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@#Introduction: Sarcopenia is one of the geriatric syndromes affecting the ability of older adults to lead an independent living. However, its risk factors among Malaysian older adults are yet to be determined. This study investigated the prevalence and risk factors of sarcopenia among community-dwelling older adults in Klang Valley. Methods: This cross-sectional study involved 393 Malaysians aged 60 and above, residing in urban areas of Klang Valley recruited through convenience sampling. Socio-demographic and food intake information were obtained using validated questionnaires. Cut-off points for sarcopenia screening were obtained from the Asian Working Group of Sarcopenia(AWGS) while body impedance analysis(BIA) was employed to determine skeletal muscle index. A handgrip dynamometer was used to assess dominant handgrip strength and a 6-meter gait speed test was used to determine walking speed. Binary logistic regression analysis was used to determine the risk factors of sarcopenia. Results: Prevalence of sarcopenia was 33.6% and women(35.9%) were more affected compared to men(30.1%). The mean age of women assessed to have sarcopenia(69.1±6.5 years old) was higher compared to men(68.3±5.8 years old) (p<0.05). After adjusting for confounding factors, older adults with one year increased in age and one mg decreased in habitual dietary iron intake were estimated to be 1.08 times and 0.93 times the chances to have sarcopenia respectively. Conclusion: Approximately one-third of community-dwelling older adults in Klang Valley were assessed to have sarcopenia. Older adults aged 60 years and above and those with low dietary iron intake were at an increased risk of developing sarcopenia.
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@#In this study, we aimed to determine gender specific age-related decline in anthropometry status, physical performance (PP) and physical activity (PA) in older persons with and without mild cognitive impairment (MCI) prospectively over 3 years. Within-group changes across three time points (baseline-Wave 1, 18 months-Wave 2, 36 months-Wave 3) based on gender and cognitive status were determined. Data was collected at Wave 3 of a longitudinal study: “Neuroprotective Model for Health Longevity among Elderly”. Secondary data from Wave 1 and 2 was obtained for analysis. Older persons with MCI were categorised to have subjective memory problems (answered ‘yes’ on item 10 of Geriatric Depression Scale), scored at least 1.5 SD below mean average on Rey Auditory Verbal Learning Test and Digit Span, no dementia, no problems with activities in daily living, intact global cognition (>19/30: Mini Mental State Examination) and without depression (Geriatric Depression Scale 15-items,≤4). Anthropometry measurements and a battery of PP tests were performed. PA was measured using Physical Activity Scale for the Elderly questionnaire. Data from 779 older persons (67.7 ± 5.3 years) consisting of 372 men (68.0 ± 5.2 years) and 407 women (67.4 ± 5.4) who completed all tests from Wave 1 to Wave 3 were analysed. There was a decline in PP (-0.7% to -14.1% per year), PA levels (-0.7% to -14.1% per year) and anthropometry status (-0.1% to -6.3% per year), except for percentage body fat (+9.9% per year) with advancing age. Within-group changes over the three years showed significant differences (p<0.05) in height and PA in non-MCI and MCI men and lower body flexibility in non-MCI and MCI women. Specifically, tailored physical and nutritional health prevention and promotion strategies for older persons based on gender and cognitive status may be beneficial to support person-centered care.
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@#The aim of this study was to detemine the effectiveness of Customized vestibular rehabilitation (CVR) in addition to the standard Canalith repositioning maneuver (CRM) on static balance among adults with posterior canal Benign Paroxysmal Positional Vertigo (BPPV). In this randomised controlled trial, 28 adults with idiopathic unilateral posterior canal BPPV were randomized to either the control or experimental group. The experimental group (n=14, mean age: 50.71±9.88 years) received CVR in addition to CRM, and the control group (n=14, mean age: 54.36±8.55 years) received only CRM for 6 weeks. Measurements of static balance (postural sway) using a portable kinematic sensor were performed at baseline, four and six weeks after treatment for both groups while standing on firm and foam surface with eyes open (EO) and closed (EC). Only standing on foam surface with EC was observed to have a significant interaction effect, F (2, 52) =5.28, p<0.05. This suggest that the groups were affected differently by the intervention and greater improvement was demonstrated in the experimental group. Post hoc test showed that a significant difference (p<0.05) in static balance was shown between baseline and 6th week after intervention. The results of our study indicate that CVR in addition to CRM improved static balance in adults with UPC BPPV at 6th week after intervention for persons with BPPV.
