Displaying publications 1 - 20 of 63 in total

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  1. Amir NN, Kamaruzzaman SB, Effendi-Tenang I, Jamaluddin M, Tan MP, Ramli N, et al.
    Eur Geriatr Med, 2021 Apr;12(2):313-319.
    PMID: 33486745 DOI: 10.1007/s41999-021-00450-2
    PURPOSE: Using data from the Malaysian Elders Longitudinal Research (MELoR), this study investigated the association between visual function (visual acuity and contrast sensitivity) and frailty in a group of urban-dwelling older adults.

    METHODS: This was a cross-sectional study. 1332 participants aged ≥ 55 years were selected by random sampling from the parliamentary electoral register. Only 1274 participants completed the frailty assessment and 1278 participants completed the contrast sensitivity assessment. Impaired vision was defined as a Snellen visual acuity of worse than 6/12 in the better eye. Poor contrast sensitivity was defined as a score on the Pelli Robson chart of lower than 1.65. Frailty was defined with the Fried's phenotype criteria. Inter-group comparisons were determined with the independent T-test for continuous variables and the Pearson's Chi-squared test for categorical variables. The odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the cross-sectional association between frailty and visual function.

    RESULTS: The mean age of participants was 68.8 ± 7.5 years, of which 58.1% (774) were women. Impaired vision and poor contrast sensitivity were present in 187 (14%) and 271 (21.2%) subjects respectively. 73 (5.8%) individuals were classified as frail, 1161 (91.0.%) pre-frail, and 40 (2.8%) non-frail. There was no significant difference in frailty phenotypes between those with good and impaired vision (p = 0.241). Fried's component of handgrip strength, gait speed and exhaustion were significantly better in those with good visual function (p 

