1 st July 2019 Current Issue Words from the President Council of SLAGM - 2019 Educational Activities Annual Academic Sessions- 2018 SLAGM articles -Ageing Phenotypes and Geriatric Syndromes -Care of Older People - Is it different? SLAGM Publications 2018-2019 Training Programmes Forthcoming Events New Members Other news SLAGM NEWS Official Newsletter of Sri Lanka Association of Geriatric Medicine Volume 1, July 2019 ISSN: 2682-714X Words from the President Dear Colleagues and Friends………..Read more Annual Academic Sessions 2018 Compiled and edited by Dr. Achala Balasuriya Dr. Hamsananthy Jeevatharan Mr. Harshitha Galhenage Office: Wijerama House, No 6, Wijerama MW, Colombo 7. E- mail : [email protected](Administrative Secretary) TP -94 (0) 11-2693025
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1
1st July 2019
Current Issue
Words from the President
Council of SLAGM - 2019
Educational Activities
Annual Academic Sessions-
2018
SLAGM articles
-Ageing Phenotypes and
Geriatric Syndromes
-Care of Older People - Is
it different?
SLAGM Publications 2018-2019
Training Programmes
Forthcoming Events
New Members
Other news
SLAGM NEWS Official Newsletter of Sri Lanka Association of Geriatric Medicine
Volume 1, July 2019 ISSN: 2682-714X
Words from the President
Dear Colleagues and Friends………..Read more
Annual Academic Sessions 2018
Compiled and edited by Dr. Achala Balasuriya Dr. Hamsananthy Jeevatharan Mr. Harshitha Galhenage
Vice Presidents Dr. Ruvan Ekanayake Dr. Priyankara Jayawardhena
Secretary Dr. Chamila Dalpathadu
Assistant Secretary Dr. Thusha Nawasiwatte
Treasurer Dr. Sajeewana Amarasinghe
Assistant Treasurer Dr. V. L. Dassanayake
Immediate Past President Dr. Dilhar Samaraweera
Council Members Dr. W.D. Thilakaratne Dr. Senaka Bandusena Dr. Lasantha Ganewatte Dr. Anoja Rajapakse Dr. Pradeepa Gajendran Dr. C.N. Wijeratne Dr. Achala Balasuriya Dr. K.V.C. Janaka Dr. Upul Dissanayake Prof. Antoinette Perera Dr. Nirmala Wijekoon Dr. G.K.K. Sewwandi Dr. Chandana Kanakaratne Dr. K.P. Karunathillake Dr. Dilanka De Silva Dr. Barana Millewithana Dr. M.N. J. Gunathilake Dr. J.B. Jayawardena
President’s Message Dear Colleagues and Friends,
Greetings from the SLAGM!
I am pleased to announce the launching of the very first Newsletter of Sri Lanka
Association of Geriatric Medicine at the Annual General Meeting in July 2019.
I believe, the Newsletter is a much needed addition to the SLAGM at this time
when our membership numbers are increasing, and we are strengthening our
links with Regional and International Geriatric Associations. We plan to publish
our SLAGM Newsletter every 3 months in the form of an E- Newsletter.
Sri Lanka Association of Geriatric Medicine was established in 2014 with the
objective of ensuring geriatric education among the medical fraternity and the
public with the common goal of promoting good health and well-being among
the senior citizens in Sri Lanka. Since inception, the SLAGM thrived under the
guidance of the eminent inaugural President, Dr. Dilhar Samaraweera.
I was fortunate to be able to serve as the President of this distinguished
Association. I am pleased that I am writing this message at a time that the
energetic Council of the SLAGM is very much contented with our activities over
the last year.
Annual Scientific Conference 2018, was the leading event organized with the
participation of more than 200 attendees under the theme “Adding quality to
added years” at the Galle Face Hotel, Colombo. There was a neuro-
rehabilitation workshop for the therapists in the pre-congress session. Seven
invited overseas speakers addressed wide range of geriatric topics in the main
academic programme.
In addition to organizing the vibrant Annual Scientific Conference, SLAGM was
able to carry out many outstation academic programmes and workshops
during this period. The Council aligned the main academic programs spanned
throughout the year in keeping with the conference theme “Adding quality to
added years” focusing on the need to establish multi- disciplinary team care
for older adults in Sri Lanka.
Widening the scope of membership by accommodating all health care
professionals on a single platform with the intention of promoting “Holistic
Approach for Elders”, is a primary target of SLAGM and we are working
towards realizing this goal. The SLAGM was the key figure to unveil the multi-
disciplinary approach in the minds of nurses and allied health professionals by
publishing the bulletin “Health Care for Older People – Holistic Approach” with
contributions from all the members of the team. This valuable bi-annual
publication is now available in all libraries related to health professional
education.
