METHODS: This study is part of the Long-term Research Grant Scheme - Towards Useful Ageing cohort study in Malaysia. Of a total of 174 participants with complete trace elements and oxidative and DNA damage data during baseline, only 147 (84.5%) were successfully followed up after 18 months. Participants who experienced any fall events in the previous 18 months during the follow-up were categorized as fallers.
RESULTS: Thirty participants (20.4%) reported at least one fall in the previous 18 months. The mean concentrations of aluminium, lead and zinc were significantly higher (P
METHODS: Both quantitative and qualitative methods were used. A questionnaire was completed by 179 undergraduates (34 males and 145 females) aged between 18 to 25 years old. This was followed by an online, in-depth, one-to-one interview among 10 female undergraduates who reported severe musculoskeletal pain. The two sets of findings were integrated using a triangulation protocol.
RESULT: The three most common musculoskeletal pains experienced by undergraduates due to online learning were low back (73.2%), followed by neck (68.7%) and shoulder (58.7%) pain. The six main themes identified from the interviews were: (1) Musculoskeletal pain characteristics; (2) academic issues; (3) difficulties faced by undergraduates due to teaching and learning; (4) emotions towards work/study; (5) work environment; and (6) time spent working at a workstation. Upper back pain was identified to be associated with personal (p < 0.05) and most environmental factors (p < 0.05). From the triangulation model, it was shown that personal, academic stressors and environmental factors were mainly from the workstation, uncomfortable environment, working posture and time spent at the workstation, which all contributed to musculoskeletal pain.
CONCLUSIONS: This study showed that exercise, academic stressors, and environmental factors were associated with musculoskeletal pain among undergraduates due to online teaching and learning sessions. There may be a need to integrate an online prevention of musculoskeletal pain education package based on a biopsychosocial model with online teaching and learning for undergraduates.
METHODS: The original CHIEF was cross-culturally adapted into the Malay language following the published guidelines on cross-cultural adaptation of health questionnaires. Its content and convergent validity were assessed using the content validity index and correlation with participants' gait speed, respectively. The reliability of M-CHIEF was assessed for its internal consistency using Cronbach's coefficient alpha and Cohen's kappa and its test-retest reliability was assessed using intraclass correlation coefficients (ICCs).
RESULTS: The M-CHIEF was rated with excellent content validity with a scale-level content validity index (S-CVI) of 0.86. Its internal consistency was demonstrated to be high with Cronbach's alpha of 0.84. The test-retest reliability at a two-week interval showed a stable score of the M-CHIEF and its subscales with an ICC value of 0.89.
CONCLUSIONS: The M-CHIEF is deemed relevant for use among Malay speakers. It can function as an instrument to quantify the environmental barriers of an individual while considering broad environmental factors including policy, physical/ structural, work/school, attitude/support, and services/assistance.
METHODS: A total of 755 older adults aged ≥60 years were recruited. Their cognitive performance was determined using the Clinical Dementia Rating. Fried's criteria was applied to identify physical frailty, and the Beck Depression Inventory assessed their mental states.
RESULTS: A total of 39.2% (n = 304) of the participants were classified as cognitive frail. In this cognitive frail subpopulation, 8.6% (n = 26) had clinical depressive symptoms, which were mostly somatic such as disturbance in sleep pattern, work difficulty, fatigue, and lack of appetite. Older adults with cognitive frailty also showed significantly higher depression levels as compared with the noncognitive frail participants (t (622.06) = -3.38; P = 0.001). There are significant associations between depression among older adults with cognitive frailty and multimorbidity (P = 0.009), polypharmacy (P = 0.009), vision problems (P = 0.046), and hearing problems (P = 0.047). The likelihood of older adults with cognitive frailty who experience impairments to their vision and hearing, polypharmacy, and multimorbidity to be depressed also increased by 2, 3, 5, and 7-fold.
CONCLUSIONS: The majority of the Malaysian community-dwelling older adults were in a good mental state. However, older adults with cognitive frailty are more susceptible to depression due to impairments to their hearing and vision, multimorbidity, and polypharmacy. As common clinical depressive symptoms among older adults with cognitive frailty are mostly somatic, it is crucial for health professionals to recognize these and not to disregard them as only physical illness. Geriatr Gerontol Int 2024; 24: 225-233.