  2. Zia A, Kamaruzzaman SB, Tan MP
    Postgrad Med, 2015 Mar;127(2):186-93.
    PMID: 25622817 DOI: 10.1080/00325481.2015.996505
    Hypertension is a highly prevalent condition among older people, but many physicians avoid aggressive treatment in this age group due to concerns about adverse effects such as orthostatic hypotension and falls. Orthostatic hypotension, which also increases in prevalence with increasing age, has been considered to be associated with antihypertensive therapy. Both orthostatic hypotension and antihypertensive medications are considered independent yet closely related predictors for falls among older people. The prescription of antihypertensive therapy among the elderly remains a long-standing controversy in geriatric medicine due to ongoing concerns about potential complications such as falls, despite conclusive evidence supporting the treatment of hypertension even among the very elderly. However, recent evidence suggests a dose-dependent relationship between blood pressure lowering therapy and falls among older individuals with preexisting risk factors for falls. In response to the spate of revisions in hypertension treatment targets for older patients in international guidelines and the recent evidence on antihypertensive therapy and falls, this review article examines the complex relationship between hypertension, antihypertensives, orthostatic hypotension, and falls among older patients.
  3. Zia A, Kamaruzzaman SB, Tan MP
    Postgrad Med, 2015 Apr;127(3):330-7.
    PMID: 25539567 DOI: 10.1080/00325481.2014.996112
    The term polypharmacy has negative connotations due to its association with adverse drug reactions and falls. This spectrum of adverse events widens when polypharmacy occurs among the already vulnerable geriatric population. To date, there is no consensus definition of polypharmacy, and diverse definitions have been used by various researchers, the most common being the consumption of multiple number of medications. Taking multiple medications is considered a risk factor for falls through the adverse effects of drug-drug or drug-disease interactions. Falls studies have determined that taking ≥ 4 drugs is associated with an increased incidence of falls, recurrent falls, and injurious falls. In light of existing evidence, careful and regular medication reviews are advised to reduce the effect of polypharmacy on falls. However, intervention studies on medication reviews and their effectiveness on falls reduction have been scarce. This article reviews and discusses the evidence behind polypharmacy and its association with falls among older individuals, and highlights important areas for future research.
  4. Khor HM, Tan J, Saedon NI, Kamaruzzaman SB, Chin AV, Poi PJ, et al.
    Arch Gerontol Geriatr, 2014 Nov-Dec;59(3):536-41.
    PMID: 25091603 DOI: 10.1016/j.archger.2014.07.011
    The presence of pressure ulcers imposes a huge burden on the older person's quality of life and significantly increases their risk of dying. The objective of this study was to determine patient characteristics associated with the presence of pressure ulcers and to evaluate the risk factors associated with mortality among older patients with pressure ulcers. A prospective observational study was performed between Oct 2012 and May 2013. Patients with preexisting pressure ulcers on admission and those with hospital acquired pressure ulcers were recruited into the study. Information on patient demographics, functional status, nutritional level, stages of pressure ulcer and their complications were obtained. Cox proportional hazard analysis was used to assess the risk of death in all patients. 76/684 (11.1%) patients had pre-existing pressure ulcers on admission and 30/684 (4.4%) developed pressure ulcers in hospital. There were 68 (66%) deaths by the end of the median follow-up period of 12 (IQR 2.5-14) weeks. Our Cox regression model revealed that nursing home residence (Hazard Ratio, HR=2.33, 95% confidence interval, CI=1.30, 4.17; p=0.005), infected deep pressure ulcers (HR=2.21, 95% CI=1.26, 3.87; p=0.006) and neutrophilia (HR=1.76; 95% CI 1.05, 2.94; p=0.031) were independent predictors of mortality in our elderly patients with pressure ulcers. The prevalence of pressure ulcers in our setting is comparable to previously reported figures in Europe and North America. Mortality in patients with pressure ulcer was high, and was predicted by institutionalization, concurrent infection and high neutrophil counts.
  5. Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Poi PJ, Chee KH, et al.
    Medicine (Baltimore), 2016 May;95(19):e3614.
    PMID: 27175670 DOI: 10.1097/MD.0000000000003614
    To evaluate the utility of blood pressure variability (BPV) calculated using previously published and newly introduced indices using the variables falls and age as comparators.While postural hypotension has long been considered a risk factor for falls, there is currently no documented evidence on the relationship between BPV and falls.A case-controlled study involving 25 fallers and 25 nonfallers was conducted. Systolic (SBPV) and diastolic blood pressure variability (DBPV) were assessed using 5 indices: standard deviation (SD), standard deviation of most stable continuous 120 beats (staSD), average real variability (ARV), root mean square of real variability (RMSRV), and standard deviation of real variability (SDRV). Continuous beat-to-beat blood pressure was recorded during 10 minutes' supine rest and 3 minutes' standing.Standing SBPV was significantly higher than supine SBPV using 4 indices in both groups. The standing-to-supine-BPV ratio (SSR) was then computed for each subject (staSD, ARV, RMSRV, and SDRV). Standing-to-supine ratio for SBPV was significantly higher among fallers compared to nonfallers using RMSRV and SDRV (P = 0.034 and P = 0.025). Using linear discriminant analysis (LDA), 3 indices (ARV, RMSRV, and SDRV) of SSR SBPV provided accuracies of 61.6%, 61.2%, and 60.0% for the prediction of falls which is comparable with timed-up and go (TUG), 64.4%.This study suggests that SSR SBPV using RMSRV and SDRV is a potential predictor for falls among older patients, and deserves further evaluation in larger prospective studies.
  6. Zia A, Kamaruzzaman SB, Tan MP
    Geriatr Gerontol Int, 2017 Mar;17(3):463-470.
    PMID: 26822931 DOI: 10.1111/ggi.12741
    AIM: The presemt study aimed to determine the association between the risk of recurrent and injurious falls with polypharmacy, fall risk-increasing drugs (FRID) and FRID count among community-dwelling older adults.

