Cognitive frailty and its association with depression, anxiety and stress during the COVID-19 pandemic among older adults in the transforming cognitive frailty into later-life self-sufficiency (AGELESS) study.

BACKGROUND: Cognitive frailty describes the co-occurrence of cognitive impairment and physical frailty and is classified into reversible and irreversible phenotypes. Data on the impact of COVID-19 pandemic imposed lockdowns, locally known as the Movement Control Order (MCO), on the psychological status of cognitively frail older adults remain scarce. Therefore, this study aimed to determine the relationship between depression, anxiety, stress and cognitive frailty among older adults during the MCO. METHOD: Participants aged above 60 years from three ageing cohorts in Malaysia were interviewed virtually. The Fatigue, Resistance, Ambulation, Illness and Loss of Weight scale, blind Montreal Cognitive Assessment, 15-item Geriatric Depression Scale, anxiety subscale of Depression, Anxiety and Stress Scale and four-item Perceived Stress Scale measured frailty, mild cognitive impairment (MCI), depression, anxiety and stress, respectively. RESULTS: Cognitive frailty data were available for 870 participants, age (mean ± SD) = 73.44 ± 6.32 years and 55.6% were women. Fifty-seven (6.6%) were robust, 24 (2.8%) had MCI, 451 (51.8%) were pre-frail, 164 (18.9%) were pre-frail+MCI, 119 (13.7%) were frail and 55 (6.3%) were frail+MCI. There were significant differences in depression and anxiety scores between the controlled MCO and recovery MCO. Using multinomial logistic regression, pre-frail (mean difference (95% confidence interval, CI) = 1.16 (0.932, 1.337), frail (1.49 (1.235, 1.803) and frail+MCI (1.49 (1.225, 1.822)) groups had significantly higher depression scores, frail (1.19 (1.030, 1.373)) and frail+MCI (1.24 (1.065, 1.439)) had significantly higher anxiety scores and pre-frail (1.50 (1.285, 1.761)), frail (1.74 (1.469, 2.062)) and frail+MCI (1.81 (1.508, 2.165)) had significantly higher stress scores upon adjustments for the potential confounders. The MCO was a potential confounder in the relationship between depression and prefrail+MCI (1.08 (0.898, 1.340)). CONCLUSION: Frail individuals with or without MCI had significantly higher depression, anxiety and stress than those who were robust. Increased depression and stress were also observed in the pre-frail group. Interventions to address psychological issues in older adults during the COVID-19 pandemic could target prefrail and frail individuals and need further evaluation.

Development of Virtual Surveys for the COVID-19 Wave of the AGELESS Longitudinal Study in Malaysia.

BACKGROUND: Rapid population aging occurring in developing nations necessitates innovation to ensure we continue to gain ground on aging research despite pandemic threats. While developed nations have resorted to virtual communications, this is challenging in developing nations due to poor internet connectivity and digital literacy. OBJECTIVES: The aim of this study was to determine the feasibility of virtual data collection for a longitudinal study of aging assessing cognitive frailty in a middle-income Southeast Asian country. METHODS: The Transforming Cognitive Frailty into Later-Life Self-Sufficiency (AGELESS) longitudinal study of aging involved community-dwelling participants aged 60 years and above. A semi-structured focus group discussion was conducted via videoconferencing with selected representatives from existing participants. The survey instrument was compiled during a hybrid meeting and refined using a virtual Delphi process involving 51 AGELESS investigators. The final draft survey and recruitment strategy were then piloted among selected participants. RESULTS: Twelve individuals participated in the virtual focus group interview. Smartphone, tablet computer, laptops, and desktop personal computers were used for information gathering, communication, banking, shopping, leisure, religion, and education, within this group. The survey instrument was redacted from 362 items in 18 sections to 141 items in 12 sections through 3 virtual Delphi rounds facilitated by email, social media messaging, and videoconferencing which attracted 213 comments. Of 45 participants selected for the pilot survey, 30 were successfully contacted after one attempt and 18 completed the survey. Cognitive frailty was present in 13%, cognitive impairment in 20%, frailty in 20%, and 47% were robust. CONCLUSION: A virtual survey instrument was developed for the AGELESS longitudinal survey of aging which was vital for determining the effects of the COVID-19 pandemic on our older population as well as sustaining research into aging despite barriers posed by the pandemic.

