Sri Lanka Journal of Geriatrics & Gerontology Feed

Deprescribing in older adults

Fri, 17 Apr 2026 00:00:00 GMT

Polypharmacy, the concurrent use of multiple medications, is highly prevalent among the elderly and has been associated with various adverse outcomes such as cognitive impairment, falls, hospitalisations, and increased mortality. In this context, deprescribing plays a critical role. Deprescribing is the process of discontinuing harmful or no longer necessary medications, addressing the harms of inappropriate polypharmacy. This process requires shared decision-making between the prescriber and the patient. This article explores the approach, tools, and challenges associated with deprescribing. It also reviews findings from various trials on deprescribing in older adults, emphasising its growing importance in enhancing geriatric care.

Launching the Sri Lanka Journal of Geriatrics and Gerontology

Fri, 17 Apr 2026 00:00:00 GMT

It is with great pride and a deep sense of responsibility that we present the inaugural issue of the Sri Lanka Journal of Geriatrics & Gerontology (SLJGG), the official journal of the Sri Lankan Association of Geriatric Medicine (SLAGM). This milestone marks a significant step in the evolution of our Association. It reflects more than a decade of sustained commitment to advancing the care, dignity, and well-being of older adults in Sri Lanka.

Telehealth in geriatric nursing: A mini narrative review

Fri, 17 Apr 2026 00:00:00 GMT

The growing global ageing population presents significant challenges for healthcare systems, necessitating innovative, scalable solutions to meet the complex needs of older adults. This mini-narrative review examines the role of telehealth in geriatric nursing, highlighting its potential to improve access, continuity, and quality of care for older adults, including those who are socially isolated or living in low-resource settings. Key telehealth interventions discussed include video consultations, remote health monitoring, telephone follow-ups, mobile applications, and ambient assisted living technologies. The review outlines the numerous benefits of telehealth, such as enhanced patient engagement, caregiver support, and reduced healthcare costs. However, it also identifies critical challenges, including technological barriers, digital literacy gaps, ethical concerns related to informed consent and data security, and systemic issues like inadequate reimbursement and policy frameworks. Special attention is given to the unique barriers and facilitators of telehealth adoption among older adults, particularly in low and middle-income countries. The review underscores the importance of user-centred design, supportive infrastructure, culturally competent training, and regulatory policies that prioritise digital equity. Despite promising advancements, research gaps persist in terms of standardised protocols, long-term outcomes, and tailored approaches for diverse geriatric populations. The paper concludes by emphasising the need for sustained investment, ethical vigilance, and nurse-led innovation to ensure that telehealth becomes a reliable, inclusive pillar of geriatric care globally.

Integrating gerontology into Sri Lanka’s health sector: A timely imperative

Fri, 17 Apr 2026 00:00:00 GMT

No abstract available.

Prevalence of delirium, depression and dementia among elderly medical inpatients of a tertiary care hospital of Sri Lanka

Fri, 17 Apr 2026 00:00:00 GMT

Background: Delirium, depression and dementia are highly prevalent neuropsychiatric conditions among older adults, and have a huge impact on quality of life, morbidity and mortality. Objectives: This study aimed at determining the prevalence of delirium, depression, and dementia among elderly medical in-patients admitted to the National Hospital of Sri Lanka. The other objectives were to describe the associations of delirium, depression, and dementia, and to determine the rate of identification by the treating team. Materials and methods: A cross-sectional descriptive study was conducted among 234 elderly patients admitted to the National Hospital of Sri Lanka. The participants were screened using Sinhala and Tamil versions of Confusion Assessment Method (CAM), Geriatric Depression Scale (GDS) and Montreal Cognitive Assessment (MoCA), and those who screened positive were subsequently assessed with Diagnostic and Statistical Manual (DSM) 5 criteria. Results: Sixty five percent were females, and the mean age was 69.47 (SD + 7.087). Forty two participants, (17.9%, 95% CI 13.3-22.5) screened positive and fulfilled DSM criteria for delirium. Fifty One (25.5%) screened positive with GDS and forty-seven (23.5%, 95% CI 17.8-30) were depressed according to DSM5. MoCA scores were positive for cognitive impairment in 130 (72.63%) and the prevalence of dementia was 14.53% (95% CI 9.7-20.6). A statistically significant association was seen for delirium with age and medical comorbidity, for dementia with age, and for depression with marital state and living circumstances. Only 17 (16.19%) out of a total of 105 cases were identified by the treating team, and 1.9 % were referred to psychiatric services. Conclusions: A significant proportion of older medical in-patients have delirium, depression and dementia, and only a small proportion is identified. It is prudent that medical staff are adequately trained to identify these conditions and liaison psychiatry services are available.

