Non-Communicable Diseases Impact Low-Income Households in Malaysia.

Background: Non-communicable diseases (NCDs) have a vast and rising impact on households at all income levels across the globe, particularly with poorer people bearing the burden. Hence, this study examines NCDs' effects on Malaysia's B40 group (low-income earners). Methods: This study used the 2015 National Health and Morbidity Survey, a population-based cross-sectional survey with 18,616 respondents from B40 households in Malaysia. Logistic regression analysis is used to assess NCDs' influence on poverty. Results: In 2015, more than 20% of the B40 households lived below the poverty level. In addition, the B40 households had a greater prevalence of NCDs, with almost half of them diagnosed with at least one NCD (47.32%); hypertension (9.90%), diabetes mellitus (17.12%) and hypercholesterolemia (22.89%). Households with a member having an NCD are more likely to experience poverty than those without NCDs. The results also suggested that B40 households with catastrophic payments were at a 25% threshold; the elderly, individuals without formal education and unpaid workers were more likely to experience poverty. Conclusion: The findings suggest that NCDs increase the likelihood of B40 households falling into poverty. These facts highlight the necessity of safeguarding B40 households from the financial burden of NCDs by creating more effective financial protection plans for Malaysia's low-income earners.

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.

Time-Use and Mental Health in Older Adults: A Scoping Review.

Time-use of older adults can be different than in earlier life, especially during the transition from pre- to post-retirement or after experiencing major life events, and the changes could affect their mental health. However, the extent and nature of such research in gerontology have not been examined to date. Therefore, this scoping review sought to map the literature on time-use and mental health in the older population to examine the extent and nature of those research activities. A scoping review was conducted using four databases-PubMed, Scopus, CINAHL, and EMBASE according to PRISMA guidelines. Data were extracted using a pretested tool to develop a descriptive analysis and thematic summary. A total of 11 articles met the eligibility criteria. Seven out of 11 studies involved cross-sectional design, while the remainder were longitudinal studies. The longitudinal studies mainly were secondary data analysis. Time-use data were mainly collected using daily diaries, and the most common mental health outcome included was depression. Only two studies did not evaluate the direct relationship between time-use and mental health. Our review has revealed studies evaluating time-use and mental health in older adults. Limitations of review and recommendations for future studies are discussed.

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.

Mediating role of neuroticism in the association between loneliness and cognitive function among community-dwelling older adults.

OBJECTIVE: The main aim of this study was to examine whether neuroticism mediates the association between loneliness and cognitive function in older adults. METHODS: This study involved 2322 representative community residents aged 60-92 years in Peninsular Malaysia. Cognition was measured by Mini-Mental State Examination (MMSE), loneliness was assessed by three-item loneliness scale, and neuroticism was assessed by the Short-Form Revised Eysenck Personality Questionnaire. Hierarchical multiple linear regression and Sobel tests were used for mediation analyses. RESULTS: Both loneliness (ß = -0.04, P = 0.03) and neuroticism (ß = -0.07, P < 0.001) were negatively and significantly associated with cognitive function, and most importantly, neuroticism mediated the association between loneliness and cognition (from ß = -0.04, P = 0.03 to ß = -0.03, P = 0.10). CONCLUSION: Neuroticism may be the potential mechanism underlying the relationship between loneliness and cognitive function in older persons.

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.

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.

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.

Chronic condition as a mediator between metabolic syndrome and cognition among community-dwelling older adults: The moderating role of sex.

