[Polypragmasia and interdrug interactions as risk factors of falling in elderly patients.]

This article presents the results of the analysis of data from patients over 75 years of age from a multidisciplinary hospital with cardiovascular disease and comorbid conditions. Pharmacotherapy of gerontological patients with multiple risk factors for falls was analysed in terms of the presence of polypragmasy and drug-drug interactions hazardous to the risk of falls. In the group of patients who experienced a fall in hospital compared to patients without a fall, the prescription lists audit showed a predominance of medicines (drugs) and drug combinations compromised by an increased risk of this serious adverse event. An audit of prescriptions of patients at increased risk of falls as a means of combating polypharmacy and identifying drugs that may cause falls can be conducted using the «Traffic light classification of FRIDs¼ and drug checkers to identify clinically relevant combinations. The use of these clinical and pharmacological tools can improve the quality and safety of medical care in a hospital setting.

[The application of the David back concept mechanotherapy in patients survived after myocardium infarction].

The medical rehabilitation in all areas of medicine is developing actively and rapidly. In cardiology, medical rehabilitation contributes to prevention of recurrent myocardial infarction and other complications in patients with myocardial infarction. The study evaluated impact of anaerobic exercise and strength rehabilitation program on hemodynamics in patients with myocardial infarction using the David back concept mechanotherapy method.

[The rehabilitation, health path, mechanotherapy in recuperation of functional reserves of organism].

The article presents historical essays concerning each method of rehabilitation, period of its revision depending on time and pathological etiology of each disease, application of rehabilitation (health path, mechanotherapy), different modes of choosing each method of rehabilitation. The term "rehabilitation" became widespread after adoption of the Federal Law No. 181 of November 24, 1995 "On social protection of disabled people in the Russian Federation". This is the set of measures targeted to recuperation of functional reserves of organism, improving quality of life, maintaining working capacity of patient, one's integration into society, reducing incapacitating states impact to support people with impaired functions to adapt to new conditions of life in society. The rehabilitation and habilitation are processes targeting to ensure that the disabled could be able to achieve and maintain optimal levels of physical, sensory, intellectual, psychological and/or social functioning. The rehabilitation covers wide range of activities, including rehabilitative medical care, physiotherapy, psychotherapy, logopedics and ergotherapy and supportive services too. The disabled are to have access to both general medical services and appropriate rehabilitation services.

[The characteristics of repeated medical social expertise of adult population of the Russian Federation in 2018-2020].

The medical social expertise is considered as recognition of a person as the disabled and specification, in accordance with established procedure, of needs of examined person in social protection measures, including rehabilitation, based on evaluation of disabilities caused by persistent dysfunction of organism. The main normative legal acts governing activities of institutions of medical social expertise are the Federal Law of November 24, 1995 "On social protection of disabled people in the Russian Federation", the Decree of the Government of the Russian Federation of February 20, 2006 № 95 "On the procedure and conditions for recognition disabled person". Because of COVID-19 pandemic conditions, the normative legal base has undergone a number of changes. In particular, on 09.04. 2020, the Resolution of the Government of the Russian Federation № 467 "On the temporary procedure for recognizing a person as disabled" came into force. The actual article considers the features of this temporarily order related to the repeated medical and social examination and its results as of 2020. The qualitative analysis of permitted to get patterns of increasing and decreasing (improvement or deterioration) of particular statistical indices.

[Effectiveness of medical rehabilitation of elderly patients who have suffered a myocardial infarction.]

At all stages of recovery after myocardial infarction (MI), the expansion of physical activity of elderly patients is one of the most important components. Of course, certain restrictions can reduce the load on the myocardium, reduce its oxygen needs and create conditions for early healing. Subsequently, depending on the dynamics and indicators of the cardiovascular system, the elderly patient is transferred from one stage of activity to another, the level of blood pressure, the number of heartbeats, the presence of arrhythmia, electrocardiogram data, EchoCG data, as well as individual load tolerance are evaluated. To date, there is a huge selection of optimal options for selecting methods of medical rehabilitation for elderly patients who have suffered a MI, and one of them is mechanotherapy. The mechanical therapy program of the David Back Concept complex - strength training is a set of simulators for working on the back muscles. The medical and diagnostic complex is designed for the diagnosis, treatment and prevention of pathologies of the musculoskeletal system, as well as for the rehabilitation of patients after surgical interventions and spinal injuries. Medical rehabilitation of elderly patients with coronary heart disease and after a MI through mechanotherapy, the program of the David Back Concept complex, provides for the restoration of their physical and social status to an optimally achievable level, determined by the capabilities of adaptive mechanisms.

