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Editorial by Dr Miguel Ramos
Philippine Journal of Internal Medicine 2011

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

Grannies get immunity

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.”

What are triglycerides?

Fat exists in the body as Triglycerides. It is a chemical that is found in blood plasma and, in association with cholesterol, form the plasma lipids.

Triglycerides come from fats eaten in foods or made in the body from other energy sources like carbohydrates. Calories ingested in a meal and not used immediately are converted to triglycerides and transported to fat cells to be stored.

How is an excess of triglycerides harmful?

Excess triglycerides in plasma is called hypertriglyceridemia. It’s linked to the occurrence of coronary artery disease and stroke in some people. Elevated triglycerides may be caused by untreated diabetes mellitus.

Like cholesterol, increases in triglyceride levels can be detected by a blood test. These measurements should be made after an overnight food and alcohol fast.

The National Cholesterol Education Program guidelines for triglycerides are:
Normal Less than 150 mg/dL
Borderline-high 150 to 199 mg/dL
High 200 to 499 mg/dL
Very high 500 mg/dL or higher

These are based on fasting plasma triglyceride levels.

AHA Recommendation — Dietary treatment goals

Changes in lifestyle habits are the main therapy for hypertriglyceridemia. These are the changes you need to make:

* If you’re overweight, cut down on calories to reach your ideal body weight. This includes all sources of calories, from fats, proteins, carbohydrates and alcohol.
* Reduce the saturated fat, trans fat and cholesterol content of your diet.
* Reduce your intake of alcohol considerably. Even small amounts of alcohol can lead to large changes in plasma triglyceride levels.
* Eat fruits, vegetables and nonfat or low-fat dairy products most often.
* Get at least 30 minutes of moderate-intensity physical activity on five or more days each week.
* People with high triglycerides may need to substitute monounsaturated and polyunsaturated fats —such as those found in canola oil, olive oil or liquid margarine — for saturated fats.

Eliminate dietary trans fatty acids, which increase triglycerides and atherogenic lipoproteins (ie, lipoprotein, LDL-C).

Substituting carbohydrates for fats may raise triglyceride levels and may decrease HDL (”good”) cholesterol in some people. Certain food products, such as bakery shortening and stick margarine, contain high trans fatty acid concentrations.

* Substitute fish high in omega-3 fatty acids instead of meats high in saturated fat like hamburger. Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in omega-3 fatty acids.

Overall, exercise is most effective in lowering triglycerides (eg, 20% to 30%) when baseline levels are elevated (ie, TG level of 150 mg/dL), activity is moderate to intensive, and total caloric intake is reduced.

Because other risk factors for coronary artery disease multiply the hazard from hyperlipidemia, control high blood pressure and avoid cigarette smoking. If drugs are used to treat hypertriglyceridemia, dietary management is still important. Patients should follow the specific plans laid out by their physicians and nutritionists.

Read More American Heart Association Healthy Tips

AHA Statement on Triglyceride and Cardiovascular Disease 2011

The Alzheimer’s Association USA released the following Alzheimer’s Disease Facts and Figures 2011.
Go to the link to access the following information:

• Overall number of Americans with Alzheimer’s disease nationally and for each state
• Proportion of women and men with Alzheimer’s and other dementias
• Estimates of lifetime risk for developing Alzheimer’s disease
• Number of family caregivers, hours of care provided, economic value of unpaid care nationally and for each state, and the impact of caregiving on caregivers
• Use and costs of health care, long-term care and hospice care for people with Alzheimer’s disease and other dementias
• Number of deaths due to Alzheimer’s disease nationally and for each state, and death rates by age

Alzheimer’s is the sixth-leading cause of death in United States and the only cause of death among the top 10 in the United States that cannot be prevented, cured or even slowed. Based on mortality data from 2000-2008, death rates have declined for most major diseases while deaths from Alzheimer’s disease have risen 66 percent during the same period.

The conclusions in this report reflect currently available data on Alzheimer’s disease. They are the interpretations of the Alzheimer’s Association.

