Background There has been rapid improvement in evidence-based care for hip fracture in UK in which prompt, effective, multidisciplinary management has been shown to improve quality and reduce costs. The aim of this study was to evaluate the current outcome of hip fractures in our hospital, and to compare it to the outcome of evidence-based management of hip fractures in UK. Methods A cross-sectional study of all hip fracture patients aged 60 and above, admitted from 1st March 2018 until 28th Feb 2019. Medical records of 105 patients obtained from a hip fracture registry were reviewed. Clinical data such as patients’ sociodemographics, fall circumstances, fractures, peri-operative details, complications and mortality were extracted and analysed. Results The surgery rate was 67% (96.5% in UK). Among the 37 patients (35.2%) not operated, 15 refused operation. Rate of early surgery was only 9.3% (71.3% in UK). Medical stabilisation (28.2%) and no operating time (40.8%) were the main reasons for surgical delay. None had falls assessment (98% in UK) and only 7.6% was started on bone protection prior to discharge (60% in UK). The average length of stay was 17 days (15.8 days in UK). The 30 day mortality was 9.5% (8.5% in UK). Discussion Our results showed that there was no significant difference in length of stay and 30 day mortality compared to UK. However, this may be due to our small sample size. Lack of awareness of falls assessment and bone protection suggests that our current model of care needed improvement. Conclusion Our results highlighted the need to implement proactive strategies to improve the management of hip fracture in our centre. Ortho-geriatrics shared-care in hip fracture management was subsequently implemented in an effort to improve patient care and service. Further studies need to be done to re-evaluate the outcomes post implementation.

Cognitive impairment is not only common but may also act as a precursor for dementia. Moreover, diabetes mellitus has been shown to promote the progression of dementia. This study aims to determine the prevalence of cognitive impairment and its associated risk factors among the elderly patients having type 2 diabetes mellitus (T2DM) in Hospital Kuala Lumpur, Malaysia. This is a cross-sectional study involving 113 participants who were attending the physician clinic. The participants were selected using the universal sampling method. The tools included a sociodemographic questionnaire, the Montreal Cognitive Assessment, the Depression Anxiety Stress Scale, and the Mini-International Neuropsychiatry Interview. Descriptive analysis was performed and followed by multiple logistic regression. The prevalence of cognitive impairment, depressive disorder, and anxiety disorder was 46.9, 10.6, and 2.7%, respectively. Indians (aOR = 4.90, 95% CI = 1.57–15.27) as well as participants who had completed their secondary (aOR = 0.34; 95% CI = 0.12–0.96) and tertiary (aOR = 0.05; 95% CI = 0.01–0.26) levels of education were significantly associated with cognitive impairment. The prevalence of cognitive impairment was high as well as significantly associated with the ethnicity and education levels of the elderly participants. Indeed both secondary and tertiary education decreased the odds ratio of developing cognitive impairment when compared with no formal and primary education. To determine and reduce the potential risk factors which contribute to cognitive impairment, an early diagnosis of T2DM is crucial. The early detection and treatment of T2DM as well as its associated risk factors are key factors in protecting against cognitive impairment.

Background The older person is at greater risk of falls due to multiple intrinsic and extrinsic factors. This is compounded when the elderly is admitted to hospitals, as they are acutely ill and placed in an unfamiliar environment. Delirium and polypharmacy further complicate these problems. As falls reflect quality of care with potential for grave outcomes, this study aimed to identify the extent and risk of falls in public hospitals. Methods We conducted a nested case control study in 12 public hospitals in Malaysia. In the cohort section, we screened all inpatients 60 years of age and above daily until discharge, or the end of the study period. Daily, we identified those who fell, inclusive of near falls, in the preceding 24 h. Our enumerators interviewed patients on experience of fall, and supplemented data from the nurses and caregivers. For each case, ten controls were chosen. Results The incidence of falls/near falls was 1.0 per 1000 patient days (95% CI: 0.9, 1.1). Intrinsic risk factors found to be significant included patients who were not from a nursing home or not cared for by a domestic helper prior to admission, had prior history of indoor fall either in home or hospital, had four or more clinical diagnoses or exited from the bed on the weak side. Significant extrinsic factors were the absence of transfer bar in toilet, call bells, light switches or walking aids that were not within reach, as well as not having a walking aid. Non-sturdy chair was associated with lesser falls than when sturdy chairs with armrests were present. Conclusion Querying patients for falls produced better results than incident reporting. Several intrinsic factors such as history of indoor or in-hospital fall, having four or more clinical diagnoses or exiting from weaker side and residence history may help to identify those at higher risk. Addressing significant extrinsic factors such as transfer bars and the identification of switches may help in reducing falls risk in hospitals. Trial registration This study was registered in National Medical Research Register of Malaysia (NMRR-07-772-1044; date 26/05/2008) with Ethics Approval from Medical Research and Ethics Committee (MREC: MRG-07-LOI-HSR-1).

