Letter to the Editor
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,...
Letter to the Editor
Emergency department falls interventions improve osteoporosis management in frail older adults
Dear Editor,
Singapore’s population is ageing rapidly and by 2030, around 1 in 4 citizens will be aged 65 and above.1 Older adults represent 21–40%...
Letter to the Editor
Safety and effectiveness of nitrous oxide procedural sedation in a paediatric emergency department
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...
Letter to the Editor
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...
Review Article
Nutrition therapy in the older critically ill patients: A scoping review
The increasing levels of life expectancy and decreasing fertility are shifting the age structure of the world population towards older ages.1 From year 2020...
Editorial
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...
Original Article
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,...
Commentary
Activating Code Crimson in the emergency department: Expediting definitive care for trauma patients with severe haemorrhage in Singapore
Public healthcare institutions (PHIs) in Singapore have a range of policies and guidelines for the management of patients presenting to the emergency department (ED)...
Editorial
Frequent attenders to multiple emergency departments in Singapore
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...
Review Article
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,...
Original Article
A Descriptive Study of the Demography, Symptomology, Management and Outcome of the First 300 Patients Admitted to an Independent Hospice in Singapore
Modern society views death as an aberration which has to be postponed and, if possible, prevented at all cost. Death is just unacceptable and...
Original Article
Day Hospital Rehabilitation for the Elderly: A Retrospective Study
Alexandra Hospital is the first hospital in Singapore with a Day Hospital for the elderly. One of the main functions of the Day Hospital...
Original Article
Self-Perception of Health among Elderly Community Dwellers in Singapore
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...
Others
Chryseobacterium meningosepticum (Flavobacterium meningosepticum)—A Report of Five Cases in a Local Hospital
Chryseobacterium meningosepticum has been known to be a causative agent of meningitis particularly in the premature and newborn infants. The first case of human...
Others
Bilateral Caudate Infarct—A Case Report
The head of caudate nucleus forms a prominent bulge in the lateral wall of the anterior horn of the lateral ventricle. Its blood supply...
Original Article
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...
Original Article
Swallowing Impairment and Feeding Dependency in the Hospitalised Elderly
Loss of ability to feed independently and swallowing impairment are common problems in the elderly and will be an increasing cause of disability as...
Original Article
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...
Original Article
Screening for Hearing Impairment in Hospitalised Elderly
The prevalence of hearing impairment in the local elderly population is not known. Hearing loss prevalence estimates that 25% to 40% of individuals over...
Original Article
End-of-life Issues—Preferences and Choices of a Group of Elderly Chinese Subjects Attending a Day Care Centre in Singapore
Doctors caring for elderly, dying and terminally ill patients are often faced with the dilemma of having to make difficult decisions especially regarding treatment...
Commentary
Preparing for the silver boom: A falls prevention tool for older adults in the emergency department
Each year, 28–35% of community dwelling adults over 65 years fall.1 This figure increases to about 50% for those above 80 years old.2 Falls...
Editorial
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...
Original 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...
Original Article
Urinary Retention in Hospitalised Older Women
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...
Original Article
Body Mass Index and Its Related Factors in the Elderly
Cardiovascular disease is one of the leading causes of mortality and morbidity in developed countries, especially among the elderly. In Taiwan, cardiovascular disease is...
Original Article
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...
Review Article
The Impact of Swallowing Disorders in the Elderly
In 1898, Bastian first reported on the case of a man who had been admitted to hospital with hemiplegia and aphasia, but who had...
Original Article
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...
Original Article
The Acute Presentation of Pulmonary Thromboembolism: A Retrospective Viewpoint
Pulmonary thromboembolism (PE) has historically been considered a rarity in the Asian population. Although well studied in the West, Asian literature on this condition...
Original Article
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...
Original Article
Correlates of Habitual Walking and Sports/Leisure-time Physical Activity in Older Persons in Singapore: Interaction Effects Between Educational Attainment and Gender
Physical inactivity has been identified as a major cause of morbidity and mortality secondary to cardiovascular disease, diabetes mellitus and hypertension. It contributes to...
Original Article
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...
Original Article
Bedside Clinical Methods Useful as Screening Test for Aspiration in Elderly Patients with Recent and Previous Strokes
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...
Review Article
End-of-life Care: Challenges and Obligations in Setting Limits to Life-sustaining Therapy
A patient with recurrent stroke disease and severe pneumonia did not respond to the previous courses of antibiotics. The medical team decided to switch...
Review Article
Considerations in the Assessment and Management of Older People with Chronic Pain
Persistent pain has been estimated to occur in 50% of community dwelling older people of age 65 years and above. It has been associated...
Review Article
Late-life Depression: Current Issues and New Challenges
Depression in late life (>60 years old) is one of the most common and treatable psychiatric disorders in the elderly. It not only causes...
Review Article
Neurofibrillary and Ethico-legal Tangles: In Search of Surrogates for Dementia Patients Lacking Decision-making Capacity and Relatives
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...
Review Article
Assessing Decision-making Capacity in Dementia Patients: A Semi-structured Approach
Given the rapid ageing of Singapore, all practising clinicians can expect to see an exponential rise in the medical and surgical problems of the...
Review Article
An Evidence-based Clinical Approach to the Diagnosis of Dementia
The prevalence of dementia or cognitive impairment in local studies has been shown to range from 2% to 13%. These differences in prevalence rates...
Review Article
Urinary Incontinence in Older Persons: A Simple Approach to a Complex Problem
Urinary incontinence is the involuntary loss of urine which is objectively demonstrable and is a social or hygienic problem. Trivial as it may sound,...
Review Article
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....
Review Article
Aged Care Issues and Services in Australia
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%...