AIM: Metabolic syndrome and chronic conditions are significant predictors of cognition; however, few studies have examined how they work together in predicting cognition in old age. Therefore, the present study examines whether a chronic condition mediates the association between metabolic syndrome and cognition. In addition, it discusses the moderating role of sex in the relationships between metabolic syndrome, chronic conditions and cognition. METHODS: Secondary analysis was carried out of data from the Malaysian national survey that involved 2322 community residents aged 60 years or older in Peninsular Malaysia. Cognition was measured by the digit symbol substitution test. Metabolic syndrome was assessed by five biomarkers: triglyceride, fasting blood sugar, systolic blood pressure, cholesterol ratio and body mass index. Chronic conditions were assessed by self-reported medical history. The structural equation modeling technique was used to analyze the mediation and moderation tests. RESULTS: The number of chronic conditions partially mediated the association between metabolic syndrome and cognition. Men and women did not differ in the relationship between metabolic syndrome and cognition; however, the number of chronic conditions was found to be negatively associated with cognition in older women, but not in men. CONCLUSIONS: Metabolic syndrome might increase the likelihood of older adults to suffer from more chronic conditions; these responses might reduce their cognition. To prevent cognitive decline in old age, specific intervention to minimize the number of chronic conditions by reducing their vascular risk factors is warranted, especially among older women. Geriatr Gerontol Int 2017; 17: 1914-1920.

Are older people more vulnerable to long-term impacts of disasters?

BACKGROUND: Despite the growing interest in the study of disasters, there is limited research addressing the elderly population that lead to prejudiced beliefs that older adults are more vulnerable to disasters than younger adults. This study aimed to compare positive mental health between elderly and young earthquake survivors. METHOD: Data for this study, consisting of 324 earthquake survivors, were obtained from a population-based cross-sectional survey conducted in Iran, 2015. The long-term effect of earthquake was assessed using the Mental Health Continuum-Short Form questionnaire. A one-way multivariate analysis of covariance (MANCOVA) using SPSS (version 22) was used in data analysis. RESULTS: Older adults scored significantly a higher level of overall positive mental health (mean [M]=34.31, standard deviation [SD]=10.52) than younger age group (M=27.48, SD=10.56, t=-4.41; P<0.001). Results of MANCOVA revealed a statistically significant difference between older and young adults on the combined positive mental health subscales (F(3,317)=6.95; P<0.001), after controlling for marital status, sex, and employment status. CONCLUSION: The present findings showing a higher level of positive mental health among elderly earthquake survivors compared with their younger counterparts in the wake of natural disasters suggest that advancing age per se does not contribute to increasing vulnerability.

Flourishing in later life.

OBJECTIVE: Flourishing is a relatively new concept in positive psychology that considers hedonic and eudaimonic aspects of well-being. The current study aims to identify the prevalence and socio-demographic and health factors associated with flourishing among older Malaysians. METHODS: The sample for this study consisting of 2202 community-dwelling older Malaysians was obtained from a national survey entitled "Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly", conducted from May 2013 to April 2014. Data analyses were conducted using the IBM SPSS Version 22.0 and AMOS Version 22.0. RESULTS: The average age of the respondents was 69.05 (SD=6.24) years. Descriptive results showed that 50.1% of the respondents were flourishing in life, 36.3% were languishing, 8.4% were struggling, and 5.2% were floundering in life. The results of Multiple logistic regression analysis revealed that gender, employment status, level of education, having living children, and chronic medical conditions are significantly associated with flourishing. However, age, marital status, living alone, and economic status did not have much impact on flourishing. CONCLUSION: To the best of our knowledge, the current study is one of the first studies that conceptualizes and assesses flourishing among older adults in Malaysia. The findings from the present study make important contributions to the existing literature on well-being. It is suggested that health and social care professionals working with older adults adopt a comprehensive approach to identify and propel non-flourishing people toward flourishing in life.

Does food insufficiency in childhood contribute to dementia in later life?

