Displaying publications 1 - 20 of 29 in total

  1. Chin AV
    Med. J. Malaysia, 2019 08;74(4):359-362.
    PMID: 31424053
    No abstract provided.
  2. Lee LK, Shahar S, Chin AV, Yusoff NA
    Psychopharmacology (Berl.), 2013 Feb;225(3):605-12.
    PMID: 22932777 DOI: 10.1007/s00213-012-2848-0
    RATIONALE: Epidemiological studies have suggested a beneficial effect of fish oil supplementation in halting the initial progression of Alzheimer's disease. However, it remains unclear whether fish oil affects cognitive function in older people with mild cognitive impairment (MCI).

    OBJECTIVES: This study investigated the effects of fish oil supplementation on cognitive function in elderly person with MCI.

    METHODS: This was a 12-month, randomised, double-blind, placebo-controlled study using fish oil supplementation with concentrated docosahexaenoic acid (DHA). Thirty six low-socioeconomic-status elderly subjects with MCI were randomly assigned to receive either concentrated DHA fish oil (n = 18) or placebo (n = 18) capsules. The changes of memory, psychomotor speed, executive function and attention, and visual-constructive skills were assessed using cognitive tests. Secondary outcomes were safety and tolerability of the DHA concentrate.

    RESULTS: The fish oil group showed significant improvement in short-term and working memory (F = 9.890; ηp (2) = 0.254; p 

  3. Lam NW, Goh HT, Kamaruzzaman SB, Chin AV, Poi PJ, Tan MP
    Singapore Med J, 2016 Oct;57(10):578-584.
    PMID: 26768064 DOI: 10.11622/smedj.2015164
    INTRODUCTION: Hand strength is a good indicator of physical fitness and frailty among the elderly. However, there are no published hand strength references for Malaysians aged > 65 years. This study aimed to establish normative data for hand grip strength (HGS) and key pinch strength (KPS) for Malaysians aged ≥ 60 years, and explore the relationship between hand strength and physical ability.

    METHODS: Healthy participants aged ≥ 60 years with no neurological conditions were recruited from rural and urban locations in Malaysia. HGS and KPS were measured using hand grip and key pinch dynamometers. Basic demographic data, anthropometric measures, modified Barthel Index scores and results of the Functional Reach Test (FRT), Timed Up and Go (TUG) test and Jebsen-Taylor Hand Function Test (JTHFT) were recorded.

    RESULTS: 362 subjects aged 60-93 years were recruited. The men were significantly stronger than the women in both HGS and KPS (p < 0.001). The hand strength of the study cohort was lower than that of elderly Western populations. Significant correlations were observed between hand strength, and residential area (p < 0.001), FRT (r = 0.236, p = 0.028), TUG (r = -0.227, p = 0.009) and JTHFT (r = -0.927, p < 0.001).

    CONCLUSION: This study established reference ranges for the HGS and KPS of rural and urban elderly Malaysian subpopulations. These will aid the use of hand strength as a screening tool for frailty among elderly persons in Malaysia. Future studies are required to determine the modifiable factors for poor hand strength.

