Related Articles

Factors affecting outcomes among older trauma patients in Singapore: A retrospective observational study

Dear Editor, Singapore faces a rapidly ageing population with its median age projected to be above 45 years by 2030. Our greying demographics is accompanied by a rise in chronic diseases and medication use, including polypharmacy.1 Longer life expectancy and increased activity levels have contributed to higher incidence of geriatric...

Anti-osteoporosis drugs reduce mortality in cancer patients: A national cohort study of elderly with vertebral fractures

Osteoporotic vertebral fractures (OVFs) are the most prevalent type of fragility fractures, affecting 25% of adults in their early 70s and 43% of those over the age of 80.1,2 Following an OVF, persistence of the vertebral deformity may lead to spinal kyphosis, which is associated with chronic lower back...

Anti-osteoporosis drugs and reduction of mortality in cancer patients

Osteoporosis and cancer share a complex relationship, with each condition influencing the progression and outcomes of the other.1 Multiple factors, such as chemo- and hormonal therapies, and the direct invasion of bone tissue by malignant cells contribute to the accelerated bone loss seen in cancer patients.1 Various anti-osteoporosis drugs,...

Impact of an ageing population on the intensive care unit

Dear Editor, Intensive care unit (ICU) resources are scarce and expensive, and deciding if intensive care is suitable for older patients involves complex clinical reasoning, ethical challenges and cost considerations. Although some studies show that ICU mortality increases with age, others suggest that age alone is not predictive of poor...

Preoperative shock index in major abdominal emergency surgery

Major abdominal emergency surgery (MAES) is a complex and high-risk procedure with a significantly greater risk of complications and mortality as compared to elective surgery.1-3 Mortality rates in MAES can range from 14% to 20%,2,4 with current literature quoting rates as high as 45%.5 To objectively assess the perioperative surgical...

Shock index: Easy to use, but can it predict outcomes following major abdominal emergency surgery?

Major abdominal emergency surgery (MAES) is commonly performed for various potentially life-threatening intra-abdominal surgical conditions with high perioperative mortality of up to 45%.1 Certain patient factors (e.g. advanced age, frailty, and presence of multiple comorbidities) and disease factors (e.g. perforated viscus and intra-abdominal sepsis) have been shown to predict...

Transitional care strategies at emergency department for elderly patients: A multicentre study in Singapore

In Singapore, greater efforts are being directed towards developing an integrated health and social ecosystem under the new Healthier SG strategy announced by the Ministry of Health. This life-course approach aims to promote overall healthier living in collaboration with key community partners (e.g. intermediate and long-term care service providers)...

A strategy to make COVID-19 vaccination more accessible to the elderly

Dear Editor, Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the Vaccination Centres (VCs). These are dedicated facilities created with the sole purpose of providing the public with safe and convenient access to vaccination services. While the...

ICU nutrition: Bracing for the silver tsunami

The global population’s life expectancy is growing with a steady increase in the proportion of older patients admitted to the intensive care unit (ICU).1 Up to 13% of the ICU patients are above the age of 80.2 Older critically ill patients have lower physiological reserves of the various organ...

Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore

The Patient-Centred Medical Home (PCMH) is a model of chronic care that replaces episodic primary care, with the delivery of primary care to patients, families and communities. It is guided by the principles of first-contact accessibility, comprehensiveness and whole-person orientation, integration and care coordination, sustained clinician-patient relationships, and quality...

Determinants of emergency department utilisation by older adults in Singapore: A systematic review

Older adults in Singapore contribute to a disproportionately higher number of visits to the emergency department (ED), mirroring trends around the world.1,2 For instance, hospital admissions among those aged ≥65 years have been on the rise from 2018 to 2020, contributing a growing burden to ED services over the...