Strengthening geriatric medicine in Sri Lanka – A global perspective

Fri, 17 Apr 2026 00:00:00 GMT

No abstract available.

Psychometric evaluation of the Sinhala version of the Falls Efficacy Scale-International in older adults with chronic obstructive pulmonary disease

Fri, 17 Apr 2026 00:00:00 GMT

Background: Fear of falling is common among older adults with Chronic Obstructive Pulmonary Disease (COPD) and is linked to activity restriction and poorer quality of life. The Falls Efficacy Scale-International (FES-I) is widely used to assess fear of falling; however, a validated Sinhala version was not available for this population. Objective: To evaluate the psychometric properties of the Sinhala version of the 16-item Falls Efficacy Scale (FES-I) in older adults with COPD. Methods: A cross-sectional study was conducted at the Central Chest Clinic and the National Hospital for Respiratory Diseases from August to September 2024. A total of 229 participants were recruited using a purposive sampling technique. The Falls Efficacy Scale-International (FES-I), translated into Sinhala, was used to assess fear of falling. Internal consistency was evaluated using Cronbach’s alpha. Construct validity was examined through exploratory factor analysis. Receiver operating curve (ROC) analysis was conducted to assess specificity and sensitivity and to determine the optimal cut-off score. Results: The mean age was 70.71±6.83 years, and the mean FES-I score was 33.21±9.0. Internal consistency of the Sinhala FES-I was excellent, with a Cronbach’s alpha of 0.889. Exploratory factor analysis revealed four factors with eigenvalues ranging from 1.121 to 6.030. The four-factor model explained 69.3% of the total variance, indicating a multidimensional structure. Cut-off point for FES-I was 31.5, which differentiates between fallers from non-fallers with a sensitivity of 78.9% and a specificity of 60%. Conclusions: The Sinhala version of the FES-I is a reliable and valid tool for assessing the level of fear of falling among Sinhala-speaking older adults with COPD in Sri Lanka.

Knowledge, attitude, practice, and associated factors towards older adults’ care among nurses in a selected hospital in the North-Central Province of Sri Lanka

Fri, 17 Apr 2026 00:00:00 GMT

Introduction: The global ageing population presents unique challenges for healthcare systems, particularly in Sri Lanka, where the proportion of older adults is projected to reach 25% by 2041. Nurses play a crucial role in imparting essential knowledge, fostering positive attitudes, and promoting effective practices in caring for older adults. This study aimed to assess the nurses' knowledge, attitudes, and practices regarding older adults, as well as their associated factors in a selected hospital in Sri Lanka. Methods: A descriptive cross-sectional study was conducted among 125 nurses working at surgical and medical wards at Polonnaruwa Teaching Hospital, Sri Lanka. Data were collected using self-administered questionnaires including the Knowledge of Older Patients Quiz (KOP-Q), modified Kogan's Attitude Scale, and a pre-tested researcher-developed practice questionnaire (Cronbach’s alpha- 0.747). Data was analysed using descriptive and inferential statistics (significance at P<0.05) in SPSS Version 25. Results: The majority of participants were female (91.2%, n=114), aged 20–30 years (53.6%, n=67), held a diploma in nursing (68.8%, n=86), and had less than 10 years of experience (73.6%, n=92). Only 9.6% (n=12) had specialised training in the care of older adults. Most (90.4%, n=113) had moderate knowledge (mean 18.02±2.57, range 0-30, (good (≥21), moderate (15–20), and poor (<15)), 94.4% (n=118) had positive attitudes (mean 92.91±7.94, range 26-156), and 76.8% (n=96) had good practices (mean 16.24±1.80). Significant factors for knowledge included age (p=0.003), gender (p=0.009), education (p=0.019), and experience (p=0.006). Attitudes were influenced by age (p=0.001), experience (p<0.000), training (p=0.045), and having older adults at home (p=0.020). Practices were associated with marital status (p=0.007), education level (p=0.001), training (p=0.045) and having an older adult at home (p=0.020). Knowledge and practice showed a weak positive correlation (r=0.271, p=0.002). Conclusions: While nurses demonstrated moderate knowledge, positive attitudes, and good practices in the care of older adults, specialised training remains limited. Key factors influencing knowledge, attitudes, and practices include age, education, experience, and the presence of older adults at home. Strengthening geriatric training programs can enhance nursing competence and improve care for older adults.

