[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.

The medical activity and satisfaction of geriatric care of Mongolia residents

Nowadays, process of aging of population covers all countries of the world. In current conditions, an important moment is increasing medical activity of elderly population and old persons. The purpose of the study is to investigate social hygienic characteristics of medical activity and satisfaction with geriatric care of the elderly residents of Mongolia. The sociological survey of 726 residents of Mongolia older than able-bodied age, 75 out of which were in nursing homes, was carried out using specially designed questionnaire that included questions on assessing medical activity and satisfaction with geriatric care. The negative correlation was established between good assessment of one's own health and age of respondents. The study revealed that 90.9% of respondents noted presence of chronic pathology, but only 21.1% of them were registered in dispensary. In age group under 65 years, 75.8% of persons capable to serving themselves made up 75.8% and in age group 75 years and older only 48.1%. The analysis established that 50.2% of elderly and senile persons consulted geriatrician, while 48.3% of those who did not consult this specialist were unaware of its existence. The number of cases of respondents visiting geriatric doctor in place of their residence was higher in cities. The respondents who received geriatric medical care were completely satisfied with it in 52.7%. The causes of dissatisfaction with geriatric medical care in aimags (regions) were inattentive attitude of medical staff, low effectiveness of treatment and insufficient availability of free provision of medications. The identified social hygienic characteristics of medical activity and satisfaction with geriatric care of the elderly and senile residents of Mongolia should be taken into account in developing measures to improve this type of care in Mongolia.

[Modern biomarkers of renal dysfunction in the elderly and senile age: clinical and prognostic significance.]

In the presented work, the role of modern biomarkers of kidney dysfunction in elderly (n=97) and senile (n=18) patients was investigated. A clinical and laboratory examination was performed with an assessment of the glomerular filtration rate (GFR) using the CKD-EPI formula. Serum levels of cystatin C and metabolism of beta-2-microglobulin (β2-MG) were assessed. In the presented sample, the prevalence of a decrease in GFR <60 ml/min was 30,4% of cases. The frequency of individuals with elevated serum cystatin C, depending on the GFR category (CKD-EPI), was as follows: C1 - in 79,9%; C2 - in 77,6%; C3A - in 74%; C3B - in 80,6%; C4 - in 100%; C5 - in 100%. An increase in the serum level of β2-MG was observed in 51,8 and 58,4% of patients, respectively, on C1 and C2 gradations of renal function. An increase in urinary β2-MG excretion was found in 40,7% of patients at C1 and 41,5% at C2 gradations of renal function. The number of patients who had elevated levels of β2-MG excretion in the urine at C3B and C4 gradations of GFR reduction was 75 and 88,6%, respectively. At the terminal stage of CKD, almost every patient showed an increase in β2-MG excretion in the urine. A statistically significant relationship between the metabolism of β2-MG and the nitrogen excretion function of the kidneys was established. In elderly and senile people, the determination of serum levels of cystatin C and β2-MG makes it possible to detect a decrease in the filtration function of the kidneys at an earlier stage compared with the assessment of GFR calculated from the level of blood creatinine. Elevated levels of cystatin C and β2-MG are additional risk factors for cardiovascular complications.

[Morphological differences of the fallopian tube ampoule in young and old age.]

The work is based on a morphological study of ampoules of the fallopian tubes of 130 young and senile women who gave birth. Macrometric, histological, immunohistochemical and micrometric methods of investigation were applied. The regularities of age-related morphological variability of the fallopian tube ampoule are revealed, which are manifested in a decrease in the parameters of their length, as well as external diameters in the middle of the ampoule and at the places of transition of the isthmus into the ampoule and ampoule into the funnel from young age to old age. Histoarchitectonics of ampoules of the fallopian tubes in women in old age is characterized by flattening of the epithelium of the mucous membrane, which forms an abundance of nearby thickened folds that form an uneven narrowing of the lumen of the ampoule. The thinning of the muscle membrane is determined with the growth of connective tissue instead of it and the accumulation of adipocytes in the subserose base. In old age, there is a more pronounced expression of vimentin, which can be traced not only in the endothelium and subendothelial layer of blood vessels, including capillaries, but also in individual fibroblasts. It was found that the features of the micrometric characteristics of the fallopian tube ampoules consist in a decrease in the inner perimeter of the epithelial lining and the lumen area, along with an increase in the area of their wall at the median cross-section in old age compared with young age.