Social networks moderate the association between physical fitness and cognitive function among community-dwelling older adults: a population-based study.

BACKGROUND: Physical fitness declines with age. Low levels of physical fitness appear to be a risk factor of cognitive impairment. Literature elucidates social networking as a potential moderator for the relationship between physical fitness and cognitive impairment. Present study aimed to examine the relationship between physical fitness and cognitive function among community-dwelling older Malaysians, and if social network moderates said relationship. METHODS: Data of 2322 representative community-dwelling older adults were obtained from the first wave of the "Longitudinal Study on Neuroprotective Model for Healthy Longevity" national survey. Cognitive function, physical fitness and social network was assessed through Malay-version of Mini-Mental State Examination, 2-min step test and Lubben Social Network Scale-6 respectively. Moderated hierarchical multiple regression was employed to investigate if social networks moderate the relationship between physical fitness and cognitive function. RESULTS: A positive association between physical fitness and cognitive function were found upon controlling for covariates. Moderated hierarchical multiple regression revealed social networks to be a moderator of the association between physical fitness and cognitive function. When physical fitness was low, those with small social network revealed lowest cognitive function. CONCLUSIONS: Social networks moderated the relationship between physical fitness and cognitive function as older adults with low levels of physical fitness and small social networks revealed lowest cognitive function. Therefore, community support or peer-based interventions among physically unfit older adults should be implemented to promote cognitive function.

The intersectional effects of ethnicity/race and poverty on health among community-dwelling older adults within multi-ethnic Asian populace: a population-based study.

BACKGROUND: Ethnicity/race and poverty are among determinants of health in older persons. However, studies involving intersectional effects of ethnicity/race and poverty on health of older adults within multi-ethnic Asian populace is limited. Hence, this study aimed to examine the intersectional effects of ethnicity/race and poverty on cognitive function, depressive symptoms, and multimorbidity among community-dwelling older adults in Malaysia. METHODS: Data were obtained from the first wave of a Peninsular Malaysia national survey - "Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly". Log-binomial regression was used to identify intersectional effects and associations between control variables and health outcomes. A comparison between Malay and non-Malay older adults within the same poverty group, as well as hardcore poor and non-hardcore poor older people within the same ethnicity groups, were conducted to understand the intersectional effects of ethnicity/race and poverty on health. RESULTS: Prevalence of cognitive impairment was highest among hardcore poor Malay group, while the risk of depression and multimorbidity were highest among hardcore poor non-Malays. In the hardcore poor group, Malay ethnicity was associated with higher prevalence of cognitive impairment but lower prevalence of depression risk and multimorbidity. In the Malay group, hardcore poor was associated with higher prevalence of cognitive impairment; however, no association was found between hardcore poor with depression risk and multimorbidity after controlling for covariates. CONCLUSIONS: Health outcomes of Malaysian older adults differ according to ethnicity and socioeconomic status. Given the importance of demographic characteristics on health outcomes, design of interventions targeting older adults within multi-ethnic settings must address specific characteristics, especially that of ethnicity and sociodemographic status so as to fulfil their needs. Several implications for future practice were discussed.

Relationship between financial well-being, life satisfaction, and cognitive function among low-income community-dwelling older adults: the moderating role of sex.

