Aim. To study the prevalence of geriatric syndromes and assess their relationship with senile asthenia in persons aged ³65 years living in Russian regions with different demographic, climatic and socio-economic characteristics. Material and methods. We examined 664 patients aged 65-107 years (mean age, 79±9 years; men, 25%) living in Moscow (n=365) and Voronezh (n=299). All patients underwent a comprehensive geriatric examination, which consisted of two stages: a survey with original questionnaire and an objective examination. Results. The prevalence of senile asthenia was 66,4%, including 47,4% in people aged 65-74, 71,1% — 75-84 years, and 82,8% — ³85 years (p for trend <0,001). Senile asthenia was associated with age (odds ratio (OR), 2,36; 95% confidence interval (CI), 1,89-2,93; p<0,001) and female sex (OR, 1,52; 95% CI 1,06-2,18; p=0,024). Patients with senile asthenia had a lower socioeconomic status. Also, close associations of senile asthenia with other geriatric syndromes (dementia, depression, vision and hearing impairment, incontinence, falls, high risk of falls, functional decline, failure to thrive) with OR from 1,32 to 7,22 were revealed. Conclusion. The first results of the EVCALIPT study indicate a high incidence of senile asthenia in persons aged ³65 years and its close association with other geriatric syndromes and socio-economic factors.

Background. This work is a review of preclinical and clinical studies of the role of telomeres and telomerase in the development and progression of coronary heart disease (CHD). Materials and methods. A search for full-text publications (articles, reviews, meta-analyses, Cochrane reviews, and clinical cases) in English and Russian was carried out in the databases PubMed, Oxford University Press, Scopus, Web of Science, Springer, and E-library electronic library using keywords and their combinations. The search depth is 11 years (2010–2021). Results. The review suggests that the relative leukocyte telomere length (LTL) is associated with the development of socially significant and widespread cardiovascular diseases such as CHD and essential hypertension. At the same time, the interests of researchers are mainly focused on the study of the relative LTL in CHD. Conclusions. Despite the scientific and clinical significance of the analyzed studies of the relative length of human LTL as a biological marker of cardiovascular diseases, their implementation in real clinical practice is difficult due to differences in the design and methodology of the analyzed studies, as well as differences in the samples by gender, age, race, and ethnicity. The authors believe that clinical studies of the role of the relative length of leukocyte telomeres in adult patients with coronary heart disease are the most promising and require large multicenter studies with a unified design and methodology.

INTRODUCTION. Pharmacotherapy in elderly and senile patients is associated with multimorbidity and polypharmacy and can lead to adverse drug reactions (ADRs). The growth of the world’s population over 60 makes the practical application of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, the key recommendations to optimise prescribing in the geriatric population, increasingly important. AIM. This study aimed to review the history of the Beers criteria, the main changes in the updated 2023 version, and national and international publications on the practical experience of using the criteria in healthcare settings. DISCUSSION. The criteria for assessing the rationality of pharmacotherapy in older patients were developed by Mark Beers in 1991. His recommendations have been regularly reviewed and updated by a panel of experts from the American Geriatrics Society (AGS); version 7 has been in effect since 2023. The criteria are designed to support pharmacotherapy decision making for adults 65 years old and older in all ambulatory, acute, and institutionalised settings of care, except hospice and end-of-life care settings. The criteria are organised into 5 categories: 1) medications that should be avoided in all older adults; 2) medications considered potentially inappropriate in patients with certain diseases or syndromes; 3) medications that should be used with caution; 4) medications that are potentially inappropriate due to the risk of clinically significant drug–drug interactions; 5) medications that should be avoided or require dosage reduction in patients with impaired renal function. Medicines with pronounced anticholinergic effects are categorised as a separate class. The criteria are based on expert grading of the quality of evidence and strength of recommendations. Compared with the previous version (2019), the updated AGS Beers Criteria® (2023) changed the most in terms of recommendations for anticoagulants and sulfonylureas. According to the results of this review, the AGS Beers Criteria® are actively used in healthcare practice in Russia and abroad to reduce the undesirable effects of potentially inappropriate medication use in elderly patients by optimising the selection of medicines and treatment regimens; to train healthcare providers and patients in the principles of rational pharmacotherapy; to reduce the cost of pharmacotherapy; and to assess the quality of medical care. CONCLUSIONS. The AGS Beers Criteria® are an effective tool for identifying potentially inappropriate medications in prescribed therapy and selecting appropriate alternatives. Their practical application in healthcare settings can reduce ADRs, hospital admissions, and mortality rates in elderly and senile patients.

Objectives: For revealing the peculiarities of the drug–drug interaction of rivaroxaban (substrate CYP3A4 and P-gp) and calcium channel blockers (CCBs) (verapamil – inhibitor CYP3A4 and P-gp and amlodipine – substrate CYP3A4) in patients 80 years and older with nonvalvular atrial fibrillation (NAF) we studied 128 patients. Methods: All patients were divided into groups depending on the therapy taken: the 1st – rivaroxaban + amlodipine (n=51), the 2nd – rivaroxaban + verapamil (n=30), the control group – rivaroxaban without CCBs (n=47). A trough steady-state plasma concentration (C _min,ss) of rivaroxaban, prothrombin time (PT) in the blood plasma and the event of clinically relevant non-major (CRNM) bleeding were assessed for each patient. Results: Patient in group 2 had higher C _min,ss of rivaroxaban, PT and CRNM than subjects in the control group (Me 73.8 [50.6–108.8] ng/mL vs. 40.5 [25.6–74.3] ng/mL; Me 14.8 [13.4–17.3] s vs. 13.8 [12.6–14.4] s; 34% vs. 13%, respectively, p0.05 for all). Conclusions: In patients ≥80 years with NAF, the use of rivaroxaban in combination with verapamil may not be safe and can lead to CRNM bleeding.

Polypharmacy in geriatric patients is associated with an increased risk of adverse outcomes. Therefore, several instruments for prescription analysis and optimization can be used to enhance the safety and efficacy of pharmacotherapy in old age population. STOPP/START criteria is one of the most popular screening tools in the Russian Federation and abroad that list potentially inappropriate drugs for use in older patients (STOPP criteria) and potentially prescribed for certain clinical cases (START criteria). Two previous versions of the STOPP/START criteria were published in 2008 and 2015. Released in 2023, the newest (third version) demonstrates the evolution of evidence-based pharmacotherapy for older and oldestold patients, featuring 133 STOPP and 57 START criteria. Expanding the base of STOPP/START criteria should support optimization of prescriptions and reducing ADRs risk in older patients. This article introduces translation of STOPP/START criteria, version 3.