Medical professionalism through the lens of dignity in older adult care

Fri, 17 Apr 2026 00:00:00 GMT

Medical professionalism represents the ethical and moral foundation of clinical practice. Within geriatric care, professionalism finds its most profound meaning through the preservation of dignity – a quality that safeguards the identity, autonomy, and humanity of older adults. This review explores how the concept of dignity integrates with the values and domains of medical professionalism, particularly in the care of frail, dependent, or cognitively impaired older persons. Dignity is multifaceted – comprising intrinsic, relational, and personal dimensions. In geriatrics, each of these becomes vulnerable to erosion through functional dependency, institutionalisation, or ageist attitudes. Professionalism thus extends beyond competence to encompass moral imagination and relational ethics. The clinician’s duty is not merely to diagnose or cure but to affirm personhood through respect, truthful communication, empathy, and advocacy. Professional virtues such as altruism, integrity, and accountability gain tangible meaning when operationalised through dignity-preserving practices, such as inclusive decision-making, safeguarding privacy, and compassionate presence. In resource-constrained contexts such as Sri Lanka, where systemic and cultural pressures often threaten humane care, reaffirming dignity is both a professional and a moral imperative. Professionalism in geriatrics is best understood as the daily discipline of dignity—an ethical commitment to recognise, respect, and uphold the humanity of older adults amidst vulnerability and decline. Such practice restores the moral heart of medicine and reinforces trust in the physician–patient relationship.

Enhancing the wellbeing of older adults through domestic automation: A Preventive Assistive Monitoring and Alert System (PAM-AS) Approach

Fri, 17 Apr 2026 00:00:00 GMT

With the enveloping problem of social isolation and vulnerability among the elderly, it is crucial that technology be integrated into the environment surrounding them. This increases the likelihood of automating the domestic niches of older adults. Domestic automation, also referred to as domotics, is the centralised control of the electrical appliances, flooring, and energy systems for convenience and comfort. Compared with concurrent demographic transitions and reportedly high social isolation among the elderly population, there is a paucity of structured approaches to developing smart homes. There is no literature addressing all domains of care for older adults living alone. This review aims to contribute to the development of a self-sufficient domestic automation model and delineate existing barriers to establishing domotics as a care plan.

Myxoedema coma with pancytopenia and diagnostic challenges

Fri, 17 Apr 2026 00:00:00 GMT

Myxoedema coma is a rare, life-threatening complication of severe hypothyroidism especially in geriatric population. We report a diagnostically challenging case of a 65-year-old man presenting with altered consciousness, bradycardia, anasarca, and hypothermia, consistent with myxoedema coma. Initial management included high-dose enteral thyroxine and IV hydrocortisone, but clinical improvement was minimal. Investigations revealed pancytopenia, deranged liver enzymes, and high anti-TPO antibodies. Severe constipation, meningoencephalitis, hepatic encephalopathy, Addisonian crisis, and other systemic illnesses were considered and excluded. The poor response to oral thyroxine suggested malabsorption, likely due to intestinal mucosal edema. Lack of IV thyroxine availability in a resource-limited setting posed a therapeutic challenge. The patient’s condition deteriorated with cardiac arrest, pleuropericardial effusions, and ventilator-associated pneumonia, ultimately leading to death. This case highlights the atypical presentation, diagnostic dilemmas, and management challenges of myxoedema coma in low-resource environments. Early recognition and aggressive management are crucial to improving outcomes in this often-misdiagnosed endocrine emergency.

Prevalence and risk factors of falls among community-dwelling older adults in Sri Lanka: A systematic review

Fri, 17 Apr 2026 00:00:00 GMT

Background: Falls have a significant negative impact on health, mobility and survival, particularly among older adults. Despite the clinical relevance, falls are not adequately studied in Sri Lanka, and this scoping review assessed the limited information on the prevalence and risk factors of falls among community-dwelling older adults in Sri Lanka. Methods: Original studies published in PubMed, Ovid, and Google Scholar were searched using the key terms “falls”, AND “prevalence” OR “incidence” OR “risk factors” OR “determinants” AND “elderly” OR “older adults” AND “Sri Lanka”. The PRISMA guidelines were followed in selecting articles. Results: The original search retrieved 13 articles; only 3 met the selection criteria. They included a total of 2010 community dwelling older adults aged ≥60 years. The prevalence of falls ranged from 258 to 508 per 1000 people. The common risk factors identified were; falls in the previous year (OR=4.65), disability (OR=2.04), house risk level (OR=1.68), advanced age (OR=3.4), female gender (OR=3.0), being employed (OR=3.6), diabetes mellitus (OR=2.7), balance or gait problems (OR=4.2), and been on at least one longterm medication (OR=3.5). Conclusions: Evidence related to falls is scarce in Sri Lanka, and limited data show that approximately one-fourth to half of older adults in the community experience at least a single fall, while the female gender, disability, comorbidity, and medication use are significant contributory factors. This review highlights a clear gap in the knowledge of falls among older adults in Sri Lanka.