BACKGROUND: Low financial well-being is a common predicament among older adults living in poverty. The existing literature suggests a correlation between financial well-being and mental health in old age. Therefore, this study aimed to identify the relationships among financial well-being, life satisfaction, and cognitive function among low-income older adults and to examine the moderating effect of sex on these relationships. METHODS: This study involved 2004 nationally representative community-dwelling older Malaysians from the bottom 40% household income group. Financial well-being was assessed by the four-item financial satisfaction scale, while life satisfaction was measured by the Satisfaction with Life Scale. Cognitive function was measured by using the Malay version of the Mini-Mental State Examination. Hierarchical multiple regression was used as the prime method for statistical analysis. RESULTS: Financial well-being was positively associated with life satisfaction and cognitive function. Sex moderated the relationship between financial well-being and life satisfaction but not between financial well-being and cognitive function. CONCLUSIONS: Financial well-being and life satisfaction were strongly correlated among older women, although no gender difference was found for the relationship between financial well-being and cognitive function. It appears financial well-being strongly predicts mental health. As such, poverty eradication initiatives targeting low-income older adults should be implemented to sustain life satisfaction and cognitive function.

Mediational Role of Self-efficacy between Selected Bio-psychosocial Factors and Elder Self-Neglect among Community-Dwelling Older Malaysian Adults.

Elder abuse and neglect have been reported as significant public health and societal problem in many different societies across the world. In Malaysia, older adults recorded a high prevalence of neglect compared to other types of elder abuse. There is a dearth of empirical work on elder self-neglect (ESN) among the older population in Malaysia. This paper aims to explore the mediational role of self-efficacy on the relationship between selected biopsychosocial factors and ESN among community-living older adults in Selangor, Malaysia. This study utilized a cross-sectional survey to gather data from a representative sample of 202 older adults from Selangor. A newly developed scale of 16-items of elder self-neglect (ESN) was used in this study. The results showed that self-efficacy partially mediated the association between ADL, IADL, depression, and capacity of self-care on ESN. Self-efficacy also fully mediated the association between neuroticism, life satisfaction, social network, and education on ESN. These findings provided a deeper understanding of the phenomenon of self-neglect among older Malaysian adults. The results will also serve as a useful reference for professionals and policymakers to develop uniform guidelines, protocols, or programs to handle cases of elder self-neglect in the community.

Emotional regulation as a mediator between the filial behaviour of the oldest son and subjective well-being of older parents in Pakistan.

BACKGROUND: The link between the filial behaviour of an adult child and older parents' well-being is well entrenched, and theoretical evidence has indicated that it may be mediated by emotional regulation. Therefore, the current study aimed to examine whether emotional regulation (i.e. cognitive reappraisal and suppression) mediates the association between filial behaviour of the oldest son (i.e. the filial behaviour of respect and filial behaviour of daily maintenance) and subjective well-being in older parents. METHODS: This correlational study recruited 400 community-dwelling older parents in Rawalpindi Pakistan through a multistage cluster random sampling technique. Subjective well-being was measured by Concise Measure of Subjective Well-being; filial behaviour was examined through receipt of 12 domains; emotional regulation was assessed by using the Emotional Regulation Questionnaire. The structural equation modelling was employed to test the mediation effects. RESULTS: Cognitive reappraisal was found to partially mediate the relationship between filial behaviour of respect and subjective well-being (ß in direct model = 0.661, P < 0.000; ß in full mediational model = 0.327, P < 0.000), but it failed to mediate between filial behaviour of daily maintenance and subjective well-being (ß in direct model = 0.080, P = 0.149; ß in full mediational model = 0.030, P = 0.362). Moreover, suppression did not exert mediation effects in the associations between the filial behaviour of respect and subjective well-being (ß = 0.003, P = 0.338); and filial behaviour of daily maintenance and subjective well-being (ß = -0.004, P = 0.221). CONCLUSIONS: Taken together, the results suggest that different dimensions of the filial behaviour of the oldest son exert differential effects on emotional regulation and subjective well-being in older parents. Based on the current findings, there is a need to develop adaptive emotional regulatory capacity intervention programs for the development and enhancement of subjective well-being in older parents within their familial context.

Factors associated with poor socioeconomic status among Malaysian older adults: an analysis according to urban and rural settings.

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

Association between oral health-related quality of life and nutritional status among older adults in district of Kuala Pilah, Malaysia.

