Factors associated with poor socioeconomic status among Malaysian older adults: an analysis according to urban and rural settings

Characterising and differentiating cognitive and motor speed in older adults: structural equation modelling on a UK longitudinal birth cohort

OBJECTIVES

Information processing speed (IPS) has been proposed to be a key component in healthy ageing and cognitive functioning. Yet, current studies lack a consistent definition and specific influential characteristics. This study aimed to investigate IPS as a multifaceted concept by differentiating cognitive and motor IPS.

DESIGN, SETTING AND PARTICIPANTS

A retrospective data analysis using data from the Medical Research Council National Survey of Health and Development (a population-based cohort of UK adults born in 1946) at childhood (ages 8, 11 and 15) and adulthood (ages 60-64 and 68-70). Using structural equation modelling, we constructed two models of IPS with 2124 and 1776 participants, respectively.

OUTCOME MEASURES

Measures of interest included IPS (ie, letter cancellation, simple and choice reaction time), intelligence (ie, childhood intelligence and National Adult Reading Test), verbal memory, socioeconomic status (SES) and cognitive functions measured by the Addenbrooke's Cognitive Examination III, as well as a variety of health indexes.

RESULTS

We found distinct predictors for cognitive and motor IPS and how they relate to other cognitive functions in old age. In our first model, SES and antipsychotic medication usage emerged as significant predictors for cognitive IPS, intelligence and smoking as predictors for motor IPS while both share sex, memory and antiepileptic medication usage as common predictors. Notably, all differences between both IPS types ran in the same direction except for sex differences, with women performing better than men in cognitive IPS and vice versa in motor IPS. The second model showed that both IPS measures, as well as intelligence, memory, antipsychotic and sedative medication usage, explain cognitive functions later in life.

CONCLUSION

Taken together, these results shed further light on IPS as a whole by showing there are distinct types and that these measures directly relate to other cognitive functions.

Predictors for the development of motoric cognitive risk syndrome in older adults

BACKGROUND

Motoric cognitive risk (MCR) syndrome refers to a condition where both slow gait and memory complaints coexist, which heightens their vulnerability to developing dementia. Considering that the risk factors of MCR are elucidated from cross-sectional studies and also likely vary based on socioeconomic status, we conducted a community-based longitudinal study to determine the predictors of MCR among older adults in Malaysia.

METHODS

Out of 1,249 older participants (aged 60 years and above) without MCR at baseline (Wave II of LRGS-TUA cohort study), 719 were successfully followed up after 3.5 years to identify predictors of subsequent MCR development. A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, psychosocial, functional status, and dietary intake. Anthropometric measurements, body composition, and physical performance were assessed. Univariate analyses were performed for each variable, followed by a hierarchical logistic regression analysis to identify the predictors of MCR that accounted for confounding effects between the studied factors.

RESULTS

The incidence rate of MCR was 4.0 per 100 person-years. Smoking (Adjusted Odd Ratio (Adj OR) = 1.782; 95% Confidence Interval (CI):1.050-3.024), hypertension (Adj OR = 1.725; 95% CI:1.094-2.721), decreased verbal memory as assessed by the lower Rey Auditory Verbal Learning Test (RAVLT) (Adj OR = 1.891; 95% CI:1.103-3.243), and decreased functional status measured using instrumental activity of daily living (IADL) (Adj OR = 4.710; 95% CI:1.319-16.823), were predictors for MCR incidence.

CONCLUSIONS

Our study results provide an initial reference for future studies to formulate effective preventive management and intervention strategies to reduce the growing burden of adverse health outcomes, particularly among Asian older adults.

Community Care Needs of Highly Complex Chronic Patients: An Epidemiological Study in a Healthcare Area

One of the priorities in family and community care is the epidemiological surveillance of the care needs and dysfunctionality present in populations of highly complex chronic patients (HCCPs) using standardised nursing languages. The aim of this study is to establish the prevalence of care needs and dysfunctionality among HCCPs in a specific health area by municipalities and geographical areas (metropolitan, north, and south) while verifying correlations with sociodemographic, financial, and health characteristics. This is an epidemiological, observational, descriptive, cross-sectional study carried out with a sample of 51,374 HCCPs, whose data were grouped into 31 municipalities. Data were collected on the following variables: sociodemographic, financial, health, functional status (health patterns), and care needs (nursing diagnoses). The mean age of the HCCPs was 73.41 (1.45) years, of which 56.18 (2.86)% were women. The municipalities in the northern area have a significantly higher proportion of older patients, HCCPs, lower incomes, and higher unemployment rates. The southern area had higher proportions of non-Spanish nationals and professionals in the hotel and catering industry, and the metropolitan area had a higher proportion of employed individuals and higher levels of education. Northern municipalities had a higher prevalence of illnesses and anxiolytic and anti-psychotic treatments. Dysfunctionality frequencies did not differ significantly by area. However, a higher prevalence of 13 nursing diagnoses was observed in the north. A high number of correlations were observed between population characteristics, dysfunctionality, and prevalent diagnoses. Finally, the frequencies of dysfunctionality in the population and the most common care needs were mapped by municipality. This research sought to ascertain whether there was an unequal distribution of these two aspects among HCCPs in order to gain a deeper epidemiological understanding of them from a family and community perspective using standardised nursing languages. This study was not registered.

Attitudinal factors associated with protein sufficiency in Chilean vegan university students - A pilot study

INTRODUCTION

vegan diets are currently an essential topic of discussion because they are recognized as a prototype of a healthy diet but are also associated with deficits in the intake of critical nutrients such as protein. Evaluating the factors that influence the deficit in their intake in vulnerable populations such as university students represents an important topic of interest, considering that this is one of the groups where veganism is most popular. Given this, the present study aimed to determine the degree of protein sufficiency and its associated factors in a sample of Chilean vegan university students.

MATERIALS AND METHODS

an exploratory cross-sectional study was conducted on 114 vegan university students who responded to an online survey on academic, attitudinal, clinical, dietary, and sociodemographic variables. Protein intake was calculated, and based on self-reported weight, daily protein adequacy was calculated according to the recommendation of 0.9 g/kg/day. Finally, the association between protein adequacy and previously consulted variables was calculated by determining the odds ratios.

RESULTS

only 53.5 % had adequate daily protein intake, which was associated with the length of time respondents had been vegan (OR, 2.86; 95 % CI, 1.07 to 7.34; p < 0.05), use of supplements (OR, 5.24; 95 % CI, 1.17 to 25.2; p < 0.05), and the frequency with which they ate lunch at home (OR, 87.7; 95 % CI, 24.1 to 304; p = 0.000).

CONCLUSION

there needs to be more protein adequacy in the assessed sample. Protein adequacy is associated with the length of time on the vegan diet, frequency of eating lunch away from home, and use of supplements regularly.

