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Background Globally the average age of the worlds’ population of older persons continues to upsurge and social support becomes increasingly relevant. Overall, in Malaysia, social support and networking prevalence was found to be lower among older persons at 30.76%. In view of the scarce data on social support and its association with smoking status and its associated factors among the older Malaysian population this study was conducted. Methods Data from the National Health and Morbidity (NHMS) 2018 survey on health of older Malaysian adults was analyzed. This was a cross sectional population-based study using a two-stage stratified random sampling design. Elderly population aged 60 years and above was selected. Data were collected were sociodemographic characteristics, smoking status, and social support. A validated Malay language, interviewer-administered questionnaire of 11-item Duke Social Support Index was applied for assessing social support among the elderly. A complex sampling design analysis was used for the descriptive statistics. The associated risk factors for social support were identified using Multiple Logistic Regression analysis. Results A total of 3923 elderly respondents participated in the study. The prevalence of good social support was significantly higher among the 60-69 years old respondents compared to the > 80 years old (73.1%, 95% CI :69.3% -76.5% vs 50.1 %, 95% CI:41.7 %- 58.6%).Multivariate logistic regression analysis showed that the odds of poor social support were 1.7 times (aOR: 1.72 % ,95%CI: 1.19 -2.48) higher for the respondents aged > 80 years old, than those aged 60-69 years. Respondents with no formal education were 1.93 higher odds of poor social support than the respondents with tertiary education (aOR: 1.93%, 95%CI: 1.13,3.30). Respondents with income < RM 1000 were 1.94 times more likely to have poor social support compared to respondents with income > RM 3000 (aOR: 1.94, 95% CI : 1.21 -3.13). Former smokers have good social support compared to current smokers (73.6% ,95% CI: 67.7-78.7 vs 65.1 %, 95%CI:58.4 -71.2). For current smokers, the odds of poor social support were 42.0% higher than for non-smokers (aOR: 1.42, 95% CI: 1.05 -1.91. Conclusion There is poor social support among the older persons who are current smokers, advancing age, no formal education and low income However, further longitudinal studies are needed to determine the exact effects of the studied variables. These findings could assist the policymakers to develop strategies at the national level to enhance social support among the older smokers to ensure cessation of smoking.

The National Health and Morbidity Survey (NHMS) 2016 was a nationwide cross-sectional survey focusing on maternal and child health. This study aimed to identify the prevalence of, and factors associated with early childhood educational program (ECE) attendance among children aged three to five years in Malaysia. Attendance to ECE has been shown to enhance children’s development, yet there is no national information on ECE attendance in Malaysia, where attendance is not compulsory for children below five years. Parents were interviewed face-to-face utilising a validated questionnaire from the UNICEF Multiple Indicator Cluster Survey using mobile devices. Multivariate logistic regression analysis was performed to identify factors associated with ECE attendance. Half (53.4%) of children aged three to five years in Malaysia attend ECE. Older children aged four to five were six times more likely to attend ECE than children three to four years. Malaysian children of Chinese ethnicity were thrice as likely than ethnic Malays to attend ECE. Children with access to >3 children’s books were twice more likely to attend ECE than those who had access to

The belief in the effectiveness of physical punishment is an important predictor for its use. The objectives of this study was to describe the factors associated with the belief for physical punishment toward children 1 to 5 years of age among Malaysian parents. Data was collected as part of the Malaysian National Health and Morbidity Survey (NHMS) 2016. The respondents were asked if they believed that physical punishment is needed to raise a child properly. A total of 60.0% of Malaysian parents believed in the need for physical punishment, with 54.3% practising it. Parents who believed in physical punishment had more than 2 times a higher likelihood of practising it (odds ratio 2.57) than those who did not. Parents need to be taught to respond positively to children’s behavior and anger management strategies in difficult parenting situations.

