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Файл:Frailty syndrome clinic, diagnosis, treatment. Study aid
.pdf
federal State Budgetary Educational Institution
of Higher Education “Samara State Medical University”
Ministry of Health of the Russian Federation
Department of Endocrinology and Geriatrics
S.V. Bulgakova, E.V. Treneva, D.P. Kurmaev,
L.A. Sharonova, O.V. Kosareva, Yu.A. Dolgikh
FRAILTY SYNDROME:
CLINIC, DIAGNOSIS, TREATMENT
Study aid
Recommended by the Coordination Council for the field of education “Healthcare and Medical Sciences”
as a course material aid for use in educational institutions implementing basic professional
educational programs of higher education in programs for training highly qualified
personnel in residency in the specialties 31.05.01 “Medical”
Protocol № 071 dated June 15, 2023 meeting of the Expert Commission on Working
with Educational Publications (hereinafter referred to as ECU)
of the Federal State Autonomous Educational Institution of Higher Education First
Moscow State Medical University named after I.M. Sechenov
Ministry of Health of the Russian Federation (Sechenov University)
Registration number of the review: 2306 EKU dated June 15, 2023
Moscow
IPR MEDIA
2025
UDC 616-009.17
BBK 56.14
F85
The author’s team of the Samara State Medical University
of the Ministry of Healthcare of the Russian Federation consisting of:
Bulgakova S.V. — Doctor of Medical Sciences, Associate Professor,
Head of the Department of Endocrinology and Geriatrics;
Treneva E.V. — Candidate of Medical Sciences, Associate Professor,
Associate Professor of the Department of Endocrinology and Geriatrics;
Kurmaev D.P. — Candidate of Medical Sciences,
Assistant of the Department of Endocrinology and Geriatrics;
Sharonova L.A. — Candidate of Medical Sciences, Associate Professor,
Associate Professor of the Department of Endocrinology and Geriatrics;
Kosareva O.V. — Candidate of Medical Sciences, Associate Professor,
Associate Professor of the Department of Endocrinology and Geriatrics;
Dolgikh Yu.A. — Candidate of Medical Sciences, Associate Professor
of the Department of Endocrinology and Geriatrics
Reviewers:
Ilnitsky A.N. — Doctor of Medical Sciences, Professor,
Head of the Department of Therapy, Geriatrics and Anti-Aging Medicine
of the Academy of Postgraduate Education of the FSBI FNCC FMBA of Russia;
Ushakova S.E. — Doctor of Medical Sciences, Associate Professor,
Head of the Department of Polyclinic Therapy and Endocrinology
of the FSBEI HE IvGMA of the Ministry of Health of Russia
F85 Frailty syndrome: clinic, diagnosis, treatment : study aid / S.V. Bulgakova,
E.V. Treneva, D.P. Kurmaev [et al.] ; Samara State Medical University. —
Moscow : IPR Media, 2025. — 151 p. — Text : electronic.
ISBN 978-5-4497-4033-5
The study aid describes in detail the leading syndrome of geriatric practice — the
syndrome of senile asthenia, presents the clinical picture of the syndrome, presents modern
approaches to the diagnosis, treatment, and prevention of this disease among older age groups.
The edition contains test tasks and situational tasks for self-control of knowledge.
The study aid is intended for students of medical universities and has been prepared in
accordance with the requirements of the current Federal State Educational Standard for Higher
Education of a specialist in the specialty “General Medicine” and the work program of the
discipline “Gerontology and Geriatrics”, approved by the Central Committee of the Samara
State Medical University of the Ministry of Health of Russia.
Educational electronic publication
Approved and recommended to the publishing
by the Central Coordination Methodological Council,
Samara State Medical University (protocol № 5 of 28.03.2023)
ISBN 978-5-4497-4033-5 © Samara State Medical University, 2025
© LLC Company «IPR MEDIA», 2025
Educational publication
Bulgakova Svetlana Viktorovna
Treneva Ekaterina Vyacheslavovna
Kurmaev Dmitry Petrovich
Sharonova Lyudmila Aleksandrovna
Kosareva Olga Vladislavovna
Dolgikh Yuliya Aleksandrovna
Editor Yu.V. Semenova
Technical editor, computer layout Yu.Yu. Zheltova
Cover by Ya.A. Kirsanov, S.S. Siziumova, photobank Freepik
Signed for use 31.01.2025. Data volume 7,5 Mb.
