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Abstract Background Cognitive frailty (CF) is an emerging concern among older persons, particularly within lower socioeconomic statuses (SES) populations. Currently, there is limited evidence on the potential reversibility of CF through multi-domain interventions within this demographic. This study aimed to investigate the effectiveness of the WE-RISE™ multi-domain intervention in addressing the potential reversibility of CF among community-dwelling older persons of lower SES, the intervention effects on multiple health dimensions, and to determine if WE-RISE™ is of low cost. Methods This 24-week randomised controlled trial included 55 community-dwelling older persons of lower SES with CF, who were randomised into either the WE-RISE™ intervention group (n = 27), or the control group receiving usual care (n = 28). The WE-RISE™ intervention comprised of 12 weeks of instructor led, community-based intervention, followed by 12 weeks of WE-RISE™@Home. CF status, cognitive and physical function, nutrition, disability, health-related quality of life, exercise self-efficacy and depression were assessed at baseline, 12th and 24th weeks. Changes in CF status was analysed descriptively, while intervention effects were analyzed with split plot ANOVA. The cost of the WE-RISE™ intervention was calculated using activity-based costing. Results At baseline, all participants in both the intervention and control groups (100%) were classified as CF. Following 12 weeks of the WE-RISE™ intervention, 74.1% of participants in the experimental group no longer met the criteria for cognitive frailty, with 63% maintaining this improvement at 24 weeks. In contrast, the CF status of participants in the control group remained largely unchanged, with only 10.7% showing improvement at 12 weeks and falling to 3.6% at 24 weeks. Significant intervention effects were observed for cognition, physical function, body composition, disability, health-related quality of life and self-perceived exercise self-efficacy (p

Abstract Background Cognitive frailty is a dual geriatric syndrome that is preventable with lifestyle changes. Lifestyle changes are influenced by literacy level. However, the association between limited health literacy (HL) and cognitive frailty (CF) is yet to be discovered. Objectives This study aims to determine the association between HL and CF among older adults. Methods Data was collected between April 2021 to March 2022 in this cross-sectional study. Citizens aged 60 years and older who can understand Malay and English were selected through purposive sampling from the AGELESS Trial screening sample frame. HLS-M-Q18 was administered to determine HL and CDR, and Fried’s Criteria were used to assess the CF status. Results A total of 757 participants were included in the analysis. 68.2% of the total participants had a limited HL level. The prevalence of CF among older adults with limited HL was 48.2% as compared to those with adequate HL (28.2%) (p

Objective: This study delves into the intriguing connection between knee osteoarthritis and diabetes in Malaysia. Specifically, the exacerbation of knee osteoarthritis in the presence of diabetes in terms of symptoms, physical performance, physical activity, psychological status, social participation, and quality of life was discussed. Design: This cross-sectional study recruited adults aged 50 and above by convenient sampling and grouped them into: knee osteoarthritis-diabetes-, knee osteoarthritis+diabetes-, knee osteoarthritis-diabetes+, and knee osteoarthritis+diabetes+. Subjects/Patients: Of 436 recruited participants, 261 (59.8%) participants reported knee osteoarthritis. Methods: Handgrip strength, Timed Up and Go test, 6 Meter Walk Test, and 5 Times Sit to Stand Test were measured using standardized procedures. Six questionnaires were administered for the remaining parameters. Results: Across groups, there were significant differences: 6 Meter Walk Test (p = 0.024), Timed Up and Go test (p = 0.020), and 5 Times Sit to Stand Test (p

Abstract Objective In this study, we aimed to assess the synergistic effects of cognitive frailty (CF) and comorbidity on disability among older adults. Methods Out of the 1318 participants from the Malaysian Towards Useful Aging (TUA) study, only 400 were included in the five-year follow-up analysis. A comprehensive interview-based questionnaire covering socio-demographic information, health status, biochemical indices, cognitive and physical function, and psychosocial factors was administered. Binary logistic regression analysis was employed to estimate the independent and combined odd ratios (ORs). Measures such as the relative excess risk due to interaction (RERI), the attributable proportion of risk due to the interaction, and the synergy index were used to assess the interaction between CF and comorbidity. Results Participants with CF (24.1%) were more likely to report disability compared to those without CF (10.3%). Synergistic effects impacting disability were observed between CF and osteoarthritis (OA) (OR: 6.675, 95% CI: 1.057–42.158; RERI: 1.501, 95% CI: 1.400–1.570), CF and heart diseases (HD) (OR: 3.480, 95% CI: 1.378–8.786; RERI: 0.875, 95% CI: 0.831–0.919), CF and depressive symptoms (OR: 3.443, 95% CI: 1.065–11.126; RERI: 0.806, 95% CI: 0.753–0.859), and between CF and diabetes mellitus (DM) (OR: 2.904, 95% Confidence Interval (CI): 1.487–5.671; RERI: 0.607, 95% CI: 0.577–0.637). Conclusion These findings highlight the synergism between the co-existence of CF and comorbidity, including OA, HD, DM, and depressive symptoms, on disability in older adults. Screening, assessing, and managing comorbidities, especially OA, HD, DM and depressive symptoms, when managing older adults with CF are crucial for reducing the risk of or preventing the development of disability.