    METHODS: Participants (n = 202) were aged ≥65 years with two or more falls or one injurious fall in the past year, whereas controls (n = 156) included volunteers aged ≥65 years with no falls in the past year. A detailed medication history was obtained alongside demographic data. Polypharmacy was defined as "regular use of five or more prescription drugs." FRID were identified as cardiovascular agents, central nervous system drugs, analgesics and endocrine drugs; multiple FRID were defined as two or more FRID. Multiple logistic regression analyses were used to adjust for confounders.

    RESULTS: The use of non-steroidal anti-inflammatory drugs was independently associated with an increased risk of falls. Univariate analyses showed both polypharmacy (OR 2.23, 95% CI 1.39-3.56; P = 0.001) and the use of two or more FRID (OR 2.9, 95% CI 1.9-4.5; P = 0.0001) were significantly more likely amongst fallers. After adjustment for age, sex and comorbidities, blood pressure, and physical performance scores, polypharmacy was no longer associated with falls (OR 1.6, 95% CI 0.9-2.9; P = 0.102), whereas the consumption of two or more FRID remained a significant predictor for falls (OR 2.8, 95% CI 1.4-5.3; P = 0.001).

    CONCLUSIONS: Among high risk fallers, the use of two or more FRID was an independent risk factor for falls instead of polypharmacy. Our findings will inform clinical practice in terms of medication reviews among older adults at higher risk of falls. Future intervention studies will seek to confirm whether avoidance or withdrawal of multiple FRID reduces the risk of future falls. Geriatr Gerontol Int 2017; 17: 463-470.

  7. Nordin N, Kamaruzzaman SB, Chin AV, Poi PJ, Tan MP
    J Nutr Gerontol Geriatr, 2015;34(1):34-49.
    PMID: 25803603 DOI: 10.1080/21551197.2014.998326
    The strong emphasis on feeding in Asian cultures may influence decisions for nasogastric (NG) tube feeding in geriatric inpatients. We evaluated the utility, complications, and opinions of caregivers toward NG tube feeding in an acute geriatric ward in a teaching hospital in Kuala Lumpur. Consecutive patients aged 65 years and older receiving NG tube feeding were included. Sociodemographic, clinical, and laboratory indices were recorded. Opinion on NG tube feeding were evaluated through face-to-face interviews with caregivers, recruited through convenience sampling. Of 432 patients admitted, 96 (22%), age ± standard deviation = 80.8 ± 7.4 years, received NG tube feeding. The complication and mortality rates were 69% and 38%, respectively. Diabetes (odds ratio [95% confidence interval] = 3.34 [1.07, 10.44], aspiration pneumonia (8.15 [2.43, 27.24]), impaired consciousness (3.13 [1.05, 9.36]), and albumin ≤26 g/dl (4.43 [1.46, 13.44]) were independent predictors of mortality. Other relatives were more likely than spouses (23.5 [3.59, 154.2]) and caregivers with tertiary education more likely than those with no formal education ( 18 [1.23, 262.7]) to agree to NG feeding. Sixty-four percent of caregivers felt NG tube feeding was appropriate at the end of life, mostly due to the fear of starvation. NG tube feeding is widely used in our setting, despite high complication and mortality rates, with likely influences from cultural emphasis on feeding.
  8. Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Tan MP
    Medicine (Baltimore), 2017 Oct;96(42):e8193.
    PMID: 29049203 DOI: 10.1097/MD.0000000000008193
    The aim of this study was to determine the relationship between falls and beat-to-beat blood pressure (BP) variability.Continuous noninvasive BP measurement is as accurate as invasive techniques. We evaluated beat-to-beat supine and standing BP variability (BPV) using time and frequency domain analysis from noninvasive continuous BP recordings.A total of 1218 older adults were selected. Continuous BP recordings obtained were analyzed to determine standard deviation (SD) and root mean square of real variability (RMSRV) for time domain BPV and fast-Fourier transform low frequency (LF), high frequency (HF), total power spectral density (PSD), and LF:HF ratio for frequency domain BPV.Comparisons were performed between 256 (21%) individuals with at least 1 fall in the past 12 months and nonfallers. Fallers were significantly older (P = .007), more likely to be female (P = .006), and required a longer time to complete the Timed-Up and Go test (TUG) and frailty walk test (P ≤ .001). Standing systolic BPV (SBPV) was significantly lower in fallers compared to nonfallers (SBPV-SD, P = .016; SBPV-RMSRV, P = .033; SBPV-LF, P = .003; SBPV-total PSD, P = .012). Nonfallers had significantly higher supine to standing ratio (SSR) for SBPV-SD, SBPV-RMSRV, and SBPV-total PSD (P = .017, P = .013, and P = .009). In multivariate analyses, standing BPV remained significantly lower in fallers compared to nonfallers after adjustment for age, sex, diabetes, frailty walk, and supine systolic BP. The reduction in frequency-domain SSR among fallers was attenuated by supine systolic BP, TUG, and frailty walk.In conclusion, reduced beat-to-beat BPV while standing is independently associated with increased risk of falls. Changes between supine and standing BPV are confounded by supine BP and walking speed.
  9. Teoh RJJ, Mat S, Khor HM, Kamaruzzaman SB, Tan MP
    Postgrad Med, 2021 Apr;133(3):351-356.
    PMID: 33143493 DOI: 10.1080/00325481.2020.1842026
    OBJECTIVES: While metabolic syndrome, falls, and frailty are common health issues among older adults which are likely to be related, the potential interplay between these three conditions has not previously been investigated. We investigated the relationship between metabolic syndrome with falls, and the role of frailty markers in this potential relationship, among community-dwelling older adults.