  4. Tan MP, Kamaruzzaman SB, Zakaria MI, Chin AV, Poi PJ
    Geriatr Gerontol Int, 2015 Jan 22.
    PMID: 25613422 DOI: 10.1111/ggi.12446
    METHODS: Information on sociodemographics, dependency using the Barthel index and fall characteristics were collected from consecutive patients attending the ED over a 6-month period. Barthel score was reassessed at 12 months. Ten-year mortality data were obtained through the National Registry Department.
    RESULTS: A total of 198 participants, with a mean age (standard deviation) of 76.2 years (6.3 years) and 74% women, were recruited. Of these, 70% sustained falls indoors, while 49% of falls occurred between 06.00 to 12.00 hours. Total Barthel scores were significantly lower at 1-year follow up compared with baseline (median [interquartile range], 20 [2] vs 18 [5], P 
  5. Tey NP, Siraj SB, Kamaruzzaman SB, Chin AV, Tan MP, Sinnappan GS, et al.
    Gerontologist, 2016 08;56(4):603-9.
    PMID: 26553738 DOI: 10.1093/geront/gnv153
    Multiethnic Malaysia provides a unique case study of divergence in population aging of different sociocultural subgroups within a country. Malaysia represents 3 major ethnicities in Asia-the Malay, Chinese, and Indian. The 3 ethnic groups are at different stages of population aging, as they have undergone demographic transition at different pace amidst rapid social and economic changes. Between 1991 and 2010, the Malaysian population aged 60 and over has more than doubled from about 1 million to 2.2 million, and this is projected to rise to about 7 million or 17.6% of the projected population of 40 million by 2040. In 2010, the aging index ranged from 22.8% among the Bumiputera (Malays and other indigenous groups), to 31.4% among the Indians and 55.0% among the Chinese. Population aging provides great challenges for Malaysia's social and economic development. The increasing prevalence of noncommunicable diseases in older adults, coupled with the erosion of the traditional family support system has increased demands on health care services with an overwhelming need for multidisciplinary and specialized geriatric care. Following the adoption of the National Policy for the Elderly in 1995, issues of population aging have gained increasing attention, especially among researchers. There is an urgent need to increase public awareness, develop infrastructure, as well as support action oriented research that will directly translate to comprehensive and cohesive social strategies, policies, and legislation to protect not just the current older Malaysians but the future of all Malaysians.
  6. Rosli R, Tan MP, Gray WK, Subramanian P, Chin AV
    Int Psychogeriatr, 2016 Feb;28(2):189-210.
    PMID: 26450414 DOI: 10.1017/S1041610215001635
    The prevalence of dementia is increasing in Asia than in any other continent. However, the applicability of the existing cognitive assessment tools is limited by differences in educational and cultural factors in this setting. We conducted a systematic review of published studies on cognitive assessments tools in Asia. We aimed to rationalize the results of available studies which evaluated the validity of cognitive tools for the detection of cognitive impairment and to identify the issues surrounding the available cognitive impairment screening tools in Asia.
  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. 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.
  9. Keevil V, Mazzuin Razali R, Chin AV, Jameson K, Aihie Sayer A, Roberts H
    Arch Gerontol Geriatr, 2013 Jan-Feb;56(1):155-9.
    PMID: 23116975 DOI: 10.1016/j.archger.2012.10.005
    Grip strength is a marker of sarcopenia, the age-related decline in muscle mass and function, and has been little researched in Asian populations. We aimed to describe the feasibility and acceptability of measuring grip strength in hospitalized, older people in Malaysia and to explore its range, determinants and association with length of stay. Patients admitted acutely to the geriatrics ward of a teaching hospital were consecutively recruited. Inability to consent or use the dynamometer led to exclusion. Maximum grip strength, anthropometric data, length of hospital stay, discharge destination, 3-point Barthel score, mini-mental state examination, falls history and number of co-morbidities and medications on admission were recorded. 80/153 (52%) eligible patients were recruited (52 women; age range 64-100 years). 9/153 (6%) refused to participate and 64/153 (42%) were excluded (34 too unwell, 24 unable to consent, 4 unable to use the dynamometer, 2 other reasons). 76/80 patients (95%) reported that they would undergo grip strength measurement again. Determinants were similar to those of Caucasian populations but grip strength values were lower. After adjustment for sex, age and height, stronger grip strength was associated with shorter length of stay [hazard ratio 1.05 (95% CI 1.00, 1.09; P=0.03)]. This is the first report of grip strength measurement in hospitalized older people in Malaysia. It was feasible, acceptable to participants and associated with length of stay. Further research is warranted to elucidate the normative range in different ethnic groups and explore its potential use in clinical practice in Malaysia.
  10. 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.
  11. Lee LK, Shahar S, Chin AV, Mohd Yusoff NA, Rajab N, Aziz SA
    Arch Gerontol Geriatr, 2012 Jan-Feb;54(1):185-91.
    PMID: 21546098 DOI: 10.1016/j.archger.2011.03.015
    The aims were to investigate the prevalence of mild cognitive impairment (MCI) within gender disparities in Malaysian older adults, and to determine the predictors of MCI according to gender disparities. A community-based sample of urban, multiethnic dwelling elderly aged 60 years of age and above from Cheras, Kuala Lumpur was recruited. Prevalence of all-type MCI, amnestic-type MCI (am-MCI) and non-amnestic-type MCI (nam-MCI) was assessed using comprehensive neuropsychological batteries. The association between demography, socioeconomic status, lifestyle practices, and nutritional status and health risk factors with MCI were examined. Predictors of MCI occurrence between gender disparities were determined. The prevalence of all-type MCI, am-MCI and nam-MCI was 21.1%, 15.4% and 5.7%, respectively. Binary logistic regression indicated that hypercholesterolemia is the significant predictor for MCI in men after adjustment for age, ethnicity and total years of education. While, in women, MCI was best predicted by married status, without exercise practice, overweight and obesity. These results suggest that approximately one-fifth of the studied elderly people had MCI. Predictors for MCI are totally different between men and women. It is critical to identify those at higher risk for MCI in order to implement preventative measures to delay or reverse this abnormal condition.
  12. Rosli R, Tan MP, Gray WK, Subramanian P, Mohd Hairi NN, Chin AV
    Clin Gerontol, 2017 03 29;40(4):249-257.
    PMID: 28459304 DOI: 10.1080/07317115.2017.1311978
    OBJECTIVES: To pilot two new cognitive screening tools for use in an urban Malaysian population and to compare their criterion validity against a gold standard, the well-established Mini-Mental State Examination (MMSE).