Purpose: To develop a brief screening tool consisting of twelve items that can be self-administered for rapid identification of older adults at risk of cognitive frailty (CF), named as Cognitive Frailty Screening Tool (CFST). Patients and methods: A total of 1318 community-dwelling individuals aged 60 years and above were selected and assessed for cognitive frailty using a set of neuropsychology batteries and physical function tests. A binary logistic regression (BLR) was used to identify predictors of CF to be used as items in the screening tool. A suitable cut-off point was developed using receiver operating characteristic analysis. Results: Twelve items were included in the screening tool, comprising of gender, education years, medical history, depressive symptoms and functional status as well as lifestyle activities. The area under the curve (AUC) was 0.817 (95 % CI:0.774–0.861), indicating an excellent discriminating power. The sensitivity and specificity for cut-off 7 were 80.8 % and 79.0 %, with an acceptable range of positive predictive value (PPV) (73.3 %) and negative predictive value (NPV) (85.2 %) for screening tools. Concurrent validity of CFST score with standard cognitive and frailty assessment tools shows a significant association with the total score of CFST with low to moderate correlation (p

Background: Despite the availability of various clinical practice guidelines (CPGs) offering evidence-based recommendations, there exists a global diversity in physiotherapy practices for managing patients with non-specific low back pain (NSLBP). In this review, we aim to critically appraise and map the current evidence regarding physiotherapy management for patients with NSLBP. Methods: A search strategy was formulated and searched in MEDLINE, Scopus, EBSCOhost, PEDro and Google Scholar between 2013 and 2023 in English. Critical appraisal was performed using International Centre for Allied Health Evidence (iCAHE) guideline checklist. Results: A total of 12 CPGs met the selection criteria were synthesised. Exercise therapy, physical activity and manual therapy were consistently recommended for patients with NSLBP across most guidelines, irrespective of symptom duration. Cognitive-behavioural therapy was frequently advised for those with chronic NSLBP. However, notable absences of recommendations for electrotherapy, mechanical traction, bed rest, and lumbar corsets in NSLBP management. Moreover, emerging treatments such as shock wave therapy and cognitive-functional therapy were not extensively addressed in the guidelines. Conclusion: Multimodal and active forms of physiotherapy management were predominantly recommended in most of the guidelines. However, there is a clear necessity for updated CPG that effectively integrate biopsychosocial approaches into the management of patients with NSLBP.

Objective This study explored the perceived benefits, barriers, and recommendations of telerehabilitation for musculoskeletal disorders among physiotherapists in Malaysia. Methods This study employed an exploratory qualitative methodology to gather the perceptions of government-employed physiotherapists in Malaysia regarding the benefits, barriers, and recommendations for telerehabilitation in treating musculoskeletal disorders. The researchers conducted semistructured focus group discussions (FGDs) via Google Meet, which were recorded, transcribed, and analyzed using thematic analysis. Results Five FGDs were conducted with 24 participants, 37.5% of whom had prior experience with telerehabilitation. The data analysis returned three main themes: (1) perceived benefits, (2) barriers, and (3) recommendations. Four subthemes were derived from perceived benefits: (1a) saving time and money, (1b) convenience, (1c) clients responsible for their treatment, and (1d) alternatives for infectious diseases. Perceived barriers revealed three subthemes: (2a) technology, (2b) organization, and (2c) personal barriers. Finally, participants provided recommendations for improving telerehabilitation services, including training programs to facilitate greater acceptance of this modality. Conclusion The findings of this study offer crucial insights into the evolving landscape of telerehabilitation in Malaysia. These findings revealed a greater prevalence of barriers to enablers among Malaysian physiotherapists, potentially influenced by varying experience levels. Despite the prevailing lack of experience among participants, this research underscores the significance of identifying barriers and enablers in implementing telerehabilitation with participants offering recommendations for integrating telerehabilitation into their practices. This study provides clear insights and a roadmap for stakeholders aiming to shape the future of telerehabilitation among physiotherapists in Malaysia.

