disability due to this socially significant pathology are associated with the demographic situation of population aging. In the contingent of people with disabilities due to hypertension, the proportion of elderly disabled is 43,4%, while the proportion of disabled people of middle and young age is less - 29,1 and 27,4%, respectively. Medical institutions should be prepared to work with a growing contingent of the elderly population, to increase the availability and quality of medical care for patients and people with disabilities due to HD, one of the most common and prognostically unfavorable pathologies that impose a limitation on vital activity.

[In-hospital Outcomes and Complications of Percutaneous Coronary Interventions in Acute ST-Elevation Myocardial Infarction in Different Age Groups]

AIM

to assess early (in-hospital) results of percutaneous coronary intervention (PCI) for ST-elevation (STE) myocardial infarction (MI) in different age groups.

MATERIALS AND METHODS

We enrolled in this study 356 patients with STEMI who underwent PCI within 24 hours of the disease during 1 year (2012). According to age all patients were divided into 2 groups: "young" ( less or equal 70 years) and "older" (>70 years).

RESULTS

Compared with young in older group there were more patients with renal (53.84 vs. 19.78%) and myocardial (23.07 vs. 6.83%, =0.0000) dysfunction, hypertension (97.43 vs. 83.81% =0.0018), history of MI (19.23 vs. 10.43%, =0,3736), and acute heart failure at admission (32.04 vs. 13.95%, =0.0003), and less smokers (10.25 vs. 34.53%). Hospital mortality in older group was higher (8.97 vs. 1.43%, =0.0007) despite effective PCI. Rate of hemorrhagic complications (major bleedings+hemotransfusions) was also higher in older group (5.12 vs. 0.71%, =0.0077).

CONCLUSION

Compared with younger older STEMI patients were characterized by more severe initial clinical condition and worse early results of primary PCI with higher mortality and rate of hemorrhagic complications. Thus the problem of improvement of management of this group of patients during hospitalization remains to be actual.

[Stomatological status and quality of life of elderly and senile people]

The stomatological status and the measures of oral health-related quality of life in elderly and senile inhabitants of Novosibirsk were researched. The high prevalence and intensity of the major stomatological diseases, the high need for oral cavity sanation and prosthetics in elderly and senile population were found out.

[The development of chronic heart failure in elderly patients with low ejection fraction at baseline in the acute phase of myocardial infarction]

There was performed analysis according to 5-year follow incidence of heart failure in patients with acute myocardial infarction (AMI) with low ejection fraction in A; the characteristics of chronic heart failure (CHF) in elderly and senile were determined; the value of a number of clinical and morphological parameters for prediction of CHF were studied. The study included 135 patients of Intensive Care Unit with a diagnosis AMI showing according to the initial echocardiography reduced ejection fraction in the first 24-48 hours. In the course of monitoring patients, routine methods of clinical examination were used, the main quantitative technique was echocardiography, qualitative indicators were assessed including by collecting anamnesis and filling out questionnaires for heart failure, and then standard statistical methods were used. In the process of observation it was found that patients with acute myocardial infarction in acute elderly age worsens the prognosis of heart failure and mortality forecast, low ejection fraction in the acute period is a negative predictor of heart failure in all age groups, but more pronounced in the elderly. Development and growth of CHF after AMI occurs, despite the growth of ejection fraction (EF) in both age groups. CHF dynamics depends on the systolic and diastolic dysfunction. In the older age group plays a decisive role systolic dysfunction.

[Features of the new minimally invasive techniques facet fixation system «Facet Wedge» in the treatment of degenerative diseases of the lumbar spine in elderly patients.]

The aim of the study was a comparative analysis of the clinical and radiographic effectiveness of the use of interbody fusion and open pedicle screw stabilization of simultaneous and new minimally invasive techniques facet fixation system «Facet Wedge» in the treatment of degenerative diseases of the lumbar spine in elderly patients. The study included 39 elderly patients (older than 60), which carries out the transforaminal interbody fusion Cage «T-pal»: open transpedicaular stabilization was used in 1st group (n=23), ipsilateral open transpedicular stabilization with contralateral transfaset installing titanium Cage «facet Wedge» -in 2nd group (n=16). We used intraoperative interventions and specific post-operative patient management, clinical data and radiographic outcomes for a comparative analysis of the parameters. Dynamic assessment was made in a period of 8 to 36 months after surgery (median 24 mo.). As a result, it found that the use of the system «facet Wedge» allows you to achieve the best clinical outcomes and fewer postoperative complications compared with open transpedicular stabilization in similar radiographic findings of bone block formation. Low traumatic facet fixation makes it possible to use methods for the treatment of elderly patients with degenerative diseases of the lumbosacral spine.