Chronic hyponatremia in the elderly: association with geriatric syndromes (review of literature)

Hyponatremia is more common in the elderly. A number of studies suggest that even mild chronic hyponatremia is a serious danger, increasing the risks of developing geriatric syndromes, falls, low bone density, fractures, cognitive impairment, and death of all causes. Although the mechanism for the development of such complications is currently not completely clear. Questions remain about the need and methods for correcting this condition, although there is some evidence that the correction of hyponatremia improves cognitive functions, postural balance, minimizing the risk of falls and fractures. These issues are addressed in this review of the literature.

[Peculiarities of the treatment of venous thromboembolism with direct oral anticoagulants in challenging patients: senile age, renal failure, fragility]

The paper is a narrative review of the literature on the use of direct oral anticoagulants (DOACs) for the VTE treatment in challenging patients: senile age (≥75 years), impaired renal function (estimated glomerular filtration rate ≤50 ml/min), fragility (one of the previous characteristics and/or bodyweight ≤50 kg). The paper discusses the studies of EINSTEIN DVT and PE (rivaroxaban), AMPLIFY (apixaban), HOKUSAI-VTE (edoxaban), RE-COVER I and II (dabigatran) in the focus of the secondary analysis in the pre-specified patient's subgroups, as well as their pooled analyzes and meta-analyzes. Based on the results of this review, it was concluded that in a subgroup of senile age patients, dabigatran increases the risk of major bleeding by 4.8 times and has no advantages over vitamin K antagonists (VKA); rivaroxaban and apixaban retain superiority over VKA on the safety outcomes and reduce the risk of major bleeding by 73% and 77%. In the subgroup of patients with impaired renal function, the use of apixaban and dabigatran is associated with an increase in the risk of major bleeding by 6.5 and 7.3 times, and these DOACs do not have advantages over VKA; rivaroxaban retains its superiority over VKA and reduces the risk of major bleeding by 78%. For fragile patients, a secondary analysis is available only for rivaroxaban, which remains superior to VKA on safety endpoints and reduces the risk of major bleeding by 73%. In the absence of direct comparisons between the available DOACs, the presented data can be used as a rational approach for the choice of appropriate treatment for VTE in challenging patients.

[The problematic issues of personnel to ensure the delivery of geriatric care.]

The article reflects the problems of personnel provision of geriatric care. this reflects a serious concern about the staffing of the geriatric service. The need to improve the system of training geriatric doctors, including the need to popularize this specialty among medical personnel and the population, is pointed out.

[Clinical effectiveness of combination treatment with α1-adrenoblokator and type 5 phosphodiesterase inhibitor for patients of advanced and senile age suffering from lower urinary tract symptoms.]

The results of the pilot study are presented, the main purpose of which was to assess the effectiveness and safety of the combined application of α-adrenoblocator and type 5 phosphodiesterase inhibitor for the treatment of patients with symptoms of the lower urinary tract of old and old age. The study involved 60 patients over 50 years of age having middle-severe lower urinary tract symptoms, erectile dysfunction, moderately pronounced infravesical obstruction, prostate volume greater than 30 cc and prostate-specific antigen levels less than 4 ng/ml. The duration of treatment in all groups was 6 months. The study participants were divided into three groups, comparable in age, clinical manifestations and laboratory-instrumental indicators: Group 1 patients received type 5 phosphodiesterase inhibitor daily, group 2 patients - α1-adrenoblocator, group 3 - α1-adrenoblocator and type 5 phosphodiesterase inhibitor. A clinical study showed that long-term combination treatment of lower urinary tract symptoms α1-adrenoblocator and type 5 phosphodiesterase inhibitor in elderly and senile patients proved to be effective, well tolerated and hardly caused side reactions, significantly improving quality of life.

[The dynamics of the structural organization of the corpus callosum from young to old age.]

The work is based on the results of histological and immunohistochemical studies performed on the sectional material of 104 human corpses (59 men and 45 women) of young and old age. A comparative analysis of the morphological characteristics of the corpus callosum tissues using hematoxylin and eosin staining, the Nissl method (by Snesarev), by Van Gieson, by Spielmeyer, by Foot. An immunohistochemical study of the samples used a panel of antibodies to glial fibrillar acid protein (GFAP), the S-100 protein. It was found that by senile age, the tissue of the corpus callosum is characterized by the accumulation of glial macrophages. With age, there is a proliferation of GFAP-immunopositive astroglia. There is no dynamics of S-100 protein expression with age. Thus, the revealed regularity of age-related variability of the cytoarchitectonics of the corpus callosum is of interest in diagnostic and therapeutic work, and its morphological picture in old age can serve as an equivalent of the anatomical norm.

[Some problems of creating a geriatric service in the regions.]

