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.
Представлен обзор по использованию комплексной гериатрической оценки (КГО) и ее компонентов в онкологии. Продемонстрирована доказательная база увеличения онкологической заболеваемости у пожилых людей во всем мире. Тактика лечения пожилых людей с данной патологией является сложной задачей. Многими авторами доказано, что КГО является сильным предиктором нежелательных явлений у пациентов старше трудоспособного возраста со злокачественными онкологическими заболеваниями. КГО рекомендована в онкологической практике по многим причинам: верификация проблем со здоровьем, обычно не выявляемых при рутинном онкологическом обследовании, проведение неонкологических вмешательств, а также изменение плана лечения онкологического заболевания. КГО является золотым стандартом в гериатрической онкологии для выявления пациентов с высоким риском неблагоприятных исходов и оптимизации лечения злокачественных новообразований, включая тактику общего ведения больного. Тем не менее, можно констатировать, что окончательная точка в поиске научно обоснованных и эффективных инструментов оценки хрупкости в практике гериатрической онкологии еще не поставлена. Сделан вывод, что разработка новых шкал и индексовых показателей, а также применение модели КГО в целом может обеспечить адекватную помощь онкологическим больным гериатрического профиля.

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.
Цель представленного обзора — демонстрация важности комплексного гериатрического обследования в кардиологии, включая гериатрические аспекты ведения данного контингента больных. До настоявшего времени в РФ полностью отсутствует гериатрический подход к ведению пациентов кардиологического профиля, что предусматривает рассмотрение международного опыта по данному вопросу. Курация пациентов пожилого и старческого возраста осложняется наличием гериатрических синдромов и возраст-ассоциированных заболеваний, ведущих к ухудшению качества жизни, повторным госпитализациям, инвалидизации и риску смерти. Ведущим гериатрическим синдромом для врача-гериатра является старческая астения и множественная сопутствующая полиморбидная патология. Пациента, попадающего в стационар по неотложному состоянию, имеющего в анамнезе сердечно-сосудистую коморбидную патологию, в первую очередь рассматривают как пациента с высоким риском сердечно-сосудистых осложнений, опуская значение риска неблагоприятных исходов, включающее потерю независимости и нарушение функционального статуса. Данный обзор показывает важность определения старческой астении вне кабинета гериатра, обосновывая необходимость повышения квалификации врачей-кардиологов по гериатрии.

UNASSIGNED: This study aims to assess the possible relationship between frailty and anthropometric indices in older adults using data from the first phase of the Birjand Longitudinal Aging Study (BLAS).
UNASSIGNED: In this cross-sectional study, we assessed the association between frailty (Frailty index (FI) and Fried frailty phenotype) and body composition indices in 1364 participants aged ≥ 60 years (September 2018 to April 2019). Analysis was conducted using one-way ANOVA and ordinal logistic regression.
UNASSIGNED: Participants were categorized as frail (n = 164), non-frail (n = 415), and pre-frail (n = 785) based on FI. A significant positive association was observed between the frailty and body mass index (BMI) (OR: 1.04, 95% CI:1.01- 1.07), waist circumference (WC) (OR: 1.02, 95% CI: 1.01- 1.03), waist-to-hip ratio (WHR) (OR: 2.36, 95% CI 1.05- 5.27) and waist-to-height ratio (WHtR) (OR: 1.27, 95%CI: 1.09- 1.47). Body shape index, body roundness index, and body adiposity index showed no significant association with frailty. Moreover, a BMI greater than 29 kg/m2 increased the odds of frailty and prefrailty by 79% (OR = 1.79, 95%CI = 1.30- 2.46, P < 0.001).
UNASSIGNED: Results of this study showed that the risk of frailty increases as BMI and abdominal obesity indices increase. Therefore, BMI and abdominal obesity indices (WC, WHR, and WHtR) could serve as suitable tools for evaluating frailty in the elderly. However, additional studies are needed to evaluate the utility of the newly developed anthropometric indices in older adults.