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Specialty Day in Geriatrics 2019
Programme
Care for The Elderly: What is Distinct? Dr. Chandana Kanakaratne Consultant Geriatrician End Stage Kidney Disease in Older Adults: Practical Considerations in Management Dr. S.Mathu Consultant Nephrologist Cognitive Impairment in Older Adults: Evaluation & Management Prof. Shehan Williams Professor in Psychiatry Hyponatraemia in Older Adults: Diagnosis and Therapeutic Considerations Dr. Manilka Sumanathilake Consultant Endocrinologist COPD Exacerbations in Older Adults: How to Prevent, Detect and Treat Dr. Amitha Fernando Consultant Respiratory Physician Frailty: Prevention Detection and Management Dr. Dilhar Samaraweera Consultant Physician Management of Urinary Incontinence in Older Adults Prof. Ajith Malalasekara Consultant Genito- Urinary Surgeon Arrhythmias in Older Adults : Detection and Management Dr. Asunga Dunuwila Consultant Cardiac Electro Physiologist
During the course of the year, the SLAGM was invited to represent the
interests of the Association at many national level activities including the
National Steering Committee on Elderly Health Care organized by the Youth,
Elderly and Disabled Unit of the MoH. Thereby, we are contributing to the
national grid on elderly health care.
As a grieving nation following the series of Easter bomb blasts, the multi –
disciplinary health care professionals that consists of all categories of staff
is the strength of the SLAGM. As we work united in the SLAGM, our
multidisciplinary team members which involve all categories of health care
workers irrespective of their level of education, religion, race or cast is the
pride of our Association.
I look forward to continuing with more educational programmes for
professionals and health care team members with a wide range of
community-based programmes for the public, as we join hands with the
New Council to be appointed following the Annual General Meeting in July
2019.
Dr. Padma Gunaratne
President
SLAGM.
Educational Activities Sri Lanka Association of Geriatric Medicine held many academic programs
for both medical doctors, nurses and allied health professionals over the
past one year. These programs focused on educating the health care
providers about the special needs of the older patient, the distinctive
aspects of providing care for the elderly, common age related morbidities
like dementia, frailty and falls. These educational programs also introduced
the need for multidisciplinary care approach to manage the ageing patient
for a holistic service provision. The resource persons for these activities
were members of the SLAGM Council, Consultants in Internal Medicine,
Neurology, Psychiatry, Rheumatology and Community Medicine.
Number of educational programs were done at National Hospital of Sri
Lanka. In 2018 June, the first Specialty Day in Geriatric Medicine was held at
ClinMARC, NHSL with the participation of postgraduate trainees,
consultants, medical officers of various grades, nurses and allied health
professionals.
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On the first of October 2018, as the world
celebrated the “World Elders Day” SLAGM
held a public educating media interview with
the participation of Dr.Padma Gunaratne
(President), Dr. Priyankara Jayawardena (Vice
President) and Dr. Dilhar Samaraweera at the
Health Promotion Bureau on the MoH.
Kandy Foundation Sessions 2018 was held in
August in collaboration with SLAGM.
During the course of 2018, SLAGM held a
special General Meeting and a new
constitution allowing membership to nurses
and other allied health professionals such as
physio and occupational therapists was
sanctioned.
In 2019, SLAGM carried out several
educational sessions in and out of Colombo to
link the health care personnel in many parts of
the island towards providing holistic care for
the older patient.
“Holistic Care for Elderly” training course for
doctors, nurses and allied Health professionals
was held on 4th January 2019 at the National
Hospital, Colombo and, also at Awissawella
BOI conference Hall ,on 8th February 2019.
Nurses Program at NHSL
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Regional Meeting at BOI Conference
Hall Awissawella
SLAGM members with Team Awissawella
On 26th of March 2019, SLAGM Regional
Meeting Galle, was held in collaboration with
the Galle Medical Association (GMA).
Postgraduate trainees of Geriatric Medicine,
consultants from Internal Medicine,
Neurology, Geriatric Medicine, Psychiatry and
Rheumatology participated at this event. Prof.
Ashish Goel from University College of Medical
Sciences, Guru Teg Bahadur Hospital New
Delhi also participated at this event.
Dr. Padama Gunaratne
Prof. Shehan Williams
Prof. Ashish Goel
SLAGM and GMA Teams at Galle
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The audience
Dr. Sithira and Dr. Suamya in” role play”
SLAGM and KCS teams
Regional Meeting Kegalle
SLAGM Regional Meeting in collaboration with
the Kegalle Clinical Society was held at the
District General Hospital Kegalle on the 14th of
June 2019. SLAGM program under the theme
“Holistic Care for the Elders” was attended by a
large number of participants involving
consultants. grade medical officers, nurses and
allied health care professionals. Highlights of
the program are shown below.
