Globally, there is an increase in older people. Clinicians, particularly primary care physicians, will need to equip themselves with knowledge and have a general approach for management of older people. In this paper, the following geriatric principles and concepts are covered: the trajectory of illness and the life course approach, multifactorial diagnoses and attributable risk, and comprehensive geriatric assessment. The illness trajectory concept enables clinicians to recognize where the patient is at, predict their likely prognosis and offer appropriate treatment decisions, balanced between aggressive curative intent and symptomatic management. The life course approach provides a model for planning intervention, which usually needs cooperation with other specialties. It is a worthwhile reminder for clinicians that older people tend to present with atypical symptoms, with multiple contributing factors towards their illness. Comprehensive geriatric assessment enables the clinician to gather sufficient information to complete clinical decision making for older people.

Venous thromboembolism (VTE) is one of the significant causes of morbidity and mortality for hospital inpatients. The use of VTE prophylaxis in high-risk patients admitted under Geriatric Medicine in RIPAS Hospital, Brunei was evaluated. The electronic medical records of all patients admitted under Geriatric Medicine between 1st February 2022 and 28th February 2022 were reviewed. For these patients, the risk of developing VTE, bleeding risk and whether they were prescribed VTE prophylaxis were assessed. There were 34 patients identified, of which 20 (58.8%) were female. Median age was 81 years, ranging from 64 to 93 years. There were 13 (38.2%) COVID-positive patients, of which 9 (69.2%) were considered high VTE risk. Among these 9 patients, 4 (44.4%) were low bleed risk; of these 4 patients only two were prescribed VTE prophylaxis. Among the 21 non-COVID patients, 17 (80.9%) were high VTE risk. There were 11 (64.7%) with low bleed risk among the 17 patients in the group. Of the 11 patients only 3 (27.3%) were prescribed VTE prophylaxis. The use of VTE prophylaxis among Geriatric Medicine inpatients could be improved. Use of the VTE prophylaxis protocol should be emphasised to clinicians and re-audited to ensure compliance

This paper describes the Geriatrics services in the hospital and community in Brunei and the impact of the COVID-19 pandemic. Due to the need for clinical staff to assess and manage COVID-19 cases at the national isolation centre and to assist with contact tracing, outpatient services were suspended. Patients had to be contacted regarding clinic cancellations and ensure they had adequate medications. There was an increase in phone-call consultations and virtual clinics were introduced. Home based nursing patients had the interval of routine nasogastric and indwelling urinary catheter changes extended. Data on the pandemic effects on Geriatric services including outpatient clinics, home visits, phone-call and virtual consultations, admissions to hospital and the home-based nursing case load after the pandemic are shown. After the pandemic, there is a need to strengthen measures to prevent pressure injuries and delirium, improve patient self-management of chronic conditions and manage the physical and mental health sequalae of the pandemic such as frailty and depression.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) virus has caused a worldwide COVID-19 pandemic. Vitamin D deficiency and insufficiency may have a significant impact on respiratory viral infections. This narrative review of systematic reviews describes the roles of vitamin D on COVID- 19 infection prognosis and whether vitamin D supplementation has any role in improving clinical outcomes of COVID-19 patients. A literature search of PubMed and Google Scholar was conducted in October 2021. Only systematic reviews published in the English language from January 2020 through October 2021 were included. Seven systematic reviews were identified. Five showed that low vitamin D levels increased the likelihood of contracting COVID-19 infections, admission into intensive care and increased mortality for severe vitamin D deficient individuals. Two reviewed the benefits of vitamin D supplementation and found an association between supplementation and a reduction in ICU admissions and mortality from COVID-19 infections. All of the systematic reviews identified a high prevalence of vitamin D deficiency in COVID-19 individuals, with a positive correlation between vitamin D deficiency and disease severity. Maintaining appropriate levels of vitamin D through oral supplementation or sunlight exposure may be beneficial to improve public resilience during this pandemic.

Palliative care provides active holistic care for people with serious health-related suffering due to illness, especially near the end of life. In the Asia-Pacific region, there is variability in palliative care services and access to drugs, with a predominant focus on hospitals and cancer. The COVID-19 pandemic also disrupted the development and provision of palliative services. In this situation analysis, palliative services and the impact of the pandemic in five Asian countries (Bangladesh, Brunei, India, Myanmar and Thailand) are described. Overall, palliative care is an underserved specialty despite an obvious need for the services in each locality. While the pandemic significantly interrupted palliative services, palliative care providers adapted by developing guidelines and using teleconferencing. Overall, much work still needs to be done to improve palliative care in the region.