Introduction: Cardiorespiratory fitness has an inverse relationship with cognitive impairment and frailty in older adults. Direct assessment of maximal oxygen consumption (VO2 max) is the gold standard to assess cardiorespiratory fitness. However, it is costly and requires a laboratory setting. Therefore, VO2 max estimation among older adults with cognitive frailty (CF) will allow the assessment of aerobic capacity, which is commonly overlooked due to the complexity of the test. Aim: This study aims to determine the use of one of three physical performance tests (2-minute step, 2-minute walk, and 1-minute sit to stand) to effectively estimate cardiorespiratory fitness among older adults with CF. Methods: In this cross-sectional study, community-dwelling individuals aged 60 years old and above in Klang Valley were screened for CF. The participants performed three physical performance tests (2-minute walk, 2-minute step, and 1-minute sit to stand) followed by treadmill-based maximal exercise testing on another day. Results: A total of 32 older adults with cognitive frailty (mean age; SD: 67.1;4.7 years) participated in this study. Nearly half of them had hypertension (43.5 %), hypercholesterolemia (43.5 %), and multimorbidity (47.8 %). Among the endurance tests performed, only the 2-minute walk test independently predicted VO2 max by sex-specific with men (R2 = 0.58, p = 0.03) and women (R2 = 0.34, p = 0.01). The 2-minute walk test had good agreement with VO2 max (ICC = 0.77, 95 % CI: −3.1–2.4). Conclusion: The 2-minute walk test is a valid tool for estimating cardiorespiratory fitness among older adults with CF. However, it should be further tested across a larger population.

Objective The research aimed to study digital divide by determining the usage of digital technology among older adults with cognitive frailty (CF) in Malaysia. Methods The dataset was obtained from the AGELESS trial screening phase conducted from October 2021 to March 2022, involving 476 community-dwelling Malaysian older adults (67.7 years old ± 6.1). Digital technology usage was assessed and CF was determined using Fried's criteria and Clinical Dementia Rating. A binary logistic regression was used to determine the sociodemographic factors associated with digital technology use among older adults with CF. Results The findings suggest a digital divide between older adults with CF and robust in Malaysia. CF individuals (72.1%) were less likely to utilise digital technology, mainly smartphone than robust older adults (89.6%). More than 70% of older people owned social media on their smartphones, namely, WhatsApp. The most frequent online activities in both groups were family interaction and obtaining current news. CF older adults were less likely to play games on their smart devices. Usage of digital technology was more common among male, younger age, attained formal education more than 6 years, had a higher monthly household income, and robust participants. Conclusions The usage of digital technology was inversely related to CF status. CF older adults were less likely to integrate digital technology into their daily living compared to robust even though they were familiar with it. The use of digital technology should be reinforced among female, advanced age, widowers/divorcees without formal education and those from lower- or middle-income statuses, and cognitively frail older people.

BackgroundWhile the potential of physical performance tests as screening tools for sarcopenia is evident, limited information on relevant reference values for sarcopenia detection. In this study, we aimed to establish the prospective relationship between physical performance tests, including time up and go (TUG), functional reach (FR), gait speed (GS), and hand grip strength (HGS) with five-year sarcopenia risk and to determine suitable cut-off values for screening activities.MethodThis was a prospective study utilizing data from the Malaysian Elders Longitudinal Research (MELoR) study, which involved community-dwelling older adults aged 55 years and above at recruitment. Baseline (2013–2015) and wave 3 (2019) data were analyzed. Sarcopenia risk was determined using the strength, assistance walking, rising from a chair, climbing stairs, and falls (SARC-F) tool, with SARC-F ≥ 4 indicating sarcopenia. Baseline physical performance test scores were dichotomized using ROC-determined cut-offs.ResultData were available from 774 participants with mean age of 68.13 (SD = 7.13) years, 56.7% women. Cut-offs values for reduced GS, TUG, FR, and HGS were: 11.5 s (74.2%; 57.2%),

