When: Tuesday 6 December 2011; registration starts 4:30 pm

Where: Richmonde Hotel, Eastwood City, C5 Libis

PCGM Membership fee: P2000
Bring your updated PMA, PRC and Philhealth forms
Bring your Certificate of Fellowship (PCGG or PSGM)

[caption id=”attachment_795″ align=”aligncenter” width=”300″ caption=”Vaccinology of Older Persons CME Programme”][/caption]

The world continues to age. As a result of intense population control, one-child policy systems, liberal abortion practices, etc., many developed countries are challenged by “below replacement” population dynamics.

As the number of dependents increase in comparison to the workforce, they are faced with the added strain on existing welfare based pension systems.

The introduction of second (pay as you go health insurance) and third pillar (long-term care insurance) systems were discussed as possible solutions. A social pension scheme was also discussed as a means of reducing extreme poverty in old age.

The program participants learned from each other thru sharing of country reports and experiences. Lively discussions helped bring awareness to unique challenges to an aging population, in particular – human rights, pension reform, poverty, HIV, and the lack of geriatric medical expertise and up-to-date research in many countries. A tour of two nursing homes and a rehabilitation center was arranged by INIA.
[caption id=”attachment_791″ align=”aligncenter” width=”300″ caption=”Policy on Ageing INIA Malta 2011″][/caption]

Greetings! During the closing ceremony of the 41st Convention of PCP held last May 4, 2011 at SMX, some of us witnessed the birth of the Philippine College of Geriatric Medicine (PCGM). This was the result of the merger of two societies
namely the Philippine Society of Geriatric Medicine (PSGM), a component society of the PCP and the Philippine Society of Geriatrics and Gerontology (PSGG), an affiliate society of the PMA.

This coming together was long overdue but thanks to the brilliant mediation of PCP’s Dr. Oscar Cabahug it was finally realized.
In behalf of the officers of PCP I would like to WELCOME the board of Directors of PCGM led by its President Dr. Shelley de la Vega, VP
Dr. Innocencio Alejandro, Sec. Dr. Edwin Fortuno, Treasurer Dr. Teresita Castillo, Auditor Dr. Doris Camagay and Communications Officer Dr. Roy Cuizon.

With PCP’s support, we hope and pray that you deliver your vision and missions - that the PCGM can respond to the challenge of providing comprehensive quality health care to all elder Filipinos, which will include us in the near future.

Philippine Journal of Internal Medicine Editorial Allow me to take this opportunity to bid goodbye to PJIM as an editor for these past
10 years where I was fortunate enough to bear witness to some of the more relevant research outputs and publications of our time. First, I would like to thank past Chief Editors Drs. Esperanza
Cabral, Rafael Castillo and current Editor in Chief Dr. Linda Lim-Varona for giving me this opportunity and trusting me to do the job. I would also like to thank Ms. Connie Bayona , as she was instrumental in my joining the PJIM editorial board; and last but not the least, I would like to express my congratulations and gratitude to the contributing authors who have submitted their works for
publication to the journal. They are the real life of the journal, they who quietly, surely and sometimes unknowingly contribute to the much needed life sustaining push to maintain a culture of research in
our medical practice.

In the spirit of “publish or perish”, rest assured that I would pursue and continue to encourage the publication of relevant researches and outputs from our peers. Mabuhay

Ang tanda
The View from Rizal
By GOV. JUN A. YNARES, M.D.
July 24, 2011, 8:00am

MANILA, Philippines — I spotted the ever-present Lolo Sisong at a recent gathering of civic leaders in Antipolo, Rizal.

The event was one of several organized by outstanding nongovernmental organization (NGO) partners of the Rizal provincial government like the United Bayanihan Foundation. This one had to do with government and private sector putting their heads together. The aim: Help senior citizens remain productive and happy.

I know no senior citizen more intellectually productive than the inimitable Lolo Sisong, Rizal province’s self-appointed official sage. So, in that meeting where those who are superior in wisdom and years were the subject matter, the Lolo ng Lalawigan’s presence was a welcome one.

Since the word “matanda” (old) kept ringing throughout the event, I decided to signal Lolo Sisong to join my huddle with NGO leaders and ask him a question I had secretly asked myself for years.

The question: Why are those who are advanced in years called “matanda”?

“Why ask me, I am not old enough to answer the question,” Lolo Sisong said with his serious humor glowing in his face.

“It takes a young person to answer the question,” I answered, smiling, knowing he would bite the bait.

“Okay, then, I will answer the question,” Lolo Sisong said, pretending to capitulate.

“You see, Junjun, ‘matanda’ comes from the word ‘tanda’,” he began.

“So, therefore?” I egged him to make it quick.

“Well, ‘Tanda’ has three meanings,” he seemed naughtily dragging the conversation.

