Biomedical subjects

C H Ee

Publications and source records attributed to C H Ee.

11 recordsLinked to original sources

PubMed2006

Functional decline of the elderly in a nursing home.

INTRODUCTION: This study aims to determine if risk factors present on admission to the nursing home could be predictive of later functional decline and to determine the causes of decline. METHODS: This is a retrospective case-control study conducted in 2000 at a voluntary welfare nursing home. Functional decline was defined as deterioration in two or more of the five activities of daily living (ADLs), namely: mobility, toileting, bathing, dressing and feeding, from the time of admission to the study period. Potential risk factors for decline studied were: age, sex, marital status, number of medical diagnoses and medications, types of medical diagnoses, and the presence of dementia on admission to the home. Causes of decline were categorised as (A) Development of new illness, (B) Progression of chronic illness, or (C) Both of the above. RESULTS: 36 out of 103 residents had functional decline. On analysis, univariate and multivariable logistic regression models, adjusted for length of stay, yielded the same significant risk factors for decline, namely: age (p-value is 0.02) and dementia (p-value is 0.04). Majority of decline (78 percent) was due to progression of chronic illnesses, most commonly dementia (15 out of 36), eight percent were due to acute illness (stroke), and 14 percent were due to both. In January 2003, 18 out of the 36 residents who declined had died. CONCLUSIONS: Functional decline is common in the nursing home. More attention should be paid to the older residents and those with dementia, right from the point of admission.

Activities of Daily Living↗

PubMed2003

Who are the residents of a nursing home in Singapore?

AIM OF STUDY: To describe the residents of a nursing home for the elderly in terms of their socio-demographic profile, mental and physical attributes, functional abilities and existing medical problems. METHOD: A random sample of 120 subjects was obtained from a total of 350 residents in a voluntary welfare nursing home. Two subjects were excluded as they did not satisfy inclusion criteria (age > or = 60 years). The subjects' biodata, social background, medical problems and functional status at the time of admission were obtained by a review of the case records. Each of the subjects was examined with attention to their general condition, hearing and vision, presence of postural hypotension, cognition and ability to perform basic activities of daily living (ADL). RESULTS: Results were available for 106 out of the 118 subjects as the rest were either discharged in the course of the study or had died. Single (36%), widowed (41%), female (71%) and age > or = 75 years (73%) consisted the majority. Most subjects (43%) were admitted because of both medical and social factors. Twenty-two percent appeared undernourished and of those who could be assessed, 14% had postural hypotension, 18% were hearing impaired and 53% had visual impairment. Fifty-two per cent suffered from mental problems while 46% and 40% had been diagnosed with hypertension and stroke respectively. Forty-eight percent had probable cognitive impairment (according to ECAQ scores) and 41% were very severely disabled (according to Barthel Index). Fifty-five percent were dependent in bathing, 50% dependent in dressing, 50% incontinent of urine (and requiring diapers), 48% were non-ambulant and 21% dependent in feeding. CONCLUSION: With a significant proportion of the population requiring nursing home care in the future, a closer review of the situation is needed. This study has identified malnutrition, urinary incontinence, falls, functional decline and impaired vision/hearing as issues that deserve greater attention and, where necessary, intervention. Whether implementing recognised effective interventions will truly benefit our nursing home residents would warrant more local studies.

Activities of Daily Living↗

PubMed2003

Nursing home falls: a local perspective.

INTRODUCTION: This study aims to examine the demography of falls, factors that contribute to falls and fall risk factors in residents of a nursing home for the elderly in Singapore. MATERIALS AND METHODS: An 18-month follow-up study was carried out on 95 nursing home residents. Information on the subjects' potential risk factors for falls was obtained through a review of their casenotes and physical examination. At the end of the study period, the casenotes were reviewed for any documented fall, the circumstances surrounding each fall and whether complications resulted from the fall. The likely factors and events associated with each fall were categorised where possible. Logistic regression was performed to determine the risk factors for falls. Subjects who died or were discharged during the study were included in the analysis. RESULTS: Several subjects (72.6%) were > or = 75 years old, required assistance in activities of daily living (71.6%), cognitively impaired (52.6%), diagnosed with mental illness (49.5%) and non-ambulant (43.2%). A total of 63 falls contributed by 38 (40%) subjects were documented over 18 months, giving an incidence of 0.5 fall per bed year. Thirteen (20.6%) injuries resulted from the falls, of which 3 were fractures. Falls associated with both intrinsic and extrinsic factors were identified in 38.1% of falls. The most common intrinsic factors were gait disorders (31.7%) and confusion/difficult behaviour (31.7%). Contributory extrinsic factors include wheelchair/commode (22.2%) and bathroom-related (15.9%) incidents. Most falls occurred during ambulation (31.7%) and transfers (17.5%). On multivariate logistic regression, the only significant risk factors for falls were "need for ambulatory aids" (odds ratio, 24.4) and "cognitive impairment" (odds ratio, 8.1). CONCLUSION: The study confirms that falls are common amongst elderly in a local nursing home. Residents with gait instability and behavioural problems due to underlying dementia or mental illnesses are most at risk. Extrinsic factors, such as bathroom activities and the use of wheelchair/commodes, are contributory. Thus, falls reduction protocols in nursing homes should include behavioural measures, enhanced care practices and environmental modifications to be effective.