AIM: This study aims to determine the use of one of three physical performance tests (2-minute step, 2-minute walk, and 1-minute sit to stand) to effectively estimate cardiorespiratory fitness among older adults with CF.
METHODS: In this cross-sectional study, community-dwelling individuals aged 60 years old and above in Klang Valley were screened for CF. The participants performed three physical performance tests (2-minute walk, 2-minute step, and 1-minute sit to stand) followed by treadmill-based maximal exercise testing on another day.
RESULTS: A total of 32 older adults with cognitive frailty (mean age; SD: 67.1;4.7 years) participated in this study. Nearly half of them had hypertension (43.5 %), hypercholesterolemia (43.5 %), and multimorbidity (47.8 %). Among the endurance tests performed, only the 2-minute walk test independently predicted VO2 max by sex-specific with men (R2 = 0.58, p = 0.03) and women (R2 = 0.34, p = 0.01). The 2-minute walk test had good agreement with VO2 max (ICC = 0.77, 95 % CI: -3.1-2.4).
CONCLUSION: The 2-minute walk test is a valid tool for estimating cardiorespiratory fitness among older adults with CF. However, it should be further tested across a larger population.
OBJECTIVE: This study aimed to design and develop the ChestCare mobile Health app using user-centred design (UCD) approach. Thus, it provided PTR for patients with COPD, enhancing their self-management of symptoms and improving their compliance with PR programs.
METHODS: In this mixed-methods sequential research, we deployed the UCD iterative design through the prototype app design and development sequence. The first phase was built based on the results of a previous needs assessment study and an analysis of related apps. This produced the initial mock-up, the foundation for the focus group discussions with physiotherapists and patients. Six physiotherapists with cardiorespiratory specialisation evaluated each app module and item of the latest mock-up using the content validity index (CVI) document. The I-CVI (S-CVI/Ave) and (S-CVI/UA) were computed. Qualitative and quantitative data were integrated, and decisions were made by comparing their results.
RESULTS: The UCD iterative design through sequential MMR has generated four mock-up app versions. The latest version identified 13 modules through 150 items validated by six experts using a CVI document. The I-CVI calculation of 145 items was 1, while 0.83 for the remaining items, was within accepted values. The S-CVI scored 99.4, indicating an overall validity of the ChestCare app as a PTR system for patients with COPD.
CONCLUSIONS: The development and validation of the ChestCare app resulted from conducting UCD iterative design and sequential MMR, which identified 13 functionalities, including symptom assessment, tracking lung volume, functional capacity test, action plan, intervention program, COPD education, COPD community, monitoring and reminders.
METHODS: Searches were conducted in PubMed, EBSCO, Web of Science, and Cochrane library for studies published between January 2017 and December 2022. We followed the Joanna Briggs Institute guidelines and the framework by Arksey and O'Malley. Screening was undertaken by two reviewers, and data extraction was undertaken by the first author. Then, the data were further reviewed and discussed thoroughly with the team members.
RESULTS: A total of 31 results were identified, with the core criteria of developing and testing a telerehabilitation system, including a mobile app for cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. All developed systems resulted from multidisciplinary teams and employed mixed-methods research. We proposed the "input-process-output" framework that identified phases of both system design and usability testing. Through system design, we reported the use of user-centered design, iterative design, users' needs and characteristics, theory underpinning development, and the expert panel in 64%, 75%, 86%, 82%, and 71% of the studies, respectively. We recorded the application of moderated usability testing, unmoderated testing (1), and unmoderated testing (2) in 74%, 63%, and 15% of the studies, respectively. The identified design and testing activities produced a matured system, a high-fidelity prototype, and a released system in 81.5%, 15%, and 3.5%, respectively.
CONCLUSION: This review provides a framework for TR system design and testing for a wide range of chronic diseases that require prolonged management through remote monitoring using a mobile app. The identified "input-process-output" framework highlights the inputs, design, development, and improvement as components of the system design. It also identifies the "moderated-unmoderated" model for conducting usability testing. This review illustrates characteristics and functionalities of the TR systems and healthcare professional roles.
OBJECTIVE: In this scoping review, we aimed to systematically map the literature on the perceptions of physiotherapists as well as the barriers and enablers of telerehabilitation in their daily practice.