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@#Online health information have a role in enhancing health in older adults. However, age-related physiological changes and non-senior friendly websites proved to be a challenge for older adults. Research investigating older adults’ preferences of features in health information websites is limited. Thus, in this review, we aim to summarize older adults’ preferences regarding the design and content of health websites. Medline, CINAHL, Cochrane Library, Scopus, Journal of Medical Internet Research (JMIR) and Google Scholar were searched for relevant articles in February 2018, using key words ‘older adults’, ‘Internet’, ‘health information’ and ‘usability’. The methodological quality of included studies was evaluated using the McMaster critical appraisal tools by two independent reviewers. Individual study design, participants’ characteristics, and identified preferences for health website features were extracted and summarized narratively. (PROSPERO registration number: CRD42018096281). Five studies (3 qualitative, 2 quantitative) were included in this review. The quality appraisal score ranged from 32% to 83%. The web feature preferences of older adults were grouped into three domains: web presentation factors, web navigation factors and health information preferences. The results highlight older adults have specific preferences when engaging with online content. This review suggests that readable text, simple design, consistent layout and straightforward web navigation are the preferred priorities for a health information website for older adults. Findings from this review may be useful to healthcare professionals and developers to understand older adults’ preferences pertaining to web design and contents in health websites specifically designed for this population.
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@#n this review weaimed to determine the prevalence of urinary incontinence (UI)and its association with declined cognitive and physical function among community dwelling older adults. Literature review was performed using multiple online databases includingMEDLINE, Science Direct andWiley Online Library from June 2000 to April 2017. Hand searching ofbibliographies of relevant studies was also carried out. The studies included ofthose conducted from within the last 17years; assessed and compared according to population characteristics, definition of urinary incontinence, prevalence and its association with cognitive and physical functionaldecline. Nine studies met the eligibility criteria of this review. Prevalence rates of UI among community dwelling older adults ranged from10% to 53% (median 32%).Physical functionaldecline in termsof mobility, locomotion and activities of daily living interruptions werefound to be correlated with UI. Although limited, the existing evidence also showed an association between declined cognitive function and UI.
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@#Knee osteoarthritis (KOA) is a major cause of disability and significantly reduce quality of life (QOL). There is limited information about knee associated problems and functional mobility among Malaysian adults with KOA. The aim of our study was to examine knee associated problems and functional mobility among this population. Forty-five (45) adults with KOA with mean age of 65.02 ± 8.083 were recruited from Hospital Canselor Tuanku Muhriz, UKM. Knee associated problems and functional mobility were measured using Knee injury and Osteoarthritis Outcome Scores (KOOS) and Timed-Up and Go (TUG) test respectively. The mean score and standard deviation for TUG test was 11.44 ± 2.69. Median scores (with interquartile ranges [IQR]) for the KOOS subscale domains were; Symptoms: 80.56, (69.44 to 91.67); Pain: 71.43 (50 to 78.57); Functional Activities of Daily Living: 82.3 (67.65 to 86.76); Sports and Recreation Function: 30 (20 to 60); and Knee-Related Quality of Life: 50 (25 to 75). Generally, participants’ TUG test performance showed that time taken to complete the test was higher than the reference values (7.14 to 8.43 seconds) identified among Malaysian community dwelling older adults with low to high risk of falls. The KOOS scores in adults with KOA in our study is similar to previous reports with Sport and Recreation Function and QOL domains been the most affected. It is important to improve functional mobility and balance in order to decrease falls risk and optimise sport and recreation function and QOL among adults with KOA.
