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The aim of this study was to determine the incidence of physical inactivity and identify the predictors for low physical activity among community-dwelling older persons living in Malaysia in 3 years follow-up. In this prospective study, physical activity levels were measured using the Physical Activity Scale for the Elderly. The arbitrary cutoff for Physical Activity Scale for the Elderly in this study was ≤70.9 for low and >141 for high physical activity levels. Out of the 955 physically active participants at baseline, 555 of them (mean [SD] age 68.82 [4.92] years) were successfully followed up to 3 years. Cumulative incidence of being physically inactive was 21% with rate of 7 per 100 person-years. It was found that being older (

Quality of life (QOL) of family caregivers of cancer patients is usually affected due to increase in caregiver burden. Their QOL has not garnered much attention by many including the health professionals and community. This study aims to explore the QOL of family caregivers of cancer patients in a multi-ethnic country in Asia and to investigate its associate factors.This is a cross-sectional study where family caregivers and patients who were diagnosed of cancers within 12 months were recruited. QOL of caregivers were measured using The Caregiver Quality of Life Index-Cancer (CQOLC). Psychological distress was measured using Hospital anxiety and depressive scale. Logistic regression analysis was performed to determine the related factors of QOL of caregivers.A total of 458 patients/caregiver pairs were included. Symptoms of anxiety and depression reported by caregivers were 24.9% and 24.2% respectively. Caregivers of patients with solid tumors have better CQOLC score compared to those who cared for patients with hematological cancers (91.25 vs 86.75). Caregivers of non-Malay ethnicity, those caring for patients with advanced stage cancer and with hematological cancers had significantly poorer QOL. QOL of caregivers are also significantly affected when patients demonstrated anxiety symptoms.This study provides detailed evaluation of the QOL of caregivers of cancer patients in Malaysia. The significant psychological distress and low caregiver QOL indicate the urgent need for comprehensive supports for caregivers with cancer patients, especially those caring for patients with haematological cancers.

The two-minute step test (2MST) has been used to estimate cardiorespiratory fitness and optimum scores are needed for performing activities of daily living with ease among older persons. However, there is limited information on the mediating role of cognitive impairment on 2MST performance and the 2MST normative data. Hence, we aim to identify the mediating role of cognitive status on performance in the 2MST among community-dwelling older adults and to establish the normative values of the 2MST.Participants aged 60 years and above were recruited through multistage random sampling from four states in Malaysia. The participants performed the 2MST using standard protocols. Mean comparison was done using an independent sample t-test or one-way analysis of variance. The 2MST normative values were then outlined descriptively.Older age groups (60-69 years: 65.4 ± 21.9 times; 70-79 years: 61.7 ± 22.9 times; ≥80 years: 51.6 ± 24.5 times) had significantly lower levels of 2MST performance (p 0.001). Women (56.6 ± 20.9 times) and participants with mild cognitive impairment (MCI) (58.7 ± 21.7 times) also had significantly lower levels of 2MST performance (p 0.001) compared with men (69.1 ± 20.7 times) and participants with normal cognition (63.7 ± 21.6 times). Cognitive status had a significant mediation effect for age and sex on 2MST performance (p 0.001). Therefore, the 2MST normative values were stratified according to cognitive status, sex, and age groups.Validation of these findings in a larger number of older populations with MCI may provide directions for cardiorespiratory fitness training to be emphasised among older persons with MCI. Geriatr Gerontol Int 2022; 22: 950-955.

BACKGROUND Emerging evidence has linked visit-to-visit, day-to-day and 24-h ABPM blood pressure variability (BPV) with cognitive impairment. Few studies have, however, considered beat-to-beat BPV. This study, therefore, evaluated the relationship between beat-to-beat BPV and cognitive function among community-dwellers aged 55 years and over. METHODS Data was obtained from the Malaysian Elders Longitudinal Research (MELoR) study, which employed random stratified sampling from three parliamentary constituencies within the Klang Valley. Beat-to-beat blood pressure (BP) was recorded using non-invasive BP monitoring (TaskforceTM, CNSystems). Low frequency (LF), high frequency (HF) and low-to-high frequency (LF:HF) ratio for BPV were derived using fast Fourier transformation. Cognition was evaluated using the Montreal Cognitive Assessment (MoCA) test, and categorized into normal aging, mild impairment and moderate-to-severe impairment. RESULTS Data from 1,140 individuals, mean age (SD) 68.48 (7.23) years, were included. Individuals with moderate-to-severe impairment had higher HF-BPV for systolic (SBP) and diastolic (DBP) blood pressure compared to individuals within the normal aging group [OR (95% CI) = 2.29 (1.62–3.24)] and [OR (95% CI) = 1.80 (1.32–2.45)], while HF-SBPV [OR (95% CI) = 1.41 (1.03–1.93)] but not HF-DBPV was significantly higher with mild impairment compared to normal aging after adjustments for potential confounders. Moderate-to-severe impairment was associated with significantly lower LF:HF-SBPV [OR (95% CI) = 0.29 (0.18–0.47)] and LF:HF-DBPV [OR (95% CI) = 0.49 (0.34–0.72)], while mild impairment was associated with significantly lower LF:HF-SBPV [OR (95% CI) = 0.52 (0.34–0.80)] but not LF:HF-DBPV [OR (95% CI) = 0.81 (0.57–1.17)], compared to normal aging with similar adjustments. CONCLUSION Higher HF-BPV, which indicates parasympathetic activation, and lower LF:HF-BPV, which addresses sympathovagal balance, were observed among individuals with moderate-to-severe cognitive impairment. Future studies should determine whether BPV could be a physiological marker or modifiable risk factor for cognitive decline.