AIM This article describes the methodology of the 2018 Malaysian National Health and Morbidity Survey, and provides an overview of the sociodemographic details of the respondents and key findings on the health of older adults. METHODS The survey included 3977 community-dwelling respondents, aged ≥60 years across Malaysia. Two-stage stratified random sampling with selection of enumeration blocks from both urban and rural areas ensured the findings were representative of the Malaysian older population. RESULTS Complex sampling analyses ensured that findings on various geriatric syndromes, non-communicable diseases, nutritional status, functional status, social well-being and quality of life are representative of the Malaysian older population. Among the limitations are that the composition of older persons varied slightly from the general older population. CONCLUSIONS This article presents the methodology of the survey, and a baseline of the major health issues for older persons in Malaysia to provide clear guidance to researchers, program managers and policymakers to fully utilize the data from the Malaysian National Health and Morbidity Survey toward achieving healthy aging. The findings might stimulate more research on the health problems faced by older people to provide inputs for policymaking and program implementation. Geriatr Gerontol Int 2020; 20: 7-15.

AIM Elder abuse is a significant public health problem. This study aims to estimate its prevalence and associated factors, using representative national Malaysian data. METHODS A nationwide population-based survey involving 3977 community-dwelling older persons aged ≥60 years was conducted via face-to-face interview, of whom 3466 older persons were eligible for screening using a locally validated tool. Elder abuse was defined as any one occurrence of neglect, financial, psychological, physical or sexual abuse perpetrated by someone in a position of trust that was experienced in the past 12 months. RESULTS About 9.0% of older persons in Malaysia have experienced elder abuse in the past 12 months, with neglect being the commonest type experienced (7.5%; 95% confidence interval [CI]: 5.54, 10.07). There is no significant difference by age group and geographical location. Males (adjusted odds ratio [aOR] 1.7; 95% CI: 1.06, 2.60), poorer social support (aOR 5.0; 95% CI: 2.25, 11.22), dependency in activities of daily living (aOR 2.1; 95% CI: 1.23, 3.44) and a previous history of abuse (aOR 10.1; 95% CI: 4.50, 22.86) show higher odds of experiencing elder abuse. Almost 5% of abused older persons reported experiencing multiple types of abuse. Reporting is low at 19.3% with none reporting to healthcare personnel. CONCLUSIONS The prevalence of elder abuse in this study is lower than global estimates, but similar to local studies. Preventive measures and programs are crucial to overcoming elder abuse and need to be carried out at multiple levels - the individual, community, healthcare and other stakeholders. Geriatr Gerontol Int 2020; 20: 85-91.

Serious injury due to motor vehicle accidents (MVAs) significantly contributes to the adolescents’ health status. The objective of this study was to estimate the prevalence of nonfatal injury due to MVAs and its associated factors among Malaysian school-going adolescents. Nationally representative samples were selected via 2-stage stratified cluster sampling. Data was collected using a validated self-administered questionnaire. Logistic regression analysis was conducted to examine the associations between the variables. A total of 1088 out of 27 497 adolescents reported that they had sustained serious injury due to MVAs with a prevalence of 4.1% (95% confidence interval [CI] = 3.7-4.5). Serious injury due to MVAs among adolescents was positively associated with being current cigarette smokers (adjusted odds ratio [aOR] = 2.5; 95% CI = 2.2-2.9), followed by Malay ethnicity (aOR = 2.4; 95% CI = 1.9-3.0), current drug users (aOR = 2.3; 95% CI = 1.9-3.0), boys (aOR = 2.1; 95% CI = 1.8-2.4), Indian ethnicity (aOR = 1.8; 95% CI = 1.2-2.5), and those who were in upper secondary school (aOR = 1.3; 95% CI = 1.2-1.5). Targeted intervention and curbing substance use among boys may reduce the morbidities from MVAs and its resulting complications.

