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This article presents a secure communication scheme based on chaotic systems using a sliding-mode observer (SMO) that is robust against disturbances affecting the transmitter and transmission process. The original message is first encrypted using a N-cipher with a key signal and then fed into the state equation, whereas the key signal is fed into the output equation. The chaotic system in the transmitter is re-expressed to decouple the disturbances from the signals of interest. An SMO is then designed based on this form and implemented in the receiver to perform synchronization, and recover the broadcast messages to perform secure communication. The conditions required for the SMO to be feasible are investigated in terms of the transmitter system matrices. A set of design procedures for the chaotic secure communication scheme is outlined. Finally, a simulated example is shown to exhibit the efficacy of the proposed scheme.

In this paper, a dual-frequency continuous wave radar is proposed to achieve both localization and activity/ gesture recognition simultaneously. Specifically, features of different movements will be classified by the activity and gesture recognition network (AGRNet) which is a lightweight network based on MobileNet. The data that are recognized corresponding to walking will be used for moving target localization by comparing the phase difference in the Doppler domain between dual frequencies. In addition, a segmentation method is proposed to effectively segment continuous signals into individual time-periods corresponding to different motions by detecting the boundaries of signal changing. The experimental results show that the proposed method accomplishes the classification accuracy over 91% with 8 motion classes with a localization accuracy in the centimeter level.

Background Potentially inappropriate prescribing is increasingly common in older patients with falls. However, published indicators to assess inappropriate prescribing remains unestablished in many countries. Objective This study determined the burden and profile of potentially inappropriate prescribing among patients attending a falls clinic using the STOPP/START criteria and evaluated the factors for falls potentially associated to inappropriate prescribing. Setting University of Malaya Medical Centre Falls Clinic. Method Data of individuals aged ≥ 65 years referred to the falls and syncope clinic were extracted from the falls registry. Potentially inappropriate prescribing was determined with the STOPP/START version 2 criteria. The relationship between potentially inappropriate prescribing with polypharmacy (≥ 5 medications), comorbidities and clinical variables were determined using Pearson’s chi-square and potential confounders adjusted for with multivariate regression. Main outcome measure Potentially inappropriate medicines and/or omitted medicines using STOPP/START criteria. Results Data from 421 individuals, aged 77.8 ± 6.7 years and 53.4% women, were included. Potentially inappropriate prescribing was present in 311 (73.9%). Potentially inappropriate medicines use accounted for 84.6% of the 325 prescriptions. 361/659 instances (54.8%) were falls-risk-increasing drugs, with vasodilators (49.3%) being the main potentially inappropriate medicine identified. Of the 177/421 with polypharmacy, 169/177 (95.5%) were exposed to ≥ one potentially inappropriate medicine. 129 instances of potentially omitted medicines were observed in 109 prescriptions (25.9%). Conclusion STOPP/START criteria are useful to identify potentially inappropriate prescribing at the falls and syncope clinic. This finding has important implications for medication review strategies at falls clinic. Future research should determine whether identifying potentially inappropriate prescribing may reduce adverse falls outcomes among patients in this setting.

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.

While lung protective mechanical ventilation (MV) guidelines have been developed to avoid ventilator-induced lung injury (VILI), a one-size-fits-all approach cannot benefit every individual patient. Hence, there is significant need for the ability to provide patient-specific MV settings to ensure safety, and optimise patient care. Model-based approaches enable patient-specific care by identifying time-varying patient-specific parameters, such as respiratory elastance, Ers, to capture inter- and intra-patient variability. However, patient-specific parameters evolve with time, as a function of disease progression and patient condition, making predicting their future values crucial for recommending patient-specific MV settings. This study employs stochastic modelling to predict future Ers values using retrospective patient data to develop and validate a model indicating future intra-patient variability of Ers. Cross validation results show stochastic modelling can predict future elastance ranges with 92.59 and 68.56% of predicted values within the 5–95% and the 25–75% range, respectively. This range can be used to ensure patients receive adequate minute ventilation should elastance rise and minimise the risk of VILI should elastance fall. The results show the potential for model-based protocols using stochastic model prediction of future Ers values to provide safe and patient-specific MV. These results warrant further investigation to validate its clinical utility.

Background Prolonged life expectancy is associated with increased prevalence of chronic diseases. The aim of this study was to determine the different disability trajectories for the top ten leading causes of death in Taiwan . Methods A total of 2,431 participants aged 50–96 in 1996 from the Taiwan longitudinal study on aging (TLSA) who died from 1996 to 2016 were analyzed. Integration of Cause of Death Data and TLSA helped sort out participants who had died from the ten leading causes of death. The level of physical disability was evaluated with the Activities of Daily Living Scale (ADLs), ranging from 0 to 6 points, in 1996, 1999, 2003, 2007, and 2011. A multilevel model was used to investigate the levels and rates of change in disability development before death. Results The outcome of the research showed that the earliest group to experience physical limitation was individuals living with diabetes. The groups with the highest ADL scores were participants with diabetes, cerebrovascular disease, and hypertension-related diseases. Most groups reach ADL scores ≥ 1 (mild-level) during 4–6 years before death except chronic hepatitis and cirrhosis and injury. Conclusions People who had died from the ten leading causes of death experienced different disability trajectories before death. The trajectory of the participants who had died from diabetes showed a unique pattern with the earliest occurrence and more severe deterioration in terms of development of disabilities. Disability trajectories provide a prediction of survival status for middle-aged and older adults associated with the ten leading causes of death.

