[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.

[Modern approach to the prevention of type 2 diabetes in the elderly.]

Type 2 diabetes mellitus is a common chronic metabolic age-associated disease. Elderly patients over 65 years of age predominate among those with type 2 diabetes. 70% of patients with prediabetes develop type 2 diabetes during their lifetime. The article presents data on the prevalence of type 2 diabetes mellitus and prediabetes in the Russian Federation. It also reflects information about the impact of lifestyle and aging on the progression of carbohydrate metabolism disorders. The paper presents studies that prove the possibility of preventing the transition of prediabetes to diabetes. Various methods of preventing type 2 diabetes mellitus, including lifestyle changes, medications, and metabolic surgery in patients with prediabetes, are being considered. Particular attention is paid to the effectiveness and possibility of using these methods of prevention in the elderly in general.

[Assessment of the progression dynamics of chronic kidney disease in elderly patients with type 2 diabetes mellitus.]

The aim of work is identification and evaluation of clinical factors influencing the dynamics of progression of chronic kidney disease in elderly patients with type 2 diabetes. In a population sample of elderly patients with type 2 diabetes, a cross-sectional observational study of clinical indicators of the standard program of dispensary observation was performed. Primary medical data were collected using the AWPE 2.0 program. 118 protocols of outpatient consultations, including 69 clinical indicators, were selected according to the compliance criteria. To assess the dynamics of the progression of chronic kidney disease, the original calculated diagnostic parameter «Glomerular filtration rate reduction index¼ (GFR RI) was used. A detailed clinical justification of the calculated diagnostic parameter GFR RI is given; correlations between quantitative and qualitative clinical indicators and GFR RI in a sample of elderly patients with type 2 diabetes are determined; statistically significant differences in clinical factors were revealed in groups identified by the rate of progression of CKD with a threshold value of 3,83 ml/min on 1,73 m2 per year, including medicamental. The proposed diagnostic parameter GFR RI allows us to give an objective assessment of the dynamics of the progression of CKD in elderly patients with type 2 diabetes; when identifying the groups of «slow¼ and «fast¼ progression of CKD, significant differences in the following clinical factors were revealed: the level of glycemia, BMI, the experience of diabetes and insulin therapy, the total dose of insulin and sulfonylureas, the presence of concomitant hypertension.

[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.

[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.

[Bioimpedance analysis of body composition and phase angle for the diagnosis of sarcopenia and frailty (literature review).]

Sarcopenia and frailty are accompanied by changes in body composition. Bioimpedance phase angle (phase angle, PhA) is one of the parameters that can be measured using Bioimpedance body composition analysis (BIA). BIA, along with Dual-Energy X-ray Absorptiometry (DEXA), is used to determine lean body mass according to the EWGSOP2 sarcopenia diagnostic protocol. Modern studies note such positive aspects of BIA, as compared to DEXA, as the speed of diagnosis, no ionizing radiation exposure on the patient's body, the lower cost of the study with high information content. The phase angle shows the quality of cell membranes and metabolic activity. Low PhA is associated with the progression of frailty and sarcopenia, disability and poor outcomes for geriatric patients. This review of the literature is devoted to the consideration of modern aspects of the use of BIA with PhA measurement in geriatric practice.

[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.

Beta coronaviruses and human endocrine system: new data (review of literature).

A new dangerous respiratory disease COVID-19 was first reported in China in December 2019, the pathogen SARS-Coronavirus 2 (SARS-CoV-2), belonging to the beta coronavirus genus, which, in addition to SARS-CoV-2, includes SARS-CoV-1 and MERS-CoV. The genome of SARS-CoV-2 is almost 80% similar to SARS-CoV-1 and 50% to MERS-CoV. The mechanisms of infection of SARS-CoV-1 and SARS-CoV-2 are also similar and occur through the binding of the virus to the type 2 angiotensin-converting enzyme protein (ACE2), which is widely represented in the human body with predominant expression in endocrine tissues. In this connection, SARS-CoV-1 and SARS-CoV-2 affect the organs of the endocrine system, causing damage and hormonal changes that affect the prognosis of the course of COVID-19. This literature review is devoted to the analysis of changes in the organs of the endocrine system that occur during infection with SARS-CoV-1 and SARS-CoV-2, as well as the potential effect of hormones on susceptibility to SARS-CoV-2.

