PROGRAMME – DAY 1
(27 OCTOBER 2023)

Dr Louisa SUN Jin
Consultant
Division of Infectious Diseases
Alexandra Hospital

Dr Louisa Sun is an infectious disease consultant from Alexandra Hospital who has been at the forefront of combating the COVID-19 pandemic. She played an instrumental role in the coordination and management of COVID-19 patient care in various healthcare settings, including the implementation of vaccination strategies and guidelines. Dr Louisa skillfully navigated the complexities of the pandemic to ensure that the hospital’s response was both effective and aligned with evolving scientific understanding, to deliver optimal care to patients. Her comprehensive and hands-on experience in dealing with the multifaceted challenges of COVID-19 uniquely positions her to share insights on this critical topic—COVID-19 vaccination in the geriatric population.

Assoc Prof DAN Yock Young
MBBS, MRCP (UK), MMed (Int Med). PhD (NUS), FAMS(Gastroenterology), FRCP(Edinburgh)

Appointment
Deputy Director-General of Health (Health Services Group), Ministry of Health
Associate Professor. Dept of Medicine, National University Singapore
Senior Consultant, Division of Gastroenterology and Hepatology, National University Hospital
Associate, Cancer Science Institute, National University of Singapore
Associate, Genome Institute Singapore, Agency for Science, Technology & Research

As deputy director-general of health (Health Services Group), A/P Dan Yock Young overseas the healthcare services organisation and provision in public hospitals, primary care as well as integration with community partners. This includes oversight of mental health and complementary health services. He co-chairs efforts in healthcare transformation specifically looking at reorganisation of primary care as well as establishment of longitudinal care models that will be future ready for Singapore’s needs.

In his academic portfolio, his research interest is in liver stem cells and their applications in liver regeneration and cancer. He is clinical lead of the multi-centre EMULSION program which aims to unravel the disease of Non-alcohol fatty liver disease and its contribution to the metabolic burden in the population. He also co-chairs GOASIA group, an Asia-Pacific effort to address gastrointestinal diseases in association with obesity in Asia.

Dr TAN Li Feng
Consultant
Division of Geriatric Medicine
Alexandra Hospital

Dr Tan Li Feng is a consultant with Alexandra Hospital (AH), under the Geriatrics department. She is also a core faculty and site director for the Geriatric Medicine Senior Residency Programme in AH and was the chairperson for the Falls Committee.

Prof Andrea Maier, MD PhD FRACP
Oon Chiew Seng Professor in Medicine, Healthy Ageing and Dementia Research
Director, Centre for Healthy Longevity (CHL), National University Health System
Healthy Longevity Translational Research Programme (HLTRP),
Yong Loo Lin School of Medicine, National University of Singapore

A/Prof Samuel CHEW Teong Huang
Clinical Associate Professor of Medicine (Duke-NUS Medicine Academic Clinical Program)
Adjunct Associate Professor of Medicine (NUS)
MB. BCh. BAO (NUI), MRCP (UK), FRCP (Edin), FAM (Singapore).
Senior Consultant Geriatrician
Department of Geriatric Medicine,
Changi General Hospital,
Singapore Health Services (CGH Campus)

Lunch Symposium Sponsored by Abbott

Preventing and Addressing Sarcopenia in Community Dwelling Older Adults in Singapore

The SHIELD Study: highlighting the impact of specialised nutritional intervention on muscle health and clinical outcomes in community dwelling older adults at risk of malnutrition.
– A/Prof Samuel CHEW Teong Huang, Singapore

The Strengthening Health in ELDerly through nutrition (SHIELD) Study is one of the largest randomised controlled clinical trials in community dwelling older adults at medium or high risk of malnutrition, as defined by the Malnutrition Universal Screening Tool (MUST), in Asia Pacific. We examined the impact of specialised oral nutrition supplementation containing HMB plus dietary counselling versus a placebo plus dietary counselling on muscle health and clinical outcomes in 811 participants aged sixty-five and above over a period of intervention of 6-months, with follow-up data at 12-months. We will share the results of the study, in the context of a rapidly ageing population not only in Singapore but Asia as a whole, whom are all at risk of the deleterious and disabling effects of malnutrition, sarcopenia and frailty.

The outcomes data will include the primary composite outcome consisting of survival without hospital (re)admission and with at least 5% weight gain at 6-months, as well as secondary outcomes data such as dietary intake, nutritional, and functional outcomes at 6-months. For the follow-up at 12-months, we will present data on the primary composite outcome, as well as the number of sick days, emergency department visits and outpatient polyclinic visits.

We will briefly review some of the current literature on the interplay between nutrition, muscle health, and frailty, and why early identification and intervention of older adults at risk of malnutrition are crucial to reduce the risk and slow down the progression of sarcopenia and frailty in this ever expanding and vulnerable population.

We will also present a summary of the results of the NOURISHED and EFFORT clinical trials, and how together with the SHIELD study, we have good quality data on how we can help our patients at risk or with malnutrition, across the continuum of care in hospital and in the community, have the best clinical and functional outcomes.

The time for an active approach, using a treat to target individualised approach, is now.

Symposium (4) Advances in Peri-Operative Care

Advances in Peri-Operative Care – Management of Perioperative Frailty and Sarcopenia – ANZ Perspective
– Dr Janani THILLAINADESAN, Sydney

In surgical settings, frailty and sarcopenia have been associated with adverse postoperative outcomes. Approaches to the assessment and management of frailty and sarcopenia have been controversial. Therapeutics and novel strategies to improve perioperative outcomes by targeting sarcopenia and frailty are being developed. To date the main strategies that have been shown to be effective focus on mobilisation, nutrition and medication optimisation.

Symposium (3) Frailty-Resilient: Trends in Management

Frailty management in 2023: Where we are now, where we hope to be
– Prof LIM Jae-Young, Korea

Annals of Geriatric Medicine and Research (Ann Geriatr Med Res, AGMR) is the official journal of the Korean Geriatrics Society and the Korean Society for Gerontology. As previous name, Journal of the Korean Geriatrics Society has been published from 1997 to 2016, quarterly. To expand international recognition, we started to release newly named journal, AGMR from Sep. 2016.  AGMR has grown into an academic platform offering future perspectives on the research needs related to geriatrics and gerontology in emerging countries with rapidly growing aging populations. As a result, AGMR received 2022 Journal Impact Factor of 3.6 and SCImago Journal Rank of 0.790 (Q2). The Journey toward becoming a high impact journal in geriatrics will be presented in this session. Challenges and opportunities for academic journals to serve the older population in global ageing will be addressed.

Lunch Symposium Sponsored by Pfizer

Symposium title: Life in an Endemic COVID-19: What does this mean for the geriatric population?
– Dr Louisa SUN Jin, Singapore

While COVID-19 moves towards endemicity, it remains a significant health risk for the medically vulnerable – including the geriatric population. Worldwide, COVID-19 associated morbidity and mortality affects the geriatric population disproportionately compared to rest of the adult population. In this session, our expert faculty will provide insights on the current impact of COVID-19 on the elderly, clinical evidence for vaccination, and the latest recommendations for the geriatric population. The faculty will also delve into contemporary issues such as vaccine hesitancy, medical education and communication, and age-specific considerations with regards to COVID-19 vaccination. Be sure to join this exciting session and learn more about these topics and get an update on COVID-19 in the geriatric context.

Exclusive Lunch Symposium for Chapter of Geriatricians and Geriatric Medicine Trainees

What is the role of Geriatricians in 5-10 years’ time in Singapore? Will the emphasis on population and preventive health shift our practice further into the community, or should we focus on providing holistic care for vulnerable seniors in hospitals? Will the increasing use of technology enhance or diminish our emphasis on person-centered and multi-disciplinary care? The Chapter of Geriatricians has planned a lively debate amongst our Geriatricians-in-training from all three healthcare clusters to state their case for the practice of Geriatrics that they wish to adopt after their training completion. Do join us for this lunchtime event!

