A 68-year-old woman with a history of Parkinson disease was admitted for Escherichia coli urinary tract infection and physical deconditioning. She was subsequently found to have a history of rheumatoid arthritis and iatrogenic Cushing syndrome with adrenal insufficiency. The patient developed high fever, fluctuating blood pressure, hypertonia, progressive confusion, and recurrent generalised tonic-clonic seizures. She was kept nil by mouth, and levodopa was withheld for 2 days. Blood test showed elevated creatine kinase level. Diagnosis of parkinsonism hyperpyrexia syndrome was made after consultation with neurologists, and levodopa was resumed. However, her condition did not improve and she later died. This case highlights the precipitating factors of parkinsonism hyperpyrexia syndrome and the importance of early recognition of the disease. Care must be taken in avoiding sudden withdrawal of levodopa in patients with Parkinson disease.

In Hong Kong, the fifth wave of the COVID-19 pandemic has resulted in >9000 deaths, of which >87% involved older adults aged 70 years, and more than half of these older adults were living in residential care homes for the elderly. 1 Frailty is a major risk factor for the high mortality in older adults. In this issue, Miu 2 reports that 70% of community-dwelling older adults are frail or prefrail and that pain management may help to prevent progression of frailty.

Background. Donning personal protective equipment (PPE) and performing cardiopulmonary resuscitation (CPR) are stressful tasks for healthcare professionals, particularly during the COVID-19 pandemic. This study aimed to assess the effectiveness of simulation training on donning PPE and performing CPR with PPE put on for nurses at a geriatric step-down hospital.

Objective.To evaluate the safety and effectiveness of the careful hand feeding (CHF) programme in a geriatric step-down hospital.Methods.Medical records of patients aged ≥65 years who received CHF in Fung Yiu King Hospital between February 2017 and November 2021 were retrospectively reviewed.Results.446 patients (178 men and 268 women) aged 66 to 109 (mean, 91) years were included for analysis.88% of patients were severely frail or very severely frail.70% of patients had advanced dementia.81.3% of patients had dysphagia.44% of patients were in imminent death status (who were highly likely to die within a week) before starting CHF.Food intake during CHF was poor or very poor in 51% of patients and satisfactory or good in 49% of patients.90% of patients required clinically assisted hydration.The mean length of hospital stay was 19.3±16 days, and the mean duration of CHF was 14±13.5 days.39% of patients died during the index admission; most of the remaining 61% of patients were discharged to their original placement.27 (6%) patients had pneumonia.Independent predictors for pneumonia were the length of hospital stay (odds ratio=1.024,p=0.014) and poor/very poor intake (odds ratio=1.82,p=0.017). Conclusion.CHF is safe in a geriatric step-down hospital and avoids use of a nasogastric feeding tube in patients in their last phase of life.It fosters comfort and dignity for dying patients.Most patients can return to their original placement for CHF after discharge.

We report a case of delayed neuropsychological sequelae manifesting as cognitive impairment and parkinsonism in a 72-year-old woman who attempted suicide by carbon monoxide poisoning 20 years earlier.

Background. Nasogastric tubes (NGT) are frequently used in geriatric settings and verification of NGT placement is important for patient safety. This study aimed to ascertain the accuracy of carbon dioxide (CO 2 ) colourimeter in the verification of NGT and to estimate the reduction in patient waiting time for resumption of NGT feeding in the general care setting.

Immune-mediated necrotising myopathy is a rare disorder characterised by muscle necrosis, fatigue, and weakness.We report one such case with symptom onset more than 3 years after regular statin use.This report serves as a diagnostic alert when a patient's statin-associated muscle symptoms fail to resolve a few weeks after statin discontinuation.

Background.Frailty is a multidimensional syndrome.Sarcopenia plays an essential role in the early diagnosis and prevention of frailty syndrome.Therefore, we examined the association of frailty syndrome with sarcopenia among community-dwelling rural older adults in West Bengal.Methods: This cross-sectional survey was conducted between October 2018 and January 2020 in 510 (230 men and 280 women) older adults aged ≥60 years who had lived for >10 years in the selected villages of Pancharul Gram Panchayat, Udaynarayanpur Block of Howrah District, West Bengal, India.Participants were assessed for frailty syndrome and sarcopenia as well as cognitive impairment, social support, history of fall, and nutritional status by a single investigator.Frailty syndrome was assessed using the modified Physical Frailty Phenotype Scale.Frailty is defined as a display of ≥3 of five physiological deficits: low weight, low gait speed, reduced muscle strength, exhaustion, and low physical activity.Sarcopenia was assessed using the Asian Working Group on Sarcopenia 2014 consensus by measuring dominant hand grip strength, gait speed, and skeletal muscle mass index.Results: Of the 510 participants, 44 (8.6%) were both frail and sarcopenic, 88 (17.3%) were frail only, 16 (3.1%)were sarcopenic only, and 362 (71.0%) were non-frail and non-sarcopenic.The prevalence of frailty syndrome was 25.9%, whereas the prevalence of sarcopenia was 11.8%.Compared with non-frail participants, frail participants were six times (adjusted OR=6.42, p<0.01) more likely to be sarcopenic after adjusting for age, marital status, educational level, occupational work, cognitive impairment, social support, history of fall, and nutritional status.

Frailty and sarcopenia are important syndromes in older people and are associated with poor outcomes.Assessment and prevention of frailty and sarcopenia are of particular importance during the COVID-19 pandemic.Since 2020, the pandemic has been a new risk factor for frailty and sarcopenia.Strict lockdown measures to protect frail older adults may worsen the frailty and sarcopenia and lead to social isolation, depression, malnutrition, and reduced access to care. 1 In the present issue, Das et al 2 investigate the association between frailty and sarcopenia in West Benga, India.Frail participants are six times more likely to be sarcopenic than non-frail people.Further study on Asian populations is warranted to determine the best management strategies.