[Frailty, sarcopenia and COVID-19 in geriatric patients (literature review).]

The global aging of the population in the modern world leads to an increase in the number of people of older age groups. Polymorbid pathology and geriatric syndromes, which include frailty and sarcopenia, can cause organism instability to various factors of the external and internal environment. The current COVID-19 pandemic, accompanied by a significant increase in mortality among the elderly and senile, makes it necessary to investigate the reasons underlying the increased vulnerability of geriatric patients to this disease. This review of the literature is devoted to this problem.

Effect of Daily Rhythms of Cortisol Secretion on the Rate of Aging in Men.

The phenomenon of human aging is the result of a complex interaction among several factors in which the immune system plays a key role. Cortisol is a glucocorticoid secreted by the adrenal gland and has a specific secretion pattern. The current study aimed at identifying the cause and pathogenesis of premature aging using biological markers. This study was performed based on the results of clinical and instrumental examinations on 91 middle-aged men aged 45-59 years. VaseraVS-1500 sphygmomanometer based on standard methods was used to measure biological age. The relationship between biological age and circadian rhythms of cortisol secretion was calculated to elucidate the pathophysiological mechanisms of aging development. The recorded data showed that the violation of the circadian rhythms of cortisol secretion characterized by a consistently high level of the hormone throughout the day was typical among individuals with accelerated types of aging. Based on the obtained data, a formula for determining the biological age of the studied groups of patients was prepared by considering the circadian rhythm of cortisol secretion, which can be an additional tool for early detection of aging in men.

[Sarcopenia and type 2 diabetes mellitus in geriatric patients (literature review).]

One of the leading geriatric syndromes, which has been included in the International Classification of Diseases ICD-10 since 2016, is sarcopenia. Sarcopenia is a progressive gener-alized disease accompanied by a loss of strength, mass, and skeletal muscle function. This dis-ease can lead to a decrease in working capacity, impaired ability to self-service, disability, and an increased risk of premature death. Type 2 diabetes mellitus (T2DM) plays an important role among the chronic non-infectious pathology of elderly and senile patients. T2DM is a serious health burden for older people, affecting approximately 25% of people over 65 years of age. This percentage is expected to rise sharply in the coming decades due to the increase in the life expectancy of the population observed in recent years. In addition to microvascular and macro-vascular complications, sarcopenia has been described as a new complication of diabetes melli-tus in the elderly. T2DM increases the risk of developing sarcopenia threefold. It is of interest to consider the mechanisms of the relationship between sarcopenia and type 2 diabetes mellitus in geriatric patients.

[Relationship of kidney functions with geriatric syndromes in elderly and old women.]

Against the background of aging, there is an increase in the number of diseases associated with age, geriatric syndromes that contribute to the development of disorders of physical and functional activity, the risk of disability and mortality increases. One of the widespread diseases is chronic kidney disease (CKD), which is dangerous not only in itself, but also as a factor in the progression of other age-associated diseases and geriatric syndromes, including frailty and sarcopenia. Among patients of older age groups, CKD is more common in women than in men. A number of researchers are studying the problems of polymorbidity, the development and progression of geriatric syndromes in patients with CKD in the pre-dialysis and dialysis stages. Undoubtedly, the negative role of severe late stages of CKD in the development of senile asthenia and sarcopenia, at the same time, the relationship of these geriatric syndromes with early pre-dialysis stages of CKD has been insufficiently studied. Therefore, it is of undoubted scientific interest to identify correlations between signs of sarcopenia and frailty in elderly and senile women, depending on renal function, stage of CKD.

Hypothyrosis syndrome: role of triodthyronine in diagnostics and combination therapy (review of literature).