LLC Company “IPR MEDIA”
8 800 555 22 35 (toll-free in Russia)
E-mail: sales@iprmedia.ru
4
CONTENT
Introduction .......................................................................................................... 6
1. Brief information on the frailty syndrome ..................................................... 10
2. Etiology and pathogenesis of the frailty syndrome ........................................ 11
3. Classification of the frailty syndrome ............................................................ 15
4. Clinical picture of the frailty syndrome ......................................................... 18
5. Diagnosis of the frailty syndrome .................................................................. 22
5.1. Stages of diagnosis. Comprehensive Geriatric Assessment .................... 22
5.2. Physical health domain ............................................................................ 24
5.3. Domain of the functional status ............................................................... 29
5.4. Domain of cognitive status ...................................................................... 30
5.5. Domain of еmotional status ..................................................................... 30
5.6. Domain of social status ........................................................................... 30
5.7. The Role of Nursing Personnel
in Comprehensive Geriatric Assessment ........................................................ 31
6. Laboratory research ........................................................................................ 37
7. Instrumental diagnostic studies ...................................................................... 39
8. Treatment, including drug and non-drug therapy,
diet therapy, pain relief. Basic principles of treatment
of patients with the frailty syndrome ................................................................. 41
8.1. Non-pharmacological methods of treatment
of the frailty syndrome ................................................................................... 44
8.2. Medical therapy....................................................................................... 47
8.3. Features of the treatment of concomitant diseases
and conditions in patients with senile asthenia syndrome ............................. 49
9. Medical rehabilitation ..................................................................................... 51
10. Prevention and dispensary observation ........................................................ 52
11. Organization of medical care ........................................................................ 53
11.1. Indications for hospitalization in a medical organization ................... 53
11.2. Indications for hospitalization of patients
in the geriatric department ............................................................................ 53
11.3. Indications for discharge of the patient
from the geriatric department ....................................................................... 55
5
12. Some geriatric syndromes ............................................................................ 56
12.1. Fall syndrome as one of the main ones in geriatrics ........................... 56
12.2. Osteoporosis. Low-traumatic skeletal fractures .................................. 59
12.3. Cognitive impairment .......................................................................... 63
12.4. Sleep disorders in the elderly .............................................................. 70
12.5. Malnutrition syndrome in the development of senile asthenia ........... 72
12.6. Polypharmacy as a geriatric syndrome ............................................... 74
12.7. Sensory disturbances in older patients ................................................ 75
12.8. Urological pathology in the elderly patients ....................................... 80
13. Mathematical modeling of the risk of developing senile
asthenia and sarcopenia ...................................................................................... 86
14. Preventive counseling of patients (recommendations
on physical activity and rational nutrition
for people over 65 years of age) ......................................................................... 93
14.1. Physical activity recommendations ..................................................... 93
14.2. Principles of rational nutrition for people
over 65 years of age ...................................................................................... 99
Test questions and tasks ................................................................................... 101
References ........................................................................................................ 123
Appendix 1. Map of comprehensive geriatric assessment of patient .............. 131
Appendix 2. How to deal with depression yourself (advice to the patient) ..... 151
6
INTRODUCTION
The study aid is intended for students of medical universities and has
been prepared in accordance with the requirements of the current federal
state educational standard for higher education of a specialist in the specialty
31.05.01 General Medicine and the work program of the discipline B1.B.65
“Gerontology and Geriatrics”, approved by the Central Committee of the
Samara State Medical University dated June 23, 2021, aimed at developing
the following competencies:
PC-2 The ability and readiness to conduct a patient examination in
order to establish a diagnosis;
PC-4 The ability and readiness to draw up a treatment plan for a
disease, prescribe medications, medical devices, clinical nutrition, non-drug
treatment in accordance with the current procedures for the provision of
medical care, clinical recommendations, followed by an assessment of
efficacy and safety;
PC-5 Ability and willingness to implement and monitor the
effectiveness of the patient's medical rehabilitation, including individual
rehabilitation programs, prescribe sanatorium treatment, assess the patient's
ability to work. Student should:
know: the principle of action of drugs, medical devices and therapeutic
nutrition, indications and contraindications for their use, possible adverse
events and complications during treatment, clinical guidelines for the use of
drugs, medical devices, therapeutic nutrition, their mechanisms of action;
indications and contraindications for prescription, complications during use;
principles of providing palliative medical care;
be able to: draw up a plan for prescribing drug, non-drug therapy and
therapeutic nutrition taking into account the diagnosis, individual needs and
age of the patient in accordance with modern clinical guidelines (treatment
protocols) and assess the effectiveness of the prescribed therapy, prescribe
drug and non-drug therapy, therapeutic nutrition taking into account the
individual needs and age of the patient, diagnosis, clinical picture in
accordance with current clinical guidelines, protocols, standards and
7
procedures for the provision of medical care; explain the rules for taking
medications and conducting non-drug therapy;
master: the rules of a personalized approach to treating a patient with
various pathologies, polymorbidity, limited physical abilities and taking
into account age, skills of interaction with medical specialists, other medical
workers and family members of a sick person when providing palliative care
to a sick person.
The increase in the average duration of human life is the most
remarkable result of scientific, technological and social progress. The most
important demographic phenomenon at the turn of the XX–XXI centuries.
was a global increase in life expectancy and, as a result, an adequate increase
in the proportion of older people in the total population of the population of
countries around the world. So, in 1950, people aged 60 years and over
accounted for 8 % of the world population, in 2000 — already 10 %, and in
2050, according to UN forecasts, their share will reach 21 %. By 2020, for
the first time in history, the number of people aged 60 and over will
outnumber children under 5 (WHO Report, 2015). In Russia, the share of
people over 60 years of age as of January 1, 2016 was 20.3 %, by 2025 it is
expected to increase to 23.9 %, by 2050 to 28.8 %. The Samara region
repeats the all-Russian tendencies. Along with the increase in the number of
people over 60, the number of age-associated diseases is also growing.