To determine the risk of adverse outcomes among prefrail and frail individuals with and without cognitive impairment as well as those with isolated cognitive impairment compared to robust individuals without cognitive impairment.Data from the Malaysian elders longitudinal research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted interviews and hospital-based health-checks from 2013 to 2015. Protocol of MELoR study has been described in previous study (Lim in PLoS One 12(3):e0173466, 2017). Follow-up interviews were conducted in 2019 during which data on the adverse outcomes of falls, sarcopenia, hospitalization, and memory worsening were obtained. Sarcopenia at follow-up was determined using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire.Follow-up data was available for 776 participants, mean (SD) age 68.1 (7.1) years and 57.1% women. At baseline, 37.1% were robust, 12.8% had isolated cognitive impairment, 24.1% were prefrail, 1.0% were frail, 20.2% were prefrail with cognitive impairment, and 4.8% had CF. Differences in age, ethnicity, quality of life, psychological status, function and comorbidities were observed across groups. The association between CF with hospitalisation and falls compared to robust individuals was attenuated by ethnic differences. Pre-frail individuals were at increased risk of memory worsening compared robust individuals [aOR(95%CI) = 1.69 (1.09-2.60)]. Frail [7.70 (1.55-38.20)], prefrail with cognitive impairment [3.35 (1.76-6.39)] and CF [6.15 (2.35-16.11)] were significantly more likely to be sarcopenic at 5-year follow-up compared to the robust group.Cognitive frailty was an independently predictor of sarcopenia at 5-year follow-up. The relationship between CF with falls and hospitalization, however, appeared to be accounted for by ethnic disparities. Future studies should seek to unravel the potential genetic and lifestyle variations between ethnic groups to identify potential interventions to reduce the adverse outcomes associated with CF.

BACKGROUND: This cohort study aimed to determine the association between body fat percentage (BF%), incident fractures and calcaneal broadband ultrasound attenuation (BUA). METHODS: Participants were drawn from the EPIC-Norfolk Prospective Population Cohort Study (median follow-up = 16.4 years). Cox models analysed the relationship between BF% and incident fractures (all and hip). Linear and restricted cubic spline (RCS) regressions modelled the relationship between BF% and BUA. RESULTS: 14,129 participants (56.2 % women) were included. There were 1283 and 537 incident all and hip fractures respectively. The participants had a mean (standard deviation) age of 61.5 (9.0) years for women and 62.9 (9.0) years for men. Amongst men, BF% was not associated with incident all fractures. While BF% < 23 % (median) was not associated with hip fractures, BF% > 23 % was associated with increased risk of hip fractures by up to 50 % (hazard ratio (95 % confidence interval) = 1.49 (1.06-2.12)). In women, BF% < 39 % (median) was associated with up to 32 % higher risk of all fractures (1.32 (1.13-1.44)), while BF% > 35 % was not associated with this outcome. Higher BF% was associated with lower risk of incident hip fractures in women. Higher BF% was associated with higher BUA amongst women. Higher BF% up to ~23 % was associated with higher BUA amongst men. CONCLUSIONS: Higher BF% is associated with lower risk of fractures in women. While there was no association between BF% and all fractures in men, increasing BF% >23 % was associated with higher risk of hip fractures in men. This appears to be independent of estimated bone mineral density. Fracture prevention efforts need to consider wider physical, clinical, and environmental factors.

Introduction Resilient ageing is conceptualised as strive towards achieving satisfactory quality of life (QoL) at old age by embracing adaptive and coping mechanisms against adversities regardless of health conditions. Preventive Home Visit (PHV) including various types of home-care interventions were introduced to delay health deterioration and improved QoL. However, research related to resilience as indicator for QoL is scarce. Therefore, this systematic review aims to evaluate the effectiveness of PHV in improving resilience among community dwelling older adults and the association with health and other QoL related outcomes. Method Database search was conducted by using five databases (PubMed, PsycINFO, CINAHL, Web of Science and Scopus) up to 31 March 2022 involving community dwelling older adults who received PHV. Three authors reviewed the articles for inclusion and performed methodological quality assessment. Results Out of 1,580 records, 13 articles involving 7,254 participants met the inclusion criteria with age range between 79 to 85 years old. Quality assessment by using Joanna Briggs Institute (JBI) Critical Appraisal Tools indicated that all Randomised Controlled Trials (RCTs) and non-RCTs articles were having low risks of bias, suggesting high-quality studies were selected for this review. One remaining study was a cross-sectional study. More than two third of the studies focused on health or combination of health and QoL and only three studies yield positive impact of PHV. The rest were either yielded mixed results or no impact of PHV intervention. There was only one study measuring resilience with results showed no significant impact of PHV or home care intervention on resiliency of the older adults. Conclusion Research on the effectiveness of PHV has been introduced since for decades ago, however study focusing on resilience related outcomes is still lacking. Based on current evidence, it is essential to further evaluate the impact of multi-domain health and psychological intervention in PHV design considering the ability of older adults to face adversity in late life.