Details are available in the website Alzheimer’s Association

The DSM-5 Task Force and Work Group members (American Psychiatric Association) are working to develop criteria for diagnoses that not only reflect new advances in the science and conceptualization of mental disorders, but also reflect the needs of our patients.

The Neurocognitive Disorders Work Group has been responsible for addressing these disorders. Among the Work Group’s proposals is the recommendation that the category be divided into three broad syndromes: Delirium, Major Neurocognitive Disorder, and Mild Neurocognitive Disorder. The Neurocognitive Disorders Work Group has posted the draft criteria for the Alzheimer Disease Subtype as an illustration of how they propose to organize other subtypes. They are inviting comment on the general approach. Work on other subtypes is currently in progress, and the Work Group is in consultation with various expert groups that work in those areas (e.g. vascular cognitive impairment and dementia, frontotemporal lobar degeneration, dementia with Lewy bodies, Huntington’s disease, Parkinson’s disease, traumatic brain injury, etc.).

While they welcome comments and suggestions on any and all aspects of the proposal, they are particularly interested in obtaining input regarding the following issues:

1) Removing the term “Dementia” and adding “Major Neurocognitive Disorders”,

2) Adding a category of “Mild Neurocognitive Disorders”,

3) Categorizing behavioral disturbances, particularly the syndromes of psychosis and depression, associated with Neurocognitive Disorders, and

4) Selecting specific domains as well as measures of severity of cognitive functional impairment

Please Click this link to DSM 5 Delirium, Dementia, Amnestic, and Other Cognitive Disorders

The U.S. Food and Drug Administration (FDA) is informing the public that prescription proton pump inhibitor (PPI) drugs may cause low serum magnesium levels (hypomagnesemia) if taken for prolonged periods of time (in most cases, longer than one year). In approximately one-quarter of the cases reviewed, magnesium supplementation alone did not improve low serum magnesium levels and the PPI had to be discontinued.

PPIs work by reducing the amount of acid in the stomach and are used to treat conditions such as gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus.

Prescription PPIs include Nexium (esomeprazole magnesium), Dexilant (dexlansoprazole), Prilosec (omeprazole), Zegerid (omeprazole and sodium bicarbonate), Prevacid (lansoprazole), Protonix (pantoprazole sodium), and AcipHex (rabeprazole sodium). Vimovo is a prescription combination drug product that contains a PPI (esomeprazole magnesium and naproxen). Over-the-counter (OTC) PPIs include Prilosec OTC (omeprazole), Zegerid OTC (omeprazole and sodium bicarbonate), and Prevacid 24HR (lansoprazole).

For Medical Professionals:
# Consider obtaining serum magnesium levels prior to initiation of prescription PPI treatment and checking levels periodically thereafter for patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics).
# Hypomagnesemia occurs with both loop diuretics (furosemide, bumetanide, torsemide, and ethacrynic acid) and thiazide diuretics (chlorothiazide, hydrochlorothiazide, indapamide, and metolazone). These agents can cause hypomagnesemia when used as a single agent or when combined with other anti-hypertensives (e.g., beta-blockers, angiotensin receptor blockers and/or ACE inhibitors).
# Advise patients to seek immediate care from a healthcare professional if they experience arrhythmias, tetany, tremors, or seizures while taking PPIs. These may be signs of hypomagnesemia.
# Consider PPIs as a possible cause of hypomagnesemia, particularly in patients who are clinically symptomatic.
# Patients who develop hypomagnesemia may require PPI discontinuation in addition to magnesium replacement.
# Be aware that consumers either on their own, or based on a healthcare professional’s recommendation, may take OTC PPIs for periods of time that exceed the directions on the OTC label. This is considered an off-label (unapproved) use. Healthcare professionals should communicate the risk of hypomagnesemia to patients if they are recommending prolonged use of an OTC PPIs.

Learn more by clicking this link to USFDA

Screening for Osteoporosis: U.S. Preventive Services Task Force Recommendation Statement

From the U.S. Preventive Services Task Force, Rockville, Maryland.

