Biomedical subjects

F J Jayaratnam

Publications and source records attributed to F J Jayaratnam.

At least 19 recordsLinked to original sources

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↗

PubMed1995

Anaemia in the hospitalised elderly.

A retrospective study was done to look at the various features of our elderly anaemic patients and to determine the usefulness of evaluating anaemia in this age group. Of the 151 patients admitted to one of the acute admission and rehabilitation wards of our Department from January 1990 to June 1990, 54 were anaemic. The prevalence of anaemia was significantly higher in the old old age group (> or = 75 years) compared to the young old, and those from an institutional background had a significantly higher prevalence of more severe anaemia (Hb < 8g/dl). The majority of causes (66%) could be easily established with a simple work-up and deficiency-related anaemias comprised 44% of the total causes. The clinical usefulness of this work-up may also extend to the mildly anaemic group (Hb > or = 10g/dl) though further studies are needed to determine the level of haemoglobin when the evaluation becomes cost-effective.

Aged↗

PubMed1994

Urinary incontinence in the hospitalised elderly--a largely reversible disorder.

A five-month prospective study of urinary incontinence in the elderly was carried out in an acute assessment and rehabilitation geriatric ward to determine the incidence, underlying causes and outcome with management. The incidence in patients 65 years or older was 22%. Of these, 21% had transient incontinence which resolved after the precipitating medical cause was treated. Incontinence was resolved in 36% and improvement obtained in another 20%. Management of urinary incontinence in this population can result in a satisfactory outcome in more than half of patients and is worth pursuing.

Aged↗

PubMed1992

Urinary symptoms and urodynamic diagnosis of patients in one geriatric department.

Fifty five patients between 65 and 89 years old who had their urinary problems assessed by urodynamics study were reviewed. The most common urinary symptom among males was urge incontinence, while retention and urge incontinence occurred with equal frequency among females. The commonest cause of retention in males was bladder outlet obstruction, while atonic neurogenic bladder was the most common cause in females. Urge incontinence was strongly associated with an unstable bladder, small bladder volume and Parkinson's disease. Retention of urine, and an atonic neurogenic bladder strongly correlated with diabetes mellitus. Three patients (out of 31) with unstable bladders also had detrusor external sphincter dyssynergia. Of these, two had Parkinson's disease. Although three patients were thought to have stress incontinence after history and physical examination, only two had stress incontinence with detrusor instability on urodynamic studies. The last patient had atonic bladder with overflow.

Aged↗

PubMed1991

The role of community health care team in the care of the elderly.

The Community Health Care Team plays an important role in helping the elderly maintain an independent life in the community for as long as possible. It does this by emphasizing preventive Geriatric Medicine, provision of supportive and care services and ensuring emotional and physical support for carers. Each member of the Community Health Care team plays an important role and works together as a team to ensure that appropriate services are provided for the varied needs of the elderly in the Community. In Singapore, Community Health Services for the elderly are provided mainly by the Home Nursing Foundation (HNF). Services available at the moment include domiciliary nursing service, rehabilitation and day care carried out at the Senior Citizen's Health Care Centres and Home rehabilitation programme undertaken by trained Staff Nurses. Close liaison is maintained with the Geriatric Department in Tan Tock Seng Hospital. Support groups in existence include a Stroke Club and a Carer's group. Respite care is presently provided by certain voluntary Homes on an ad-hoc basis. The aim of effective community based care for the elderly should be adequate provision of services followed by the effective use of resources.

Aged↗

PubMed1991

Hypertension in the elderly.

Hypertension is a common finding in the elderly. Appropriate treatment would reduce the incidence of strokes and cardiovascular events. Caution is however indicated in the selection of whom to treat and how treatment is carried out. Treatment should be initiated only if advantages outweigh disadvantages for that individual patient. Treatment has to be tailored to the individual patient.

Aged↗

PubMed1991

Health care services for the elderly--a Singapore perspective.

Singapore is greying at a phenomenal pace as well as in a markedly disproportionate manner. By the year 2030, the elderly will comprise around 25% of the total population; at the same time the numbers of younger and economically active persons will decline. The reasons for this process are varied and its implications disturbing. An important consequences is the urgent need for careful and comprehensive planning to meet the elderly's needs. The needs are best addressed when the elderly are looked at as either being well or frail. A guiding principle is that most of them prefer and should remain within community (and not be institutionalised). Efficient and appropriate community services must be developed so as to support the elderly's stay in the community.

Aged↗

PubMed1991

Heart failure in the elderly.

Heart failure commonly occurs in the elderly age group. Treatment mainly centres on the use of digoxin and diuretics. In intractable heart failure other agents ie inotropic agents and vasodilators may be considered. Routine maintenance on diuretic and digoxin should not be encouraged. A conscious effort to tail off these medication is needed.