Excellence in Scientific Publication Symposium: Publishing high-impact Asian research – Insights from the inside

Moderated by Prof Reshma A MERCHANT (JNHA co-chief editor)

In the last decade there has been growing numbers of high-quality publications in the field of Geriatrics and Gerontology in Asia Pacific. Two renowned editors will share on past and emerging research topics.

Prof Hidenori ARAI, National Center for Geriatrics and Gerontology, Japan

The Japan Geriatrics Society (JGS) has been publishing the official English journal “Geriatrics & Gerontology International (GGI)” since 2001. The impact factor of GGI has been increasing and is now 3.3 in 2022. This is attributable to the publication of guidelines and statements developed by the JGS and other related societies including the Japan Federation of Gerontological Societies, the Japanese Association on Sarcopenia and Frailty, the Japanese Society of Dysphagia Rehabilitation, and the Science Council of Japan. Brief overview of the recent progress and current status of GGI will be presented.

Prof LIM Jae-Young, Editor-in-Chief of Annals of Geriatric Medicine and Research, Seoul National University College of Medicine, South Korea.

Annals of Geriatric Medicine and Research (Ann Geriatr Med Res, AGMR) is the official journal of the Korean Geriatrics Society and the Korean Society for Gerontology. AGMR has grown into an academic platform offering future perspectives on the research needs related to geriatrics and gerontology in emerging countries with rapidly growing aging populations. As a result, AGMR received 2022 Journal Impact Factor of 3.6 and SCImago Journal Rank of 0.790 (Q2). Challenges and opportunities for academic journals to serve the older population in global ageing will be presented.

Workshop A: Multi-component Inter-disciplinary Interventions for Frailty and Sarcopenia

You will learn about:
– Regional & local guidelines for management of sarcopenia & frailty
– General exercise prescription principles
– Exercise prescription specific to sarcopenia and physical frailty
– Exercise modification, considering an individual’s co-morbidities and unique characteristics
– Practical dietary advice for individuals who are sarcopenic and/or frail
– A real-world frailty management program from a community partner

There will be several lectures to cover the intended learning objectives. Participants will then discuss a case study in small groups before having an interactive discussion with the workshop facilitators in the larger group. There will also be an opportunity for Q&A at the end of the session. Relevant resources and materials will be provided to the participants.

Speakers:
– Dr Joyce Yap, Consultant Geriatrician, Tan Tock Seng Hospital
– Ms Josephine Wang, Senior Physiotherapist, Singapore General Hospital
– Dr Tey Siew Ling is Senior Lead, Clinical Science and Nutrition at Abbott’s Nutrition R&D Centre
– Ms Anita Ho, Assistant Director, Care Corner Seniors Services
– Ms Pauline Fong, Senior Programme Executive, Care Corner Seniors Service

While frailty and sarcopenia are well recognised as important geriatric syndromes now, the struggle that many clinicians have is less in the recognition and diagnosis of these syndromes; but rather, how to practically advise older adults on the appropriate interventions to manage these conditions. The tendency is to give generic advice on physical activity, exercise and diet which often fails to achieve the intended outcomes. This challenge is compounded by the fact that older adults tend to have multiple co-morbidities and functional impairments, leading to the need to individualise exercise and nutritional advice to each patient’s unique characteristics.

This workshop aims to fill this practice gap. Clinicians from geriatric medicine, physiotherapy and dietetics will share their expertise and provide an inter-disciplinary lens and practical approach for exercise and nutritional interventions in the management of sarcopenia and physical frailty. A community partner will share their on-going frailty management program, which has successfully incorporated evidence-based exercise and nutritional interventions for the residents in their program and achieved good outcomes.

Plenary 6: Exercise in Older Persons across the Frailty Spectrum: What works, What doesn’t, What next?
– Prof Maria FIATARONE SINGH, Australia

There is no age above which physical activity ceases to have benefits across a wide range of diseases and disabilities.  Insufficient physical activity and excess sedentary behavior are lethal conditions; physical activity is the antidote, for all older adults, whether fit or frail, of any age. Exercise should be prescribed, as is all other medical treatment, with consideration of patient risks and benefits, knowledge of appropriate modality and dose (intensity, frequency, volume), monitoring for drug interactions, benefits and adverse events, and utilisation of the strongest possible behavioral medicine techniques known to optimise adoption and adherence.  Given the dose-response relationships demonstrated between the volume and intensity of physical activity engagement and disease treatment and mortality, recommendations focusing on simply reducing sedentary behavior are insufficient as a robust treatment for common diseases/syndromes in this cohort.  Frailty and sarcopenia are not barriers to exercise, but rather, the most important reasons to prescribe it.

Prof Maria FIATARONE SINGH
Professor, Geriatrician
Medicine and Health
University of Sydney

Panel Discussion: The Asia-Pacific Clinical Practice Guidelines in Frailty Management (2017) Revisited
Panel: Prof Chang Won Won (Korea), Prof Prasert Assantachai (Thailand), Prof Shahrul Bahyah Kamaruzzaman (Malaysia), A/Prof DING Yew Yoong (Singapore)
Moderator: Prof Christopher Lien (Singapore)

The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty (2017) arose from a panel discussion at the 2016 Asia Pacific Geriatrics Conference in Singapore. It is arguably the first document to present evidence-based recommendations for the screening, assessment and management of frailty for the Asia-Pacific region. Since its publication, it has been widely disseminated with close to 500 citations, and also forms the basis for frailty management guidelines and care plans which have been implemented in different settings.

‘This panel discussion aims to revisit the 2017 guidelines in light of developments and expansion of the evidence base in the intervening years. It brings together regional experts and practitioners in the field of geriatric medicine and frailty. Beyond general consensus about the broad principles of what works in clinical practice, it is timely to critically evaluate the evidence base for individual and health-system interventions to consider how we as a group of professional experts can guide development and further action in areas such as: sense-making of the myriad of tools for evaluation; integration of related concepts such as intrinsic capacity and resilience across the continuum of care; and the delivery of costeffective interventional strategies

Symposium (1) Advances in Muscle Health/Sarcopenia

Sarcopenic Obesity: Controversies, updates and next steps
– Dr LIM Jun Pei, Singapore

Sarcopenic obesity has fast been gaining recognition as an emerging public health concern, given the confluence of twin epidemics of aging and obesity. Despite the recognition of its importance, the field is still plagued by varying definitions of sarcopenic obesity and conflicting outcomes of this condition. In addition, many of the cut-offs and measurements for the definitions of SO are extrapolated from literature based on sarcopenia. Furthermore, traditional treatment options for obesity potentially exacerbate muscle loss and hence sarcopenia, leading to a pressing need for specific intervention studies for SO itself.

In this presentation, we will provide updates of the latest sarcopenic obesity research perspectives from the Sarcopenic Obesity Global Leadership Initiative which was convened in November 2022. We will also share results from our cohort of community ambulant dwelling older adults where we directly compare the various SO definitions with severity staging and the associations in prediction of muscle strength and mass loss, physical function decline, and inflammatory biomarkers changes over a period of 3 years.

Symposium (2) Frailty-Resilient: Trends in Multi-dimensional Frailty

The Relationship Between Frailty and Intrinsic Capacity in Older Adults
– Dr Justin CHEW, Singapore

Frailty and intrinsic capacity (IC) are key concepts that influence health outcomes and quality of life in aging populations. Despite their interrelated nature, their relationship remains poorly understood, representing a significant gap in efforts to incorporate these concepts in clinical practice. This presentation aims to offer an overview of the interplay between frailty and IC among community-dwelling older adults. Drawing on recent research, this presentation will discuss how a nuanced understanding of the interaction between these constructs can enhance risk profiling and guide targeted interventions.

