Dr Nagammai Thiagarajan, a graduate of the Postgraduate Diploma in Primary Care for the Elderly (PGDPCE) programme, was recently awarded the Falls Champions Award by the Malaysian Falls Prevention Network (MYFALLS). The award ceremony was held on 4 December 2021 at Le Meridien Hotel, Kuala Lumpur. This award was in recognition of her fervent leadership in the development of better geriatric services in the country.

Dr Nagammai is a Family Medicine Specialist based at the Klinik Kesihatan Kuala Lumpur (KKKL) in Titiwangsa, Kuala Lumpur. She completed the PGDPCE programme in December 2020 as part of the inaugural batch of students. The PDGPCE programme is offered by the Department of Medical Sciences at the School of Medical and Life Sciences, Sunway University and is the first of its kind programme in Malaysia. Dr Nagammai was also awarded the Tan Sri Dato’ Seri Dr Jeffrey Cheah Scholastic Award during her graduation in July 2021. Dr Nagammai is currently pursuing her subspecialty in geriatrics under the Malaysian Ministry of Health.

As the family physician in-charge of outpatient clinics, Dr Nagammai saw the need for better older person care due to the large proportion of senior citizens visiting her clinic which sparked her interest in elderly care and her postgraduate training in elderly care.

Dr Nagammai formed a senior citizen’s group, popularly known as the ‘WarMas Group’ (Warga Emas) in February 2020. The community now has 36 members, and the multidisciplinary team above holds bimonthly activities such as Zumba, health talks, cooking classes, outdoor and group activities, and mental health counselling, among many others.

As a result of Dr Nagammai’s interest in falls and completing the PGDPCE programme, she inaugurated the Fall Prevention Clinic in Primary Care as an initial step in a complex service for the aged population. The service began in February 2021, with a multidisciplinary team consisting of medical officers, nurses, medical assistants, pharmacists, physiotherapists, occupational therapists, a dietician and a counsellor.

The objective of the clinic is to prevent falls among the elderly and reduce the risks of injury. This includes identifying risk factors of falls and conducting holistic assessments. Interventions involve reviewing medication, physical therapy and occupational therapy; as well as increasing patients’ and caregivers’ awareness on fall risks.

Among the Malaysian community-dwelling elderly over 60 years, falls incidence ranged between 15 to 34%. These figures corroborate with the global reports with one-third/fourth older adults experiencing a fall annually. So, this Fall Prevention clinic is a very important development in the country’s growth geriatrics management.

The clinic at Klinik Kesihatan Kuala Lumpur (KL Health Clinic) runs every Thursday with around 25 patients per month. These patients are typically referred from the outpatient clinic. The target population consists of older people with an increased risk of falls or diagnosed with osteoporosis.

The clinic provides various clinical assessments associated with risks of falls such as functional impairment, cognitive decline, and problems in various categories of physical health such as cardiovascular, musculoskeletal, and visual systems. Screening and diagnosis of osteoporosis are offered with an in-house bone mineral density measurement using DEXA while oral treatment of osteoporosis is also available within this clinic’s services.

The pharmacist’s team at the clinic provides services for medication chart review and offers insights for de-prescribing, thus reducing poly-pharmacy and potentially inappropriate drugs. The physiotherapist’s team offers assessment and training for strength, gait, balance and coordination. The occupational therapist provides home and environmental assessments as well as advice on how to intervene. The dietician provides an assessment on nutritional status and lean mass, and its management. Counselling services are provided for patients requiring psychological intervention. The clinic also runs a virtual clinic for subsequent follow-ups that needs an early review.

The Team is supported by the visiting Geriatrics Team from Hospital Kuala Lumpur for optimum care of patients at KKKL. Given such leadership initiatives from Dr Nagammai, it is no surprise that she won the Falls Champions Award with the best of success wishes from the school.