Objective This scoping review aimed to identify the design and usability testing of a telerehabilitation (TR) system, and its characteristics and functionalities that are best-suited for rehabilitating adults with chronic diseases. Methods Searches were conducted in PubMed, EBSCO, Web of Science, and Cochrane library for studies published between January 2017 and December 2022. We followed the Joanna Briggs Institute guidelines and the framework by Arksey and O’Malley. Screening was undertaken by two reviewers, and data extraction was undertaken by the first author. Then, the data were further reviewed and discussed thoroughly with the team members. Results A total of 31 results were identified, with the core criteria of developing and testing a telerehabilitation system, including a mobile app for cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. All developed systems resulted from multidisciplinary teams and employed mixed-methods research. We proposed the “input-process-output” framework that identified phases of both system design and usability testing. Through system design, we reported the use of user-centered design, iterative design, users’ needs and characteristics, theory underpinning development, and the expert panel in 64%, 75%, 86%, 82%, and 71% of the studies, respectively. We recorded the application of moderated usability testing, unmoderated testing (1), and unmoderated testing (2) in 74%, 63%, and 15% of the studies, respectively. The identified design and testing activities produced a matured system, a high-fidelity prototype, and a released system in 81.5%, 15%, and 3.5%, respectively. Conclusion This review provides a framework for TR system design and testing for a wide range of chronic diseases that require prolonged management through remote monitoring using a mobile app. The identified “input-process-output” framework highlights the inputs, design, development, and improvement as components of the system design. It also identifies the “moderated-unmoderated” model for conducting usability testing. This review illustrates characteristics and functionalities of the TR systems and healthcare professional roles.

IntroductionAging is associated with physiological changes in multiple systems in the body and may impact the transportation choices of older adults. In this study, we examine the associations between biopsychosocial factors and the transportation choices of Malaysian older adults.MethodsOne hundred and nineteen (119) older adults, aged 60 and above, living in Klang Valley, Malaysia were recruited for this cross-sectional study. Participants were interviewed face-to-face to obtain sociodemographic data, health status (whether there were and, if yes, the number of comorbidities), outdoor mobility and transportation patterns, Instrumental Activity Daily Living (IADL) status and cognitive function. Participants’ physical performance (dominant handgrip strength, 10-m walk, and timed up and go tests), hearing threshold (pure tone audiometry), and vision function (visual acuity, contrast sensitivity) were measured. Transportation patterns of older adults were categorized into three groups, that is, flexible (using public transport and/or private vehicles), using only private vehicles and restricted (relying on others or walking).ResultsFurther information is needed to enable such older adults as older women, those with comorbidities and poorer functional status to access transportation, especially to meet their health care needs.DiscussionThe majority (51%) of participants were in the ‘using only private vehicles’ group, followed by the ‘flexibles’ (25%) and the ‘restricted’ (24%). Factors significantly associated with the restricted transportation group were: (a) being female (AdjOR 15.39, 95% CI 0.86–23.39, p

Introduction: Cardiovascular health contributes significantly to the incidence of cognitive impairment. Prior to conducting exercise-related intervention, it is crucial to explore cardiovascular health blood parameters that have been commonly used as guidance for the purpose of monitoring. Information on the effectiveness of exercise on cardiovascular-related biomarkers is lacking, especially among older adults with cognitive frailty. Therefore, we aimed to review existing evidence on cardiovascular-related blood parameters and their changes following exercise intervention among older adults with cognitive frailty.Methods: A systematic search was conducted on PubMed, Cochrane, and Scopus databases. Related studies involving only human and full text in either English or Malay language were selected. Types of impairment were limited to cognitive impairment, frailty, and cognitive frailty. Studies were restricted to randomized controlled trial and clinical trial design studies. For charting purposes, all variables were extracted and tabulated. Trends in types of parameters studied were explored.Results: A total of 607 articles were screened, and the final 16 were included in this review. Four cardiovascular-related blood parameter categories were extracted: inflammatory, glucose homeostasis, lipid profile, and hemostatic biomarkers. The common parameters monitored were IGF-1 and HbA1c, glucose, and insulin sensitivity in some studies. Out of the nine studies on inflammatory biomarkers, exercise interventions showed a reduction in pro-inflammatory markers, namely, IL-6, TNF-α, IL-15, leptin, and C-reactive protein and an increase in anti-inflammatory markers, namely, IFN-γ and IL-10. Similarly, in all eight studies, glucose homeostasis-related biomarkers had improved with exercise intervention. The lipid profile was tested in five studies, with four studies showing improvements with exercise intervention via a decrease in total cholesterol, triglycerides, and low-density lipoprotein and an increase in high-density lipoprotein. A decrease in pro-inflammatory biomarkers and an increase in anti-inflammatory biomarkers were demonstrated with multicomponent exercise, including aerobic exercise in six studies and aerobic exercise on its own in the remaining two studies. Meanwhile, four out of six studies that yielded improvements in glucose homeostasis biomarkers involved only aerobic exercise and the remaining two studies involved multicomponent with aerobic exercise.Conclusion: The most consistent blood parameters studied were glucose homeostasis and inflammatory biomarkers. These parameters have been shown to improve with multicomponent exercise programs, particularly with the inclusion of aerobic exercise.