OBJECTIVE To evaluate the role of PhA in diabetes in a large population of older adults with a high prevalence of diabetes in order to gain new insights on the potential diagnostic and prognostic role of PhA in individuals with diabetes. DESIGN Cross-sectional study. SETTING Teaching Hospital. PARTICIPANTS 1085 individuals aged 55 years or over. MEASUREMENTS Phase Angle was obtained using bioimpedance analysis with the Bodystat QuadScan® 4000. Diabetes mellitus was considered present with fasting hyperglycaemia (serum fasting glucose >6.66 mmol/l), HbA1c > 42 mmol/mol (6.1%), or self-reported Diabetes or the consumption of glucose-lowering agents. RESULTS The mean age of the (standard deviation) of the 1,085 participants was 68.11 (7.12) years and 60.7% were women. Among male participants, individuals with PhA within the lowest quartile (PhA ≤4.9) were significantly more likely to have diabetes mellitus [odds Ratio (95% confidence interval, CI), 2.02 (1.17-3.47)] following adjustments for age, body mass index and other comorbidities. The above relationship was attenuated following further adjustment hypoglycaemic medications. Men on oral hypoglycaemic agents had significantly reduced PhA [mean difference (95% CI), -0.44 (-0.67 to -0.22)]. No significant relationship between PhA and diabetes existed among women. CONCLUSION The association between lower PhA (≤4.9) in men aged 55 and over and diabetes which is accounted for by oral hypoglycaemic agents. The mechanisms underlying this relationship remain unclear. This relationship should also be evaluated further to determine the potential of PhA as a prognostic tool for diabetes.

Background: Rapid population aging occurring in developing nations necessitates innovation to ensure we continue to gain ground on aging research despite pandemic threats. While developed nations have resorted to virtual communications, this is challenging in developing nations due to poor internet connectivity and digital literacy. Objectives: The aim of this study was to determine the feasibility of virtual data collection for a longitudinal study of aging assessing cognitive frailty in a middle-income Southeast Asian country. Methods: The Transforming Cognitive Frailty into Later-Life Self-Sufficiency (AGELESS) longitudinal study of aging involved community-dwelling participants aged 60 years and above. A semi-structured focus group discussion was conducted via videoconferencing with selected representatives from existing participants. The survey instrument was compiled during a hybrid meeting and refined using a virtual Delphi process involving 51 AGELESS investigators. The final draft survey and recruitment strategy were then piloted among selected participants. Results: Twelve individuals participated in the virtual focus group interview. Smartphone, tablet computer, laptops, and desktop personal computers were used for information gathering, communication, banking, shopping, leisure, religion, and education, within this group. The survey instrument was redacted from 362 items in 18 sections to 141 items in 12 sections through 3 virtual Delphi rounds facilitated by email, social media messaging, and videoconferencing which attracted 213 comments. Of 45 participants selected for the pilot survey, 30 were successfully contacted after one attempt and 18 completed the survey. Cognitive frailty was present in 13%, cognitive impairment in 20%, frailty in 20%, and 47% were robust. Conclusion: A virtual survey instrument was developed for the AGELESS longitudinal survey of aging which was vital for determining the effects of the COVID-19 pandemic on our older population as well as sustaining research into aging despite barriers posed by the pandemic.

Introduction Osteoarthritis (OA) is a major cause of physical impairment in older persons. Few studies have determined the relationship between the presence of OA and frailty. We evaluated the prospective relationship between knee pain and frailty in a Malaysian longitudinal cohort. Method Data from Malaysian Elders Longitudinal Research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted questionnaires and hospital-based health-checks from 2013–2015. The presence of knee pain was determined with the single question, ‘do you have pain in your knee(s)?’. Frailty status was determined at follow-up in 2019 using SARC-F. Results Data from 1,226 individuals, mean age (SD) = 68.97 (7.48), range = 54–97 years and 56.6% women at baseline, were included. 408 (33.3%) had knee pain. Individuals with knee pain were significantly more likely to be female (66.2% vs 51.8%, p Conclusion Knee pain was associated with an increased risk of frailty with 5-years follow-up in an urban population in Kuala Lumpur. More detailed evaluation using imaging and clinical diagnosis of osteoarthritis is now indicated. Future studies should also seek to identify modifiable risk factors for the development of frailty in individuals with knee OA and develop strategies to prevent frailty.