Dr. P. Gunaratne (President) addressing the
gathering
Dr. Dilhar Samaraweera (Founder President),
lighting the lamp
Dr. Chandana Kanakaratne
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Fourth Annual Academic Sessions of
the SLAGM 2018
Geriatric Medicine and Neuro-Rehabilitation
Conference of the SLAGM was held between 25th
and 27th October 2018 in collaboration with
Association of Sri Lankan of Neurologists (ASN) at
the Gall Face Hotel Colombo. The theme for the
conference was “Adding Quality to Added Years”.
The vibrant clinical program was attended by a
large number of delegates both local and
international. The Guests of Honour for the
inauguration were the President of the British
Geriatric Society, Dr. Eileen Burns and Dr. Nirmal
Surya, Honorary Associate Professor of Neurology
at the Bombay Hospital and Research Centre. The
Minister of Health, Dr. Rajitha Senaratne graced
the occasion as the Chief Guest.
There were Pre-congress workshops on
Management of Spasticity for doctors and,
rehabilitation of Stroke and Parkinson’s disease
for physio and occupational therapists conducted
by international resource persons from India and
Australia. The international faculty members
were, Professor Susan Kurrle from Hornsby
Kuringal Hospital Sydney, Australia, Prof. Ian
Cameron, Professor of Rehabilitation Medicine,
University of Sydney, Dr. Veena Raykar Consultant
specialist in Rehabilitation from Concord Hospital
Sydney, Dr.Abhishek Srivastava, Consultant in
Rehabilitation Medicine and Director of
Neurological Rehabilitation and physical Medicine
at Kokilaben Hospital Mumbai, India, Ms. Reenai
Pillay Senior Rehabilitation and Occupational
Therapist, Concord Hospital Sydney Australia and
Ms. Clarie Gill a Senior Physiotherapist from St
George Hospital Sydney Australia.
Local faculty members included Dr. Padma
Gunaratne, President SLAGM and Consultant
Neurologist, Dr. Sudath Gunasekara, Consultant
Clinical Neurophysiologist, Dr.Senaka Bandusena
Consultant Neurologist, Dr. Champika
Gunawardena, Consultant Neurologist, Dr. Dilhar
Samaraweera, Consultant Physician, Dr. Kapila
Ranasingha, Consultant Psychiatrist and Dr.
Shiromi Maduwage Consultant Community
Physician.
Dr. Chandana Kanakaratne, Consultant Physician
(Consultant Geriatrician UK), Dr.Chandana
Karunathilake, Consultant Orthopaedic Surgeon,
Dr.Manilka Sumanathilake, Consultant
Endocrinologist, Dr. Arosha Dissanayake,
Consultant Physician, Mr. Yasantha Kodagoda,
Additional Solicitor General and President’s
Counsel, Dr. Noel Somasundaram Consultant
Endocrinologist, Dr.Panduka Karunanayake
Consultant Physician and Prof. Godwin
Constantine, Consultant Cardiologist.
Highlights from the Pre- Congress
Session
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Annual Academic Sessions 2018
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Annual Dinner 2018
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SLAGM articles
Ageing Phenotypes and Geriatric Syndromes Dr. Saumya Darshani, Registrar in Geriatric Medicine, National Hospital, Colombo
The hallmark of ageing is decrease in functional properties of cells, tissue and organ systems. This loss of
functional properties results in a loss of homeostasis leading to decreased adaptability to stressors causing
adverse health outcomes such as morbidity or mortality. This phenomenon is now believed to be of
random occurrence and accumulation of functional loss due to multiple factors rather than a programmed
genetically determined process, therefore we witness the individual variations in aging. This explains why
merely the chronological age does not precisely predict the phonotypical age.
Figure: Ageing phenotypes and genesis of geriatric syndromes.
(Source-Oxford Textbook of Geriatric Medicine)
Ageing Phenotypes
There are four ageing phenotypes described in the literature which are results of multisystem effects of
ageing. These can be taken as parameters that measures rate of ageing.
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1. Change in body composition
There is a progressive decline in lean body mass comprising muscle and visceral organs after 30 years
which is accelerated after 60 years. There is an increase in fat mass during middle age, then decline in
latter ages. It is mostly the visceral and inter-muscular fat that increases while there is decline in
subcutaneous fat. However until around 70 years body weight is usually stable or slightly increases while
there is parallel decrease in both fat-free mass and fat after 70 years. Furthermore, there is development
of poor quality muscles due to increased fat infiltration within the muscle with ageing. These major
changes in body composition negatively affect functional status and contribute to impaired mobility and
disability in older adults.