BACKGROUND: Poor oral health has an impact on food choices and intake of important nutrients among older population. The use of oral health-related quality of life instruments along with the clinical dental indicators can help to assess the oral problems that lead to nutritional problems in this group. This study aims to determine the association between oral health-related quality of life (OHRQoL) and nutritional status among a group of older adults in Kuala Pilah district, Malaysia. METHODS: A cross-sectional study was carried out on 446 older adults aged 50 years and above from 20 randomly selected villages. Respondents were interviewed to collect information on their demographic characteristics and oral health perception, followed by physical examination to measure height, weight and body mass index (BMI) of respondents. The validated Malay version of General Oral Health Assessment Index (GOHAI) was used to measure OHRQoL. RESULTS: About one-third (35.8%) of the respondents had normal BMI. Majority of the respondents were overweight (40.4%) and obese (19.9%), while only a small proportion was underweight (3.9%). Mean GOHAI score was 53.3 (SD = 4.7), indicating low perception of oral health. About 81.6% respondents had moderate to low perception of oral health. Logistic regression analysis showed a statistically significant association between the GOHAI and BMI scores (OR = 2.3; p < 0.01). CONCLUSIONS: Oral health-related quality of life was significantly associated with nutritional condition of respondents. Older adults with poor perception of their oral health were more likely to have unsatisfactory BMI compared to those who perceived their oral health to be good.

Reproductive factors influencing bone mineral density in postmenopausal women.

This study examined the relationship between reproductive characteristics and bone mineral density (BMD) in postmenopausal women who had been referred to the menopause clinics of the National Population and Family Development Board and of the Hospital Kuala Lumpur from July 2011 to January 2012. The participants of this study were 201 postmenopausal Malaysian women aged 45-71 years. Some socio-demographic, lifestyle, and reproductive factors were recorded. Calcaneal BMD was measured by quantitative ultra-sonography. Correlations of reproductive factors with BMD were assessed by Pearson's correlation test and multiple regression analysis. Age at menopause was not significantly correlated with BMD, while the years after menopause, age at the first menstrual period, number of pregnancies, and total lactation periods were inversely correlated with it. Among reproductive factors, only the association between lactation duration and BMD remained significant after adjusting for age, body mass index, activity, and calcium intake. The results indicated that except for prolonged total time of lactation, other reproductive factors were not significantly associated with BMD in postmenopausal women.

What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: There is strong research evidence for falls prevention among older people in the community setting, although most is from Western countries. Differences between countries (eg sunlight exposure, diet, environment, exercise preferences) may influence the success of implementing falls prevention approaches in Asian countries that have been shown to be effective elsewhere in the world. The aim of this review is to evaluate the scope and effectiveness of falls prevention randomized controlled trials (RCTs) from the Asian region. METHOD: RCTs investigating falls prevention interventions conducted in Asian countries from (i) the most recent (2012) Cochrane community setting falls prevention review, and (ii) subsequent published RCTs meeting the same criteria were identified, classified and grouped according to the ProFANE intervention classification. Characteristics of included trials were extracted from both the Cochrane review and original publications. Where ≥2 studies investigated an intervention type in the Asian region, a meta-analysis was performed. RESULTS: Fifteen of 159 RCTs in the Cochrane review were conducted in the Asian region (9%), and a further 11 recent RCTs conducted in Asia were identified (total 26 Asian studies: median 160 participants, mean age:75.1, female:71.9%). Exercise (15 RCTs) and home assessment/modification (n = 2) were the only single interventions with ≥2 RCTs. Intervention types with ≥1 effective RCT in reducing fall outcomes were exercise (6 effective), home modification (1 effective), and medication (vitamin D) (1 effective). One multiple and one multifactorial intervention also had positive falls outcomes. Meta-analysis of exercise interventions identified significant benefit (number of fallers: Odds Ratio 0.43 [0.34,0.53]; number of falls: 0.35 [0.21,0.57]; and number of fallers injured: 0.50 [0.35,0.71]); but multifactorial interventions did not reach significance (number of fallers OR = 0.57 [0.23,1.44]). CONCLUSION: There is a small but growing research base of falls prevention RCTs from Asian countries, with exercise approaches being most researched and effective. For other interventions shown to be effective elsewhere, consideration of local issues is required to ensure that research and programs implemented in these countries are effective, and relevant to the local context, people, and health system. There is also a need for further high quality, appropriately powered falls prevention trials in Asian countries.

