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Objectives To determine the longitudinal impact of elder financial and psychological abuse on risk of death among older Malaysians.Design 7-year prospective cohort study. Baseline data were collected in late 2013 and respondents were followed up in June 2020.Setting Kuala Pilah, Negeri Sembilan, Malaysia.Participants 1927 community-dwelling older adults aged 60 or older randomly sampled from the national census. Individuals with severe cognitive impairment were excluded.Outcome measure Mortality data were provided by the Malaysian National Registration Department and linked to respondents’ national identification numbers. Kaplan-Meier curves and Cox regression were used to examine victims’ survival periods and the impact of abuse on risk of death.Results Overall, 450 respondents (23.4%) died after 7 years. Among financial and psychological abuse victims, death percentage was 25.8% compared with 23.3% among those who did not experience these types of abuse. Kaplan-Meier curves showed shorter survival among abuse victims, but Cox regression found no significant impact of financial and psychological abuse on mortality risk (HR 1.05, 95% CI 0.78 to 1.41). Among all the variables studied, only cognitive impairment led to higher mortality risk (HR 1.32, 95% CI 1.03 to 1.69).Conclusion Our findings contradict prior empirical studies that supported the link between elder abuse and neglect (EAN) and mortality, even though we focused on two abuse subtypes. Results in this study are more in line with the recently emerging evidence that showed no association between EAN and mortality.

ObjectivesChildhood adversity has been linked with later victimization of young and middle-aged adults, but few studies have shown persistence of this effect among elders, especially outside of North America. This research examined the association between adverse childhood experiences (ACEs) and elder abuse among older adults aged 60 years and over in Malaysia.DesignCross sectional data were collected via face-to-face interview from June to August 2019.SettingEight government community health clinics in Kuala Pilah, a district in Negeri Sembilan state approximately 100km from Malaysian capital city Kuala Lumpur.ParticipantsOlder adults aged 60 years and above (N = 1984; Mean age 69.2, range 60-93 years) attending all eight government health clinics in the district were recruited for a face-to-face interview about health and well-being.MeasurementThe Adverse Childhood Experience International Questionnaire (ACE-IQ) and the Revised Conflict Tactics Scale (CTS) were utilized to estimate childhood adversity and elder abuse respectively.ResultsMultiple logistic regression analysis revealed a significant relationship between the number of cumulative ACEs and elder abuse. Compared to older adults with no self-reported adversity, those reporting three ACEs (OR 2.67, 95% CI 1.84,3.87) or four or more ACEs (OR 1.7, 95% CI 1.16, 2.48) had higher risk of any elder abuse occurrence since age 60 years. The effect was most prominent for financial and psychological elder abuse. The associations persisted in multivariate logistic regression models after adjusting for sociodemographic and health factors.ConclusionEarly life adversities were significantly associated with victimization of older adults. Social and emotional support to address elder abuse should recognize that, for some men and women, there is a possibility that vulnerability to maltreatment persisted throughout their life course.

Objectives This review aims to: (1) explore the social support measures in studies examining the association between social support and depression among community-dwelling older adults in Asia and (2) the evidence of association.Design A systematic review was conducted using electronic databases of CINAHL, PubMed, PsychINFO, Psychology and Behavioural Sciences Collection, SocINDEX and Web of Science for articles published until the 11th of January 2018.Eligibility criteria All observational studies investigating the association between social support and depression among community-dwelling older adults in Asia were included.Participants Older adults aged 60 years and more who are living in the community.Exposure measures Social support.Outcome measures Depression.Results We retrieved16 356 records and screened 66 full-text articles. Twenty-four observational studies were included in the review. They consisted of five cohort studies and 19 cross-sectional studies. Social support was found to be measured by multiple components, most commonly through a combination of structural and functional constructs. Perceived social support is more commonly measured compared with received social support. Good overall social support, having a spouse or partner, living with family, having a large social network, having more contact with family and friends, having emotional and instrumental support, good support from family and satisfaction with social support are associated with less depressive symptoms among community-dwelling older adults in Asia.Conclusions There were 20 different social support measures and we applied a framework to allow for better comparability. Our findings emphasised the association between good social support and decrease depression among older adults. Compared with western populations, family support has a greater influence on depression among community-dwelling older adults in Asia. This indicates that the family institution needs to be incorporated into designed programmes and interventions when addressing depression in the Asian context.Trial registration number CRD42017074897.