BACKGROUND: Despite several studies attempting to identify the risk factors for dementia, little is known about the impact of childhood living conditions on cognitive function in later life. The present study aims to examine the unique contribution of food insufficiency in childhood to dementia in old age. METHODS: Data for this study of 2,745 older Malaysians aged 60 years and older was obtained from a national survey entitled "Mental Health and Quality of Life of Older Malaysians" conducted from 2003 through 2005 using a cross-sectional design. The Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy was used to measure dementia. A multiple binary logistic regression using Statistical Package for Social Sciences version 21 was conducted to assess the unique effect of food insufficiency in childhood on developing dementia in old age. RESULTS: A notably higher prevalence of dementia was found in respondents who indicated they had experienced food insufficiency in childhood than in their food-sufficient counterparts (23.5% versus 14.3%). The findings from multiple logistic regression analysis revealed that food insufficiency in childhood would independently increase the risk of developing dementia in old age by 81%, after adjusting for sociodemographic factors (odds ratio =1.81, 95% confidence interval 1.13-2.92, P<0.01). CONCLUSION: Findings from the present study showing that food insufficiency in early life significantly contributes to dementia in later life highlight the importance of childhood living conditions in maintaining cognitive function in old age. It is, therefore, suggested that older adults with childhood food insufficiency might be targeted for programs designed to prevent dementia.

Social embeddedness as a mechanism for linking social cohesion to well-being among older adults: moderating effect of gender.

BACKGROUND: The positive effect of social cohesion on well-being in older adults has been well documented. However, relatively few studies have attempted to understand the mechanisms by which social cohesion influences well-being. The main aim of the current study is to identify social pathways in which social cohesion may contribute to well-being. METHODS: The data for this study (taken from 1,880 older adults, aged 60 years and older) were drawn from a national survey conducted during 2008-2009. The survey employed a two-stage stratified sampling process for data collection. Structural equation modeling was used to test mediating and moderating analyses. RESULTS: The proposed model documented a good fit to the data (GFI =98; CFI =0.99; RMSEA =0.04). The findings from bootstrap analysis and the Sobel test revealed that the impact of social cohesion on well-being is significantly mediated by social embeddedness (Z=5.62; P<0.001). Finally, the results of a multigroup analysis test showed that social cohesion influences well-being through the social embeddedness mechanism somewhat differently for older men than women. CONCLUSION: The findings of this study, in addition to supporting the importance of neighborhood social cohesion for the well-being of older adults, also provide evidence that the impact of social cohesion towards well-being is mediated through the mechanism of social embeddedness.

Dyadic effects of attitude toward aging on psychological well-being of older Malaysian couples: an actor-partner interdependence model.

BACKGROUND: There is a growing body of literature indicating that attitudes toward aging significantly affect older adults' psychological well-being. However, there is a paucity of scientific investigations examining the role of older adults' attitudes toward aging on their spouses' psychological well-being. Therefore, the present study aimed to examine the dyadic effects of attitude toward aging on the psychological well-being of older couples. METHODS: Data for the present study, consisting of 300 couples aged 50 years and older, were drawn from a community-based survey entitled "Poverty among Elderly Women: Case Study of Amanah Ikhtiar" conducted in Peninsular Malaysia. An actor-partner interdependence model using AMOS version 20 (Europress Software, Cheshire, UK) was used to analyze the dyadic data. RESULTS: The mean ages of the husbands and wives in this sample were 60.37 years (±6.55) and 56.33 years (±5.32), respectively. Interdependence analyses revealed significant association between older adults' attitudes toward aging and the attitudes of their spouses (intraclass correlation =0.59; P<0.001), and similar interdependence was found for psychological well-being (intraclass correlation =0.57; P<0.001). The findings from AMOS revealed that the proposed model fits the data (CMIN/degrees of freedom =3.23; goodness-of-fit index =0.90; confirmatory fit index =0.91; root mean square error of approximation =0.08). Results of the actor-partner independence model indicated that older adults' psychological well-being is significantly predicted by their spouses' attitudes toward aging, both among older men (critical ratio =2.92; P<0.01) and women (critical ratio =2.70; P<0.01). Husbands' and wives' own reports of their attitudes toward aging were significantly correlated with their own and their spouses' psychological well-being. CONCLUSION: The findings from this study supported the proposed Spousal Attitude-Well-Being Model, where older adults' attitudes toward aging significantly affected their own and their spouses' psychological well-being. The theoretical and practical implications of the findings are discussed.