Moderating effect of intrinsic religiosity on the relationship between depression and cognitive function among community-dwelling older adults.

OBJECTIVES: Research has found that depression in later life is associated with cognitive impairment. Thus, the mechanism to reduce the effect of depression on cognitive function is warranted. In this paper, we intend to examine whether intrinsic religiosity mediates the association between depression and cognitive function. METHOD: The study included 2322 nationally representative community-dwelling elderly in Malaysia, randomly selected through a multi-stage proportional cluster random sampling from Peninsular Malaysia. The elderly were surveyed on socio-demographic information, cognitive function, depression and intrinsic religiosity. A four-step moderated hierarchical regression analysis was employed to test the moderating effect. Statistical analyses were performed using SPSS (version 15.0). RESULTS: Bivariate analyses showed that both depression and intrinsic religiosity had significant relationships with cognitive function. In addition, four-step moderated hierarchical regression analysis revealed that the intrinsic religiosity moderated the association between depression and cognitive function, after controlling for selected socio-demographic characteristics. CONCLUSION: Intrinsic religiosity might reduce the negative effect of depression on cognitive function. Professionals who are working with depressed older adults should seek ways to improve their intrinsic religiosity as one of the strategies to prevent cognitive impairment.

Predicting cognitive function of the Malaysian elderly: a structural equation modelling approach.

OBJECTIVES: The aim of this study was to identify the predictors of elderly's cognitive function based on biopsychosocial and cognitive reserve perspectives. METHOD: The study included 2322 community-dwelling elderly in Malaysia, randomly selected through a multi-stage proportional cluster random sampling from Peninsular Malaysia. The elderly were surveyed on socio-demographic information, biomarkers, psychosocial status, disability, and cognitive function. A biopsychosocial model of cognitive function was developed to test variables' predictive power on cognitive function. Statistical analyses were performed using SPSS (version 15.0) in conjunction with Analysis of Moment Structures Graphics (AMOS 7.0). RESULTS: The estimated theoretical model fitted the data well. Psychosocial stress and metabolic syndrome (MetS) negatively predicted cognitive function and psychosocial stress appeared as a main predictor. Socio-demographic characteristics, except gender, also had significant effects on cognitive function. However, disability failed to predict cognitive function. CONCLUSION: Several factors together may predict cognitive function in the Malaysian elderly population, and the variance accounted for it is large enough to be considered substantial. Key factor associated with the elderly's cognitive function seems to be psychosocial well-being. Thus, psychosocial well-being should be included in the elderly assessment, apart from medical conditions, both in clinical and community setting.

Prevalence of hypotension and its association with cognitive function among older adults.

BACKGROUND AND OBJECTIVE: The negative effect of hypertension has overshadowed possible health problems associated with hypotension. The purposes of this study were to describe the prevalence of hypotension in older adults and to determine the association between hypotension and cognitive function, after adjusting for possible covariates. METHODOLOGY: The data for the study consisting of 1067 community-dwelling older adults were obtained from a national survey entitled "Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly", conducted in Malaysia. The hypotension was considered as blood pressure <120/75 mm Hg, measuring by standard mercury manometer. Data analysis was performed using the SPSS Version 22.0. RESULTS: The mean age of the respondents was 68.27 (SD = 5.93). Mean score of cognitive function as measured by MMSE was 22.70 (SD = 4.95). The prevalence of hypotension was 29.3%. The prevalence of cognitive impairment for hypotension group was 25.6%. Results of multiple linear regression analysis revealed that hypotension is negatively associated with cognitive function (Beta = -0.11, p<.01), after adjusting for age, gender, education, marital status, employment status, diabetes, heart disease, stroke and gastritis. CONCLUSION: The study showing hypotension is significantly associated with decreased cognitive function in later life, implies more attention to low blood pressure in old age.