The current evidence on the relationship between a higher body mass index (BMI) and falls in older adults is conflicting. This study, therefore, evaluated the relationship between BMI and falls and explored underlying mechanisms for this relationship. Data from 1,340 individuals from the Malaysian Elders Longitudinal Research study, obtained through home-based computer-assisted interviews and followed by hospital-based health checks, were utilized. A history of the presence of falls in the previous 12 months was obtained. The presence of at least one fall in the past 12 months was associated with a higher BMI (odds ratio = 1.03, 95% confidence interval [1.01, 1.06]). The relationship between a higher BMI and falls was, however, attenuated by a lower percentage of lean body mass, which accounted for 69% of the total effect of BMI on the risk of falls. Future studies should now investigate this aforementioned relationship prospectively.

To conduct a scoping review of articles which have evaluated BPV and cognitive function. Articles with keywords, titles or abstracts containing the terms 'cognitive' OR 'cognition' OR 'dementia' AND 'blood pressure variability' were identified from CINAHL, Medline, PMC and Web of Science.Methods of acquisition and analysis of BPV and cognitive measurements and their relationship were extracted from selected articles. Of 656 studies identified, 53 articles were selected. Twenty-five evaluated long-term (LTBPV), nine mid-term (MTBPV), 12 short-term (STBPV) and nine very short-term BPV (VSTBPV) with conflicting findings on the relationship between BPV and cognition. Variations existed in devices, period and procedure for acquisition. The studies also utilized a wide range of methods of BPV calculation. Thirteen cognitive assessment tools were used to measure global cognition or domain functions which were influenced by the population of interest. The interpretation of available studies was hence limited by heterogeneity. There is an urgent need for standardization of BPV assessments to streamline research on BPV and cognition. Future studies should also establish whether BPV could be a potential modifiable risk factor for cognitive decline, as well as a marker for treatment response.

This study aimed to determine undergraduates’ mental health status, quality of life and burn-out status in clinical and non-clinical programs as well as its association during COVID-19 pandemic period. A cross sectional survey was carried out by distributing the questionnaire through online social media platforms such as WhatsApp, Facebook, and Twitter. Mental health, burn-out statuses and quality of life of the undergraduates were assessed using 21-item Depression Anxiety Stress Scale (DASS-21), Copenhagen Burnout Inventory and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) respectively. A total of 308 respondents (111 from clinical, 197 from non-clinical programs), mean (SD) age=21.88(1.29) years participated in this cross-sectional online survey. The results revealed that undergraduates in the non-clinical programs are more likely to experience higher levels of depression, anxiety and stress, which demonstrated by higher median (IQR) scores in each component of DASS-21 (Non-clinical VS Clinical) [depression, 18 (10-28) VS 8 (2-20); anxiety, 16 (8-26) VS 10 (2-16), and stress, 20 (12-28) VS 12 (4-22)]. Similarly, higher burnout median score, 58.83 (48.83 - 75.00) was noted among undergraduates in non-clinical programs with a lower mean (SD) Q-LES- Q-SF score=58.75 (18.03). Undergraduates from non-peninsular Malaysia showed lower quality of life scores [2.06(1.03-4.13)], while undergraduates with good internet accessibility had higher quality of life scores [2.06(1.03-4.13)]. The association between lower mental health status, QoL and burn-out among non-clinical students remained significant even after adjustment for gender, household income, type of university (IPTA vs IPTS), race, and internet accessibility at university. Our findings suggest that undergraduates from clinical programs had better mental health status and quality of life when compared to their peers from non-clinical programs during COVID-19 pandemic period.

Background As a result of the COVID-19 pandemic, changes in data collection methods have been introduced in research to ensure continuity despite physical distancing and lockdown restrictions. However, little is currently known about the potential differences in information collected using these traditional face-to-face methods compared to the incorporation of virtual methods to address the above, particularly in studies involving older adults. Aims Our objectives were, therefore, to compare data collected during the pandemic using hybrid methods from older individuals participating in falls research to that collected through traditional face-to-face methods. Methods Participants comprised of individuals recruited to two fall studies which hurdled the start of the COVID-19 pandemic. Both studies recruited individuals aged 60 years and over with at least one fall in the past 12 months, and controls with no history of falls in the past 12 months. Pre-pandemic, individuals were interviewed face-to-face exclusively, those interviews after the start of the pandemic were conducted virtually with physical assessments conducted face-to-face to minimize physical contact. Cognitive, physical, and psychological status were determined using the visual cognitive assessment tool (VCAT), timed-up-and-go (TUG), functional reach (FR), handgrip strength (HGS), and the 21-item depression, anxiety and stress scale (DASS-21). In addition quality of life, physical activity and social participation were also measured. Results Of the 145 participants (median age (interquartile range, IQR) of 73.5 (67-81) years), 69 (47.6%) were interviewed face-to-face, while 76 (53.4%) were assessed using a hybrid method. Participants in both groups had similar age, gender, ethnic breakdown, marital status, education levels, anthropometric measurements, and medication burden. More face-to-face participants had hypertension and fall compared to hybrid participants Differences were observed in presence of fall characteristics, with fewer fallers seeing a doctor and more fallers attending the emergency department after the start of the pandemic. After adjustment for baseline differences, participants interviewed using hybrid status had lower depression scores (odds ratio, OR (95% confidence interval, CI)=0.29(0.14-0.61) and stress scores (OR(95%CI)=0.33(0.15-0.72)), but greater fear of falling (OR(95%CI)=2.16(1.04-4.48)) and reduced social participation (OR(95%CI)=2.64(1.20-5.79)). Conclusion Alterations in recruitment and data collection methods to overcome pandemic restrictions should take into consideration potential differences in individuals who agree to participate as well as the influence of major life events on the psychological status of participants.