Dr Justin CHEW
Consultant
Department of Geriatric Medicine
Tan Tock Seng Hospital

Dr Justin Chew is the Research & Innovation Lead at IGA, and Consultant at the Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. He is also an adjunct faculty at the Geriatric Education & Research Institute (GERI); clinical faculty and adjunct lecturer for the Yong Loo Lin School of Medicine, National University of Singapore and LKCMedicine, Nanyang Technological University, Singapore. Dr Chew is a recipient of the NMRC Research Training Fellowshop and the NHG-LKCMedicine Clinician Scientist Fellowship. His research interests are in frailty, intrinsic capacity and models of care to improve outcomes for frail older persons.

Dr LIM Jun Pei
Consultant
Tan Tock Seng Hospital

Dr Lim Jun Pei is the Translation Lead at the Institute of Geriatrics and Active Aging, and Consultant at the Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.  She is a co-investigator with the IGA GeriLabs study and published in peer-review journals on sarcopenic obesity. She also holds a Master of Public Health with the Dartmouth Institute (USA) and had been inducted into the Delta Omega Honorary Society in Public Health. She also holds education responsibilities as the Assistant Program Director for the Internal Medicine Residency Programme of National Healthcare Group. She is passionate about the knowledge translation of evidence to clinical practice through dissemination of evidence through effective, engaging and timely health-professional education.

Symposium (2) Frailty-Resilient: Trends in Multi-dimensional Frailty

Accelerated aging, frailty and associated factors
– A/Prof JUNG Heewon, Korea

This presentation delves into the phenomenon of accelerated aging and its consequential condition, frailty, uncovering a multifactorial web of underlying mechanisms. The discussion begins with the recent development of the concept of the epigenetic aging clock and its impact on healthy aging research, particularly through dissecting inter-individual heterogeneity in aging speeds. For instance, the Dunedin study revealed an accelerated pace of aging (DunedinPoAm, DunedinPACE) in midlife was significantly associated with inferior general, physical, and cognitive performance at the age of 45. Recent studies further corroborate the correlation between the frailty index and epigenetic biological age measures, notably the second-generation aging clocks. Additionally, our preliminary data from older adults in Korea support the correlation between aging clocks and the frailty index/phenotype. Lastly, I will discuss the potential research and clinical relevance of accelerated aging in relation to stress, COVID-19, lifestyle factors, and related interventions.

A/Prof JUNG Heewon
Assistant professor
Asan Medical Center, Division of Geriatrics

Heewon Jung, MD, PhD is an attending geriatrician (clinical assistant professor) of Asan Medical Center. His research focus includes 1) Clinical care models for high-risk, frail older patients in acute hospitals, 2) Clinical and translation research on human aging, frailty, and sarcopenia, and 3) Sensor-based algorithms to measure age-related mobility parameters in older adults. He received education and training at Seoul National University, and Seoul National University Hospital. He has been involved in establishing several cohort studies regarding frailty. Served as an Enrolled Technical Research Personnel, as PhD candidate at the Korean Advanced Institute of Science and Technology (KAIST), performing research on skeletal muscle regeneration and intestinal regeneration using animal injury models. Currently, he is conducting research works with supports from the National Research Foundation, the Ministry of Agriculture, Food and Rural Affairs, the Ministry of Health and Welfare, and the Ministry of Trade, industry, and Energy of Korea.

Prof Hidetaka WAKABAYASHI
Professor
Tokyo Women’s Medical University Hospital

Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD): Board member, Associate Editor of the Journal of Cachexia, Sarcopenia and Muscle (JCSM)
Asian Working Group for Cachexia (AWGC): member
Sarcopenic Obesity Global Leadership Initiative (SOGLI): Expert Panel
GLIM working group for low muscle mass definition (cutpoints): member
Education
2013 – 2016 Jikei University Graduate School of Medicine, Doctor of Medical Science
1989 – 1995 Yokohama City University School of Medicine, Bachelor of Medicine, Medical Doctor
Professional Experiences
2020 – present Tokyo Women’s Medical University Hospital, department of rehabilitation medicine, Professor
2008 – 2020 Yokohama City University Medical Center, department of rehabilitation medicine
2003 – 2008 Saiseikai Yokohama City South Hospital, department of rehabilitation medicine
2000 – 2003 Yokohama Stroke and Brain Center, department of rehabilitation medicine
1998 – 2000 Yokohama Rehabilitation Center, department of rehabilitation medicine
1997 – 1998 Yokohama City University Hospital, department of rehabilitation medicine
1995 – 1997 Japanese Red Cross Medical Center, junior resident of internal medicine

Symposium (5) Innovations in Care: Healthcare Settings

Rethinking Hospital Models of Care for better outcomes
– A/Prof AUYEUNG Tung Wai, Hong Kong

Geriatric Care Model is always challenging and continuously evolving so as to tailor the diversified needs of the older persons. Hospitals remain to be the last resort for acute care of older patients. However, most are not elderly friendly if not unfriendly. In this talk, I am going to describe what sorts of service remodeling has and is taking place in Hong Kong. How we have redesigned the care process from emergency room to acute inpatient care and integrated the community health care and social care with hospital care.

A/Prof AUYEUNG Tung Wai
Jockey Club Institute of Ageing, The Chinese University of Hong Kong

Dr AuYeung is also an Honorary Associate Professor of the Faculty of Medicine and a Research Associate of the Jockey Club Institute of Ageing, The Chinese University of Hong Kong. He has published in international peer-reviewed journals in research areas such as body composition study in old age, sarcopenia and frailty, cognitive decline, diabetes mellitus in older people and end of life medicine. As such, he has been invited frequently to speak in various overseas and local conferences. He is also a member of the Asian Working Group for Sarcopenia. In addition, he is a council member of The Hong Kong Geriatrics Society and now the Convenor of the Frailty and Sarcopenia Special Interest Group. He is also the Editor-in-Chief of the Asian Journal of Gerontology and Geriatrics, the official journal of the Society and has edited three practical manuals about neurocognitive disorders for the Society.

Workshop (B) Oral Frailty and Sarcopenic Dysphagia

Programme highlights
– Overview of oral health in ageing
– Oral frailty: concept, assessment and management
– Sarcopenic dysphagia: diagnosis and treatment
– Rehabilitation strategies for oral frailty and sarcopenia

International and local faculty
– Prof Hidetaka Wakayabashi, Japan
– Dr Keisuke Maeda, Japan
– Dr Ang Kok-Yang, Singapore
– Dr Justin Chew, Singapore

This pre-conference workshop offers a comprehensive exploration into the emerging concepts of oral frailty and sarcopenic dysphagia. These conditions are critical yet frequently unrecognised aspects of health in ageing populations that significantly impact overall well-being, nutrition, and quality of life in older adults.

Guided by a team of international and local experts, this workshop will examine the concept and measures of oral frailty, a condition that extends beyond conventional definitions of oral health, encompassing the functional capacity of the oral system. Understanding oral frailty necessitates a broad perspective, including not only the condition of teeth and gums, but also the performance of oral functions, such as mastication and swallowing.

In addition, the workshop will examine the emerging concept of sarcopenic dysphagia, a condition characterised by reduced swallowing ability due to age-related muscle loss. This condition can impact both skeletal muscles and those involved in swallowing, leading to malnutrition and an increased risk of severe complications such as aspiration pneumonia. Workshop participants will learn about the diagnostic criteria and prevalence of sarcopenic dysphagia, offering practical tools for early identification and intervention.

The program includes comprehensive lectures and interactive case studies, preparing attendees with a toolkit of assessment methods, including the non-invasive Kuchi-Kura Taberu (KT) Index, a measure useful for promoting oral intake in patients with dysphagia. The workshop will also discuss multidisciplinary treatment approaches and rehabilitative strategies for managing oral frailty and sarcopenic dysphagia. This experience will offer healthcare professionals, researchers, and others involved in the care of older adults an exceptional opportunity to deepen their expertise in these key components of health in ageing, and to enhance proficiency in comprehensive care for the older person.