Predictors of poor cognitive status among older Malaysian adults: baseline findings from the LRGS TUA cohort study.

BACKGROUND: Concepts of successful aging (SA), usual aging (UA), and mild cognitive impairment (MCI) have been developed to identify older adults at high risk of Alzheimer's diseases (AD), however, the predictors have rarely been investigated in a single study. Thus, this study aims to explore the risk factors of MCI as compared to UA and SA among older adults, in a large community based cohort study in Malaysia. METHOD: 1993 subjects from four states in Malaysia were recruited. A comprehensive interview-based questionnaire was administered to determine socio-demographic information, followed by assessments to evaluate cognitive function, functional status, dietary intake, lifestyle and psychosocial status. Risk factors of cognitive impairment were assessed using the ordinal logistic regression (OLR). RESULT: The prevalence of SA, UA and MCI in this study was 11, 73 and 16 % respectively. OLR indicated that higher fasting blood sugar, hyperlipidemia, disability, lower education level, not regularly involved in technical based activities, limited use of modern technologies, lower intake of fruits and fresh fruit juices and not practicing calorie restriction were among the risk factors of poor cognitive performance in this study. CONCLUSION: This study will be a stepping stone for future researchers to develop intervention strategies to prevent cognitive decline.

Approaches in methodology for population-based longitudinal study on neuroprotective model for healthy longevity (TUA) among Malaysian Older Adults.

A number of longitudinal studies on aging have been designed to determine the predictors of healthy longevity, including the neuroprotective factors, however, relatively few studies included a wide range of factors and highlighted the challenges faced during data collection. Thus, the longitudinal study on neuroprotective model for healthy longevity (LRGS TUA) has been designed to prospectively investigate the magnitude of cognitive decline and its risk factors through a comprehensive multidimensional assessment comprising of biophysical health, auditory and visual function, nutrition and dietary pattern and psychosocial aspects. At baseline, subjects were interviewed for their status on sociodemographic, health, neuropsychological test, psychosocial and dietary intake. Subjects were also measured for anthropometric and physical function and fitness. Biospecimens including blood, buccal swap, hair and toenail were collected, processed and stored. A subsample was assessed for sensory function, i.e., vision and auditory. During follow-up, at 18 and 36 months, most of the measurements, along with morbidity and mortality outcomes will be collected. The description of mild cognitive impairment, successful aging and usual aging process is presented here. A total 2322 respondents were recruited in the data analysis at baseline. Most of the respondents were categorized as experiencing usual aging (73 %), followed by successful aging (11 %) and mild cognitive impairment (16 %). The LRGS TUA study is the most comprehensive longitudinal study on aging in Malaysia, and will contribute to the understanding of the aging process and factors associated with healthy aging and mental well-being of a multiethnic population in Malaysia.

Portrait representation of postmenopausal women's experiences of living with urinary incontinence.

This study explored the meaning of the experiences of community-dwelling postmenopausal women who were born and grew up in a Muslim country when drawing a picture about their lived experiences of urinary incontinence. Hermeneutic phenomenology underpinned the study's interpretive research approach. In-depth, semistructured interviews were conducted in two sessions with nine postmenopausal women. The participants were asked to draw a picture about their lived experiences of urinary incontinence in a self-portrait. Three themes emerged to illuminate the meaning of urinary incontinence, including "disruption of normal functioning," "self-imposed restrictions," and "feeling of despair." Discussion of these themes was presented, and practice and research implications were suggested.

Home based exercise to improve turning and mobility performance among community dwelling older adults: protocol for a randomized controlled trial.