Introduction Previous studies have found that older adults with osteoarthritis (OA) were more likely to fall. However, the role of inflammation in OA severity, impaired physical function and increased risk of fall remains unclear. Therefore, the aim of this study is to explore the association between the inflammatory biomarkers and OA severity. Method This is a cross sectional case-control study which includes 69 individuals aged 55y recruited from orthopaedic clinics, geriatric clinics, primary care and senior citizen groups. Demographic characteristics, medical history, lifestyle factors, Knee Injury and Osteoarthritis Outcome Scores (Koos) were obtained through computer-assisted questionnaires and physical performance were measured. Blood samples were drawn after an overnight fast for a routine laboratory panel. The 20 inflammatory markers were measured and quantified using validated enzyme linked immunosorbent assays included TGFA, IFNG, IL1ra, IL1A, IL1B, IL2, IL3, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12P40, IL12P70, IL13, IL15, IL17A and TNFA. Results Of the 69 participants, mean (SD) age being 66.67 (7.605) and 71% women, 18 (26.1%) reported severe, 13(18.8%) moderate, 20 (29.0%) mild and 18 (26.1%) no OA, women. Significant differences in BMI (p-value Conclusion More research is needed to see whether this applies to a bigger population and more detailed research needs to be done in regards to TGF-A, IL-6 and IL-8 which shows promise as a severity biomarker for osteoarthritis.

Background Diabetes mellitus (DM) is a highly prevalent NCD affecting 20-30% of worldwide population with a rapidly rising prevalence in LMICs. It has been suggested that DM is one of the important risk factors for falls in older people attributed to complications. However, only a handful studies has evaluated the mechanisms of falls in diabetes. Aim To determine the potential mediating factors for falls individuals with diabetes mellitus Methods Cross-sectional analysis was conducted using the Malaysian Elders Longitudinal Study (MELoR) first wave data. The MELoR study recruited Klang Valley residents aged >55 years. DM was defined as fasting hyperglycaemia (serum fasting glucose > 6.66 mmol/l) or HbA1c > 42 mmol/mol (6.1%) or self-reported diabetes by participants or consumption of hypoglycaemic medications. Falls were identified by enquiring about the presence of fall in the past 12 months. Physical measurements obtained were hand grip strength (HGS), timed-up-and-go (TUG) and functional reach. Result Of 1579 participants, mean (SD) age 68.85 (7.48) years and 901 (57.1%) female, DM was present in 796 (50.4%) participants while 363 (22.9%) had falls in the past 12months. DM was associated with 35% of increased odds of falls compared to those without DM (odds ratio (95% CI)= 1.35 (1.07-1.71)). The association was remained significant after adjustment of demographic differences, body mass index and TUG. The associations were, however, attenuated after the inclusion of HGS in the model. Conclusion Weaker HGS appeared to account for the increased risk of falls in individuals aged 55 ears and above with DM. Reduced HGS is a marker including in the frailty phenotype. It is unclear why HGS rather than TUG, which is a composite measure of gait speed, lower limb girdle and dynamic balance mediated the relationship. A prospective study is required to determine the temporal relation between HGS and falls in diabetes.

Background Cross-sectional studies linking the association between obesity and falls are limited and their results are somewhat conflicting. The inconsistent evidence between obesity and falls could be explained by the utilization of different measures of obesity including BMI, WC, waist hip ratio (WHR) and percentage body fat (%BF) in different studies. Aims To examine the prospective association between various measures of obesity and falls among community-dwelling older adults. Methods We utilized data from the wave 1 and wave 2 of the Malaysian Elder’s Longitudinal Research Study (MELoR). Basic demographic characteristics, medical history, lifestyle factors and falls history in preceding 12 months was recorded by computer assisted questionnaire in participant’s home while anthropometric measurements, body composition assessments and physical performance were collected at the hospital during a hospital check-up at baseline. The main exposure variables were increased body mass index (BMI), waist circumference (WC), waist hip ratio (WHR) and percentage body fat (%BF) and the main outcome was self-report falls in the preceding 12 months at time of follow-up. Results Among 746 participants at baseline and follow-up (mean age 68.9 ± 7.3 years, old, 56.7% women), 150(20.1%) individuals had ≥1 time of fall at follow-up. No differences in mean age and proportion of men and women among fallers and non-fallers. However, fallers were found to have higher WHR, lower percentage muscle mass and performed poorer in physical performance (p-value Conclusions In conclusion, our findings suggest that WHR is the measure of adiposity most likely to differentiate fallers from non-fallers prospectively. Future studies should evaluate the mechanisms underlying the increased risk of falls associated with increased WHR.