METHODS: The five-stage methodological framework recommended by Arksey and O'Malley (2005) was used for this scoping review. In the framework, eight databases were searched using key search terms such as "telerehabilitation", "physiotherapists", "readiness", "enablers" and "barriers" All findings were organised into perceptions and readiness, enablers, and barriers.
RESULTS: Fourteen articles met the inclusion criteria and were categorized as: (1) perception and readiness, (2) enablers, and (3) barriers. In the perception and readiness category, new trends in healthcare, advancement in physiotherapy practices and the benefits to clients were identified. The enablers identified included prior training, personal experience, familiarity with technology, functional equipment and space, and client selection. The barriers to the adoption of telerehabilitation in physiotherapy practice are pinpointed to poor technology, communication hurdles, limited availability, lack of familiarity, and client-related concerns.
CONCLUSION: While initial evidence suggests a generally positive perceptions it is important to consider both facilitators and barriers when understanding adoption. This review's findings revealed a wide research gap, with unequal weightage towards barriers compared to enablers, and highlights the need for further research. Developing telerehabilitation guidelines that cater to both physiotherapists and clients is necessary.
OBJECTIVES: The aim of this study was to determine the feasibility of virtual data collection for a longitudinal study of aging assessing cognitive frailty in a middle-income Southeast Asian country.
METHODS: The Transforming Cognitive Frailty into Later-Life Self-Sufficiency (AGELESS) longitudinal study of aging involved community-dwelling participants aged 60 years and above. A semi-structured focus group discussion was conducted via videoconferencing with selected representatives from existing participants. The survey instrument was compiled during a hybrid meeting and refined using a virtual Delphi process involving 51 AGELESS investigators. The final draft survey and recruitment strategy were then piloted among selected participants.
RESULTS: Twelve individuals participated in the virtual focus group interview. Smartphone, tablet computer, laptops, and desktop personal computers were used for information gathering, communication, banking, shopping, leisure, religion, and education, within this group. The survey instrument was redacted from 362 items in 18 sections to 141 items in 12 sections through 3 virtual Delphi rounds facilitated by email, social media messaging, and videoconferencing which attracted 213 comments. Of 45 participants selected for the pilot survey, 30 were successfully contacted after one attempt and 18 completed the survey. Cognitive frailty was present in 13%, cognitive impairment in 20%, frailty in 20%, and 47% were robust.
CONCLUSION: A virtual survey instrument was developed for the AGELESS longitudinal survey of aging which was vital for determining the effects of the COVID-19 pandemic on our older population as well as sustaining research into aging despite barriers posed by the pandemic.
METHODS: This study included 302 ambulating Malaysian institutionalised older adults. Frailty was identified using Fried's frailty criteria. Cognitive status was assessed using the Mini Mental State Examination and Addenbrooke's Cognitive Examination. Functional fitness was assessed using the Senior Fitness test. The association between frailty groups, cognitive status and functional fitness was analysed using binary logistic regression.
RESULTS: Prevalence of frailty, prefrailty and robustness in the older adults was 56.6%, 40.7% and 2.9%, respectively. Frailty was found to be associated with hypertension (OR 2.15, 95% CI: 1.11-4.16, p = 0.024), lower cognitive status (Addenbrooke's Cognitive Examination) (OR 0.98, 95% C.I: 0.96-0.99, p = 0.038), and lower dynamic balance and mobility (Timed Up and Go test) (OR 1.09, 95% CI: 1.01-1.16, p = 0.024).
CONCLUSION: Frailty is highly prevalent among Malaysian institutionalised older adults. Hypertension, cognitive impairment and lower dynamic balance and mobility were found to be risk factors of frailty. Screening of frailty and its associated factors should be prioritized among institutionalised older adults in view of early prevention and rehabilitation.
Patients and Methods: A total of 253 participants aged 60 years and above participated in this cross-sectional study. The participants were subjected to pure tone audiometric assessment. The hearing threshold was calculated for the better ear and classified into pure-tone average (PTA) for the octave frequencies from 0.5 to 4 kHz and high-frequency pure-tone average (HFA) for the octave from 2 to 8kHz. Then, the risk factors associated with PTA hearing loss (HL) and HFAHL were identified by using multivariate logistic regression analysis.