Workshop (C) CGA, Osteosarcopenia, and Bone health

The four segments of the workshop are:
– Assessing a patient with the Clinical frailty scale: the pitfalls of looking at the pictorial CFS and some tips for accurate CFS assessment
– Comprehensive Geriatric Assessment: a practical template and approach of comprehensive geriatric care using the Institute of Healthcare improvement 4 M model
– Bone health- a balancing act in the frail
– Onco Geriatrics: are scales giving us the extra dimensions of care

The program is designed to be fast paced and interactive with case studies.

Local faculty
– Dr Lim Seok Mei, Singapore
– Dr Lydia Au, Singapore
– Dr Melanie Tan, Singapore
– Dr Nydia Camelia, Singapore

This pre-conference workshop outlines practical applications of common tools that Geriatricians utilise.

Workshop (D) Assessment of Sarcopenia and Muscle Health

You will learn about:
– Ins and outs of Sarcopenia assessment and diagnosis: AWGS 2019 consensus and Singapore CPG
– Tips and insights about muscle health evaluation: Hand-grip Strength, Repeated Chair-stand Test, Short Physical Performance Battery, Gait Speed
– Hands-on session about muscle mass evaluation: Body Impedance Analyser (BIA) – how to perform and interpret the results
– Management approaches after evaluation: workup, differential diagnosis and interventions

Course instructors:
– Dr Lim Jun Pei, Singapore
– Dr Rachel Cheong, Singapore
– Audrey Yeo, Singapore
– Tan Cai Ning, Singapore
– A/Prof Lim Wee Shiong, Singapore

With the release of the Asian Working Group for Sarcopenia (AWGS) 2019 consensus and the Singapore clinical practice guidelines (CPG) for sarcopenia, there is a pressing need for translation of assessment of sarcopenia and muscle health to practice. However, there is often uncertainty about the practical aspects and nuances of measurements. For example: Should the dominant or non-dominant hand be tested for hand-grip strength measurement? How should the repeated chair stand test (RCST) be performed – with standing-stop or siting-stop? Moreover, having assessed the patient, how does one  interpret the results in context of the patient’s profile and goals to allow for prioritization and personalisation of management strategies?

This pre-conference workshop aims to bridge the research-practice gap through providing participants a hands-on experience in performing the various measurements of muscle strength, physical performance, and muscle mass. Led by clinicians and research assistants who conduct sarcopenia-related research, participants will be able to learn from the rich ground experience of administering the measurements for different profile of participants. Participants will also be able to appreciate the strengths and limitations of the various measures and protocols. Using case examples and facilitated discussions, participants will become familiar with the protocol for case identification and diagnosis of sarcopenia in different settings, as well as appreciate the significance of sarcopenia detection in the management of geriatric patients.

Prof WON Chang-Won
Professor
College of Medicine, Kyung Hee University

Dr. Won finished Bachelor of Medicine at Seoul National University and was trained as a residency in Family Medicine, Seoul National University Hospital. He is now Professor of Department of Family Medicine at Kyung Hee University Hospital,  and a Director of Senior Health Care Center at Kyung Hee University Hospital, Korea. He has led KFACS (Korean frailty and aging cohort study) as a PI from 2016 to 2021. He is now a president of the Korean Society of Sarcopenia.

Dr TAN Woan Shin
Joint Faculty Member (GERI); Deputy Director (NHG)
Geriatric Education & Research Institute (GERI)
National Healthcare Group (NHG)

Woan Shin works at the intersection of health economics, applied epidemiology and evaluation science. She received her Ph.D. in Health Services Research from the Nanyang Technological University as a National Medical Research Council (NMRC) Research Training Fellow; and graduated from the National University of Singapore with bachelor’s and master’s degrees in economics. She believes that effective translation of research findings to practice and policy is needed to create meaningful impacts to improve population health. Her research work uses a range of quantitative and qualitative methodologies to support evidence-based health services development. She has a special interest in new models of geriatric and palliative care.

A/Prof Angela Koh
Senior Consultant Cardiologist, National Heart Centre Singapore
Associate Professor, Duke-National University of Singapore Medical School, Singapore

Cardiologist and national clinician scientist from National Heart Centre Singapore and Associate Professor at Duke-NUS Medical School. Principal Investigator of population-based cohort and clinical trial studies in cardiovascular health and disease in older adults.

Dr Rachel CHEONG Chin Yee
Consultant
Department of Geriatric Medicine, Khoo Teck Puat Hospital
Geriatric Education and Research Institute

Dr Cheong is a geriatrician with deep passion for improving the care of older adults, particularly those with cognitive impairment. She currently serves as a geriatrician at Khoo Teck Puat Hospital, where she also holds a joint faculty position at the Geriatric Education and Research Institute.

With extensive experience in the specialized unit for patients with cognitive impairment, Dr Cheong has gained invaluable expertise in managing and providing person-centered care to this vulnerable population. Recognizing the significance of cognitive impairment in healthcare, she co-chairs the 6th Vital Sign workgroup at Khoo Teck Puat Hospital. This workgroup focuses on enhancing care for cognitive impaired patients within the Yishun Health Campus. She holds a Master of Science in Public Health and has actively pursued research in the field of person-centered care for individuals with cognitive impairment in acute settings and cognitive frailty.

A/Prof Tan Kok Yang
Deputy Chairman Medical Board (Perioperative Services)
Khoo Teck Puat Hospital, Yishun Health

He specializes in minimally invasive colorectal surgery with a special interest in low rectal cancers and advanced endoscopy.

He is on the International Advisory Board of Digestive Endoscopy and also on the Editorial Boards of European Journal of Surgical Oncology, World Journal of Gastroenterology and World Journal of Gastrointestinal Endoscopy.
He is the editor of the books “Colorectal Cancer in the Elderly” and “Transdisciplinary Perioperative Care in Colorectal Surgery” published by Springer in 2012 and 2014 respectively.

He is the Chair of the General Surgery Residency Advisory Committee of Singapore. He also serves on multiple committees at the Ministry of Health of Singapore. He served as the President of the Society of Colorectal Surgeons of Singapore from 2015 to 2017.

His other passion in the field of surgery is the improvement of outcomes in elderly patients. He is the Clinical Director of the Geriatric Surgery Programme of Khoo Teck Puat Hospital. He is actively involved in projects and clinical research on this challenging group of patients and is a member of the American Geriatrics Society and founded The Geriatric Surgery Society of Singapore in 2017.

He was awarded the Public Administration Medal (Bronze) in 2023.

A/Prof Laura TAY
Senior Consultant
Sengkang General Hospital

A/Prof Laura Tay is Head and Senior Consultant, Department of Geriatric Medicine, Sengkang General Hospital. She is also Head of SingHealth-Duke NUS Centre of Memory and Cognitive Disorders, and co-leads the SingHealth Office of Ageing Research. Her research interests include frailty, intrinsic capacity, sarcopenia and cognitive disorders. She is the recipient of grants examining frailty trajectories, multi-domain interventions targeting prefrailty, and integrated approach to frailty and intrinsic capacity. She leads the Geriatric Services Hub in the NorthEast, a primary and community care service for frail older adults.