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.

Aerial grasping empowers unmanned aerial vehicles to find applications beyond structured logistics. However, it brings a number of challenges including inaccurate positioning of the end effector and limited energy sources. Moreover, solutions so far have difficulty in handling a variety of objects. A novel closed structure compliant gripper was developed to address the challenges above. The gripper has a large self-centering work envelope and is normally-closed for passive grasping. Introduction of compliance as a form of morphological computation was also considered to enhance grasping capabilities, where multi-material 3D printing would facilitate rapid design changes based on target application. To grasp different objects, the gripper has hot-swappable 3D printed fingertips which are optimized with a multi-objective Bayesian Optimization process using physical bench experiments mimicking drone grasping and ascent on a common object set. The morphology of the fingertip including tip width, curvature and distribution of soft and hard material on contact surface, are optimized with a bench test that mimics quadcopter takeoff and landing. The best design from optimization shows an improvement of more than 10% from the initial design in successful grasp operations, demonstrated by field tests with a quadcopter.

The mechanical compliance of soft robots comes at a cost of higher uncertainty in their sensing and perception, which deteriorates the accuracy of predictive models. Predictive uncertainty, which expresses the confidence behind model predictions, is necessary to compensate for the loss of accuracy in soft robot perceptive models. Nevertheless, developing a general framework to capture uncertainties is further challenged by the complex dynamics of soft robots and the difficulties in sensorizing them. In this work, we present a predictive uncertainty estimation framework based on deep learning for soft robot multimodal sensing. We show that the framework can learn to quantify uncertainty and thus is able to express the confidence associated with the predictions during inference. Being data-driven, it is scalable to different types of soft robots and sensor modalities. We demonstrate the framework on a complex multimodal sensing task where a single flex sensor is used to predict the full-body configuration of a soft actuator, as well as the magnitude and location of external contact force. We also discuss how predictive uncertainties are critical to achieve safe learning and model interpretability in soft robotics.

Background Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. In this study, we aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls. This was done in the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians. Methods Data from 1,763 Malaysian community-dwelling older persons aged ≥ 60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up. Results Three hundred and nine (17.53 %) participants reported fall occurrences at an 18-month follow-up, of whom 85 (27.51 %) had two or more falls. The incidence rate for occasional and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being female (OR: 1.57; 95 % CI: 1.04–2.36), being single (OR: 5.31; 95 % CI: 3.36–37.48), having history of fall (OR: 1.86; 95 % CI: 1.19–2.92) higher depression scale score (OR: 1.10; 95 % CI: 1.02–1.20), lower hemoglobin levels (OR: 0.90; 95 % CI: 0.81-1.00) and lower chair stand test score (OR: 0.93; 95 % CI: 0.87-1.00) remained independent predictors of occasional falls. While, having history of falls (OR: 2.74; 95 % CI: 1.45–5.19), being a stroke survivor (OR: 8.57; 95 % CI: 2.12–34.65), higher percentage of body fat (OR: 1.04; 95 % CI: 1.01–1.08) and lower chair stand test score (OR: 0.87; 95 % CI: 0.77–0.97) appeared as recurrent falls predictors. Conclusions Having history of falls and lower muscle strength were predictors for both occasional and recurrent falls among Malaysian community-dwelling older persons. Modifying these predictors may be beneficial in falls prevention and management strategies among older persons.

To determine the association between visual acuity and contrast sensitivity with frailty measures Older adults with poor contrast sensitivity are significantly more likely to be frail (OR: 5.34, p = 0.004). No association was identified between visual acuity and frailty (p = 0.241). Poor contrast sensitivity is significantly associated with frailty. Using data from the Malaysian Elders Longitudinal Research (MELoR), this study investigated the association between visual function (visual acuity and contrast sensitivity) and frailty in a group of urban-dwelling older adults. This was a cross-sectional study. 1332 participants aged ≥ 55 years were selected by random sampling from the parliamentary electoral register. Only 1274 participants completed the frailty assessment and 1278 participants completed the contrast sensitivity assessment. Impaired vision was defined as a Snellen visual acuity of worse than 6/12 in the better eye. Poor contrast sensitivity was defined as a score on the Pelli Robson chart of lower than 1.65. Frailty was defined with the Fried’s phenotype criteria. Inter-group comparisons were determined with the independent T-test for continuous variables and the Pearson’s Chi-squared test for categorical variables. The odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the cross-sectional association between frailty and visual function. The mean age of participants was 68.8 ± 7.5 years, of which 58.1% (774) were women. Impaired vision and poor contrast sensitivity were present in 187 (14%) and 271 (21.2%) subjects respectively. 73 (5.8%) individuals were classified as frail, 1161 (91.0.%) pre-frail, and 40 (2.8%) non-frail. There was no significant difference in frailty phenotypes between those with good and impaired vision (p = 0.241). Fried’s component of handgrip strength, gait speed and exhaustion were significantly better in those with good visual function (p