Perceived Need for Community Geriatric Services: A Survey at a Regional Hospital in Singapore in an Inpatient Setting

Singapore has one of the most rapidly ageing populations in the wor1d. The number of the very aged (>75 years old) has already increased from 42,700 in 1985 to 75,500 in 1995. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

The Reliability and Validity of the Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the Elderly Chinese in Hong Kong

The Alzheimer’s Disease Assessment Scale (ADAS) is a 21-item scale designed to assess the severity of cognitive and non-cognitive impairment in patients with Alzheimer’s disease (AD). This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Delirium in patients following general anaesthesia

Delirium is a disturbance of consciousness characterised by an acute onset and fluctuating course of inattention, accompanied by either a change in cognition or a disorganised thinking, resulting in an impaired ability of the patient to receive, process, store and recall information. Delirium develops over a short period of...

Critical Success Factors in Implementing Clinical Pathways/Case Management

Supplement on Casemix Conference Singapore 2001 held on 17-19 August 2001 in Singapore This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Critical Role of Functional Decline in Delayed Discharge from an Acute Geriatric Unit

In the last decade, many countries have experienced alarming transformation in their demographic patterns, with the elderly population emerging as the fastest growing segment of the population. Owing to their generally poorer health status in terms of chronic illnesses and long-term disability, the elderly consume a disproportionate amount of...

The Practice of Foregoing Life Support in the Critically Ill “Old Old”: A Singapore Perspective

Studies on the foregoing of life support (FLS) in North America, Europe and Australia have shown diversity in terms of the incidence, decision-making process and outcome. However, they have not specifically looked into such practice in the elderly. This article is available only as a PDF. Please click on “Download...

Early Unplanned Readmission of Elderly in Singapore: A Retrospective Study

The number of elderly people in Singapore is expected to increase over the next 2 decades. The proportion of those 60 years and above is estimated to increase from the present 11% to 27% by the year 2030. This article is available only as a PDF. Please click on “Download...

Evidence-based Medicine: The Key to Guidelines, Disease and Care Management Programmes

Health care in America and the rest of the industrialised world continues to reinvent itself at an ever-accelerating rate. The societal pressures for high quality, high value care that produces measurable improvement in quality processes and outcomes is increasing from the government and private sectors. This article is available only...

Epidemiology of Beta-haemolytic Group G Streptococcal Bacteraemia in Singapore (1996 to 1998)

Human isolates of group G streptococci (GGS) that form large colonies are similar to group A streptococci (GAS) in terms of virulence and cause a range of serious infections. These included infective endocarditis which had been emphasised in older reports1 but was found to be uncommon in later studies. This...

Nursing Home Falls: A Local Perspective

Falls in the elderly has been a well-studied subject and now occupies an important place in geriatric medicine. While many studies have been done on falls in community-dwelling elderly, relatively few studies have focused on the problem in institutionalised elderly. This article is available only as a PDF. Please click...

The Development of Geriatric Psychiatry Services in Singapore

The population of Singapore is ageing. In 2002, it was estimated that there were 252,700 persons aged >65 years, forming 7.5% of the population. By 2030, there will be 794,000, forming 18.4% of the population. This article is available only as a PDF. Please click on “Download PDF” on top...

Emergency Department Usage by Community Step-Down Facilities – Patterns and Recommendations

It is projected that elderly persons will make up 18.4% of Singapore’s population by the year 2030. Currently, there are 5189 residents staying in nursing homes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Critically Ill Elderly Who Require Mechanical Ventilation: The Effects of Age on Survival Outcomes and Resource Utilisation in the Medical Intensive Care Unit of a General Hospital

Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly population above the age of 65 will rise from 7.5% in 2002 to 18.9% by the year 2030. This article is available only as a PDF....

Strategies to Promote Better Outcomes in Young People with Chronic Illnesses

The epidemiology of child health in the developed world is changing. Mortality from infectious diseases has fallen sharply over the past century due to public health measures, such as sanitation and immunisation, better housing and sweeping improvements in health care. This article is available only as a PDF. Please click...

