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.

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.

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.

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.

The association between religious orientation and life satisfaction in older adults living with morbidity and multimorbidity: a gender perspective in Malaysia.

BACKGROUND: Little is known about gender differences in the relationship between religious orientation and life satisfaction in older adults living with chronic disease(s). Therefore, the purpose of this article was to examine the moderating effect of gender on the association between religious orientation and life satisfaction in older adults living with morbidity and multimorbidity. METHODS: The study involved 1790 community-dwelling older adults aged 60 and above living with at least one chronic medical condition. The Satisfaction with Life Scale and Revised Intrinsic/Extrinsic Religious Orientation Scale were used to measure life satisfaction and religious orientation. Moderated hierarchical multiple regression was used to test the moderation effect. RESULTS: Results showed that while intrinsic religiosity was positively associated with life satisfaction, extrinsic religiosity was found to have a negative relationship with life satisfaction. Gender moderated the association between intrinsic religiosity and life satisfaction. CONCLUSIONS: The findings suggested that the positive impact of intrinsic religiosity on life satisfaction was stronger in older women living with morbidity and multimorbidity. Healthcare practitioners can help disadvantaged older women in identifying their religious values and practices to improve their subjective wellbeing.

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.

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.

Application of the European quality indicators for psychosocial dementia care in long-term care facilities in the Asia-Pacific region: a pilot study.

OBJECTIVES: An Asia-Pacific regional collaboration group conducted its first multi-country research project to determine whether or not European quality indicators (QIs) for psychosocial care in dementia could be implemented as a valid tool in residential aged care across seven Asia-Pacific sites (Australia, Hong Kong Special Administrative Region, Mainland China, Malaysia, Singapore, South Korea, and Thailand). METHOD: Following the European QI protocol, auditing and data extraction of medical records of consenting residents with dementia were conducted by trained auditors with relevant health care backgrounds. Detailed field notes by the auditors were also obtained to describe the characteristics of the participating care facilities, as well as key issues and challenges encountered, for each of the 12 QIs. RESULTS: Sixteen residential care facilities in the seven Asia-Pacific sites participated in this study. Data from 275 residents' records revealed each of the 12 Qis' endorsement varied widely within and between the study sites (0%-100%). Quality of the medical records, family and cultural differences, definitions and scoring of certain indicators, and time-consuming nature of the QI administration were main concerns for implementation. CONCLUSION: Several items in the European QIs in the current format were deemed problematic when used to measure the quality of psychosocial care in the residential aged care settings in participating Asia-Pacific countries. We propose refinements of the European QIs for the Asian-Pacific context, taking into account multiple factors identified in this study. Our findings provide crucial insights for future research and implementation of psychosocial dementia care QIs in this region.

Information processing speed as a mediator between psychosocial stress and global cognition in older adults.

BACKGROUND: The link between psychosocial stress and cognitive function is complex, and previous studies have indicated that it may be mediated by processing speed. Therefore, the main aim of this study was to examine whether processing speed mediates the association between psychosocial stress and global cognition in older adults. Moreover, the moderating role of gender in this model is examined as well. METHODS: The study included 2322 community-dwelling older adults in Malaysia who were randomly selected through a multistage proportional cluster random sampling technique. Global cognition construct was measured by the Mini-Mental State Examination and Montreal Cognitive Assessment; psychosocial stress construct was measured by perceived stress, depression, loneliness, and neuroticism; and processing speed was assessed by the Digit Symbol Substitution Test. Structural equation modelling was used to analyze the mediation and moderation tests. RESULTS: Processing speed was found to partially mediate the relationship between psychosocial stress and global cognition (ß in the direct model = -0.15, P < 0.001; ß in the full mediation model = -0.11, P < 0.001). Moreover, the relationship between psychosocial stress and global cognition was found to be significant in men only, whereas the association between processing speed and global cognition was significant in men and women. CONCLUSIONS: Psychosocial stress may increase the likelihood that older adults will experience poor processing capacity, which could reduce their higher level cognition. Results indicate that there is a need to develop processing capacity intervention programmes for psychologically distressed older adults to prevent them from suffering cognitive decline.

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.

The impact of giving support to others on older adults' perceived health status.

BACKGROUND: Social support that may contribute to the physical and mental health of older adults is widely studied. However, much of the existing research has focused on the impact of receiving support; the effects of giving support have largely been neglected. Using the biopsychosocial perspective, this study aimed to examine the independent impact of giving support to others on older adults' perceived health status. METHODS: Data for this study were obtained from a nationwide community-based cross-sectional survey entitled 'Determinants of Wellness among Older Malaysians: A Health Promotion Perspective', which was conducted in 2010. To assess the unique effects of giving support on perceived health status, above and beyond other possible known factors, a four-step hierarchical regression model using SPSS was used to test the hypothesis. RESULTS: The findings from the analysis revealed that giving support to others was a significant positive predictor of older adults' perceived health status after receiving support, demographic variables and chronic medical conditions were considered. Further results showed that giving support to others had almost twice the effect on perceived health status (ß = 0.11, P < 0.001) as receiving support (ß = 0.06, P < 0.05). CONCLUSION: The findings from this study underscore the need to develop programmes that encourage older adults' participation in productive activities such as caring for and helping others and volunteering.