Individual and Neighborhood-level Socioeconomic Status and Somatic Mutations Associated With Increased Risk of Cardiovascular Disease and Mortality: A Cross-Sectional Analysis in the Women's Health Initiative

BACKGROUND

Clonal hematopoiesis of indeterminate potential (CHIP), the expansion of leukemogenic mutations in white blood cells, has been associated with increased risk of atherosclerotic cardiovascular diseases, cancer, and mortality.

OBJECTIVE

We examined the relationship between individual- and neighborhood-level socioeconomic status (SES) and CHIP and evaluated effect modification by interpersonal and intrapersonal resources.

METHODS

The study population included 10,799 postmenopausal women from the Women's Health Initiative without hematologic malignancy or antineoplastic medication use. Individual- and neighborhood (Census tract)-level SES were assessed across several domains including education, income, and occupation, and a neighborhood-level SES summary z-score, which captures multiple dimensions of SES, was generated. Interpersonal and intrapersonal resources were self-reports. CHIP was ascertained based on a prespecified list of leukemogenic driver mutations. Weighted logistic regression models adjusted for covariates were used to estimate risk of CHIP as an odds ratio (OR) and 95% confidence interval (95% CI).

RESULTS

The interval-scale neighborhood-level SES summary z-score was associated with a 3% increased risk of CHIP: OR (95% CI) = 1.03 (1.00-1.05), p = .038. Optimism significantly modified that estimate, such that among women with low/medium and high levels of optimism, the corresponding ORs (95% CIs) were 1.03 (1.02-1.04) and 0.95 (0.94-0.96), pInteraction < .001.

CONCLUSIONS

Our findings suggest that reduced risk of somatic mutation may represent a biological pathway by which optimism protects contextually advantaged but at-risk women against age-related chronic disease and highlight potential benefits of long-term, positive psychological interventions.

Healthy Aging and its Determinants Among Community-dwelling Older Persons in East Coast, Malaysia: A Multidimensional Assessment

Objectives

Exploring the possibility of healthy aging among older persons is crucial for achieving optimal health in the growing older population. This study aimed to determine the prevalence, pattern, and determinants of healthy aging among older persons in Terengganu, Malaysia.

Methods

We conducted a community-based cross-sectional study involving older persons aged % 60 years. An interviewer-guided questionnaire, anthropometric measurements, and physical assessments were administered to operationalize healthy aging based on a multidimensional concept.

Results

Among the 765 older persons surveyed, only 14.1% (95% CI: 11.64?"16.59) were classified as healthy agers. Multiple logistic regression analysis revealed that superior intrinsic religiosity (odds ratio (OR) = 3.42; 95% CI: 1.34?"8.73), higher social interaction (OR = 2.82; 95% CI: 1.32?"6.04), larger calf circumference (OR = 2.05; 95% CI: 1.24?"3.38), taking water intake % 5 cups per day (OR = 2.01; 95% CI: 1.23?"3.30), better gait speed (OR = 1.71; 95% CI: 1.04?"2.80), having savings (OR = 1.71; 95% CI: 1.10?"2.66), and normal waist circumference (OR = 1.63; 95% CI: 1.04?"2.55) were found positively associated with healthy aging.

Conclusions

Only one in 10 older persons in the state met all the criteria for healthy aging. Specific aspects of religious status, social interaction, socioeconomic, behavioral, physical, and nutritional factors were found to predict healthy ageing in this population. These important determinants should be considered in developing a well-defined and comprehensive public health policy to promote healthy aging in the nation.

Hearing care services for adults with hearing loss in Malaysia: a scoping review

OBJECTIVE

This scoping review aimed to identify knowledge gaps in relation to access to, and outcomes from, hearing care services for adults in Malaysia.

DESIGN

Scoping review.

STUDY SAMPLE

1261 studies from 4 databases (PubMed, CINAHL, Embase and Scopus) and 7 studies from grey literature were identified. After removing duplicates, 647 studies were screened for title and/or abstract, and five studies met the criteria and were included.

RESULTS

Audiologists reported offering a range of diagnostic assessment and rehabilitation services, including hearing aids, assistive listening devices, auditory training, and counselling. However, the uptake of hearing services was low; rates of hearing aid use among people with at least mild hearing loss were around 2.7%-4.4%; 6.5%-7.3% for those with at least moderate loss. There were no data on the outcomes from hearing services.

CONCLUSIONS

This scoping review highlighted the limited uptake of hearing services among adults in Malaysia, despite the existence of services. Furthermore, it revealed a lack of information about the factors contributing to this limited uptake. To address the burden of hearing loss, there is an urgent need to identify barriers to access, improve access and uptake, and evaluate the benefits of adult hearing services in Malaysia.

Influence of education and subjective financial status on dietary habits among young, middle-aged, and older adults in Japan: a cross-sectional study

BACKGROUND

Research has suggested an association between lower socioeconomic status (SES) and unhealthy dietary habits. However, differences in the effects of different SES indicators and age remain unclear. The current study addressed this research gap by investigating the relationship between SES and unhealthy dietary habits, specifically focusing on educational attainment and subjective financial status (SFS) among varied age groups.

METHODS

Data were derived from a mail survey of 8,464 people living in a suburb of Tokyo, Japan. Participants were classified into three age groups (20-39 years: young adults; 40-64 years: middle-aged adults; and 65-97 years: older adults). SES was assessed based on individual educational attainment and SFS. Unhealthy dietary habits were defined as skipping breakfast and a low frequency of balanced meal consumption. Participants were asked how often they ate breakfast, and those who did not respond "every day" were categorized as "breakfast skippers." Low frequency of balanced meal consumption was defined as eating a meal that included a staple meal, main dish, and side dishes at least twice a day for less than five days per week. Poisson regression analyses with robust variance adjusted for potential covariates were used to determine the interactive effects of educational attainment and SFS on unhealthy dietary habits.

RESULTS

Individuals with lower educational attainment across all age groups skipped breakfast more frequently compared to those with higher educational attainment. For older adults, poor SFS was associated with skipping breakfast. Young adults with poor SFS and middle-aged adults with lower educational attainment tended to eat less balanced meals. In addition, an interaction effect was found in older adults, where those with lower education despite good SFS and those with poor SFS despite higher education were at a greater risk of falling into unhealthy diet.

CONCLUSIONS

The findings suggested that different SES indicators affect healthy dietary habits in different generations, and therefore, health policies should consider the potential influence of different SES on promoting healthier dietary habits.

Associations between biopsychosocial factors and transportation patterns of older adults residing in Klang Valley, Malaysia

Introduction

Aging is associated with physiological changes in multiple systems in the body and may impact the transportation choices of older adults. In this study, we examine the associations between biopsychosocial factors and the transportation choices of Malaysian older adults.

