Dear Editor, End-stage renal disease (ESRD) patients have higher mortality, hospital admissions and invasive procedures towards the end of life.1 However, many of them (82%) prioritise minimising suffering over life prolongation. Although twice as many patients prefer dying at home and inpatient hospice (65%) compared to hospital (27%), hospice utilisation...

Modern society views death as an aberration which has to be postponed and, if possible, prevented at all cost. Death is just unacceptable and cannot be regarded as a natural process of life. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Loss of ability to feed independently and swallowing impairment are common problems in the elderly and will be an increasing cause of disability as the population ages. A study in Europe suggested that up to 10% of people older than 50 experience troublesome dysphagia. This article is available only as...

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...

A patient with recurrent stroke disease and severe pneumonia did not respond to the previous courses of antibiotics. The medical team decided to switch to another broad-spectrum antibiotic. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

In Australia, the number of elderly people is increasing rapidly. In 2001, the population of Australia was approximately 19 million people and about 12.6% of this population were >65 years old. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

The last century has witnessed the establishment of geriatric medicine as a well-recognised medical specialty supported by a respectable body of evidence, which shows that it is able to improve the health outcomes of frail older persons. Since the pioneering work of Marjory Warren in the 1930s, different models...

Across the globe, there has been a rapid increase in the absolute and relative numbers of older persons. According to the 1993 World Bank report, the number of people aged 65 and above will form 1 in 4 of the population in 2025.1 The projected percentage increase in the...

Pulmonary hernia is a rare and uncommon clinical entity that has been defined as a protrusion of pleural membranes or lung parenchyma through the defect in the thoracic enclosure. According to aetiology, pulmonary hernias can be congenital (due to rib or intercostal hypoplasia or agenesis) or acquired (traumatic, pathological...

Around two-thirds of people with incurable diseases in economically developed countries wish to die at home, but less than one third succeed in doing so. Developing primary care-based services for the dying in the community is essential to reach and serve the whole population, and to provide care where...

Opioid use in terminally ill cancer patients at the end of life has been a source of concern amongst many for fear of its perceived life shortening effects, despite evidence to the contrary. This fear has, in fact, contributed to the reluctance in utilising these drugs to provide adequate...

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...

The concept of medical futility has been present since antiquity, and traditionally marked the shift in the primary goal of care to providing physical and emotional comfort. Only by following the declaration of futility could interventions be designed to relieve distress and pain for the patient, and bringing a...

The number of persons aged over 65 will increase from 8.4% in 2005 to 18.7% in 2030, which translates to absolute numbers of 296,900 in 2005 to 873,300 of older persons in Singapore by 2030. The life expectancy at birth has also increased from 79.1 years (2003) to 80.6...

Dear Editor, We read with interest the article published in the June 2021 issue of the Annals titled “Use of telemedicine in healthcare during COVID-19 in Pakistan: Lessons, legislation challenges and future perspective”.1 We would like to share our perspectives on using telemedicine to deliver palliative care during the COVID-19...

Understanding the way personhood or “what makes you, you” is conceptualised is pivotal to the practice of medicine. Conceptions of personhood determine the moral and legal status of an individual, is central to the protection of rights and privileges and is pivotal to the maintenance of the distinctiveness of...

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...

The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is described as a thrombo-inflammatory syndrome,1 with severe respiratory illness occurring in about 13% of affected patients. This can rapidly transform into a life-threatening condition in...

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...