[Drug therapy of atrial fibrillation in elderly patients.]

Currently, studies of the causes of atrial fibrillation are actively conducted. However, molecular and cellular mechanisms of atrial fibrillation have not been precisely established so far. Great success in the treatment of atrial fibrillation was achieved thanks to the development of surgical methods. However, these approaches, unfortunately, are not always applicable to elderly and senile patients. Antiarrhythmic drugs used in atrial fibrillation, exhibit a large number of side effects. Much attention of researchers is now attracted by fundamentally new directions in the drug treatment of atrial fibrillation. These include predserdno-selective antifibrillatory funds. Drugs, the action of which is aimed at at atrial remodeling, inflammation and fibrosis, so is of interest. Effective suppression of atrial remodeling, inflammation and fibrosis prevents the formation of a permanent form of atrial fibrillation. A new approach to the treatment of atrial fibrillation, taking into account the vegetative status of the patient, will undoubtedly increase its effectiveness.

[Features of the formation of disability due to coronary heart disease in people of retirement age in the Russian Federation in the period 2006-2017.]

The article analyzes the structure and dynamics of disability due to coronary heart disease of the Russian Federation at the retirement age in the period 2006-2017. Revealed the prevalence in the structure disabilities of retirement age in all years of the study. Their total number is large - 2,3 million and constantly decreases. The level of disability in this age group is high, in the first years of the study it is much less than the level of middle-aged disabilities, but in recent years they differ slightly. The structure of disability of retirement age since 2010 is formed by re-recognized disabled people.

[Initiation of pharmacotherapy as a risk factor for older patients.]

The article presents the literature and original data on the problems of falls in elderly patients. The connection of the fact of falling with initiation of therapy by a number of drugs known to have a negative impact on the risk of falling is considered. The article presents data on the frequency and structure of falls on the example of patients with cardiovascular diseases older than 75 years, treated in a multidisciplinary hospital. The analysis of the data showed a tendency of prevalence of the fact of falling in 1/3 patients (33,8%) in the first 5 days of hospital stay, which may be associated with high drug burden and the appointment of «new¼ drugs for the patient. The study noted that it was on the first day that the selection of therapy took place and additional drugs were often prescribed, leading to a state of polypragmasia. Analysis of individual groups of drugs was able to reliably confirm the relationship between the appointment of drugs that increase.

[Influence of amiodarone on the spectral analysis of heart rate variability in patients with atrial fibrillation elderly and senile age.]

Atrial fibrillation is more common among elderly patients. Number of comorbidities, such as heart failure, coronary heart disease, disorders of the conduction system of the heart increases with age. Atrial fibrillation is a health problem. In developed countries, there is a high prevalence of the disease. The disease affects more than 33 million people worldwide. Spectral analysis of heart rate variability can be successfully used to evaluate the effectiveness of therapy. The use of this method gives an idea of the role of the autonomic nervous system in the regulation of chronotropic function of the heart. These data help to define conditions of manifestation of efficiency of antiarrhythmic drugs. In this study, spectral analysis were studied in patients with different forms of atrial fibrillation. The effect of amiodarone class III antiarrhythmic drug were studied this study. It is shown that the structure of spectrum of heart rate variability in patients with newly diagnosed atrial fibrillation differs significantly from that in patients with disease duration from 6 months to several years on the background of amiodarone.

[Morphological and functional features of circulatory system in retired and active elite athletes].

Regular physical activity over a long period of time increases the output of the cardiovascular system. That leads to development of a normal (physiological) athlete's heart. Bradycardia, cardiac hypertrophy, and arterial hypotension are three major characteristics of a normal athlete's heart. Changes in parameters of cardiovascular system and features of heart remodeling are determined by type, frequency, and duration of a physical activity. Excessive levels of physical activity could result in development of a pathologic athlete's heart, negatively affect hearts metabolism, and increase the risk of both atherosclerosis and myocardial infarction. Autopsy studies have shown that atherosclerosis, which leads to development of an ischemic heart disease, is often found in both young and elderly athletes. 56% of sudden deaths in all athletes were due to cardiovascular problems. Reports of ischemic heart disease in athletes of all ages have increased over the past few years. Echocardiographic features and clinical outcomes of stable angina and myocardial infarction in retired professional athletes are not well studied. Further studies are needed to improve diagnosis, prevention, treatment, and rehabilitation in elite athletes with ischemic heart disease.