The rise of model-based and machine learning methods have created increasingly realistic opportunities to implement personalized, patient-specific mechanical ventilation (MV) in the ICU. These methods require monitoring of real-time patient ventilation waveform data (VWD) during MV treatment. However, there are relatively few non-invasive and/or non-proprietary systems to monitor and record patient-specific lung condition in real-time. In this paper, we present a CARE network data acquisition and monitoring system (CARENet) to automate data collection and to remotely monitor patient-specific lung condition and ventilation parameters. The automated system acquires VWD from a mechanical ventilator using a data acquisition device (DAQ), stores data in network-attached storage (NAS), and processes VWDs via a data management platform (DMP) web application. The web application enables real-time and retrospective model-based monitoring and analysis of clinical MV data. In particular, CARENet provides detailed breath-by-breath patient-specific respiratory mechanics, as well as the overall trends assessing changes in patient condition. Validation testing with a retrospective data set illustrated how breath-to-breath and time-varying patient-ventilator interaction during MV can be monitored, and, in turn, can be used to guide MV treatment. The network data acquisition system design presented is low-cost, open, and enables continuous, automated, scalable, real-time collection and analysis of waveform data, to help improve decision making, care, and outcomes in MV.

Objective: Alzheimer’s disease (AD), the commonest form of dementia which is characterized by progressive decline in cognitive function, can only be definitively diagnosed after death. Although bio...

Context Advanced colorectal cancer and its treatment can bring about challenges associated with psychological distress. Objectives The primary aims of this study were to examine the feasibility and acceptability of a cognitive behavioral therapy (CBT)-based intervention to improve coping with the disease. The secondary aim is to evaluate preliminary intervention efficacy. Methods Patients with advanced colorectal cancer in Singapore (N = 60) were randomized to either receive a four-session CBT intervention immediately or be waitlisted. Intervention feasibility (i.e., recruitment and intervention adherence) and acceptability (i.e., participant satisfaction and cultural sensitivity) were assessed. Changes in psychological distress and self-efficacy were examined. Results The study successfully recruited the intended sample (mean age 61; 62% men). A proportion (12%) reported Hospital Anxiety and Depression Scale scores indicative of distress at baseline. Most (88%) completed all sessions. Participants reported high rates of satisfaction (97%), helpfulness (96%), and cultural sensitivity (95%) of the intervention. The intervention group did not show decrease in psychological distress; however, self-efficacy in cancer-related coping (information seeking: effect size [ES] = 0.64; 95% CI = 0.17, 0.85; coping with side effects: ES = 0.69; 95% CI = 0.33, 0.82; and maintaining positive attitude: ES = 0.45; 95% CI = 0.19, 0.79) increased in the intervention group compared with the waitlisted group. Conclusion The CBT-based intervention was feasible and acceptable to patients in Singapore. There is no sufficient evidence to warrant a larger trial in this sample with low baseline distress. Future work should identify and target those who are most in need of support.

Objective: Malaysia is only beginning to age in 2020, but is expected to do this at an unprecedented rate in the next two decades. We aim to develop a national curriculum for undergraduate geriatric medicine in Malaysia to ensure future doctors are adequately equipped to address the healthcare needs of our older population. Method: The draft curriculum was developed by the Malaysian Society of Geriatric Medicine through literature review and mapping to the Malaysian Accreditation Guidelines for Undergraduate Medical Programme 2015. The curriculum was then refined through a modified Delphi process which involved 15 expert panel members each from Malaysia, Australia and the United Kingdom. Results: A total of three Delphi rounds were conducted. Five out of seven invited panellists agreed to participate in the first Delphi round. A larger group was invited via e-mail and fifteen panellists agreed to participate in Delphi rounds two and three, which resulted in 75 and 15 comments respectively. The final document with 34 learning outcomes was accepted with 80% agreement and consisted of detailed objectives grouped under 10 overarching core topics. Conclusion: Following consensus agreement determined through a Delphi process, a Malaysian undergraduate curriculum for geriatric medicine, aligned with the Malaysian Accreditation Guidelines, has been developed and will be shared with the 32 medical colleges in Malaysia to determine the current level of, and barriers to delivery.

To palliate suffering, understanding the circumstances leading to suffering and its amelioration could be helpful. Our study aimed to explore contributing and relieving factors of suffering in palliative care. Adult palliative care stage III or IV cancer in-patients were recruited from University of Malaya Medical Centre. Participants recorded their overall suffering score from 0 to 10 three times daily, followed by descriptions of their contributing and relieving factors. Factors of suffering were thematically analysed with NVIVO. Descriptive data were analysed with SPSS. 108 patients participated. The most common contributing factor of suffering was health factor (96.3%), followed by healthcare factor (78.7%), psychological factor (63.0%) and community factor (20.4%). The most common relieving factor was health factor (88.9%), followed by psychological factor (78.7%), community factor (75.9%) and healthcare factor (70.4%). Self-reported assessment of suffering offers a rapid approach to detect bothering issues that require immediate attention and further in-depth exploration.