Abstract

Description: Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis.

Methods: The USPSTF evaluated evidence on the diagnostic accuracy of risk assessment instruments for osteoporosis and fractures, the performance of dual-energy x-ray absorptiometry and peripheral bone measurement tests in predicting fractures, the harms of screening for osteoporosis, and the benefits and harms of drug therapy for osteoporosis in women and men.

Recommendations: The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. (Grade B recommendation)

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men. (I statement)

Osteoporosis Screening Table USPSTF

Patient Population Under Consideration

This recommendation applies to older adults in the general U.S. population who do not have a history of an osteoporotic fracture, osteoporosis secondary to another condition, or other specific clinical indications for bone measurement testing. The USPSTF did not define a specific upper age limit for screening in women because the risk for fractures continues to increase with age and treatment harms remain no greater than small. Clinicians should take into account the patient’s remaining lifespan when deciding whether to screen patients with significant illness. In the Fracture Intervention Trial (1), the benefit of treatment emerged 18 to 24 months after initiation of treatment.

The quantity and quality of data on osteoporotic fracture risk other than hip fracture are much less for Asian, American Indian or Alaska Native, Hispanic, and black women than for white women. The USPSTF’s recommendation to screen women aged 65 years or older for osteoporosis applies to all racial and ethnic groups because the harms of the screening tests are no greater than small, the consequences of failing to identify and treat women who have low bone mineral density (BMD) are considerable, and the optimal alternative age at which to screen nonwhite women is uncertain.

Assessment of Risk

Multiple instruments to predict risk for low BMD and fractures have been developed and validated for use in postmenopausal women, but few have been validated for use in men. To predict fracture risk, the area under the receiver-operating characteristic curve ranges from 0.48 to 0.89 (2). Less complex instruments (that is, those with fewer variables) seem to perform as well as more complex ones (3). The USPSTF found no studies that assessed the effect on patient outcomes of using risk prediction instruments alone or in combination with bone measurement tests.

The USPSTF used the FRAX (Fracture Risk Assessment) tool (World Health Organization Collaborating Centre for Metabolic Bone Diseases, Sheffield, United Kingdom), available at www.shef.ac.uk/FRAX/, to estimate 10-year risks for fractures because this tool relies on easily obtainable clinical information, such as age, body mass index (BMI), parental fracture history, and tobacco and alcohol use; its development was supported by a broad international collaboration and extensively validated in 2 large U.S. cohorts; and it is freely accessible to clinicians and the public. The FRAX tool includes questions about previous DXA results but does not require this information to estimate fracture risk.

Based on the U.S. FRAX tool, a 65-year-old white woman with no other risk factors has a 9.3% 10-year risk for any osteoporotic fracture. White women between the ages of 50 and 64 years with equivalent or greater 10-year fracture risks based on specific risk factors include but are not limited to the following persons: 1) a 50-year-old current smoker with a BMI less than 21 kg/m2, daily alcohol use, and parental fracture history; 2) a 55-year-old woman with a parental fracture history; 3) a 60-year-old woman with a BMI less than 21 kg/m2 and daily alcohol use; and 4) a 60-year-old current smoker with daily alcohol use. The FRAX tool also predicts 10-year fracture risks for black, Asian, and Hispanic women in the United States. In general, estimated fracture risks in nonwhite women are lower than those for white women of the same age.

Although the USPSTF recommends using a 9.3% 10-year fracture risk threshold to screen women aged 50 to 64 years, clinicians also should consider each patient’s values and preferences and use clinical judgment when discussing screening with women in this age group. Menopausal status is one factor that may affect a decision about screening in this age group.

Considerations for Practice Regarding the I Statement

When deciding whether to screen men for osteoporosis, clinicians should consider the following factors.

Potential Preventable Burden

Bone measurement tests may potentially detect osteoporosis in a large number of men and prevent a substantial part of the burden of fractures and fracture-related illness in this population. The aging of the U.S. population is likely to increase this potentially preventable burden in future years.