Results: The prevalence of ARHL based on PTA and HFA among the community-dwelling older adults was 75.5% and 83.0%, respectively. Following multifactorial adjustments, being older (OR: 1.239; 95% CI: 1.062-1.445), having higher waist circumference (OR: 1.158; 95% CI: 1.015-1.322), lower intake of niacin (OR: 0.909; 95% CI: 0.831-0.988) and potassium (OR: 0.998; 95% CI: 0.996-1.000), and scoring lower in RAVLT T5 (OR: 0.905; 95% CI: 0.838-0.978) were identified as the risk factors of PTAHL. Meanwhile, being older (OR: 1.117; 95% CI: 1.003-1.244), higher intake of carbohydrate (OR: 1.018; 95% CI: 1.006-1.030), lower intake of potassium (OR: 0.998; 95% CI: 0.997-0.999), and lower scores on the RAVLT T5 (OR: 0.922; 95% CI: 0.874-0.973) were associated with increased risk of having HFAHL.
Conclusion: Increasing age, having higher waist circumference, lower intake of niacin and potassium, higher intake of carbohydrates and having lower RAVLT T5 score were associated with increased risk of ARHL. Modifying these risk factors may be beneficial in preventive and management strategies of ARHL among older persons.
METHODS: In this prospective cohort study, a total of 400 participants aged 60 years and above were successfully followed up at 5 years. Participants' socio-demographic, medical history, psycho-social, physical, cognitive and dietary intake information was obtained. Cognitive frailty was defined as comorbid physical frailty (> 1 Fried criteria) and mild cognitive impairment (Petersen criteria). Univariate analysis was performed for all variables, followed by hierarchical binary logistic regression (BLR) analysis to identify the ability of CF in predicting the incidence of falls, injuries, and disability. The significant value was set at p
METHODS: The dataset was obtained from the AGELESS trial screening phase conducted from October 2021 to March 2022, involving 476 community-dwelling Malaysian older adults (67.7 years old ± 6.1). Digital technology usage was assessed and CF was determined using Fried's criteria and Clinical Dementia Rating. A binary logistic regression was used to determine the sociodemographic factors associated with digital technology use among older adults with CF.
RESULTS: The findings suggest a digital divide between older adults with CF and robust in Malaysia. CF individuals (72.1%) were less likely to utilise digital technology, mainly smartphone than robust older adults (89.6%). More than 70% of older people owned social media on their smartphones, namely, WhatsApp. The most frequent online activities in both groups were family interaction and obtaining current news. CF older adults were less likely to play games on their smart devices. Usage of digital technology was more common among male, younger age, attained formal education more than 6 years, had a higher monthly household income, and robust participants.
CONCLUSIONS: The usage of digital technology was inversely related to CF status. CF older adults were less likely to integrate digital technology into their daily living compared to robust even though they were familiar with it. The use of digital technology should be reinforced among female, advanced age, widowers/divorcees without formal education and those from lower- or middle-income statuses, and cognitively frail older people.
PATIENTS AND METHODS: The available data related to cognitive frailty among a sub-sample of older adults aged 60 years and above (n=815) from two states in Malaysia were analysed. In the LRGS-TUA study, a comprehensive interview-based questionnaire was administered to obtain the socio-demographic information of the participants, followed by assessments to examine the cognitive function, functional status, dietary intake, lifestyle, psychosocial status and biomarkers associated with cognitive frailty. The factors associated with cognitive frailty were assessed using a bivariate logistic regression (BLR).
RESULTS: The majority of the older adults were categorized as robust (68.4%), followed by cognitively pre-frail (37.4%) and cognitively frail (2.2%). The data on the cognitively frail and pre-frail groups were combined for comparison with the robust group. A hierarchical BLR indicated that advancing age (OR=1.04, 95% CI:1.01-1.08, p<0.05) and depression (OR=1.49, 95% CI:1.34-1.65, p<0.001) scored lower on the Activity of Daily Living (ADL) scale (OR=0.98, 95% CI:0.96-0.99, p<0.05), while low social support (OR=0.98, 95% CI:0.97-0.99, p<0.05) and low niacin intake (OR=0.94, 95% CI:0.89-0.99, p<0.05) were found to be significant factors for cognitive frailty. Higher oxidative stress (MDA) and lower telomerase activity were also associated with cognitive frailty (p<0.05).
CONCLUSION: Older age, a lower niacin intake, lack of social support, depression and lower functional status were identified as significant factors associated with cognitive frailty among older Malaysian adults. MDA and telomerase activity can be used as potential biomarkers for the identification of cognitive frailty.