Malaysia has an increasingly aging population. Despite the substantial benefits of physical activity for healthy aging, older adults are considered the most physically inactive segment of the Malaysian population. The purpose of this study was to determine the prevalence of physical inactivity among older adults in Malaysia and its correlates. We analysed data on adults aged ≥60 years (n = 3790) from the National Health and Morbidity Survey (NHMS) 2015, a cross-sectional, nationwide population-based survey covering information on socio-demographic characteristics, physical activity and other lifestyle-related variables, health conditions, and functional limitations. Individuals included in this study were classified as physically active or physically inactive. Logistic regression was used to determine factors associated with physical inactivity. The overall prevalence of physical inactivity among older adults aged ≥60 years old was 48.8%. Physical inactivity was significantly more prevalent among females, older age groups, Indians, those being single/widowed/divorced, those with no formal education, those who reported high sedentary time (≥7 h/day), those with diabetes, anaemia, and functional limitations (p < 0.001). In fully adjusted analyses, females, older age, high household income (≥MYR4000), inadequate fruits and vegetables consumption (

ObjectivesTo determine the longitudinal impact of elder financial and psychological abuse on risk of death among older Malaysians.Design7-year prospective cohort study. Baseline data were collected in late 2013 and respondents were followed up in June 2020.SettingKuala Pilah, Negeri Sembilan, Malaysia.Participants1927 community-dwelling older adults aged 60 or older randomly sampled from the national census. Individuals with severe cognitive impairment were excluded.Outcome measureMortality data were provided by the Malaysian National Registration Department and linked to respondents’ national identification numbers. Kaplan-Meier curves and Cox regression were used to examine victims’ survival periods and the impact of abuse on risk of death.ResultsOverall, 450 respondents (23.4%) died after 7 years. Among financial and psychological abuse victims, death percentage was 25.8% compared with 23.3% among those who did not experience these types of abuse. Kaplan-Meier curves showed shorter survival among abuse victims, but Cox regression found no significant impact of financial and psychological abuse on mortality risk (HR 1.05, 95% CI 0.78 to 1.41). Among all the variables studied, only cognitive impairment led to higher mortality risk (HR 1.32, 95% CI 1.03 to 1.69).ConclusionOur findings contradict prior empirical studies that supported the link between elder abuse and neglect (EAN) and mortality, even though we focused on two abuse subtypes. Results in this study are more in line with the recently emerging evidence that showed no association between EAN and mortality.

Our study aims to describe and determine factors associated with hospitalization among victims of elder abuse and neglect (EAN) in rural Malaysia. A cross sectional study based on the baseline data of the Malaysian Elder Mistreatment Project (MAESTRO) collected from November 2013 until July 2014 involving 1927 older adults in Kuala Pilah, Negeri Sembilan was conducted. EAN was determined using the modified Conflict Tactics Scale (CTS) and hospitalization rates were determined based on self-report. The prevalence of overall EAN was 8.1% (95%CI 6.9–9.3). Among male respondents, 9.5% revealed history of abuse and among female respondents, 7.2% reported experiencing EAN. The annual hospitalization rates per 100 persons within the past one year among EAN victims and non-victims were 18 per 100 persons (SD = 46.1) and 15 per 100 persons (SD = 64.1) respectively. Among respondents with history of EAN, 16.0% (n = 21) had been hospitalized in the past 12 months while among respondents with no EAN experience, 10.2% (n = 153) were hospitalized. Multivariable analyses using Poisson regression did not show any significant association between EAN and hospitalization. This could be due to the complex interactions between medical and social circumstances that play a role in hospital admissions, factors affecting the health care system, and access to health care among EAN victims.

AIM Dementia is the major cause of disability among older persons and leading physical and psychological sequelae for both the person living with dementia (PLwD) and their caregivers. The aim of this study was to determine the prevalence of dementia in Malaysia and identify the factors influencing quality of life (QoL) of caregivers of PLwD. METHODS A nationwide survey was conducted among individuals aged ≥60 years. Cognition was assessed with the Identification and Intervention for Dementia in Elderly Africans (IDEA) tool. QoL of older caregivers was assessed using the Control, Autonomy, Self-Realization and Pleasure (CASP-19) questionnaire. RESULTS The prevalence of dementia among older adults aged ≥60 years in Malaysia was found to be 8.5%. The prevalence was found to be higher among females, those with no formal education and those in rural areas in Malaysia. The mean QoL of family caregivers of PLwD was significantly lower than the caregivers of older adults without dementia were (P

