Urinary incontinence (UI) is a common disorder among older adults, with a global prevalence between 2% to 58%. UI has been associated with social isolation, increased morbidity and reduced quality of life (QoL). The aim of this study was to investigate the sociodemographic, clinical, cognitive and physical function risk factors of UI among Malaysian community dwelling older adults. This study is part of a larger scale population based longitudinal study on neuroprotective model for healthy longevity among older adults (LRGS TUA). A total of 1560 Malaysian community dwelling older adults aged 60 years and above were screened in this phase III LRGS study. Participants sociodemographic and clinical history were obtained. Mini Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT) and Digit Span tested cognitive function. Timed Up and Go Test (TUG), Hand Grip Strength Test, Chair Stand Test and Lawton Instrumental Activities of Daily Living tested physical function. The overall prevalence of UI was 15.7% (n = 245) in this study, with 11.8% (n = 88) in men and 19.3% (n = 157) in women. Logistic regression analysis showed that TUG (Adjusted odds ratio [OR], 1.071; 95% confidence interval [CI], 1.02-1.13), MMSE (OR, 0.93; CI, 0.90-0.97), weight (OR, 1.02; CI, 1.00-1.03), and constipation (OR 0.60; CI, 0.46-0.78) (p < 0.005) were significant risk factors of UI. The results indicate, decreased physical and cognitive function; increase in weight and having constipation increased the risk of UI. Maintaining optimum mobility, cognitive function, body weight and constipation prevention are vital in the prevention and management of UI among older adults.
Physical performance in older adults is known to decline with ageing. However, there is limited information about physical performance difference among older adults with; successful (SA), usual ageing (UA) and mild cognitive impairment (MCI). The purpose of this study was to compare the differences in physical performance among older adults in these three categorised groups. This study is part of a larger scale population based longitudinal study on neuroprotective model for healthy longevity among older adults (LRGS TUA). Physical performance was assessed using hand grip (HGT; upper limb strength), 2 minutes step (2MST; endurance), sit to stand (STS; lower limb strength), sit and reach (SRT; lower body flexibility), timed up and go (TUG; mobility and balance), back scratch (BST; upper body flexibility) and gait speed (GS; walking speed) tests. Cognitive status was measured using Mini Mental Status Examination (MMSE) for global function, Digit Span for attention and working memory; Rey Auditory Verbal Learning Test (RAVLT) for verbal memory. Participants were categorised in three groups; SA, UA and MCI. SA group were those without diabetes, hypertension, chronic lung disease, cancer, heart diseases and stroke, had normal scores in MMSE (score of >22), optimum self-rated health and no functional limitations measured using Instrumental Activities of Daily Living questionnaire (IADL). Participants with MCI had subjective information of cognitive impairment from caretakers, minimum or low functional limitation, global function with ≤ 19 score on MMSE and 1 SD from below the normal mean of the group for Digit Span and RAVLT. Older adults with UA had minimal or no functional limitation and average scores of MMSE, Digit Span and RAVLT which were between the scores of SA and MCI group. Data was collected among 1291 participants in Phase three of LRGS TUA study. Data was analysed for differences among the three groups using one way ANOVA test. The results showed that majority of older adults was categorized as UA group (71.14%), followed by SA (15.19% ) and MCI (12.72%). Higher performance in physical performance measures except in SRT were demonstrated in SA group compared to MCI and UA groups. Post hoc Sheffe test showed that there was a significant difference (p < 0.05) in the SA and UA group for all tests except for HGT and SRT. MCI and UA groups were significantly different (p < 0.05) in STS, TUG and GST tests. The results suggested that UA and MCI groups had reduced physical performance in lower limb muscle strength, mobility, balance and walking speed compared SA group. Promoting optimum physical performance is important among older adults for successful ageing.