[This corrects the article DOI: 10.1371/journal.pone.0180222.].

To examine the association between elder abuse and poor sleep using a Malay validated version of Pittsburgh Sleep Quality Index (PSQI).This study was divided into two phases. Phase I tested the construct validity and reliability of the Malay version of PSQI. Phase II was a population-based, cross-sectional study with a multi-stage cluster sampling method. Home-based interviews were conducted by trained personnel using a structured questionnaire, to determine exposure and outcome.Kuala Pilah, a district in Negeri Sembilan which is one of the fourteen states in Malaysia.1648 community-dwelling older Malaysians.The Malay version of PSQI had significant test re-test reliability with intra-class correlation coefficients of 0.62. Confirmatory factor analyses revealed that one factor PSQI scale with three components (subjective sleep quality, sleep latency, and sleep disturbances) was most suitable. Cronbach's Alpha was 0.60 and composite reliability was 0.63. PSQI scores were highest among neglect (4.11), followed by physical (4.10), psychological (3.96) and financial abuse (3.60). There was a dose-response relationship between clustering of abuse and PSQI scores; 3.41, 3.50 and 3.84 for "no abuse", "1 type of abuse" and "2 types or more". Generalized linear models revealed six variables as significant determinants of sleep quality-abuse, co-morbidities, self-rated health, income, social support and gait speed. Among abuse subtypes, only neglect was significantly associated with poor sleep.The Malay PSQI was valid and reliable. Abuse was significantly associated with poor sleep. As sleep is essential for health and is a good predictor for mortality among older adults, management of abuse victims should entail sleep assessment. Interventions or treatment modalities which focus on improving sleep quality among abuse victims should be designed.

Socioeconomic inequalities in health represent unfairness in the health distribution of a population. Efforts to produce information on mortality distributions in many low and middle income countries (LMICs) are mostly hampered by lack of data disaggregated by socioeconomic groups. In this paper we describe how mortality statistics obtained from multiple data sources were combined to provide an evaluation of the socioeconomic distribution of mortality in Malaysia, a LMIC located in the Asia Pacific region.This study has an ecological design. As a measure of socioeconomic status, we used principal component analysis to construct a socioeconomic index using census data. Districts were ranked according to the standardised median index of households and assigned to each individual in the 5-year mortality data. The mortality indicators of interest were potential years of life lost (PYLL), standardised mortality ratio (SMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR). Both socioeconomic status and mortality outcomes were used compute the concentration index which provided the summary measure of the magnitude of inequality.Socially disadvantaged districts were found to have worse mortality outcomes compared to more advantaged districts. The values of the concentration index for the overall population of the Peninsula are C = -0.1334 (95% CI: -0.1605 to -0.1063) for the PYLL, C = -0.0685 (95% CI: -0.0928 to -0.0441) for the SMR, C = -0.0997 (95% CI: -0.1343 to -0.0652) for the IMR and C = -0.1207 (95% CI: -0.1523 to -0.0891) for the U5MR. Mortality outcomes within ethnic groups were also found to be less favourable among the poor.The findings of this study suggest that socioeconomic inequalities disfavouring the poor exist in Malaysia.

OBJECTIVES: To assess whether gender differences exist in the clinical presentation, angiographic severity, management and outcomes in patients with coronary artery disease (CAD). METHODS: The study comprised of 1,961 women and 8,593 men who underwent percutaneous coronary intervention (PCI) and were included in the Malaysian NCVD-PCI Registry from 2007-2009. Significant stenosis was defined as ≥70% stenosis in at least one of the epicardial vessels. RESULTS: Women were significantly older and had significantly higher rates of diabetes mellitus, hypertension, chronic renal failure, new onset angina and prior history of heart failure whereas smokers and past history of myocardial infarction were higher in men. In the ST-elevation myocardial infarction (STEMI) cohort, more women were in Killip class III-IV, had longer door-to-balloon time (169.5 min. vs 127.3 min, p

