[Targeted use of comprehensive geriatric assessment tools in cardiology. Part I (literature review).]

The purpose of this review is to demonstrate the importance of using a comprehensive geriatric examination in cardiology, including geriatric aspects of the management of this patient population. Until now, the Russian Federation has completely lacked a geriatric approach to the management of cardiological patients, which provides for consideration of international experience in this survey. The curation of elderly and elderly patients is complicated by the presence of geriatric syndromes and age-associated diseases leading to deterioration of quality of life, repeated hospitalizations, disability and risk of death. The leading geriatric syndrome in geriatric practice is senile asthenia and multiple comorbid polymorbid pathologies of the geriatric patient. A patient admitted to an acute care hospital with a history of cardiovascular comorbid pathology is primarily viewed as a patient at high risk for cardiovascular complications, omitting the risk of adverse outcomes, including loss of independence and impaired functional status. The following literature review demonstrates the importance of defining senile asthenia outside of the geriatrician's office, justifying the need for advanced training for cardiologists in geriatrics.

[Frailty assessment in geriatric oncology.]

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.

[Chronic kidney disease and accelerated aging: the role of comprehensive geriatric assessment.]

This review presents data from the literature on the characteristics of the course of chronic kidney disease from the perspective of the geriatric patient. Chronic kidney disease and progression of renal failure is a prototype model of premature and accelerated aging. Many authors have stated that a better mechanistic understanding of the phenomenon of premature aging, early diagnosis of chronic kidney disease, and a geriatric approach to the patient can improve the effectiveness of management and prolongation of life in this category of patients. Comprehensive geriatric assessment is one of the most important tools used by geriatricians and their teams to globally assess elderly patients and plan effective interventions. It is concluded that the use of comprehensive geriatric assessment in patients with chronic kidney disease may improve the clinical status of patients and allow selection of patients who may benefit most from renal replacement therapy compared to a conservative approach. And even in the early stages of chronic kidney disease, a comprehensive geriatric assessment may be useful in formulating a complete intervention plan and optimizing quality of life, autonomy, and prognosis. However, despite recognition of the importance of comprehensive geriatric assessment, the means to implement this tool in nephrology departments have not been developed and require special training programs and appropriate skills. It is concluded that much more needs to be done to realize the continuity of nephrologists and geriatricians in the provision of meaningful skilled care to older patients with chronic kidney disease.

[Targeted use of comprehensive geriatric assessment tools in cardiology. Part II (literature review).]

This review presents a targeted examination of the application of comprehensive geriatric assessment tools across various cardiovascular pathologies, including acute coronary syndrome, myocardial infarction, acute and chronic heart failure, and aortic stenosis. It has been demonstrated that assessing patient frailty in cardiovascular pathology is crucial for determining both short-term and long-term prognosis, as well as for evaluating the risk of various complications during cardiac surgical interventions. Currently, there is active research into necessary measures aimed at improving outcomes in frail elderly patients with cardiovascular diseases, such as interdisciplinary rehabilitation and geriatric approaches. Frail patients with cardiovascular diseases should be considered as requiring a personalized approach in the provision of cardiological care, with a deep understanding of geriatric issues in the elderly, to reduce complications and improve prognosis.

[Geriatric syndromes: the importance of the problem, controversial issues of terminology.]

The foundation of healthy aging is the prevention of disability. In modern medical usage, a syndrome refers to a collection of symptoms and signs with a single underlying cause that may not yet be known. Geriatric syndromes, on the other hand, refer to multifactorial health conditions and occur when the accumulated effects of impairments in multiple systems make an older person vulnerable to situational changes. The use of the term "syndrome" in geriatrics emphasizes the multiple causes of a single manifestation involving an abundance of factors involving multiple organs and systems and is characterized by unique features of common health problems in older adults. It is the geriatric syndromes that can have a significant impact on quality of life and disability. Therefore, early detection of these medical conditions using targeted geriatric assessment is essential in geriatrics. Understanding the essence and feminology of geriatric syndromes, their correct positioning and interpretation is an extremely urgent problem. The main purpose of the presented review is precisely to try to answer these questions. In addition, it has not yet been determined whether geriatric syndromes should be included in the diagnosis (the only exception is sarcopenia syndrome, which was officially included in the 10th International Classification of Diseases in 2016).