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@#Falls is a global health issue among older adults. Identifying measuring tools that can predict falls risk among older adults can assist in early falls risk detection and prevention. Best measuring tools that can predict falls risk among Malaysian community dwelling older adults is not known. The objective of our study was to determine if Timed Up and Go (TUG) test and Activities-Specific Balance Confidence (ABC) scale could be used as a falls risk predictor tools among Malaysian community dwelling older adults. Hundred and six (n = 106) community dwelling older adults who were attending Klinik Kesihatan Cheras participated in this cross sectional study. Falls incidence in the past one year was obtained from the participants. TUG test was performed and ABC scale was administered. Data was analysed using binomial logistic regression and receiver operating curves (ROC). The cut off values identified for TUG test and ABC scale were 9.02 seconds (area under the curve, AUC was 0.711; 95% CI 0.577-0.844) and 82.81% (area under the curve, AUC was 0.682; 95% CI 0.562-0.802) respectively. Hence, older adults with a score of above 9.02 seconds for TUG test and a score of below 82.81% for ABC scale were noted to have a higher risk of falls. Results of this study demonstrated that both TUG test (p < 0.001) and ABC scale (p < 0.01) were significant predictors of falls risk. Our study results indicated that both mobility (TUG test) and fear of falls (ABC scale) measuring tools, with the present cut off values can be used to identify community dwelling older adults who are at a higher risk of falls. Identifying older adults with higher risk of falls can assist the health professionals to optimise falls prevention and management approaches.
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@#Optimum physical health is important in maintaining independence among older adults. There is limited information regarding physical health status among older adults attending primary care clinics in the local population. The aim of this study was to examine physical health among older adults attending Primary Care Clinic at Cheras, Malaysia. A cross-sectional study was conducted at Primary Care Clinic at Cheras, Malaysia with a total 106 participants (mean age of 68 ± 6.3 years). Participants performed a battery of physical function tests. The results showed that the percentages of participants who performed below recommended norms for the 30secs Chair Stand Test (lower limb strength), Chair Sit and Reach Test (lower limb flexibility), Back Scratch Test (upper limb flexibility), Timed Up and Go (TUG) (functional mobility), Single Leg Stance Test (balance) and 2 mins Walk Test (2MWT) (aerobic endurance) were 32%, 18%, 21%, 29%, 22% and 78% respectively. The results suggest that the majority of older adults visiting primary health care clinics had inadequate physical function in relation to aerobic endurance. Older adults attending primary health care clinics should be encouraged to improve their physical health status, especially aerobic endurance, to optimise their physical independence.
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@#Reduced muscle strength and quality of life (QoL) has an impact on adults at risk of osteoporotic fractures. Muscle strength and QoL among Malaysian adults at risk of osteoporotic fractures is not known. The aim of our study was to examine muscle strength and QoL status and its relationship among adults at low and moderate to high risk of osteoporotic fractures. In this cross-sectional study, we recruited 27 men and 78 women with mean age 69.3 ± 8.5 years from Orthopaedic Clinic, Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia. A 10-year probability of major osteoporotic fractures were calculated according to WHO fracture risk assessment tool (FRAX) with femoral neck BMD (cut-point 10%). Participants were categorized as low and moderate to high risk of osteoporotic fractures based on FRAX results. Back extensor muscle strength (BES) and dominant hand grip strength (HGS) was measured using a load cell system and a hand dynamometer respectively. European QoL questionnaire (EQ5Dvas) was used to measure QoL. Multiple linear regression was performed with QoL as a dependent variable and back extensor muscle strength and hand grip strength as the independent variables. Approximate 40% of adults were categorized into moderate to high risk of osteoporotic fractures. The mean values among the low and moderate to high risk of osteoporotic fractures for QoL was 80.5 ± 13.2 and 76.9 ± 16.9 (p = 0.77); hand grip strength was 25.7 ± 17.3 and 20.6 ± 5.5 kg (p < 0.001) and back extensor strength was 25.0 ± 7.0 and 18.9 ± 9.5 Newton (p < 0.01) respectively. Hand grip muscle strength appeared to be a determinant of QoL and accounted for 5.8% of the total variance. Improved muscle strength may lead in better QoL among adults at risk of osteoporotic fractures.