Background Fear of falling (FoF) is common in older people with a history of falls and increases the risk of future falls. It is postulated that individuals with FoF may lose the balance control in response to threatening situations due to psycho-emotional responses to a previous event. Little is known of how FoF influences postural control in older people. Aim To compare the influence of age in the association between FoF and postural control among older persons Methods A case-control study involving individuals aged ≥65 years with ≥2 falls or one injurious fall over 12 months with volunteers aged ≥65 years with no falls in the past year. Postural sway was quantified by using a long force-plate balance platform (Balancemaster, NeuroCom, USA). Fear of falling was assessed using the short Falls Efficacy Scale-International questionnaire. Result Of 102 participants recruited in this study, 33 (32.4%) were aged 65-69y, 36 (35.3%) aged 70-74y, and 33 (32.4%) age≥ 75y. There was no significant difference in FoF across the groups. The oldest age group had poorer postural control. Fear of falling in the youngest old group was associated with poorer standing balance in ‘eyes closed, firm surface’ conditions (p-value=0.012), forward maximal excursion (p-value=0.007), forward end point (p-value=0.001), forward movement velocity (p-value=0.008) and forward directional control (p-value Conclusion The influence of FoF on postural control is age dependent with posturography measurements only significantly associated with FoF within the 65-69y age group, but not the 70-74y or ≥ 75y age groups. Psychological interventions for fall prevention may therefore be more appropriately targeted according to age groups, rather than treating all over 65s as a homogenous group. This approach should be evaluated in future studies.

The Malaysian Elders Longitudinal Research (MELoR) study found 1 in 4 residents aged 65 years and over living in the Klang Valley of Malaysia fall at least once a year in their survey conducted between 2013 and 2015. Recent figures obtained from the First Older Persons’ National Health and Morbidity Survey conducted in 2018 revealed that 15% of Malaysians aged 60 years and over fall at least once a year. In a 10-year follow-up study involving 200 individuals who presented to the emergency department over a six-month period in 2002, 22% were no longer alive at one year, and 80% had died at 10 years. Older age, indoor falls, subsequent hospital admission and functional impairment predicted death at one year. Cross-sectional data from MELoR revealed ethnic differences in fall prevalence, with the ethnic Indians more likely to report falls in the past 12 months compared to the ethnic Malays. Independent risk factors for falls identified from MELoR were urinary incontinence, reduced grip strength, hearing impairment, comorbidities and reducing walking speed. The ethnic differences in falls in our population remain unexplained. Lifestyle and cultural practices may well be the underlying rationale, but genetic influences cannot currently be ruled out. The results of a randomized controlled trial on multifactorial interventions, the Malaysian Falls Assessment and Intervention Trial (MyFAIT), was published last year. Mo differences in falls outcomes with an individualized multifactorial intervention were observed, despite improvements in physical performance and psychological status in the intervention group compared to the control group. The research group has now secured two-year funding to evaluate post-fall behavior in our setting in the Life After Falls (LiAF) study. In addition, dissemination and upskilling efforts are underway through training workshops, formation of the Malaysian Falls Network (MyFalls) and collaborations with the private sector to increase awareness on falls and increase fall prevention efforts throughout the country.

To evaluate the relationship between waist-to-hip ratio and fall-related outcomes in community-dwelling individuals aged 55 years and above. A higher waist-to-hip ratio remained independently associated with increased risk of falls compared to those with a lower waist-to-hip ratio. Waist-to-hip ratio should be measured when assessing fall risk in adults aged 55 years and above. To evaluate the relationship between waist-to-hip ratio (WHR) and fall-related outcomes in community-dwelling individuals aged 55 and above. Cross-sectional data obtained from the first wave of the Malaysian Elders Longitudinal Research (MELoR) study were utilized for this study. Participants aged 55 years and over were recruited using simple random sampling from the electoral rolls of three local parliamentary constituencies. Socio-demographics, falls history and medical history were obtained through home-based computer-assisted interviews while anthropometric measurements, including WHR, and physical performance were obtained during hospital-based health checks. WHR was categorized into three arbitrary categories stratified by gender. Data on both falls and WHR were available for 1335 participants, mean age ± standard deviation (SD) = 68.4 ± 7.1 years. Logistic regression analyses using dummy variables revealed that individuals within the higher WHR group were significantly more likely to report a history of fall in the preceding 12 months {adjusted odds ratio (aOR) [95% confidence interval (CI)] = 1.78 (1.18–2.67)}, fear of falling [aOR (95% CI) = 1.58 (1.08–2.32)], impaired timed-up-and-go [2.14 (1.44–3.17)] and reduced functional reach [1.68 (1.18–2.38)] compared to those with lower WHR. A higher WHR remained independently associated with increased risk of falls compared to those with lower WHR after additional adjustment for fear of falling and functional performance. Our finding suggests WHR as an independent risk factor for higher risk of fall which may indicate body shape as a potentially modifiable risk factor for falls in adults in aged 55 years and over.

