We report a case of tuberculous pericarditis in a 65-year-old man. Tuberculous pericarditis is an extra-pulmonary tuberculous in endemic areas. Its complications include constrictive pericarditis and cardiac tamponade. Computed tomography and cardiovascular magnetic resonance imaging are important tools to detect pericardial disease. Measurement of adenosine deaminase level in the pericardial fluid is a valuable diagnostic test, with good specificity and sensitivity. Timely administration of anti-tuberculous and steroid therapy reduces the risk of constrictive pericarditis.

The term 'geriatrics giants' was first coined by late Prof Bernard Issacs. 1 Geriatrics giants include four common syndromes of older adults, namely intellectual impairment, instability, immobility, and incontinence.Under intellectual impairment, there are three 'Ds': dementia, depression, and delirium.These conditions may be a single pathology entity or as manifestations of frailty secondary to increased impairment of multiple systems. 2 In this issue, Ho et al 3 and Dehghankar et al 4 report that intellectual impairment is a common manifestation of diseases in older adults.

We report a case of sealed perforation of jejunoileal diverticulitis in an 88-year-old man presented with transient abdominal pain.An urgent computed tomography of the abdomen and pelvis showed foci of extraluminal free air suspected of perforation.The patient was treated with intravenous antibiotics and regular follow-ups.He recovered after 2 months of conservative treatment.

Objective.To determine the association between depression and quality of sleep in older people in Qazvin, Iran.Methods.Older people aged 60 years who were referred to urban health centres in Qazvin, Iran between 2018 and 2019 were randomly selected via multistage cluster sampling.Inclusion criteria were ability to communicate and no history of cognitive, psychiatric, or neurological disorders (according to medical records).Depression and sleep quality of participants were assessed by two trained nurses.Depression was assessed using the validated Iranian version of the 15-item Geriatric Depression Scale (GDS-15).Sleep quality and its problems over a 1-month period was measured using the self-report Pittsburgh Sleep Quality Index (PSQI).A cut-off score of >5 is considered poor sleep quality.Results.194 men and 206 women aged 60 to 87 years were recruited.The mean GDS score was 7.04; 255 (63.8%) had no depression and 145 (36.3%) had depression.The two groups differed significantly in terms of education (p=0.021),chronic disease (p=0.015), and economic status (p=0.026).80% of participants had poor sleep quality (PSQI score of >5).The mean PSQI score was higher in those with depression than in those without depression (7.82 vs 6.71, P<0.001).Participants with depression also had higher subscores in sleep latency (p=0.021),sleep disturbances (p=0.047),use of sleeping medication (p=0.011), and daytime dysfunction (p=0.003).In the logistic regression analysis, poor sleep quality (PSQI score of >5) was associated with 2.55-fold increased risk of depression after adjusting for age, sex, disease, and economic status.Discussion.The prevalence of poor sleep quality and depression in Iranian older people is high.Poor sleep quality is associated with depression in older people.Interventions should be provided to improve sleep quality of older people.Measures to attract social participation, promote health status, and provide consulting services for older people are warranted.

Objective.This study aims to compare older and younger patients with COVID-19 infection in terms of patient characteristics, presenting symptoms, laboratory parameters, complications, treatment received, and outcomes.Methods.Medical records of patients aged 12 years who were admitted to Hospital Tengku Ampuan Rahimah between 1 January 2021 and 31 June 2021 with polymerase chain reaction-proven COVID-19 infection were retrospectively reviewed.Data collected included sociodemographic data (age, ethnicity, sex, and residence), comorbidities, COVID-19 presentation (acute presenting symptoms, primary working diagnosis, disease severity, laboratory parameters on admission, and treatment received), and outcomes (complications, length of hospital stay, discharge destination, oxygen support required, and mortality).Results.A total of 259 patients aged 18 to 91 years were admitted to our hospital with COVID-19 infection.Of them, 182 (70.3%) were younger patients and 77 (29.7%) were older patients (aged >60 years).More older patients than younger patients had comorbidities (87.0%vs 49.5%, p<0.001) and presented with delirium (13% vs 0.5%, p<0.001) and lethargy (33.8% vs 15.9%, p=0.001).More older patients had severe COVID-19 infection (72.7% vs 38.5%, p<0.001), with 9.1% necessitating intubation.More older patients were prescribed favipiravir (64.9% vs 32.4%, p<0.001), antibiotics (76.6% vs 44%, p<0.001), and steroid (75.3% vs 40.1%, p<0.001).More older patients required intensive care (32.5% vs 17%, p=0.003).More older patients developed complications such as secondary infection (41.6% vs 17%, p<0.001) and acute kidney injury necessitating dialysis (20.8% vs 8.8%, p=0.005).Older patients had longer length of hospital stay (14 vs 12 days, p<0.001) and higher mortality (18.2% vs 4.4%, p<0.001). Conclusion.Older patients with COVID-19 infection tend to have more severe disease, higher complication rate, and higher mortality.Timely management is essential to minimise morbidity and mortality.