2. Imbalance in energy availability and demand
The degenerative process that characterizes ageing occurs when the individual’s ability to balance energy
production and expenditure declines.
Resting metabolic rate (RMR) is the energy required to maintain structural and functional homeostasis at
physical rest, in fasting and neutral conditions. RMR that is higher than expected for a certain age, sex and
body composition has been found to be an independent risk factor for mortality and predicts future
greater burden of chronic diseases. Consequently, it should be considered a marker of health
deterioration in older adults.
It is observed in studies that the peak oxygen consumption (VO2 max),which estimates the maximum
energy that can be produced by an organism over extended time periods declines with age around 10%
per decade starting from 30s. This decline is more accelerated in chronic disease and those with sedentary
life. VO2 max is a reflection of cardiovascular and respiratory adaption to transport oxygen and
adaptations within muscle to use oxygen to meet the energy demands of physical activity and thereby
represents the maximal ability to use oxygen to meet the energy demands of physical activity (maximal
aerobic capacity), physical function and mobility in older adults.
3. Homeostatic dysregulation
With ageing, there is impairment in acute inflammatory responses resulting in increased susceptibility to
infections. However on the other hand, there is mild persistent chronic inflammation in the body causing
tissue damage and degeneration. This is revealed by detection of elevated levels of serum C-reactive
protein and interleukin-6 (IL-6) which is shown to be associated with age related chronic diseases,
hospitalizations, disability and mortality.
Homeostatic dysreguations also can be seen in hormonal regulations where there is decline in anabolic
hormones such as GH, IGF-1, vitamin D, DHEAS, testosterone, estrogens and relative preservation of
catabolic hormones such as thyroid hormones and cortisol. This dysregulation can result in physical
disability and cognitive impairment and also predicts cardiovascular and all-cause mortality in older
adults.
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4. Neuronal functions and neuroplasticity
It is commonly observed that the memory, processing speed, executive function, and reasoning are
commonly reduced with ageing. Contrary, other mental functions like verbal abilities, numerical abilities
and general knowledge tend to be spared. There are both structural and functional changes in brain with
ageing which are responsible for decline in brain functions. These changes are modified by genetic and
environmental factors. It is evident that cardiovascular and metabolic risk factors, inflammation, stress,
and deposition of iron and beta-amyloid accelerate brain ageing, while leading an intellectually
challenging, physically active, and socially engaged life mitigate cognitive decline and play a protective
role enhancing neuroplasticity, and perhaps also facilitate novel neurogenesis in specific parts of the brain.
The above four ageing phenotypes explain how ageing results in physical and cognitive frailty and multi-
morbidity. The rising susceptibility for disease occurrence by ageing process creates multi-morbidity
which defined as the co-existence of at least two diseases. Therefore ageing has become the major risk
factor for multi-morbidity. The frailty, multi-morbidity and disability are inter-connected. However, the
causal relationship between frailty and multi-morbidity is yet to be proven.
The multisystem effects of ageing lead to well recognized geriatric syndromes including falls, urinary
incontinence, dementia, delirium, pressure ulcers etc. Most geriatric syndromes are results of specific
combinations of over expressed ageing phenotypes. Those syndromes are multi factorial health
conditions that have emerged when the accumulated effects of impairments in multiple systems render
an older person vulnerable to situational challenges. Therefore its pathophysiology is different from the
pathophysiology of most non-geriatric conditions (one alteration leading to one disease involving one
system). For example, urinary incontinence in older individuals is usually due to a combination of changes
in body composition with consequent reduced muscle mass and strength of the bladder and pelvic floor
muscles, altered neurological reflexes related to neuro-degeneration (both central and peripheral nervous
systems) and recurrent urinary tract infections due to poor immunity. Therefore, the treatment of urinary
incontinence in an elderly female who presented with concomitant urinary tract infection is not really
achieved only by mere treatment of infection. One must address the problems such as pelvic muscle
weakness, constipation, mobility issue, depression and much more to overcome the syndrome.
Therefore, knowing the phenotypical changes that occur with ageing is essential not only for advancing
research, but also for the clinical diagnosis, etiological identification and treatment of geriatric syndromes
and may improve the healthcare of older adults.
References
1. Fabbri E, Zoli M, Ferrucci L (2017).The emergence of ageing phenotypes and multisystem decline. In: Michel JP,
Beattie BL, Martin FC, Walston JD. Oxford Textbook of Geriatric Medicine. 3rd ed.: Oxford University Press;. pp. 311-
316.
2. Fedarko NS. The Biology of Aging and Frailty.Clin Geriatr Med. 2011 Feb; 27(1): 27–37.