To evaluate the role of PhA in diabetes in a large population of older adults with a high prevalence of diabetes in order to gain new insights on the potential diagnostic and prognostic role of PhA in individuals with diabetes.Cross-sectional study.Teaching Hospital.1085 individuals aged 55 years or over.Phase Angle was obtained using bioimpedance analysis with the Bodystat QuadScanThe mean age of the (standard deviation) of the 1,085 participants was 68.11 (7.12) years and 60.7% were women. Among male participants, individuals with PhA within the lowest quartile (PhA ≤4.9) were significantly more likely to have diabetes mellitus [odds Ratio (95% confidence interval, CI), 2.02 (1.17-3.47)] following adjustments for age, body mass index and other comorbidities. The above relationship was attenuated following further adjustment hypoglycaemic medications. Men on oral hypoglycaemic agents had significantly reduced PhA [mean difference (95% CI), -0.44 (-0.67 to -0.22)]. No significant relationship between PhA and diabetes existed among women.The association between lower PhA (≤4.9) in men aged 55 and over and diabetes which is accounted for by oral hypoglycaemic agents. The mechanisms underlying this relationship remain unclear. This relationship should also be evaluated further to determine the potential of PhA as a prognostic tool for diabetes.

While metabolic syndrome, falls, and frailty are common health issues among older adults which are likely to be related, the potential interplay between these three conditions has not previously been investigated. We investigated the relationship between metabolic syndrome with falls, and the role of frailty markers in this potential relationship, among community-dwelling older adults.Data from the first wave Malaysian Elders Longitudinal Research (MELoR) study comprising urban dwellers aged 55 years and above were utilized. Twelve-month fall histories were established during home-based, computer-assisted interviews which physical performance, anthropometric and laboratory measures were obtained during a hospital-based health check. Gait speed, exhaustion, weakness, and weight loss were employed as frailty markers.Data were available for 1415 participants, mean age of 68.56 ± 7.26 years, 57.2% women. Falls and metabolic syndrome were present in 22.8% and 44.2%, respectively. After adjusting for age, sex, and multiple comorbidities, metabolic syndrome was significantly associated with falls in the sample population [odds ratio (OR): 1.33, 95% confidence interval (CI): 1.03; 1.72]. This relationship was attenuated by the presence of slow gait speed, but not exhaustion, weakness, or weight loss.Metabolic syndrome was independently associated with falls among older adults, and this relationship was accounted for by the presence of slow gait speed. Future studies should determine the value of screening for frailty and falls with gait speed in older adults with metabolic syndrome as a potential fall prevention measure.

Aim To determine the association between vitamin D and knee pain among participants of the Malaysian Elders Longitudinal Research (MELoR) study. Method This was a cross-sectional study from the MELoR study consisting of a representative group of 1011 community-dwelling older persons (57% female), mean age 86.5 (54-94) years; 313 were Malays, 367 Chinese and 330 Indians. Participants were asked if they had knee pain. Levels of serum 25-hydroxy cholecalciferol (25-[OH]D), an indicator of vitamin D status, were measured using routine laboratory techniques. Results In unadjusted analysis, presence of knee pain was significantly associated with vitamin D deficiency (odds ratio [OR] 1.42; 95% confidence interval (CI) 1.08-1.85, P 0.011). Vitamin D levels were significantly associated with ethnicity differences where Malays (OR 7.08; 95% CI 4.94-10.15) and Indians (OR 6.10; 95% CI 4.28-9.71) have lower levels of vitamin D compared to Chinese. Subsequent multivariate analysis revealed that the association between vitamin D deficiency and knee pain was confounded by ethnic differences. Conclusion A previous study suggested that vitamin D deficiency was associated with knee pain. This relationship was reproduced in our study, but we further established that the association was explained by ethnic variations. As vitamin D status is dependent on skin tone, diet and sunlight exposure, which are all effected by ethnicity, future studies are now required to determine whether a true relationship exists between vitamin D and knee pain.

Background Cardiovascular problems such as orthostatic hypotension are common risk factors for falls in older persons. Arterial stiffness has been suggested as the key determinant of cardiovascular risk. Published evidence to support the assumption on the associations between arterial stiffness parameters and falls remains limited. Aim To determine the association between arterial stiffness and falls in older people. Methods This was a cross-sectional analysis of MELoR first wave data. Of 446 participants included, 103 reported at least one falls in the past 12 months. The assessment of arterial pulse wave components was performed by non-invasive applanation tonometry of radial artery a SphygmoCor device (AtCor Medical, Sydney, Australia). Result Participants with mean age 68.28 (7.28) and 60% female were included in this study. Fallers showed significant higher central arterial pressure percentage at heart rate 75bpm compared to the non-fallers [mean (SD): 16.61 (8.16) vs 14.79 (6.89), p=0.026]. The association remained significant after adjustment for age and hypertension. In addition, peripheral diastolic pressure in fallers was significantly lower than non-fallers (p-value=0.049). Conclusion Augmented index at the heart rate of 75bpm was associated with falls in older people. Thus, this study suggests that this parameter could be the determinants in assessing risk of falls. A prospective study is therefore recommended to determine temporal associations between arterial stiffness and falls.

