The review focuses on the use of oral anticoagulants in fragile elderly patients. The issues of prevalence and diagnosis of senile asthenia syndrome or “fragility”, as well as its effects on the risks of thrombosis, bleeding and death, are discussed. The evidence base, which is quite limited, for the participation of fragile elderly patients in randomized controlled trials and real clinical practice trials with direct oral anticoagulants is presented. Nevertheless, one of the studies of real clinical practice showed that only therapy with rivaroxaban (out of three direct oral anticoagulants) compared with warfarin reduced the risk of stroke/systemic embolism and ischemic stroke alone in fragile elderly patients with atrial fibrillation after 2 years of observation.

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Cognitive dysfunction is one of the most common disorders in the elderly and senile age. There are currently 57 million people with dementia worldwide.Objective: to assess cognitive functions, to understand the prevalence of cognitive impairment (CI) and to analyze their associations with socioeconomic, demographic and anthropometric factors and geriatric syndromes in people aged ≥65 years.Patients and methods. Subjects living in 11 regions of the Russian Federation took part in the EVKALIPT epidemiological study. The inclusion criterion was age ≥65 years. Participants were divided into three age groups (65–74 years, 75–84 years, and ≥85 years) according to the protocol. All patients underwent a comprehensive geriatric assessment, comprising a specially designed questionnaire and physical examination. Cognitive functions were assessed using the mini-Cog test. The study included 3545 patients (of which 30% were males) aged 65 to 107 years.Results and discussion. According to the data obtained in our study, CI was detected in 60.8% of the subjects, and severe disorders – in 19.9% (0 or 1 point according to the mini-Cog). Patients with CI had a lower socioeconomic status. One-way regression analysis showed that the risk of CI increased by 10% with increasing age for every 1 year but did not depend on the sex of the subjects. Associated with increased CI risk also were: living alone (by 28%), living in a nursing home (by 90%), widowhood (by 2.2 times) or absence of a partner (by 2.2 times), underweight (by 2.9 times) and normal body weight (by 1.6 times), disability (by 54%), primary (by 4.8 times) and secondary (by 75%) education, bad economic conditions (by 95%). On the contrary, the presence of overweight and obesity reduced the risk of CI by 14 and 24% respectively, living in a family – by 24%, having a spouse – by 55%, divorce – by 29%, having a job – by 73%, higher education and a scientific degree – by 55 and 59%, medium and good economic conditions – by 38 and 52%, respectively. In patients with CI, the incidence of all geriatric syndromes was higher.Conclusion. The frequency of CI among elderly patients was higher compared with data from other studies. The EVKALIPT study was the first to obtain national data on the prevalence and characteristics of CI in persons aged ≥65 years in the general population.

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