Aim Quality of life (QoL) among the older persons provides valuable insights into the potential modifiable risk factors that affect well-being in later life. This study aimed to describe the QoL and psychosocial factors of QoL of older persons in Malaysia. Methods We used the 19-item Control, Autonomy, Self-realization and Pleasure scale, a validated instrument that measures psychological well-being related to QoL in older persons. Scores range from 0 to 57, and higher scores indicate better QoL. We included several factors as covariates. Analysis of complex samples was carried out using Stata 15. Descriptive analysis was carried out to determine QoL by sociodemographic characteristics and other factors. Linear regression analysis was used to identify psychosocial factors that influence QoL. Results A total of 3444 individuals aged ≥60 years completed all 19-item Control, Autonomy, Self-realization and Pleasure items. The estimated mean QoL score was 47.01 (95% CI 46.30-47.72). Adjusted for confounders, QoL was lower among individuals with no formal education (-2.554, 95% CI -3.684, -1.424), probable depression (-1.042, 95% CI -1.212, -0.871) and food insecurity (-0.815, 95% CI -1.083, -0.548). QoL continued to improve with improved ADL score (0.302, 95% CI 0.052, 0.552), IADL score (0.646, 95% CI 0.382, 0.909) and better social support (0.308, 95% CI 0.187, 0.429). Conclusions Lower education, depression, food insecurity, presence of limited functional status and poor social support negatively influenced QoL in older Malaysians. This study identified potentially modifiable factors that could be targeted for interventions to enhance QoL of older persons in Malaysia. Geriatr Gerontol Int 2020; 20: 92-97.

Aim Falls are a common problem among older people, leading to major morbidity and increased mortality. The study aimed to determine the prevalence of falls among older persons in Malaysia and its associated factors. Methods Data were obtained from the National Health and Morbidity Survey 2018 (NHMS 2018), a cross-sectional study using stratified cluster sampling design. Older persons were defined as aged ≥60 years in this study. Descriptive and logistic regression analyses were conducted using SPSS version 25.0. Results Overall, 14.1% (95% confidence interval [CI]: 12.46, 15.84) of older persons reported having experienced at least one fall during the past 12 months. Univariate analyses revealed an association between the history of falls with not being employed (odds ratio [OR]: 1.35 [95% CI: 1.03, 1.77]), diabetes mellitus (OR: 1.65 [95% CI: 1.33, 2.04]), limitation in activities of daily living (ADL) (OR: 1.90 [95% CI: 1.43, 2.54]) or instrumental ADL (OR: 1.47 [95% CI: 1.16, 1.84]). Multiple logistic regression revealed that falls were positively associated with those who had diabetes mellitus (OR: 1.55 [95% CI: 1.23, 1.94]) and limitation in ADL (OR: 1.56 [95% CI: 1.14, 2.15]); 43.9% of falls occurred outdoors. Conclusion One in six older Malaysian people experience at least one fall over a 12-month period. Diabetes mellitus and limitation in ADL were the factors associated with falls among older persons. A comprehensive and targeted program designed to reduce risk of falls is urgently needed. Future research should identify suitable programs for our setting to reduce the potential society burden of falls in older Malaysians. Geriatr Gerontol Int 2020; 20: 33-37.

Objectives To examine the cross‐sectional and longitudinal relationships between elder abuse and neglect (EAN) and chronic pain in rural older Malaysians. Design Two‐year prospective cohort study. Setting Kuala Pilah, a district in Negeri Sembilan approximately 100 km from the capital city, Kuala Lumpur. Participants Community‐dwelling older adults aged 60 and older. Using a multistage cluster sampling strategy, 1,927 respondents were recruited and assessed at baseline, of whom 1,189 were re‐assessed 2 years later. Measures EAN was determined using the modified Conflict Tactic Scale, and chronic pain was assessed through self‐report using validated questions. Results The prevalence of chronic pain was 20.4%. Cross‐sectional results revealed 8 variables significantly associated with chronic pain—age, education, income, comorbidities, self‐rated health, depression, gait speed, and EAN. Abused elderly adults were 1.52 times as likely to have chronic pain (odds ratio=1.52, 95% confidence interval (CI)=1.03–2.27), although longitudinal analyses showed no relationship between EAN and risk of chronic pain (risk ratio=1.14, 95% CI=0.81–1.60). This lack of causal link was consistent when comparing analysis with complete cases with that of imputed data. Conclusion Our findings indicate no temporal relationship between EAN and chronic pain but indicated cross‐sectional associations between the two. This might indicate that, although EAN does not lead to chronic pain, individuals with greater physical limitations are more vulnerable to abuse. Our study also shows the importance of cohort design in determining causal relationships between EAN and potentially linked health outcomes.