BACKGROUND: The primary aim of the study was to validate the Zulfiqar Frailty Scale (ZFS) and examine its concordance with the modified Short Emergency Geriatric Assessment (mSEGA) scale, Part A.
METHODS: A prospective observational study was conducted in Guadeloupe (France) over a two-month duration (from 20 February to 20 April 2024), involving elderly individuals aged 65 and older, deemed self-sufficient with an ADL (Activities of Daily Living) score exceeding four out of six.
RESULTS: Within this community cohort of 98 individuals, averaging 75 years in age, frailty according to the modified SEGA criteria was prevalent in 29%. Frailty according to the \"ZFS\" score was prevalent in 40%. Key predictors of frailty identified in our study included age, comorbidity (Charlson score), polypharmacy (total number of medications and therapeutic classes), and functional ability (ADL scores). Notably, experiences of falls and hospitalizations within the past six months significantly influenced the classification of frailty according to both ZFS and SEGA scales. Significant associations with the presence of home care aides (p < 0.0001), monopodal support test results (p < 0.0001), memory impairments (p < 0.0001), and recent hospitalizations (p = 0.0054) underscored the multidimensional impact of frailty. The Pearson correlation coefficient and its 95% confidence interval between the SEGA and Zulfiqar Frailty Scales stood at 0.73 [0.61: 0.81]. The discernment threshold for frailty was set at three out of six criteria, showcasing a sensitivity of 64% and a negative predictive value of 80%. The area under the curve (AUC) for the Zulfiqar Frailty Scale was reported as 0.8.
CONCLUSIONS: The \"ZFS\" tool allows for the detection of frailty with a highly satisfactory sensitivity and negative predictive value.

OBJECTIVE: Poor oral health has been predicted the development of frailty and sarcopenia as well as the subsequent need for long-term care. This cross-sectional study examined the relationships among tooth loss, prefrailty, and dietary patterns in community-dwelling older Japanese females.
METHODS: Information on the number of teeth, food consumption, and lifestyle factors was collected from 271 participants aged ≥ 65 yrs using a questionnaire. The number of teeth was self-reported and classified into 2 groups: natural teeth ≥ 20 and natural teeth < 20. Prefrailty was assessed using the Japanese version of the Cardiovascular Health Study. Three dietary patterns (\"vegetables and dairy products\" [VD], \"rice and fish and shellfish\" [RF], and \"bread and beverages\") were adopted from a cluster analysis of the intakes of 20 foods evaluated using the Food Frequency Questionnaire. The odds ratios (ORs) for prefrailty and dietary patterns were calculated using a binary logistic regression analysis.
RESULTS: A total of 267 participants were analyzed, excluding those with frailty (n = 4). The rates of natural teeth < 20 and prefrailty were 57.3 and 37.4%, respectively. Natural teeth < 20 was positively correlated with prefrailty (OR, 4.66; 95% confidence interval [CI], 2.54-8.52) and inversely correlated with VD pattern (OR, 0.43; 95% CI, 0.27-0.69). Furthermore, both VD (OR, 0.38; 95% CI, 0.16-0.91) and RF (OR, 0.26; 95% CI, 0.11-0.62) patterns were inversely correlated with prefrailty.
CONCLUSIONS: Maintaining the number of natural teeth ≥ 20 into old age plays an important role in preventing a prefrailty. The promotion of VD and RF dietary patterns has potential as an effective nutritional strategy for preventing tooth loss and prefrailty.

UNASSIGNED: The aim was to systematically review the association between depression and frailty in the elderly.
UNASSIGNED: Databases such as PubMed, Web of Science, Embase, and Scopus were searched for articles on the link between the risk of depression and frailty since the creation of the databases to September 1, 2023. A pair of investigators collaboratively conducted the screening, collected data, and evaluated the potential for bias in the included studies. R software was utilized for meta-synthesis.
UNASSIGNED: Eight cohort studies comprising 13 043 participants and 14 854 senior individuals with depression were included. The meta-analysis showed that there was a significant connection regarding frailty and the incidence of depression among the elderly (Risk Ratio [RR] = 3.26, 95% Confidence Interval [CI]: 1.68-6.32). Subgroup evaluations showed that there was no association between frailty and depression in the community-dwelling elderly (RR = 2.28, 95% CI: 0.644-8.102) and in the elderly patients with depression assessed by Center for Epidemiological Studies Depression Scale (CES-D) (RR = 5.82, 95% CI: 0.481-70.526).
UNASSIGNED: Frailty is correlated with the risk of depression in the elderly. Frailty is a contributing factor to depression in the elderly.