[Disability in the elderly owing to cerebrovascular diseases: the leading desadaptive syndromes]

The article presents data on the main desadaptive syndromes have disabilities due to cerebrovascular diseases in the elderly according to the results of analysis of medical expert documents the Bureau of medico-social examination of Saint-Petersburg in the period from 2010 to 2014. The characteristics of the level, structure, dynamics and distribution according to groups of disability due to cerebrovascular diseases in retirement were shown; clinical expert in the features of the population of older people with disabilities due to cerebrovascular diseases were analyzed. We revealed a consistent decrease in the number of persons with disabilities over 5 years, increase the proportion of persons with disabilities of group III and group I disabled. We have determined the structure of the main desadaptive syndromes in the structure of the cerebrovascular diseases, causing dysfunctions of the body and disability.

[Evaluation of bio-inverse communication and Cytoflavin effects on the dynamics of the clinical and psychophysiological condition of elderly patients with osteochondrosis]

We conducted a study of 150 patients on the basis of polyclinic № 91 in St. Petersburg. The effect of Cytoflavin and bio-inverse communication therapy on the dynamics of the condition of elderly patients with osteochondrosis was evaluated. A number of positive effects from such an addition to existing therapy, potentiating the nominal effect, were revealed.

[Peculiarities of clinical and psychophysiological status of elderly patients with osteochondrosis.]

We conducted a study of 220 patients in polyclinic № 91 in St. Petersburg. It was revealed that elderly patients with osteochondrosis are characterized by a high prevalence and severity of osteochondrosis against the background of metabolic disorders in the structures of the spine. At the same time, the actual condition of the spine does not always determine the severity of the pain syndrome. The effect of osteochondrosis on the development of comorbid pathology has been clarified. The ways of correction of the clinical and psychophysiological status of elderly patients with osteochondrosis such as appointment of Cytoflavin, behavioral therapy and biofeed back therapy are suggested.

[The compliance of elderly women being at the social institution.]

The aim of the work is to analyze the prevalence and severity of the psychological characteristics of the compliance of elderly women being at the social institution in comparison with the same age group living in the family and receiving support from relatives. The experimental group of the research consisted of 27 women at the age of 70-79 years being at the social institution, named Regional State Autonomous Institution Social Welfare «Sedankinsky nursing house for the disabled and aged people» of Vladivostok, from 6 to 12 months. As well as the comparative group included 27 women at the age of 72-79 years, who became widowed and lived in families. The following psychodiagnostic techniques were used in the research: Questionnaire «The level of compliance», the technique of diagnostics of psychological well-being of the individual, Hospital Anxiety and Depression Scale (HADS). The results of this study showed that the low level of general, emotional, behavioral and social compliance dominated in the group of the elderly women, who lived in the nursing house, in comparison with the group of the elderly women living in families. Besides, the level of psychological well-being is below normal combined with a raised level of depression. In the group living in favorable social conditions, viz. in families, the level of general compliance is average. Furthermore, the level of psychological well-being is characterized as one with better focus on building emotionally close relations combined with a sense of meaningfulness of life. The level of depression in the comparative group is significantly lower, than in the experimental group. The achieved characteristics show the necessity of increasing a compliance level of the patients living in the social institutions by carrying out a set of measures to optimize the conditions and quality of physician-patient interaction. Moreover, it is important not only to teach them to take medicine systematically, but also to take an active deliberate position on their own health care.

[Behavioral psychotherapy and citoftavin in the treatment of deforming coxarthrosis in elderly patients]

The authors studied the efficiency of the expansion of the standard course of conservative therapy of deforming coxarthrosis by appointment Cytoflavin and behavioral therapy. The study was performed on 104 elderly patients. It was found that the addition of the existing scheme increases the effectiveness of therapeutic interventions, which manifests itself as the improvement of the mental and physical components of quality of life by reducing pain and increasing the functionality of some of the affected hip. At the heart of positive clinical effect is a decrease in processes of inflammation and reduction of tension of regulatory processes in the organism. Positive quality extra medical appointments was the absence of significant side effects when taken orally Cytoflavin requiring discontinuation of the drug, as well as the absence of failure patients from further sessions of behavioral therapy.

[Specifics of the use of NSAIDs in senior age]

Nonsteroidal anti-inflammatory drugs (NSAIDs) have a strong analgesic and anti-inflammatory effects and are widely used in clinical practice. Patients with chronic disorders of the joints, in particular the spine, are main consumers of NSAIDs. However, risk factors for side-effects should be taken into consideration in the treatment with NSAIDs, especially in patients of old age. The careful control of treatment taking into account the risk of developing gastrointestinal and cardiovascular events is needed.