ObjectivesTo determine the prevalence and factors associated with multimorbidity among community-dwelling older adults in Malaysia.DesignA population-based cross-sectional study.Setting13 states and 3 Federal Territories in Malaysia.ParticipantsA total of 3966 adults aged 60 years and above were extracted from the nationwide National Health and Morbidity Survey (NHMS) 2018 data set.Primary outcome measuresMultimorbidity was defined as co-occurrence of at least two known chronic non-communicable diseases in the same individual. The chronic diseases included hypertension, type 2 diabetes mellitus, dyslipidaemia and cancer.ResultsThe prevalence of multimorbidity among Malaysian older adults was 40.6% (95% CI: 37.9 to 43.3). The factors associated with multimorbidity were those aged 70–79 years (adjusted OR (AOR)=1.30; 95% CI=1.04 to 1.63; p=0.019), of Indian (AOR=1.69; 95% CI=1.14 to 2.52; p=0.010) and Bumiputera Sarawak ethnicities (AOR=1.81; 95% CI=1.14 to 2.89; p=0.013), unemployed (AOR=1.53; 95% CI=1.20 to 1.95; p=0.001), with functional limitation from activities of daily livings (AOR=1.66; 95% CI=1.17 to 2.37; p=0.005), physically inactive (AOR=1.28; 95% CI=1.03 to 1.60; p=0.026), being overweight (AOR=1.62; 95% CI=1.11 to 2.36; p=0.014), obese (AOR=1.88; 95% CI=1.27 to 2.77; p=0.002) and with abdominal obesity (AOR=1.52; 95% CI=1.11 to 2.07; p=0.009).ConclusionThis study highlighted that multimorbidity was prevalent among older adults in the community. Thus, there is a need for future studies to evaluate preventive strategies to prevent or delay multimorbidity among older adults in order to promote healthy and productive ageing.

BackgroundHypertension is one of the most important risk factors for cardiovascular diseases. Thus, it is an important public health challenge worldwide. In Malaysia, only a few studies have focused on the trends of hypertension specifically for the aging population. In view of the rapid growth of the elderly population in Malaysia, there is an urgent need to explore the condition of hypertension in this aging population. Hence, the objectives of this study were to determine the trends of population mean systolic and diastolic blood pressure (BP) levels, the prevalence, awareness, treatment and control of hypertension, and its' associated factors among older persons in two cross-sectional national surveys that were conducted in 2006 and 2015 in Malaysia.MethodsThis was a subanalysis of secondary data collected from the two cross-sectional national population-based surveys conducted in Malaysia in 2006 and 2015. Adults aged 60 and older who had participated in these two surveys were included in the study.ResultsA total of 4954 (2295 males and 2659 females) and 3790 (1771 males and 2019 females) respondents completed the hypertension module surveys in 2006 and 2015, respectively. The mean age of the respondents was 68.5±6.9 years in 2006 and 68.6±7.1 years in 2015 and the difference was not significant. The prevalence of hypertension significantly reduced from 73.8% in 2006 to 69.2% in 2015 (pConclusionsThe mean population BP levels and hypertension prevalence among the elderly population in Malaysia have reduced significantly over the past decade. Although the awareness, treatment and control of hypertension among older adults have improved significantly, the awareness and control rates remain suboptimal. As population aging is inevitable, appropriate public health programs and optimal treatment strategies targeting this vulnerable group are urgently needed to improve the overall awareness and control of hypertension and to prevent hypertension-related complications.

