Predictive Value of the GLIM Criteria in Chinese Community-Dwelling and Institutionalized Older Adults Aged 70 Years and Over.

OBJECTIVES: The Global Leadership Initiative on Malnutrition (GLIM) has recently published criteria for classifying malnutrition. This study investigated the associations between malnutrition and adverse outcomes, and identified which component(s) of the GLIM criteria is/are risk factor(s) of adverse outcomes in Chinese older adults. DESIGN: A prospective cohort study of Chinese older adults in a healthy ageing study. SETTING: Participants' place of residence. PARTICIPANTS: Community-dwelling and institutionalized Chinese older adults aged ≥70 years living in Hong Kong. MEASUREMENTS: Malnutrition at baseline was classified according to selected GLIM criteria. Adverse outcomes including poor self-rated health, functional limitation (Barthel Index), falls, frailty (FRAIL scale), hospitalization and mortality were assessed after a 3-year follow-up. Associations between malnutrition and components of selected GLIM criteria (weight loss, low body mass index (BMI), low muscle mass and disease burden) and each adverse outcome were examined using adjusted binary logistic regression and Cox proportional hazards model. Odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI) are presented. RESULTS: Data of 1576 community-dwelling (45.5% female, 78.1±6.5 years) and 427 institutionalized (69.6% female, 85.5±6.4 years) older adults were included at baseline. Among community-dwelling older adults, malnutrition was associated with frailty (n=899, OR: 2.44, 95% CI: 1.05-5.70) and mortality (n=1007, HR: 1.37, 95% CI: 1.12-1.66). No association was found for other outcomes. Among institutionalized older adults, malnutrition was not associated with any outcomes. Low BMI and low muscle mass were risk factors of frailty; while weight loss was a risk factor of mortality in community-dwelling older adults. Weight loss and disease burden were risk factors of mortality among institutionalized older adults. CONCLUSION: The association between malnutrition and frailty and mortality was observed in community but not in institutional settings. Further studies are required to draw more definitive conclusions on the use of GLIM criteria in institutional settings.

Effect of whole soy and purified daidzein on ambulatory blood pressure and endothelial function--a 6-month double-blind, randomized controlled trial among Chinese postmenopausal women with prehypertension.

BACKGROUND/OBJECTIVES: Although observational studies suggest that soy foods or isoflavones are cardio-protective, clinical trials on whole soy or isoflavone daidzein (one major isoflavone and the precursor of equol) on blood pressure (BP) and endothelial function (EF) are few and have not been specifically conducted among equol producers, a population most likely to benefit from soy treatment. SUBJECTS/METHODS: We performed a 6-month double-blind, randomized, placebo-controlled trial to examine the effect of whole soy (soy flour) or purified daidzein on BP and EF in prehypertensive or untreated hypertensive postmenopausal women verified to be equol producers. A total of 270 eligible women were recruited and randomized to either one of the three treatment groups, 40 g soy flour (whole soy group), 40 g low-fat milk powder+63 mg daidzein (daidzein group) or 40 g low-fat milk powder (active control group) daily, each given as a solid beverage powder for 6 months. The primary outcome measures were 24 h ambulatory BP (ABP) and EF assessed by flow-mediated dilation using brachial artery ultrasound. RESULTS: A total of 253 subjects completed the study according to protocol. Urinary isoflavones indicated good compliance with the interventions. Intention to treat and per-protocol analysis indicated that there was no significant difference in the 6-month changes or % changes in parameters of ABP and brachial flow-mediated dilation among the three treatment groups. A further subgroup analysis among hypertensive women (n=138) did not alter the conclusions. CONCLUSIONS: Whole soy and purified daidzein had no significant effect on BP and vascular function among equol-producing postmenopausal women with prehypertension or untreated hypertension.

Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults.