    METHODS: Data from the first wave Malaysian Elders Longitudinal Research (MELoR) study comprising urban dwellers aged 55 years and above were utilized. Twelve-month fall histories were established during home-based, computer-assisted interviews which physical performance, anthropometric and laboratory measures were obtained during a hospital-based health check. Gait speed, exhaustion, weakness, and weight loss were employed as frailty markers.

    RESULTS: Data were available for 1415 participants, mean age of 68.56 ± 7.26 years, 57.2% women. Falls and metabolic syndrome were present in 22.8% and 44.2%, respectively. After adjusting for age, sex, and multiple comorbidities, metabolic syndrome was significantly associated with falls in the sample population [odds ratio (OR): 1.33, 95% confidence interval (CI): 1.03; 1.72]. This relationship was attenuated by the presence of slow gait speed, but not exhaustion, weakness, or weight loss.

    CONCLUSION: Metabolic syndrome was independently associated with falls among older adults, and this relationship was accounted for by the presence of slow gait speed. Future studies should determine the value of screening for frailty and falls with gait speed in older adults with metabolic syndrome as a potential fall prevention measure.

  10. Yong SS, Kwan Z, Ch'ng CC, Yong ASW, Tan LL, Han WH, et al.
    BMC Geriatr, 2020 06 24;20(1):223.
    PMID: 32580764 DOI: 10.1186/s12877-020-01610-y
    BACKGROUND: The ageing skin is more susceptible to pruritic dermatoses, which are associated with adverse psychosocial effects and reduced quality of life among older adults. This cross-sectional study aimed to identify the burden of pruritus and factors associated with its presence and severity among older adults recruited to the Malaysian Elders Longitudinal Research study.

    METHODS: Seven hundred seventy individuals aged 55 years (lower age limit) and above were interviewed as to whether they experienced pruritus during the preceding week and the locations involved if present. The association between generalised pruritus, sleep quality, and major systemic risk factors were explored.

    RESULTS: 5.97% of respondents reported generalised pruritus. Generalised pruritus was associated with poorer sleep quality, with Pittsburgh Sleep Quality Index score above 6. Mean haemoglobin level was lower in subjects with generalised pruritus (13.14 g/dL) but there was no significant difference in the frequency of generalised pruritus and severe generalized pruritus between subjects with clinically defined anaemia. Also, there were no significant associations between other major systemic risk factors and generalised pruritus in this population-based study. There was no association between generalised pruritus with depression, anxiety or stress.