We assessed the current situation of physical abuse among adolescents at home in Malaysia. A total of 27 497 school-going adolescents answered a self-administered questionnaire during the Malaysian National Health and Morbidity Survey 2017. A complex sampling analysis was applied to identify factors associated with physical abuse among adolescents using multivariate logistic regression analysis. The prevalence of physical abuse at home among students was 11.8%. Our result shows that adolescents aged 13 years had significantly higher odds of such abuse, with odds decreasing as the adolescents age. Girls and adolescents from Indian ethnicity (minority ethnic group) had higher odds of such abuse. Other associated factors were mental health problems, substance abuse, and problems at school. Physical abuse among adolescents at home should be countered with appropriate measures.

Body weight is a factor, with body weight perception a mediator, toward being a victim of bullying. This study aimed to explore the association between body weight, body weight perception, and bullying among students 13 to 17 years of age in Malaysia. Data were collected using a self-administered questionnaire. A 2-stage stratified cluster sampling design was used, and 212 schools across Malaysia were selected for this survey. Body weight was measured and body weight perception was the student’s reflection of their body weight. The prevalence of being bullied among adolescents in Malaysia was 16.2%. Being too thin or being obese increased the probability of being bullied. Students with a normal body mass index, but with a misperception of their body weight, also had increased odds of being bullied. Obesity prevention, together with instilling positive body weight perception, should be part of all programs directed toward tackling the problem of bullying.

This study aimed to assess the prevalence and factors associated with bullying victimization from a nationwide school-based survey among 27 458 students aged 13 to 17 years. The overall prevalence of having been bullied in the past 30 days was 16.2%; this decreased with age. Multivariate logistic regression analysis revealed that factors most strongly associated with bullying victimization were exposure to physical attacks (adjusted odds ratio [aOR] = 2.46, 95% confidence interval [CI] = 2.17-2.79), illicit drug use (aOR = 2.44, 95% CI = 1.78-3.34), involvement in physical fights (aOR = 1.97, 95% CI = 1.74-2.23), being younger than 14 years (aOR =1.95, 95% CI = 1.59-2.38), and having ever attempted suicide (aOR = 1.83, 95% CI = 1.51-2.21). Other significantly associated factors include loneliness, truancy, making suicidal plans, and symptoms of depression, anxiety, and stress. Exposure to bullying victimization can result in negative lifelong sequelae and important associated factors should be considered in planning effective school-based anti-bullying interventions.

Limited evidence on the association of being bullied with depression among adolescents was found in Malaysia. This study aimed to determine the association of being bullied and depression among Malaysian school-going adolescents. Data from the National Health and Morbidity Survey 2017, a cross-sectional study conducted from March to May 2017, was analyzed using descriptive and multiple logistic regression analysis. A validated tool, the Depression, Anxiety, and Stress Scale-21 was used to categorize those with moderate or higher levels of depressive symptoms as having depression. A total of 27 399 school-going adolescents participated and 18.3% were found depressed. Adolescents of Indian ethnicity (adjusted odds ratio [aOR] = 2.02, P < .001), those with parents living apart (aOR = 1.41, P < .001), and those who were being bullied (aOR = 2.98, P < .001) were more likely to have depression. This study demonstrated the association between being bullied and having depression. Comprehensive preventive strategies should be implemented taking into consideration the findings from this study.

Various factors contribute to suicidal attempt. This study aims to determine the relationship between suicidal attempt and its associated factors among school-going adolescents in Malaysia. Data from the National Health and Morbidity 2017 survey were analyzed. This survey was implemented as a nationwide school-based survey targeting adolescents 13 to 17 years old. Descriptive and multiple logistic regression analysis was done using SPSS version 20. A total of 27 399 adolescents participated in this survey. The prevalence of suicidal attempt was 6.9% (95% confidence interval = 6.2-7.7). Multivariate analysis found that the odds of suicidal attempt among adolescent with depression is 4.3 (adjusted odds ratio = 4.3; 95% confidence interval = 3.9-4.8). Other significant factors are young adolescent, non-Malay ethnicities especially Indian, adolescent with parents living apart, and those without peer support and parental connectedness. A holistic approach for the planning of preventative strategies and public health policies should be made according to these risk factors.

