Since December 2019, the novel coronavirus (COVID-19) had affected millions globally, particularly putting elderly and persons with chronic diseases at risk (1). 95% of all COVID-19 deaths in Singapore are older adults (2). As public health policymakers try to control the pandemic by focusing resources on COVID-19, the general population fear contracting coronavirus from hospitals, resulting in changes in their healthcare seeking behaviour. We describe two cases demonstrating the direct and indirect impact of COVID-19 to our geriatric patients in Singapore who have sustained hip fractures.

Background. During the fifth wave of the COVID-19 pandemic in Hong Kong, a geriatric team was established to provide interdisciplinary intervention and discharge planning for older patients in a community treatment facility (CTF) at the AsiaWorld-Expo. This study examined clinical outcomes among these older patients and identified key determinants of these outcomes.Methods. Medical records of patients aged ≥60 years who were admitted to the CTF for management of COVID-19 by a geriatric team between 24 March 2022 and 4 May 2022 were retrospectively reviewed. Baseline characteristics, geriatric syndrome statuses, laboratory results, treatments, and clinical outcomes were collected. Risk factors for transfer to an acute care hospital, 28-day mortality, and 28-day readmission were examined.Results. Among 257 patients admitted to the CTF, 29.6% had geriatric syndromes; poor oral feeding was most common. The proportion of patients with frailty increased by 14.4% upon discharge. The 28-day mortality rate was 12.5%; risk factors were dexamethasone use and transfer to an acute care hospital. The 28-day readmission rate was 33.9%; risk factors were higher Charlson Comorbidity Index, dementia, and moderate to severe hyponatraemia.Conclusions. Geriatric syndromes (particularly poor oral feeding) were common in older patients with COVID-19 who were associated with significant post-hospitalisation mortality, readmission, and worsened frailty with functional decline. These findings highlight the importance of a geriatric care model in the management of older patients with COVID-19.

Follicular lymphoma (FL) is one of the most commonly diagnosed types of indolent non-Hodgkin lymphoma (NHL). The median age of diagnosis for FL is 65 years old. Although the median life expectancy after diagnosis is approximately 10 years, the incurable disease has a high risk of transformation. This case report focuses on an 80-year-old patient diagnosed with low-grade follicular lymphoma which subsequently transformed leading to the patient’s eventual demise as the patient took on the palliative intent. This case report aims to highlight the importance of clinical markers or prognostic factors to identify patients, specifically the elderly population who are at risk of transformation to aggressive forms when their FL remains at stage I-II phases. Currently, elderly patients with FL tend to be quickly dismissed with curative intent with chemotherapy, given their age and comorbidities, despite forming the majority of the population with follicular lymphoma. Age more than 60 years old has been shown to be one of the most powerful yet poor prognostic features in follicular lymphoma international prognostic index (FLIPI)—the main scoring system used for FL. Hence, further studies are required to look into the tailoring treatment for elderly patients with follicular lymphoma after risk stratifying them with appropriate clinical and prognostic markers.

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