Smoking status and its relationship with depression among the elderly population in Malaysia: Findings from the National Health and Morbidity Survey 2018.

INTRODUCTION: Literature exploring smoking status and its association with depression among the elderly population using nationwide data in Malaysia is limited. Hence, a nationwide survey to determine the prevalence of smoking and depression among the elderly (aged ≥60 years) population was undertaken. METHODS: This secondary dataset analysis used data from the National Health and Morbidity Survey (NHMS) 2018. Data from 3914 participants were collected on elderly health in the Malaysian population. Sociodemographic characteristics were recorded. Smoking status was grouped as current smokers, former smokers, and non-smokers. A validated Malay language version of the Geriatric Depression Scale (M-GDS-14) was used to screen for depression among the elderly. RESULTS: There was a significant association between smoking status with location, gender, employment status, marital status, ethnicity, education level, income, and depression. Current smokers are significantly higher in rural than urban areas. Among depressed participants, 65.7%, 17.1% and 17.2% were non-smokers, former smokers and current smokers, respectively. Multiple logistic regression showed that single (unmarried/separated/ divorced/widowed) participants were more likely to be depressed compared to married participants (AOR=1.68; 95% CI: 1.16-2.43). Whilst unemployed participants were more likely to be depressed than those who were employed (AOR=1.72; 95% CI: 1.22-2.44). Other Bumiputras were more likely to have depression compared to Malay, Chinese and Indian participants. Participants without formal education were more likely to be depressed compared to those having tertiary education. These participants have a 2-fold increased risk of depression (AOR=2.13; 95% CI: 1.02-4.45). Participants whose monthly salaries were <2000 MYR (AOR=3.67; 95% CI: 1.84-7.31) and 1000-1999 MYR (AOR=2.71; 95% CI: 1.23-5.94) were more likely to have depression compared with those who had received ≥3000 MYR. Ever smokers were more likely to be depressed than non-smokers (AOR=1.68; 95% CI: 1.23-2.29). CONCLUSIONS: Elderly Malaysians are indeed at risk of developing depression particularly if they had ever smoked. Public health awareness and campaigning are pertinent to disseminate these outcomes in order to spread the awareness associated with smoking-related depression.

A Malay Version of the Attitude to Ageing Questionnaire: Its Adaptation, Validation, and Reliability in the Malaysian Older Adult Population.

BACKGROUND: The Attitude to Ageing Questionnaire (AAQ) was developed to assess perceptions of the aging process among older adults. The 24 items were framed into three factors. This study aimed to translate the AAQ from English to the Malay language (AAQ-M) and determine its factorial structure and validity in a Malaysian population. METHODS: The original AAQ underwent a standard translation process, as well as content and face validation, to produce the AAQ-M. The construct validity of the AAQ-M was then assessed in 254 older adults aged 60 years and above attending a public primary care clinic in Seremban, Malaysia. RESULTS: Exploratory factor analysis showed a three-factor model for the AAQ-M with acceptable reliability and Cronbach α values ranging from 0.71 to 0.82 for each factor. A total of five items were omitted for poor factor loadings (<0.32) or because they did not conceptually fit into the factor they were loaded onto. Of the final 19 AAQ-M items, seven were physical change factors, eight were psychosocial loss factors, and four were psychological growth factors. This three-factor model explained 37.9% of the total variance. CONCLUSION: The AAQ-M version confirmed that the three-factor model, namely physical change, psychosocial loss, and psychological growth, was similar to that of the original AAQ. The AAQ-M is a valid and reliable instrument for assessing the three aspects of attitudes toward aging in the Malaysian older adult population.

Meal replacement in dietary management of type-2 diabetes mellitus: a scoping review protocol.