BackgroundThe ageing skin is more susceptible to pruritic dermatoses, which are associated with adverse psychosocial effects and reduced quality of life among older adults. This cross-sectional study aimed to identify the burden of pruritus and factors associated with its presence and severity among older adults recruited to the Malaysian Elders Longitudinal Research study.MethodsSeven hundred seventy individuals aged 55 years (lower age limit) and above were interviewed as to whether they experienced pruritus during the preceding week and the locations involved if present. The association between generalised pruritus, sleep quality, and major systemic risk factors were explored.Results5.97% of respondents reported generalised pruritus. Generalised pruritus was associated with poorer sleep quality, with Pittsburgh Sleep Quality Index score above 6. Mean haemoglobin level was lower in subjects with generalised pruritus (13.14 g/dL) but there was no significant difference in the frequency of generalised pruritus and severe generalized pruritus between subjects with clinically defined anaemia. Also, there were no significant associations between other major systemic risk factors and generalised pruritus in this population-based study. There was no association between generalised pruritus with depression, anxiety or stress.ConclusionThe negative effect of pruritus on sleep quality suggests a possible deleterious effect of pruritus on health and quality of life. Further prospective research on the longer-term effects of pruritus on health status is now warranted.(222 words)

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.

Background Age is an established risk factor for poor outcomes in individuals with influenza‐related illness, and data on its influence on clinical presentations and outcomes in the South‐East Asian settings are scarce. The aim of this study was to determine the above among adults with influenza‐related upper respiratory tract infection at a teaching hospital in Malaysia. Methods A retrospective case‐note analysis was conducted on a cohort of 3935 patients attending primary care at the University Malaya Medical Centre, Malaysia from February 2012 till May 2014 with URTI symptoms. Demographics, clinical characteristics, medical and vaccination history were obtained from electronic medical records, and mortality data from the National Registration Department. Comparisons were made between those aged

Maintaining healthy blood glucose (BG) levels is vital in ensuring the health of intensive care unit patients. In present work, there exists model-based glycemic control protocols that capture insulin-glucose dynamics that can provide patient-specific treatments. The Stochastic Targeted Glycemic Control (STAR) protocol is a model-based glycemic control protocol that utilizes stochastic modelling together with the Intensive Control Insulin Glycemic Control (ICING) model. STAR has shown its effectiveness in Christchurch and Hungary. However, it is currently less effective in Malaysia. A study is conducted to compare the stochastic model between the STAR original and Malaysian cohort to identify if the difference in effectiveness is due to a difference in stochastic insulin sensitivity (SI) models between cohorts. Results from this study show that there could be a difference of up to 49.4% in predictive ability of the stochastic models from the two cohorts, suggesting that it could play a role in being the cause for its lack in effectiveness. With further patient data collection, this hypothesis could be proven or otherwise eliminated from the possible causes for the lack of effectiveness of the STAR protocol in Malaysia.

Sensory data such as bending curvature and contact force are essential for controlling soft robots. However, it is inconvenient to measure these variables because sensorizing soft robots is difficult due to their inherent softness. An attractive alternative is to use an observer/filter to estimate the variables that would have been measured by those sensors. Nevertheless, an observer/filter requires a model which can be analytically demanding for soft robots due to their high nonlinearity. In this paper, we propose an Unknown Input Extended Kalman Filter (UI-EKF) consisting of an EKF interconnected with a UI-optimizer to respectively estimate the state (curvature) and unknown input (contact force) for a pneumatic-based soft finger based on an identified nonlinear model. We also prove analytically that the estimation errors are bounded. Experimental results show that the UI-EKF can perform the estimation with high accuracy, even when the identified system model is not accurate and the sensor measurement is noisy. In other words, the proposed framework is able to estimate proprioceptive (internal) and exteroceptive (external) variables (curvature and contact force respectively) of the robot using a single sensor (flex), which is still an open problem in soft robotics.

Several studies have been suggested that immunity plays a part in neurodevelopment and schizophrenia pathogenesis. Early age of onset in schizophrenia is associated with genetic factors which affect neurodevelopment. This study aims to identify immune abnormalities associated with neurodevelopmental impairments in early-onset schizophrenia (EOS) and adult-onset schizophrenia (AOS) patients. We determined the plasma levels of six cytokines (IL-1β, IL-4, IL-6, IL-10, IL-12 and TNF-α) in schizophrenia patients and healthy controls. Measurements included neurological soft signs (NSS) to distinguish and subgroup those with neurodevelopmental impairments. The study included 210 schizophrenia patients, which were divided into 84 EOS and 126 AOS patients, as well as 122 healthy controls. We observed significant differences in levels of IL-4, IL-6 and IL-10 between EOS and AOS patients. The results demonstrated the area under ROC curve (AUC) of the IL-4 in EOS and healthy controls was 0.81. Moreover, these results indicated that AUC of the IL-4 and the combination of IL-4, IL-6 and IL-12 in EOS with NSS and healthy controls were 0.91 and 0.95. These cytokines are altered in EOS and schizophrenia patients with neurodevelopmental impairments and demonstrated good classification abilities. These findings manifested that both pro- and anti-inflammatory cytokines are contributed to the clinical and pathophysiological features of schizophrenia. Future works are expected to explore potential genetic effectors and predictors as well as therapeutic directions in personalized medicine for early-onset schizophrenia.

Mechanical ventilator (MV) is a vital life support machine for respiratory failure patients in Intensive Care Unit (ICU). Critical and beneficial information on patient’s breathing pattern can be obtained from the ventilator for research studies in a form of ventilator waveform data (VWD). However, imperfect data collection system and lack of Electronic Health Record system integration has deterred the study of VWD to improve patient’s treatment. Furthermore, data acquisition of VWD is not easily accessible and cost-prohibitive to deploy. Therefore, current studies are limited to small samples of breathing cycle, despite continuously changing patient’s respiratory state during the day. Hence, this proposed system allows constant monitoring of patient’s ventilation data and real-time VWD visualization on mobile devices. This system consists of a data acquisition device (DAQ) to acquire VWD and a mobile web application to display patient’s breathing condition in real time. In addition, the collected VWD data are stored securely in network attached storage and onto cloud storage to prevent data loss. This framework has been successfully tested with MV attached with test lung. This proposed system can potentially expedite research studies by providing a better data collection and management specifically in the clinical environment.