Supplemental material, Supplementary_Table for Body Weight, Body Weight Perception, and Bullying Among Adolescents in Malaysia by Shubash Shander Ganapathy, LeeAnn Tan, Rajini Sooryanarayana, Mohd Hazrin Hashim, Thamil Arasu Saminathan, Fazila Haryati Ahmad, Ruhaya Salleh and Nur Shahida Abdul Aziz in Asia Pacific Journal of Public Health

Background Elder abuse and neglect (EAN) is a growing public health problem, and numerous adverse health effects of abuse in late life have been documented. Little is known, however, about the impact of elder abuse on sleep quality. This study examines the longitudinal relationship between EAN and sleep quality. Methods This was a 2-year prospective cohort study involving 1927 older adults in a rural Malaysian district, Kuala Pilah. A multi-stage cluster sampling strategy was employed. After 2 years, 1189 respondents were re-assessed. EAN was determined using the modified Conflict Tactic Scale, while sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Results The prevalence of elder abuse was 8.1% (95% CI:6.9,9.3). Longitudinal analysis using generalized estimating equations showed that elder abuse contributed to higher PSQI scores (B:0.49, 95% CI:0.17,0.58). Sub-analyses demonstrated that psychological abuse and neglect had significant longitudinal relationships with increase of PSQI scores, while other subtypes did not. Conclusion Abuse in late life, particularly psychological abuse and neglect, result in greater PSQI scores. Even though this may imply decline in sleep quality, our findings were not considered clinically significant as they did not exceed the clinical cut-off score of five. Nevertheless, sleep quality is an important determinant of health and a predictor of mortality among older adults; thus, understanding its relationship with abuse is useful to health care providers and policy-makers in improving health services and upgrading preventive measures.

Background Globally, diarrhoea is one of the major causes of morbidity and mortality among children under than 5 years of age. There is a scarcity of published data on acute gastroenteritis (AGE) prevalence in Malaysia among children. This study aims to determine factors associated with diarrhoea in children aged less than 5 years in Malaysia. Method Data from the National Health and Morbidity Survey 2016 conducted by Ministry of Health was analysed. This nationwide survey involved 15,188 children below five years old. The survey was carried out using a two-stage stratified sampling design to ensure national representativeness. The Questionnaire from UNICEF’s Multiple Indicator Cluster Survey (MCIS) was adapted to suit local requirements. Analysis was done using SPSS Version 23. Descriptive followed by multiple logistic regression were done to identify relevant factors. Result The prevalence of diarrhoea among children under five in Malaysia was 4.4% (95% CI: 3.8,5.2). Analysis using logistic regression indicated that only ethnicity and usage of untreated water were significantly associated with diarrhoea among children after controlling for relevant factors. By ethnicity, children in the ‘Other Bumiputera’ group had 2.5 times the odds of having diarrhoea compared to children of Malay ethnicity. Children of Indian ethnicity were also at higher risk, at almost double the odds, as well as other ethnic groups (1.5 times). Children who used untreated water supply were two times more likely to develop diarrhoea. Conclusion There is a higher risk of diarrhoea among children of ‘Other Bumiputera’ ethnicity, Indian ethnicities, and other ethnic groups and those who consume untreated water. Strategies to reduce diarrhoea among children should be targeted towards these at-risk populations. In addition, the Government must strive to ensure universal access to treated clean water in Malaysia and the Ministry of Health must focus on raising awareness on how to prevent diarrhoea.

