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...

Alexandra Hospital is the first hospital in Singapore with a Day Hospital for the elderly. One of the main functions of the Day Hospital is to rehabilitate the disabled elderly. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The single most important determinant of the quality of an elderly person’s life is health. In the elderly, health matters affect all other areas of life, including his willing ness to seek and accept help. This article is available only as a PDF. Please click on “Download PDF” on top...

Chryseobacterium meningosepticum has been known to be a causative agent of meningitis particularly in the premature and newborn infants. The first case of human infection with this organism was reported by King in 1959. This article is available only as a PDF. Please click on “Download PDF” on top to...

The head of caudate nucleus forms a prominent bulge in the lateral wall of the anterior horn of the lateral ventricle. Its blood supply is from the deep penetrators from the middle cerebral and anterior cerebral arteries. This article is available only as a PDF. Please click on “Download PDF”...

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 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.

The prevalence of hearing impairment in the local elderly population is not known. Hearing loss prevalence estimates that 25% to 40% of individuals over 65 years of age are hearing impaired. However, there is no universal agreement on the definition of “normal hearing” and comparison between studies that report...

Doctors caring for elderly, dying and terminally ill patients are often faced with the dilemma of having to make difficult decisions especially regarding treatment where the benefit and burden is not clearly defined. Issues relating to death and dying, such as whether to disclose the diagnosis and prognosis to...

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...

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...

Voiding dysfunction is a relatively common problem in hospitalised older patients. Up to one-third of hospitalised elderly were reported to have post-void residual urine volume (PRUV) of more than 50 mL. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Cardiovascular disease is one of the leading causes of mortality and morbidity in developed countries, especially among the elderly. In Taiwan, cardiovascular disease is the third leading cause of death after neoplasm and cerebrovascular disease. This article is available only as a PDF. Please click on “Download PDF” on top...

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...

In 1898, Bastian first reported on the case of a man who had been admitted to hospital with hemiplegia and aphasia, but who had transient difficulty in deglutition. Necropsy revealed that apart from two limited lesions in the left hemisphere, the patient’s brain was normal. This article is available only...

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...

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...

Physical inactivity has been identified as a major cause of morbidity and mortality secondary to cardiovascular disease, diabetes mellitus and hypertension. It contributes to the loss of physiological and psychological capabilities that result in overall reduction in function and independent living. This article is available only as a PDF. Please...

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...

Cerebrovascular disease is the fifth commonest cause of hospitalisation in Singapore, and accounts for 2.7% of all hospital discharges. Neurogenic dysphagia is a common complication of stroke disease and it has been shown that post stroke dysphagic patients have 6.95 times higher risk of developing pneumonia when compared to...

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.

Persistent pain has been estimated to occur in 50% of community dwelling older people of age 65 years and above. It has been associated with multiple functional and psychological complications. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Depression in late life (>60 years old) is one of the most common and treatable psychiatric disorders in the elderly. It not only causes distress and suffering, but leads to impairment of physical, mental and social functioning, worsens prognosis for certain medical conditions, aggravates suicidal risk and increases utilisation...

Dementia is an age-prevalent chronic degenerative disease that causes gradual and progressive deterioration of a patient’s cognitive abilities. With Singapore’s rapidly ageing population, the prevalence of dementia has been rising inevitably and steadily. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Given the rapid ageing of Singapore, all practising clinicians can expect to see an exponential rise in the medical and surgical problems of the elderly. One such condition is dementia. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The prevalence of dementia or cognitive impairment in local studies has been shown to range from 2% to 13%. These differences in prevalence rates depend very much on the sensitivities of the different locally validated cognitive screening instruments used, as some may be better at detecting early dementia and,...

Urinary incontinence is the involuntary loss of urine which is objectively demonstrable and is a social or hygienic problem. Trivial as it may sound, it is in fact a major geriatric syndrome which may pose as major public health threat with increasing magnitude in this ageing society, due to...

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...

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...

Ignatz Nascher first proposed disease and medical care of the aged as a separate specialty and invented the term “geriatrics” in 1909. However, the growth of geriatric medicine and healthcare of the elderly is often attributed to the pioneering work of Majorie Warren who successfully treated and rehabilitated seemingly...

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.

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....

Symptoms and signs of thyroid dysfunction in the elderly tend to be atypical and may be mistakenly attributed to the ageing process. Currently, thyroid function tests are performed on patients who manifest signs and symptoms of overt thyroid disease or as part of the investigations for dementia in the...

