Dengue is an increasingly common infection among older adults, whose presentations are often atypical and easily misattributed to other causes of fever. We report the case of a 72-year-old man who presented with a short history of intermittent fever, lethargy and increased urinary frequency, initially treated as a suspected urinary tract infection. Laboratory investigations showed leucopenia, thrombocytopenia and mild anaemia. Urinalysis and cultures were negative. Dengue NS1 antigen testing confirmed the diagnosis. During the admission, the patient developed marked thrombocytopenia but did not progress to plasma leakage, bleeding, organ impairment or shock. He was managed with careful supportive care and frequent monitoring, recovering fully by Day 10 of admission. This case highlights the diagnostic challenges of dengue in older adults, whose altered physiological responses may mask classical features such as myalgia, rash and haemorrhagic manifestations.

Background: Frailty is a health condition preceding impairment and disease, resulting in vulnerability and risk of poor outcomes. Frailty is a multidimensional geriatric syndrome encompassing physical, psychological and cognitive components. Psychological frailty refers to reduced emotional resilience, mood stability, and coping capacity. This paper aims to review the current literature on psychological frailty and mental health outcomes among older adults. Methodology : Four electronic databases, PubMed, Scopus, Science Direct and Web of science were used to systematically search for studies published between January 2019 and December 2023, that examined the effect of psychological frailty on mental health outcomes in older adults, including depression, anxiety, and overall well -being. Results: There were 154 articles screened, with 7 studies meeting inclusion criteria. All included studies assessed psychological frailty using the Tilburg Frailty Indicator (TFI), a multidimensional frailty tool with a psychological domain. Psychological frailty, as measured using the TFI, was consistently associated with depressive symptoms, anxiety, and reduced quality of life. The psychological domain of the TFI demonstrated moderate internal consistency (Cronbach ’s α = 0.712 -0.797). Conclusion: Psychological frailty is a potential risk factor for the development of adverse mental health outcomes in older adults. The use of validated measures, such as the TFI may improve the identification of psychological frailty for early intervention strategies in both community and medical settings to protect older adults ’ mental health

Introduction: Polypharmacy and potentially inappropriate prescribing (PIP) are increasingly recognised as important contributors to medication -related harm among older adults. However, published national data on the prevalence of polypharmacy and PIP in Brunei Darussalam are unavailable. The objectives of this study was to determine the prevalence of polypharmacy and PIP among adults aged 65 years and above in Brunei Darussalam using Screening Tool of Older Persons ’ potentially inappropriate Prescriptions (STOPP) version 2 criteria. Materials and Methods: A retrospective cross -sectional study was conducted using data from the Brunei Healthcare Information Management System (Bru -HIMS). A stratified proportional random sample of 2,000 older adults with documented medical encounters in 2016 was selected. Polypharmacy was defined as the concurrent use of five or more medications. PIP was assessed using STOPP version 2 criteria. Descriptive statistics were used to summarise prescribing patterns. Results: Of the 2000 older adults included (mean age 73.0 ± 6.6 years), 1,181 (59.1%) had polypharmacy. Among those with polypharmacy, 1,057 (89.5%) could be assessed using STOPP criteria, and 206 (19.5%) had at least one PIP. The most frequently identified PIPs involved prolonged use of proton pump inhibitors for uncomplicated peptic ulcer disease at full therapeutic dosage for more than eight weeks, where dose reduction, discontinuation, or transition to maintenance therapy (e.g. H2 receptor antagonists) is indicated, prescribing without evidence -based indication, duplication of drug classes, use of ACE inhibitors or angiotensin receptor blockers in patients with hyperkalaemia, and use of first -generation antihistamines. Conclusion: Polypharmacy and PIP are common among older adults in Brunei Darussalam. The findings highlight the need for systematic medication review and deprescribing strategies to optimise pharmacotherapy and improve medication safety in older populations

Background: Frailty is a health condition preceding impairment and disease, resulting in vulnerability and risk of poor outcomes. Frailty is a multidimensional geriatric syndrome encompassing physical, psychological and cognitive components. Psychological frailty refers to reduced emotional resilience, mood stability, and coping capacity. This paper aims to review the current literature on psychological frailty and mental health outcomes among older adults. Methodology : Four electronic databases, PubMed, Scopus, Science Direct and Web of science were used to systematically search for studies published between January 2019 and December 2023, that examined the effect of psychological frailty on mental health outcomes in older adults, including depression, anxiety, and overall well -being. Results: There were 154 articles screened, with 7 studies meeting inclusion criteria. All included studies assessed psychological frailty using the Tilburg Frailty Indicator (TFI), a multidimensional frailty tool with a psychological domain. Psychological frailty, as measured using the TFI, was consistently associated with depressive symptoms, anxiety, and reduced quality of life. The psychological domain of the TFI demonstrated moderate internal consistency (Cronbach ’s α = 0.712 -0.797). Conclusion: Psychological frailty is a potential risk factor for the development of adverse mental health outcomes in older adults. The use of validated measures, such as the TFI may improve the identification of psychological frailty for early intervention strategies in both community and medical settings to protect older adults ’ mental health