Objectives: Aging is a rising phenomenon globally and elder abuse is becoming increasingly recognized as a health and social problem. This review aimed to identify the prevalence of elder abuse in community settings, and discuss issues regarding measurement tools and strategies to measure elderly abuse by systematically reviewing all community-based studies conducted worldwide. Method: Articles on elder abuse from 1990 to 2011 were reviewed. A total of 1,832 articles referring to elders residing at home either in their own or at relatives' houses were searched via CINAHL and MEDLINE electronic databases, in addition to a hand search of the latest articles in geriatric textbooks and screening references, choosing a total of 26 articles for review. Results: Highest prevalence was reported in developed countries, with Spain having 44.6% overall prevalence of suspicion of abuse and developing countries exhibiting lower estimates, from 13.5% to 28.8%. Physical abuse was among the least encountered, with psychological abuse and financial exploitation being the most common types of maltreatment reported. To date, there is no single gold standard test to ascertain abuse, with numerous tools and different methods employed in various studies, coupled with varying definitions of thresholds for age. Conclusion: Current evidences show that elder abuse is a common problem in both developed and developing countries. It is important that social, health care, and legal systems take these findings into consideration in screening for abuse or reforming existing services to protect the health and welfare of the elderly.

Introduction Despite being now recognised as a global health concern, there is still an inadequate amount of research into elder mistreatment, especially in low and middle-income regions. The purpose of this paper is to report on the design and methodology of a population-based cohort study on elder mistreatment among the older Malaysian population. The study aims at gathering data and evidence to estimate the prevalence and incidence of elder mistreatment, identify its individual, familial and social determinants, and quantify its health consequences. Methods and analysis This is a community-based prospective cohort study using randomly selected households from the national census. A multistage sampling method was employed to obtain a total of 2496 older adults living in the rural Kuala Pilah district. The study is divided into two phases: cross-sectional study (baseline), and a longitudinal follow-up study at the third and fifth years. Elder mistreatment was measured using instrument derived from the previous literature and modified Conflict Tactic Scales. Outcomes of elder mistreatment include mortality, physical function, mental health, quality of life and health utilisation. Logistic regression models are used to examine the relationship between risk factors and abuse estimates. Cox proportional hazard regression will be used to estimate risk of mortality associated with abuse. Associated annual rate of hospitalisation and health visit frequency, and reporting of abuse, will be estimated using Poisson regression. Ethics and dissemination The study has been approved by the Medical Ethics Committee of the University of Malaya Medical Center (MEC Ref 902.2) and the Malaysian National Medical Research Register (NMRR-12-1444-11726). Written consent was obtained from all respondents prior to baseline assessment and subsequent follow-up. Findings will be disseminated to local stakeholders via forums with community leaders, and health and social welfare departments, and published in appropriate scientific journals and presented at conferences.

BackgroundAs Malaysia is fast becoming an ageing nation, the health, safety and welfare of elders are major societal concerns. Elder abuse is a phenomenon recognised abroad but less so locally. This paper presents the baseline findings from the Malaysian Elder Mistreatment Project (MAESTRO) study, the first community-based study on elder abuse in Malaysia.DesignCross-sectional study, analysing baseline findings of a cohort of older adults.SettingKuala Pilah district, Negeri Sembilan state, Malaysia.ObjectivesTo determine the prevalence of elder abuse among community dwelling older adults and its associated factors.ParticipantsA total of 2112 community dwelling older adults aged 60 years and above were recruited employing a multistage sampling using the national census.Primary and secondary outcome measuresElder abuse, measured using a validated instrument derived from previous literature and the modified Conflict Tactic Scales, similar to the Irish national prevalence survey on elder abuse with modification to local context. Factors associated with abuse and profiles of respondents were also examined.ResultsThe prevalence of overall abuse was reported to be 4.5% in the past 12 months. Psychological abuse was most common, followed by financial, physical, neglect and sexual abuse. Two or more occurrences of abusive acts were common, while clustering of various types of abuse was experienced by one-third of abused elders. Being male (adjusted OR (aOR) 2.15, 95% CI 1.23 to 3.78), being at risk of social isolation (aOR 1.96, 95% CI 1.07 to 3.58), a prior history of abuse (aOR 3.28, 95% CI 1.40 to 7.68) and depressive symptomatology (aOR 7.83, 95% CI 2.88 to 21.27) were independently associated with overall abuse.ConclusionElder abuse occurred among one in every 20 elders. The findings on elder abuse indicate the need to enhance elder protection in Malaysia, with both screening of and interventions for elder abuse.