Objective: We aimed to examine the bidirectional associations between specific executive function (EF) and physical function (PF) subdomains among older adults. Methods: A systematic literature search (MEDLINE, EMBASE, PsycINFO, EBSCOHOST, Scopus and EmCare) was undertaken from February 2018 to May 2020. Observational studies measuring associations between EF and PF subdomains among older adults were included. Results: Twenty-nine studies met the inclusion criteria. Twenty-seven studies reported associations between EF and PF. There were bidirectional associations between slower processing speed and slower gait speed; slower processing speed and lower muscle strength; and lower verbal fluency and slower gait speed. Lower muscle strength was unilaterally associated with lower working memory. Conclusions: We found consistent bidirectional associations between processing speed with gait speed and muscle strength, and verbal fluency and gait speed.There was a unidirectional association between muscle strength and working memory. Common causal mechanisms for EF and PF require further studies. Refereed/Peer-reviewed

Introduction Patient safety, such as inpatient falls, is a global problem, accounting for increasing compensation costs from our healthcare facilities. The aim of this study was to evaluate the patient safety culture among healthcare providers. Method An online survey was developed within the hospital staff portal at the University of Malaya Medical Centre, with a dialogue box appearing on the launching of the portal website inviting the members of staff to participate in the survey. The survey contained a safety assessment questionnaire (SAQ) which measures the patient safety culture. The SAQ consists of 36 items measuring the six domains: teamwork climate, job satisfaction, safety climate, stress recognition, working conditions, and perception of management. Each domain is assigned a percentage score, and comparisons of scores according to healthcare disciplines were then made. Results 5275 (80%) responded to the online SAQ which was sent out to all 6562 healthcare professionals employed, by the hospital. The teamwork and safety climate was poor among supporting staff, with scores of 56.7 and 59.8 respectively. Job satisfaction (62.9), perception of ward management (56.8), and hospital management (53.2), and working conditions (44.7) were less among the clinicians. Stress recognition (36.5) was in alarmingly low among the nurses. Conclusion A comprehensive unit-based safety programme will be conducted in response to the SAQ findings, and should incorporate objective falls the outcome in order to convince the hospital hierarchy of the need for urgent solutions to lower the rates of inpatient falls.

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 One in three older adults fall each year leading to increased disability, hospitalizations and mortality. Recent studies suggested an increased risk of falls among obese individuals which may correlate with increased rates of falls hospitalizations. However, there is not much information supporting the hypothesis that obesity may influence the risk of falls related hospitalizations. Aims To prospectively investigate whether body mass index (BMI) is a predictor for falls hospitalization by age group in the population of the EPIC-Norfolk Study. Methods Body height and weight were measured at baseline and BMI calculated. Falls hospitalization status over 20 years’ follow-up was ascertained using data linkage with centralized NHS records. Participants were categorized into the four BMI groups: underweight (BMI Results Data from 25636 individuals, (54.7%) women and (45.3%) men, mean age 59.2 ± 9.3 years, were included. For individuals within the under 55-year age group at baseline, individuals who were overweight (HR = 1.25; 95% CI= 1.01-1.56) and obese (HR = 1.54; 95% CI= 1.17-1.81) were at higher risk of falls hospitalization compared with those with normal BMI. As for individuals aged ≥ 65 years at recruitment, individuals who were obese were less likely to be hospitalized after a fall (HR = 0.85; 95% CI= 0.74 – 0.97) compared to those with normal BMI. Conclusions The relationship between obesity and falls hospitalization over 20 years differed between those aged

Introduction An ageing society in this period of technological development may benefit from having service robots assist them in daily tasks. To that end, service robots that are equipped with soft grippers have the potential to handle the unstructured nature of objects such as eye-glasses and cutlery at homes. Drawing from Technology Acceptance Model, this paper aims to analyse technology adoption of a “soft service robot” for object retrieval tasks among older adults. Method A video demonstrating the operational functions of an in-house developed soft service robot was shown to 30 participants aged 60 and above. The video shows that the soft service robot can be remotely controlled through the internet to move around and pick up various household objects delicately. The soft service robot also enables users to interact with another individual through an integrated tablet. Thirty participants completed a survey measuring perceived ease of use, perceived usefulness, attitude towards the soft service robot and behavioural intention using seven-point Likert scales. Multiple regression analysis was performed to test the hypothesized model. Results Our study showed that the behavioral intention of older adults was jointly determined by the perceived usefulness (β=0.401; p-value< 0.01) and the attitude of the older adults towards the soft service robot (β=0.530; p-value0.05) in the model. Conclusion Our findings indicated that making a soft service robot easier-to-use has little or no impact on the formation of intentions. Essentially, a soft service robot that is perceived to be useful will be accepted by older adults. From a practical standpoint, it is of significant importance for service robotics designer and developers to build soft service robot with useful functions to enhance greater adoption of such technology among older adults.

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.

