[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 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.

[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).

[Audiological testing in complex geriatric assessment of patients.]

The aim of the study is to evaluate the advantage of including audiological testing in the system of comprehensive geriatric assessment (CGA) of patients. The results of a survey of 988 elderly and senile people (average age 77±7,4 years) are presented, each of whom underwent a CGA and hearing assessment by filling out a questionnaire Hearing Handicap Inventory for the Elderly, Screening version (HHIE-S). All patients were divided into two groups: the first group included 780 inpatient patients undergoing medical and social rehabilitation in different departments of the Saint-Petersburg City Geriatric Center. The second group included 208 outpatient patients, of whom 81 additionally underwent an audiological examination, which included ENT examination and pure tone audiometry to determine the degree of hearing loss. A correlation was revealed between the hearing state and the cognitive status of patients according to the results of the Mini-Mental State Examination (MMSE) questionnaire, as well as the senile asthenia index. The results of the work indicate the need to include the HHIE-S questionnaire in the system of comprehensive geriatric assessment for early detection and correction of hearing loss, and prevention of cognitive disorders.

[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 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.

[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.

[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.

[The problems of older people and directions of medical, social and psychological support during the COVID-19 pandemic.]

The review article examines the medical, psychological and social problems that older people face due to the pandemic. The article contains the analysis of the mortality rate in the older age group in different countries. It also demonstrates the negative impact of the pandemic stress on the formation of psychopathological disorders (anxiety, asthenia, panic, cognitive dysfunction). The authors carried out an analysis of psychological support methods for various psychopathological disorders among the elderly, based on both the results of their own clinical experience in the treatment and psychological correction of the disorders of older people experiencing the pandemic, and similar results of other researches in other countries. The results of the presented research during the pandemic suggest that the frequency of asthenia and psychosomatic disorders in patients was increased. The paper presents algorithms for the differential diagnosis and treatment of asthenia as part of the post-covid syndrome. The article contains an objective scientific and practical assessment of the experience of self-isolation for the elderly, as well as the analysis of the reasons for mental maladjustment and the formation of addictions. The algorithm and the results of psychological support, provided to older people by a psychosocial support organization, are demonstrated.

[Audiological correlates of age-related manifestations of auditory disorders.]

The aim of the study was a comparative analysis of complaints and audiological findings in patients of the audiological center depending on their age. The results of the examination of 300 firstly consulted patients (random sample) are presented. The group of young patients (19-44 years) included 40 people; middle age (45-59 years) - 62 people; elderly (60-74 years) - 100 people; senile age (75-90 years) - 98 people. The survey included the collection of complaints and anamnesis, ENT checkup, pure tone audiometry, impedancemetry, speech audiometry in headphones to detect the signs of Central Auditory Processing Disorder or in the free sound field to assess the effectiveness of hearing aids. It was found that for early diagnosis of hearing loss and prevention of age-related sensory-cognitive dysfunction, it is advisable to use not only the results of pure tone audiometry, but also the data of speech audiometry, as well as the analysis of subjective complaints. The results of the work indicate the need for hearing screening in the population over 60 years old.

[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.

[Age-related issues of the quality of life in hearing impaired patients.]

The aim of the research was to study the quality of life in hearing impaired patients of different age. 100 patients referred to the city audiology centre because of their hearing disorders were examined: 50 patients from 34 to 59 years old and 50 patients from 60 years and older, from which 32 patients were of older age (60 to 74 years old) and 18 of oldest age (75 to 86 years old). A degree of hearing loss was assessed according to results of pure tone audiometry. To study the quality of life all patients filled in the questionnaire MOS SF-36, which evaluates physical and psychological components of health, and the questionnaire HHIA(E)-S, designed specifically for patients with hearing disorders. The HHIA(E)-S scale was found to show high correlation with hearing loss degree in patients younger than 60 years old (R2=0,98 with statistically significant difference, p<0,05), with decreasing correlation in patients from 60 years and older (R2=0,98; no significant difference while assessing various hearing loss degrees). Considerable difficulties in this age group may be explained by the fact, that older and especially oldest patients have a challenge with hearing aids usage (or they are of low efficiency for them) and with assessing theirs difficulties on the questionnaire scales. The HHIA(E)-S scale is useful as a screening tool for early detection of hearing loss, referral of patients to an audiologist and prompt hearing aid fitting.

[Falls in the elderly and senior age prevention perspectives.]

The high prevalence of reported falls among elderly people whom medical care was required indicates ineffective work provided to prevent them. The purpose of this systematic review was to describe the status of the postural balance in an elderly person issue and to identify preventive interventions aimed at reducing the number of the falls in the elderly, whose effectiveness has been proven empirically. The sample included 32 studies conducted over the period from 2012 to 2018 with the participation of persons aged 55 years and older, apart from the studies involving persons with diabetes mellitus or other chronic diseases. The main areas of the study for the prevention of the falls in the elderly are the assessment of the regular physical activity role (FA), common exercises and their impact on the biological age and age-related involution of human functionality, factors that prevent FA, and motivation for FA. The studies being conducted do not take into account conditionally established groups of patients: patients with the chronic diseases, patients relatively healthy and patients with personal anxiety. The most promising studies in terms of the falls prevention in the elderly people today are the walking parameters in elderly people study, which makes it possible to predict the degree of deterioration of their mobility and the falls risk, as well as setting up the schools of psychological support in terms of social services.

[Hearing loss in adults in older age groups.]

There has been a steady increase in the prevalence of hearing loss among people in many countries around the world. One of the main reasons for this negative trend is an increase in life expectancy and an increase in the proportion of the elderly people, which means an increase in the number of people with age-related changes in the auditory system (presbycusis). Aging is accompanied primarily by damage to the structures of the inner ear, but it can also affect the central parts of the auditory analyzer, causing frustration at all levels of the auditory neural pathway. Presbycusis is accompanied by impaired hearing and speech intelligibility. Along with speech hearing, spatial hearing suffers. Just as in other countries of the world, in Russia the prevalence of age-related hearing loss is increasing year by year. The data on the prevalence of hearing impairment in the Russian Federation vary, due to the lack of uniform approaches to the registration of persons with hearing impairment. Creation of a surdologic register is necessary for information support of complex medical and social rehabilitation of surdological patients. Since hearing loss has a significant negative impact on the quality of life of patients, knowledge of the prevalence of hearing disorders among the population will allow to plan properly the need for technical means of hearing and speech rehabilitation at the state level, to promote social rehabilitation and active longevity of citizens of older age groups.

[Age related aspects of cochlear implantation.]

The objective of this study was to assess the long-term results of cochlear implantation in terms of age-related changes. 67 patients of different age with chronic bilateral severe sensorineural hearing loss and deafness with experience of use of cochlear implants (CI) for at least 5 years were tested. The 1st group included young patients (25,5±7,9 years), the 2nd group - middle-aged (51,4±5,4 years), the 3rd group - elderly patients (67±5,6 years). The examination, which conducted before and after the planned replacement of the speech processor, included: pure tone and speech audiometry in the free field, subjective assessment of satisfaction with CI, assessment of the state of speech function and psychological testing using the Montreal Cognitive Assessment and Mini-Mental State Examination. The increase in speech intelligibility in silence and in a background noise after the replacement of speech processors was revealed. The expediency of cochlear implantation in geriatric practice to maintain the mental and social status of elderly people, prevention of dementia, improving the quality of their lives in the conditions of increasing the age-related risks of sensory and cognitive dysfunction was shown.