Falls is a global health concern due to its many negative consequences in older adults. Early falls screening and prevention is important among older adults. We developed Falls Screening Mobile Application (FallSA) as a self falls screening tool among older adults. FallSA was developed using data of physical performance test, demographic information and questions to inform falls risk from a larger population based longitudinal study on neuroprotective model for healthy longevity among older adults (LRGS TUA). The aim of this study was to determine validity and reliability of FallSA as a self-screening tool to inform falls risk among Malaysian older adults. This cross sectional study was conducted among 91 community dwelling older adults aged 60 years and above. FallSA was validated against Physiological Profile Assessments (PPA), a comprehensive falls risk assessment tool. Participants used FallSA to test their falls risk by repeating the test twice between an hour. Validity and test–retest reliability of FallSA was examined by using Spearman correlation, Kappa, Sensitivity and Specificity, Intra correlation coefficient (ICC), Cronbach alpha and Bland-Altman. Concurrent validity test was significant with moderate correlation rs = 0.518, p < 0.001, moderate agreement K = 0.516, p < 0.001 and acceptable Sensitivity: 80.4% and Specificity: 71.1%. Reliability of FallSA was shown to be good (ICC: 0.948, CI: 0.921-0.966), good internal consistency α = 0.948, p < 0.001 and good agreement was indicated by small mean differences and narrow limits of agreement (LoA). The results of this study suggest that FallSA was a valid and reliable tool to inform falls risk among Malaysian older adults. Further prospective studies are required to determine the accuracy of FallSA to correctly classify older adults into fallers and non-faller groups.
Reduced muscle strength and quality of life (QoL) has an impact on adults at risk of osteoporotic fractures. Muscle strength and QoL among Malaysian adults at risk of osteoporotic fractures is not known. The aim of our study was to examine muscle strength and QoL status and its relationship among adults at low and moderate to high risk of osteoporotic fractures. In this cross-sectional study, we recruited 27 men and 78 women (mean age 69.3 ± 8.5 years) from Orthopaedic Clinic, Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia. A 10-year probability of major osteoporotic fractures were calculated according to WHO fracture risk assessment tool (FRAX) with femoral neck BMD (cut-point 10%). Participants were categorized as low and moderate to high risk of osteoporotic fractures based on FRAX results. Back extensor muscle strength and dominant hand grip strength were measured using a load cell system and a hand dynamometer respectively. European QoL questionnaire (EQ5Dvas) was used to measure QoL. Multiple linear regression was performed with QoL as a dependent variable and back extensor muscle strength and hand grip strength as the independent variables. Approximate 40% of adults were categorized into moderate to high risk of osteoporotic fractures. The mean values among the low and moderate to high risk of osteoporotic fractures for QoL was 80.5 ± 13.2 and 76.9 ± 16.9 (p = 0.77); hand grip strength was 25.7 ± 17.3 and 20.6 ± 5.5 kg (p < 0.001) and back extensor muscle strength was 25.0 ± 7.0 and 18.9 ± 9.5 Newton (p < 0.01) respectively. Hand grip muscle strength appeared to be a determinant of QoL and accounted for 5.8% of the total variance. Improved muscle strength may lead to better QoL among adults at risk of osteoporotic fractures.
Older adults who walk in their neighbourhood with greater street connectivity are reported to have lower limb physical performance decline. There is limited information regarding the association between built environment characteristics and physical performance in older adults. The aim of this study was to examine the association between built environment characteristics, physical performance, falls risk and functional mobility among older adults. Sixty four (27 men and 37 women) community dwelling older adults aged 60 years and above (mean 67.4 ± 7.1 years) from senior citizen clubs in Kuala Lumpur, Malaysia participated in this cross-sectional study. Built environment characteristics were assessed using an adapted Neighbourhood Environment Walkability Scale (NEWS). Physical performance and falls risk was measured using Short Physical Performance Battery (SPPB) and Profile Physiological Profile Assessment (PPA) respectively. Timed Up and Go (TUG) and gait speed tests were used to assess functional mobility. There was a significant correlation between built environment and physical performance (r = 0.43, p < 0.001) and functional mobility measured using gait speed test (r = 0.27, p < 0.05) among older adults. Built environment was identified as a significant determinant of physical performance (R2 = 0.19, p < 0.001). Built environment characteristics is an important external factor in preserving physical performance in older adults. Programmes and policies for a more favourable built environment characteristics in the neighbourhoods should be encouraged to promote and maintain physical performance among older adults.