UNLABELLED: We pooled bone mineral density (BMD) data published in 91 articles including 139,912 Chinese adults and then established a national-wide BMD reference database at the lumbar spine and femur neck for Chinese adults. The prevalence of osteoporosis in the middle-aged and elderly Chinese population was also estimated. INTRODUCTION: Well-accepted reference value of BMD is lacking in Chinese. We established the reference database and assessed osteoporosis prevalence based on published literature conducted in the Mainland China, Taiwan, and Hong Kong Chinese. METHODS: We searched for all published articles indexed in MEDLINE, PubMed, CNKI, and SinoMed up to January 2013. We included cross-sectional studies that examined BMD using a dual-energy X-ray absorptiometry at the femur neck (FN) and/or lumbar spine (LS) in healthy adults. Overall age-specific mean (SD) BMD were pooled after standardization. RESULTS: Ninety-one studies including 51,906 males and 88,006 females (≥ 20 years) in 38 cities in China were included in this pooling study. Gender- and age-specific reference curves of standardized BMD (sBMD) at the LS and FN were constructed. The sBMD cutoffs for osteoporosis classification were 0.746 and 0.549 in women, and 0.680 and 0.568 g/cm(2) in men; age-standardized prevalence of osteoporosis was 23.9 % and 12.5 % in women and 3.2 % and 5.3 % in men aged ≥ 50 years at the LS and FN, respectively. Meta-regression analysis showed that greater age and altitude, lower latitude, smaller city size, earlier detection time, and random sample were correlated to lower sBMD in at least one gender-specific bone sites; the Hologic DXA produced a higher value of FN sBMD than the other two devices (Lunar and Norland). CONCLUSION: We have established a national-wide BMD reference database at the LS and FN for Chinese adults and estimated the prevalence of osteoporosis in the middle-aged and elderly Chinese population.

Longitudinal changes in physical activity levels over 5 years and relationship to cardiorespiratory fitness in Chinese midlife women.

AIM: Better understanding the impact of changes in physical activity levels on cardiorespiratory fitness, as measured by maximal oxygen uptake (VO(2max)) may inform preventive interventions. We aimed to determine longitudinal changes in physical activity levels over 5 years and the relationship between these changes with VO(2max) in a sample of Chinese midlife women. METHODS: A total of 184 Chinese women aged 50-64 years in Hong Kong were enrolled for this study. Physical activity was assessed with the modified Chinese Baecke questionnaire at baseline (2002-2004) and follow-up (2008-2009). VO(2max) was measured with a symptom-limited maximal exercise test on an electrically braked cycle ergometer at follow-up. RESULTS: Compared with subjects who were persistently inactive, those who were increasingly/persistently active had significantly higher levels of VO(2max) (P<0.05). Being persistently active was also independently associated with a high level of VO(2max) (OR: 4.4, 95%CI: 1.0-19.2). However, the rate of decline in VO(2max) with age was apparently greater in persistently active subjects compared with their persistently inactive peers, but the differences were not statistically significant. CONCLUSION: Our findings suggest that maintaining a high level of physical activity may lead to higher levels of VO(2max).

Sex differences in stroke incidence and survival in Hong Kong, 2000-2007.

BACKGROUND: Few studies have examined the impact of sex across different age groups and over time on chronic diseases in Asia. The objective of this study was to explore the effect of sex across different age groups and over time on stroke incidence and 30-day case fatality in Hong Kong. METHODS: Over 90% first hospitalizations for stroke in Hong Kong (from 2000 to 2007) were identified from the Clinical Management System of the Hospital Authority. Age-specific rate ratios (RRs; women to men) for incidence of first hospitalization and the 30-day case fatality were estimated based on Poisson regression models after adjustment for year of hospitalization. RESULTS: Women below the age of 85 years had a lower incidence of first hospitalization than men, and the effect size varied with age [35-44 years: RR = 0.56, 95% confidence interval (CI) = 0.49-0.64; 45-54 years: 0.65, 0.53-0.79; 55-64 years: 0.58, 0.48-0.71; 65-74 years: 0.71, 0.58-0.85; 75-84 years: 0.83, 0.68-1.00)]. Women aged ≥85 years had a stroke incidence similar to men, but the adjusted 30-day case fatality was significantly higher than that of men aged ≥85 years (RR = 1.14, 95% CI = 1.05-1.23). CONCLUSIONS: Lower rates of incidence were observed in women than men aged 35-84 years in Hong Kong but short-term case fatality is greater in women aged ≥85 years.

The effects of isoflavones combined with soy protein on lipid profiles, C-reactive protein and cardiovascular risk among postmenopausal Chinese women.