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@#Falls in older adults is a major health issue globally. Falls prevalence reports vary based on the study settings. The importance of a fast, easy self-assessment tool to identify falls risk has been emphasised in numerous studies. The aim of our study was to pool information on the prevalence of falls and its risk assessment tools based on a scoping review. This information will be beneficial to inform current falls prevalence and to decide on the best falls risk assessment tool to be used among Malaysian community-dwelling older adults. Articles referred were based on the following electronic databases (MEDLINE Complete, CINAHL, Rehabilitation & Sports Medicine Source and SPORTDiscus) via EBSCOHOST, Science Direct, PubMed, Cochrane Library, Embase® and Google Scholar. Twelve studies were identified to meet the inclusion and exclusion criteria. Our review findings showed that current falls prevalence (between 4.2% and 61%) among Malaysian community dwelling older adults was consistent with the findings in Asia. Falls risk assessment tools used were similar to the ones used in other countries, taking the multiple falls risk factors in consideration.
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@#Physical Activity Scale for the Elderly (PASE) is a simple, valid and reliable questionnaire that can be administered to quantify older adults’ physical activity levels during daily living. However, PASE in Malay language for use among older population is not available. The objective of our current study was to evaluate the reliability and validity of the Malay translated Physical Activity Scale for Elderly (PASE-M) for the use among older adults. Objective results of physical activity were obtained by wearing continuously an accelerometer for one week among a population of older adults in Malaysia who speak Malay language. Participants completed PASE-M twice, on day-8 (PASE-M1) and day-15 (PASE-M2). Concurrent validity between PASE-M1 and accelerometer results was assessed using Spearman’s rank correlation coefficient. Test-retest reliability for one week interval of PASE-M was tested using Spearman’s rank correlation coefficient and Intra-class correlation coefficients (ICC). Forty-four community-dwelling older adults (12 men and 32 women; mean age ± SD= 66.95 ± 5.34) participated in this study. However, only 33 participants (8 men and 25 women; mean age ± SD= 66.64 ± 5.51) were able to achieve the minimum accelerometer wearing time and filled up the PASE-M questionnaire for two times with one weeks interval. The results showed the PASE-M score was significantly correlated with vector magnitude (VM) counts (r=0.54, p<0.01), time in moderate-to-vigorous physical activity (MVPA) (r =0.55, p<0.01), energy expenditure (r =0.53, p<0.01) and walking steps (r=0.39, p<0.05). A high reliability (ICC = 0.96) was demonstrated between first and the subsequent administration of PASE-M (p<0.01, 95% CI: 0.92-0.98). The PASE-M is a valid and reliable questionnaire to assess physical activity level for Malaysian community-dwelling older adults.
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@#Negative attitudes towards ageing are reported to be associated with greater functional impairment in older adults.There is limited information regarding attitudes towards ageing and physical performance in regard to adults aged 55 to 64 years. The objective of our study was to examine the association of attitude towards ageing on physical performance which includes mobility, agility and falls risk. This cross sectional study was conducted at five senior citizen clubs around Klang Valley in Malaysia. A total of 154 community dwelling adults aged 55 and above (mean:65.8+6.82) participated in this study. Attitude towards ageing was measured using Kogan’s Attitude towards Older People Questionnaire (KAOP). Mobility and agility were measured using gait speed test and ten step test respectively. Risk of falls was assessed using physiological profile aproach (PPA). Approximately 75% of the participants had positive attitude towards ageing with high to very high risk of falls. A significant (p<0.05) correlation was demonstrated between attitude towards ageing, falls risk and gait speed.Regression analysis showed that attitudes toward ageing had a relationship with falls risk, explaining 6% of the variance, F (1, 152) =10.26, p<0.01.The results of this study suggest that there is some relationship between attitude towards ageing and falls risk measured using a combination of physical performance test. Positive attitude towards ageing should be promoted among adults in an earlier age for overall physical health among older adults.