Introduction Older adults may remove themselves voluntarily from social activities due to health concerns and physical limitations that leads to loneliness. Additionally, loneliness is associated with poorer health among older adults. Therefore, this study aims to improve health status among community-dwelling older adults in the sub-urban area through this social participation project by creating awareness on empowering the older adults in managing their health and social life. Methods This is a community-based participatory research (CBPR) applying both quantitative and qualitative approaches. Quantitative data was obtained with a standardized data collection document and obtained during a series of health screening programs. The data was analyzed using descriptive statistics. Key results 87 older adults participated in two health screening events. The mean age was 66 ± 6.5 (SD) years, median BMI was 26.5 (IQR=6.4), mean systolic blood pressure was 141 ± 14.6 (SD) mmHg, median diastolic blood pressure was 78 (IQR=10) mmHg, median timed up and go was 10 (IQR=3) seconds, median trail-making test A was 45.8 (IQR=24.4) seconds, median trail-making test B was 115.8 (IQR=99.3) seconds. The mean hand grip strength for male was 30.76 ± 5.1 (SD) kg for right hand and 31.87 ± 24.5 (SD) kg for left hand. The mean hand grip strength for female was 18.40 ± 5.1 (SD) kg for right hand and 17.14 ± 5.0 (SD) kg for left hand. Discussion The results may represent a portion of community-dwelling older adults who are actively engage in community activities such as religious classes, weddings or events. Therefore, the results showed normal values for all physical and mental tests. However, 61% of the participants were overweight or obese and had higher mean systolic blood pressure suggesting the need for more education and awareness on health management.

Introduction While mild cognitive impairment (MCI) is a risk factor for falls in older adults, the effects of MCI on physical performance associated with MCI have not been adequately characterised. The aim of the study was to profile physical performance patterns associated with MCI. Methodology 53 older fallers (31 females, 22 males) from the Falls Clinic at Universiti Malaya Medical Centre, aged 60 years and above (76.5±6.6) were screened and categorised into 2 groups – with MCI and non-MCI – using a Visual Cognitive Assessment Test (VCAT) cut-off score of ≥23. Participants’ sociodemographic data were recorded. Participants performed the Senior Fitness Test that consisted of a battery of physical performance tests. Results Older fallers with MCI (n=26) had significantly (p0.05) differences for the 30-second chair stand, chair sit-and-reach and back scratch tests. Conclusion Older fallers with MCI had poorer upper body muscle strength, balance and aerobic endurance compared to those with normal cognition. However, flexibility and lower body muscle strength were similar in older fallers with and without MCI. Further studies to evaluate specifically tailored interventions according to the pattern of physical impairment reported with MCI are needed.

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.

Introduction Recent studies identified a relationship between gait difficulties and risk of developing dementia, a condition now termed motoric cognitive risk. We interrogated a clinical dataset to determine the relationship between cognitive assessment scores and physical performance scores to identify the strength of association between these two types of measures. Methods Consecutive patients referred to the falls and syncope service and the University of Malaya Medical Centre were recruited. The cognitive function of consenting individuals was assessed using the Montreal Cognitive Assessment (MoCA) and Visual Cognitive Assessment Tool (VCAT). Physical performance was assessed using hand grip strength (HGS), timed-up-and-go (TUG) and functional reach (FR). Results One hundred and forty-seven individuals, mean age (standard deviation,SD)=76.1 (7.8) years, 85 (58%) women were included. The mean (SD) for right and left HGS, FR and TUG scores for the overall population were 19.1 (7.0)kg, 19.0 (12.1)kg, 28.9 (39.7)cm, TUG 19.2 (11.0)s respectively. The mean MoCA and VCAT scores were 21.1 (7.1) and 20.3 (6.3) respectively. Right HGS correlated moderately with MoCA (r=0.367) and VCAT scores (r=0.397). Left HGS had a weak to moderate correlation with MoCA (r=0.281) and VCAT (0.271). FR, however, was not correlated with either MoCA (r=0.073) and VCAT (0.020). TUG scores were moderately negatively correlated with MoCA (-0.3206) but weakly correlated with VCAT (-0.175) Conclusion Our evaluation of the relationship between cognitive scores and physical performance in a falls and syncope clinic setting found that a relationship exists between muscle strength measured with grip strength and composite assessment of gait and balance using the TUG. Dynamic balance measured with functional reach, however, was not associated with cognitive function. Future studies will need to identify the possible mechanisms linking cognitive function with strength and gait in order to establish cognitive function as a modifiable risk factor for falls in older adults.

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.

Background The drugs prescribed for hypertension, hyperglycaemia, and mental disorders affects patients’ mental and postural stability, and ends up in fall related incidents in over 60% cases. Hence, a study was aimed to review the drugs prescribed in older patients with at-least one episode of fall incidents. Method A retrospective study was carried out at a 1000 bedded teaching hospital using electronic big data system to record patients’ information. Results Out of 135 patients who had fall incident(s) during the study period, 69 were male and 66 were female. Majority (n=77; 57%) of the patients were older than 60 years of age and have had at least one co-morbid conditions. Most of the fall incidents have occurred during their inpatient period and at the time of using toilets (67%) and at bedside (22%). Around 42% of the fall incidents were moderate to severe and sadly one patient died due to large subdural hematoma and intra-parenchymal bleeding secondary to fall. Corticosteroids (36%), diuretics (27%), antihypertensives (26%), antidiabetics (25%) and other class of drugs (45%) were commonly prescribed in the patients; and these drugs were given either alone or in combination with other drugs. These drugs have high impact on fall incidents as it may lower the blood volume, blood pressure and blood sugar; it may in turn cause postural instability. Most of the fall incidents where noticed in patients who had diuretics plus antihypertensives (26%), antihypertensives plus antidiabetics (22%), antihypertensives plus antidiabetics plus antihyperlipidemic agents (18%) and corticosteroids (15%) concurrently and at irregular dosing interval. Conclusion Regular monitoring of prescription drugs and its complications are of at most important to prevent future fall related incidents. Hence, an efficient and continuous medication review is warranted in an emergency basis to make the drugs safer to the patients.