    CONCLUSION: The negative effect of pruritus on sleep quality suggests a possible deleterious effect of pruritus on health and quality of life. Further prospective research on the longer-term effects of pruritus on health status is now warranted. (222 words).

  11. Mat S, Kamaruzzaman SB, Chin AV, Tan MP
    Front Public Health, 2020;8:571196.
    PMID: 33163471 DOI: 10.3389/fpubh.2020.571196
    Objectives: To determine the temporal relationship between the presence of knee pain and knee pain severity identified at baseline with fall risk, fear of falling and changes in instrumental activity of daily living at 12-months follow-up. Methods: This was a prospective study from the Malaysian Elders Longitudinal Research (MELoR) study involving community dwelling older persons aged 55 years and older. The presence of one fall in the preceding 12 months, knee pain, and functional capacity were determined at baseline (2013-2015) and follow-up (2015-2016). Function was determined as loss of at least one of seven instrumental activities of daily living (IADL). Physical performance was evaluated at baseline using the timed-up-and-go (TUG) test. Fear of falling (FoF) was determined using the single question "Are you afraid of falling?" Results: Data were available for 605 participants, mean (SD) age = 69.10 (7.24) years. Knee pain was present in 30.2% at baseline. Neither the presence of knee pain nor knee pain severity at baseline were associated with falls at 1-year follow-up. Knee pain was significantly associated with FoF at follow-up [aRR (95%CI) = 1.76 (1.02-3.04)] but not changes in IADL. Among individuals with no falls at baseline, the presence of knee pain was protective of falls at follow-up after adjustment for baseline physical performance [adjusted rate ratio, aRR (95% confidence interval, CI) = 0.35 (0.13-0.97)]. Conclusion: Knee pain is associated with increased FoF at 1.5 years' follow-up within a multi-ethnic population aged 55 years, residing in an urban location in a middle-income South East Asian nation. Interestingly, after differences in muscle strength was accounted for, knee pain was protective against falls at follow-up. Our findings challenge previous assumptions on joint pain and falls and highlights the importance of large prospective studies and further mechanistic research incorporating psychological factors in this area of increasing prominence.
  12. Alex D, Khor HM, Chin AV, Hairi NN, Cumming RG, Othman S, et al.
    Front Public Health, 2020;8:506238.
    PMID: 33304870 DOI: 10.3389/fpubh.2020.506238
    Falls are major issues affecting the older population with potentially serious complications, including fractures, head injury, institutionalization, fear of falling and depression. While risk factors for falls have been established across Western Europe and North America, geographical differences in falls risk have not been well researched. We aim to examine the clinical and physical risk factors for falls in a middle-income South East Asian country. Cross-sectional data from the Malaysian Elders Longitudinal Research (MELoR) study involving 1,362 community dwelling individuals aged 55 years and above was utilized. Information on sociodemographic and medical history was obtained by computer-assisted questionnaires completed during home visits and hospital-based detailed health checks. Univariate and multivariate analyses compared non-fallers and fallers in the previous 12 months. Urinary incontinence, hearing impairment, depression, arthritis and cognitive impairment were risk factors for falls in the past 12 months after adjustment for age in our study population. Awareness about the risk factors in a population helps the design of fall prevention strategies that target specific or multiple risk factors.
  13. McStea M, McGeechan K, Kamaruzzaman SB, Rajasuriar R, Tan MP
    Postgrad Med, 2016 Nov;128(8):797-804.
    PMID: 27558757 DOI: 10.1080/00325481.2016.1229103
    Metabolic Syndrome (METs) definitions vary and diagnosis takes into account consumption of medications commonly prescribed for conditions defining METs. This paper evaluates the potential differences in population characteristics using two different methods of defining METs, with and without the adjustment of the effects of pharmacotherapy on biochemical and blood pressure (BP) measurements Methods: This was a cross-sectional study utilizing the Malaysian Elders Longitudinal Research (MELoR) cohort comprising urban community-dwellers aged ≥55 years. Participants were interviewed using a structured questionnaire during home visits where medications were reviewed. Health impacts assessed included heart disease, stroke, body mass index (BMI), peptic ulcers, arthritis, and number of medications and comorbidities. Risk factors and health impacts associated with METs were determined by Poisson multivariate regression models using a binary and count dependent variables.
  14. Mat S, Jaafar MH, Sockalingam S, Raja J, Kamaruzzaman SB, Chin AV, et al.
    Int J Rheum Dis, 2018 May;21(5):930-936.
    PMID: 29611292 DOI: 10.1111/1756-185X.13279
    AIM: To determine the association between vitamin D and knee pain among participants of the Malaysian Elders Longitudinal Research (MELoR) study.