    METHODS: The IDEA cognitive screen, Picture-based Memory Impairment Scale (PMIS), and MMSE were administered to a convenience sample of elderly (≥ 65 years) from the community and outpatient clinics at an urban teaching hospital. Consensus diagnosis was performed by two geriatricians blinded to PMIS and IDEA cognitive screen scores using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) clinical criteria. The MMSE performance was used as a reference.

    RESULTS: The study enrolled 66 participants, with a median age of 78.5 years (interquartile range [IQR], 72.5-83.0) years and 11.0 median years of education (IQR, 9.0-13.0). Forty-three (65.2%) were female, and 32 (48.4%) were Chinese. The area under the receiver operating characteristic (AUROC) curve values were .962 (IDEA cognitive screen), .970 (PMIS), and .935 (MMSE). The optimal cutoff values for sensitivity and specificity were: IDEA cognitive screen: ≤ 11, 90.9% and 89.7%; PMIS: ≤ 6, 97.3% and 69.0%; and MMSE: ≤ 23, 84.6% and 76.0%. Although the sample size was small, multivariable logistic regression modelling suggested that all three screen scores did not appear to be educationally biased.

    CONCLUSION: The IDEA and PMIS tools are potentially valid screening tools for dementia in urban Malaysia, and perform at least as well as the MMSE. Further work on larger representative, cohorts is needed to further assess the psychometric properties.

    CLINICAL IMPLICATIONS: Study provides alternative screening tools for dementia for both non-specialists and specialists.
  13. Hussin NM, Shahar S, Din NC, Singh DKA, Chin AV, Razali R, et al.
    Aging Clin Exp Res, 2019 Feb;31(2):215-224.
    PMID: 30062670 DOI: 10.1007/s40520-018-1007-9
    BACKGROUND: Multimorbidity in older adults needs to be assessed as it is a risk factor for disability, cognitive decline, and mortality.

    AIMS: A community-based longitudinal study was performed to determine the incidence and to identify possible predictors of multimorbidity among multiethnic older adults population in Malaysia.

    METHODS: Comprehensive interview-based questionnaires were administered among 729 participants aged 60 years and above. Data were analyzed from the baseline data of older adults participating in the Towards Useful Aging (TUA) study (2014-2016) who were not affected by multimorbidity (349 without any chronic diseases and 380 with one disease). Multimorbidity was considered present in an individual reporting two or more chronic diseases.

    RESULTS: After 1½ years of follow-up, 18.8% of participants who were initially free of any diseases and 40.9% of those with one disease at baseline, developed multimorbidity. The incidence rates were 13.7 per 100 person-years and 34.2 per 100 person-years, respectively. Female gender, smoking, and irregular preparing of food (lifestyle) were predictors for incidence of multimorbidity, especially in those without any disease, while Body Mass Index (BMI) 22-27 kg/m2 and inadequate daily intake of iron were identified as predictors of multimorbidity among participants who already have one disease.

    CONCLUSIONS: The incidence rates of multimorbidity among Malaysian older adults were between the ranges of 14-34 per 100 person-years at a 1½-year follow-up. Gender, smoking, BMI 22-27 kg/m2, inadequate daily intake of iron and lack of engagement in leisure or lifestyle physical activities were possible predictors in the development of multimorbidity. There is a need to formulate effective preventive management strategies to decelerate multimorbidity among older adults.

