Development of a Valid and Reliable Scale to Assess Knowledge, Attitude and Practice (KAP) on Frailty, Nutrition and Exercise among Malaysian Elderly

@#Introduction: “Frailty Intervention through Nutrition Education and Exercise (FINE)” program is an educational program, an initiative to ameliorate frailty status among elderly due to the alarming number of frailty cases in Malaysia. The current study aims to develop and determine the validity and reliability of the KAP questionnaire on frailty, nutrition and exercise to assess the effectiveness of the “FINE” program among the Malaysian elderly. Methods: The KAP questionnaire was created based on the developed frailty module and education materials. Content and face validity were conducted before the reliability study among five health professionals and 20 elderly, while 79 elderly were involved in a reliability study in three different Projek Perumahan Rakyat (PPR) flats in the Kuala Lumpur area. Data were analysed to determine its internal consistency reliability. Results: Six items were removed during content and face validity, two from each domain. All items in the knowledge section were within an acceptable range of difficulty and discrimination following the item analysis. Yet, item-to-total correlation removes one item for attitude and four items for the practice domain. The analysis found that the internal consistency reliability was 0.852, 0.732 and 0.600 for the KAP section, respectively. Conclusion: The final version of the KAP questionnaire consisted of (11) knowledge, nine (9) attitudes and six (6) practice items proven to be valid and reliable. Thus, it could be used to assess the effectiveness of the “FINE” program among the Malaysian elderly.

Factors Associated with Diet Quality during COVID-19 Pandemic among Undergraduate Students in Universiti Putra Malaysia

@#Introduction: The COVID-19 preventive and restriction measures may disrupt an individual’s daily diet quality, potentially leading to obesity and other non-communicable diseases. This study aims to assess and determine factors associated with diet quality during the COVID-19 pandemic among undergraduate students at Universiti Putra Malaysia. Methods: 130 eligible undergraduate students, who participated in this cross-sectional study were assessed using Global Physical Activity Questionnaire (GPAQ), Depression, Anxiety, Stress Scale (DASS-21), and Rapid Eating Assessment for Participants short version (REAP-S). Self-reported sociodemographic characteristics, body weight status, and nutrition knowledge were evaluated. Statistical analysis was conducted using IBM SPSS 26.0 and p<0.05 was denoted as statistically significant. Results: Most of the respondents were female (76.2%), aged between 20-22 years old (64.6%), Bumiputera (80.0%), funded by loan or scholarship (73.1%), low socioeconomic status (60.0%), residing in the family household (57.7%), consumed home-cooked meals (58.5%), and used the e-hailing food services for 0-3 days/week (63.1%). There was an equal distribution in the year and program of study in every selected faculty. Most were having normal BMI status (54.6%), good nutrition knowledge (66.9%), sedentary (48.5%), less severe mental health status (85.4%), and good diet quality (62.3%). Nonetheless, throughout the study, only the anxiety subscale was associated with diet quality (r= -0.20, p<0.05). Conclusion: Perceived anxiety may lead to poor diet quality. Future studies could determine the food environment and food security faced by the students as these factors vary among individuals. It is also recommended to measure diet quality differences before, during, or after the pandemic.

Associations between Sociodemographic, Body Mass Index, Body Image Perception, Physical Activity and Sleep Quality with Mental Health among University Students in Universiti Putra Malaysia during the COVID-19 Pandemic

@#Introduction: Mental health problem among university students during COVID-19 pandemic became one of the global main issues. There is limited study on mental health among university student during COVID-19 pandemic. Therefore, this study aimed to determine the associations between socio-demographic, body mass index, body image perception, physical activity and sleep quality with mental health among university students in Universiti Putra Malaysia. Methods: This is a cross-sectional study with a total sample of 130 students aged 18 to 25 years old which were recruited through a multistage sampling. An English online self-administered questionnaire was used to collect the data on socio-demographic characteristics, weight and height, body image perception (BSQ-8C), physical activity (GPAQ), sleep quality (PSQI), and mental health (DASS-21). Results: Majority of the respondents were female (76.2%), Malay (78.5%), in second year of study (28.5%), from low income family (59.2%) and stayed with parents during COVID-19 pandemic (57.7%). Results showed 44.6% of respondents had depressive symptoms, 56.9% had anxiety symptoms and 29.2% had stress symptoms with severity mild to extremely severe. Body mass index (r=0.205, p<0.005), body image perception (r=0.538, p<0.001), and sleep quality (r=0.460, p<0.001) were associated with depression subscale. Meanwhile, body image perception (r=0.449, p<0.001), and sleep quality (r=0.450, p<0.001) were correlated with anxiety subscale. Stress subscale was correlated with body image perception (r=0.473, p<0.001) and sleep quality (r=0.492, p<0.001). Conclusion: Affected students should be helped and referred to healthcare practitioner to ensure they able to overcome with these problems and remains healthy during this pandemic.

