Dear Editor,Nitrous oxide (N2O) produces dissociative euphoria, amnesia and analgesia, and is a common sedative for procedural sedation in paediatric emergency departments (EDs) due...

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...

Public healthcare institutions (PHIs) in Singapore have a range of policies and guidelines for the management of patients presenting to the emergency department (ED)...

The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its...

Modern society views death as an aberration which has to be postponed and, if possible, prevented at all cost. Death is just unacceptable and...

Alexandra Hospital is the first hospital in Singapore with a Day Hospital for the elderly. One of the main functions of the Day Hospital...

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...

Chryseobacterium meningosepticum has been known to be a causative agent of meningitis particularly in the premature and newborn infants. The first case of human...

The head of caudate nucleus forms a prominent bulge in the lateral wall of the anterior horn of the lateral ventricle. Its blood supply...

Singapore has one of the most rapidly ageing populations in the wor1d. The number of the very aged (>75 years old) has already increased...

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 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...

The prevalence of hearing impairment in the local elderly population is not known. Hearing loss prevalence estimates that 25% to 40% of individuals over...

Doctors caring for elderly, dying and terminally ill patients are often faced with the dilemma of having to make difficult decisions especially regarding treatment...

Delirium is a disturbance of consciousness characterised by an acute onset and fluctuating course of inattention, accompanied by either a change in cognition or...

In the last decade, many countries have experienced alarming transformation in their demographic patterns, with the elderly population emerging as the fastest growing segment...

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...

Cardiovascular disease is one of the leading causes of mortality and morbidity in developed countries, especially among the elderly. In Taiwan, cardiovascular disease is...

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...

In 1898, Bastian first reported on the case of a man who had been admitted to hospital with hemiplegia and aphasia, but who had...

The number of elderly people in Singapore is expected to increase over the next 2 decades. The proportion of those 60 years and above...

Pulmonary thromboembolism (PE) has historically been considered a rarity in the Asian population. Although well studied in the West, Asian literature on this condition...

Human isolates of group G streptococci (GGS) that form large colonies are similar to group A streptococci (GAS) in terms of virulence and cause...

Physical inactivity has been identified as a major cause of morbidity and mortality secondary to cardiovascular disease, diabetes mellitus and hypertension. It contributes to...

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...

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...

A patient with recurrent stroke disease and severe pneumonia did not respond to the previous courses of antibiotics. The medical team decided to switch...

Persistent pain has been estimated to occur in 50% of community dwelling older people of age 65 years and above. It has been associated...

Depression in late life (>60 years old) is one of the most common and treatable psychiatric disorders in the elderly. It not only causes...

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...

Given the rapid ageing of Singapore, all practising clinicians can expect to see an exponential rise in the medical and surgical problems of the...

The prevalence of dementia or cognitive impairment in local studies has been shown to range from 2% to 13%. These differences in prevalence rates...

Urinary incontinence is the involuntary loss of urine which is objectively demonstrable and is a social or hygienic problem. Trivial as it may sound,...

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....

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%...

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...

Ignatz Nascher first proposed disease and medical care of the aged as a separate specialty and invented the term “geriatrics” in 1909. However, the...

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...

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...

Symptoms and signs of thyroid dysfunction in the elderly tend to be atypical and may be mistakenly attributed to the ageing process. Currently, thyroid...

Casemix refers to the numbers and types of patients within a healthcare setting and Diagnosis Related Groupings (DRGs) represent one mode of classifying casemix....

A general philosophy in the care of elderly patients is to use the least drugs possible to achieve the desired clinical outcome. In the...

The elderly usually have multiple medical problems, requiring prescription drugs to treat diseases and to prevent complications arising from them. Currently, in the United...

Dementia has been reported to affect 4% to 13% of individuals above the age of 65, with the difference in prevalence rates being dependent...

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...

With the introduction of block budget for acute care hospitals, cost containment is an important issue for all secondary and tertiary hospitals. Though health...

Hospitalisation is a stressful event for the older person. The physiological changes associated with ageing, such as decreased muscle strength and aerobic activity, reduced...

Emergency department (ED) deliveries are uncommon in the Singapore setting, as patients presenting with labour to the ED are sent to the obstetric suites...

With the exponential increase in the elderly population in Singapore, the training of young physicians of tomorrow in the care of elderly patients will...

Haemolysis of blood samples leads to inaccurate results and often necessitates a repeat sample. Escalating workloads and finite resources are an increasing problem in...

More than 100 years ago Alois Alzheimer first presented the clinical and pathological features of an unusual brain disease at his seminal lecture in...

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...

The United Nations International Plan of Action on Ageing (IPA), formulated during the First World Assembly on Ageing in Vienna in 1982, listed gerontological...

The number of older adults in Singapore has been steadily increasing over the years and will continue to do so. In 2007, older adults...

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...

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...

Pneumonia is the fourth leading cause for hospitalisation, and the third leading cause of death in Singapore.1 Overall, it is consistently one of the...

With increasing life expectancy and low fertility rates, the proportion of the elderly is rapidly increasing in developed nations, Singapore being no exception. The...

The term “stroke” comprises all diseases in which a region of the brain is transiently or continuously affected by ischaemia or haemorrhage, and/or in...

Herpes zoster (HZ) occurs when latent virus in the dorsal-root ganglia becomes reactivated and causes a vesicular and often painful rash with a dermatomal...

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...

Intravascular access is a vital component of emergency care and resuscitation. There is nothing more frustrating for the emergency physician than the inability to...

Intertrochanteric (IT) fracture is among the most common orthopedic injuries in the elderly population, and is associated with osteoporosis. It usually occurs as a...

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...

Osteoporotic hip fractures are common and have significant consequences on mortality and functional capability which indirectly has familial, social and economic repercussions. The inpatient...

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...

Some guidelines currently promote the taking of blood cultures in patients admitted to hospital with non-hospital acquired pneumonia in order to identify pathogens and...

Ageing is a complex process. Achieving it successfully has implications and significance not only for individuals on a personal level but for society at...

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,...

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...

Hip hemiarthoplasties are commonly performed for displaced femoral neck fractures. The advantages of hemiarthroplasty over internal fixation include earlier mobility, less reoperations and better...

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...

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...

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...

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...

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 coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during...

Intestinal obstruction (IO) caused by malignancy and adhesion bands from previous surgery is common among adults. However, IO caused by congenital adhesion bands (CAB)...

A shift in worldwide population ageing demographics has occurred in the 21st century. The longevity miracle is most keenly felt in Singapore, a young...

Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with...