Potential Harms

Potential harms of screening men are likely to be small and consist primarily of opportunity costs.

Current Practice

Routine screening of men currently is not a widespread practice.

Costs

Many additional DXA scanners may be required to screen sizeable populations of men for osteoporosis; DXA machines range in cost from $25 000 to $85 000.

Assuming that the relative benefits and harms of therapy in men are similar to those in women, the men most likely to benefit from screening would have 10-year risks for osteoporotic fracture equal to or greater than those of 65-year-old white women who have no additional risk factors. However, current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men.

Screening Tests

The most commonly used bone measurement tests used to screen for osteoporosis are DXA of the hip and lumbar spine and quantitative ultrasonography of the calcaneus. Quantitative ultrasonography is less expensive and more portable than DXA and does not expose patients to ionizing radiation. Quantitative ultrasonography of the calcaneus predicts fractures of the femoral neck, hip, and spine as effectively as DXA. However, current diagnostic and treatment criteria for osteoporosis rely on DXA measurements only, and criteria based on quantitative ultrasonography or a combination of quantitative ultrasonography and DXA have not been defined.

Screening Intervals

The potential value of rescreening women whose initial screening test did not detect osteoporosis is to improve fracture risk prediction. A lack of evidence exists about optimal intervals for repeated screening and whether repeated screening is necessary in a woman with normal BMD. Because of limitations in the precision of testing, a minimum of 2 years may be needed to reliably measure a change in BMD; however, longer intervals may be necessary to improve fracture risk prediction. A prospective study of 4 124 women aged 65 years or older found that neither repeated BMD measurement nor the change in BMD after 8 years was more predictive of subsequent fracture risk than the original measurement (4).

Treatment

In addition to adequate calcium and vitamin D intake and weight-bearing exercise, multiple drug therapies are approved by the U.S. Food and Drug Administration to reduce fractures, including bisphosphonates, parathyroid hormone, raloxifene, and estrogen. The choice of therapy should be an individual one based on the patient’s clinical situation and the tradeoff between benefits and harms. Clinicians should provide patient education on how to use drug therapies to minimize adverse effects. For example, esophageal irritation from bisphosphonate therapy can be reduced by taking the medication with a full glass of water and by not lying down for at least 30 minutes afterward.

Other Approaches to Prevention

The USPSTF has updated its evidence review on falls prevention in older adults (2) and plans to issue an updated recommendation; in future months, the USPSTF also will issue a separate statement on the preventive effects of vitamin D and calcium supplements on osteoporotic fractures. When complete, these documents will be made available at www.uspreventiveservicestaskforce.org.

Useful Resources

The 10-year risk for osteoporotic fractures can be calculated for individuals by using the FRAX tool and could help to guide screening decisions for women younger than 65 years.

Summary guides for clinicians and patients on fracture prevention treatments for postmenopausal women who have osteoporosis are available from the Agency for Healthcare Research and Quality at http://effectivehealthcare.ahrq.gov. The recommendations in these guides may differ from those of the USPSTF because they were based on a systematic review that pooled data from trials that included women who had previous clinical fractures.

Other Considerations
Research Needs and Gaps

Given the absence of direct evidence that screening for osteoporosis reduces fracture-related morbidity or mortality, studies of long-term health outcomes of screened and nonscreened population groups are important. Research is needed to test the effectiveness of drug therapies for osteoporosis in men who do not have a history of fractures. The results of ongoing randomized trials of bisphosphonates for fracture prevention in men at high risk for fractures could help to assess whether these drugs are effective in men. Research to evaluate the outcome of screening women during periods of rapid bone loss (for example, during menopause) also should be supported.

Further research that would inform clinical decisions about screening for osteoporosis include studies to establish parameters for treatment using quantitative ultrasonography as a primary screening test for osteoporosis, studies that ascertain the true incidence of major osteoporotic fractures in nonwhite ethnic groups in the United States, studies clarifying optimal screening intervals, and studies of the effect of clinical and subclinical vertebral fractures on health-related quality of life.