BACKGROUND: Previous reports have associated frailty with the existence of various chronic diseases. Especially for cardiovascular diseases, this relationship seems to be bidirectional as common pathophysiological mechanisms lead to the progression of both diseases and frailty. The study aimed to examine the relationship between chronic diseases and frailty in a sample of older Greek inpatients Methodology: In 457 consecutively admitted older patients (226, 49.5% females), the median age was 82 years (interquartile range [IQR] 75-89), and demographic factors, medical history, cause of admission, and the degree of frailty assessed with the Clinical Frailty Scale were recorded. The level of frailty was calculated for the pre-hospital status of the patients. Parametric tests and logistic regression analysis were applied to identify diseases independently associated with frailty.
RESULTS: Using the scale, 277 patients (60.6%) were classified as frail and 180 as non-frail (39.4%). In univariate analysis, frail patients were more likely to have respiratory disease, dementia, Parkinson\'s disease, chronic kidney disease (CKD), atrial fibrillation (AFIB), neoplastic disease, depression, stroke, heart failure (HF), and coronary artery disease. In binomial regression analysis, the diseases that were statistically significantly associated with frailty were respiratory diseases (P = 0.009, odds ratio [OR] = 2.081, 95% confidence interval [CI] 1.198-3.615), dementia (P ≤ 0.001, OR = 20.326, 95% CI 8.354-49.459), Parkinson\'s disease (P = 0.049, OR = 3.920, 95% CI 1.005-15.295), CKD (P = 0.018, OR = 2.542, 95% CI 1.172-5.512), AFIB (P = 0.017, OR = 1.863, 95% CI 1.118-3.103), HF (P = 0.002, OR = 2.411, 95% CI 1.389-4.185), and coronary artery disease (P = 0.004, OR = 2.434, 95% CI 1.324-4.475).
CONCLUSIONS: Among diseases independently associated with frailty, chronic diseases such as respiratory diseases, dementia, Parkinson\'s disease, CKD, and cardiovascular diseases (AFIB, HF, and coronary heart disease) have an important role. Recognizing the diseases that are highly related to frailty may contribute, by their optimal management, to delaying the progression or even reversing frailty in a large proportion of the elderly.

Prevention and diagnosis of frailty syndrome (FS) in patients with heart failure (HF) require innovative systems to help medical personnel tailor and optimize their treatment and care. Traditional methods of diagnosing FS in patients could be more satisfactory. Healthcare personnel in clinical settings use a combination of tests and self-reporting to diagnose patients and those at risk of frailty, which is time-consuming and costly. Modern medicine uses artificial intelligence (AI) to study the physical and psychosocial domains of frailty in cardiac patients with HF. This paper aims to present the potential of using the AI approach, emphasizing machine learning (ML) in predicting frailty in patients with HF. Our team reviewed the literature on ML applications for FS and reviewed frailty measurements applied to modern clinical practice. Our approach analysis resulted in recommendations of ML algorithms for predicting frailty in patients. We also present the exemplary application of ML for FS in patients with HF based on the Tilburg Frailty Indicator (TFI) questionnaire, taking into account psychosocial variables.