BACKGROUND & AIMS: Observational studies note that regular dietary soy protein intake (6-11 g day(-1)) has a significant association with lower blood lipids; however, these observations have not been confirmed by clinical trials. This study aimed to ascertain the effects of moderate intake of soy protein (15 g) with isoflavones or isoflavones alone on serum lipid profiles, inflammatory markers (C-reactive protein and uric acid) and composite cardiovascular risk in Chinese postmenopausal, prediabetic women. METHODS AND RESULTS: A double-blind randomised, placebo-controlled trial was conducted among 180 postmenopausal Chinese women with prediabetes or early untreated diabetes, aged 46-70 years and, on average, 6.0 years since menopause. Participants were randomly assigned to one of the three arms to receive 15-g soy protein and 100-mg isoflavone (Soy group), or 15-g milk protein and 100 mg isoflavone (Iso group) or 15-g milk protein (placebo group) on a daily basis for 6 months. The results showed that no significant difference was observed in serum high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), total cholesterol (TC), triaclyglycerol (TG), high sensitive C-reactive protein and a composite 10-year cardiovascular risk between the three groups at both 3 and 6 months. Serum uric acid marginally increased by 1.22% in the Soy group and decreased by 4.28% and 4.82% in the Iso and placebo groups at 3 months (P = 0.087), but no difference was observed at 6 months (P = 0.264). CONCLUSION: Soy protein with isoflavones or isoflavones alone at the provided dosage showed no significantly beneficial effects on measured cardiovascular risk factors in postmenopausal Chinese women with early hyperglycaemia.

Effect of dietary fiber intake on breast cancer risk according to estrogen and progesterone receptor status.

BACKGROUND/OBJECTIVES: There is few data on the association between dietary fiber intake and estrogen receptor (ER)/progesterone receptor (PR)-defined breast cancer risk. The present study aimed to investigate the associations between total dietary fiber and dietary fiber fractions intake and breast cancer risk by ER and PR status in a hospital-based case-control study among Chinese women. SUBJECTS/METHODS: Four hundred and thirty-eight cases with primary breast cancer were consecutively recruited from June 2007 to August 2008 and frequency matched to 438 controls by age (5-year interval) and residence (rural/urban). A validated food frequency questionnaire was used to assess the dietary intake through a face-to-face interview. Unconditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence interval (CI) after adjusting for various potential confounders. RESULTS: A statistically significant inverse association was found between total dietary fiber and fiber fractions intake and breast cancer risk. The adjusted ORs (95% CIs) for the highest versus the lowest quartile of intake were 0.31 (0.20-0.47) for total dietary fiber, 0.73 (0.48-1.11) for soy fiber, 0.48 (0.22-0.97) for vegetable fiber and 0.54 (0.31-0.92) for fruit fiber. No association was observed for cereal fiber intake and risk. An inverse association between dietary fiber intake and breast cancer risk was observed in ER+, ER-, PR+, ER+PR+ and ER-PR+ tumors. CONCLUSIONS: Our results suggest that consumption of total dietary fiber and fiber from vegetable and fruit was inversely associated with breast cancer risk. These inverse associations were more prominent in some subtypes of ER and PR breast cancers.

Menopausal transition and changes of body composition: a prospective study in Chinese perimenopausal women.

OBJECTIVES: Whether age or menopause per se influences fat distribution remains controversial. This study aimed to investigate the change of body composition, particularly body fat distribution, in relation to menopausal transition in a 30-month prospective study of perimenopausal women. METHODS: A total of 438 community-based healthy women aged 44-55 years participated in the Hong Kong Perimenopausal Women Osteoporosis Study. Data were obtained at baseline, and at 9-, 18- and 30-month during the follow-up. Soft tissue measurements consisting of fat mass and lean muscle mass of the trunk and whole body were obtained by the dual energy X-ray absorptiometry. Percentage change of body measurements over the follow-up period was compared between women who remained premenopausal, those who went through menopausal transition, and those who were menopausal since baseline. RESULTS: A slight decrease in the lean mass but an increase in the total fat mass and trunk fat mass (TFM) over the follow-up period were noted. Multivariate linear regression analysis showed that age was negatively associated with an increase in central obesity. Adjusted for the important predictors--age, age of menarche and education level, menopausal status was a significant and independent predictor of the decrease in lean mass and the increase in percent of body fat, TFM and trunk-leg fat mass ratio. CONCLUSION: Our 30-month longitudinal study showed that menopause has an independent effect on an increase in fat mass, and an increase in central obesity in perimenopausal Chinese women.

Acute gastroenteritis in Hong Kong: a population-based telephone survey.