The article reflects the current state of geriatric care in the Russian Federation at the stage of formation of a three-level model of geriatric service. The problems in the organization of geriatric services at the regional level, including the problem of training the appropriate profile, the negative attitude of the elderly to geriatric departments and geriatrics in General. Measures to improve the work in this direction are proposed.

[Prevalence and intensity of smoking among the patients with ischemic heart disease of older age living in the Far North.]

The article presents an analysis of the prevalence, intensity and correlation of smoking with other risk factors of ischemic heart disease among patients with chronic ischemic heart disease aged 60 years and older living in the Far North on the basis of ethnicity, age and sex. Smoking dependence on age was traced in patients of non-indigenous ethnicity. There was a lower prevalence of smoking among women, as opposed to men and among long-livers in comparison with the elderly and senile age. High intensity and length of smoking were revealed in both ethnic groups of men patients. The average smoking experience of smokers at the time of the survey was more than 50 years, and of former smokers - more than 30 years. The quantity of more than 25 packs per year was established as a high smoking index for both ethnic groups. The high smoking index is 1,5 times more common in patients of non-indigenous ethnicity compared to Yakut group. The highest smoking index was recorded in the group of patients under 75 years. The higher the smoking index is in smoking non-indigenous group, the lower is the cholesterol level of HDL regardless of the place of birth and the length of residence in the Far North. The analysis has revealed the correlation of smoking with other risk factors: blood lipids, arterial pressure (BP), body mass index (BMI), abdominal obesity (AO) and the dependence of the suffered myocardial infarction from the smoking experience and the value of smoking index. Smoking cessation leads to a decrease in blood pressure, BMI, and promotes HDL cholesterol.

[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.

Management of acute coronary syndrome in older adults (data from russian federal acute coronary syndrome registry)

AIM

In the present study was to investigate the quality of medical care for patients with acute coronary syndrome (ACS) old age and compliance of the treatment current guidelines. The data is exported from the system of the Federal register OKS.

MATERIALS AND METHODS

Analyzed medical history 33 893 patients with ACS entered in the system registry of ACS for the period from 01.01.2016 to 31.12.2016. a comparison was made of the quality of care in patients with ACS elderly (75 years and older, n=8773) and in younger patients.

RESULTS

The results of the study showed that in patients of senile age, when compared with younger patients, comorbid conditions are significantly more often observed, as well as a significantly higher risk of hospital and 6-month death, calculated on the GRACE scale.

CONCLUSION

Patients of senile age with ACS are almost twice less likely to undergo percutaneous coronary interventions than younger ones, which worsens the prognosis in these patients and increases mortality.

[Morphology and cytoarchitectonics of the popliteal lymph node in people of senile age.]

Histological methods were used to study popliteal lymph nodes in 10 people in senile age (80-91 years). Deep destructive changes of the reticular stroma were noted. The content of cells in the node is sharply reduced. Zones without cells appear. The mantle disappears in all lymphoid nodules of lymph node. There are no dividing cells. Plasma cells in cords are found in rare cases. All structural elements of the node have a similar cellular composition. The sinus of the node is expanded. Collagen fibers grow in the parenchyma of the node, fat cells appear. Morphological data indicate the loss of node functions of lymphocytopoiesis, humoral and cellular immunity.

[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.

[Age-related changes Kernogan`s index of venous vessels hollow and parenchymatous organs at stages of a postnatal ontogenesis]

Kernogan`s index determination of hollow and parenchymatous organs' venous vessels was conducted on 80 men corpses of the three age groups. Average age of the investigated men corpses of the mature period is 27,8±4,2 years, elderly - 67,8±3,7 years, senile - 81,9±4,5 years. The age variability transformation of venous vessels bandwidth of lungs, kidneys, heart, stomach and ileum were obligate. It was revealed that the Kernogan`s index of venous vessels changes can be equally detected at different age periods. While, with the obsolence, there is a gradual indicator's decline, which is mostly discerned in parenchymatous organs, while for the hollow organs transformations are less essentic.

[Mental disorders in senile age patients with cerebrovascular disease and postural instability]

The features of psychiatric disorders in senile cerebrovascular patients and their relationships with postural disorders were investigated. The dizziness and imbalance lead to social exclusion of patients, which contributes to emotional disorders, a frequent variant of which is depression (71 % of cases). A close correlation of anxious and depressive symptoms was received (59 % of cases). It was showed by computerized stabilometry that emotional disorders exacerbate existing imbalance, reflected in increasing of speed of the center of pressure, length and area of statokineziogramm.