    METHOD: This was a cross-sectional study from the MELoR study consisting of a representative group of 1011 community-dwelling older persons (57% female), mean age 86.5 (54-94) years; 313 were Malays, 367 Chinese and 330 Indians. Participants were asked if they had knee pain. Levels of serum 25-hydroxy cholecalciferol (25-[OH]D), an indicator of vitamin D status, were measured using routine laboratory techniques.

    RESULTS: In unadjusted analysis, presence of knee pain was significantly associated with vitamin D deficiency (odds ratio [OR] 1.42; 95% confidence interval (CI) 1.08-1.85, P 0.011). Vitamin D levels were significantly associated with ethnicity differences where Malays (OR 7.08; 95% CI 4.94-10.15) and Indians (OR 6.10; 95% CI 4.28-9.71) have lower levels of vitamin D compared to Chinese. Subsequent multivariate analysis revealed that the association between vitamin D deficiency and knee pain was confounded by ethnic differences.

    CONCLUSION: A previous study suggested that vitamin D deficiency was associated with knee pain. This relationship was reproduced in our study, but we further established that the association was explained by ethnic variations. As vitamin D status is dependent on skin tone, diet and sunlight exposure, which are all effected by ethnicity, future studies are now required to determine whether a true relationship exists between vitamin D and knee pain.
  15. Jaafar MH, Mahadeva S, Tan KM, Chin AV, Kamaruzzaman SB, Khor HM, et al.
    Nutr Clin Pract, 2019 Apr;34(2):280-289.
    PMID: 30251336 DOI: 10.1002/ncp.10195
    BACKGROUND: A barrier to gastrostomy feeding exists among Asian clinicians and caregivers due to negative perceptions regarding complications. We compared clinical and nutrition outcomes in older dysphagic Asian patients with nasogastric (NG) or gastrostomy tube feeding using a pragmatic study design.

    METHODS: The choice of enteral tube access was determined by managing clinicians and patients/caregivers. Comparisons of tube feeding methods were made during a 4-month period, adjusting statistically for inherent confounders.

    RESULTS: A total of 102 participants (NG: n = 52, gastrostomy: n = 50) were recruited over 2 years from 2013 to 2015. Subjects on long-term NG tube feeding were older (82.67 ± 7.15 years vs 76.88 ± 7.37 years; P < .001) but both groups had similar clinical indications (stroke: 63.5% NG vs 54% gastrostomy; P = .33). After adjustment for confounders, gastrostomy feeding was associated with fewer tube-related complications (adjusted odds ratio [aOR] = 0.19; 95% confidence interval [CI] = 0.06-0.60) and better complication-free survival rate (aOR = 0.32; 95% CI = 0.12-0.89) at 4-month follow-up. Anthropometric and biochemical nutrition parameters improved significantly in both groups at 4 months, but no significant differences were observed at the end of the study.

    CONCLUSION: Gastrostomy feeding is associated with a greater 4-month complication-free survival and lower tube-related complications compared with long-term NG feeding in older Asians with dysphagia. However, no differences in nutrition outcomes were observed between NG and gastrostomy feeding at 4 months.