A/Prof LIM Wee-Shiong
Director
Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital

A/Prof Wee-Shiong Lim is Director at the Institute of Geriatrics and Active Aging, and Senior Consultant at the Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. He is Associate Professor (Clinical Practice) at Lee Kong Chian School of Medicine, Nanyang Technological University; Adjunct Associate Professor at Yong Loo Lin School of Medicine, National University of Singapore; Fellow of the American Geriatrics Society; and Associate Fellow of the Association for Medical Education in Europe. A/Prof Lim’s comprehensive track record of scholarly work includes over 200 peer-reviewed publications; Associate Editor of Journal of Frailty and Aging; involvement in international, regional and national workgroups in sarcopenia and frailty; and research and teaching awards in Geriatric Medicine and Health Professions Education. He is a member of the Asian Working Group for Sarcopenia (AWGS); Asian Working Group for Cachexia (AWGC); Asia Pacific Geriatrics Network (APGN); and the Global Leadership Initiative in Sarcopenia (GLIS).

Dr Janani THILLAINADESAN
Staff Specialist Geriatrician and Conjoint Senior Lecturer
Concord Hospital, Sydney and University of Sydney

Dr Janani Thillainadesan is a Staff Specialist Geriatrician at Concord Hospital, early career researcher at the Centre for Education and Research on Ageing and Conjoint Senior Lecturer at the University of Sydney. Janani was a recipient of a NHMRC Postgraduate Scholarship, and her PhD work culminated in the implementation and evaluation of a novel geriatric comanagement model of care for hospitalised older vascular surgery patients that was shown to reduce medical complications. She was awarded the Australian and New Zealand Society for Geriatric Medicine 2021 Career Investigator Prize. Janani is now leading a research program focussed on medical education of junior doctors in hospital. She was awarded the 2023 Royal Australasian College of Physicians Vincent Fairfax Research Fellowship to establish this research. Janani is Co-Chair of her hospital’s Human Research Ethics Committee, and leads the Geriatric Medicine collaboration with National Geriatric Hospital via Hoc Mai, the Australia-Vietnam Medical Foundation.

Dr Edward Chong, MBChB (UK), MRCP (UK), FAMS
Consultant, Department of Geriatric Medicine,
Head, Geriatric Medicine Continence Service
Programme Lead, Emergency Department Interventions for Frailty (EDIFY)
Tan Tock Seng Hospital

Dr Edward Chong is a Consultant for the Department of Geriatric Medicine, Tan Tock Seng Hospital (TTSH). He graduated with a degree in Bachelor of Medicine & Bachelor of Surgery from the University of Liverpool, United Kingdom, in 2008. He has also successfully obtained certification in MRCP (UK) in 2012 and the Geriatric Medicine Specialty Certificate Examination in 2015. His clinical and research interests include continence care in older persons and frailty. He is currently the programme lead of the front door geriatric service in TTSH, also known as the Emergency Department Interventions for Frailty (EDIFY).

Dr Doris NG
Senior Consultant | Director
Department of Gastroenterology and Hepatology
Nutrition Support Services
Tan Tock Seng Hospital

I am a Senior Consultant in the Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital. I also hold positions of Director of Nutrition Support Services, committee member of ERAS Implementation Committee and Clinical Teacher at the National University of Singapore Medical School and Lee Kong Chian School of Medicine. I am also a Visiting Consultant for Nutrition Support Team at Seng Kang General Hospital.

I graduated from Queen’s University of Belfast, UK and completed my postgraduate specialist training in the UK, including a PhD in Clinical Nutrition with the Institute of Human Nutrition, University of Southampton.

I am the President-Elect of the Society for Parenteral and Enteral Nutrition (Singapore). I was the founding President and Scientific Chair for SingSPEN (2013-2018). I am the course organizer (2014-2019) and teacher (2019) of the ESPEN LLL Nutrition Course and also course director for Total Nutrition Therapy Course.

Asst Prof LEE Eng Sing
Senior Consultant, Family Physician
Deputy Director, Clinical Research Unit
National Healthcare Group Polyclinics
Director, Primary Care and Family Medicine Research Programme,
Lee Kong Chian School of Medicine, Nanyang Technological University

Asst/Prof Lee Eng Sing actively promotes primary care research culture, capacity and capability in Singapore. His research interest is on multimorbidity, chronic disease management, digital solutions for primary care and health services research. Asst/Prof Lee practices at Hougang Polyclinic, National Healthcare Group Polyclinics (NHGP) as a senior consultant family physician. He is also the principal clinician researcher and Deputy Director of Clinical Research Unit at NHGP.

Asst/Professor Lee is also the Director of Primary Care and Family Medicine Research Programme and a Co-Principal Investigator in the Health for Life in Singapore Study (HELIOS) in Lee Kong Chian School of Medicine. He leads the Primary Care Research Network and is also the co-Director of the Centre of Primary Health Care Research and Innovation.

Asst/Prof Lee also spends time as a fellow in MOH Office for Healthcare Transformation (MOHT) where he supports the care protocol sub-workgroup of Healthier Singapore initiative.

Associate Professor Reshma A MERCHANT
Head of Division Geriatric Medicine, National University Hospital
Co-Chief Editor Journal of Nutrition, Health, and Aging
National University Health System

She is a member of WHO Global Network on Long-term care and recognized as a thought leader and expert in policy, research and practice in fields associated with population ageing by International Federation on Ageing. She holds leadership positions at national and international advisory boards including the Ministry of Health Frailty Implementation Workgroup. She has won multiple clinical and teaching awards such as the NUHS-Mochtar Riady Pinnacle Master Clinician Award in 2022. Her primary areas of research interests are in sarcopenia, frailty and healthy ageing. She is well published, co-author on international consensus papers on frailty and sarcopenia and involved in the Queenstown Health District planning. She is the co-chief editor for the Journal of Nutrition, Health, and Aging. She graduated from the University of Edinburgh and obtained her postgraduate qualification from the Royal College of Physicians, London, in 1999, where she worked for several years before returning to Singapore in 2001.

Dr Taiki SUGIMOTO
Research fellow
Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology
2021 Apr–present Research fellow, Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology

2019 Apr–present Research fellow, Center for Comprehensive Care and Research on Memory Disorder, National Center for Geriatrics and Gerontology
2017 Apr–2019 Mar Research fellowship for Young Scientists, Japan Society for the Promotion of Science
2015 Apr–2017 Mar Research fellow, Center for Comprehensive Care and Research on Memory Disorder, National Center for Geriatrics and Gerontology

Dr Terence ONG
Consultant Geriatrician & Senior Lecturer
Faculty of Medicine, Universiti Malaya

Dr Terence Ong is a consultant geriatrician and senior lecturer at the Universiti Malaya. He is part of a newly set up elective colorectal surgery service at University Malaya Medical Centre, Kuala Lumpur. Dr Ong completed his clinical and research training at Nottingham University Hospitals and the University of Nottingham. His interests are in musculoskeletal health, fragility fractures, and geriatric liaison services. Dr Ong is on the committee of the Malaysian Osteoporosis Society, Fragility Fracture Network Malaysia and the Malaysian Society of Geriatric Medicine. He currently serves on the editorial board for Age and Ageing and the Medical Journal of Malaysia.

Prof LIM Jae-Young
Professor and Chair of Department of Rehabilitation Medicine
Seoul National University College of Medicine, and Seoul National University Bundang Hospital

Prof Jae-Young Lim is a Professor of the Seoul National University College of Medicine, and Chair of Dept. of Rehabilitation Medicine, Seoul National University Bundang Hospital, and Director of Division of Musculoskeletal Rehabilitation. He is an Editor-in-Chief of “Annals of Geriatric Medicine and Research” and an Associate Editor of “PM & R”. As a member of the Development Group for Sarcopenia and Low Back Pain in World Health Organization, he has contributed to developing WHO Package of Interventions for Rehabilitation. He is a member of the Asian Working Group for Sarcopenia and General Secretary-Elect of Fragility Fracture Network. He worked on research projects focused on the rehabilitation intervention and standard management for sarcopenia and fragility fractures of older adults as a principal investigator. He has published over 200 peer-reviewed papers in reputed international journals and written 15 book chapters.

