Background: Older adults undergoing surgery frequently have multiple comorbidities and reduced physical and cognitive reserves. This study aims to assess the effect of physical and cognitive frailty on long-term mortality in older patients undergoing elective non-cardiac surgery in a tertiary center. Methods: Patients aged ≥65 years old admitted to surgical wards at the University of Malaya Medical Centre were recruited. Physical frailty and cognitive status were assessed using the Fried Frailty Index (FFI) and the Montreal Cognitive Assessment, respectively. Patients were stratified into six groups based on their frailty and cognitive status: Group 1, normal cognition and non-frail (reference group); Group 2, normal cognition and frail; Group 3, mild cognitive impairment (MCI) and non-frail; Group 4, MCI and frail; Group 5, dementia and non-frail; and Group 6, dementia and frail. Results: A total of 406 patients with a mean FFI score of 1.1±1.2 were recruited. Predictors of mortality include male sex (hazard ratio [HR]=1.96; 95% confidence interval [CI], 1.14–3.37; p=0.015), presence of active malignancy (HR=3.86; 95% CI, 2.14–6.95; p<0.001), and high FFI scores (1.8±1.2 vs. 1.0±1.1; p=0.013). Compared to Group 1, long-term mortality risk was significantly increased in Group 4 (HR=3.17; 95% CI, 1.36–7.38) and Group 6 (HR=3.91; 95% CI, 1.62–9.43) patients. Conclusion The combination of physical frailty and cognitive impairment was associated with long-term mortality risk among older patients who underwent elective non-cardiac surgery. This highlights the importance of assessing physical frailty and cognitive function of all older surgical patients to guide targeted intervention, especially for those with impairments which may be potentially reversible.

Background: Older adults undergoing surgery frequently have multiple comorbidities and reduced physical and cognitive reserves. This study aims to assess the effect of physical and cognitive frailty on long-term mortality in older patients undergoing elective non-cardiac surgery in a tertiary center. Methods: Patients aged ≥65 years old admitted to surgical wards at the University of Malaya Medical Centre were recruited. Physical frailty and cognitive status were assessed using the Fried Frailty Index (FFI) and the Montreal Cognitive Assessment, respectively. Patients were stratified into six groups based on their frailty and cognitive status: Group 1, normal cognition and non-frail (reference group); Group 2, normal cognition and frail; Group 3, mild cognitive impairment (MCI) and non-frail; Group 4, MCI and frail; Group 5, dementia and non-frail; and Group 6, dementia and frail. Results: A total of 406 patients with a mean FFI score of 1.1±1.2 were recruited. Predictors of mortality include male sex (hazard ratio [HR]=1.96; 95% confidence interval [CI], 1.14–3.37; p=0.015), presence of active malignancy (HR=3.86; 95% CI, 2.14–6.95; p<0.001), and high FFI scores (1.8±1.2 vs. 1.0±1.1; p=0.013). Compared to Group 1, long-term mortality risk was significantly increased in Group 4 (HR=3.17; 95% CI, 1.36–7.38) and Group 6 (HR=3.91; 95% CI, 1.62–9.43) patients. Conclusion The combination of physical frailty and cognitive impairment was associated with long-term mortality risk among older patients who underwent elective non-cardiac surgery. This highlights the importance of assessing physical frailty and cognitive function of all older surgical patients to guide targeted intervention, especially for those with impairments which may be potentially reversible.

Background: Older adults undergoing surgery frequently have multiple comorbidities and reduced physical and cognitive reserves. This study aims to assess the effect of physical and cognitive frailty on long-term mortality in older patients undergoing elective non-cardiac surgery in a tertiary center. Methods: Patients aged ≥65 years old admitted to surgical wards at the University of Malaya Medical Centre were recruited. Physical frailty and cognitive status were assessed using the Fried Frailty Index (FFI) and the Montreal Cognitive Assessment, respectively. Patients were stratified into six groups based on their frailty and cognitive status: Group 1, normal cognition and non-frail (reference group); Group 2, normal cognition and frail; Group 3, mild cognitive impairment (MCI) and non-frail; Group 4, MCI and frail; Group 5, dementia and non-frail; and Group 6, dementia and frail. Results: A total of 406 patients with a mean FFI score of 1.1±1.2 were recruited. Predictors of mortality include male sex (hazard ratio [HR]=1.96; 95% confidence interval [CI], 1.14–3.37; p=0.015), presence of active malignancy (HR=3.86; 95% CI, 2.14–6.95; p<0.001), and high FFI scores (1.8±1.2 vs. 1.0±1.1; p=0.013). Compared to Group 1, long-term mortality risk was significantly increased in Group 4 (HR=3.17; 95% CI, 1.36–7.38) and Group 6 (HR=3.91; 95% CI, 1.62–9.43) patients. Conclusion The combination of physical frailty and cognitive impairment was associated with long-term mortality risk among older patients who underwent elective non-cardiac surgery. This highlights the importance of assessing physical frailty and cognitive function of all older surgical patients to guide targeted intervention, especially for those with impairments which may be potentially reversible.

Introduction: Many tools have been developed to determine medication appropriateness in older persons including the 2015 American Geriatric Society (AGS) Beers criteria and the Screening Tool of Older People’s Prescriptions (STOPP) criteria. We aimed to determine and compare the prevalence of potentially inappropriate medications (PIMs) based on the Beers criteria 2015 and the STOPP criteria v2 among older persons admitted to a general hospital in Malaysia. Methods: A cross-sectional study comprising of 160 patients aged 65 years old and above admitted to the general medical wards of a tertiary teaching hospital were recruited. Beers criteria 2015 and the STOPP criteria v2 were used to evaluate participants’ medication list on admission, during hospitalisation and on discharge for PIMs. Prevalence of PIMs which was calculated as the total number of patients with one or more PIMs over the total number of patients. Results: The prevalence of PIMs identified by Beers criteria 2015 on admission, during hospitalisation and on discharge were 54.85%, 64.40% and 48.80% respectively. The prevalence of PIM based on STOPP criteria v2 were 33.08%, 47.50% and 42.50% respectively. The most prevalent PIMs according to Beers criteria 2015 and STOPP criteria v2 were diuretics, tramadol, ticlopidine, proton pump inhibitor, benzodiazepines and antipsychotics. Conclusion: The prevalence of PIMs use is high among hospitalised older persons in Malaysia. While it is not possible to avoid all PIMs listed in the Beers and STOPP criteria, clinicians should exercise caution in prescribing drugs such as benzodiazepines, antipsychotics and proton pump inhibitors for older persons weighing the risk versus benefit of the drugs.

Objectives: The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP). Methods: A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation. Results: This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients’ fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate. Conclusions The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.