  16. Tan PJ, Khoo EM, Chinna K, Saedon NI, Zakaria MI, Ahmad Zahedi AZ, et al.
    PLoS One, 2018;13(8):e0199219.
    PMID: 30074996 DOI: 10.1371/journal.pone.0199219
    OBJECTIVE: To determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia.

    DESIGN: Pragmatic, randomized-controlled trial.

    SETTING: Emergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia.

    PARTICIPANTS: Individuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months.

    INTERVENTION: Individually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment.

    PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall.

    RESULTS: Two hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613-1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846-1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782-1.522)] and mortality rate [RR = 0.896 (95% CI 0.335-2.400)] did not differ between groups.

    CONCLUSION: Individually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations.

    TRIAL REGISTRATION: ISRCTN Registry no. ISRCTN11674947.

    Study site: emergency department, medical outpatients and primary care clinic at a teaching hospital in Kuala Lumpur, Malaysia
  17. Mat S, Jaafar MH, Ng CT, Sockalingam S, Raja J, Kamaruzzaman SB, et al.
    PLoS One, 2019;14(11):e0225075.
    PMID: 31751378 DOI: 10.1371/journal.pone.0225075
    Knee pain is often underreported, underestimated and undertreated. This study was conducted to estimate the prevalence, burden and further identify socioeconomic factors influencing ethnic differences in knee pain and symptoms of OA among older adults aged 55 years and over in Greater Kuala Lumpur (the capital city of Malaysia). The sample for the Malaysian Elders Longitudinal Research (MELoR) was selected using stratified random sampling, by age and ethnicity from the electoral rolls of three parliamentary constituencies. Information on knee pain was available in 1226 participants, mean age (SD) 68.96 (1.57) years (409 Malay, 416 Chinese, 401 Indian). The crude and weighted prevalence of knee pain and self-reported knee OA symptoms were 33.3% and 30.8% respectively. There were significant ethnic differences in knee pain (crude prevalence: Malays 44.6%, Chinese 23.5% and Indians 31.9%, p<0.001). The presence of two or more non-communicable diseases (NCD) attenuated the increased risk of knee pain among the ethnic Indians compared to the ethnic Chinese. The prevalence of knee pain remained significantly higher among the ethnic Malays after adjustment for confounders. While the prevalence of knee pain in our older population appears similar to that reported in other published studies in Asia, the higher prevalence among the ethnic Malays has not previously been reported. Further research to determine potential genetic susceptibility to knee pain among the ethnic Malays is recommended.
  18. Singh DKA, Shahar S, Vanoh D, Kamaruzzaman SB, Tan MP
    Geriatr Gerontol Int, 2019 Aug;19(8):798-803.
    PMID: 31237103 DOI: 10.1111/ggi.13717
    AIM: The identification of risk factors associated with comorbidities and physical fitness might provide pathways for planning therapeutic targets for future falls prevention. Results from large datasets that examined falls risk factors in Asia have been limited. The aim of the present study was to identify the risk factors for falls by pooling data consisting of medical history, physical performance and self-rated health from two large Malaysian epidemiological studies.

    METHODS: Matching variables from the Towards Useful Aging and Malaysian Elders Longitudinal Research datasets related to falls, physical performance and determinants of falls were identified and pooled for analysis. The Timed Up and Go test and dominant handgrip strength tests were used as physical performance measures. Falls were self-reported, and functional status was assessed using activities of daily living.

    RESULTS: Data of 3935 participants, mean age 68.9 ± 6.8 years, 2127 (54.0%) women and 1807 (46.0%) men were extracted for analyses. In an adjusted model, independent risk factors for falls from this cohort studies were diabetes (OR 1.258), arthritis (OR 1.366), urinary incontinence (OR 1.346), poor self-rated health (OR 1.293), higher body mass index (OR 1.029) and lower handgrip strength (OR 1.234).