Introduction Falls is a global issue due to its devastating consequences and costs associated with fall injuries in older adults. There is limited information regarding knowledge and perceptions about falls among older individuals in Malaysia. The aim of this study was to assess knowledge and perceptions of falls among older adults. Methods A total of twenty-five (n=25) community dwelling older adults were invited to participate in this study (age range 61-83, median=73). Focus group discussions were conducted to explore older adults’ perceptions on falls, while the Fall Risk Assessment Questionnaire (FRAQ) was used to assess their knowledge on falls. Results Three themes emerged from the qualitative data, which were ‘Ageing and its association with falls’, ‘Reactions to a fall’ and ‘Knowledge of fall interventions’. The quantitative results showed that more than half of the participants considered themselves at the risk of falls (n=15, 60%). Older adults had better knowledge on behavioral and environmental (percentage of errors: 19.4%; 35.2%) compared to medical and medication related fall risk factors (percentage of errors: 55.2%; 57.33%). Discussion Older adults had both positive and negative views on ageing and falls. Some of the fall prevention strategies highlighted were in line with evidence-based recommendations. However, majority exhibit fall prevention behaviors that were largely based on their personal experiences. Older adults lacked the knowledge on medical related fall risk factors as these require understanding of various medical conditions and the related medications. Conclusion Education intervention emphasizing on ageing, medical and medication related fall risk factors should now be evaluated.

Objective: The aim of this review was to determine the contents and parameters of self‐management education programs (SMEPs) for older adults with knee osteoarthritis (KOA). Methods: A systematic electronic literature search (Scopus, MEDLINE, ProQuest, CINAHL, Cochrane and a grey literature specific site through Google Scholar) was undertaken between March and May 2018 (search updated in June 2019). Studies were selected based on predetermined criteria. Data relating to the contents and parameters of the SMEP were extracted and collated. Results: A total of 11 experimental studies met the inclusion criteria. Overall quality of the selected studies was good. The contents used for SMEP in older adults with KOA were information and management of KOA, healthy lifestyle and additional management strategies for KOA. The parameters used were face‐to‐face sessions led by health professionals and were chiefly group‐based. Conclusion: This review comprehensively summarises the structure of multifaceted SMEP for people with KOA, which could be used to inform clinical practice and future research. Refereed/Peer-reviewed

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.

Aim The COVID-19 pandemic has disrupted the delivery of healthcare to vulnerable older adults, prompting the expansion of telemedicine usage. This study surveyed the acceptance of virtual medical consultations among older adults and caregivers within geriatric outpatient services in a tertiary hospital during the pandemic. Methods A cross-sectional survey was conducted among caregivers and patients attending geriatric outpatient services in Kuala Lumpur, Malaysia. The survey measured the availability of equipment for virtual consultations, prior knowledge and experience of telemedicine and willingness to consult geriatricians through virtual technology, using the Unified Theory of Acceptance and Use of Technology (UTAUT) scale. Results A total of 197 caregivers and 42 older patients with a mean age of 54.28(±13.22) and 75.62(±7.32) years respectively, completed the survey. 156(79.2%) of the caregivers were adult children accompanying patients. The mean UTAUT score was 65.97(±13.71) out of 90, with 66.64(±13.25) for caregivers and 62.79(±15.44) for older adults, suggesting a high acceptance of adopting virtual consultations in lieu of face-to-face care. The independent predictors of acceptance towards virtual consultation were: possession of an electronic device capable of video-communication, living with someone, living in a care home, weekly online banking usage and perceived familiarity with virtual platforms. Conclusion Caregivers and patients indicated a high level of acceptance of virtual medical consultations, which is likely facilitated by caregivers such as adult children or spouses at home or staff in care homes. To minimize the transmission of COVID-19 in a highly vulnerable group, virtual consultations are an acceptable alternative to face-to-face consultations for older people and their caregivers in our setting.