Hypothyroidism syndrome is one of the most common pathologies of the endocrine system. Assessment of euthyroid status can not always be carried out according to the TSH indicator. In a number of patients with normal TSH levels and a clinical picture of hypothyroidism, the serum T3 concentration is determined at the lower limit of the norm or below it with a high content of free T4 in the blood. In world practice, positive experience has been accumulated in the combined use of preparations of sodium levothyroxine and liothyronine, a synthetic form of exogenous triiodothyronine. A number of studies have noted the advantages of using combination therapy for hypothyroidism over levothyroxine monotherapy in certain groups of patients. Possible reasons for the ineffectiveness of standard treatment for hypothyroidism are described.

[Risk factors of frailty in elderly women with the chronic non-infectious diseases.]

Against the background of an aging population, there is an increase in the frequency and prevalence of chronic non-infectious diseases with age. The syndrome of frailty, the frequency of which also increases with aging, is considered as a prognostic factor for the adverse outcomes of chronic diseases and mortality among geriatric patients. Moreover, in women, frailty is more common than in men. An earlier diagnosis and identification of signs of frailty is necessary to prevent the progression of both the syndrome itself and multiple age-associated chronic diseases.

Hypovitaminosis D in the elderly: relationship with sarcopenia and dementia (review of literature).

The growth in the world population of elderly and senile people provokes interest in the processes and mechanisms leading to aging and age-associated diseases. Hypovitaminosis D is common in geriatric patients and has been suggested by a number of authors as a cause of diseases such as dementia and sarcopenia. This literature review is devoted to the analysis of the role of vitamin D in the development of the above diseases, their prevention and treatment.

[What is primary: frailty or sarcopenia? (literature review).]

Among the many geriatric syndromes, undoubtedly, one of the first places is, in other words, the leading positions are occupied by frailty and sarcopenia. Despite their wide coverage in the modern scientific medical literature, the question of the relationship of these geriatric syndromes with each other is still relevant. Which of the above syndromes is primary and which is secondary? Do they compete with each other, mutually burden each other, do not depend on each other, or are they united by common pathological mechanisms? This literature review is devoted to these issues.

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.

[Specificity of anemic syndrome in geriatric patients with chronic kidney disease.]

Anemic syndrome is detected in 10-25% of geriatric patients, and with increasing age, there is a tendency to increase the incidence of the disease. Among the diseases that lead to the development of anemia, kidney pathology plays an important role. Progressive deterioration of kidney function in old age is associated with an increased risk of fractures, sarcopenia, and the development of cognitive impairment. Also, nephrogenic anemia aggravates the prognosis in patients with cardiovascular diseases, which is associated with an increase in myocardial ischemia, an increase in tissue hypoxia, a progression of left ventricular hypertrophy, and a decrease in left ventricular systolic function.

[Specificity of estimation and prognostic value of glomerular filtration rate in older age groups with cardiovascular pathology.]

The demographic situation in recent decades has been characterized by a progressive increase in the proportion of older age groups in both developed countries and the Russian Federation. The main contribution to morbidity and mortality of people over 60 years of age is made by diseases of the circulatory system. Early development and progression of cardiovascular diseases contributes to kidney dysfunction, often developing against the background of morphological changes occurring with age in the kidneys, called "senile kidney". Reduction of glomerular filtration rate in elderly patients is not mandatory and in most cases occurs as a result of an existing pathological process. The combined effect of changes in GFR and cardiovascular disease on the prognosis of older patients remains poorly understood, which determines the relevance of the study of chronic kidney disease in geriatric patients.

[Calcium and vitamin K: effects on bone tissue and vascular remodeling (literature review).]

Calcium preparations are included in the treatment and prevention regimens for low bone mineral density. However, recent scientific studies have shown that additional calcium intake can increase the risk of heart disease, which is associated with the deposition of calcium in the endothelium of blood vessels. The significance of vascular wall mineralization is not limited to local accumulation of calcium deposits, but is largely determined by their activating effect on the progression of atherosclerosis. Vitamin K plays an important role in calcium homeostasis, reduces arterial calcification and arterial stiffness and, as a result, has a protective effect when taking calcium. This literature review provides current information about the calcium paradox, discusses the main molecular mechanisms of vascular calcification, and considers therapeutic strategies for vitamin К2 treatment.