Predictors and outcomes of perioperative delirium in older females with fragility hip fractures at a tertiary care centre, Sri Lanka: A case-control study

Fri, 17 Apr 2026 00:00:00 GMT

Introduction: Hip fractures are common in older adults. Perioperative delirium is a common complication following a hip fracture. This study was designed to examine the predictors and outcomes of perioperative delirium following hip fracture in older females. Methodology: This case-control study was conducted among inward patients in Colombo South Teaching Hospital who were admitted with hip fractures. Data were collected using an interviewer administered questionnaire. Cases were defined as female patients more than 65 years of age diagnosed with perioperative delirium and control group included female patients more than 65 years of age without delirium. Data were collected at two points; during hospital stay and one month following surgery. Data was analysed using SPSS 23.0. Results: A total of 104 female patients were included (52 in each group). The average age of the study participants was 78.4 years. 53.8% had three or more medical co-morbidities and 64.4% had polypharmacy. The majority were indoor falls (n=69, 66.3%). The average time taken to reach the hospital was 75.5 hours, the mean time taken for the admission to the orthopaedic ward since arrival was 85.5 hours and the mean time to surgery from admission was 111.4 hours. High preoperative pain and having one or more falls during the last year were significantly associated with development of delirium. The cases were observed to have lower Barthel index score and lower level of mobility after 1 month. Conclusions: Perioperative delirium is strongly associated with pre-operative pain and having one or more falls during last year. A significant waiting time for surgery and late admissions were noted during the study. Implementing protocols to optimize pain management, identification of factors leading to delay in admission and surgery will be potential future interventions for a better outcome.

Spontaneous pneumoperitoneum in an older adult with uncomplicated COVID-19: A case report

Fri, 17 Apr 2026 00:00:00 GMT

Pneumoperitoneum typically signifies gastrointestinal perforation and warrants urgent surgical intervention. However, spontaneous pneumoperitoneum (free intraperitoneal air without a clear cause) is an uncommon clinical entity. In the context of COVID-19, pneumoperitoneum is most frequently reported among patients receiving mechanical ventilation, typically due to barotrauma. Pneumoperitoneum in nonventilated, clinically stable patients is exceedingly rare. We report a case of a 75-year-old man with well-controlled diabetes mellitus who presented with mild COVID-19 symptoms, managed as an outpatient. He later developed acute abdominal distension and pain. Clinical evaluation revealed mild diffuse tenderness without peritonitis. An erect abdominal X-ray demonstrated free subdiaphragmatic air consistent with pneumoperitoneum, but no signs of bowel obstruction, such as multiple air-fluid levels or significant bowel dilatation. Conservative management was initiated in the absence of peritoneal signs or hemodynamic instability. The patient remained stable, and symptoms resolved without surgical intervention. Follow-up imaging and endoscopic evaluation revealed no abnormalities. This case highlights a rare presentation of spontaneous pneumoperitoneum in a non-intubated, oxygen-independent patient with COVID-19. Proposed mechanisms include viral-induced mucosal disruption, microthrombi-related ischaemia, and air translocation across fascial planes. The absence of obstructive radiographic features supported conservative management. Plain radiography played a central role in diagnosis and monitoring. Spontaneous pneumoperitoneum may occur in patients with mild COVID-19 without barotrauma or perforation. In the absence of clinical deterioration or obstructive features, conservative management guided by imaging is a safe and effective approach. Awareness of this entity is crucial to avoid unnecessary surgical interventions.

Multiple myeloma presenting with digital gangrene and renal impairment in a frail older adult: A case report

Fri, 17 Apr 2026 00:00:00 GMT

Multiple myeloma (MM) is a plasma cell malignancy that primarily affects the elderly, with high mortality rates. MM can present with a wide range of clinical manifestations. While common features include anaemia, renal dysfunction, bone pain, and hypercalcaemia, atypical presentations may delay diagnosis and affect outcomes. We report the case of a 74-year-old frail man with multiple comorbidities who presented with progressive digital gangrene and worsening renal function. Initial investigations ruled out peripheral arterial disease and raised the possibility of vasculitis. However, serum and urine electrophoresis revealed monoclonal kappa light-chain gammopathy. The bone marrow biopsy confirmed the diagnosis of MM, while imaging revealed spinal lytic lesions. Renal biopsy revealed both cast nephropathy and membranoproliferative glomerulonephritis. Patient refused chemotherapy, and while on supportive care, he died of sepsis and renal failure. This case highlights an unusual presentation of MM, emphasising the fact that apart from vasculitis, monoclonal gammopathies should also be considered as a differential diagnosis for digital ischaemia and renal impairment in older patients. Furthermore, it emphasises the significance of integrating the patient’s functional status, comorbidities, and treatment preferences into clinical decision-making. In frail older adults, shared decision-making ensures that care remains patient-centred, appropriate, and ethically grounded.