Methods

One hundred and nineteen (119) older adults, aged 60 and above, living in Klang Valley, Malaysia were recruited for this cross-sectional study. Participants were interviewed face-to-face to obtain sociodemographic data, health status (whether there were and, if yes, the number of comorbidities), outdoor mobility and transportation patterns, Instrumental Activity Daily Living (IADL) status and cognitive function. Participants' physical performance (dominant handgrip strength, 10-m walk, and timed up and go tests), hearing threshold (pure tone audiometry), and vision function (visual acuity, contrast sensitivity) were measured. Transportation patterns of older adults were categorized into three groups, that is, flexible (using public transport and/or private vehicles), using only private vehicles and restricted (relying on others or walking).

Results

Further information is needed to enable such older adults as older women, those with comorbidities and poorer functional status to access transportation, especially to meet their health care needs.

Discussion

The majority (51%) of participants were in the 'using only private vehicles' group, followed by the 'flexibles' (25%) and the 'restricted' (24%). Factors significantly associated with the restricted transportation group were: (a) being female (AdjOR 15.39, 95% CI 0.86-23.39, p < 0.001); (b) being Malay (AdjOR 21.72, 95% CI 0.36-16.12, p < 0.001); (c) having higher number of comorbidities (AdjOR 14.01, 95% CI 0.20-13.21, p = 0.007); and (d) being dependent in IADL (AdjOR 13.48, 95% CI 0.51-1.78, p = 0.002).

Contribution of socio-economic and demographic factors to the trend of adequate dietary diversity intake among children (6-23 months): evidence from a cross-sectional survey in India

BACKGROUND

The present study aims to estimate the factors contributing to the change adequate diversified dietary intake (ADDI) from 2005-06 to 2015-16 among children aged 6-23 months in India.

METHODS

A cross-sectional study was conducted using a large representative survey data. Data from the National Family Health Survey 2005-06 and 2015-16 was used. The effective sample size for the present study was 14,422 and 74,132 children aged 6-23 months in 2005-06 and 2015-16, respectively. The outcome variable was minimum adequate dietary diversity intake. Binary logistic regression was used to evaluate the factors associated with ADDI. Additionally, the Fairlie method of decomposition was used, which allows quantifying the total contribution of factors explaining the decadal change in the probability of ADDI among children aged 6-23 months in India.

RESULTS

There was a significant increase in ADDI from 2005-06 to 2015-16 (6.2%; p < 0.001). Additionally, compared to the 2005-06 years, children were more likely to have ADDI [AOR; 1.29, CI: 1.22-1.35] in 2015-16. Mother's education explained nearly one-fourth of the ADDI change among children. Further, the regional level contribution of 62.3% showed that the gap was widening across regions between the year 2005-06 and 2015-16 in ADDI among children. The child's age explained 5.2% with a positive sign that means it widened the gaps. Whereas the household wealth quintile negatively contributed and explained by -5.2%, that means between the years the gaps has reduced in ADDI among children aged 6-23 months.

CONCLUSION

Our findings indicate that increasing awareness of the use of mass media and improving the education levels of mothers would be beneficial for adequate dietary diversity intake among children aged 6-23 months. Investments should support interventions to improve overall infant and young children feeding practices in India.

The evolving disparities in location and socioeconomics of an ageing Australian society

OBJECTIVES

It is well known that there are associations between overall health, age, socioeconomic status and rural residency. The objective of this study was to determine the distribution of Australia's aged population by socioeconomic status, as well as remoteness.

METHODS

The study employed the Australian Statistical Geography Standard (Statistical Area Level 1 and Remoteness Areas). The database of the geographic boundaries was integrated into the ageing population and socioeconomic data using the Geographic Information System. The socioeconomic data was analysed through the Index of Relative Socioeconomic Disadvantage.

RESULTS

Over a decade, the older population in Australia has increased noticeably. In 2016, there was a high percentage of older people (≥65 years) in Tasmania (Tas), 19%, while the lowest percentage was recorded in the Northern Territory (NT), 7%. Across the country, Tasmania had the highest percentage of older citizens living in the most disadvantaged areas since 2006, with 48% recorded in 2016. There was an association between the remoteness areas and the education and income levels of the ageing cohort. However, this association differed between the states and territories. This socioeconomic gap becomes more evident in the very remote areas of the country.

CONCLUSIONS

The ageing population in Australia is increasing rapidly; this was associated with an evolving socioeconomic disparity among this ageing society. Our results demonstrated that socioeconomic inequalities were to be found among the older people based on their distribution over the remoteness areas in Australia. This information should be used to target healthcare and ageing policies that meet the specific needs of older people.

The prevalence of menstrual disorders and premenstrual syndrome among adolescent girls living in North Borneo, Malaysia: a questionnaire-based study

Background

This study aimed to determine menstrual characteristics and related morbidities among adolescent girls living in Sabah, North Borneo, a less-developed state in Malaysia.

Methods

Data were obtained from a quantitative survey conducted in three government high schools located in Ranau, Sabah. The participants were adolescent girls who had attained menarche between the ages of 14 and 19.

Results

Based on the analysis of questionnaires completed by 757 adolescent girls, the mean age at the time of the survey was 17 ± 1.4 years, and the mean menarche age was 12.2 ± 1.1 years. Our data demonstrated that 85.7% of the participants experienced dysmenorrhoea, of which at least 42.1% (mean pain score ± SD: 4.81 ± 0.76, 95% confidence interval (CI) 4.72, 4.90) experienced moderate dysmenorrhoea, and 11.2% (mean pain score ± SD: 7.86 ± 0.94, 95% CI 7.64, 8.08) experienced severe dysmenorrhoea. Over 70% of these girls complained of tiredness, headache, and appetite changes during menses.

Conclusions

The prevalence of menstrual disorders and related morbidities was high among the girls residing in Sabah. Reproductive health issues in rural and socioeconomically deprived areas remains poorly addressed. The main consequence of neglecting menstrual disorders and their related morbidities is impaired future sexual reproductive health in adults. Thus, addressing adolescent reproductive health issues is crucial, especially for girls living in areas where access to healthcare is difficult. The information gathered from this study can be used to strategize effective interventions to improve adolescents' reproductive health status in rural areas.

Seroprevalence of Zika Virus among Forest Fringe Communities in Peninsular Malaysia and Sabah: General Population-Based Study

Zika virus (ZIKV) has had a history in Malaysia since its first isolation in 1966. However, it is believed that the immunity status among forest fringe communities has been underreported. We conducted cross-sectional surveillance of forest fringe communities from 10 Orang Asli villages and their peripheral communities in Perak, Pahang, and Sabah in Malaysia. A total of 706 samples were collected from 2019 to 2020 and screened for ZIKV exposure using an anti-ZIKV IgG ELISA kit. A neutralization assay against ZIKV was used to confirm the reactive samples. The seroprevalence results reported from the study of this population in Malaysia were 21.0% (n = 148, 95% CI, 0.183-0.273) after confirmation with a foci reduction neutralization test. The presence of neutralizing antibodies provides evidence that the studied forest fringe communities in Malaysia have been exposed to ZIKV. Multivariate analysis showed that those older than 44 years and those with an education below the university level had been exposed significantly to ZIKV. In addition, higher seropositivity rates to ZIKV were also reported among secondary school students from Bentong (Pahang) and residents from Segaliud (Sabah). No associations were identified between Zika seropositivity and gender, household size, house radius to the jungle, and income level. The presence of neutralizing antibodies against ZIKV among the study population might indicate that the causative pathogen had already circulated widely in forest fringe regions. Intervention for vector control, protection from mosquito bites, and awareness improvement should be encouraged in this population.