Background The aim of the present study was to analyse the demographic pattern, fall circumstances and identify risk factors associated with the occurrence of falls among older adults presenting to falls clinic Hospital Kuala Lumpur Setting and design A clinic-based cross-sectional study in Falls Clinic Hospital Kuala Lumpur Subjects and Method Medical records of 113 patients attending the Falls Clinic Hospital Kuala Lumpur were analysed. Data on falls circumstances, socioeconomic/demographic factors were collected, and possible risk factors were tested for possible association with outcome, i.e. Recurrent falls using univariate and multivariate analysis. Results Of the 113 patients studied, 37.2% (42) were aged more than 80, female predominant 60.2 % (68). 73.5% (83) had recurrent falls and 80.5% (91) had indoor falls. The 3 most common mechanism of falls were tripped/slipped 39.8% (45), loose balance 38.9% (44) and dizziness 31% (35). 67.3% (76) sustained injuries, of which 27.6% (21) were major injuries. Among major injuries, 76.2% (16) had fractures and 23.8% (5) had ICH. The 3 commonest risk factors are poly-pharmacy (5 or more meds) 83.2% (94), poor vision 77.9% (88) and multiple co-morbidities (3 or more) 77%. After multiple logistic regression analysis, ‘usage of anti-hypertensives’ achieved statistically significance with OR of 3.85 (p value 0.008, 95% CI 1.41-10.52). Conclusion The usage of anti-hypertensives is associated with almost 4 times more likely to have recurrent falls after removing cofounding factors from our clinic based study. We should prioritise falls prevention on older adults with polypharmacy, poor vision and multiple comorbidities especially those with anti-hypertensives.

Introduction Falls among hospital inpatients are common, generally ranging from 2.3 to 7 falls per 1000 patient bed days1. Around 30% of falls as inpatient are injurious2. Falls are associated with a longer length of stay in hospital and greater utilization of healthcare facilities3. Objective The goal of this study is to describe patient characteristics, circumstances of fall and clinical outcomes after inpatient fall Methodology This is a retrospective, descriptive study of all patients admitted to the Medical Department in year 2017 who sustained an inpatient fall. The data was obtained from the database of the Falls Team HKL. Results 162 patients, with an average age of (61.82±15.50) years were included in this study. Of these, 103(63.58%) were male and 74(45.68%) were ≥65 years. 120(74.1%) were walking unaided prior to admission. 146(90.1%) patients were admitted with an acute medical illness and 13(8.0%) with an acute fall. Median time to first fall was 5(IQR 3-8) days after admission. 160(98.77%) falls occurred in the ward. 79(48.77%) falls occurred between 9:00pm to 6:59am. 75(46.3%) patients fell near their bed and 56(34.6%) fell in the toilet. 47(29.01%) had an injurious fall; 32(19.7%) had minor injury, 9(5.6%) had moderate injury and 6(3.7%) had severe injury. Patients with injurious falls were more likely to have “Direct Impact to Head” during fall [OR; 12.73 (95%CI 5.62 – 28.82)]. They were also more likely to have a Head CT after fall [(OR; 6.41 (95%CI 3.02 – 13.62)]. 18(11.1%) patients died during hospitalisation. Median time to death was 9(IQR 4-16.25) days after fall. 144(88.9%) patients were discharged alive at median 6(IQR 3.75 – 9.25) days after fall. Upon discharge, only 49(30.2%) patients were walking unaided. Conclusion Inpatient falls affects patients of all age groups, regardless of gender. Our data shows that Inpatient falls can cause increased morbidity due to falls related injuries; however, there is no difference in age, gender, length of stay or death as inpatient between patients with injurious and non-injurious falls.