The objective of this study was to describe and compare the quality of clinical guidelines for Type 2 diabetes mellitus (T2D) from Kenya, Zimbabwe, Tanzania and Nepal. Alumni from “peoples-uni” were invited to review and evaluate T2D clinical management guidelines used in their settings. The “Appraisal of Guidelines for REsearch & Evaluation II” (AGREE II) instrument was used to evaluate the guidelines. Each guideline was randomly allocated to three assessors, who evaluated the guidelines separately and allocated scores for items on the AGREE II tool. The guidelines from Zimbabwe and Kenya scored generally better than the Tanzania and Nepal guidelines. The main areas that needed the most improvement across all the guidelines were rigour of development (41%), applicability (40%) and editorial independence (35%). There is a need to improve several aspects of T2D clinical guidelines, which is a useful starting point to improve management of these patients.

Pharmacovigilance is used to detect, assess, understand, and prevent the adverse effects of medications. The need for safety monitoring has evolved around unfortunate incidents in history, with deaths caused by anesthesia and congenital malformations from thalidomide use. Reports from adverse drug reactions (ADRs) are stored in a global database and can be used to evaluate the associations between various medications and associated ADRs. Clinicians play an important role in the recognition and reporting of ADRs to national pharmacovigilance centers (NPCs). The purpose of NPCs is to make the clinicians understand their functions, including the monitoring, investigation, and assessment of ADR reports, along with periodical benefit-risk assessments of medications via multiple sources. A case study on NPCs and the types of safety issues evaluated by them are provided to illustrate their role in medicine safety surveillance. ADR monitoring was also combined with vaccine safety surveillance approaches. Overall, this study will provide insights to clinicians on the importance of pharmacovigilance in maintaining patient safety with the proper use of medications.

BACKGROUND: Falls are common in older people and a leading cause of injury. Exercise programmes are available for falls prevention, including the Otago Exercise Programme (OEP). The Southeast Asia region has a rapidly ageing population with unique aspects to consider in falls prevention. This systematic review aims to explore the effectiveness of OEP in Southeast Asia for falls prevention. METHODS: A literature search conducted in April 2020 of PubMed and Google Scholar databases was performed to identify randomised controlled trials on OEP in Southeast Asia. RESULTS: Three studies met inclusion criteria for the systematic review. The studies in Malaysia and Thailand did not identify any differences in the rate of falls with the modified OEP intervention compared to conventional treatment. The study from Indonesia inferred a reduced fall risk with improved Timed Up and Go with the intervention, but did not quantify fall rates. CONCLUSION: The three studies identified used a modified OEP, with limited evidence of efficacy or reduction in fall rates. Further research is required, particularly randomized controlled trials to evaluate OEP for falls prevention in Southeast Asia.
Accidental Falls ; Secondary Prevention ; Asia, Southeastern

Objective: This retrospective, cross-sectional, observational study assessed the duration of coronavirus disease 2019 (COVID-19) symptoms during the second wave in Brunei Darussalam. Methods: Data from COVID-19 cases admitted to the National Isolation Centre during 7–30 August 2021 were included in the study. Symptom onset and daily symptom assessments were entered into a database during hospitalization and disease was categorized by severity. The time between symptom onset and hospital admission, the duration of symptoms and length of hospitalization were assessed separately by age group, disease severity and vaccination status using one-way analysis of variance with Bonferroni post hoc corrections. Results: Data from 548 cases were included in the study: 55.7% (305) of cases were male, and cases had a mean age of 33.7 years. Overall, 81.3% (446) reported symptoms at admission (mean number of symptoms and standard deviation: 2.8 ± 1.6), with cough (59.1%; 324), fever (38.9%; 213) and sore throat (18.4%; 101) being the most common. Being older, having more severe disease and being unvaccinated were significantly associated with the time between symptom onset and hospital admission, symptom duration and length of hospitalization. Discussion: Knowing which factors predict the duration of COVID-19 symptoms can help in planning management strategies, such as the duration of isolation, predict the length of hospitalization and treatment, and provide more accurate counselling to patients regarding their illness.