Dr. Keisuke MAEDA
Chief
National Center for Geriatrics and Gerontology

Dr. Keisuke Maeda serves as the Medical Chief of the Department of Geriatric Medicine at the National Center for Geriatrics and Gerontology. He earned both his MD and PhD from Kumamoto University. After gaining extensive clinical experience, he assumed the position of Associate Professor at Aichi Medical University, where he successfully spearheaded a nutritional support team at the university hospital. Presently, he holds a position as a Visiting Professor at the university.

Dr. Maeda harbors a profound interest in geriatric nutrition, a field recently acknowledged as a novel dimension of clinical nutrition. Geriatric nutrition encompasses an array of issues including aging, frailty, sarcopenia, malnutrition, dysphagia, dementia, aspiration pneumonia, artificial nutrition, disease-related malnutrition, and cachexia. With his commitment to this field, he has published over 140 articles in English and more than 100 articles and books in Japanese, all revolving around geriatric nutrition.

Prof PENG Li-Ning
Chief, Division of Geriatric Medicine, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
Center for Geriatrics and Gerontology, Taipei Veterans General Hospital

Prof. Peng graduated from Taipei Medical University School of Medicine in 2003. In 2011, she earned a master’s degree from the Institute of Hospital and Health Care Administration, and in 2018, she obtained her doctoral degree from the Institute of Public Health, both at National Yang Ming Chiao Tung University.

Prof. Peng underwent residency training in family medicine from 2003 to 2007 and received geriatric training from 2007 to 2008 at Taipei Veterans General Hospital. She assumed the role of attending physician in the Department of Family Medicine in 2008. In 2013, she was promoted to the position of division chief of geriatric medicine at the Center for Geriatrics and Gerontology, Taipei Veterans General Hospital and transitioned to the position of chief in the Division of Research, Development, and Promotion in 2021.

Prof. Peng took on the role of assistant professor at Yang-Ming University in 2013 and became the associate professor in 2019.

Prof MIAO Chunyan
President’s Chair Professor
Chair of the School of Computer Science and Engineering
Fellow of SCS, IES and SAEng
Founding Director, Alibaba-NTU Singapore Joint Research Institute (JRI)
Founding Director, Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University

Prof Miao Chunyan is a President’s Chair Professor and the Chair of the School of Computer Science and Engineering (SCSE) at NTU Singapore. She is a Fellow of the Singapore Computer Society (SCS), the Institution of Engineers Singapore and the Academy of Engineering Singapore.

Prof Miao is an internationally renowned expert and visionary leader who has made major contributions to society by advancing human-centered artificial intelligence (HAI) which empowers seniors to age successfully and enjoy a dignified lifestyle. She has made pioneering contributions in the field of AI for health and ageing including early risk analytics for chronic diseases such as Parkinson, dementia, 3H and frailty based on unobtrusive sensing and insights gained from analysis of personalized behaviour trajectories. She has an exemplary track record in publications, citations, technology transfer and impactful research and development programs.

Prof KANG Lin
Geriatrics Department
Peking Union Medical College Hospital

Associate director of Geriatric department of PUMCH & PUMC
Chairman of Youth Committee of Geriatric Specialist Branch of Beijing Medical Doctor Association
Deputy chairman of Youth Committee of Geriatric Specialist Branch of Chinese Medical Association
Deputy chairman of Youth Committee of Parenteral and Enteral Nutrition Society of Beijing Medical Association
Member of World Association of Chinese Doctors
Member of Asian Working Group for Sarcopenia
Editorial board member of Aging Medicine journal,Archives of Gerontology and Geriatrics, Journal of Geriatrics Cardiology,European Geriatric Medicine

Professor KOH Woon Puay
Professor
Yong Loo Lin School of Medicine, National University of Singapore

Dr Koh is Professor in Healthy Longevity Translational Research Programme at NUS. Being a population health scientist, Prof Koh’s research is in studying the epidemiology of chronic diseases of importance to Singapore, such as cancer, cardio-metabolic, musculoskeletal and neurodegenerative diseases. She is the Principal Investigator of the Singapore Chinese Health Study, and has co-authored about 450 scientific papers on diet, lifestyle and genes in relation to risk of diseases such as cancer, cardiovascular diseases, diabetes, gout, osteoporosis, osteoarthritis, tuberculosis disease, physical frailty and cognitive impairment. She has received over $34 million dollars in research funding from NIH (USA), NMRC and NUS. In her role as Assistant Dean and Director for the NUSMed Clinician-Scientist Development Unit, she mentors budding clinician-scientists in NUS, and has recently been given the Nature Awards for Mentoring in Science in recognition for her commitment and achievement in mentoring those in the early stages of their careers.

Symposium (1) Advances in Muscle Health/Sarcopenia

Sarcopenic dysphagia: Diagnosis and treatment with rehabilitation nutrition
– Prof Hidetaka WAKABAYASHI, Japan

Sarcopenic dysphagia is defined as difficulty of swallowing due to sarcopenia of the swallowing and generalized skeletal muscles. Diagnostic algorithm for sarcopenic dysphagia was the most widely used and should be used. Dysphagia rehabilitation along with nutritional support consisting of approximately 35 kcal/kg/day determined using their ideal bodyweight is recommended in the position paper about sarcopenia and dysphagia. Our study showed that managing > 30 kcal/kg/day energy based on ideal body weight (IBW) improved swallowing function more compared with managing < 30 kcal/kg/day energy in patients with sarcopenic dysphagia.

Rehabilitation nutrition is a combination of both rehabilitation and nutrition care management. High quality rehabilitation nutrition is provided by a rehabilitation nutrition care process. Rehabilitation nutrition care process includes assessment and diagnostic reasoning, diagnosis, goal setting, intervention, and monitoring. Aggressive nutrition therapy is important to treat sarcopenic dysphagia. Energy requirement in people with sarcopenic dysphagia is energy expenditure plus energy accumulation.

Symposium (6) Innovations in Care: Community

Interventions for prefrail community-dwelling older persons: What’s now, what’s new, what’s next?
– Dr Laura TAY, Singapore

Prefrailty has been widely regarded as the intermediate state between being robust and frail. Its potential for reversibility has gathered increasing attention as a target for preventative interventions to prevent or reverse disability. However, its definition and measurement still lacks clarity, including its existence as a distinct concept, challenging its adoption in community screening. We review evidence supporting the existence of prefrailty on a continuum but also its biological heterogeneity. This will have implications in the design of more personalized preventative interventions to reduce the progression to frailty and its consequences.

Symposium (6) Innovations in Care: Community

Nutritional interventions for frailty prevention in the community: From evidence to practice
– A/Prof PENG Li-Ning, Taiwan

The importance of nutritional interventions in the community setting for preventing frailty among older adults cannot be overstated.

Proper nutrition provides the essential building blocks for maintaining muscle mass, and overall physical function. Adequate intake of macro- and micronutrients become crucial in preventing the decline in muscle health commonly associated with frailty prevention.

Targeted nutritional strategies can address age-related chronic diseases and functional decline. These interventions not only impact physical health but also contribute to cognitive function, mental well-being, and vitality in later life.

Evidence-based nutrition interventions in older adults are crucial due to their potential to significantly enhance health outcomes, quality of life, and overall well-being for this population. Older adults often face challenges in obtaining well-balanced diets, which can lead to malnutrition or nutrient deficiencies. Evidence-based interventions offer practical strategies to address these nutritional gaps, ensuring that individuals receive adequate nutrition required for optimal health and functionality.

Symposium (6) Innovations in Care: Community

Promoting Frailty Screening and Integrated Care Intervention in China – Insights, challenges, next steps
– Prof KANG Lin, China

We summarize the nine years experiences of Frailty Screening and Sarcopenia outpatient clinic in Geriatrics Department of Peking Union Medical College Hospital in mainland China, especially the accurate measurement reduces evaluator bias. We also introduce the MDT  integrated care intervention and age-friendly service during the COVID-19 Pandemic.The Chinese version of NCGG-HEPOP is a great help to the mandarin speaking population.