Introduction: Polypharmacy and potentially inappropriate prescribing (PIP) are increasingly recognised as important contributors to medication -related harm among older adults. However, published national data on the prevalence of polypharmacy and PIP in Brunei Darussalam are unavailable. The objectives of this study was to determine the prevalence of polypharmacy and PIP among adults aged 65 years and above in Brunei Darussalam using Screening Tool of Older Persons ’ potentially inappropriate Prescriptions (STOPP) version 2 criteria. Materials and Methods: A retrospective cross -sectional study was conducted using data from the Brunei Healthcare Information Management System (Bru -HIMS). A stratified proportional random sample of 2,000 older adults with documented medical encounters in 2016 was selected. Polypharmacy was defined as the concurrent use of five or more medications. PIP was assessed using STOPP version 2 criteria. Descriptive statistics were used to summarise prescribing patterns. Results: Of the 2000 older adults included (mean age 73.0 ± 6.6 years), 1,181 (59.1%) had polypharmacy. Among those with polypharmacy, 1,057 (89.5%) could be assessed using STOPP criteria, and 206 (19.5%) had at least one PIP. The most frequently identified PIPs involved prolonged use of proton pump inhibitors for uncomplicated peptic ulcer disease at full therapeutic dosage for more than eight weeks, where dose reduction, discontinuation, or transition to maintenance therapy (e.g. H2 receptor antagonists) is indicated, prescribing without evidence -based indication, duplication of drug classes, use of ACE inhibitors or angiotensin receptor blockers in patients with hyperkalaemia, and use of first -generation antihistamines. Conclusion: Polypharmacy and PIP are common among older adults in Brunei Darussalam. The findings highlight the need for systematic medication review and deprescribing strategies to optimise pharmacotherapy and improve medication safety in older populations

Palliative care improves the quality of life for patients with life-limiting illnesses and their families. However, integrating these services into healthcare systems remains challenging, particularly in resource-limited settings. This paper provides a perspective on challenges and opportunities from Brunei in building awareness and sustainable palliative care. Key challenges include limited access to trained specialists, fragmented care systems, low health and death literacy, and the need for culturally adapted approaches. Potential solutions to address these barriers include training community leaders such as village heads, establishing multidisciplinary interest groups, and piloting palliative care in high-need areas such as intensive care units. Integrating palliative care into medical education and healthy ageing initiatives may foster a long-term cultural shift in supporting palliative care.

Pressure injuries are areas of localised damage to skin and underlying tissue, usually over bony prominences. Pressure injuries are painful, worsen quality of life, increases hospital length of stay and risk of morbidity and mortality. In Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, there were previous concerns regarding pressure injuries, prompting service initiatives to improve prevention measures. However, after the COVID-19 pandemic, these concerns recurred warranting an audit of pressure injury prevention measures. The audit of routine pressure injury prevention forms in Geriatrics and Palliative Medicine inpatients was performed for 2 weeks. The completion rate of forms was 89.8% and 50% for Geriatrics and Palliative patients respectively. Among the Geriatrics and Palliative inpatients, one-third had pressure injuries before admission, while one-eighth developed them in hospital. The most prevalent risk factors were limited mobility, reduced physical activity and malnutrition.

Falls among older adults in hospital settings are a significant concern for patient safety, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. This narrative review explores current practices and strategies for falls prevention in hospital environments, emphasizing policy development, risk assessment, and multidisciplinary approaches. Risk factors for falls include intrinsic factors such as impaired mobility and cognitive decline, and extrinsic factors such as poor design and environmental hazards. Effective fall prevention begins with structured screening and assessment processes, shifting from predictive scoring tools to individualized risk management. A safe environment with adequate lighting, non-slip flooring, and ease of access to appropriate assistive devices is important to minimize fall risks. Universal fall prevention strategies such as patient education and proper bed positioning are necessary but should be complemented by targeted interventions for high- risk patients.

Russell’s viper (Daboia russelii) envenomation is a major public health problem in South and Southeast Asia, often resulting in life-threatening complications such as acute kidney injury (AKI), disseminated intravascular coagulation (DIC), and shock. Serum lactate dehydrogenase (LDH), an accessible and cost- effective biochemical marker, has been proposed as a surrogate indicator of tissue injury, haemolysis, and severity of systemic envenomation. This review explores the role of LDH in the context of Russell's viper bite, examining the pathophysiological basis of envenomation and its complications, the mechanism of LDH elevation, and clinical studies correlating LDH levels with severity and outcomes. The findings suggest that elevated LDH may assist in early recognition of severe envenomation, guide timely interventions, and serve as a valuable adjunct to clinical and laboratory assessment in resource-limited settings.