Incidence and Predictors of Mortality among Community-Dwelling Older Adults in Malaysia: A 5 Years Longitudinal Study

With older adults accounting for 10.7% of the Malaysian population, determining the predictors of mortality has now become crucial. Thus, this community-based longitudinal study aimed to investigate the predictors for mortality among community-dwelling older adults using a wide range of factors, including clinical or subclinical. A total of 2322 older adults were interviewed and assessed by trained fieldworkers using validated structured questionnaires. The questionnaire consisted of information on socio-demographic characteristics, health status, neuropsychological and psychosocial functions, lifestyle, dietary intake and biophysical measures. The incidence rate of mortality was 2.9 per 100 person-years. Cox regression analysis indicated that advancing age (Adjusted Hazard Ratio, Adj HR = 1.044, 95% CI: 1.024–1.064), male (Adj HR = 1.937, 95% CI: 1.402–2.675), non-married status (Adj HR = 1.410, 95% CI: 1.078–1.843), smoking (Adj HR = 1.314, 95% CI: 1.004–1.721), a higher fasting blood sugar (Adj HR = 1.075, 95% CI: 1.029–1.166), a lower serum albumin (Adj HR = 0.947, 95% CI: 0.905–0.990), a longer time to complete the TUG test (Adj HR = 1.059, 95% CI: 1.022–1.098), and a lower intake of total dietary fibre (Adj HR = 0.911, 95% CI: 0.873–0.980) were the predictors of mortality in this study. These findings provide an estimated rate of multiethnic mortality in middle-income countries and diet is one of the predictors. These predictors of mortality could be a reference in identifying new public health strategies to ensure longer healthier life spans with lower disability rate among community-dwelling older adults in Malaysia.

New Strategies to Improve the Quality of Life for Normal Aging versus Pathological Aging

In the context of the manifestation of the phenomenon of normal aging and functional decline at older adults with neurodegenerative pathology, the development of physical activities and healthy lifestyle has become a priority that involves many decisions and responsibilities. Therefore, the study of the quality of life of the elderly in terms of delaying early aging and improving the lifestyle of patients with neurodegenerative diseases is a scientific challenge representing research of great interest and relevance. By promoting physical activity based on telerehabilitation programs or performed according to coordinated training either in the community or at home for both study groups, significant improvements have been obtained. The aim of this paper was to evaluate the intervention suitable patterns, surveys delivered through variables online platforms and tools to reflect the stagnation of early aging and the evolution of patients with PD and dementia. Our study involved selected original studies, intensively processed, which demonstrated through intervention specific tools, such as quantitative, qualitative, socio-economics, physical, and cognitive indicators, that significant improvements can be achieved in the process of early aging, but also significant progress in patients with neurodegenerative diseases. By searching the last five years of papers, our review, presents the importance of intervention by telerehabilitation or by scheduled physical exercises quantified by specific indicators.

The Impact of Physical Activity Levels and Functional Fitness Status on the Quality of Life Perceived by Older Adults Living in Rural and Urban Areas: The Portuguese Inland Case

Health-related quality of life (HRQoL) is influenced by several factors, such as living place, physical activity (PA), and functional fitness levels. Evidence shows that functional fitness and PA levels are strongly associated with positive HRQoL, especially in the older population. However, the impact of the living place has not been investigated as an influencing variable in this context. Therefore, this study aimed to investigate the relationship between the HRQoL, PA, and functional fitness of older adults living in rural and urban areas of Portugal. A cross-sectional study was performed with community-dwelling adults aged 65 years and over (n = 261) living in the city of Guarda. The participants were assessed for sociodemographic, anthropometric, clinical health, HRQoL, PA levels, and functional fitness status. The results showed that rural residents presented higher scores of HRQoL and functional fitness than older individuals living in urban areas. Regression models showed that functional fitness variables influence the HRQoL overall score and mental and physical subcomponents of HRQoL, regardless of the living place. In contrast, PA levels only influenced the HRQoL score in rural residents. The findings suggest that intervention programs to improve the physical health, quality of life, and well-being of the older population need to consider the country’s different geographical areas.

Enablers and Barriers of Accessing Health Care Services among Older Adults in South-East Asia: A Scoping Review

South-East Asia (SEA) is the home of the largest number of the world’s older population. In this scoping review, we aimed to map the existing enablers and barriers of accessing healthcare services among older adults in SEA countries. Articles that were published from January 2001 until November 2021 were searched in four data sources (PubMed, Web of Science, EBSCO Host and The Cochrane Library). Studies pertaining to the factors which assist or obstruct older Southeast Asian adults from assessing healthcare services were chosen for this scoping review. First, two reviewers screened the titles and abstracts of articles in the data sources. After identifying appropriate articles, the reviewers read them. Data extracted by one reviewer were verified by the other reviewer. The findings were then classified according to Penchansky and Thomas’s five domains of access. A total of 19 studies were included in the final scoping review. Accessibility and acceptability were the two factors most often identified as enablers or barriers to older adults from accessing healthcare. Other often mentioned factors were finances, transportation and social/family support. Older adults living in rural areas were especially impacted by these factors. To promote healthy ageing, optimum healthcare and wellbeing among older adults in Southeast Asia, it is extremely important to consider accessibility and acceptability when planning healthcare services.

Drone Usage for Medicine and Vaccine Delivery during the COVID-19 Pandemic: Attitude of Health Care Workers in Rural Medical Centres

Rural areas are often difficult to access reliably with medicine and vaccines. This study aimed to examine rural health care workers’ attitude towards drone delivery for medicine and vaccines and the factors that influenced it. Health care workers from four rural health care facilities were sampled. Participants self-reported their demographic information, attitude towards medicine and vaccine delivery using drones, perception of benefits and risks of using drones, and perceived leadership innovativeness through an online or a pen-and-paper questionnaire. A total of 272 health care workers (mean age = 36.19, SD = 8.10) from all of the sites participated in this study. More than half of the study participants agreed or strongly agreed that using a drone to deliver medicine and vaccines is a good idea (54.2%, 95% CI [47.5, 60.8]), a wise idea (54.6%, 95% CI [47.9, 61.2]), and is desirable (52.5%, 95% CI [45.7, 59.0]). Males (β = 0.223), workers from the Obstetrics and Gynaecology department (β = 0.135), a lower perceived delivery risk (β = −0.237), and higher leadership innovativeness (β = 0.336) predicted positive attitudes towards drone usage. Assistant medical officers (β = −0.172) had a negative attitude. There is a need to further understand the roles of occupation and leadership innovativeness in predicting health care workers’ attitude towards drone usage, as these differences could be embedded within their roles in the health care system.