[COVID-19 as a trigger for the onset and progression of neurodegenerative pathology predominantly in elderly and senile population.]

A brief literature review on the association of COVID-19 and the manifestation or progression of neurodegenerative pathology is presented. The etiopathogenetic mechanisms of central nervous system damage are shown. The evidence base of the effect of SARS-CoV-2 on the central nervous system, which leads to the development of long-term neurological diseases, including neurodegeneration, is analyzed. It is concluded that it is necessary to develop official criteria and methodological recommendations for monitoring especially elderly and senile patients for possible onset or progression of neurodegenerative pathology.

[The role of hyperuricemia in the development of cognitive changes in the elderly.]

It is known that hyperuricemia is recognized as an independent cardiovascular risk factor. However, uric acid can also perform useful functions due to its antioxidant properties, which may be especially relevant in the context of neurodegenerative diseases. This review examines the currently available data on the relationship between serum uric acid levels and cognitive functions in the elderly, paying special attention to the etiology of cognitive disorders (Alzheimer's disease, Parkinson's dementia and vascular dementia). Despite the high heterogeneity of existing studies due to the different characteristics of the studied populations and methods of assessing cognitive impairment, it was concluded that uric acid can modulate cognitive function in different ways depending on the etiology of dementia. Modern studies demonstrate that uric acid can have a neuroprotective effect in Alzheimer's disease and Parkinson's dementia, while hypouricemia is a risk factor for faster disease progression and is a possible marker of malnutrition. Conversely, a high level of uric acid in the blood serum can negatively affect the course of the disease in vascular dementia. Further studies are needed to clarify the physiopathological role of uric acid in various types of dementia and its clinical and prognostic significance.

[The role of geriatric services in the diagnosis and monitoring of outcomes of postcoital syndrome (review).]

In addition to the rapid and rippling spread of the pandemic across the globe today, there is a growing problem called «long-COVID-19¼, a term that describes the long-term effects of a new coronavirus infection COVID-19. How the disease proceeds after «recovery¼, including the long-term physical and psychological health consequences, the future of COVID-19 survivors remains largely unclear. This is especially true for the contingent older age groups. This article summarizes the experience of foreign studies aimed at determining the duration and clarifying the nature of multi-organ complications after undergoing COVID-19, as well as ways of long-term rehabilitation of patients in older age groups with post-COVID syndrome.

[Integrated geriatric assessment - resolved and unresolved issues (review).]

The review presents an analysis of the literature on the controversial issues of the use of Comprehensive Geriatric Assessment. For all its obvious significance and expediency, the questions remain WHO, WHERE and WHEN conducts it? Should it initially be one-step or step-by-step? What are the intermediate and end points of the study? Which tool for its screening is the least time-consuming and long-lasting? It is concluded that many issues have not yet been resolved and further research is needed on this issue.

[Comorbidity/polymorbidity - problems of terminology and application of index indicators (review).]

The review presents a literature analysis on controversial issues of the use of the terms polymorbidity, multimorbidity, comorbidity. Increasing publication activity on the topic of comorbidity/multimorbidity is noted. The main discussion is conducted in several areas: what term should be used - comorbidity, multimorbidity or polymorbidity; use or not use index indicators of comorbidity; if used, specifically for what purpose; what is the effectiveness of these indicators. It is concluded, that many issues have not yet been resolved and further research is needed on this issue. It is time to define terminology and specify WHERE and WHEN comorbidity/polymorbidity indexes are needed.

[Timing and methodology for the integrated geriatric assessment of the city geriatric center.]

A study was carried out on the timing of the complex geriatric assessment by nursing staff in the geriatric center of Saint Petersburg. 65 patients (women) were examined. It is concluded that the complex geriatric assessment can and should be carried out by the nursing staff, the duration of the complex geriatric assessment depends on the actual age, and the expression of frailty, the average time spent on it varies from 1 to 2 hours, the complex geriatric assessment should be carried out within 1 to 3 days.