Casemix refers to the numbers and types of patients within a healthcare setting and Diagnosis Related Groupings (DRGs) represent one mode of classifying casemix. In essence, DRGs are categories of clinically meaningful patient conditions which require similar levels of hospital resources for their treatment. This article is available only as...

A general philosophy in the care of elderly patients is to use the least drugs possible to achieve the desired clinical outcome. In the United States (US), however, although patients >65 years old represent only 13% of the total population, they consume nearly 30% of all prescription medications. This article...

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...

Dementia has been reported to affect 4% to 13% of individuals above the age of 65, with the difference in prevalence rates being dependent on the screening tools used and the criteria adopted for the diagnosis of dementia. The evaluation of any individual presenting with suspected dementia has a...

Many cross-sectional and longitudinal studies have reported an association between sensory and cognitive functions in the normal ageing population. Few studies have assessed the association between sensory and cognitive impairment as most studies on cognitive ageing excluded those with sensory and cognitive impairments. This article is available only as a...

With the introduction of block budget for acute care hospitals, cost containment is an important issue for all secondary and tertiary hospitals. Though health care cost was rising at a rate of 31.2% between the year 2002 and 2003, it is important to keep the cost of health care...

Hospitalisation is a stressful event for the older person. The physiological changes associated with ageing, such as decreased muscle strength and aerobic activity, reduced bone density, altered appetite and tendency towards urinary incontinence, predispose older patients to complications during hospitalisation. Studies have shown that about one-third of older persons...

With the exponential increase in the elderly population in Singapore, the training of young physicians of tomorrow in the care of elderly patients will need to change accordingly. A potential way to fulfill this need is to increase the number of specialists proportionately to manage elderly patients effectively. This article...

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...

More than 100 years ago Alois Alzheimer first presented the clinical and pathological features of an unusual brain disease at his seminal lecture in Tübingen. The patient, Auguste Deter, suffered memory loss, disorientation, hallucinations and died at an early age of 55. This article is available only as a PDF....

The number of older adults in Singapore has been steadily increasing over the years and will continue to do so. In 2007, older adults aged 65 years and above accounted for 8.5% of the total population and by the year 2030, it is estimated that this group will account...

Dementia is a growing public health issue in the Asia-Pacific region. The number of people with dementia in the Asia-Pacific region will increase from 13.7 million people in 2005 to 64.6 million people in 2050. This article is available only as a PDF. Please click on “Download PDF” on top...

With increasing life expectancy and low fertility rates, the proportion of the elderly is rapidly increasing in developed nations, Singapore being no exception. The elderly (over 65 years) population in Singapore is expected to grow from 7.2% in 2000 to 18.4% by 2030. This article is available only as a...

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 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...

Ageing is a complex process. Achieving it successfully has implications and significance not only for individuals on a personal level but for society at large, where demographic changes and population consequences pose significant clinical and public health issues. This article is available only as a PDF. Please click on “Download PDF”...

Hip hemiarthoplasties are commonly performed for displaced femoral neck fractures. The advantages of hemiarthroplasty over internal fixation include earlier mobility, less reoperations and better functional outcome at 1 year. Considerable differences of opinion exists regarding the choice between unipolar and bipolar designs. The main theoretical advantage of a bipolar over...

Sepsis is a prevalent and important cause of morbidity and mortality in the general population. Approximately 750,000 patients in the United States alone develop severe sepsis each year. Of this, more than 60% are patients older than 65 years. Morbidity and mortality remain high in spite of advances in...

Bullous pemphigoid (BP) is a subepidermal blistering dermatosis characterised by circulating autoantibodies targeting BP180 and BP230 hemidesmosomal proteins. Anti-BP180 NC16A IgG antibodies have been demonstrated to be directly pathogenic in blister formation. Anti-BP180 IgG titres were noted to parallel disease activity in several case series, as well as reflect...

The year 2014 had marked the 10th anniversary of the nationwide Age-related Macular Degeneration (AMD) Awareness Week in Singapore.1 This public health campaign, organised annually since 2005, aims to generate awareness and understanding of AMD by promoting the importance of education, early detection, and knowledge of treatment and rehabilitation...

Case 1: An 85-year-old male with past history of hypertension is otherwise healthy and enjoys his daily walks and good food. During a health screening, he was found to be hyperlipidaemic (LDL 3.4 mmol/L; HDL 1.0 mmol/L). He was started on simvastatin 20 mg nocte by his physician. He...

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...

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in Singapore and from around the world. Between 2010–12, local OHCA patients with a witnessed arrest and shockable rhythm had a survival-to-hospital discharge rate of 11.0%. Treatment of OHCA patients is resource-intensive since it requires invasive interventions and potentially...