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It is inevitable for older persons to experience a loss in physical performance and cognitive function because of the ageing process. The reduction of muscle mass that comes with ageing is linked to a decrease in physical performance. Ageing has also been associated with a decline in cognitive function. Multiple studies have found a relationship between physical performance deterioration and cognitive function deterioration. This research aims to see if there's a link between demographic characteristics, physical performance assessments, and cognitive function among Malaysian older persons. A cross-sectional study was conducted among 37 community-dwelling older persons aged 60 years old and above. Written consents were collected from participants. Demographic information, physical performance test and cognitive function test were collected. Using SPSS® version 28, the data was analysed using Spearman's Rho, and One Way ANOVA. The Timed Up Go test (TUG) and Mini-Mental State Examination (MMSE) were strongly associated. HGT, on the other hand, shows no link between MMSE and HGT. There is statistically significant, indicating that cognitive levels were influenced by the level of education level, F(2,34) = 6.45, p = 0.004. More tests that demonstrate the link between physical performance and cognitive function should be included. This will provide healthcare providers with a variety of choices in selecting the best outcome measure for evaluating an older person`s physical and cognitive function. Early diagnosis of physical and cognitive function levels will further empower early intervention in the older person.

BACKGROUND Malignant pleural effusion is typically a sign of an aggressive and advanced disease, generally with a short life expectancy. This causes a lot of burdens symptomatically to patients with advanced malignancy. Hence, a lot of patients are made known early to palliative service to help optimize patients’ quality of life. One of the procedures to help prevent the recurrence of symptomatic malignant pleural effusion is bedside chemical pleurodesis following thoracocentesis. The aim of this audit is to assess the efficacy and safety of carrying out the above procedure in a palliative setting. METHOD Retrospective electronic records of patients were reviewed from January 2020 until December 2021. Malignant pleural effusion was confirmed by cytological assessment of pleural fluid following chest tube drainage. Chemical pleurodesis was done by pleural fluid instillation of bleomycin. RESULTS Eighteen patients were included, with 6 male cases and 12 female cases. The mean age was 69.4 years, with 61% of the patients suffering from lung malignancy. Complete response is seen in 44.4% and partial response is seen in 22.2%. The failure rate is 33.3%. The complications were minimal with only 5.6% of patients having fever and 11.1% having pleuritic pain.  CONCLUSIONS The audit shows that bedside chemical pleurodesis performed by a palliative team is as efficacious and safe as when it is performed by other specialists. It helps improve the symptoms in 66% of our patients and thus improve their quality of life.

A 73-year-old male whom suffers from stage 4 adeno-squamous lung carcinoma with high programmed death-ligand 1 (PD-L1 immunohistochemistry-tumor proportion score (TPS)>50 began his treatment with a type of immune checkpoint inhibitors (ICI) therapy. After 8th cycle of treatment, patient experiences vague symptoms of fever, lethargy and drowsy. Initial working diagnosis was infection and empirical treatment was initiated. Subsequently as patient’s condition did not improve despite appropriate antibiotics, other diagnosis was considered which include adrenal insufficiency and this confirms after checking cortisol level. Hydrocortisone was started promptly and patient clinical condition improved. Decision was to stop ICI treatment interim. Consideration to re-challenge again with ICI may be considered once patient is more fit in the future. Adrenal insufficiency following ICI treatments are rare and misdiagnosed due to its non-specific symptoms. Nonetheless, it comes with high morbidity and mortality. Hence, we wanted to emphasize more on this condition as more elderly patients whom suffers from various type of cancers will be exposed towards ICI treatment.

The wake of the novel coronavirus (COVID-19) pandemic had caused substantial disruptions to the usual delivery of healthcare services. This is because of restrictive orders that were put in place to curb the spread of the infection. Palliative care services in Brunei also face challenges to deliver effective services during this period. However, the impact of advanced illnesses on patients' health and end-of-life care are issues that cannot be planned, postponed or cancelled. Hence, the palliative care team needs to continue to deliver effective palliative care services. As Brunei faced its second pandemic wave in August 2021, crucial adaptations were made to ensure palliative care service was not disrupted. This reflective case study aims to discuss the adaptations made in providing palliative care during this era of disruptions.