Handgrip Strength Assessment and Its Associated Factors among Hospitalized Elderly in Klang Valley Hospitals

@#Introduction: Handgrip strength is a crucial biomarker of aging. Poor handgrip strength among hospitalized elderly increases the risk of health complications leading to a higher risk of hospital readmissions and mortality. This study aimed to determine handgrip strength among hospitalized elderly in Klang Valley hospitals alongside its associated factors. Methods: A total of 57 subjects were recruited for this study. Face-to-face interviews and physical assessments were conducted to obtain data on sociodemographic factors, medical background, anthropometry assessments and biochemical markers level. Dietary intake was obtained through two days of 24-hour dietary recall while tools such as Global Oral Health Assessment Index (GOHAI) and Mini Nutrition Assessment- Short Form (MNA-SF) were used to assess perception towards oral health and malnutrition risk, respectively. Reference value from the Asian Working Group of Sarcopenia (2014) was used to compare handgrip strength. Results: 94.7% of the subjects were found to have low handgrip strength with a mean value of 8.28 + 6.92 kg/force. Factors including age (r=- 0.370, p=0.005), educational level (r=0.471, p=<0.0005), perception towards oral health (r=0.370, p=0.005) and energy intake (r=0.367, p=0.005) were significantly associated with handgrip strength. Meanwhile, other variables were not significantly associated. Conclusion: The majority of the subjects had poor handgrip strength. Factors such as age, educational level, perception towards oral health and energy intake were significantly associated with handgrip strength while the rest were non-significantly associated. Thus, more research and intervention strategies should be done to improve handgrip strength among hospitalized elderly to achieve a healthy aging nation.

Assessment of Body Fat Percentage and Its Associated Factors among Hospitalized Elderly

@#Introduction: Elevated body fat percentage among elderly has resulted in a significant number of morbidity and mortality. Thus, this study aimed to determine the body fat percentage and its associated factors among hospitalized elderly in Klang Valley hospitals. Methods: A total of 57 subjects aged ≥ 60 years were recruited from the geriatric wards of three Klang Valley hospitals (Hospital Sungai Buloh, Hospital Tengku Ampuan Rahimah and Hospital Kuala Lumpur) using purposive and convenience sampling. A face-to-face interview and physical examination were conducted to obtain the data on socio-demographic characteristics, medical background, anthropometric measurements, total cholesterol levels, hand-grip strength, perception towards oral health, dietary assessment and malnutrition risk. The body fat percentage was assessed using a handheld bio-electrical impedance OMRON HBF-302 and compared with Gallagher’s classification of body fat percentage. A simple descriptive statistic and correlation analysis were used to analyze the body fat percentage and its associated factors. Results: Majority of hospitalized elderly (49%) had elevated body fat percentages. Weight (p≤0.0005), BMI (p≤0.0005), and malnutrition risk (p≤0.0005) were significantly associated with the body fat percentage. Meanwhile, other variables were not significantly associated with body fat percentage in hospitalized elderly. Conclusion: Weight, BMI, and malnutrition risk were found to be significantly associated with the body fat percentage. Other variables were not significantly associated. Thus, a better understanding of factors associated with body fat percentage is necessary in managing elevated body fat percentage to reduce the risk of morbidity and mortality among hospitalized elderly.

Prevalence and Factors Associated with Geriatric Malnutrition in Healthcare Institutions: A Systematic Review

@#Aim and Design: The world’s population is ageing. Not only it changes the body composition, but ageing also causes psychological, pathological and economic alterations. These may impact an individual’s quality of life and nutritional status. Thus, this systematic review article aims to review the prevalence of geriatric malnutrition in healthcare institutions and its associated factors. Data Sources: The articles are screened and reviewed based on their titles, abstracts and keywords. English written articles, open-accessed and published between January 2009 and December 2019 are then selected. Review Methods: The PRISMA method is used for this study. Potential studies related to geriatric malnutrition in healthcare institutions were identified using two different combinations and two major electronic search engines, namely Pubmed and Science Direct. Results: From a search of 1011 articles, 22 articles were identified related to geriatric malnutrition in healthcare institutions. Globally, it is found that the prevalence of malnourished elderly patients ranged between 6% – 74.5%. The factors associated with malnutrition among the elderly in the healthcare institutions were recognised, namely socio-demography, medical background, anthropometry data, biochemical data, nutrition-focus physical findings, and dietary inadequacy. Conclusion and Impact: Despite the studies done, geriatric malnutrition is still a matter of concern. Hence, future strategies for interventions need to be taken to aid in overcoming this issue otherwise affecting the health status and life expectancy of the elderly.