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.

A thematic review on therapeutic toys and games for the elderly with Alzheimer's disease.

PURPOSE: Alzheimer's disease (AD) is a common and devastating neurological ailment that affects millions of the elderly worldwide. Therapeutic toys and games have emerged as potential non-pharmacological interventions for AD. However, despite a growing number of documents on the subject, research on the future direction of therapeutic toys and games for AD remains scarce. To address this gap, this study aims to (1) map the future trends of therapeutic toys and games for AD and (2) identify the categories and design characteristics. MATERIALS AND METHODS: Using a thematic review framework, a systematic literature search was conducted in two electronic databases (Scopus and WoS) using established criteria. Thematic analysis was done using ATLAS.ti 23 to identify prominent themes, patterns and trends. RESULTS: A total of 180 documents were found. Twenty-five articles met the inclusion criteria. A thematic review of these 25 articles identified 13 initial codes, which were been clustered into four themes: detection and evaluation; intervention; toy/game category; and design characteristics. The word "Cognitive" appears most frequently in documents according to word cloud. CONCLUSIONS: Therapeutic toys and games are used to detect and as an intervention for AD. Most of the current studies focused on specific cognitive functions. More research is needed about play therapy for neuropsychiatric symptoms. This thematic review also proposed a conceptual framework for designing toys and games tailored to the needs of the elderly with AD, offering valuable insights to future researchers focusing on this domain.

Most studies focused on cognitive function among Alzheimer's patients.More research is needed about the rehabilitation of neuropsychiatric symptoms among Alzheimer's patients.Games and toys have been evaluated as beneficial for detecting and as an intervention for Alzheimer's disease (AD). More research is needed about how to design games or toys tailored to the needs of the elderly with AD.

Do depression and educational attainment mediate the association between ethnicity and dementia?

INTRODUCTION: Research shows marked differences in the prevalence of dementia among different ethnic groups. However, there is a relative dearth of studies focusing on how ethnicity may influence dementia. The main aim of the current study is to test potential mediating effects of depression and level of education on the association between ethnicity and dementia. METHODS: The sample for this study, consisting of 2,796 community-dwelling elderly people aged 60 years and older, was drawn from a cross-sectional national survey entitled 'Mental Health and Quality of Life of Older Malaysians'. The Malaysian adapted version of the Geriatric Mental State-Automated Geriatric Examination for Computer-Assisted Taxonomy was used to assess dementia and depression. Data analysis was conducted using IBM SPSS version 19. RESULTS: As expected, the result of the χ2 analysis revealed significant ethnic difference in the prevalence of dementia (χ2 = 58.05, p ≤ 0.001). The results of the mediational analyses revealed that depression (Z = 4.05, p ≤ 0.001) and education (Z = 2.78, p ≤ 0.01) significantly, but partially, mediate the association between ethnicity and dementia. This suggests that disparities of depressive symptoms and education contribute to ethnic difference in the prevalence of dementia. CONCLUSIONS: These findings provide more insight into how ethnicity may influence an individual's vulnerability to dementia. The limitations of the study along with implications of the findings and needs for further study are discussed.

Theories and measures of elder abuse.

Elder abuse is a pervasive phenomenon around the world with devastating effects on the victims. Although it is not a new phenomenon, interest in examining elder abuse is relatively new. This paper aims to provide an overview of the aetiological theories and measures of elder abuse. The paper briefly reviews theories to explain causes of elder abuse and then discusses the most commonly used measures of elder abuse. Based on the reviewed theories, it can be concluded that elder abuse is a multifactorial problem that may affect elderly people from different backgrounds and involve a wide variety of potential perpetrators, including caregivers, adult children, and partners. The review of existing measurement instruments notes that many different screening and assessment instruments have been developed to identify elders who are at risk for or are victims of abuse. However, there is a real need for more measurements of elder abuse, as the current instruments are limited in scope.

Social isolation in older Malaysians: prevalence and risk factors.

BACKGROUND: Social isolation is one of the most important emerging issues among ageing populations, as it reduces well-being, health and quality of life. The purpose of this study was to identify prevalence and risk factors of social isolation in older Malaysians. METHODS: The sample for this study was drawn from a national survey entitled 'Patterns of Social Relationships and Psychological Well-Being among Older Persons in Peninsular Malaysia'. Social isolation was measured with the Lubben Social Network Scale. RESULTS: The findings from the present study showed that 49.8% of older Malaysians are at risk for social isolation. The results of logistic regression analysis revealed that the number of sons, number of brothers, number of sisters, household size, self-rated health, place of residence, home ownership, sex and ethnicity were significantly associated with social isolation. CONCLUSION: These findings may have some implications for social and health-care policymakers in planning and developing new and effective interventions such as educational programmes to reduce social isolation among this vulnerable population.