“Go ahead, what are they?” I asked, impatient.

“One, ‘tanda’ means ‘mark’,” he started the long process of sagely enumeration.

“Two, ‘tanda’ means ‘sign’,” Lolo Sisong continued.

“Three, ‘tanda’ means ‘recall’ or ‘remember’, or ‘reminisce’,” he ended.

“Care to explain?” I asked again, impatience growing.

“That’s where I’m going,” he answered, seemingly irked by my nagging.

“You see, a senior person has a lot of ‘tanda’ in his body and in his character – the marks of what he has gone through in life,” Lolo Sisong said. “His body and his personality shows the many marks of the happy and painful experiences that the senior person has gone through,” he added.

“Now, the quality of his body, his mind and his character as shaped by those experiences shows whether or not they made him into a better person… or a bitter one,” Lolo Sisong explained.

“So, when you see a senior person, you look at the ‘marks’ to determine what kind of person he is,” he essayed.

Impressed by the wisdom, I said, “Move on to number two – ‘tanda’ meaning ‘sign’.”

“Be patient, I am old, remember?” he answered, even more irked.

“Okay, ‘tanda’ also means ‘sign’,” he moved on. “Senior people are either ‘warning signs’ or signs similar to the beacon light of a lighthouse,” Lolo Sisong said, choosing his words carefully.

“When you find a bitter old person, he is a warning sign to you – don’t go where he went, such as his vices and his scheming ways,” he explained. “But when you find a ‘better’ senior person, ask him which path he chose and follow it – he is showing you a beacon light,” Lolo Sisong added.

I was silent, reflecting.

“May I go to point number three,” Lolo Sisong said, obviously trying to irk me reciprocally.

“Please go ahead,” I answered serious this time.

“Well, ‘tanda’ also refers to that big vault of memories of the many years we have gone through in life,” he began his final point.

“That is the gold mine of our advanced years – the definite advantage of being senior over being young,” Lolo Sisong moved on.

“We can open that vault anytime to retrieve the things that matter a lot to people – memories of love and joy, of friends and loved ones, of the many valuable experiences which prove to us that we did spend our years wisely,” he said, his aging eyes all of a sudden looking young.

“And if a senior person is generous, he lets young people into that vault and lets them frolic in the gold mine of precious memories,” he said, using his poetic abilities.

I was still silent, awed by the obvious advantage in wisdom that senior people have.

“That’s also what we mean by ‘growing old gracefully’, Junjun”, Lolo Sisong attempted to conclude.

“One ages well by being conscious of his role as ‘mark’, ‘sign’ and ‘treasure trove of memories,” he said.

“So, be careful about how experiences make their mark on you,” he continued.

“Be conscious about your role – are you a danger sign or a beacon light to the younger generation,” he moved closer to his closing.

“And consciously build the kind of memories that you bring into your vault,” he, at last, ended.

“Gotta go,” Lolo Sisong said, acting like a busy young person.

“Thanks much,” I said, trying to memorize his key points.

“By the way, those three things are also a technique on how one stays young despite advancing years,” Lolo Sisong post-scripted.

“Will remember that,” I answered.

“Only if your mind can stay young like mine,” Lolo Sisong said, underscoring that the last word is always his.

I kept my mouth shut, impressed by how he has, indeed, made great use of his years.

Feedback: provinceofrizal@yahoo.com

Journal: Arch Intern Med. 2011;171(15):1363-1369. doi:10.1001/archinternmed.2011.330

A 2- year randomized trial found no significant difference in bone loss or menopausal symptoms between women taking soy tablets or placebo.

Patients were women age 45-60 years, within 5 years of menopause and without osteoporosis.

Subjects were were randomly assigned, in equal proportions, to receive daily soy isoflavone tablets, 200 mg, or placebo.

Results
After 2 years, no significant differences were found between the participants receiving soy tablets (n = 122) and those receiving placebo (n = 126) regarding changes in bone mineral density in the spine (–2.0% and –2.3%, respectively), the total hip (–1.2% and –1.4%, respectively), or the femoral neck (–2.2% and –2.1%, respectively).

A significantly larger proportion of participants in the soy group experienced hot flashes and constipation compared with the control group. No significant differences were found between groups in other outcomes.

Authors’ Conclusions
In this population, the daily administration of tablets containing 200 mg of soy isoflavones for 2 years did not prevent bone loss or menopausal symptoms

This guideline is an official statement of the American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS).

Methods: This guideline is based on a targeted literature update from
March 2007 to December 2009 to evaluate the evidence and update
the 2007 ACP clinical practice guideline on diagnosis and management
of stable COPD.

Recommendation 1: ACP, ACCP, ATS, and ERS recommend that spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms (Grade: strong recommendation, moderate-quality evidence). Spirometry should not be used to screen for airflow obstruction in individuals without respiratory symptoms (Grade: strong recommendation, moderate-quality evidence).