The Health-Seeking Behavior among Malaysian Adults in Urban and Rural Areas Who Reported Sickness: Findings from the National Health and Morbidity Survey (NHMS) 2019

Understanding care-seeking behavior among urban and rural populations can help to support the planning and implementation of appropriate measures to improve health in the community. This study aims to determine the factors associated with the health-seeking behavior among Malaysian adults in urban and rural areas who reported sickness. This study used data of Malaysian adults aged 18 years and over from the National Health and Morbidity Survey 2019; a cross-sectional, national household survey that targeted all non-institutionalized residents in Malaysia. Respondent’s characteristics and health-seeking behavior were described using complex sample descriptive statistics. Multivariable logistic regression analysis was conducted to examine the association between potential factors (sociodemographic characteristics, enabling, and health need) and health-seeking behaviors (seeking treatment from healthcare practitioners and self-medication). A total of 10,484 respondents, estimated to represent 18.9 million Malaysian adults aged 18 years and over, were included in the analysis. Prevalence of seeking treatment from healthcare practitioners and self-medication among Malaysian adults with self-reported sickness were 57.3% and 23.3%, respectively. Self-reported sickness among both the urban and rural populations who rated their health as poor to very poor was more likely to seek treatment than those who rated good to excellent. However, among the urban population, those who rated their health as poor to very poor were less likely to self-medicate. Among the urban population, government employees were more likely to seek treatment, and being without formal education significantly increased the likelihood to self-medicate. Among the rural population, those with at least one long-term condition were more likely to seek treatment than those with none. Understanding the factors which influence health-seeking behavior among the urban and rural population could close the gaps in healthcare utilization among the population in Malaysia.

Potential Owner-Related Risk Factors That May Contribute to Obesity in Companion Dogs in Aotearoa New Zealand

Approximately a third of all Aotearoa New Zealand (NZ) households include a dog, with 28% of these dogs being overweight or obese, conditions that are associated with many serious health issues. Therefore, healthy weight interventions that focus on the owner’s role are of great importance to companion animal welfare in NZ. Accordingly, the present study explores the feeding practices associated with NZ dogs and identifies potential owner-related risk factors contributing to these animals being overweight or obese. The current study used data collected from a survey conducted online in 2019 between January and March of NZ residents over 18. Along with demographic questions, the respondents were asked questions regarding their dog’s body condition and diet questions related to the body. Nearly a quarter (26%, n = 609) of the survey participants (n = 2358) owned at least one dog. The current study reported that increasing age range, household income and the number of children increased the likelihood of having a dog while increasing qualification level and living in a town/city decreased the likelihood. The majority of the respondents fed their dog(s) treats (59%) and 85% fed them specialised food bought from a pet shop, veterinary clinic and/or different online sources. Just over a third of the participant (39%) reported that they fed their dog(s) biscuits from the supermarket, 36% fed their dog(s) raw meat, and 34% of respondents fee their dog(s) table scraps/human food. These results suggest that many dog owners feed their dog(s) various food types, making it a challenging task to determine the exact amount required from each type in order not to exceed caloric intake. Disagreement regarding the correct body condition were reported among twenty per cent of the respondents. This finding indicates a knowledge gap among the NZ dog-owning population that may negatively affect their dogs’ welfare and wellbeing. Future research into pro-equity approaches to address these issues is needed so that dogs in NZ can live not only a good life but also their best life.

Infectious diseases among elderly persons: Results from a population-based observational study in Shandong province, China, 2013-2017

Background

The health of the elderly is one of the major challenges in today's ageing society. However, research on infectious diseases among the elderly is limited. This study aimed to describe the epidemiological characteristics and dynamics of infectious diseases among the elderly population aged ≥60 years in Shandong province, China.

Methods

Incidence data for infectious diseases were collected from the Shandong Multi-Center Healthcare Big Data Platform from January 2013 to June 2017, which involved 550 432 elderly persons. We compared the incidence of each infectious disease and disease category, stratified by age, gender, and region. Annual percentage change (APC) was estimated using logarithmic linear regression to examine the incidence trends. Poisson regression was conducted to identify the effect of demographic factors on incidence, with incidence rate ratio (IRR) and their 95% confidence intervals (CIs) estimated.

Results

A total of 27 595 cases of 102 infectious diseases were reported during the study period, with an overall incidence of 1425.51/100 000 person-years. The most common infectious diseases were respiratory and mucocutaneous diseases among the elderly persons, with annual increases of 17.45% and 20.44%, respectively (both P<0.05). In rural areas, the incidence of respiratory, gastrointestinal, blood- and sex-transmitted, and mucocutaneous infections increased significantly, with APCs of 178.52%, 204.66%, 28.24%, 63.01%, respectively (all P<0.05). Elderly males had a higher risk of infections than that of females, with the highest IRRa of 2.94 (95% confidence interval (CI) = 2.89, 3.00) in respiratory diseases. The elderly aged 85-89 years had a much higher risk of respiratory diseases than those aged 60-64 years (IRRa = 9.85, 95%CI: 9.39, 10.33); however, the risk of blood- and sex-transmitted diseases was highest among the elderly aged 65-69 years (IRRa = 1.24, 95% CI = 1.06, 1.45).

Conclusions

Ageing population are facing a substantial challenge on infectious diseases. More attention should be paid to infections with significant growth. Targeted strategies and measures on elderly persons in different regions and subgroups are urgently needed.

Socioeconomic, Eating- and Health-Related Limitations of Food Consumption among Polish Women 60+ Years: The 'ABC of Healthy Eating' Project

The study aimed at identifying the socioeconomic, eating- and health-related limitations and their associations with food consumption among Polish women 60+ years old. Data on the frequency of consumption of fruit, vegetables, dairy, meat, poultry, fish, legumes, eggs, water and beverages industrially unsweetened were collected with the Mini Nutritional Assessment (MNA^®) and were expressed in the number of servings consumed per day or week. Three indexes: the Socioeconomic Status Index (SESI), the Eating-related Limitations Score (E-LS) and the Health-related Limitations Score (H-LS) were developed and applied. SESI was created on the base of two variables: place of residence and the self-reported economic situation of household. E-LS included: difficulties with self-feeding, decrease in food intake due to digestive problems, chewing or swallowing difficulties, loss of appetite, decrease in the feeling the taste of food, and feeling satiety, whereas H-LS included: physical function, comorbidity, cognitive function, psychological stress and selected anthropometric measurements. A logistic regression analysis was performed to assess the socioeconomic, eating-, and health-related limitations of food consumption. Lower socioeconomic status (vs. higher) was associated with a lower chance of consuming fruit/vegetables ≥ 2 servings/day (OR = 0.25) or consuming dairy ≥ 1 serving/day (OR = 0.32). The existence of multiple E-LS limitations (vs. few) was associated with a lower chance of consuming fruit/vegetables ≥ 2 servings/day (OR = 0.72), consuming dairy ≥ 1 serving/day (OR = 0.55) or consuming water and beverages industrially unsweetened ≥6 cups/day (OR = 0.56). The existence of multiple H-LS limitations was associated with a lower chance of consuming fruit/vegetables ≥ 2 servings/day (OR = 0.79 per 1 H-LS point increase) or consuming dairy ≥ 1 serving/day (OR = 0.80 per 1 H-LS point increase). Limitations found in the studied women were related to insufficient consumption of selected groups of food, which can lead to malnutrition and dehydration. There is a need for food policy actions, including practical educational activities, to eliminate barriers in food consumption, and in turn to improve the nutritional and health status of older women.