Link to Full Article:
Ann Intern Med E-309published ahead of print January 17, 2011

The 32-year relationship between cholesterol and dementia from midlife to late life. Neurology. November 23, 2010 75:1862-1863
Authors: Mielke, Zandi, Shao, et al

Methods:
The Prospective Population Study of Women, consisting of 1,462 women without dementia aged 38–60 years, was initiated in 1968–1969 in Gothenburg, Sweden. Follow-ups were conducted in 1974–1975, 1980–1981, 1992–1993, and 2000–2001. All-cause dementia was diagnosed according to DSM-III-R criteria and AD according to National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association criteria. Cox proportional hazards regression examined baseline, time-dependent, and change in cholesterol levels in relation to incident dementia and AD among all participants. Analyses were repeated among participants who survived to the age of 70 years or older and participated in the 2000–2001 examination.

Results:
Higher cholesterol level in 1968 was not associated with an increased risk of AD (highest vs lowest quartile: hazard ratio [HR] 2.82, 95% confidence interval [CI] 0.94–8.43) among those who survived to and participated in the 2000–2001 examination. While there was no association between cholesterol level and dementia when considering all participants over 32 years, a time-dependent decrease in cholesterol over the follow-up was associated with an increased risk of dementia (HR 2.35, 95% CI 1.22–4.58).

Conclusion:
These data suggest that midlife cholesterol level is not associated with an increased risk of AD. However, there may be a slight risk among those surviving to an age at risk for dementia. Declining cholesterol levels from midlife to late life may better predict AD risk than levels obtained at one timepoint prior to dementia onset. Analytic strategies examining this and other risk factors across the lifespan may affect interpretation of results.

They pointed to animal and cell culture studies suggesting a causal link with high cholesterol leading to amyloid-beta deposition characteristic of Alzheimer’s disease. However, cholesterol declines in older age, “perhaps as a function of underlying subclinical pathology, sarcopenia, or change in appetite,” Haan explained. The study was also limited by loss of participants due to death or refusal, possible undiagnosed dementia, lack of genotyping for high-risk alleles, and unknown generalizability to men and populations outside of Sweden, the researchers noted.

WHEN: November 18-19, 2010

WHERE: San Lazaro Hospital Auditorium, Quiricada Street Sta. Cruz, Manila

The Vaccine Study Group, a research study group under the UP Manila – National Institutes of Health (NIH) has initiated and organized a Clinical Vaccinology Course for Health Care Providers, in cooperation of Philippine Foundation for Vaccination (PFV), Aging Study Group-NIH, San Lazaro Hospital and Society of Adolescent Medicine of the Philippines (SAMPI).

The main objective of the course is to give an overview and update in the field of vaccinology so that participants to the course will be confident to use vaccines both in clinical practice and as a public health intervention. The group believes that vaccination is the most effective control measure for diseases and would lead to an improvement of the health and economic status of communities and nations.

The course will be conducted by a group of distinguished professors, scientist and public health experts who have received basic and advanced vaccinology courses in France, Korea and other reputable vaccine institutions to enable them to give you what you would want to know most about vaccines.

HOW: Please contact the following to register (P2500.00 for two (2) days per registrant) or give a donation to our cause.

Dr Lulu C Bravo - Mobile No.: +6319189215998 or NIH 632-5254266 INTROP office: 5269167 PFV office: 567-2397.

Visit Link to Vaccinology Course Details

Philippine Society of Geriatric Medicine – Asia Pacific Geriatric Conference January 19-21, 2011, Cebu City, Philippines

The Organizing Committee through its Research Committee invites submission of abstracts in geriatrics and gerontology consistent with its theme, “Sharing and Integrating Best Practices in Geriatrics in the Asia Pacific Region.” These abstracts should be original and not be published elsewhere at the time of submission. A copy of the Institutional Review Board approval letter must be submitted for research abstracts.

Click here for Abstract submission detials