Among them is also the syndrome of senile asthenia (frailty).
According to foreign studies, the prevalence of frailty among people
living at home aged 65 and older averages about 10.7 %, pre-frail older
adults — 41.6 %. The prevalence of frailty increases with age, reaching
26.1 % among people aged 85 and over. Frailty syndrome is significantly
more frequently diagnosed in women than in men. In nursing homes, the
prevalence of frailty reaches 52.3 %.
According to Russian studies, among the population of St. Petersburg
(Kolpino) 65 years and older, the prevalence of frailty, depending on the
approach to its diagnosis, ranges from 21.1 to 43.9 %, pre-frail older
adults — from 24.7 to 65.5 %. Among patients of polyclinics in Moscow of
8
the same age group, the prevalence of frailty ranges from 4.2 to 8.9 %, prefrail older adults — from 45.8 to 61.3 %.
At present, a regulatory and legal framework for the development of
the geriatric service has been developed: Decree of the Government of the
Russian Federation of February 5, 2016 No. 164r “Approve the attached
Action Strategy in the interests of older citizens in the Russian Federation
until 2025”, Order of the Ministry of Health of the Russian Federation of
July 28, 1999 No. 297 “On improving the organization of medical care for
elderly and senile citizens in the Russian Federation”, Order of the Ministry
of Health of the Russian Federation dated January 29, 2016 No. 38n “On
approval of the Procedure for the provision of medical care in the field of
“geriatrics”, Order of the Ministry of Health of the Russian Federation dated
20.12.2019 No. 1067n “On amendments to the procedure for providing
medical care in the geriatrics profile, approved by Order of the Ministry of
Health of the Russian Federation dated January 29, 2016 No. 38n”.
These documents played a positive role in the creation of a geriatric
system in the country, the main principle of which is the creation of a unified
system of long-term care for geriatric patients through the continuity of
management between healthcare and social service institutions.
One of the priorities of the action strategy in the interests of older
citizens in the Russian Federation until 2025 is the improvement of the
social service system, its innovative development. Improving the quality of
life of senior citizens is one of the priorities. The most demanded form is
the provision of social services at home. This is especially true for patients
suffering from movement disorders and senile dementia. This form 4 of
social service allows them to keep living in their usual environment, without
being placed in social service hospitals.
Further tasks in the implementation of the “Strategy of Actions in the
Interests of Senior Citizens in the Russian Federation until 2025” are
defined as follows:
- development of strategies for the prevention of chronic noncommunicable diseases in older people, including the formation of a healthy
lifestyle and early diagnosis of chronic age-associated non-communicable
9
diseases and risk factors for their development, followed by timely
correction in order to reduce morbidity, disability and mortality;
organization of geriatric service as a unified system of long-term medical
care, continuity of patient management by various levels of the health
system, as well as health and social protection services; improving the
provision of medical care at the territorial medical sites to citizens of the
older generation with senile asthenia;
- development of palliative care in the interests of older citizens;
- improvement of a unified system of professional training and
additional professional education of specialists in providing medical,
including geriatric, and social assistance to citizens of the older generation;
-increasing the awareness of medical workers on the issues of protecting the
health of citizens of the older generation;
- carrying out activities aimed at promoting a healthy lifestyle, creating
conditions for physical education for older citizens, taking into account their
age and state of health;
- formation of a respectful attitude towards citizens of the older
generation, regardless of their physical condition and other aspects of their
life as members of society.
Given that in the system of providing medical care to the older
population, the main burden falls on outpatient clinics, the most important
role in the tactics of managing geriatric patients belongs to primary care
specialists. Not every elderly or senile patient needs to be seen by a
geriatrician. The selection of patients for the provision of specialized
geriatric care is based on the identification of the main geriatric syndromes
and the syndrome of senile asthenia, which limit the functionality and life
of an elderly person. With the already developed syndrome of senile
asthenia, it is necessary to connect all possible measures for the provision
of socio-medical assistance and support, carrying out close interaction with
social services.
To understand the peculiarities of working with patients of older age
groups, first of all, it is necessary to give the basic concepts and definitions
in this area of medical knowledge.
10
1. BRIEF INFORMATION ON THE FRAILTY SYNDROME
Definition of the disease, ICD-10 code, formulation of the diagnosis.
Frailty syndrome (frailty) is a key geriatric syndrome characterized by
an age-associated decrease in the physiological reserve and functions of
many body systems, leading to an increased vulnerability of the body of an
elderly person to the effects of endo- and exogenous factors, with a high risk
of developing adverse health outcomes, loss of autonomy and death. Frailty
syndrome is closely associated with other geriatric syndromes and with
polymorbidity, may be potentially reversible and affects patient
management.
R54 — Old age without mention of psychosis, old age without
mention of psychosis, senile: asthenia, weakness.
Frailty is listed as the first comorbid condition, and all identified
geriatric syndromes must be included in the diagnosis. Frailty may not be
the only geriatric syndrome identified
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