Accidental Falls↗

PubMed1999

Functional status of the elderly in Singapore.

BACKGROUND: This study was done to look at prevalence and factors affecting functional dependence. The data in this paper were part of the 'Community Study on State of Health, Function, Cognitive and Social State of Elderly People in Singapore' conducted in Singapore between September 1992 and December 1993. PATIENTS: Four hundred and one elderly, aged 60 years and above were studied. Sixty-eight subjects (17%) were dependent in at least one function of Activities of Daily Living (ADL) as measured by the Barthel's Index (BI). RESULTS: The most common problem identified using this index was urinary incontinence. Forty subjects (10.4%) were dependent in at least one Instrumental Activities of Daily Living (IADL) function. The most common mode of transportation was by public transport, of which travelling by bus was the most common (59.9%) and mass rapid transit (MRT) was the least common (4%). Female gender and age > or = 75 were significant factors associated with dependence measured on Barthel's index but not on IADL. CONCLUSION: Results of this study were also compared with two previous surveys done in Singapore. Discrepancies in results noted could be attributed to different definitions in which the functions were assessed. We should aim to standardise the definition and measures of function in the local context in order to measure changes in the elderly population.

Activities of Daily Living↗

PubMed1998

Self-perception of health among elderly community dwellers in Singapore.

Majority (90.5%) of the elderly living in the community in Singapore had a positive (satisfactory to good) perception of their health. This study found that age (70 years or older), recent hospitalisation, regular medical follow-up, hearing impairment, presence of chronic medical conditions (like musculo-skeletal problems, hypertension, ischaemic heart disease and chronic obstructive lung disease), impairment in activities of daily living, history of falls, those on regular medications and those with financial difficulties all adversely influenced perception of health. Those able to participate in regular outdoor leisure activities have a positive influence. Factors that did not significantly influence perception of health were gender, health-promoting activities, work, poor eyesight, cognitive impairment, urinary incontinence, diabetes, history of stroke and the ability to use public transport.

Activities of Daily Living↗

PubMed1997

Epidemiology of falls among the elderly community dwellers in Singapore.

AIM: Falling is a serious medical problem for elderly persons. This study was done to look at prevalence and risk factors for falls in community dwelling elderly in Singapore. METHOD: A random sample of 3,000 persons aged 60 years and above was chosen from a database based on the 1990 population census. Letters were sent out to 2,582 subjects who had local and complete addresses. In the letter, they were informed about the purpose of the survey, and invited to participate in a questionnaire and clinical health screening at an appointed date at a polyclinic. Participants were reminded the day before their appointment by telephone, and a new appointment could be given at the subject's convenience. RESULTS: We found a prevalence rate of falls of 17.2%. Two-thirds of these had single falls, while one-third had recurrent falls, defined as having more than one fall within the previous one year. The following factors were found to be significantly associated with increase falling in the elderly: age > or = 75 years (O.R. = 1.82, 95% C.I. 0.95-3.50), female sex (O.R. = 2.5, 95% C.I. 1.40-4.48), Malay race (O.R. = 2.66, 95% C.I. 1.21-5.86), poor vision (O.R. = 1.7, 95% C.I. 0.99-2.90), Barthel's score of less than 20 (O.R. = 1.76, 95% C.I. 0.94-3.28), those taking 2 or more drugs daily (O.R. = 2.1, 95% C.I. 1.22-3.72) and the presence of hypertension (O.R. = 1.78, 95% C.I. 1.06-3.01). Fall rate is also twice as high in women as in men. At the same time, we found that women in the group we studied also tend to exercise less than the men. Fallers also had significantly more mobility and activities of daily living (ADL) disabilities (reflected by a lower Barthel's score) and this is consistent with other results. The only factor that reduced the risk of falling was regular exercise (O.R. = 1.64, 95% C.I. 0.93-2.93). CONCLUSION: In our study, we found differences between the group with single and recurrent falls. In the group with single falls, the fall tend to occur outdoors (O.R. = 2.97, 95% C.I. 1.03-8.60) and during the day (O.R. = 3.47, 95% C.I. 1.20-10.0), tend to be accidental (O.R. = 3.16, 95% C.I. 1.05-9.50) and tend to seek medical attention (O.R. = 3.68, 95% C.I. 1.23-11.0). Overall, 32 persons (46.4%) seek medical treatment after their falls, and of these, 65.6% were women. Risk factors for falls should be screened for all elderly.

Accidental Falls↗

PubMed1997

Hypoglycaemia in the elderly.

