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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...

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 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...

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....

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...

Use of Physical Restraints in Nursing Homes: Current Practice in Singapore

Singapore’s population is ageing rapidly. It is estimated that the proportion of elderly aged 65 and above will rise from 7.2% of the total population in the year 2000 to 18.2% in 2030.1 Increase in life expectancy due to the availability of modern healthcare services has resulted in a...

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...

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...

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...

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 result of low energy trauma e.g. trivial falls. It carries considerable morbidity and mortality. In Singapore, there has been an increase in the incidence of...

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...

2013 Runme Shaw Memorial Lecture: Clinical Applications of Stem Cells in Modern Medicine—21st Century and Beyond

The rapid advancement of biomedical research in the recent years was propelled by a series of groundbreaking technological inventions and breakthrough discoveries. In this lecture, I will discuss about the scientific achievements that led to different eras of intense research with profound impact on biomedicine, focusing on the use...

Blue Dye, Blue Skin

A 59-year-old Chinese lady was scheduled for wide excision of an invasive ductal carcinoma of the left breast, with sentinel lymph node biopsy (SLNB). She had a history of mild depression treated with alprazolam and paroxetine. She was assessed to be ASA (American Society of Anaesthesiologists) Class 1. Her...

Role of Multi-Detector Computed Tomography (MDCT) in Diagnosis of Pulmonary Artery Dissection: A Rare but Fatal Entity

A 33-year-old male who was undergoing treatment with phosphodiesterase 5 inhibitor and anticoagulant for idiopathic pulmonary arterial hypertension presented to the emergency department with acute onset of dyspnoea and chest pain. His cardiovascular examination had shown features of cardiomegaly and pulmonary arterial hypertension with no pathological murmur. His blood...

Topical Papaverine as Rescue Therapy for Vasospasm Complicated by Unsecured Aneurysm

A 55-year-old female presented in 2010 with a World Federation of Neurosurgeons (WFNS) grade 3 subarachnoid haemorrhage (SAH). She had aneurysms of the right middle cerebral artery (MCA) (Fig.1A) and anterior choroidal arteries, plus a left pericallosal and anterior cerebral aneurysm (ACA). Clipping was delayed by emergent Takotsubo cardiomyopathy....

A 58-year-old Woman with Dry Cough and Pulmonary Nodules

Pulmonary epithelioid haemangioendothelioma is a rare vascular neoplasm of endothelial origin. We describe a case which involved solely the lungs and a novel therapeutic strategy using pegylated liposomal doxorubicin was attempted. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Early Influences in Childhood Obesity—Implications for Adult Metabolic Disease

In the past 20 years, an epidemic of adult and childhood obesity has swept through the developed world resulting in the “globesity” epidemic. This is clinically significant since obesity is a major risk factor for many chronic diseases which now occur earlier in life. Recent landmark research has identified...

Projecting the Number of Older Singaporeans with Activity of Daily Living Limitations Requiring Human Assistance Through 2030

Similar to other developed countries in Asia, including Japan, South Korea and Taiwan, the population of Singapore is ageing rapidly. In 2011, 9.3% of the population was 65 years of age or older. Due in part to decades of sub-replacement level fertility rates and increases in longevity, by 2030...

Percutaneous Transluminal Angioplasty of Transplant Renal Artery Stenosis

Renal transplantation has become a successful means of treatment for patients with end-stage renal failure. However, in patients with kidney transplants, graft dysfunction can occur as a result of transplant renal artery stenosis (TxRAS). This can present with raised creatinine levels or as refractory hypertension resulting in increased use...

Effect of Using an Audiovisual CPR Feedback Device on Chest Compression Rate and Depth

There is increasing evidence to show that good quality cardiopulmonary resuscitation (CPR) is important in achieving better resuscitative outcomes. One of the determinants for successful defibrillation is the effectiveness of chest compressions. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Surgical Outcome in Thoracolumbar Fractures Managed by Short-segment Pedicle Instrumentation

Thoracolumbar junction vertebrae are particularly vulnerable in traumatic injuries and up to 90% of all spinal fractures occur in this area. Treatment of thoracolumbar fractures has been a controversial subject for many years. Non-operative management recommended by some authors is effective when there is no evidence of neural compression...

Normative Data for the Singapore English and Chinese SF-36 Version 2 Health Survey

Health-related Quality of Life (HRQoL) measures are increasingly being incorporated into clinical research and practice as a tool to understand, from the patients’ perspective, the impact of a disease on their physical, mental and social well-being. The Medical Outcomes Short-Form 36 (SF-36) Questionnaire is arguably the most commonly used...

Wake-up Stroke and Onset-to-door Duration Delays: Potential Future Indications for Reperfusion Therapy

In ischaemic stroke, acute reperfusion therapy aims to recanalise arterial obstruction leading to salvage of hypoperfused cerebral tissue with the goal of improving clinical outcomes. Reperfusion treatments include intravenous thrombolysis with alteplase which is licensed within the narrow therapeutic window of 4.5 hours, novel intravenous fibrinolytics which are under...

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...

Improving the End-of-Life Experience in Singapore: Building Capacity in Palliative Care Education and Research

Singapore is ageing rapidly. Whereas ageing symbolises advancements that the country has made in public health and medicine over the past few decades, it has brought new concerns regarding care for the elderly, and especially in the last years or months of life. A report commissioned by the Lien...

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...