Recommendation 2: For stable COPD patients with respiratory symptoms and FEV1 between 60% and 80% predicted, ACP, ACCP, ATS, and ERS suggest that treatment with inhaled bronchodilators may be used (Grade: weak recommendation, low-quality evidence).

Recommendation 3: For stable COPD patients with respiratory symptoms and FEV1 <60% predicted, ACP, ACCP, ATS, and ERS recommend treatment with inhaled bronchodilators (Grade: strong recommendation, moderate-quality evidence).

Recommendation 4: ACP, ACCP, ATS, and ERS recommend that clinicians prescribe monotherapy using either long-acting inhaled anticholinergics or long-acting inhaled Beta-agonists for symptomatic patients with COPD and FEV1 <60% predicted. (Grade: strong recommendation, moderate-quality evidence). Clinicians should base the choice of specific monotherapy on patient preference, cost, and adverse effect profile.

Recommendation 5: ACP, ACCP, ATS, and ERS suggest that clinicians may administer combination inhaled therapies (long-acting inhaled anticholinergics, long-acting inhaled Beta-agonists, or inhaled corticosteroids) for symptomatic patients with stable COPD and FEV1 <60% predicted (Grade: weak recommendation, moderate-quality evidence).
Recommendation 6: ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe pulmonary rehabilitation for symptomatic patients with an FEV1 <50% predicted (Grade: strong recommendation, moderate-quality evidence). Clinicians may consider pulmonary rehabilitation for symptomatic or exercise-limited patients with an FEV1 >50% predicted. (Grade: weak recommendation, moderate-quality evidence).
Recommendation 7: ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia (PaO2 < or equal to 55 mm Hg or SpO2 < or equal to 88%) (Grade: strong recommendation, moderate-quality evidence).

All statins, despite their proven benefit in lowering the risk of heart attacks and strokes, carry some risk of an injury called myopathy, characterized by unexplained muscle weakness or pain.

But the risk is greater for patients who take the 80 mg doses of simvastatin, especially in the first year of treatment. Colman says the muscle damage is often caused by interactions with other medications.

The new FDA Simvastatin Safety Label now reads:
1. Use of the 80-mg dose of simvastatin should be restricted to patients who have been taking it for a long time (e.g., 12 months or more) without signs or symptoms of clinically significant toxic effects on muscle.
2. Patients who are currently taking an 80-mg dose of simvastatin without adverse effects but who need to begin taking an interacting drug that is contraindicated or is associated with a dose cap for simvastatin should be switched to an alternative statin with less potential for a drug–drug interaction.
3. Patients in whom the LDL cholesterol goal cannot be achieved with a 40-mg dose of simvastatin should instead be given other appropriate LDL cholesterol–lowering therapy.

Drug Interactions Associated with Increased Risk of Myopathy
and Rhabdomyolysis/Interacting Agents Prescribing Recommendations:

Contraindicated with simvastatin
Itraconazole
Ketoconazole
Posaconazole
Erythromycin
Clarithromycin
Telithromycin
HIV protease inhibitors
Nefazodone
Gemfibrozil
Cyclosporine
Danazol

Do not exceed 10 mg of simvastatin daily
Amiodarone
Verapamil
Diltiazem

Do not exceed 20 mg of simvastatin daily
Amlodipine
Ranolazine

Avoid large quantities of grapefruit juice
Grapefruit juice
(>1 qt daily)

Patients currently taking 80-mg simvastatin-containing medicines should:

* Not stop taking their medicine unless told to by their healthcare professional.
* Review their medical history with their healthcare professional, the currently prescribed dose of simvastatin, and a list of their other current medications to determine if the medicines they are taking are appropriate. Know that certain medications should never be taken with simvastatin.
* Immediately contact their healthcare professional if they experience muscle pain, tenderness or weakness, dark or red colored urine, or unexplained tiredness.
* Talk to their healthcare professional about any questions or concerns they have about simvastatin-containing medicines.
* Report side effects from the use of simvastatin-containing medicines to the FDA MedWatch program.

Copy of House Bill 1071 Philippine Congress 2010

Copy of Senate Bill 1809

and

HelpAge International

During a recent forum on Policy for Older Persons held at the UP Manila-National Institutes of Health, Rep. David Koh, Senior Citizen’s Party List announced the good news that House Bill 1071 was approved at the Committee level. It now seeks approval from the Senate, as Senate Bill Number 1809.

The original bill, seeks to ensure that older persons and persons with disability are protected from institutional, community and domestic violence and sexual assault and to improve outreach efforts and other services available to persons victimized by such violence.

The original bill, “Older Filipino’s Protection from Violence Act” was authored by Rufus B. Rodriguez and Maximo B. Rodriguez Jr.