A population-based telephone survey of acute gastroenteritis (AG) was conducted in Hong Kong from August 2006 to July 2007. Study subjects were recruited through random digit-dialing with recruitments evenly distributed weekly over the 1-year period. In total, 3743 completed questionnaires were obtained. An AG episode is defined as diarrhoea >or=3 times or any vomiting in a 24-h period during the 4 weeks prior to interview, in the absence of known non-infectious causes. The prevalence of AG reporting was 7%. An overall rate of 0.91 (95% CI 0.81-1.01) episodes per person-year was observed with women having a slightly higher rate (0.94, 95% CI 0.79-1.08) than men (0.88, 95% CI 0.73-1.04). The mean duration of illness was 3.6 days (S.D.=5.52). Thirty-nine percent consulted a physician, 1.9% submitted a stool sample for testing, and 2.6% were admitted to hospital. Of the subjects aged >or=15 years, significantly more of those with AG reported eating raw oysters (OR 2.4, 95% CI 1.3-4.4), buffet meals (OR 1.8, 95% CI 1.3-2.5), and partially cooked beef (OR 1.8, 95% CI 1.2-2.7) in the previous 4 weeks compared to the subjects who did not report AG. AG subjects were also more likely to have had hot pot, salad, partially cooked or raw egg or fish, sushi, sashimi, and 'snacks bought at roadside' in the previous 4 weeks. This first population-based study on the disease burden of AG in Asia showed that the prevalence of AG in Hong Kong is comparable to that experienced in the West. The study also revealed some 'risky' eating practices that are more prevalent in those affected with AG.

Higher sea fish intake is associated with greater bone mass and lower osteoporosis risk in postmenopausal Chinese women.

SUMMARY: We examined the cross-sectional association of the intakes of different types of fishes with bone mass and osteoporosis risk in postmenopausal Chinese women. We found that higher intake of sea fish is independently associated with greater bone mass and lower osteoporosis risk among postmenopausal Chinese women. INTRODUCTION: Fish contains many important nutrients that are beneficial on bone health, but limited data on the relationship between fish intake and bone health are available. We examined the association of the intakes of different types of fishes with bone mineral density (BMD) and bone mineral content (BMC) and osteoporosis risk. METHODS: This population-based cross-sectional study was conducted among 685 postmenopausal Chinese women. Habitual dietary intakes were assessed using food frequency questionnaire. BMD and BMC at the whole body, lumbar spine, and left hip were measured with dual-energy x-ray absorptiometry. RESULTS: After adjusting for the potential confounders, we observed dose-dependent relations between sea fish intake and BMDs, BMCs, and osteoporosis risk; the mean BMDs were 3.2-6.8% higher, and BMCs 5.1-9.4% higher in the top quintile groups (Q5) of sea fish intake than in the bottom quintile (Q1) at the whole body and hip sites (p < 0.05); the odds ratios (95% confidence interval (CI)) for osteoporosis (T-score < -2.5) in Q5 were 0.23 (0.08-0.66), 0.12 (0.03-0.59), and 0.06 (0.01-0.44) compared with those in Q1 at the whole body, total hip, and femur neck, respectively. No independent association between consumption of freshwater fish or shellfish and bone mass was observed. CONCLUSION: Higher intake of sea fish is independently associated with greater bone mass and lower osteoporosis risk among postmenopausal Chinese women.

A mild favorable effect of soy protein with isoflavones on body composition--a 6-month double-blind randomized placebo-controlled trial among Chinese postmenopausal women.

BACKGROUND: In vitro and animal studies suggested that soy protein and isoflavones promote weight and body fat loss. However, clinical trials in humans were few and the effects remained uncertain. OBJECTIVES: To examine whether soy protein with isoflavones and isoflavone extracts exert beneficial effects on body composition among postmenopausal women. DESIGN: A double-blind randomized placebo-controlled trial was conducted among 180 postmenopausal Chinese women with mild hyperglycemia. After a 2-week adaptation, participants were randomly assigned to one of the three arms to receive 15 g soy protein and 100 mg isoflavones (Soy group), or 15 g milk protein and 100 mg isoflavones (Iso group), or 15 g milk protein (placebo group) on a daily basis for 6 months. RESULTS: We observed a mild but significant favorable effect of soy protein with isoflavones on the changes of body weight (BW), body mass index, and body fat percentage relative to isoflavone extracts and milk protein after 6-month supplementation. The mean differences of BW between the Soy and the Iso groups were -0.75 kg (95% CI: -1.363 to -0.136, P=0.017), and between the Soy and the placebo groups were -0.60 kg (95% CI: -1.209 to -0.019, P=0.047). The mean difference of change percentage in body fat percentage between the Soy and the Iso groups was -3.74% (95% CI: -6.88 to -0.60%, P=0.02), and between the Soy and the placebo groups was -2.54% (95% CI: -5.69 to 0.12%. P=0.08). CONCLUSIONS: Six-month supplementation of soy protein with isoflavones had a mild favorable effect on body composition in postmenopausal women.