[Aging and kidneys: problems in evaluating of the glomerular filtration rate in elderly.]

Aging causes significant changes in the kidneys. One of the most important manifestations of an aging kidney is a reduction in glomerular filtration rate (GFR). Unfortunately, there is no generally accepted, adequate method for evaluating GFR in the elderly. The perspectivies of the relatively new approaches (BIS1, BIS2, FAS) are not clear and doubtful. The feasibility of standardization of GFR values by body surface area among of the older persons has not been determined. Possible that the diagnosis setting «chronic kidney disease¼ in elderly solely on the base of GFR decline may be an inadequate approach and promote a kind of «nephrological ageism¼.

[Kidney function at patients of advanced and senile age before and in 24, 48, 120 hours after carrying out X-ray endovascular intervention].

Research of a functional condition of kidneys at patients of advanced and senile age before and in 24, 48, 120 hours after carrying out X-ray endovascular intervention. Patients of age groups are examined: 34-59 years (49,7±7,8) - 35 people (group of control), 60-74 years (66,1±4,1) - 48 people and 75-82 years (78,8±4,2) - 22 people. Сonclusion: it is confirmed the fact that at patients of advanced and senile age dynamic control of a functional condition of kidneys after 1st, 3rd and 5th days and till 3 weeks after carrying out X-ray endovascular interventions is necessary.

[ADVANCED AND SENILE AGE FOR THE FIRST DAYS AFTER X-RAY ENDOVASCULAR INTERVENTIONS].

Research of the glomerular filtration rate at the patients of advanced and senile age who underwent X ray endovascular intervention is conducted. Patients of age groups are examined: 34-59 years (49,7±7,8 years) - 35 people (group of control), 60-74 years (65,5±4,1) - 38 people and 75-82 years (77,5±2,5) - 12 people. Methods of screening calculation of the glomerular filtration rate are compared. The conclusion that regardless of techniques of definition of GFR and its initial level, the orientation of change of this parameter is characterized by its decrease at all patients after performance of coronary angiography, but more at patients of senile age group is drawn. It is expedient to use Cockcroft-Gault's formula for screening determination of speed of the glomerular filtration rate at people of advanced and senile age, in particular in patients with ischemic heart disease when carrying out X-ray endovascular interventions.

[Percutaneous transluminal coronary angioplasty, X-ray contrast researches and contrast-induced nephropathy in geriatrics. Part I. Percutaneous transluminal coronary angioplasty in patients of advanced and senile age with acute cardiovascular pathology].

The state-of-the-art review of literature on the problem of percutaneous transluminal coronary angioplasty in patients of the senior age groups with sharp cardiovascular pathology is submitted in tree parts. Angiographic and clinical criteria which identify indications and contraindications to perform percutaneous transluminal coronary angioplasty are defined and analysed.

[Ethnic features of multipathology in elderly and senile patients of the Republic of Sakha suffering from chronic brain ischemia]. / Etnicheskie osobennosti mul'tipatologii u patsientov pozhilogo i starcheskogo vozrasta Respubliki Sakha (Yakutiya), stradayushchikh khronicheskoi ishemiei mozga.

OBJECTIVE: To study ethnic characteristics of multipathology in elderly and senile patients with chronic cerebral ischemia living in the Republic of Sakha (Yakutia). MATERIAL AND METHODS: The study included 522 inpatients, aged 60 to 89 years, who were divided into subgroups depending on the stage of chronic cerebral ischemia, ethnicity (Evens, Yakuts and Russians) and age (elderly and senile). RESULTS: In addition to vascular cerebral pathology, comorbidities were identified in patients of older age groups. At the same time, polymorbidity was less pronounced in the Evens, the indigenous inhabitants of the northern regions of Yakutia, than in the Yakuts and representatives of the non-indigenous population - Russians. CONCLUSION: The relatively rare occurrence of comorbid pathologies in Evens is presumably associated with greater adaptation to the extreme climatic conditions of the North.