Introduction Older persons with diabetes are at an increased risk of falls leading to fractures, head injuries and disability. Objective To evaluate the potential relationship between falls and diabetes in older persons and identify differences in risk factors for falls among older persons with and without diabetes using the first wave dataset of the Malaysian Elders Longitudinal Research (MELoR) study. Methodology Community dwelling adults aged ≥ 55 years were selected through stratified random sampling from three parliamentary constituencies in greater Kuala Lumpur. Baseline data was obtained through computer-assisted, home-based interviews. Presence of falls was established by enquiring about falls in the preceding 12 months. Diabetes was defined as self-reported, physician-diagnosed diabetes, diabetes medication use and a HbA1c of ≥ 6.3%. Results Diabetes was present in 44.4% of the overall 1610 participants. The prevalence for fall among older diabetics was 25.6%. Recurrent falls (odds ratio (OR) 1.65; 95% confidence interval (CI) 1.06 - 2.57) was more common among diabetics. Following adjustment for potential confounders, osteoporosis (OR 2.58; 95% CI 1.31 - 5.08) and dizziness (OR 1.50; 95% CI 1.01 - 2.23) were independent risk factors for falls. Better instrumental activities of daily living scores were protective against falls (OR 0.75; 95% CI 0.58 - 0.97). Conclusion The presence of osteoporosis and dizziness was associated with increased risk of falls among older diabetics. These findings will need to be confirmed in future prospective follow-up of this cohort.

IntroductionOne of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which older people receive healthcare and all deprescribing interventions is warranted to enhance the current knowledge.Methods and analysisThis systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was performed in Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO (2 November 2020). We will also search in trial registers. We will include randomised controlled trials, in which any deprescribing intervention is compared with usual care and reports falls as an outcome. Both title and abstract screening and full-text screening will be done by two reviewers. The Cochrane Collaboration revised tool of Risk of Bias will be applied to perform risk of bias assessment. We will categorise the results separately for every setting. If a group of sufficiently comparable studies will be identified, we will perform a meta-analysis applying random effects model. We will investigate heterogeneity using a combination of visual inspection of the forest plot along with consideration of the χ2 test and the I2 statistic results. We have prespecified several subgroup and sensitivity analyses.Ethics and disseminationEthics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Furthermore, this systematic review will inform the recommendations of working group of polypharmacy and FRIDs of the anticipated World’s Falls Guidelines.PROSPERO registration numberCRD42020218231.

Few studies to date have evaluated dementia care in Malaysia, and the focus of studies has primarily been on epidemiological and laboratory research. In this study, we aimed to identify potential challenges for the delivery of dementia care in Malaysia and priorities for research and enhancing existing dementia care. This study used thematic analysis to evaluate the open and focus group workshop discussions guided by semi-structured questions. Triangulation of the collected data (sticky notes, collated field notes, and transcripts of discussions) was achieved through stakeholder consensus agreement during a workshop held in 2017. Five main themes as priorities for dementia care were identified: (1) availability of a valued multi-disciplinary care service, (2) accessibility of training to provide awareness, (3) the functionality of the governance in establishing regulation and policy to empower care services, (4) perceived availability and accessibility of research data, and (5) influence of cultural uniqueness. The findings of this study seek to enhance existing dementia care in Malaysia but have potential application for other low and middle-income countries with a similar social and health care set up. The constructed relationship between themes also tries to tackle the challenges in a more efficient and effective manner, as none of these aforementioned issues are standalone challenges. In addition, we demonstrated how a carefully constructed workshop with defined aims and objectives can provide a useful analysis tool to evaluate health and social care challenges in a multidisciplinary forum.

Background falls and fall-related injuries are common in older adults, have negative effects both on quality of life and functional independence and are associated with increased morbidity, mortality and health care costs. Current clinical approaches and advice from falls guidelines vary substantially between countries and settings, warranting a standardised approach. At the first World Congress on Falls and Postural Instability in Kuala Lumpur, Malaysia, in December 2019, a worldwide task force of experts in falls in older adults, committed to achieving a global consensus on updating clinical practice guidelines for falls prevention and management by incorporating current and emerging evidence in falls research. Moreover, the importance of taking a person-centred approach and including perspectives from patients, caregivers and other stakeholders was recognised as important components of this endeavour. Finally, the need to specifically include recent developments in e-health was acknowledged, as well as the importance of addressing differences between settings and including developing countries. Methods a steering committee was assembled and 10 working Groups were created to provide preliminary evidence-based recommendations. A cross-cutting theme on patient’s perspective was also created. In addition, a worldwide multidisciplinary group of experts and stakeholders, to review the proposed recommendations and to participate in a Delphi process to achieve consensus for the final recommendations, was brought together. Conclusion in this New Horizons article, the global challenges in falls prevention are depicted, the goals of the worldwide task force are summarised and the conceptual framework for development of a global falls prevention and management guideline is presented.

Urinary Incontinence (UI) negatively impact women’s physical, psychological and health-related quality of life. Pelvic strengthening exercise is the first line management in UI. We hypothesized that Hyacinth exercise is better than Pelvic Floor Exercise (PFE) in strengthening pelvic floor muscles, thus reducing female urinary incontinence. This randomized controlled trial involved 180 women with UI. Participants were taught on either Hyacinth exercise or PFE alone. Improvement in urinary symptoms and pelvic muscle strength were evaluated using a validated female pelvic floor questionnaire and objectively measured at 2 months and 6 months. Significant improvement in urinary symptoms and pelvic muscle strength post treatment at 2 months and 6 months was seen in both groups with p≤0.001. Although earlier improvement seen in Hyacinth group, it did not reach level of significant when compared, between the two exercises. Mean bladder score (PFE vs Hyacinth arm) 9.13±6.54 vs. 8.74±5.21, p=0.93 (2 months) and 5.80±4.15 vs. 5.79±4.22, p=0.92 (6 months). Although there was no statistical difference between the two groups for our primary and secondary outcomes, Hyacinth group demonstrated earlier improvement in urinary symptoms at 2 months.