Abstract Background Cognitive frailty, a combination of physical frailty and cognitive impairment, is associated with functional decline in older adults. However, there is limited information if cognitive frailty predicts the incidence of falls, injuries, and disability. In this study, we aimed to determine the ability of cognitive frailty in predicting the incidence of falls, injuries and disability among multi-ethnic older adults in Malaysia at 5 years follow-up. Methods In this prospective cohort study, a total of 400 participants aged 60 years and above were successfully followed up at 5 years. Participants’ socio-demographic, medical history, psycho-social, physical, cognitive and dietary intake information was obtained. Cognitive frailty was defined as comorbid physical frailty (> 1 Fried criteria) and mild cognitive impairment (Petersen criteria). Univariate analysis was performed for all variables, followed by hierarchical binary logistic regression (BLR) analysis to identify the ability of CF in predicting the incidence of falls, injuries, and disability. The significant value was set at p

Abstract Background Online learning is an attractive option for educators, especially as means of overcoming the challenges posed by the global pandemic. Although it is best to evaluate student readiness prior to commencement of an online course, to ensure successful development and delivery of student-centric teaching and learning strategies, readiness towards online learning among physiotherapy undergraduates is unknown. The main aim of this study was to examine physiotherapy undergraduates’ readiness towards online learning. Methods In this cross-sectional study, participants were selected through a combination of total population and convenience sampling. The Student Online Learning Readiness questionnaire was distributed among physiotherapy undergraduates from two public and two private universities in Malaysia to investigate their technical, social and communication competencies. Information about device characteristics were obtained to evaluate their equipment readiness. Descriptive and group comparisons were conducted using independent t-test, and analysis of variance with p 80% possessed smartphones and laptop) level of equipment readiness. Institution and gender had no significant effect on the level of readiness (p > 0.05). Year 1 and 2 had significantly higher levels of social competencies with instructor compared to final year physiotherapy undergraduates (p

Abstract Background Falls are one of the major causes of mortality and morbidity in older adults. However, despite adoption of prevention strategies, the number of falls in older adults has not declined. The aim of this study was to examine fall awareness behaviour and its associated factors among Malaysian community dwelling older adults. Methods A total of 144 community dwelling older adults (mean age of 70.69 ± 4.3 years) participated in this study. Physical performance were assessed using timed up and go (TUG), gait speed (GS), chair stand and hand grip tests. Fall Awareness Behaviour (FaB) and Fall Risk Assessment Questionnaires (FRAQ) were administered to assess behaviour and fall prevention knowledge respectively. Results Stepwise linear regression analysis showed that the practice of fall awareness behaviour (R2 = 0.256) was significantly associated with being male [95% C.I: 2.178 to 7.789, p

Abstract 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.

Falls is a common and debilitating condition among the older population, intensifying the need to educate older persons about falls. Technology advancement enables effective and efficient delivery of falls education to the older population. However, there is paucity of information on the perception of Malaysian older population on falls and their preferred website characteristics such as font size, design, layout, colour, navigation, and use of graphics or videos. Physiological changes in vision, cognition and psychomotor skills can affect how the older persons use the website. As Malaysia is a multicultural country, the needs of the website characteristics and falls perception of older persons may differ greatly. The aim of this study was to explore the perceptions of the older persons about falls and their desired website characteristics. Twenty-five community-living older persons (n = 25) of age 60 years and above were involved in the focus group discussions. NvivoTM software was used for data management and thematic analysis was undertaken. Emerging themes included 'Perceptions of falls in older persons', 'Actions taken when falls occurred', 'Perceived prevention strategies for falls' and 'End user requirements for falls educational website'. Falls were perceived as both an avoidable and a non-avoidable incident. Although the participants mentioned physical activity and home hazard modifications as strategies to prevent falls, they mainly discussed self-initiated precautionary approaches in falls prevention. Regarding desired website characteristics, the participants emphasized on easily readable text, appealing design, clear information, use of images/videos, and simple website navigation. Special requirements for colour selection and multi-language options were also raised. The delivery of falls education through website can be made possible by understanding the perception of older persons about falls and their requirements for the website. This is especially important as ethnic and cultural influences may play a role on their perceptions about falls and desired website characteristics.