Introduction Falls in older persons lead to psychological as well as physical effects resulting in loss of quality of life, functional impairment and institutionalization. Previous studies have established falls in the previous 12 months as a risk factor for subsequent falls, but few have evaluated sequentially. This study aims to determine the sequential trend of 12-month retrospective fall recall over a four-year follow-up period. Methods The Promoting Independence in our Seniors with Arthritis (PISA) study recruited individuals aged >=60 years followed up over four year. Participants were asked about presence of any fall in the preceding 12 months during each annual visit. Assessment performed during each visit included weight and the Knee Injury and Osteoarthritis Outcome Score (KOOS), hand grip strength, timed-up-and-go test, functional reach and Hospital Anxiety and Depression Scale. Results Falls data were available for 218, 156, 117 and 100 individuals with 22.5%, 23.1%, 24.7% and 29.3% reporting falls at the first, second, third and fourth visits respectively. The mean age (standard deviation) at recruitment was 66.9 (7.1) years and 166 (74.1%) were women. The odds ratio (OR) (95% confidence interval, CI) for falls in the first, second and third years for fallers at recruitment were 2.45 (1.07-5.59), 3.55 (1.49-8.84) and 1.14 (0.43-3.05) respectively. Fallers at the second follow-up, were more likely to falls during second [OR (95%CI) = 2.41(1.94-12.90)] and third years [5.20 (1.91-14.13)]. Faller at the third visit for falls were more likely to fall in the third yaer [OR (95%CI) = 3.88(1.55-9.69)]. Conclusion Falls in the preceding 12 months was associated with increased risk of falls in the subsequent two years. Faller at recruitment, however. were no longer at increased risk of falls at the third year of follow-up. This has implications for resource planning in terms to determine whether intervention is still useful with long waiting lists in overcrowded public health facilities.

Background While anticholinergic use is associated with stroke, dementia and mortality, few have evaluated its potential link with falls. To determine the relationship between anticholinergic cognitive burden (ACB) and falls over five years using the Malaysian Elders Longitudinal Research (MELoR). Methods Community-dwelling adults aged 55 years and over were recruited through electoral roll sampling. Data obtained at baseline and follow-up (FU) at two and five years were included. Falls in the preceding 12 months were recorded. Results Of the 1499 individuals (mean (SD) age= 68.9(7.5) yrs and 53.3% female) with information on baseline ACB exposure, 575(38.4%) had ACB scores of 1-2 and 117(7.8%) had ACB scores ≥ 3 . Differences in age, ethnicity, smoking status, diabetes, hypertension, cardiovascular disease, arthritis and education existed between ACB groups. Fall occurrence differed between ACB groups at recruitment (p = 0.004) and 2-year FU (p = 0.001) but not at 5-year FU (p = 0.053). Logistic regression revealed an independent association between ACB 1-2 and falls at baseline (odds ratio, OR (95% confidence interval, CI) =1.412(1.035-1.926)) and ACB ≥ 3 and falls at 2-yr FU (OR (95%CI) =2.098(1.032-4.263)) following adjustment for confounders. Conclusion Low level exposure to drugs with anticholinergic properties was associated cross-sectionally with falls, while exposure to higher levels were prospectively associated with falls at 2-year but not at 5-year FU. Future studies should determine whether avoidance of drugs with anticholinergic effects will lead to reduction in falls.

Sumaiyah Mat,1 Chin Teck Ng,1–3 Farhana Fadzil,4 Faizatul Izza Rozalli,4 Maw Pin Tan1,5 1Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia; 2Department of Rheumatology and Immunology, Singapore General Hospital, 3Duke-NUS Medical School, National University Singapore, Singapore; 4Department of Radiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 5Geriatric Division, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Abstract: The purpose of this study was to investigate the role of fear of falling (FoF) and psychological symptoms in explaining the relationship between osteoarthritis (OA) symptom severity and falls. Individuals aged ≥65 years with ≥2 falls or ≥1 injurious fall over the past 12 months were included in the falls group, while volunteers aged ≥65 years with no history of falls over 12 months were recruited as controls. The presence of lower extremity OA was determined radiologically and clinically. Severity of symptoms was assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. FoF and psychological status were measured with the shortened version of the Falls Efficacy Scale-International and the 21-item Depression, Anxiety and Stress Scale (DASS-21), respectively. Of 389 (229 fallers, 160 non-fallers) potential participants, mean (SD) age: 73.74 (6.60) years, 141 had clinical OA and 171 had radiological OA. Fallers with both radiological OA and clinical OA had significantly higher FoF and DASS-21 scores than non-fallers. FoF was significantly positively correlated with symptom severity in fallers and non-fallers with radiological and clinical OA. Depression, anxiety, and stress scores were only significantly correlated with symptom severity among fallers but not non-fallers in both clinical and radiological OA. The relationship between mild symptoms and reduced risk of falls compared to no symptoms in those with radiological OA was attenuated by increased anxiety. The increased falls risk associated with severe symptoms compared to mild symptoms in clinical OA was attenuated by FoF. FoF may, therefore, be a potentially modifiable risk factor for OA-associated falls which could be considered in future intervention studies. Keywords: falls, fear of falling, osteoarthritis, psychological status, aged