AIM: To determine the prevalence, presentation, causes and consequences of hypoglycaemia in the elderly, and to make preventive recommendations. METHOD: Retrospective review of case records. RESULTS: The definition of hypoglycaemia is defined as symptoms with a capillary blood sugar of less than 3 mmol/L measured on the Reflolux II or Accutrend glucometer. Out of 1,919 admissions to our department from November 1993 to January 1996, there were 45 cases of hypoglycaemia. The average age was 76.2 years (range 66 to 89 years); 32 were females, 13 males, 35 had diabetes mellitus and 10 were non-diabetics. Forty patients presented with neuroglycopaenic symptoms and 5 patients presented with adrenergic symptoms. Thirteen patients presented were solely due to drugs (mainly glibenclamide); 9 cases were due only to disease (mainly psychiatric illnesses with poor intake); 23 cases were due to both drugs and diseases (mainly a combination of glibenclamide, tolbutamide and psychiatric illness with poor intake, renal failure, gastroenteritis and sepsis). All were easily reversed with an intravenous bolus of 50% glucose or continuous 10% glucose infusions. Forty-three patients did not suffer any morbidity, one suffered a stroke and another fell because of giddiness. CONCLUSION: We recommend that: (1) the importance of having regular meals be emphasised to elderly patients and their carers, especially if they are taking hypoglycaemic agents; (2) regular home glucose monitoring for diabetic patients; (3) assessment and monitoring of renal function before prescribing hypoglycaemic agents; (4) avoidance of the use of long or medium acting sulphonylureas eg. chlorpropamide, glibenclamide in the elderly; (5) adjustment of hypoglycaemic agents (in consultation with a trained nurse/doctor) if the patient suffers from gastroenteritis and (6) less stringent blood glucose control in those with psychiatric illnesses who may have variable food intake.

Aged↗

PubMed1995

Atypical presentation in the elderly--case report of an acute abdomen.

An elderly woman with an acute abdomen due to a perforated peptic ulcer is discussed to illustrate the problem of atypical presentation of illness in the elderly. The importance of not dismissing non-specific symptoms and signs such as confusion, restlessness, abdominal distention and non-localising abdominal tenderness in the elderly, is highlighted. In addition, the useful radiological features of pneumoperitoneum are described. The need for functional assessment and rehabilitation are emphasised as important components in the practice of geriatric medicine.

Abdomen, Acute↗

PubMed1991

Stroke rehabilitation of elderly patients in Singapore.

A retrospective study of 100 elderly stroke patients admitted to a rehabilitation centre in Singapore was done to study the characteristics of the patients and the factors associated with the outcome. The mean age of the patients was 72.7 +/- 5.4 years with an equal sex ratio. There was a predominance of Chinese. Two or more concomitant diseases were present in 43% of the patients with a markedly high prevalence of hypertension. Majority had unilateral motor deficit, and cerebral infarcts were seen in 66% of the scans done. Altogether 79% of the patients improved on their level of self-care in activities of daily living (ADL) while 60% showed improvement in their level of mobility. Patients with good prognosis were those who were assessed to be at least partially independent in ADL prior to rehabilitation and those who showed improvement in the motor power of their affected limbs during rehabilitation. Those with dense hemiplegia at the outset were likely to remain dependent. Age, sex, delay in rehabilitation, duration of rehabilitation, presence of dysphasia and sides of deficit had no bearing on the outcome.

Activities of Daily Living↗

PubMed1990

Effects of low dose guar in non-insulin dependent diabetic patients.

Thirteen non-obese, non-insulin-dependent diabetic patients were given guar granulate in an average dose of 7.1 grams daily for 8 weeks. The mean fructosamine fell from 3.3 +/- 0.69 mmol/L (p less than 0.01). Mean glycosylated haemoglobin (HbA1c) fell from 8.17 +/- 2.2% preguar to 7.67 +/- 1.81% (1 = ns) and to 7.39 +/- 1.23% (p = ns) at 8 weeks and 12 weeks postguar respectively. Eight weeks after the discontinuation of guar fructosamine rose to 3.61 +/- 0.95 mmol/L (p less than 0.05) while HbA1c rose to 8.23 +/- 2.08% (p = 0.05). There were no significant changes in fasting blood glucose, lipids, and body weight. Mild gastrointestinal side-effects occurred in 11 patients during the treatment with guar. It is concluded that daily ingestion of low dose guar modestly improves glycaemic control, such improvement dissipating by 8 weeks following cessation of its use.

Adult↗

PubMed1989

Characteristics of geriatric admissions to two medical departments in Singapore.

A survey was conducted to study certain characteristics of geriatric patients admitted to two medical departments in Singapore. The aim was to create awareness as well as to provide a better understanding of these elderly as more and more doctors would have to attend to them. Our results show that about 27% of admissions were geriatric patients. The typical geriatric patient in this study was about 75 years old (mean age 74.6 years) and was likely to present with breathlessness due to heart disease or pneumonia. The overall duration of stay in hospital was 10 days and only about 6% of the patients had "discharge" problems needing assistance from the Medical Social Worker. About one in five patients died in hospital, usually from pneumonia or ischaemic heart disease.

Aged↗