BackgroundRecent falls prevention guidelines recommend early routine fall risk assessment among older persons. ObjectiveThe purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons. MethodsFallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively. ResultsThe findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P

Aim : The goal is to explore available evidence and provide greater clarity to what is described as psychosocial intervention to improve cognitive function among older population with MCI as well as identifying areas for future research. Methods : An electronic literature search of PubMed, Cochrane, Ebscohost, Medline, Scopus, and gray resource was conducted to find articles published in English language between 2010 and September 2020. This review focused on research undertaken using randomized clinical trials study design. We extracted information regarding the publication date, geographical location, study setting, intervention mechanism, type of cognitive measurement used, and outcome of the studies. References of this literature were also reviewed to ensure comprehensive search. Result : Out of 240 potential records found, a total of 27 articles were identified following the first round of screening and deletion of duplicates. Full-text article reviews and analysis in the second round of screening narrowed the selection down to four articles. Another three relevant articles obtained from references were also included making a total of seven articles in the final analysis. Findings : Psychosocial intervention strategies for improvement of cognitive function, done in various setting all over the globe, covered a range of approaches including art therapy, visual art therapy, therapeutic writing therapy, reminiscence activity, and cognitive behavioral approach. Most were conducted in weekly basis within 1-to-2-hour duration of session. Cognitive function of older adult in psychosocial intervention group was significantly improved in two studies. Three studies showed no significant improvement at all in the cognitive function, and another one reported success in improving cognitive function over time in the intervention group than in control group. One study did not describe the interaction effect. Different types of cognitive measurement also were used to quantify different domains of cognitive function in the reviewed studies. Conclusion : The idea of using psychosocial intervention for improving cognitive function has begun to increasingly accepted recently. Findings from the limited studies are encouraging, although the outcome of the cognitive function was mixed. Large-scale and longer duration of psychosocial intervention with bigger sample size is warranted for future studies.

Abstract Background Limited information is available from longitudinal studies regarding the predictors and incidence of MCI in older Asian adults. Thus, a community-based longitudinal study was conducted to determine the incidence of MCI among multi-ethnic older adults in Malaysia. The role of health and lifestyle as predictors of MCI was also examined. Methods Analysis of data obtained from the Towards Useful Aging (TUA) study (2014–2016), wave 1 (baseline) and wave 2 (1½ years of follow-up) was conducted. For the baseline, comprehensive, interview-based questionnaires were administered to 1227 subjects who were 60 years old and above. MCI is a unique transitional state between normal ageing and dementia. MCI characteristics include a decline and disturbance of cognition, minimal impairment of complex activities, ability to perform regular daily functions, and absence of dementia. The incidence of MCI was assessed using comprehensive neuropsychological batteries. The study then performed a logistic regression analysis to examine the effect of each possible predictor of MCI. This analysis began with univariate analyses and a separate review of the effect of every variable. Binary logistic analyses followed hereafter. Results During the follow-up after 1½ years, 179 (14.6%) of the participants who did not exhibit MCI at baseline were observed to have developed MCI. Among the participants who did not exhibit MCI at baseline, the incidence rate was 10.5 per 100 person-years. Male sex and lack of engagement in mental activities were predictors of MCI among participants without MCI at baseline. Conclusion After the 1½-year follow-up, the incidence rate for MCI was considerably high among the respondents. Being male and being less engaged in mental activities were predictors of the occurrence of MCI. Mental activities need to be promoted for the prevention of MCI incidence among older adults.

Abstract Background Poverty at old age is associated with poor dietary habit, nutritional status and higher rates of chronic diseases and psychosocial problems. However, there is limited information about this matter according to urban and rural settings. The aim of this study was to identify dietary, nutritional, physical and cognitive factors associated with poor socioeconomic status (SES) among older adults according to urban and rural settings in Malaysia. Methods An analysis was conducted among 2237 older adults who participated in a longitudinal study on aging (LRGS TUA). This study involved four states in Malaysia, with 49.4% from urban areas. Respondents were divided into three categories of SES based on percentile, stratified according to urban and rural settings. SES was measured using household income. Results The prevalence of low SES was higher among older adults in the rural area (50.6%) as compared to the urban area (49.4%). Factors associated with low SES among older adults in an urban setting were low dietary fibre intake (Adj OR:0.91),longer time for the Timed up and Go Test (Adj OR:1.09), greater disability (Adj OR:1.02), less frequent practice of caloric restriction (Adj OR:1.65), lower cognitive processing speed score (Adj OR:0.94) and lower protein intake (Adj OR:0.94). Whilst, among respondents from rural area, the factors associated with low SES were lack of dietary fibre intake (Adj OR:0.79), lower calf circumference (Adj OR: 0.91), lesser fresh fruits intake (Adj OR:0.91), greater disability (Adj OR:1.02) and having lower score in instrumental activities of daily living (Adj OR: 0.92). Conclusion Lower SES ismore prevalent in rural areas. Poor dietary intake, lower fitness and disability were common factors associated with low in SES, regardless of settings. Factors associated with low SES identifiedin both the urban and rural areas in our study may be useful inplanning strategies to combat low SES and its related problems among older adults.