Associations between socioeconomic status and obesity, sarcopenia, and sarcopenic obesity in community-dwelling older adults: The Tasmanian Older Adult Cohort Study

BACKGROUND

Social disadvantage may contribute to increased prevalence of sarcopenia and obesity. This study investigated if socioeconomic factors are associated with obesity, sarcopenia, or sarcopenic obesity (SO), in community-dwelling older adults.

METHODS

This was a cross-sectional analysis of data from the Tasmanian Older Adult Cohort study. Obesity was defined by body fat percentage (Men: ≥25%; Women: ≥35%) and sarcopenia was defined as the lowest 20% of sex-specific appendicular lean mass (ALM)/height (m²) and handgrip strength. Socioeconomic factors investigated were education (tertiary degree, secondary or no secondary school), occupation (high skilled white-collar, low skilled white-collar, or blue-collar) and residential area (advantaged or disadvantaged area). Multinomial logistic regression analyses yielding odds ratios (95% confidence intervals) were performed and adjusted for potential confounders. Mediation analysis was performed.

RESULTS

1099 older adults (63.0 ± 7.5 years; 51.1% women) participated. Older adults with a tertiary degree were significantly less likely to have obesity (0.68; 0.47, 0.98) and SO (0.48; 0.24, 0.94) compared with those who had no secondary schooling. No associations were found for occupation. Similarly, older adults living in advantaged areas were significantly less likely to have obesity (0.61; 0.39, 0.95). Steps per day mediated the association between residential area and body fat percentage by 51%.

CONCLUSION

Lower educational attainment, but not occupation, was associated with increased likelihood for both obesity and SO in community-dwelling older adults. Low physical activity levels in disadvantaged areas substantially contributed to higher obesity prevalence in this population. Further research is necessary to confirm whether similar associations exist in populations with greater levels of social disadvantage and to design effective community-based interventions.

Effect of Smartphone App's Intervention on Consumers' Knowledge, Attitude, Practice, and Perception of Food Poisoning Prevention When Dining Out at Selected Rural Areas in Terengganu

(1) Background: Lack of food safety awareness and preventive behaviour when dining out increases the risk of food poisoning. Furthermore, food poisoning cases among rural communities have been rising in recent years. However, the health-related mobile application is a promising tool in improving food poisoning prevention knowledge, attitude, practice, and perception (KAP2) among consumers. Therefore, the current study developed a novel smartphone app, MyWarung©, and determined its efficacy in increasing awareness, attitude, practice, and perception of food poisoning and its prevention when dining out, especially among rural consumers. (2) Methods: A quasi-experimental pre-and post-intervention study with a control and intervention group were performed on 100 consumers in Terengganu. (3) Results: The intervention's inter-group outcomes were analysed using the Mann-Whitney test, while the within-group effects were ascertained using the Wilcoxon sign rank test via the SPSS software. It was found that the control group had higher median scores in knowledge (30.0, IQR 7.0), attitude (46.0, IQR 5.0), and practice (34.0, IQR 3.0) than the intervention group before intervention. After the intervention programme, the intervention group showed significant improvement in food poisoning knowledge (p = 0.000), attitude (p = 0.001), and practice (p = 0.000). However, the intervention group's perceived barriers (p = 0.129) and susceptibility (p = 0.069) and the control group's perceived barriers (p = 0.422) did not show any significant improvement. (4) Conclusion: The findings indicated that the MyWarung© mobile app usage enhanced the food poisoning knowledge, preventive attitude, and practice among consumers when dining out.

Relationship between financial well-being, life satisfaction, and cognitive function among low-income community-dwelling older adults: the moderating role of sex

BACKGROUND

Low financial well-being is a common predicament among older adults living in poverty. The existing literature suggests a correlation between financial well-being and mental health in old age. Therefore, this study aimed to identify the relationships among financial well-being, life satisfaction, and cognitive function among low-income older adults and to examine the moderating effect of sex on these relationships.

METHODS

This study involved 2004 nationally representative community-dwelling older Malaysians from the bottom 40% household income group. Financial well-being was assessed by the four-item financial satisfaction scale, while life satisfaction was measured by the Satisfaction with Life Scale. Cognitive function was measured by using the Malay version of the Mini-Mental State Examination. Hierarchical multiple regression was used as the prime method for statistical analysis.

RESULTS

Financial well-being was positively associated with life satisfaction and cognitive function. Sex moderated the relationship between financial well-being and life satisfaction but not between financial well-being and cognitive function.

CONCLUSIONS

Financial well-being and life satisfaction were strongly correlated among older women, although no gender difference was found for the relationship between financial well-being and cognitive function. It appears financial well-being strongly predicts mental health. As such, poverty eradication initiatives targeting low-income older adults should be implemented to sustain life satisfaction and cognitive function.

Predictors of Changes in Cognitive Function in Older Korean Adults: The 2006-2018 Korean Longitudinal Study of Aging

Cognitive decline with normal aging varies widely among individuals. This study aimed to investigate predictors of longitudinal changes in cognitive function in community-dwelling Korean adults aged 65 years and older. Data from 727 older adults who participated in the Korean Longitudinal Study of Aging (KLoSA) survey from 2006 (baseline) until 2018 (seventh wave) were used. Cognitive performance was assessed with the Korean Mini-Mental State Examination. The participants were retrospectively classified into normal cognition, mild cognitive impairment, and moderate/severe cognitive impairment. Education, income, religion, living area, alcohol intake, smoking, physical activity, handgrip strength, functional dependency, depression, comorbidity, medications, fall experience, and unintentional weight loss were included as covariates. A linear mixed regression analysis showed that a steeper decline in cognitive function over time was significantly associated with parameters of poor socio-economic status, health conditions, and unhealthy behaviors. Individuals with mild cognitive impairment or moderate/severe cognitive impairment were likely to have steeper cognitive declines compared with individuals with normal cognition. The current findings of the study showed that age-related cognitive decline was multifactorial in older Korean adults.

The association between water hardness and xerosis-Results from the Danish Blood Donor Study

BACKGROUND

The pathophysiology of xerosis depends on extrinsic and intrinsic exposures. Residential hard water may constitute such an exposure.