BACKGROUND: The prevalence of type-2 diabetes mellitus (T2DM) has been increasing globally. Without proper management, T2DM can develop into serious complications and even death. Diet modification is one of the most effective tools in managing T2DM at the early stage, but it requires knowledge and compliance from the patients. Thus, meal replacement (MR) has gained its popularity as a tool for diet modification to improve glycemic control and also reducing weight in T2DM patients. There are several existing meal replacement studies but not much is known on the general scope and effect of these existing MRs. Hence, this review is aimed to provide an overview of the existing evidences regarding the application of meal replacement on T2DM patients and identify the gaps or limitations in the studies. METHODOLOGY: The scoping review will be carried out in six stages: (1) identifying the research question, (2) identifying relevant studies through electronic databases (i.e., PubMed, Scopus, Cochrane Reviews, Google Scholar, EBSCOHOST, Science Direct) and also gray literature, and (3) selection of studies to be included based on inclusion criteria. Search and initial screening of studies to be included will be conducted by two independent reviewers. Discrepancies will then be solved through discussion with other reviewers; (4) charting and categorizing extracted data in a pretested data extraction form; (5) collating, summarizing, and reporting the results; and lastly, (6) conducting consultation with stakeholders and experts in diabetes. DISCUSSION: This scoping review protocol is aimed to provide a framework enabling us to map and summarize the findings from existing studies involving meal replacement. It will help researchers to identify the research gap and provide recommendations for future meal replacement studies. The results from this scoping review will be useful to various stakeholders in healthcare. It is also part of a research project in which the information obtained will be utilized in a clinical trial of a developed meal replacement plan. Dissemination of knowledge will also be done through presentations at related scientific conferences.

Prevalence of obesity and its associated risk factors among the elderly in Malaysia: Findings from The National Health and Morbidity Survey (NHMS) 2015.

BACKGROUND: Obesity is a crucial public health problem and is rising globally. This study was conducted to determine the prevalence of obesity and its associated factors among the elderly in Malaysia. METHODS: Data were obtained from the National Health and Morbidity Survey (NHMS) 2015. This was a cross sectional population-based study using a two stage stratified random sampling design. Elderly population aged 60 years and above was selected. Data were collected using pre-tested self-administered questionnaire in the form of sociodemographic profile, non-communicable diseases (NCD) comorbidities (status on hypertension, diabetes and hypercholesterolemia) and NCD risk factors (current smoker and physical activity). Obesity has been defined using the World Health Organization (WHO) Body Mass Index (BMI) guideline, 1998. A complex sampling design analysis was used for the descriptive statistics. The associated risk factors for obesity were identified using Multiple Logistic Regression analysis. RESULTS: A total of 3794 respondents were included in this study. The prevalence of obesity among Malaysian elderly was 30.2%. The prevalence of obesity among the elderly was significantly higher in females, respondents from urban areas and Indians. Approximately one third of the elderly with non-communicable diseases such as hypertension (33.1%) and diabetes (38.8%), respectively, were obese. Among elderly who were obese, majority of them (89.8%) had at least one NCD. The prevalence of obesity was 16.8% among current smokers (aOR 0.59). Multiple logistic regression analysis revealed that elderly females (aOR [adjusted odds ratio] 1.52), having secondary education (aOR 1.96) with household income of RM 3000 and above (aOR 1.57) as well as being hypertensive (aOR 1.61) and diabetic (aOR 1.50) were more likely to be obese. In contrast, the Chinese elderly respondents (aOR 0.62) and current smokers (aOR 0.59) were less likely to be obese. There were no significant associations of obesity with hypercholesterolemia or with physical activity. CONCLUSIONS: A substantial proportion of Malaysian elderly were obese, and factors associated with obesity among them were being female, having secondary education with a household income of RM 3000 and above and being hypertensive or diabetic. Enhanced health promotion and education should be targeted at younger people in order to prevent obesity in the later years.

Trends in population blood pressure and prevalence, awareness, treatment and control of hypertension among older persons: The 2006 & 2015 National Health and Morbidity Survey in Malaysia.