Urinary tract infection (UTI) is common in women and older people. Cranberry is effective in preventing UTI. We searched databases of Ovid, Cochrane, Medline, CINAHL, and Google Scholar using keywords (cranberry, urinary tract infection, antibiotic resistance, elderly, and geriatric) to identify systematic reviews that contained randomised controlled trials (with control and experimental groups) that investigated the effectiveness of cranberry interventions in improving urinary tract health in older adults with or without recurrent UTI. A total of six systematic reviews were included. The number of participants in each review ranged from 1494 to 4473, with >10 000 participants overall. All six reviews included participants aged >65 years. Many participants were female and from age-care and hospital settings. All six reviews found some level of support for the cranberry groups to have greater reduction in UTI recurrence than the placebo groups. Nonetheless, one review found non-significant trends. Trends towards a reduction in UTI were noted among older people who regularly consumed cranberry products. More specifically, twice daily consumption of cranberry capsule (containing at least 36 mg proanthocyanidins) was most protective against bacterial adhesion and virulence in the urinary tract.

Introduction.Pain and frailty are common geriatric syndromes and can lead to adverse health outcomes.This study aims to examine the association between pain and frailty in community-dwelling older adults in Hong Kong and to suggest a patient-centred intervention for frail older people with pain.Methods: Community-dwelling older adults aged ≥65 years were invited to attend a health check programme.Characteristics of pain were recorded, including the presence of pain, the total number of pain sites, the highest pain intensity, and the frequency of pain.The 5-item FRAIL scale was used to screen frailty.The Lawton instrumental activity of daily living (IADL) scale was used to assess independence.Handgrip strength of the dominant hand and walking speed for 6 meters were measured.Results: Of 445 older adults who attended the health check programme, 265 women and 64 men (mean age, 75 years) agreed to participate and were included for analysis.Of them, 123 (37.4%) reported persistent pain, 116 (35.5%) reported sporadic pain, and 90 (27.4%) reported no pain.Participants were classified as frail (n=47, 14.3%), prefrail (n=200, 60.8%), or robust (n=82, 24.9%).Comparing the combined frail and prefrail group with the robust group, frailty was independently associated with age (odds ratios [OR]=1.053,p=0.007),Lawton IADL (OR=0.602,p=0.004), and sporadic pain (OR=2.072,p=0.031), after adjusting for walking speed and handgrip strength. Conclusion:The prevalence of frailty is high among communitydwelling older adults in Hong Kong.Age, IADL, and sporadic pain are independently associated with frailty; only pain is amenable.Pain management may help prevent progression to frailty in older people.

We report a case of calciphylaxis of the fingers in a 75-year-old woman with end-stage renal disease. She was on haemodialysis and had diabetes mellitus, hypertension, ischaemic heart disease, and hypothyroidism. She presented with progressive blackish discoloration of the fingertips of both hands. Calciphylaxis is caused by arterial calcification with consequent tissue necrosis and gangrene. It commonly occurs in patients with chronic kidney disease undergoing haemodialysis. Treatment involves modifying risk factors, wound care, cinacalcet, and sodium thiosulfate in addition to haemodialysis.

Background. Inpatient falls complicate and lengthen hospital admissions for older adults. Cognitive impairment is a risk factor for falls. Current fall prevention education is ineffective for people with cognitive impairment. We aimed to investigate whether an educational video is a better mode of delivery than verbal education for individuals with cognitive impairment in terms of recall and fall prevention.