Short and long-term outcomes after gastrectomy for gastric carcinoma in elderly patients

As worldwide life expectancy rises, the number of candidates for surgical treatment of gastric carcinoma over 70 years will increase. This study aims to examine outcomes after gastric carcinoma in elderly patients. This study is a retrospective review of 697 patients undergoing gastrectomy with radical intent for gastric carcinoma during January 2007 to January 2013. A total of 534 patients were less than 70 years old (group A), and 163 patients 70 years or greater (group B). We analyzed the effect of age on short and long-term variables including overall survival and disease-free survival. Major morbidity was observed to occur in 19 patients of group A, and 15 of group B. Mortality, both 30-day and 90-day was observed in 1 and 3 of group A, and 3 and 6 of group B. Five-year overall survival and disease-free survival was 61% and 60% for group A, 50% and 43% for group B respectively. Gastrectomy should be carefully considered in patients 70 years old and can be justified with low mortality and acceptable long-term outcomes.

[The study of general satisfaction in stationary social institutions (Yaroslavl Regional Gerontology Center)]

The article analyzes the satisfaction with social environment of patients of older age groups living in the Yaroslavl Regional Gerontology Center. On the basis of a survey of 118 patients of older age groups the satisfaction with the living conditions in the institution, the provision of socio-medical assistance, catering, leisure activities and social environment were assessed. 92,4 % of patients reported of their satisfaction, in general, with the stay. The obtained information confirms necessity of creation of qualitative therapeutic environment in a hospital of social service.

[Metabolic risk factors in patients 60 years and older with arterial hypertension, living in extreme conditions of the Far North]

To evaluate the criteria of metabolic syndrome (MS) in elderly, 505 men aged 60-99 years, with hypertension, indigenous and non-indigenous ethnic group living in the extreme conditions of the Far North were studied. The analysis of anthropometric parameters revealed that height, body weight, BMI, waist circumference, hip circumference, the ratio of waist to hip size, waist to growth were significantly lower in the elderly and senile Yakuts compared with those of non-indigenous ethnicity (p<0,001). Ethnic differences were found in SBP and DBP levels (p<0,001). The obtained results suggest that in elderly, old age patients and centenarians living in the Far North, almost all analyzed parameters of the metabolic syndrome were significantly correlated with abdominal obesity (p<0,001).

Correlations of psycho-physiological parameters influencing the physical fitness of aged women

Regular assessment of psycho-physiological parameters in aged subjects helps to clarify physical and mental conditions which are important in the prevention of health-endangering events to assure a healthy aging. Thirty older care female residents consented voluntarily to participate in the study. The somatic and psycho-physiological parameters recorded were handgrip force, disjunctive reaction time, balance control and whole body movement coordination, the electrocardiogram and heart rate variability. Significant correlations were found between (a) reaction time and balance control efficiency (r = -0.567, p < 0.009), (b) reaction time and movement coordination accuracy (r = -0.453, p < 0.045), (c) cardiac state and movement coordination accuracy (r = 0.545, p < 0.016), (d) cardiac stress and cardiac state (r = -0.495, p < 0.031), and (e) cardiac stress and force (r = -0.822, p < 0.045). In conclusion, for the aim of establishing basic battery tests for assessing psycho-physiological condition of physical fitness our results emphasize the importance of systematic physical activity, endurance and strength training supporting muscle force, balance control and whole-body movement coordination, in addition to improving the cardiac stress index level. The strong interrelation among these parameters allows the drawing of a more complete view regarding the health condition of aged individuals.

[The specific features of the course of acromegaly in old age and possibilities of somatulin treatment]

Acromegaly is a severe neuroendocrine disease caused by chronic excessive production of growth hormone. There are 50-70 cases of this disease per 1 million people. In the vast majority of cases, the cause of the disease is a pituitary adenoma from somatotrophic cells. With the advent in clinical practice of prolonged analogues of somatostatin, endocrinologists have new therapeutic options. In the article we present a clinical case of the patient with the diagnosis: acromegaly, active form; Endosuprasellar pituitary adenoma (somatotropinoma); Hypopituitarism (secondary adrenal insufficiency, secondary hypothyroidism); Chronic pyelonephritis in the acute phase; Hypertension of the II stage, ischemic heart disease, angina pectoris II functional class; Common atherosclerosis with a primary lesion of the aorta, coronary vessels and cerebral vessels.