Total Cholesterol Level and Its Associated Factors among Hospitalized Elderly: A Cross-sectional Study

@#Introduction: The total cholesterol level of hospitalized elderly should be monitored as the long-term consequence of hypercholesterolemia is the development of cardiovascular diseases. This study aimed to determine the total cholesterol level among hospitalized elderly and its associated factors in Hospital Serdang, Selangor. Methods: A total of 115 hospitalized elderly aged 60 and above have participated in the study. Data on socio-demographic characteristics, medical backgrounds, anthropometric measurements, biochemical, dietary intake, malnutrition risk, lifestyle, and total cholesterol level were obtained through face-to-face interviews and physical examination. Dietary intake was assessed using the two-day diet history. Mini Nutritional Assessment (MNA-SF) was used to determine the malnutrition risk of the subjects. Results: The prevalence of hypercholesterolemia among the subjects was 29.6% with a mean value of 4.08 ± 1.51 mmol/L. Comorbidities specifically dyslipidemia (χ2 =14.291, p≤0.0005), and other comorbidities (χ2 =7.843, p=0.005), waist circumference (r=0.199, p=0.033), LDL-C (r=0.455, p≤0.0005), triglyceride (r=0.459, p≤0.0005), fasting blood glucose (r=0.386, p≤0.0005), carbohydrate (r=-0.333, p≤0.0005), fat (r=0.327, p≤0.0005), saturated fat (r=0.304, p=0.001), PUFA (r=0.275, p=0.003), MUFA (r=0.327, p≤0.0005), sodium (r=0.211, p=0.024), and duration of physical activity (r=-0.287, p=0.002) were found to be significantly associated with the total cholesterol level. Meanwhile, other variables were found not to be associated. Conclusion: Current study reported the prevalence of hypercholesterolemia of 29.6%. Comorbidities specifically dyslipidemia and other comorbidities, waist circumference, LDL-C, TG, fasting blood glucose, carbohydrate, fat, saturated fat, PUFA, MUFA, sodium, and duration of physical activity were significantly associated with the total cholesterol level. Meanwhile, other variables were not significantly associated.

Determination of the prevalence of hypertension and factors associated with blood pressure among hospitalised elderly in Hospital Serdang, Selangor, Malaysia

@#Introduction: Increasing trends of hypertension has been recognised as a common disease among the elderly. This study aimed to determine the prevalence of hypertension and factors associated with blood pressure among hospitalised elderly. Methods: This was a cross-sectional study involving 124 patients in Hospital Serdang, Selangor, Malaysia. Data on socio-demography, medical background, anthropometry, blood biochemistry and lifestyle were collected through face-to-face interviews and medical records. Dietary intake was obtained through two days of food history. Malnutrition risks and stress level were determined using the Mini Nutritional Assessment Short-Form (MNA-SF) and the Geriatric Depression Scale (GDS). Results: There were 59.7% males and 40.3% females with mean age of 66.81±5.35 years. Majority were found to have hypertension (72.6%). Approximately 38.7% had normal body mass index (BMI). Most of them reported insufficient dietary intakes except for trans fats, sodium, and caffeine. Nearly 62.1% were engaged with physical activity, 23.4% were smoking, and 4.8% were taking alcohol. Approximately 66.1% and 86.3% were classified as having normal nutritional status and normal stress levels. In this study, the prevalence of hypertension among elderly patients warded in Hospital Serdang, Selangor was 72.6% and factors such as length of stay, number of co-morbidities, number of medications, having co-morbidities of hypertension, dyslipidaemia and diabetes mellitus, polypharmacy, height, BMI, fibre, polyunsaturated fat, dietary cholesterol, caffeine, and duration of physical activity were found to be associated with blood pressure. Conclusion: The present study found that majority of patients (72.6%) had hypertension. Future studies regarding factors associated with blood pressure are recommended.

Dietary Nutrient Intake and Meal-related Situations among Elderly Outpatients with Chronic Obstructive Pulmonary Disease from Respiratory Clinics, Malaysia