    CONCLUSIONS: Although the risk factors that emerged from our analyses were similar to available studies among older adults, the Timed Up and Go test did not appear as one of the risk factors in the present study that included middle-aged adults. Our findings will require confirmation in a prospective study. Geriatr Gerontol Int 2019; 19: 798-803.

  19. Mat S, Razack AH, Lim J, Khong SY, Kamaruzzaman SB, Chin AV, et al.
    PMID: 31850355 DOI: 10.3389/fmed.2019.00277
    Objectives: While the negative impact of falls in older persons has been recognized, the association between knee pains and falls remains inconclusive due to underreporting and undertreatment of knee pain. This study was conducted to evaluate the relationship between knee pain and knee pain severity with falls risk and to further determine factors which influence this potential relationship. Design: This was cross-sectional study from the Malaysian Elders Longitudinal Research (MELoR) study. Setting: Urban community dwellers in a middle-income South East Asian country. Participants: One thousand two hundred twelve of a representative sample of community dwelling older persons aged 55 years and older. Outcome measures: Falls in the preceding 12 months and knee pain were collected during a home-based computer-assisted interview. Physical and functional performance were measured using the Timed Up and Go test and the Katz and Lawton scales, respectively. Psychological status was determined using the Depression Anxiety and Stress Scale (DASS-21). Results: Of the 1,212 participants included in this analysis, knee pain was present in 402 (33.17%) individuals (124 (30.85%) mild, 210 (52.24%) moderate, 68 (16.92%) severe). The presence of knee pain was associated with increased risk of falls [odds Ratio, OR(95% confidence interval, CI): 1.81 (1.37-2.38)]. Severe knee pain was an independent predictor for falls after adjustment for functional impairment and psychological status. Mild, moderate, and severe knee pain had a specific indirect effect on falls through reducing functional impairment, which in turn increases their psychological concern. Conclusion: Future studies should explore this relationship prospectively and evaluate whether interventions which alleviate psychological concerns and improve function will reduce falls risk in those with mild to moderate knee pain.
  20. Xu XJ, Myint PK, Kioh SH, Mat S, Rajasuriar R, Kamaruzzaman SB, et al.
    Arch Gerontol Geriatr, 2021 09 30;98:104535.
    PMID: 34601313 DOI: 10.1016/j.archger.2021.104535
    BACKGROUND: While anticholinergic use is associated with stroke, dementia and mortality, few have evaluated its potential link with falls. To determine the relationship between anticholinergic cognitive burden (ACB) and falls over five years using the Malaysian Elders Longitudinal Research (MELoR).

    METHODS: Community-dwelling adults aged 55 years and over were recruited through electoral roll sampling. Data obtained at baseline and follow-up (FU) at two and five years were included. Falls in the preceding 12 months were recorded.

    RESULTS: Of the 1499 individuals (mean (SD) age= 68.9(7.5) yrs and 53.3% female) with information on baseline ACB exposure, 575(38.4%) had ACB scores of 1-2 and 117(7.8%) had ACB scores ≥3. Differences in age, ethnicity, smoking status, diabetes, hypertension, cardiovascular disease, arthritis and education existed between ACB groups. Fall occurrence differed between ACB groups at recruitment (p = 0.004) and 2-year FU (p = 0.001) but not at 5-year FU (p = 0.053). Logistic regression revealed an independent association between ACB 1-2 and falls at baseline (odds ratio, OR (95% confidence interval, CI) =1.412(1.035-1.926)) and ACB≥3 and falls at 2-yr FU (OR (95%CI) =2.098(1.032-4.263)) following adjustment for confounders.

    CONCLUSION: Low level exposure to drugs with anticholinergic properties was associated cross-sectionally with falls, while exposure to higher levels were prospectively associated with falls at 2-year but not at 5-year FU. Future studies should determine whether avoidance of drugs with anticholinergic effects will lead to reduction in falls.

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