BACKGROUND: Hypertension is one of the most important risk factors for cardiovascular diseases. Thus, it is an important public health challenge worldwide. In Malaysia, only a few studies have focused on the trends of hypertension specifically for the aging population. In view of the rapid growth of the elderly population in Malaysia, there is an urgent need to explore the condition of hypertension in this aging population. Hence, the objectives of this study were to determine the trends of population mean systolic and diastolic blood pressure (BP) levels, the prevalence, awareness, treatment and control of hypertension, and its' associated factors among older persons in two cross-sectional national surveys that were conducted in 2006 and 2015 in Malaysia. METHODS: This was a subanalysis of secondary data collected from the two cross-sectional national population-based surveys conducted in Malaysia in 2006 and 2015. Adults aged 60 and older who had participated in these two surveys were included in the study. RESULTS: A total of 4954 (2295 males and 2659 females) and 3790 (1771 males and 2019 females) respondents completed the hypertension module surveys in 2006 and 2015, respectively. The mean age of the respondents was 68.5±6.9 years in 2006 and 68.6±7.1 years in 2015 and the difference was not significant. The prevalence of hypertension significantly reduced from 73.8% in 2006 to 69.2% in 2015 (p<0.001). Among the respondents with hypertension, the awareness, treatment and control of hypertension significantly increased from 49.7% to 60.2%, 86.7% to 91.5% and 23.3% to 44.8%, respectively, from 2006 to 2015. Logistic regression analysis showed that female sex and unemployed/retiree were significantly associated with higher hypertension prevalence in both 2006 and 2015. Being unemployed/ retiree was significantly associated with higher awareness of hypertension in both 2006 and 2015. In both 2006 and 2015, Chinese ethnicity were significantly associated with higher awareness and control of hypertension. CONCLUSIONS: The mean population BP levels and hypertension prevalence among the elderly population in Malaysia have reduced significantly over the past decade. Although the awareness, treatment and control of hypertension among older adults have improved significantly, the awareness and control rates remain suboptimal. As population aging is inevitable, appropriate public health programs and optimal treatment strategies targeting this vulnerable group are urgently needed to improve the overall awareness and control of hypertension and to prevent hypertension-related complications.

Practical Problems of Medication Use in the Elderly Malaysians and Their Beliefs and Attitudes Toward Deprescribing of Medications.

OBJECTIVE: This study aimed to investigate the prevalence of practical problems with medications use experienced by elderly patients and the management strategy employed to overcome the problems. This study also aimed to evaluate the belief and attitude of elderly patients toward deprescribing. METHODS: A cross-sectional study was conducted among elderly patients that seeking treatment in a primary care clinic in Malaysia from September to November 2018 using a set of researcher-assisted and validated questionnaire on their consent. FINDINGS: A total of 182 elderly patients were included in this study. A majority of participants (n = 87, 47.8%) admitted experiencing practical problems with their medication use. There are varieties of choice of management strategy employed by elderly patients to overcome the problems. For the willingness to deprescribing, there were positive correlation for patients' age (rs (182) =0.183, P < 0.05) and number of medications (rs (182) =0.271, P < 0.01) with the burden factor. There were also a negative correlation of age (rs (182) = -0.174, P < 0.05) and number of medication (rs (182) = -0.176, P < 0.04) with appropriateness of medications. CONCLUSION: A majority of Malaysian elderly experience practical problems with their medication use. Elderly patients' belief and attitudes toward deprescribing were influenced by age and number of medications.

Long-term effects of honey on cardiovascular parameters and anthropometric measurements of postmenopausal women.

OBJECTIVE: To investigate the long-term effects of Tualang Honey versus Honey Cocktail (mixture of honey, bee bread, and royal jelly) on cardiovascular markers and anthropometric measurements of postmenopausal women. METHODS: We conducted a randomised, double blinded, two-armed parallel study comparing 20 g/day of Tualang Honey versus 20 g/day Honey Cocktail among postmenopausal women aged 45-65 years. The cardiovascular parameters and anthropometrics measurements were assessed at baseline, 6 months, and 12 months of the intervention. RESULTS: 100 subjects were successfully randomised into the groups. There was a significant decrease in the diastolic blood pressure from 77.92 mmHg at baseline to 73.45 mmHg at 12 months (F-statistic = 2.55, p-value = 0.047) in the Tualang Honey group compared to Honey Cocktail. There was also a significant decrease in the fasting blood sugar from 6.11 mmol/L at baseline to 5.71 mmol/L at 12 months (F-statistic = 4.03, p-value = 0.021) in the Tualang Honey group compared to the Honey Cocktail group. The body mass index remained unchanged at 27 kg/m2 (F-statistic = 1.60, p-value = 0.010) throughout 12 months of the intervention in the Honey Cocktail group. CONCLUSION: Subjects who received Honey Cocktail showed remarkable effects on body mass index. However, Tualang Honey supplementation showed superior effect in lowering diastolic blood pressure and fasting blood sugar compared to Honey Cocktail. Further studies are required to ascertain the underlying mechanism(s) of Tualang Honey and Honey Cocktail on each observed parameter.