Aged↗

PubMed1991

Management of stroke in the elderly.

Stroke management involves prevention, management of the acute stroke and rehabilitation. Hypertension is probably the most important controllable risk factor in stroke, both ischaemic and haemorrhagic. In the acute stroke, there is as yet no effective medical treatment. Care in the acute phase is mainly supportive with attention to airways, feeding, skin, bowel and bladder care. Rehabilitation aims to maximise the patient's natural recovery and to help him adapt to any residual disability. It involves a multidisciplinary team approach. An accurate and comprehensive assessment of the patient is important to enable the team to set realistic goals. Goals set usually involve functional end-points. The type of community and home support available will influence decision of whether patient could be discharged home. Ideally a patient should be rehabilitated back into his community and support of carers is important if they are to continue with their caring role.

Acute Disease↗

PubMed1991

Actinomycosis of the brain.

Actinomyces species are rare but treatable causes of central nervous system infection. A case of actinomycotic cerebral abscess is reported. The primary source of infection was probably the lung based on radiological findings although culture of the bronchial brushings was negative. The patient had surgical excision and repeated drainage with two prolonged causes of antibiotic therapy. At follow-up examination 36 months later, the patient was well except for a residual left hemiplegia. Diagnosis of cerebral actinomycosis can be made by anaerobic culture of the appropriate specimens or on histologic grounds. Optimal management combines adequate surgical drainage and prolonged antibiotic therapy.

Actinomycosis↗

PubMed1991

Drugs and the elderly.

Prescribing for the older individual requires a great deal of thought. Multiple pathology is usually associated with multiple drug taking and therefore a high risk of adverse drug reactions. Physiological changes have important bearing on drug usage. Constant vigilance is required to ensure safe prescribing.

Aged↗

PubMed1991

Parkinson's disease.

The management of the elderly patient with idiopathic Parkinson's disease requires great attention to detail. Treatment should only be considered when the daily activities of life are affected. Medication should be commenced cautiously. Regular review is essential and co-ordination with other members of the multidisciplinary team is vital.

Antiparkinson Agents↗

PubMed1991

Assessment of an elderly patient.

A complete and comprehensive assessment is the first step towards rational management of the elderly patient. The traditional approach of direct response to specific complaints is inadequate. Systemic enquiries for unstated treatable complaints is essential. A full assessment consists of physical diagnosis, mental assessment, functional assessment and social assessment.

Activities of Daily Living↗

PubMed1991

Acute confusion in the elderly.

Acute confusion is common in the elderly ill patient. Its presence should provoke an urgent search for its cause. The key to management of acute confusion is in the removal or reversal of the factors responsible together with good nursing care.

Acute Disease↗

PubMed1991

Falls.

An elderly person experiencing recurrent falls is at risk. He is at risk from injury sustained during the fall and at risk from the complications of immobility resulting from loss of confidence. Urgent early assessment and identification of causative and risk factors is essential.

Accidental Falls↗

PubMed1991

The physiology of ageing.

Normal ageing is responsible for the finite life-span of the human race. It is important for the doctor treating the elderly to know the difference between changes secondary to normal ageing and changes which occur as a result of disease. There is ongoing research to increase our knowledge on the ageing process. Age-related physiological decline results in defective homeostasis responsible for the susceptibility of the individual to succumb in minor stresses. Knowledge of physiological decline in the various organs has clinical implications in the interpretation of physiological tests, especially when the organ systems are stressed, in the need to adjust dosage of drugs given to the elderly and in the understanding of some atypical presentations of illness in the elderly.

Age Factors↗

PubMed1991

Urinary incontinence in the elderly.

Urinary incontinence is a problem affecting a significant proportion of the elderly population. It has substantial medical, psychological, social and economic implications. It is to be regarded as a symptom with multifactorial causes. A useful clinical classification of urinary incontinence is by its pathophysiology. A summary of clinical approach, specified investigations and management principles for the condition is outlined.

Age Factors↗

PubMed1991

Faecal incontinence in the elderly.

Faecal incontinence is distressing both to the patient and the carers. However with accurate diagnosis of its cause, the condition can often be treated. Causes can be classified by pathophysiology. The most common cause in the elderly is faecal impaction with overflow incontinence. Other causes include inflammatory conditions of the bowel, neurological disorder, functional incontinence and iatrogenic incontinence. Management depends on an accurate diagnosis. A proper bowel and drug history is important. A rectal examination is mandatory, in order not to miss a diagnosis of faecal impaction with overflow incontinence. Specific treatment is directed at the cause.

Age Factors↗