Abstract Background The examination of psychometric properties in instruments measuring abuse of older people (AOP) is a crucial area of study that has, unfortunately, received relatively little attention. Poor psychometric properties in AOP measurement instruments can significantly contribute to inconsistencies in prevalence estimates, casting a shadow of uncertainty over the magnitude of the problem at national, regional, and global levels. Objectives This review rigorously employed the Consensus‐based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline on the quality of outcome measures. It was designed to identify and review the instruments used to measure AOP, assess the instruments' measurement properties, and identify the definitions of AOP and abuse subtypes measured by these instruments, ensuring the reliability and validity of the findings. Search Methods A comprehensive search was conducted up to May 2023 across various online databases, including AgeLine via EBSCOhost, ASSIA via ProQuest, CINAHL via EBSCOhost, EMBASE, LILACS, ProQuest Dissertation & Theses Global, PsycINFO via EBSCOhost, PubMed, SciELO, Scopus, Sociological Abstract via ProQuest, Chinese National Knowledge Infrastructure (CNKI), Google Scholar and WHO Global Index Medicus. Additionally, relevant studies were identified by thoroughly searching the grey literature from resources such as Campbell Collaboration, OpenAIRE, and GRAFT. Selection Criteria All quantitative, qualitative (addressing face and content validity), and mixed‐method empirical studies published in peer‐reviewed journals or grey literature were included in this review. The included studies were primary studies that (1) evaluated one or more psychometric properties, (2) contained information on instrument development, or (3) examined the content validity of the instruments designed to measure AOP in community or institutional settings. The selected studies describe at least one psychometric property: reliability, validity, and responsiveness. Study participants represent the population of interest, including males and females aged 60 or older in community or institutional settings. Data Collection and Analysis Two reviewers evaluated the screening of the selected studies' titles, abstracts, and full texts based on the preset selection criteria. Two reviewers assessed the quality of each study using the COSMIN Risk of Bias checklist and the overall quality of evidence for each psychometric property of the instrument against the updated COSMIN criteria of good measurement properties. Disagreements were resolved through consensus discussion or with assistance from a third reviewer. The overall quality of the measurement instrument was graded using a modified GRADE approach. Data extraction was performed using data extraction forms adapted from the COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments. The extracted data included information on the characteristics of included instruments (name, adaptation, language used, translation and country of origin), characteristics of the tested population, instrument development, psychometric properties listed in the COSMIN criteria, including details on content validity, structural validity, internal consistency, cross‐cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, responsiveness, and interoperability. All data were synthesised and summarised qualitatively, and no meta‐analysis was performed. Main Results We found 15,200 potentially relevant records, of which 382 were screened in full text. A total of 114 studies that met the inclusion criteria were included. Four studies reported on more than one instrument. The primary reasons for excluding studies were their focus on instruments used solely for screening and diagnostic purposes, those conducted in hospital settings, or those without evaluating psychometric properties. Eighty‐seven studies reported on 46 original instruments and 29 studies on 22 modified versions of an original instrument. The majority of the studies were conducted in community settings (97 studies) from the perspective of older adults (90 studies) and were conducted in high‐income countries (69 studies). Ninety‐five studies assessed multiple forms of abuse, ranging from 2 to 13 different subscales; four studies measured overall abuse and neglect among older adults, and 14 studies measured one specific type of abuse. Approximately one‐quarter of the included studies reported on the psychometric properties of the most frequently used measurement instruments: HS‐EAST (assessed in 11 studies), VASS‐12 items (in 9 studies), and CASE (in 9 studies). The instruments with the most evidence available in studies reporting on instrument development and content validity in all domains (relevance, comprehensiveness and comprehensibility) were the DEAQ, OAPAM, *RAAL‐31 items, *ICNH (Norwegian) and OAFEM. For other psychometric properties, instruments with the most evidence available in terms of the number of studies were the HS‐EAST (11 studies across 5 of 9 psychometric properties), CASE (9 studies across 6 of 9 psychometric properties), VASS‐12 items (9 studies across 5 of 9 psychometric properties) and GMS (5 studies across 4 of 9 psychometric properties). Based on the overall rating and quality of evidence, the psychometric properties of the AOP measurement instruments used for prevalence measurement in community and institutional settings were insufficient and of low quality. Authors' Conclusions This review aimed to assess the overall rating and quality of evidence for instruments measuring AOP in the community and institutional settings. Our findings revealed various measurement instruments, with ratings and evidence quality predominantly indicating insufficiency and low quality. In summary, the psychometric properties of AOP measurement instruments have not been comprehensively investigated, and existing instruments lack sufficient evidence to support their validity and reliability.