OBJECTIVES

To estimate the prevalence of xerosis and to compare water hardness exposure in blood donors with and without xerosis.

METHODS

In this retrospective cohort study in 2018-2019, blood donors with self-reported moderately or severely dry skin were compared to blood donors without dry skin. Blood donors with ichthyosis, lichen planus and psoriasis were excluded. Water hardness data was collected from the Geology Survey of Denmark and Greenland.

RESULTS

Overall, 4,748 of 30,721 (15.5%; 95% confidence interval 15.1-15.9%) blood donors had xerosis. After excluding blood donors with ichthyosis, lichen planus and psoriasis, 4,416 blood donors (2,559 females; median age 38.4 years [interquartile range 28.0-49.8]; 700 smokers) remained in this study. Water softer than 12-24 degrees Deutsche härte was associated with decreased probability of xerosis (odds ratio 0.83; 95% confidence interval 0.74-0.94) and water harder than 12-24 degrees Deutsche härte was associated with increased probability of xerosis (odds ratio 1.22; 95% confidence interval 1.03-1.45). The association between water hardness and xerosis remained significant after excluding blood donors with dermatitis.

CONCLUSIONS

Water hardness is associated with xerosis independent of other dermatoses.

Association between socioeconomic status and cognitive functioning among older adults in Ghana

OBJECTIVES

Extensive analysis of the associations between socioeconomic status and cognition has been conducted among older adults. However, it is not clear whether associations in high-income countries are similar in low-and middle-income countries. This research aims to investigate the association between the socioeconomic status of older adults in Ghana and their cognitive function by using a sample of older adults that is nationally representative.

METHODS

Data were obtained from a sample of older Ghanaian adults (50+) from the Study of Global AGEing and Adult Health Wave 1 (n = 3710) of the World Health Organization. Objectively, cognition was measured by verbal recall, verbal fluency, forward digit span, and backward digit span, while variations in cognition overall were evaluated against socioeconomic factors using linear regression.

RESULTS

Older age, older women, rural life, increasing memory difficulty, and being diagnosed with stroke were the most significant determinants of impaired cognitive function. Higher education and higher income were significantly associated with a better cognitive function than those with no formal education and low income.

CONCLUSIONS

These results provide new evidence for public health programs in Ghana and other low-and middle-income countries to tackle cognitive impairments in growing populations.

Healthcare Utilization and Knee Osteoarthritis Symptoms among Urban Older Malaysian

Knee osteoarthritis (OA) is a prevalent chronic disorder in the older population. While timely management is important to minimize the consequences of knee OA, information on the utilization of healthcare services among this population remains limited. Therefore, the objectives of this study were to determine the healthcare utilization and its associated factors in older persons with knee OA. Cross-sectional data from 1073 participants aged 60 years and above from the Malaysian Elders Longitudinal Research (MELoR) study were included. The utilization rate of healthcare services was quantified. Factors related to the utilization of healthcare services were determined using logistic regression analysis. Healthcare utilization among participants with knee OA was significantly higher than those without knee OA (p < 0.01). Outpatient usage was higher (p < 0.01) in comparison to inpatient and pharmacotherapy. Being married and having an income were significantly associated with seeking outpatient care (OR: 11.136, 95% CI: 1.73–52.82, p < 0.01) and pharmacotherapy (OR: 10.439, 95% CI: 1.187–91.812, p < 0.05), while females were less likely to utilize inpatient care services (OR: 0.126, 95% CI: 0.021–0.746, p < 0.05). The higher rate of healthcare utilization among older persons with knee OA indicates the increased healthcare needs of this population, who are commonly assumed to suffer from a benign disease.

The hygiene hypothesis, the COVID pandemic, and consequences for the human microbiome

The COVID-19 pandemic has the potential to affect the human microbiome in infected and uninfected individuals, having a substantial impact on human health over the long term. This pandemic intersects with a decades-long decline in microbial diversity and ancestral microbes due to hygiene, antibiotics, and urban living (the hygiene hypothesis). High-risk groups succumbing to COVID-19 include those with preexisting conditions, such as diabetes and obesity, which are also associated with microbiome abnormalities. Current pandemic control measures and practices will have broad, uneven, and potentially long-term effects for the human microbiome across the planet, given the implementation of physical separation, extensive hygiene, travel barriers, and other measures that influence overall microbial loss and inability for reinoculation. Although much remains uncertain or unknown about the virus and its consequences, implementing pandemic control practices could significantly affect the microbiome. In this Perspective, we explore many facets of COVID-19-induced societal changes and their possible effects on the microbiome, and discuss current and future challenges regarding the interplay between this pandemic and the microbiome. Recent recognition of the microbiome's influence on human health makes it critical to consider both how the microbiome, shaped by biosocial processes, affects susceptibility to the coronavirus and, conversely, how COVID-19 disease and prevention measures may affect the microbiome. This knowledge may prove key in prevention and treatment, and long-term biological and social outcomes of this pandemic.

Sociodemographic Factors Affecting Older People's Care Dependency in Their Daily Living Environment According to Care Dependency Scale (CDS)

The aim of the research was to determine the influence of sociodemographic factors on older people’s care dependency in their living environment according to the Care Dependency Scale (CDS). Methods: The research was conducted in a group of 151 older people staying in their own homes. The methods applied in the research included a sociodemographic questionnaire and scales including the Abbreviated Mental Test Score (AMTS), CDS, Katz Index of Independence in Activities of Daily Living (ADL), Lawton’s Instrumental Activities of Daily Living (I-ADL), Mini Nutritional Assessment (MNA), and Geriatric Depression Scale (GDS). Results: Gender had a significant impact on the level of care dependency. The surveyed females obtained the medium or high level of dependency more often than males (22.4% vs. 6.1%), and the low level of dependency was significantly more frequent among men than women (p = 0.006). Moreover, the age of the respondents determined their level of care dependency. The subjects with a medium or high level of care dependency were significantly older (p = 0.001). The subjects with a low level of care dependency were more likely to be married than people with a medium/high level (p < 0.001). The level of education had a significant impact on care dependency. A higher level of education correlated with a medium/high level of dependency (p = 0.003). Conclusions: The survey results confirmed that sociodemographic factors have a significant impact on the level of care dependency. When planning care in the home environment, special attention should be paid to older women, who are more likely to lose their independence than men. These women should be given additional support.

The Association between Dietary Variety and Physical Frailty in Community-Dwelling Older Adults

The aim of this cross-sectional study was to examine the association between diet variety and physical frailty in community-dwelling older adults. Data of 577 older adults (mean age: 74.0 ± 6.3 years, women: 62.5%) were analyzed. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk & dairy products, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Physical frailty was assessed using Fried's component (slowness, weakness, exhaustion, low physical activity, and weight loss). The participants were classified into frail, pre-frail, and non-frail groups. The prevalence of physical frailty was 6.6%. This study found significant associations between physical frailty and low FFS after adjusting for covariates (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.84-0.97, p < 0.01). The optimal cutoff point of the FFS for physical frailty was ≤16 points. FFS lower than the cutoff point were significantly associated with physical frailty after adjusting for covariates (OR 3.46, 95% CI 1.60-7.50, p < 0.01). Diet variety assessed using the FFS cutoff value of ≤16 points was related to the physical frailty status in community-dwelling older adults.