  14. Ngu SS, Tan MP, Subramanian P, Abdul Rahman R, Kamaruzzaman S, Chin AV, et al.
    Pain Manag Nurs, 2015 Aug;16(4):595-601.
    PMID: 26088939 DOI: 10.1016/j.pmn.2014.12.002
    Pain assessment in older individuals with cognitive impairment is challenging. Evidence on the performance of pain assessment tools in this population remains limited. The aim of this study was to evaluate the performance of self-reported pain, nurse-reported pain, and observational pain tools among older patients with cognitive impairment using a prospective observational design. In all, 152 older individuals admitted to the acute geriatric ward were recruited through convenience sampling. Three methods of pain assessment were compared: self-reported pain (SRP), observational pain using the Pain Assessment in Advanced Dementia (PAINAD) tool, and nurse-reported pain (NRP). Cognition and mood were assessed with the Mini-Mental State Examination (MMSE) and the 15-item Geriatric Depression Scale (GDS-15). There was moderate agreement between SRP and PAINAD (k = 0.438) and fair agreement between SRP and NRP (k = 0.263). There was statistically significant correlation between SRP and GDS-15 (r = 0.382, p 
  15. Mohd Hasni DS, Lim SM, Chin AV, Tan MP, Poi PJH, Kamaruzzaman SB, et al.
    Geriatr Gerontol Int, 2017 May;17(5):839-846.
    PMID: 27215446 DOI: 10.1111/ggi.12783
    AIM: Cytokines released from chronically-activated microglia could result in neuroinflammation. An accurate profile of the relationship between cytokines and Alzheimer's disease (AD) pathogenesis, as well as the patterns of these inflammatory mediators in AD patients could lead to the identification of peripheral markers for the disease. The present study was undertaken to identify pro- and anti-inflammatory cytokines associated with AD in the Malaysian population.

    METHODS: Further to informed consent from 39 healthy subjects and 39 probable AD patients, 8.5 mL of peripheral blood was collected and serum was extracted. The differential levels of 12 serum cytokines extracted from peripheral blood samples were measured using Procarta Multiplex Cytokine and enzyme-linked immunoassay kits. Concentrations of cytokines were measured at 615 nm using a fluorometer.

    RESULTS: Except for tumor necrosis factor-α, all classical pro-inflammatory cytokines (interleukin [IL]-1β, IL-6, IL-12 and interferon-γ) were found to be significantly upregulated (P 53.65 ρg/mL and <9.315 ρg/mL, respectively).

    CONCLUSIONS: Both the non-classical pro-inflammatory CXCL-10 and anti-inflammatory IL-13 cytokines showed promising potential as blood-based cytokine biomarkers for AD. This is the first study of non-classical cytokine profiles of Malaysian AD patients. Geriatr Gerontol Int 2017; 17: 839-846.

  16. 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.
  17. Saedon NI, Zainal-Abidin I, Chee KH, Khor HM, Tan KM, Kamaruzzaman SK, et al.
    Clin. Auton. Res., 2016 Feb;26(1):41-8.
    PMID: 26695401 DOI: 10.1007/s10286-015-0327-5
    To determine the magnitude of postural blood pressure change, differences in ECG between fallers and non-fallers were measured. Postural blood pressure change is associated with symptoms of dizziness, presyncope, and syncope.
  18. 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.

  19. Alex D, Khor HM, Chin AV, Hairi NN, Othman S, Khoo SPK, et al.
    BMJ Open, 2018 07 17;8(7):e019579.
    PMID: 30018093 DOI: 10.1136/bmjopen-2017-019579
    OBJECTIVES: Falls represent major health issues within the older population. In low/middle-income Asian countries, falls in older adults remain an area which has yet to be studied in detail. Using data from the Malaysian Elders Longitudinal Research (MELoR), we have estimated the prevalence of falls among older persons in an urban population, and performed ethnic comparisons in the prevalence of falls.

    DESIGN: Cross-sectional analysis was carried out using the first wave data from MELoR which is a longitudinal study.

    SETTING: Urban community dwellers in a middle-income South East Asian country.

    PARTICIPANTS: 1565 participants aged ≥55 years were selected by simple random sampling from the electoral rolls of three parliamentary constituencies.

    OUTCOME MEASURES: Consenting participants from the MELoR study were asked the question 'Have you fallen down in the past 12 months?' during their computer-assisted home-based interviews. Logistic regression analyses were conducted to compare the prevalence of falls among various ethnic groups.

    RESULTS: The overall estimated prevalence of falls for individuals aged 55 years and over adjusted to the population of Kuala Lumpur was 18.9%. The estimated prevalence of falls for the three ethnic populations of Malays, Chinese and Indian aged 55 years and over was 16.2%, 19.4% and 23.8%, respectively. Following adjustment for ethnic discrepancies in age, gender, marital status and education attainment, the Indian ethnicity remained an independent predictor of falls in our population (relative risk=1.45, 95% CI 1.08 to 1.85).

    CONCLUSION: The prevalence of falls in this study is comparable to other previous Asian studies, but appears lower than Western studies. The predisposition of the Indian ethnic group to falls has not been previously reported. Further studies may be needed to elucidate the causes for the ethnic differences in fall prevalence.

  20. 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.
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