Symposium (6) Innovations in Care: Community

Insights on implementation from a novel frailty care model
– Dr TAN Woan Shin, Singapore

The Geriatric Services Hub (GSH) is a novel frailty programme piloted by five hospitals in Singapore to provide early identification of frailty and offering comprehensive and coordinated care in the community. It partners different service providers, including primary-care providers and community-care organisations, to conduct comprehensive geriatric assessments to identify needs of frail older adults and to establish a care plan for each individual patient. This talk will discuss the findings of a qualitative evaluation conducted across three time-points of the pilot to understand the contexts in which the GSH programmes were conceptualised and implemented, the enablers and constraints encountered by implementers as they delivered care in the community, and how they responded to such realities on the ground.

Symposium (1) Advances in Muscle Health/Sarcopenia

Dietary factors in sarcopenia & frailty: Insights from the Singapore Chinese Health Study
– Prof KOH Woon-Puay, Singapore

With global ageing, there has been a rapid increase in the number of physically frail older adults, resulting in increased pressure on healthcare systems worldwide. As such, there has been increasing international attention on interventions which might prevent or slow its progression in ageing populations. An emerging body of evidence now supports the role of nutrition and diet in the prevention of physical frailty, and shows that a diet high in fruit, vegetables, and whole grains may be associated with reduced risk of frailty. Nevertheless, additional longitudinal studies, especially Asian ones, are needed to confirm the association of dietary patterns with frailty. Furthermore, few studies have focused their investigations on the intake of caffeine-containing beverages like coffee and tea. Findings from the Singapore Chinese Health Study cohort on prospective association of caffeine and dietary patterns at midlife with physical frailty at late life will be presented at this talk.

Symposium (1) Advances in Muscle Health/Sarcopenia

Assessment of muscle mass and muscle quality: Rethinking the role of DXA and BIA 
– Prof WON Chang-Won, Korea

For diagnosis of sarcopenia, not only muscle mass, but muscle quality is important. DXA and BIA are recommended for muscle mass measurement, but DXA assessment includes subcutaneous tissue, BIA assessment is affected by extracellular water amount. New BIA tool uses the 3 MHz high-frequency measurement technology and seems to increase the accuracy. DXA technique can estimate intramuscular fat, and it can improve accuracy of DXA.  Total muscle mass can be more accurately measured using D3-creatine (D3 Cr) dilution, but it has still shortcoming that it is based on a prediction model. Measuring muscle quality is still controversial. Ultrasound(US) is promising as it assess m. quality and mass. An increase in the amount of intramuscular fat(echodensity) provides helpful information about the presence of inflammation, fibrosis, and adipose tissue infiltration and it is correlated with lower muscle function and strength. Phase angle of BIA is reported to be associated with muscle quality.

Symposium (2) Frailty-Resilient: Trends in Multi-dimensional Frailty

Cardiac Frailty: A new Geriatric Syndrome?
– A/Prof Angela KOH, Singapore

Frailty is often described in cardiovascular disease patients, who are often older adults. This context is widely accepted, provides knowledge but may not hold the solutions to tackling frailty. In this talk, I hope to emphasize the importance of unravelling early relationships between frailty and the heart, prioritizing efforts on cardiovascular ‘health’ (over cardiovascular ‘disease’).

Symposium (2) Frailty-Resilient: Trends in Multi-dimensional Frailty

Cognitive frailty: frontiers and challenges
– Dr Taiki SUGIMOTO, Japan

Since the first proposal of concept and operational definition of “cognitive frailty” (simultaneous presence of physical frailty and cognitive impairment without concurrent dementia), cognitive frailty has been widely investigated. In this session, we would like to discuss the operational definition of cognitive frailty, its consequences, contributing factors and underlying mechanisms, as well as interventions for cognitive frailty.

Although there is yet no consensus on its definition and assessment tools, those with both frailty/physical dysfunction and cognitive impairment are shown to be associated with a higher risk of various adverse outcomes including incident dementia. While the underlying mechanisms of cognitive frailty are still unclear, many factors have been shown to be associated with cognitive frailty. Accumulating evidence indicates the need for comprehensive geriatric assessment that helps identify the possible causes of cognitive frailty and develop a multimodal individualized intervention to prevent adverse health outcomes for older adults with cognitive frailty.

Symposium (3) Frailty-Resilient: Trends in Management

Frailty in primary care settings: What works, what doesn’t
– A/Prof LEE Eng Sing, Singapore

Patients with multimorbidity are commonly seen in primary care.  These patients are also frequently found to be frail with higher decline in intrinsic capacity.  The speaker will attempt to tease out the interconnected concepts of multimorbidity, frailty, sarcopenia, intrinsic capacity and complexity.  He will also describe the challenges and the clinical implications faced by family physicians for screening and addressing them.  Some of the research work that his research team members have done or are doing will be shared to bring more clinical context to the local primary care setting.  Specifically, he proposes to look at the preventive part of frailty and sarcopenia where family physicians are best placed in the medical system to address them given their training and predisposition towards thinking about not just diseases patients have, but the patients in whom the diseases occur.

Symposium (3) Frailty-Resilient: Trends in Management

Gamification for Cognitive Frailty
– Prof MIAO Chun-Yan, Singapore

In an era where cognitive frailty is becoming increasingly prevalent amongst the elderly, the quest for innovative and effective monitoring and intervention methods is crucial. Gamification, characterized by its interactive and immersive nature, not only offers an enjoyable experience but also serves as a catalyst for heightened motivation in cognitive training. AI, when synergized with gamification techniques, can enable long-term monitoring and provide supplementary insight in addition to traditional clinical assessments. This combination facilitates scalable and in-depth data collection, ensuring that interventions are both timely and personalized. Throughout this talk, we will delve into select examples of serious games. These instances will illustrate the transformative potential at the nexus of gamification and AI, spotlighting their role in shaping the future of cognitive health interventions.

Symposium (3) Frailty-Resilient: Trends in Management

Multi-dimensional intervention and social prescribing – Role of healthy precinct
– Prof Reshma MERCHANT, Singapore

The number of older adults aged 65 years and over is projected to double to 1.5 billion by 2050 as a result of advancement in medical, public health, social and economic development. The last decade of life is spent in poor health and many countries are embarking on initiatives such as the Healthy Precinct to narrow the gap between lifespan and healthspan. The United Nations General Assembly declared 2021-2030 as the Decade of Healthy Ageing where all stakeholders including government, private sectors, community, and academia will need to come together to add life to years through designing national / subnational programs on age-friendly cities and communities. Multi-dimensional interventions such as nutrition, exercise and social prescribing have proven to be useful in changing frailty trajectory. What can we learn from implementation of Healthy Precinct in Singapore

Symposium (4) Advances in Peri-Operative Care

Management of Periop Sarcopenia – Singapore Perspective
– Dr Doris NG, Singapore

Symposium (4) Advances in Peri-Operative Care

Management of Periop Sarcopenia – Malaysian Perspective
– Dr Terence ONG, Malaysia

This session will highlight the current scope and challenges faced by a newly set up pre-operative service in Malaysia.

Symposium (5) Innovations in Care: Healthcare Settings

Delirium management in acute settings
– Dr Rachel CHEONG, Singapore

This talk explores the potential of multidomain person-centered interventions in improving delirium management within acute settings. Delirium, a common and often underdiagnosed condition, poses significant challenges in the acute setting, impacting patient outcomes and increasing healthcare costs. Traditional management strategies primarily focus on medical interventions, neglecting the importance of addressing physical function and personalized care.