@#Introduction: Chronic obstructive pulmonary disease (COPD) patients usually have dietary problems leading to malnutrition issues. Therefore, this study aimed to determine macro and micronutrient intakes and meal-related situations among outpatients COPD elderly and its adequacy according to their requirements. Methods: 140 patients were included in this cross-sectional study at Respiratory Clinics of Hospital Serdang and Institut Perubatan Respiratori. Socio-demographic and health status data were collected by interviewing patients and reviewing their medical records. A three-day diet history (two-day on weekdays, one day on weekend) was analysed using Nutritionist Pro and compared against their requirements. Meal-related situation was assessed using three open-ended questions that related to food shopping, cooking and eating and analysed using content analysis. Results: Patients were 70±7 years old, 97% male, 59% Malay, 48% had primary education, 75% married, 72% ex-smokers and 54% presented with comorbidities. Majority of them had no episode of exacerbation for the past one year and in moderate stage of the COPD severity. Mean energy intake was 916±221 kcal/day with 98% of them have under-reported their intake. Almost all patients had inadequate macro and micronutrient intake; energy (97%), protein (97%), carbohydrate (86%), fat (99%), vitamin A (95%), C (86%), D (99%) and E (99%). The meal-related situation reported patients had difficulties with food shopping and preparation and problems during mealtime. Conclusion: COPD elderly reported inadequate intake of macro and micronutrients and had problems during mealtime. This indicates the need for Malaysian nutrition guidelines specific to COPD patients and nutrition intervention in the primary setting.

Factors associated with food choices among elderly: a scoping review

@#Introduction: The aging population is a matter of global concern. Age-related physiological, pathological, psychosocial, economic, cultural and environmental changes are common and may greatly influence the quality of life of the elderly. The aim of this review was to explore the determinants and motivations that drive the elderly in making food choices. Methods: The search strategy of this literature review used the PRISMA protocol. Potential literature that was related to food choices was identified using two different combinations of keywords and two major electronic search engines, namely Pubmed and Science Direct. The articles that were selected for this review had to be in the English language, open-accessed and published between January 2007 and December 2017. Results: From a search of 1398 articles, 15 articles (seven quantitative and eight qualitative) were identified that were related to food choices among the elderly. The key factor that determined food choices among the elderly population was identified to be health. Others included convenience, sensory appeal, price, early food experience and more. The limitations of these studies that were reported were the small sample size and the reliance on self-reporting. The conclusions that were drawn were for specific groups that were studied in this review should be extrapolated or generalised with caution. Conclusion: Strategies for intervention programmes should be undertaken in collaboration with health professionals, researchers, policymakers, and the food industry. Future research is needed in the elderly who have chronic diseases, are dependent or who have disabilities.

Health-related quality of life of elderly with chronic obstructive pulmonary disease from selected government institutions

@# Introduction: It is widely recognised that health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous studies were conducted among the younger adult population and there is limited information on the elderly population. This study aimed to determine the COPD assessment test (CAT) score in the elderly with COPD. Methods: This was a crosssectional study involving 140 elderly patients who had been diagnosed with COPD at two selected government institutions. Data on socio-demographic and health status were collected by interviewing patients and reviewing their medical records. The HRQOL was measured using CAT. The independence sample t-test and one-way ANOVA were conducted to compare the CAT scores with socio-demographic and health status. Results: The socio-demographic and health characteristics of the patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay (59%), married (75%), ex-smokers (72%), had attained primary education (48%), had co-morbidities (54%), no history of hospitalisation or visits to the emergency department due to COPD (57%), and were in moderate stage of airflow obstruction (53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were classified as having worst symptoms of COPD (93%) as they had high CAT score which was ≥ 10. Conclusion: Majority of the patients in this study had high scores of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared to non-smokers. More attention need to be given to these subgroups in order to increase their quality of life.

Association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with quality of life among elderly haemodialysis patients

@#Introduction: A compromised quality of life (QOL) as a result of haemodialysis (HD) is a rising global issue. Elderly HD patients face more challenges than younger counterparts. This study determined the association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with QOL, among elderly HD patients. Methods: A cross-sectional study was conducted among 112 HD elderly patients in selected dialysis centres in Selangor, Malaysia. The patients completed interview-based questionnaires on socio-demographic characteristics, risk of malnutrition (Dialysis Malnutrition Score, DMS), depression (Patient Health Questionaire-9, PHQ-9) and QOL (KDQOL-36). Anthropometric measurements, 24-hour dietary recall and food intake information were obtained from them and biochemical data from their medical records. Results: Just over half (50.9%) of the patients had a normal body mass index while 85.7% had optimal albumin levels. The proportion of patients who met the recommended energy and protein intakes were 19.0% and 3.4%, respectively. Patients were at moderate risk of malnutrition, had minimal depression level and perceived better QOL in terms of effects and symptoms of kidney disease. There was a significant positive correlation between protein intake and the physical domain of QOL (p=0.02) and negative correlation between risk of malnutrition with physical and mental composites of QOL (p<0.001). There was significant negative correlation between depression and physical composite, mental composite, burden, effects and the symptoms of kidney disease (p<0.001). Conclusion: The present findings provide better insight on QOL for future screening, preventive measures and intervention. Further investigation regarding factors associated with QOL among elderly patients is recommended.