Polypharmacy and Inappropriate Medication Use in Singapore Nursing Homes

The elderly usually have multiple medical problems, requiring prescription drugs to treat diseases and to prevent complications arising from them. Currently, in the United States, those who are 65 years and older (geriatric age group) make up 13% of the total population but consume 33% of all prescription drugs. This...

“Future” Threat of Gram-negative Resistance in Singapore

Gram-negative bacteria are important causes of urinary tract infections, bloodstream infections, healthcare-associated pneumonia, and intra-abdominal infections. The increasing resistance of Enterobacteriaceae is a significant challenge. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Independent Predictors for Mortality in Patients with Positive Stenotrophomonas maltophilia Cultures

Stenotrophomonas (formally Pseudomonas or Xanthomonas) maltophilia is a gram-negative bacillus emerging as an opportunistic, nosocomial pathogen associated with a high mortality rate. Although it was previously considered to have limited pathogenicity, recent reports suggested that infection with S. maltophilia was associated with significant morbidity and mortality, particularly in severely...

Performance Measures for Mental Healthcare in Singapore

Mental disorders are prevalent worldwide and while they are disabling and costly, they have not received that amount of attention and resources needed. A recent survey of low-income and middle-income countries (as per World Bank classification) revealed that government spending on mental health is much lower than what is...

Hip Fractures in the Elderly: The Impact of Comorbid Illnesses on Hospitalisation Costs

Management of hip fractures is costly and continues to generate significant costs throughout the one-year period after discharge.1 They demand considerable resources from a country’s health care system.2,3 Hip fractures are the commonest cause for admission in the acute orthopaedics setting in the elderly.4 As a result of an...

A Review of Geriatric Education in Singapore

The United Nations International Plan of Action on Ageing (IPA), formulated during the First World Assembly on Ageing in Vienna in 1982, listed gerontological education at all levels as a priority in order to meet the challenges of global population ageing.1 The Second World Assembly on Ageing held in...

Surgical Management of Obesity – National University Hospital Experience

The Singapore National survey of 1992 reported the prevalence of obesity to be 5.1%, increasing to 6.0% in 1998, and in the 2004 survey it had increased to 6.9%.1 The increase reflects the profound changes in our society’s lifestyle and eating habits. Today, obesity is not only a threat...

The Natural History and Prognosticative Factors of Adult Extremity Soft Tissue Sarcomas: An Asian Perspective

Soft tissue sarcomas (STSs) are extremely rare tumours, making up about 1% of all malignancies. In Singapore, they accounted for 0.7% of all cancers in males and 0.5% of all cancers in females with 217 case presentations in the period between 1998 and 2002. This article is available only as...

Profiling Acute Presenting Symptoms of Geriatric Patients Attending an Urban Hospital Emergency Department

Singapore’s population is ageing rapidly. Today 1 out of every 12 Singaporeans is aged 65 or above. In 2030, it is expected to be 1 out of 5.1 This poses a challenge to our healthcare system especially our emergency departments. This article is available only as a PDF. Please click...

Evaluation of Intensive Care Unit-acquired Urinary Tract Infections in Singapore

Urinary tract infection (UTI) is one of the most common types of nosocomial infections encountered in the inpatient settings including intensive care unit (ICU). Amongst patients admitted to ICU, studies have revealed the incidence of nosocomial UTIs to range from 9% to 29%. This article is available only as a...

Risk Assessment Models in Acute Coronary Syndromes and Their Applicability in Singapore

Strategies for managing cardiovascular disease are evolving rapidly. This evolution and improvement in care is responsible for reducing mortality especially in patients presenting with acute coronary syndromes (ACS). Nevertheless, there is room for further improvement in outcomes, particularly amongst high-risk patient subgroups in this population. This article is available only...

