Chan's Practical Geriatrics

This book represents a highly useful, simple window for the young physician to start a journey of discovery into the joys of caring for the aged. Once physicians begin to recognize the differences in the care of the older person, it will lead to a flowering of joy as they recognize their ability to enhance the quality of life of our elders. The author, in developing this book, allows the reader to glimpse at the beauty that lies around each turn in the 'hidden garden' of aged care

Chan's Practical Geriatrics

The assessment and management of elderly patients is often dreaded by Junior Medical Staff and General Practitioners. The complex nature of many geriatric syndromes and the limited time for consultations or review often means it is difficult to assess the older patients thoroughly. This practical book of geriatric medicine is meant to make life a little easier for busy General Practitioners and Junior Medical Staff. It is problem orientated, in the format of history taking, examination, investigation and management, which is the cornerstone we generally approach patients. It is also succinct, smmnarising cmmnon problems and avoiding unnecessary details or uncmmnon diseases making it a good companion for busy practitioners. Often, explanations are given to why salient questions are asked in history taking, and why certain physical examination or investigations are done which is different to the didactic approach of a lot of traditional textbooks. Scenarios are also given in many chapters to assist the understanding of some common geriatric syndromes or diseases. Junior Medical Staff who are preparing for their physician's examination may find this book helpful in dealing with complex geriatric issues, which may occur during long cases. Senior medical students doing geriatrics may too find this book useful, especially if they are confronted with clinical geriatric viva but some basic theoretical knowledge is assumed. This book is not intended to replace traditional geriatric textbooks, but rather to supplement them. It is also our hope that our contribution will minimize the pain of busy doctors managing older patients. Like all other textbooks, despite the best of effort, errors invariably will occur and facts should be counter-checked with senior clinicians and other textbooks or literature

Aged care services in Australia and commentary on lessons learnt

The Australian aged care service is a mature and evolving service. It is comprehensive with good continuity of care between hospital and community. Innovative models of care that are built on the principles of improved efficiency, better quality, and safety are constantly being introduced as our population is aging, resulting in higher demand in our healthcare services and increasing healthcare cost. Collaborative effort of a multidisciplinary team underpins our successful aged care model as most of our older patients have multiple comorbidities with various functional and psychosocial needs. General practitioners play an important role in the care of older patients in the community

An elderly woman with calcification of the basal ganglia presenting with shuffling gait : a review with a case report

Elderly patients with an unsteady shuffling gait or signs that mimic Parkinson’s disease (PD) are often referred to geriatricians for confirmation or exclusion of PD. Nonetheless these same signs and symptoms occur with many other conditions. We report on a patient who was referred by her general practitioner for investigation of possible PD because of an unsteady shuffling gait

Falls prevention in the elderly : translating evidence into practice

Falls are a common problem in the elderly. A common error in their management is that injury from the fall is treated, without finding its cause. Thus a proactive approach is important to screen for the likelihood of fall in the elderly. Fall assessment usually includes a focused history and a targeted examination. Timed up-and-go test can be performed quickly and is able to predict the likelihood of fall. Evidence-based fall prevention interventions include multi-component group or home-based exercises, participation in Tai Chi, environmental modifications, medication review, management of foot and footwear problems, vitamin D supplementation, and management of cardiovascular problems. If possible, these are best implemented in the form of multifactorial intervention. Bone health enhancement for residential care home residents and appropriate community patients, and prescription of hip protectors for residential care home residents are also recommended. Multifactorial intervention may also be useful in a hospital and residential care home setting. Use of physical restraints is not recommended for fall prevention

Review of non-convulsive status epilepticus and an illustrative case history manifesting as delirium

Non-convulsive status epilepticus can result in significant morbidity and mortality. The condition can be difficult to recognise, and can mimic delirium due to other underlying pathologies. There are several clinical subtypes, although these can be difficult to distinguish by their clinical features alone. Electroencephalogram is the key diagnostic tool to making the diagnosis, but this investigation is a limited resource in many institutions. In this review, we present a case of non-convulsive status epilepticus, manifesting as delirium, and then proceed to a literature review on this important diagnosis

Management for motor and non-motor complications in late Parkinson's disease

The prevalence of neurodegenerative diseases such as Parkinson's disease (PD) increases with age. in an aging population, an understanding of the management of late complications of PD is becoming ever more important. Drug treatment for Parkinson's disease is largely symptomatic and relies primarily on levodopa (L-dopa) and adjuvant therapies including dopamine agonists and catechoi-0-methyitransferase (COMT) inhibitors. Rehabilitation and allied health input also constitutes a core part of successful management. Most subjects who are symptomatic for more than 5 years are prone to late complications of PD. Some of these are related to the treatment, such as motor fluctuations, including the "on-off" phenomenon and levodopa-related peak dose dyskinesia. Others, such as postural hypotension, falls, psychosis, and dementia, although well-recognized problems in the elderly, often require different treatment strategies if occurring in the context of PD. The practical evidence-based management of motor and non-motor complications in late PD is discussed

Stroke care in older people

Strokes are common in the population of older adults. However, the evidence for the management of strokes in older adults is scarce. This paper reviews the current knowledge of stroke care in the context of the management of older adults with stroke

COVID-19 in aged care homes : a comparison of effects initial government policies had in the UK (primarily focussing on England) and Australia during the first wave

Background: COVID-19 pandemic has had a major impact globally, with older people living in aged care homes suffering high death rates. Objectives: We aimed to compare the impact of initial government policies on this vulnerable older population between the UK and Australia during the first wave of attack. Methods: We searched websites of governments in the UK and Australia and media outlets. We examined the key policies including the national lockdown dates and the distribution of some important resources (personal protective equipment and testing) and the effects of these initial policies on the mortality rates in the aged care homes during the first wave of attack of COVID-19. Results: We found that both countries had prioritized resources to hospitals over aged care homes during the first wave of attack. Both countries had lower priority for aged care residents in hospitals (e.g. discharging without testing for COVID-19 or discouraging admissions). However, deaths in aged care homes were 270 times higher in the UK than in Australia as on 7 May 2020 (despite UK having a population only 2.5 times larger than Australia). The lower fatality rate in Australia may have been due to the earlier lockdown strategy when the total daily cases were low in Australia (118) compared to the UK (over 1000), as well as the better community viral testing regime in Australia. Conclusion: In conclusion, the public health policy in Australia aimed towards earlier intervention with earlier national lockdown and more viral testing to prevent new cases. This primary prevention could have resulted in more lives being saved. In contrast, the initial policy in the UK focussed mainly on protecting resources for hospitals, and there was a delay in national lockdown intervention and lower viral testing rate, resulting in more lives lost in the aged care sector