Following the rapid increase of the aging population, health promotion and prevention of physical disability and dementia in older persons are essential for healthy aging. For example, there may be a potential to prevent or reverse cognitive frailty, the co-existence of both physical frailty and cognitive impairment in older persons. However, evidence-based interventions targeting the prevention or potential reversibility of cognitive frailty among community dwelling older adults are scarce. In this paper, we described the rationale, development and delivery of a multi-domain intervention comprising multi-component physical exercise prescription, cognitive training, dietary counseling and promotion of psychosocial support, called the WE-RISE trial. The aim of WE-RISE intervention is to potentially reverse cognitive frailty. This is a two-armed, single blinded, randomized controlled trial conducted over a duration of 6 months, at senior citizen activity centers within the Klang Valley, Malaysia. Ambulating, community dwelling older adults aged 60 years and above with cognitive frailty are randomized into two groups; (1) intervention group: which receives an instructor based “WE-RISE” intervention for the first 3 months, and then a home-based “WE-RISE at Home” intervention for the following 3 months; (2) control group: usual care with no modifications to their daily routine. Primary outcome is cognitive frailty status and secondary outcome include physical function, cognitive performance, nutritional status, psychosocial status and quality of life which are obtained during baseline screening and subsequent follow ups at 3rd and 6th month. Description of the intervention is done using the template for intervention description and replication (TIDieR) checklist. This trial protocol has received approval from Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2018-558) and the Department of Social Welfare Malaysia (MyResearch Reference: JKMM 100/12/5/2: 2018/405). Trial registration number: ACTRN12619001055190.

Knee osteoarthritis (KOA) is closely related with ageing, physical disability and functional dependency. The course of KOA is considered progressive and irreversible. Engagement with self-management may, however, minimize the impact of KOA. To be fully engaged with self-management activities, knowledge about KOA is a prerequisite. There is limited empirical data on older adults' understanding on KOA and their information needs about KOA. Therefore, the aims of this study were to explore older adults' knowledge about KOA and their perspectives on the information required to enable self-management. Three focus groups were conducted with 16 older adults with KOA. The sample consisted of three men and thirteen women with the mean age 73.2 years (range from 61 to 89). Thematic content analysis revealed two themes which were understanding about KOA and information needed about KOA. Participants' knowledge about KOA varied between individuals with many expressing that they needed more information about KOA. A targeted strategy is needed to educate older adults about KOA in order to support and prepare them for self-management.

BACKGROUND: Health Science graduates are increasingly in demand for improving and providing life services among the ageing population. Having substantial knowledge and positive attitude towards ageing will be a key step towards better care giving. However, to date there is limited published literature regarding knowledge and attitude towards ageing among health science students in Malaysia. The objective of our study was to assess knowledge and attitudes towards ageing among health science students. METHODOLOGY: A total of 786 (120 male, 666 female) health science undergraduates participated in this study. This cross-sectional study was conducted using Palmore’s Facts on Aging Quiz I (FAQ I) and Kogan’s Attitudes towards Older People (KAOP) to assess knowledge of ageing and attitudes towards older adults respectively. RESULTS: Majority of students in clinical (69.6%) and non-clinical programmes (65.6%) showed moderate knowledge towards ageing. More than two-third of students in clinical (77.2%) and non-clinical programs (75.8%) demonstrated a slightly positive attitude towards ageing. A significant moderate positive correlation (r=.308, p< 0.05) was found between knowledge of ageing and attitudes towards older adults. Clinical type of programme (t = -1.97, p

Background: Malaysia is experiencing an increase in the percentage of older people who have a higher life expectancy. However, information regarding the prevalence and risk factors of frailty is scarce for Malaysian older adults. The aim of this cross-sectional study is to determine the prevalence and risk factors of frailty among multi-ethnic community dwellings for older adults in Malaysia. Methods: A total of 473 older adults aged 60 years and above (210 men and 263 women) were randomly selected from 10 different areas in the Klang Valley of Malaysia. The respondents were screened at selected community centres; their frailty status was defined using Fried's criteria. Respondents were assessed for their physical functional status using selected parameters of a senior fitness test and other physical performance tests regarding their activities in daily life. Anthropometric measurements, cognitive function and symptoms of depression were also assessed for each respondent. Results: The prevalence of frailty was 8.9% and of pre-frailty was 61.7%, with women having a higher prevalence compared to men (p