BACKGROUND: Turning is a common activity for older people, and is one of the activities commonly associated with falls during walking. Falls that occur while walking and turning have also been associated with an increased risk of hip fracture in older people. Despite the importance of stability during turning, there has been little focus on identifying this impairment in at risk older people, or in evaluating interventions aiming to improve this outcome. This study will evaluate the effectiveness of a 16 week tailored home based exercise program in older adults aged (50 years and above) who were identified as having unsteadiness during turning. METHODS/DESIGN: A single blind randomized controlled trial will be conducted, with assessors blind to group allocation. Study participants will be aged 50 years and above, living in the community and have been identified as having impaired turning ability [outside of age and gender normal limits on the Step Quick Turn (180 degree turn) task on the Neurocom® Balance Master with long plate]. After a comprehensive baseline assessment, those classified as having balance impairment while turning will be randomized to intervention or control group. The intervention group will receive a 16 week individualized balance and strength home exercise program, based on the Otago Exercise Program with additional exercises focused on improving turning ability. Intervention group will attend four visit to the assessment centre over 16 weeks period, for provision, monitoring, modification of the exercise and encourage ongoing participation. Participants in the control group will continue with their usual activities. All participants will be re-assessed on completion of the 16 week program. Primary outcome measures will be the Step Quick Turn Test and Timed-Up and Go test. Secondary outcomes will include other clinical measures of balance, psychological aspects of falls, incidence of falls and falls risk factors. DISCUSSION: Results of this study will provide useful information for clinicians on the types of exercises to improve turning ability in older people with increased falls risk and the effectiveness of these exercises in improving outcomes. TRIAL REGISTRATION: ACTRN12613000855729.

Gender as a moderator of the relation among social support functions and life satisfaction in older Malaysians.

The aim of this study was to examine the moderating role of gender on relations among social support functions and life satisfaction in older Malaysians. The study sample was 1,800 older residents in a community; all were at least 60 years old. This study was a cross-sectional and corelational survey, and the data were collected by multistage stratified sampling. This study revealed that fewer social support functions, and therefore less life satisfaction, were available for females than for males. The results of moderated regression analyses demonstrated that gender interacted only on the relationship between positive social interaction support and tangible support with life satisfaction. Specifically, at a high tangible support level, females had lower life satisfaction when compared to a low tangible support level. There may be a need for new programs and services to provide other aspects of social support to older female adults to improve and maintain life satisfaction in later life.

Characterization of social frailty domains and related adverse health outcomes in the Asia-Pacific: a systematic literature review.

Background: Frailty is a significant healthcare challenge worldwide, increasing interest in developing more assessment tools covering for frailty. Recently, there has been a growing awareness of a correlation between social variables and frailty in older people. However, there is a lack of understanding of the social domains of frailty and the related adverse outcomes, particularly in the Asia-Pacific settings. This study aimed to characterize the social frailty domains and their health outcomes by overviewing the frailty screening tools in older people living in the Asia-Pacific region. Methodology: A systematic review, using the PRISMA guideline, was conducted on articles published between 2002 and 2023 from three electronic databases: PubMed, Scopus, and ScienceDirect. A manual search was conducted for the references of the included articles using Google Scholar. Included articles must be in English and were based on empirical evidence published in peer-reviewed journals and focus on the assessment of domains of social frailty in older people aged 60 or over in the Asia-Pacific (East Asia, Southeast Asia, and Oceania). Result: A total of 31 studies were included in the thematic analysis, from which 16 screening tools measuring six social domains were reviewed. The six domains were: social networks, followed by social activities, social support, financial difficulties, social roles, and socioeconomic, arranged in four categories: social resources, social needs, social behaviors (or social activities), and general resources. The six social domains predicted mortality, physical difficulties, and disability incidence. Other adverse health outcomes were also associated with these social domains, including cognitive disorders, mental illness, and nutritional disorders (n = 5 domains each), dementia (n = 4 domains), and oral frailty, hearing loss, obesity, and chronic pain (n = 3 domains each). Conclusion: Overall, social frailty is a complex construct with multiple dimensions, including the frailty of social and general resources, social behaviors, and social needs, leading to several health disorders. The findings contribute to understanding the conceptual framework of social frailty in older people and its related health outcomes. Therefore, it could facilitate professionals and researchers to monitor and reduce the risks of adverse health outcomes related to each domain of social frailty, contributing to a better aging process.