In response to the COVID-19 pandemic, policies, and treatment guidelines underwent rapid and frequent change. This threatened to disrupt the measured practice of evidence-based medicine (EBM), which relies on tried-and-tested interventions. The uncertainty was compounded by the overwhelming amount of misinformation disseminated via social media. Thus, arose a need for valid information to guide clinical practice. COVID-19 Evidence Retrieval Service (CERS), an evidence retrieval service piloted at a local and then rolled out at a national level, was conceived and developed to address this issue. This article describes the components and implementation of the (CERS), The service’s objective was to review the available medical literature for the best evidence to answer COVID-19-related questions posed by practicing clinicians. Team members providing the service comprised librarians, clinicians, public health specialists, and medical students. Multiple lessons were learned through the development and provision of CERS. Firstly, the rapid nature of the pandemic necessitated adaptations of the current practice of EBM. Secondly, all work processes were conducted online, which proved efficient and sustainable. Thirdly, Lower Middle-Income Country (LMIC) oriented services such as CERS were valid because they provided more relevant questions to resource-limited healthcare systems. Our experience has reinforced that an integrated, evidence-based retrieval service is feasible and valuable to support healthcare workers and policymakers in making informed decisions by performing a systematic appraisal. Crucially, medical students and young healthcare professionals can play a pivotal role in setting up these services.

Falls are major issues affecting the older population with potentially serious complications, including fractures, head injury, institutionalization, fear of falling and depression. While risk factors for falls have been established across Western Europe and North America, geographical differences in falls risk have not been well researched. We aim to examine the clinical and physical risk factors for falls in a middle-income South East Asian country. Cross-sectional data from the Malaysian Elders Longitudinal Research (MELoR) study involving 1,362 community dwelling individuals aged 55 years and above was utilized. Information on sociodemographic and medical history was obtained by computer-assisted questionnaires completed during home visits and hospital-based detailed health checks. Univariate and multivariate analyses compared non-fallers and fallers in the previous 12 months. Urinary incontinence, hearing impairment, depression, arthritis and cognitive impairment were risk factors for falls in the past 12 months after adjustment for age in our study population. Awareness about the risk factors in a population helps the design of fall prevention strategies that target specific or multiple risk factors.

Background: Economic development is known to shift the distribution of obesity from the socioeconomically more advantaged to the less advantaged. We assessed the socioeconomic trends in overweight, obesity, and abdominal obesity across a period of significant economic growth. Methods: We used the Malaysian National Health and Morbidity Survey data sets for the years 1996, 2006, and 2011 to analyze the trends among adults aged 30 years and above. The World Health Organization’s Asian body mass index cut-off points of ≥23.0 kg/m2 and ≥27.5 kg/m2 were used to define overweight and obesity, respectively. Abdominal obesity was defined as having a waist circumference of ≥90 cm for men and ≥80 cm for women. Household per-capita income was used as a measure of socioeconomic position. As a summary measure of inequality, we computed the concentration index. Results: Women in Peninsular Malaysia demonstrated patterns that were similar to that of developed countries in which the distributions for overweight, obesity, and abdominal obesity became concentrated among the poor. For women in East Malaysia, distributions became neither concentrated among the rich nor poor, while distributions for men were still concentrated among the rich. Chinese women, particularly from the richest quintile, had the lowest rates and lowest increase in overweight and obesity. All distributions of Chinese women were concentrated among the poor. The distributions of Malay men were still concentrated among the rich, while distributions for Chinese and Indian men and Malay and Indian women were neither concentrated among the rich nor poor. Conclusion: As the country continues to progress, increasing risks of overweight and obesity among the socioeconomically less advantaged is expected.

Good nutrition in the first "1000 days," including breastfeeding and appropriate complementary foods, prepares for a healthy childhood and adult life, also contributes to the prevention of the double burden of malnutrition. Exclusive breastfeeding provides all required nutrients until an infant is around 6 months of age when complementary foods are needed. A literature review was undertaken of complementary foods in the Asia Pacific region. The foods being used at present are often of low nutrient density may provide insufficient amounts of some critical nutrients, and generally the variety is limited. Guidelines for complementary feeding are provided to assist in education and in public health planning.