Knee osteoarthritis (OA) is a common musculoskeletal condition that leads to decreased physical performance and falls among older adults. However, there is limited information comparing physical performances among older adult fallers with and without knee OA. The aim of this study was to compare physical performance between older adult fallers with and without knee OA. Participants were divided into two groups using the clinical diagnosis of knee OA based on National Institute of Health and Care Excellence guidelines; with and without knee OA. Participants performed a battery of physical performance tests that included chair sit and reach, back scratch, dominant handgrip strength, timed up and go (TUG), 30 seconds chair stand and 2 min walk. Independent t-test was used to compare physical performance between groups. Thirteen older adult fallers with knee OA (mean age = 70.92 ± 8.83 years) and 20 older adult fallers without knee OA (76.4 ± 7.92 years) participated in this study. There were no significant differences in sociodemographic profiles and physical performance among older adult fallers with and without knee OA (p > 0.05). However, hamstring flexibility was not within norm in 64% of older adult fallers with knee OA compared to 42% without OA. Physical performance between fallers with and without clinically diagnosed knee OA was similar. Hence, physiotherapy interventions for both groups may be similar and focused on strength and endurance training. In addition, to minimize falls risk and further improve physical performance, hamstring stretching must be emphasized among older adults with knee OA.
Older adults who fall recurrently have sub-optimal physical performance especially muscle strength, mobility and balance. Recurrent falls lead to a heightened fear of falls. However, there is limited information regarding other domains of physical performance, namely flexibility and endurance. In addition, there is still limited knowledge pertaining fear of falls and physical activity levels among Malaysian community-dwelling older adults who are recurrent fallers. The aim of our study was to compare fear of falls, physical performance and physical activity levels among older adults with falls and recurrent falls. This cross- sectional study was carried out in two Malaysian urban districts. Physical performance was examined using Functional Fitness MOT (FFMOT). Modified Baecke Questionnaire and Activities-Specific Balance Confidence (ABC-6) Scale were administered to evaluate the level of daily physical activity and fear of falls respectively. A total of 35 older adults participated in this study, 20 fallers (mean age: 71.95±8.22) and 15 recurrent fallers (mean age: 76.73±8.82) respectively. Our study results showed that older adults with recurrent falls had significantly reduced lower extremity strength, dynamic balance, endurance, balance confidence in activities of daily living and physical activity levels compared to faller group (p < 0.05). Although flexibility and upper limb strength were not significantly different among fallers and recurrent fallers, overall improvement in physical performance should be targetted in falls prevention and management. This is vital to prevent further deterioration in physical performance among older adults with recurrent falls.
Falls are a public health concern among older adults. There is a need to take significant measures such as screening for the risk of a fall as a means of prevention and management. A cross-sectional study was conducted to determine discriminative and predictive ability of physical performance measures in identifying the risk of fall among Malaysian community dwelling older adults. Three hundred twenty-five Malaysian community dwelling older adults aged 60 years and above (67.67+ 5.5 years) participated in this study. This study was a part of a larger longitudinal study ‘LRGS TUA’. Physiological Profile Assessment (PPA), a comprehensive tool for quantifying risk of fall was used as a standard measure of comparison to 6 Meter Gait Speed (GS), Timed Up and Go (TUG) and Walking While Talking (WWT) tests to establish discriminative and predictive ability. Participants recorded incidence of falls in a ‘falls diary’ over a span of six months. To determine the optimum cut off scores of the test identified to classify fall risk, receiver operator curves (ROC) were used and its sensitivity and specificity were calculated. A significant mean difference between fallers and non-fallers was demonstrated only with TUG test (p<0.05). TUG test cut off score in discriminating older adults at risk of fall was established at eight seconds, with a sensitivity and specificity of 83.95% and 32.4%, respectively, in this study. Eighty-four percent older adults who experienced a fall in our study were identified to be at risk of fall when screened using this TUG cut off score. Our study results suggested TUG test to be an optimal screening tool for risk of fall among community dwelling older adults.