Junior Doctors’ Attitudes Towards Older Adults and its Correlates in a Tertiary-care Public Hospital

Singapore is a rapidly ageing society. The proportion of older persons above the age of 65 was 6.8% of the population in 1995 and is projected to increase to 20% by the year 2030. The medical community is also faced with a similar problem in caring for an ageing...

Stress Levels amongst Caregivers of Patients with Osteoporotic Hip Fractures – A Prospective Cohort Study

With the issue of an ageing population in many first-world countries, osteoporotic hip fractures remain a concern. These fractures are known to have a significant impact on the functional status, quality of life and mental health of patients. This article is available only as a PDF. Please click on “Download...

Hormone Receptors and HER-2 Status as Surrogates for Breast Cancer Molecular Subtypes Prognosticate for Disease Control in Node Negative Asian Patients Treated with Breast Conservation Therapy

Breast cancer is a major cause of morbidity and mortality in women worldwide. Asian women have a lower incidence of breast cancer historically but over the last 40 years, breast cancer incidence in countries such as China, Korea and Japan has increased. In Singapore, not only is breast cancer...

Older Age at Initial Presentation to Human Immunodeficiency Virus (HIV) Care and Treatment at the Communicable Disease Centre (CDC) in Singapore, 2006 to 2011

Since the first case of human immunodeficiency virus (HIV) in Singapore was identified in 1985, the incidence of HIV/acquired immunodeficiency syndrome (AIDS) has steadily increased, reaching a peak rate of 125.2 cases per million population in 2008. From 2006 to 2011, 28.3% of newly diagnosed HIV/AIDS cases in Singapore...

Can Preoperative Scoring Systems be Applied to Asian Hip Fracture Populations? Validation of the Nottingham Hip Fracture Score (NHFS) and Identification of Preoperative Risk Factors in Hip Fractures

Osteoporotic hip fractures are common and have significant consequences on mortality and functional capability which indirectly has familial, social and economic repercussions. The inpatient mortality rates approach 4% to 12%, while 1-year mortality is between 12% to 37%.2, Studies from Denmark, Italy, the United Kingdom (UK), and the United...

Anticoagulation Needs in Asians with Atrial Fibrillation: A Mythbuster

Atrial fibrillation (AF) increases the risk of stroke 5-fold in Caucasians. While the relative risk for stroke is somewhat lower in Asia, estimated at 3.6% in Singapore, total AF and stroke-associated mortality rates are reported to be similar. This article is available only as a PDF. Please click on “Download...

Changing Landscape of Nursing Homes in Singapore: Challenges in the 21st Century

Nursing homes trace their evolution to American alms-houses in the 1930s where retired nurses welcomed the elderly and ill into their homes. In Singapore, community-based charitable organisations pioneered the earliest sheltered accommodations for homeless and destitute elderly immigrants. For instance, the local chapter of the Little Sisters of the...

Determinants of Health-Related Quality of Life Among Community Dwelling Elderly

Singapore is experiencing an unprecedented age shift as the post-war baby boomers turn 65 years in 2012. Currently there are 378,700 people aged 65 and above, and these numbers are estimated to go up to 600,000 by 2020. These growing elderly population have multiple coexisting medical conditions which are...

Prehabilitation and Its Role in Geriatric Surgery

The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As the life expectancy of the population has improved significantly in the past few decades, a substantial portion of this rapidly ageing population will place a...

Congenital adhesion band causing recurrent subacute intestinal obstruction in a virgin abdomen

Intestinal obstruction (IO) caused by malignancy and adhesion bands from previous surgery is common among adults. However, IO caused by congenital adhesion bands (CAB) in the elderly is rare. We report a case of a 63-year-old man who presented with acute-on-chronic intestinal obstruction due to CAB, which caused pseudointestinal...

Tackling osteoporosis and fragility fractures in Singapore

A shift in worldwide population ageing demographics has occurred in the 21st century. The longevity miracle is most keenly felt in Singapore, a young nation which gained its independence only in 1965, but has one of the fastest growing ageing populations in the world. It is estimated that by...