Multidomain person-centered approach integrates various domains of care. It shifts the paradigm by placing the individual at the center of their care, acknowledging their unique preferences, values, and needs. By incorporating these elements, healthcare professionals can enhance physical function and reduce the risk of delirium in hospitalized patients. This talk will delve into the evidence supporting the effectiveness of multidomain interventions in preventing and managing delirium, highlighting the feasibility of implementing such approaches in acute care settings.

Symposium (5) Innovations in Care: Healthcare Settings

Geriatrics at the front-door: Emergency Department Intervention For Frailty (EDIFY)
– Dr Edward CHONG, Singapore

Emergency departments (ED) remain the forefront of acute hospital care and stands as a portal to navigate patients through a complex healthcare system that includes acute, subacute, intermediate, ambulatory, and community care. With the surging number of frail older persons presenting to EDs – many of whom do not require acute hospitalization – the escalating demands in serving an aging population with complex multi-dimensional needs, and in ensuring safe and effective coordination of care, require full attention from healthcare policy makers and administrators.

At Tan Tock Seng Hospital, Singapore, the Emergency Department Interventions for Frailty (EDIFY) Programme was designed to deliver early geriatric specialty care at the ED with a primary aim of reducing potentially avoidable acute hospital admissions. Also, the programme hopes to promote the delivery of comprehensive geriatric assessment (CGA) and inculcate the practice of delivering frailty education to patient and/or their caregivers at the ED.

We will be discussing on the latest evidence of front-door geriatric medicine, including key findings from EDIFY’s programme evaluation studes. EDIFY has now been established as a permanent service at our hospital and further plans of expansion are underway.

Symposium (5) Innovations in Care: Healthcare Settings

Diagnostic Criteria for Cachexia by the Asia Working Group for Cachexia
– Prof Keisuke MAEDA, Japan

Cachexia, a malnutrition condition associated with chronic diseases, lacks definitive diagnostic criteria for Asians. To address this, the Asian Working Group for Cachexia (AWGC) was formed. This report presents the development of diagnostic criteria for Asian individuals. The AWGC consisted of 40 experts from Asian countries. Web conferences, in-person meetings, and three Delphi rounds were conducted from February 2021, led by Japanese members. Consensus was reached in March 2023. Agreed-upon etiologies include cancer, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney failure, rheumatoid arthritis, chronic respiratory failure, chronic liver failure, connective tissue diseases, and poorly controlled chronic infectious diseases. Essential diagnostic items include etiology, weight loss or low BMI assessment, and evaluation of anorexia, reduced grip strength, or elevated CRP levels. Further studies are needed to determine cutoff values and validate the criteria, promoting research on cachexia in Asia.

Prof Avan SAYER
William Leech Professor
Geriatric Medicine
Newcastle University, UK

Prof Hidenori ARAI
President
National Center for Geriatrics and Gerontology, Japan

Prof Jean WOO
Professor
Medicine & Therapeutics
The Chinese University of Hong Kong

Prof Liang-Kung CHEN
Director
Center for Geriatrics and Gerontology
Taipei Veterans General Hospital

Plenary 4: Forging a Frailty Resilient Health System – The Singapore Journey
– Prof Wee-Shiong LIM, Singapore 

Ageing has been described as the biggest social transformation in Singapore for this generation. The beginning of the 21st century has seen health systems worldwide struggle to deliver quality healthcare amidst challenges posed by increasing prevalence of frailty with ageing populations. Singapore is no exception, with the journey marked by three key epochal transitions: 1) Frailtyreality healthcare system; 2) Frailty-ready healthcare system; and 3) Frailty-resilient health system

The increasing prevalence of frailty with population aging and the accompanying complexities in physical, cognitive, social and psychological dimensions have rendered the conventional modus operandi of reactive, fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In response to the ever-changing healthcare landscape, Singapore underwent a transformational journey underpinned by the Ministry of Health (MOH)’s three beyonds: beyond healthcare to health, beyond hospital to community, and beyond quality to value. Programmes and initiatives were developed to forge a frailty-ready healthcare system across the frailty spectrum, ranging from the well healthy (“living well”), the well unhealthy (“living with illness”), the unwell unhealthy (“living with frailty”), and the end-of-life (“dying well”). Recent developments include the 2023 Action Plan for Successful Aging Plan anchored on the 3Cs of care, contribution and connectedness; Healthier SG initiative involving primary care doctors and community care partners as key partners in the implementation efforts for healthy ageing; the MOH Frailty Strategy Policy Report; and the launch of the Singapore Physical Activity Guidelines, the Singapore Clinical Practice
Guidelines for Sarcopenia, and the Singapore Standard 693 Geragogy Guidelines on Training Senior Learners.

As Singapore prepares for a super-aged society, it is incumbent upon policy makers, healthcare practitioners, community partners, academics and the lay public to unite their efforts to forge a frailty-resilient health system that enables older persons “to be and to do what they value for as long
as possible.”

Thank you to all corresponding authors for your participation.

Please be informed that the Notification for Abstract Acceptance have been sent out.

In the event of you not receiving any email notification from us, please email to acfs-9@sgms.org.sg with the following information by 5 September 2023, 2359hrs SGT.

– Your full name (as indicated during submission)
– Date of abstract submission
– Original abstract (PDF)

Prof Matteo CESARI
World Health Organisation (WHO)

Plenary 7: Frailty, Intrinsic Capacity, Resilience and Successful Aging: A Cross-disciplinary Discourse in the Post-pandemic Era
– Prof Jean WOO, Hong Kong

The WHO promotes healthy ageing using a life course approach to building and maintaining intrinsic capacity, with functional ability as an outcome rather than mortality from diseases. Functional ability is in turn determined by intrinsic capacity and the physical and social environment. This talk attempts to relate frailty to these new constructs, and how these may be measured.

The Covid 19 Pandemic provided a natural stressor to test resilience of individuals and societies, and indirectly provide an indicator of how well different societies understand and manage the needs of older adults in aging populations. Aging societies could do better in the post pandemic era to review how the management of future pandemics could be improved from the point of view of older adults.

Plenary 5: Celebrating 10 years of AWGS – What have we learnt?
– Prof Liang-Kung CHEN, Taiwan

Emerging from the nascent field of sarcopenia research in Asia during the 2010s, the inception of the Asian Working Group for Sarcopenia (AWGS) a decade ago marked a pivotal moment in the pursuit of understanding and addressing this insidious condition. Guided by an unwavering commitment to advancing knowledge, AWGS has not only spearheaded groundbreaking research but has also revolutionized the landscape of sarcopenia-related inquiry throughout Asian countries. AWGS’s formidable achievements transcend the mere formulation of diagnostic consensus. AWGS’s nuanced approach has enabled the development of tailored screening, assessment, and treatment protocols, catering to the unique healthcare systems prevalent across the region. AWGS has significantly contributed to the promotion of healthy aging and fostered an atmosphere of adaptability that permeates throughout various medical contexts. Embracing a proactive stance, AWGS focuses on the critical issue of muscle health within the aging process and endeavors to forge novel pathways for early intervention, establishing a framework that fosters vitality and resilience among individuals traversing the later stages of life’s journey.

Plenary 2: Sarcopenia Definition, Diagnosis and Treatment: Where are we in 2023?
– Prof Avan SAYER, UK

Sarcopenia, the loss of skeletal muscle mass and function, is a disorder commonly associated with increasing age as well as with many long-term health conditions. It is important to recognise in clinical practice because it can lead to a range of adverse health outcomes including impaired mobility, falls and increased mortality.

Research in this field is advancing rapidly and there is growing consensus on the definition and diagnosis of sarcopenia. Progress is also being made in understanding the underlying skeletal muscle biology. However translation of findings into the development of new treatments at scale and pace remains an area for future development. Interdisciplinary collaborative approaches will be key.

Plenary 3: Healthy Aging and ICOPE – From Concept to Implementation
– Prof Matteo CESARI, Italy

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