Cost-effectiveness analysis of influenza and pneumococcal vaccination for Hong Kong elderly in long-term care facilities.

BACKGROUND: To compare cost and quality-adjusted life-years (QALYs) gained by influenza vaccination with or without pneumococcal vaccination in the elderly living in long-term care facilities (LTCFs). METHODS: Cost-effectiveness analysis based on Markov modelling over 5 years, from a Hong Kong public health provider's perspective, on a hypothetical cohort of LTCF residents aged > or = 65 years. Benefit-cost ratio (BCR) and net present value (NPV) of two vaccination strategies versus no vaccination were estimated. The cost and QALYs gained by two vaccination strategies were compared by Student's t-test in probabilistic sensitivity analysis (10,000 Monte Carlo simulations). RESULTS: Both vaccination strategies had high BCRs and NPVs (6.39 and US$334 for influenza vaccination; 5.10 and US$332 for influenza plus pneumococcal vaccination). In base case analysis, the two vaccination strategies were expected to cost less and gain higher QALYs than no vaccination. In probabilistic sensitivity analysis, the cost of combined vaccination and influenza vaccination was significantly lower (p<0.001) than the cost of no vaccination. Both vaccination strategies gained significantly higher (p<0.001) QALYs than no vaccination. The QALYs gained by combined vaccination were significantly higher (p = 0.030) than those gained by influenza vaccination alone. The total cost of combined vaccination was significantly lower (p = 0.011) than that of influenza vaccination. CONCLUSION: Influenza vaccination with or without pneumococcal vaccination appears to be less costly with higher QALYs gained than no vaccination, over a 5-year period, for elderly people living in LTCFs from the perspective of a Hong Kong public health organisation. Combined vaccination was more likely to gain higher QALYs with lower total cost than influenza vaccination alone.

Change in bone mineral density and its determinants in pre- and perimenopausal Chinese women: the Hong Kong Perimenopausal Women Osteoporosis Study.

UNLABELLED: This 30-month study investigating bone change and its determinants in 438 perimenopausal Chinese women revealed that the fastest bone loss occurred in women undergoing menopausal transition but maintenance of body weight and physical fitness were beneficial for bone health. Soy protein intake also seemed to exert a protective effect. INTRODUCTION: This 30-month follow-up study aims to investigate change in bone mineral density and its determinants in Hong Kong Chinese perimenopausal women. METHODS: Four hundred and thirty-eight women aged 45 to 55 years were recruited through random telephone dialing and primary care clinic. Bone mass, body composition, lifestyle measurements were obtained at baseline and at 9-, 18- and 30-month follow-ups. Univariate and stepwise multiple regression analyses were performed with the regression coefficients of BMD/C (derived from baseline and follow-up measurements) as the outcome variables. Menopausal status was classified as pre- or postmenopausal or transitional. RESULTS: Menopausal status was the strongest determinant of bone changes. An annual bone loss of about 0.5% was observed among premenopausal, 2% to 2.5% among transitional, and about 1.5% in postmenopausal women. Multiple regression analyses, revealed that a positive regression slope of body weight was protective for follow-up bone loss at all sites. Number of pregnancy, soy protein intake and walking were protective for total body BMC. Higher baseline LM was also protective for neck of femur BMD. CONCLUSION: Maintenance of body weight and physical fitness were observed to have a protective effect on for bone loss in Chinese perimenopausal women.

Public health significance of the frailty index.

BACKGROUND: A quantifiable indicator of frailty would be very useful in assessing the health state of older populations, as well as enable the effect of interventions to be evaluated over time. METHODS: A total of 2032 people aged 70 years and over recruited by stratified random sampling, and information obtained regarding physical and functional health, and psychological factors. The frailty index (FI) was constructed from 62 variables. Associations between the FI, and changes in ADL score, mental score, and hospitalization days over a 10-year period were evaluated. RESULTS: For the baseline to 3-year changes, a 0.10 increase in baseline FI is accompanied by a 0.499-point faster drop in ADL score, a 0.223-point faster decline in mental score, and 4.57-day faster increase in hospital days. For 3-10-year changes, frailty was a significant predictor only of changes in mental score, with results indicating that, on average, each increase of 0.10 in the baseline frailty index was associated with 0.613-point drop in mental score during this period. Chronological age and frailty had differential associations with those changes. CONCLUSION: The FI is a valid indicator of morbidity and requirement for health and social services for ageing populations.

Validity of body mass index and waist circumference in the classification of obesity as compared to percent body fat in Chinese middle-aged women.