Review Article
Aged Care Services in Singapore – An Overview
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...
Editorial
Challenges in Geriatric Medicine: Geriatric Services and Education
Ignatz Nascher first proposed disease and medical care of the aged as a separate specialty and invented the term “geriatrics” in 1909. However, the...
Others
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...
Others
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...
Original Article
Thyroid Dysfunction in Elderly Patients
Symptoms and signs of thyroid dysfunction in the elderly tend to be atypical and may be mistakenly attributed to the ageing process. Currently, thyroid...
Original Article
Improving the Diagnosis Related Grouping Model’s Ability to Explain Length of Stay of Elderly Medical Inpatients by Incorporating Function-linked Variables
Casemix refers to the numbers and types of patients within a healthcare setting and Diagnosis Related Groupings (DRGs) represent one mode of classifying casemix....
Original Article
Impact of a Pharmacist Consult Clinic on a Hospital-based Geriatric Outpatient Clinic in Singapore
A general philosophy in the care of elderly patients is to use the least drugs possible to achieve the desired clinical outcome. In the...
Original Article
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...
Original Article
Evaluation of Dementia: The Case for Neuroimaging All Mild to Moderate Cases
Dementia has been reported to affect 4% to 13% of individuals above the age of 65, with the difference in prevalence rates being dependent...
Original Article
Are Sensory and Cognitive Declines Associated in Older Persons Seeking Aged Care Services? Findings From a Pilot Study
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...
Original Article
Factors Causing Delay in Discharge of Elderly Patients in an Acute Care Hospital
With the introduction of block budget for acute care hospitals, cost containment is an important issue for all secondary and tertiary hospitals. Though health...
Original Article
Factors Associated With Functional Decline of Hospitalised Older Persons Following Discharge From an Acute Geriatric Unit
Hospitalisation is a stressful event for the older person. The physiological changes associated with ageing, such as decreased muscle strength and aerobic activity, reduced...
Original Article
When the Stork Arrives Unannounced – Seven Years of Emergency Deliveries in a Non-obstetric General Hospital
Emergency department (ED) deliveries are uncommon in the Singapore setting, as patients presenting with labour to the ED are sent to the obstetric suites...
Original Article
Attitudes of First-year Medical Students in Singapore Towards Older People and Willingness to Consider a Career in Geriatric Medicine
With the exponential increase in the elderly population in Singapore, the training of young physicians of tomorrow in the care of elderly patients will...
Original Article
Observational Study to Determine Factors Associated with Blood Sample Haemolysis in the Emergency Department
Haemolysis of blood samples leads to inaccurate results and often necessitates a repeat sample. Escalating workloads and finite resources are an increasing problem in...
Editorial
Alzheimer’s Disease – Towards More Patient-centred and Meaningful Clinical Outcomes
More than 100 years ago Alois Alzheimer first presented the clinical and pathological features of an unusual brain disease at his seminal lecture in...
Original Article
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...
Commentary
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...
Original Article
Resource Consumption in Hospitalised, Frail Older Patients
The number of older adults in Singapore has been steadily increasing over the years and will continue to do so. In 2007, older adults...
Original Article
Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden
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...
Original Article
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...
Original Article
Predicting Positive Blood Cultures in Patients presenting with Pneumonia at an Emergency Department in Singapore
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...
Original Article
Validity and Reliability of the Expectations Regarding Aging (ERA-12) Instrument among Middle-Aged Singaporeans
With increasing life expectancy and low fertility rates, the proportion of the elderly is rapidly increasing in developed nations, Singapore being no exception. The...
Original Article
Factors Affecting the B-Type Natriuretic Peptide Levels in Stroke Patients
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...
Original Article
Herpes Zoster as a Useful Clinical Marker of Underlying Cell-mediated Immune Disorders
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...
Original Article
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...
Original Article
An Observational, Prospective Study to Determine the Ease of Vascular Access in Adults Using a Novel Intraosseous Access Device
Intravascular access is a vital component of emergency care and resuscitation. There is nothing more frustrating for the emergency physician than the inability to...
Original Article
Clinical Outcome Following Treatment of Stable and Unstable Intertrochanteric Fractures with Dynamic Hip Screw
Intertrochanteric (IT) fracture is among the most common orthopedic injuries in the elderly population, and is associated with osteoporosis. It usually occurs as a...
Original Article
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...
Original Article
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...
Clinical Update
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...
Original Article
External Validation of the Cham Score for Ordering of Blood Cultures in Emergency Department Patients with Non-Hospital Acquired Pneumonia
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...
Editorial
Successful Ageing in Singapore—A Viable Goal?
Ageing is a complex process. Achieving it successfully has implications and significance not only for individuals on a personal level but for society at...
Review Article
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,...
Original Article
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...
Original Article
Unipolar versus Bipolar Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly: Is There a Difference?
Hip hemiarthoplasties are commonly performed for displaced femoral neck fractures. The advantages of hemiarthroplasty over internal fixation include earlier mobility, less reoperations and better...
Letter to the Editor
Diagnosing Bacteraemia Early in Older Adults
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...
Original Article
Anti-BP180 NC16A IgG Titres as an Indicator of Disease Activity and Outcome in Asian Patients with Bullous Pemphigoid
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...
Editorial
A Decade of Progress in the Understanding, Prevention and Treatment of Age-related Macular Degeneration in Singapore
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...
Editorial
Evidence-balanced Medicine: “Real” Evidence-based Medicine in the Elderly
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...
Commentary
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...
Letter to the Editor
Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore
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...
Letter to the Editor
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)...
Editorial
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...
Letter to the Editor
Decrease in emergency department attendances during COVID-19 especially in school-going children
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...