The frail and elderly are considered to be at particular risk of suffering an adverse drug reaction. Empirical studies confirm the increased rate of adverse drug reactions. Whether frailty per se impairs drug metabolism or the underlying organ ageing processes and multimorbidity cannot be answered with certainty based on current data. Cardiovascular diseases exhibit a considerable interdependence with frailty. For example, there is a disproportionate syndromal interdependence between heart failure and frailty, and the typical ageing processes of the sinus node can be interpreted as heartbeat frailty. Multimorbidity in the elderly often includes a cluster of chronic cardiovascular diseases, often leading to the use of several cardiovascular medications as required. More recent definitions of polypharmacy assess the appropriateness of drugs rather than their number. The Fit-fOR-The-Aged (FORTA) list, the PRISCUS 2.0 list and the \"Cochrane Library Special Collection on deprescribing\", for example, offer a practice-oriented assessment aid. In the treatment of arterial hypertension, the target values for older people have also been set ever lower in recent years. In the case of frail elderly people, on the other hand, the guidelines do not specify a strict blood pressure target corridor; tolerability is the crucial factor here. When initiating antihypertensive therapy in frail individuals, one can consider monotherapy-in a departure from the standard case of dual combination therapy. The OPTIMISE study showed that discontinuation of one blood pressure medication did not lead to better tolerability of the drug therapy. Current studies come to differing conclusions regarding the risk-benefit assessment of new oral anticoagulants compared to vitamin K antagonists in the anticoagulation of frail elderly people with atrial fibrillation. Shared decision-making, which could improve adherence particularly in older people, is recommended.
UNASSIGNED: Gebrechliche alte Menschen gelten als besonders gefährdet, eine unerwünschte Arzneimittelwirkung zu erleiden. Empirische Studien belegen die erhöhte Rate unerwünschter Arzneimittelwirkungen. Ob „frailty“ per se den Arzneimittelmetabolismus beeinträchtigt oder führend die zugrunde liegenden Organalterungsprozesse und die Multimorbidität, kann nach aktueller Datenlage nicht sicher beantwortet werden. Herz-Kreislauf-Erkrankungen weisen eine erhebliche Verflechtung mit „frailty“ auf. So gibt es eine überproportionale syndromale Interdependenz zwischen Herzinsuffizienz und „frailty“, und die typischen Alterungsprozesse des Sinusknotens können als „heartbeat frailty“ interpretiert werden. Die geriatrietypische Multimorbidität beinhaltet häufig einen Cluster chronischer Herz-Kreislauf-Erkrankungen, was oftmals auch bedarfsgerecht zur Multimedikation mit Einsatz mehrerer kardiovaskulärer Medikamente führt. Neuere Definitionen der „Polypharmazie“ bewerten weniger die Zahl der Medikamente als deren Angemessenheit. Eine praxisorientierte Bewertungshilfe bieten unter anderem die Fit-fOR-The-Aged(FORTA)-Liste, die PRISCUS‑2.0‑Liste sowie die „Cochrane Library Special Collection on deprescribing“. Bei der Behandlung der arteriellen Hypertonie wurden in den letzten Jahren die Zielwerte auch für ältere Menschen immer niedriger angesetzt. Bei gebrechlichen alten Menschen hingegen geben die Leitlinien keinen starren Blutdruckzielkorridor vor, die Verträglichkeit ist hier das Entscheidende. Bei der Einleitung einer antihypertensiven Therapie kann bei gebrechlichen Personen – abweichend vom Regelfall einer Zweifachkombination – eine Monotherapie erwogen werden. In der OPTIMISE-Studie führte das Absetzen eines Blutdruckmedikaments nicht zu einer besseren Verträglichkeit der medikamentösen Therapie. In Bezug auf die Nutzen-Risiko-Bewertung von neuen oralen Antikoagulanzien im Vergleich zu Vitamin-K-Antagonisten in der Antikoagulation bei gebrechlichen alten Menschen mit Vorhofflimmern kommen aktuelle Studien zu unterschiedlichen Ergebnissen. Ein „shared decision-making“ wird empfohlen, was gerade bei betagten Personen die Adhärenz verbessern könnte.

BACKGROUND: Frailty syndrome is a state of increased vulnerability to stressors, marked by lowered physical strength and increased dependence on others. The well-established changes in gut microbiota associated with old age suggest a probable relationship between gut microbiota and frailty.
RESULTS: This study was aimed at finding the relationship between gut microbiota and frailty syndrome, by comparing the sociodemographic data and the gut microbiota profiles of 23 non-frail and 14 frail elderly individuals. We used the quantitative polymerase chain reaction method (qPCR) to determine the bacterial loads of Bifidobacteria, Lactobacillus, Bacteroidetes, Prevotella, and Escherichia coli in stool samples from test subjects. We discovered a significant increase in the bacterial load of Prevotella in frail elderly individuals aged 70 or above. Other bacterial loads and ratios were not significantly different between the two groups.
CONCLUSIONS: More comprehensive studies with larger sample sizes and encompassing a wider range of inflammation-related bacteria need to be performed to discover the existence and exact nature of these relations.