OBJECTIVE: To evaluate the validity of currently recommended obesity cutoffs of body mass index (BMI, in kg/m(2)) and waist circumference (WC, in cm) for Asians by the WHO/IASO/IOTF and for Chinese by the Working Group on Obesity in China (WGOC) using the percentage body fat (%BF)-obesity criteria. DESIGN: A cross-sectional study. SUBJECTS: A total of 1122 community-based Hong Kong Chinese women aged between 41 and 63 years. MEASUREMENTS: Total %BF and percent truncal fat (%TF) were measured using dual-energy X-ray absorptiometry. Anthropometric indices were measured using standard methods. RESULTS: Regression analyses showed that the BMI cutoffs of 23, 24, 25, and 28 kg/m(2) corresponded to the %BF of 34.8, 35.9, 36.9 and 39.5%, and the 80 cm WC corresponded to 34% TF, respectively. Compared with the %BF obesity cutoff (>/=40%), the WHO/IASO/IOTF BMI-obesity criterion (>/=25) shows a good sensitivity (75%) and specificity (71%); and the WGOC criterion (BMI>/=28) had a low sensitivity (41%) but an excellent specificity (93%), respectively. Corresponding to the BMI cutoffs of 23, 24, 25 and 28 kg/m(2), the %BF cutoffs associated with peak kappa statistic were 33, 34, 35 and 40%, and the relevant %TF linked with 80 cm WC was 33%, respectively. CONCLUSION: BMI and WC have a good accuracy in the prediction of obesity. Our findings suggest that the WGOC BMI cutoffs are appropriate, but 80 cm of WC is a very rigorous cutoff for this population when using the criteria of 34 and 40% of body fat or truncal fat for overweight and obesity.

Social determinants of frailty.

BACKGROUND: Frailty represents a body-wide set of a linked deterioration that occurs with ageing, but is susceptible to active intervention and is reversible. The concept of frailty should include broader environmental factors. A quantitative measure of frailty, the frailty index (FI), developed for elderly Canadians and shown to be valid for an elderly Chinese population, was examined for its association with socioeconomic, lifestyle, and social support network factors in an elderly Chinese cohort. OBJECTIVE: 2,032 people aged 70 years and over recruited by stratified random sampling of the population were surveyed in 1990-1991, and information obtained regarding physical and functional health, psychological factors, lifestyle, socioeconomic and social support factors. The FI was constructed from 62 variables covering cognitive, psychological and physical health, and tested for association with socioeconomic, lifestyle and social support factors using ANOVA and t test. RESULTS: The mean FI for women was higher than for men (0.16 +/- 0.08, n = 1,033 vs. 0.13 +/- 0.08, n = 999, p < 0.001, t test). For men, increasing frailty was observed with non-white collar occupations, inadequate expenses, no or little exercise, abstinence from alcohol, few relatives or neighbours and no or infrequent participation in helping others. For women, little contact with relatives (rather than number of relatives), and absence of participation in community/religious activities were additional factors. CONCLUSION: FI is influenced by social and environmental factors in keeping with the concept of frailty being multi-dimensional. Such a quantitative measure may be a useful indicator of the health of elderly populations as well as for public health measures to combat frailty.

Depression is the predominant factor contributing to morale as measured by the Philadelphia Geriatric Morale Scale in elderly Chinese aged 70 years and over.

OBJECTIVE: To examine factors contributing to the total Philadelphia Geriatric Morale Scale (PGMS) and its two subscales: reconciled ageing and unstrained affect. METHOD: The PGMS was administered to 759 community-living subjects aged 70 years and over. Information regarding socioeconomic status, health conditions, sensory impairment, physical symptoms, social support, activities of daily living as measured by the Barthel Index, life satisfaction, and the Geriatric Depression Score, was collected. Associations between these factors and PGMS and its subscale were examined using univariate analysis (Mann-Whitney; Kruskal-Wallis tests), and multivariate analysis using the classification and regression tree (CART) method. RESULTS: Gender, old age, physical, socioeconomic and social factors were significantly associated with PGMS. There was a strong correlation with GDS (r = 0.77, p < 0.001). In the CART analysis, for both subscales and the total score, GDS was the predominant factor contributing to the score. Other factors include self perception of health, enough expenses, overall satisfaction with life, gender, and constipation. DISCUSSION: The PGMS and GDS are closely related. In addition to the GDS, health perception, life satisfaction, and adequate finance were factors contributing to quality of life in elderly Hong Kong Chinese.