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Walking SpeedABSTRACT
Negative attitudes towards ageing are reported to be associated with greater functional impairment in older adults. There is limited information regarding attitudes towards ageing and physical performance in regard to adults aged 55 to 64 years. The objective of our study was to examine the association of attitude towards ageing on physical performance which includes mobility, agility and falls risk. This cross sectional study was conducted at five senior citizen clubs around Klang Valley in Malaysia. A total of 154 community dwelling adults aged 55 and above (mean:65.8+6.82) participated in this study. Attitude towards ageing was measured using Kogan’s Attitude towards Older People Questionnaire (KAOP). Mobility and agility were measured using gait speed test and ten step test respectively. Risk of falls was assessed using physiological profile aproach (PPA). Approximately 75% of the participants had positive attitude towards ageing with high to very high risk of falls. A significant (p<0.05) correlation was demonstrated between attitude towards ageing, falls risk and gait speed.Regression analysis showed that attitudes toward ageing had a relationship with falls risk, explaining 6% of the variance, F (1, 152) =10.26, p<0.01.The results of this study suggest that there is some relationship between attitude towards ageing and falls risk measured using a combination of physical performance test. Positive attitude towards ageing should be promoted among adults in an earlier age for overall physical health among older adults.
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Ageing is associated with changes in body balance mechanism. The gold standard assessment for body balance is posturography. However, because of the high cost constraints, not many health centers are equipped with the equipment. Nintendo Wii balance board (WBB) has been reported as a potential tool to be used to assess body balance and sway. Also, because WBB is more economical and portable, it has greater potential to be used in primary health centers and community settings. The objective of this study was to compare balance measures using BRU™ and WBB among young and older healthy adults during quiet standing. Thirty three young (26.9±5.6 years) and 33 older adults (65.6±4.4 years) were randomly tested on both equipments. Subjects performed 30sec trial for each of the four testing conditions: quiet standing on a firm or compliant surface (foam) with eyes-open and closed. The results showed significant differences in balance measurements between all four testing conditions and age groups using both equipments.This study also found significant positive correlations between the COPand sway velocity, SV (of the BRU™) and COB (of the WBB) in all test conditions. These results indicated that WBB coupled with its commercially available software could potentially be used as a screening tool for balance assessment in primary health centres.
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@#Ageing is associated with changes in body balance mechanism. The gold standard assessment for body balance is posturography. However, because of the high cost constraints, not many health centers are equipped with the equipment. Nintendo Wii balance board (WBB) has been reported as a potential tool to be used to assess body balance and sway. Also, because WBB is more economical and portable, it has greater potential to be used in primary health centers and community settings. The objective of this study was to compare balance measures using BRU™ and WBB among young and older healthy adults during quiet standing. Thirty three young (26.9±5.6 years) and 33 older adults (65.6±4.4 years) were randomly tested on both equipments. Subjects performed 30sec trial for each of the four testing conditions: quiet standing on a firm or compliant surface (foam) with eyes-open and closed. The results showed significant differences in balance measurements between all four testing conditions and age groups using both equipments.This study also found significant positive correlations between the COPand sway velocity, SV (of the BRU™) and COB (of the WBB) in all test conditions. These results indicated that WBB coupled with its commercially available software could potentially be used as a screening tool for balance assessment in primary health centres.
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Older adults who walk in their neighbourhood with greater street connectivity are reported to have lower limb physicalperformance decline. There is limited information regarding the association between built environment characteristicsand physical performance in older adults. The aim of this study was to examine the association between built environmentcharacteristics, physical performance, falls risk and functional mobility among older adults. Sixty four (27 men and 37women) community dwelling older adults aged 60 years and above (mean 67.4 ± 7.1 years) from senior citizen clubs inKuala Lumpur, Malaysia participated in this cross-sectional study. Built environment characteristics were assessed usingan adapted Neighbourhood Environment Walkability Scale (NEWS). Physical performance and falls risk was measuredusing Short Physical Performance Battery (SPPB) and Profile Physiological Profile Assessment (PPA) respectively. TimedUp and Go (TUG) and gait speed tests were used to assess functional mobility. There was a significant correlation betweenbuilt environment and physical performance (r = 0.43, p < 0.001) and functional mobility measured using gait speedtest (r = 0.27, p < 0.05) among older adults. Built environment was identified as a significant determinant of physicalperformance (R2 = 0.19, p < 0.001). Built environment characteristics is an important external factor in preservingphysical performance in older adults. Programmes and policies for a more favourable built environment characteristicsin the neighbourhoods should be encouraged to promote and maintain physical performance among older adults
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Knee osteoarthritis (OA) is a common chronic joint disease that results in pain and disability in many people. Culturalpractice may influence patients’ views about their condition, its related issues and management. The aim of our study wasto explore the perspective about knee OA and its related issues among Malaysian patients with knee OA. Twelve patientsdiagnosed with knee OA (8 females and 4 males) attending physiotherapy sessions at a University Hospital, mean age(SD): 67.1(9.4) years and median visual analog scale score of 5/10 participated in this qualitative study. One to one indepthinterviews were conducted, audio recorded and later transcribed verbatim. Three main themes were identified fromthe transcribed data; knee pain and its’ related issues (reason and aggravating factors of knee pain, coping strategies),impact of knee pain (impact on daily activities and emotions) and physiotherapy management (effects and expectationsof physiotherapy, compliance and adherence towards home exercises). Most participants expressed that their knee painwas aggravated by certain movements that had an effect on their daily activities namely squatting. The findings alsosuggested that physiotherapy management was perceived as secondary prevention rather than a cure. Findings fromthis study provides information about the perceptions and related issues of patients with knee OA. This information mayhelp health professionals in tailoring patient-centered care and provide better management.