Senate Bill 1809 was authored by Senator Miriam D Santiago with Sen Lito Lapid as co-author. The bill is described as AN ACT TO ESTABLISH PROGRAMS AND ACTIVITIES TO AID VICTIMS OF ELDER ABUSE, AND PROVIDE TRAINING TO HEALTH AND GOVERNMENT PROFESSIONALS IN THE ASSISTANCE OF SUCH VICTIMS, It was read on first reading in September 2010 and was referred to the Committee(s) on SOCIAL JUSTICE, WELFARE AND RURAL DEVELOPMENT and FINANCE.

In a similar action, HelpAge International calls for the following Actions:

• the 186 countries that have ratified CEDAW (UN Convention on Elimination of All Forms of Discrimination Against Women) meet their existing obligations to put in place systems, legal and other, to protect all women, young and old, from violence and abuse.

• data collection and disaggregation is improved to make the issue more visible.

• governments invest in training of health professionals, the judiciary and law enforcement agencies to recognise abuse

• more funding is allocated to community initiatives that change attitudes and tackle age discrimination and ageism.

Finally, a UN Convention of the Rights of Older People would ensure that all countries that ratify it had an obligation to put in place these protective legal systems.

June 15 is World Elder Abuse Awareness Day

Link and Reference:
From the Medical Observer
Wednesday, June 15, 2011

The newly minted Expanded Senior Citizens’ Act of 2010 (Republic Act 9994) brings up an often overlooked aspect of elderly health care—geriatric vaccination. The law specifically provides for free influenza-virus and pneumococcal-disease shots among indigent senior citizens. It also singled out these vaccines for a 20-percent discount and value-added tax exemption when purchased by all senior citizens, regardless of their capacity to pay.

Pneumonia is fourth among the leading causes of death among Filipino elders, according to geriatric-health specialist Shelley De la Vega. In the United States, giving flu shots to senior citizens has been found to lower their chances of getting sick, being hospitalized and dying not only from influenza itself but also from heart attack and stroke during the flu season.

And yet, only about 1.4 percent of Filipino elders receive the pneumococcal vaccine while 3.4 percent get the flu vaccine, based on a national health survey done in 2001. “I hope that when we do another survey this year or next year, we will have better numbers, 50 percent, at least,” De La Vega said, during a recent forum on geriatric vaccination at the San Lazaro Hospital in Manila.

Most of the elderly who have been getting the vaccines so far are likely to belong to the more affluent Filipino communities where geriatric vaccines have been available for free since five years ago, said De La Vega.

In the absence of such freebies, she believes that even the relatively well-off seniors, not just the poorest of the poor as provided by law, need help in accessing the vaccines. “A lot of people cannot afford to pay out of pocket so we would like to find ways in which the government, through PhilHealth for example, can help alleviate the burden.”

Vaccines for other diseases like tetanus, herpes zoster, diphtheria, pertussis, and hepatitis are also on De la Vega’s wish list of vaccines that can be provided to Filipino senior citizens.

DoH needs help

It falls upon the Department of Health (DoH) to provide the free vaccination to indigent seniors under the law. And it is proving to be a challenge for the agency.

Dr. Lyndon Suy, DoH manager for emerging and reemerging infectious diseases, estimates that the agency would need around PhP1 billion to provide the free vaccines. This amount is based on statistics that the elderly comprises two to three percent of the country’s present population of roughly 90 million.

“This is not a small budget that you can just reallocate from other DoH programs without crippling them. We’re talking of a big chunk of money that needs a special provision from Congress,” he explained.

Suy admits that this issue of funding has led to a stand-off in the implementation from the DoH side. The agency still has to come up with its implementing rules and regulations (IRR) on the law as it searches for ways of sourcing the vaccine fund.

One possibility the agency is exploring is to get the local government units, especially the big-revenue cities and first-class municipalities, to buy the vaccines themselves for their indigent elderly constituents.

This is already happening in some Metro Manila cities. The Pasig city government has already vaccinated close to 8,000 of its senior citizens for both flu and pneumococcal disease since 2008. The city is prioritizing indigent and low-income individuals from its most highly populated and depressed areas. In Quezon City, many barangay senior citizens’ associations allocate part of the senior citizens’ fund given by the city government for flu vaccination.

For Suy, the importance of the LGU participation in the vaccine initiative cannot be stressed enough, from helping with the database of free vaccine recipients to assisting in the health-education activities that are meant to accompany each vaccination.

De la Vega agreed that the vaccination program has to be in the context of the elderly person’s total well-being. “You just don’t go there to give a shot in the arm. You educate them about other diseases and how to manage their lifestyle,” she said. “That way, you are also helping reinforce positive health-seeking behavior.”

Click image for details.