This study aimed to investigate the impact of food insecurity and poor nutrient intake on the psychological health of middle-aged and older adults during the COVID-19 pandemic. A sub-sample of 535 individuals aged 52 years and above, from the earlier cohort and interventional studies (n = 4) from four selected states in Peninsular Malaysia, were recruited during the COVID-19 outbreak (April to June 2020). Telephone interviews were conducted by trained interviewers with a health sciences background to obtain participants’ information on health status, physical activity, food security, and psychological health (General Health Questionnaire-12; normal and psychological distress). Univariate analyses were performed for each variable, followed by a logistic regression analysis using SPSS Statistics version 25.0. Results revealed food insecurity (OR = 17.06, 95% CI: 8.24–35.32, p < 0.001), low protein (OR = 0.981, 95% CI: 0.965–0.998, p < 0.05), and fiber intakes (OR = 0.822, 95% CI: 0.695–0.972, p < 0.05) were found to be significant factors associated with the psychological distress group after adjusting for confounding factors. The findings suggested that food insecurity and insufficiencies of protein and fiber intakes heightened the psychological distress during the COVID-19 pandemic. Optimal nutrition is vital to ensure the physical and psychological health of the older population, specifically during the current pandemic.

Introduction: Dementia is pressing problem for family and society. Next generation health care providers which are current healthcare program students are important part of professional caregiving system in future. Particularly, having good knowledge and attitudes towards dementia will be key elements in providing best care for people with dementia. Aim: The aim of this paper is to review the literature of the knowledge and attitudes towards dementia among college and university students. Materials and Methods: Academic Search Complete, Psychology and Behavioural Sciences Collection, Medline Complete, SocINDEX with full text, Education Research Complete and ERIC databases from January 2010 to March 2017 were used to identify relevant papers for this review. Key words used in the search were "knowledge," or "attitude," or "perception," or "opinion," or "belief," and Dementia," or "Alzheimer's," and "students." The inclusion criteria were peerreviewed academic journals, English language, focussed on knowledge, attitude, perception, opinion or beliefs towards Dementia or Alzheimer's Disease (AD) and studies that include college and university students as study sample. Meanwhile, the exclusion criteria were papers published before January 2010, non-English language papers, topics not related to knowledge and attitude towards Dementia and the study sample does not represent college and university students. Results: A total of eighteen studies on knowledge and attitudes towards dementia among college and university students were found and reviewed. Ten of the studies (55.56%) were experimental intervention programmes while seven (38.89%) were questionnaire surveys. However, one paper did not report the study design. The intervention programmes which included clinical hands-on experience with dementia patients consistently improved students knowledge and attitudes towards people living with dementia. Current evidence shows that there is room for improvement in the curricular, particularly for courses related to clinical healthcare services. Conclusion: This review provides basis for future planning to improve the current curricular by addressing the gaps in knowledge, incorporating hands-on clinical experience as well as integrating interprofessional approaches into the teaching or training module.

The aim of this study was to establish 'Timed up and Go' test (TUG) normative data among community dwelling older adults stratified based on cognitive status, gender and age groups.A total of 2084 community dwelling older adults from wave I and II were recruited through a multistage random sampling method. TUG was performed using the standard protocol and scores were then stratified based on with and without mild cognitive impairment (MCI), gender and in a 5-year age groups ranging from ages of 60's to 80's.529(16%) participants were identified to have MCI. Past history of falls and medical history of hypertension, heart disease, joint pain, hearing and vision problem, and urinary incontinence were found to have influenced TUG performance. Cognitive status as a mediator, predicted TUG performance even when both gender and age were controlled for (B 0.24, 95% CI (0.02-0.47), β 0.03, t 2.10, p = 0.36). Further descriptive analysis showed, participants with MCI, women and older in age took a longer time to complete TUG, as compared to men with MCI across all age groups with exceptions for some age groups.These results suggested that MCI needs to be taken into consideration when testing older adults using TUG, besides age and gender factors. Data using fast speed TUG may be required among older adults with and without MCI for further understanding.

In this review, we aimed to identify the risk factors that may influence cognitive impairment among stroke survivors, namely, demographic, clinical, psychological, and physical determinants. A search from Medline, Scopus, and ISI Web of Science databases was conducted for papers published from year 2004 to 2015 related to risk factors of cognitive impairment among adult stroke survivors. A total of 1931 articles were retrieved, but only 27 articles met the criteria and were reviewed. In more than half of the articles it was found that demographical variables that include age, education level, and history of stroke were significant risk factors of cognitive impairment among stroke survivors. The review also indicated that diabetes mellitus, hypertension, types of stroke and affected region of brain, and stroke characteristics (e.g., size and location of infarctions) were clinical determinants that affected cognitive status. In addition, the presence of emotional disturbances mainly depressive symptoms showed significant effects on cognition. Independent relationships between cognition and functional impairment were also identified as determinants in a few studies. This review provided information on the possible risk factors of cognitive impairment in stroke survivors. This information may be beneficial in the prevention and management strategy of cognitive impairments among stroke survivors.