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There is limited information regarding gender differences in spinal morphological attributes among healthy young adultsalthough alterations have been reported to influence postural changes, mainly with forward-bending and extensionpostures. The aim of this preliminary study was to examine gender differences in spinal morphological attributes oflumbar extensor muscles that includes its muscle fibre angles, thickness, endurance and thoracolumbar curvature amongyoung adults. Nineteen male and 26 female healthy young adults (aged 21-24 years) matched for age, body mass indexand physical activity levels participated in this preliminary study. Fibre angles and thickness of lumbar extensor muscleswere examined using ultrasonography. Lumbar extensor muscle endurance and thoracolumbar curvatures were assessedusing Sorenson’s test and a flexible ruler respectively. Paired t-test showed a significant mean difference (p < 0.01)between the right and left fibre angles. However, no significant mean difference (p = 0.50) was found between the rightand left muscle thickness. Results of independent t-test showed a significant difference (p < 0.01) in muscle thicknessbetween males and females. No significant differences were shown in right fibre angle (p = 0.12), left fibre angle (p =0.89), muscle endurance (p = 0.46), thoracic curvature (p = 0.76) and lumbar curvature (p = 0.06) between genders.There were no gender differences in spinal morphological attributes except for lumbar extensor muscle thickness inyoung adults age between 21 to 24. This study data may be useful as an initial reference norm of spinal morphologicalattributes among young adults. Further studies may be required to examine the factors that may influence changes inspinal morphological attributes among healthy adults.
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Falls is one of the main problems in older adults, which indirectly contributes to deterioration of quality of life, morbidityand mortality. The purpose of this study was to examine the difference in values between Timed Up and Go (TUG) andgait speed tests among community dwelling older adults with high and low risk of falls classified using PPA (PhysiologicalProfile Assessment). This cross-sectional study involved 278 older adults aged between 60 to 88 years, recruited fromsenior citizen club around Klang Valley. 40.6% older adults had high risk of falls and mostly were women (75%). Theresults of the study showed that there was a significant (p < 0.05) difference in TUG and Gait speed tests performancebetween older adults with high and low risk of falls. Declined mobility (longer time of TUG test) and increased age wereidentified as significant (p < 0.05) risk factors for falls in this study. The TUG test reference values obtained in this studymay be useful for early identification, prevention and management of falls among community dwelling older adults.
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Introduction: There is limited information regarding the effects of interactive virtual reality (VR) games on psychological and physical well-being among adults with physical disabilities. We aimed to examine the impact of VR games on psychological well-being, upper limb motor function and reaction time in adults with physical disabilities. Methods: Fifteen participants completed the intervention using Wii VR games in this pilot study. Depressive, Anxiety and Stress Scales (DASS) and Capabilities of Upper Extremity (CUE) questionnaires were used to measure psychological well-being and upper limb motor function respectively. Upper limb reaction time was measured using reaction time test. Results: Results showed that there was a significant difference (p<0.05) in DASS questionnaire and average reaction time score after intervention. Conclusion: There is a potential for using interactive VR games as an exercise tool to improve psychological wellbeing and upper limb reaction time among adults with disabilities.