Association between Dietary Patterns and Handgrip Strength: Analysis of the Korean National Health and Nutrition Examination Survey Data Between 2014 and 2017

Non-invasive anthropometric measurement methods such as those for measuring height and weight are crucial in pediatric patients. However, research focusing on the association between the type of dietary pattern and handgrip strength and handgrip-to-weight ratio in adolescents has not been carried out yet. This cross-sectional analysis of the 2014–2017 Korean National Health and Nutrition Examination Survey assessed 2327 adolescents (aged 10–18 years) who had their handgrip strength measured and analyzed its association with dietary pattern. The clusters were examined for nutritional values, and the ready-to-eat, balanced, and Western-style fast-food clusters were ultimately generated. Overall, 85.6% of the participants were assigned to a ready-to-eat dietary pattern, 9.3% to a Western-style fast-food dietary pattern, and 5.1% to a balanced dietary pattern. Compared with the participants following a balanced dietary pattern, those following a ready-to-eat dietary pattern were shown to have a significantly lower handgrip strength and handgrip-to-weight ratio. Decreased handgrip strength and handgrip-to-weight ratio values in participants following ready-to-eat dietary patterns indicate a diffuse problem in adolescents’ health and possibly imply an association between reduced muscle quality and dietary pattern. Therefore, the overall environmental factors potentially inducing such unhealthy dietary preferences should be investigated, and appropriate lifestyle changes in Korean adolescents should be encouraged.

A Multi-Domain Intervention Protocol for the Potential Reversal of Cognitive Frailty: "WE-RISE" Randomized Controlled Trial

Following the rapid increase of the aging population, health promotion and prevention of physical disability and dementia in older persons are essential for healthy aging. For example, there may be a potential to prevent or reverse cognitive frailty, the co-existence of both physical frailty and cognitive impairment in older persons. However, evidence-based interventions targeting the prevention or potential reversibility of cognitive frailty among community dwelling older adults are scarce. In this paper, we described the rationale, development and delivery of a multi-domain intervention comprising multi-component physical exercise prescription, cognitive training, dietary counseling and promotion of psychosocial support, called the WE-RISE trial. The aim of WE-RISE intervention is to potentially reverse cognitive frailty. This is a two-armed, single blinded, randomized controlled trial conducted over a duration of 6 months, at senior citizen activity centers within the Klang Valley, Malaysia. Ambulating, community dwelling older adults aged 60 years and above with cognitive frailty are randomized into two groups; (1) intervention group: which receives an instructor based "WE-RISE" intervention for the first 3 months, and then a home-based "WE-RISE at Home" intervention for the following 3 months; (2) control group: usual care with no modifications to their daily routine. Primary outcome is cognitive frailty status and secondary outcome include physical function, cognitive performance, nutritional status, psychosocial status and quality of life which are obtained during baseline screening and subsequent follow ups at 3rd and 6th month. Description of the intervention is done using the template for intervention description and replication (TIDieR) checklist. This trial protocol has received approval from Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2018-558) and the Department of Social Welfare Malaysia (MyResearch Reference: JKMM 100/12/5/2: 2018/405). Trial registration number: ACTRN12619001055190.

Malnutrition, low diet quality and its risk factors among older adults with low socio-economic status: a scoping review

Low socio-economic status (SES) is often associated with various health-related problems. Therefore, the present paper aims to review the available literature to identify the prevalence of malnutrition, prevalence of poor diet quality and its associated risk factors among older adults with low SES. A literature search was performed using four databases, namely PubMed, Google Scholar, Springer and Science Direct. The search terms used were 'diet quality', 'nutritional status', 'dietary intake', 'overweight', 'obesity', 'underweight', 'older people' and 'low socioeconomic status (SES)'. The overall prevalence of undernutrition among older adults with low SES worldwide was in the range of 28·9 to 48 %, while overnutrition was reported to be between 8·1 to 28·2 %. In Asia, the prevalence of undernourished older adults ranged from 3 to 64·9 %, while 2·5 to 32·8 % were overnourished. Most of the studies (60 %) included in the present review used BMI as the tool to identify malnutrition, but none of the nutritional screening tools were considered to be the 'gold standard'. For dietary assessment, FFQ and multiple 24 h dietary recall improved the estimation of individual dietary intake. Risk factors for poor diet quality included financial hardship, functional limitation, sex, place of residence, smoking and oral health. Poor nutritional status, especially lack of good-quality diet, and thinness are prevalent among older adults with low SES. Hence, it is important to establish nutrition-related programmes and intervention studies among this group of individuals for improving their health status and quality of life.

Do Where The Elderly Live Matter? Factors Associated with Diet Quality among Korean Elderly Population Living in Urban Versus Rural Areas

This study aimed to examine whether there is an area difference on diet quality among the Korean elderly population. The effect of personal factors on diet quality is also estimated and compared between rural and urban areas. A cross-sectional data from the 2013-2015 Korea National Health and Nutrition Examination Survey (KNHANES) was used for this study. The participants were older adults aged ≥ 65 years (n = 3207) who participated in the KNHANES. Urban and rural areas classified the region and the Korean Healthy Eating Index (KHEI) assessed the diet quality. Personal factors that were related to diet quality included socio-demographic factors, health behaviors, and health conditions. This study found that the diet quality was different between urban and rural areas in the Korean elderly population, showing a higher mean of KHEI scores in urban areas than rural areas (67.3 for urban seniors, 63.6 for rural seniors, p < 0.001), and the regional difference was still significant, even after adjusting for the personal factors (p < 0.001). Different sets of personal factors were found to be significant that explain the diet quality of participants between areas, such as economic resources, walking exercise, and perceived oral health status in urban areas, and age and food insecurity in rural areas. In conclusions, this study found that there was a regional disparity in diet quality and some personal factors affecting diet quality were dependent on areas, which implied that regional environment with diverse contexts could influence diet quality. These findings emphasize the need to provide targeted intervention programs that take into account both the characteristics of individuals and local food environments in order to improve the overall diet quality in older adults.

Ageing of the Diaphragm Muscle

The diaphragm muscle is the most important contractile district used for breathing. Like other muscles in the human body, it is subject to ageing and sarcopenia. Sarcopenia can be classified as primary (or age-related) when there are no local or systemic pathologies that cause a functional and morphological detriment of skeletal musculature. Secondary sarcopenia occurs when there is a cause or more pathological causes (illness, malnutrition, immobility) related or unrelated to ageing. In the elderly population, transdiaphragmatic pressure (Pdi) decreases by 20-41%, with a decline in the overall strength of 30% (the strength of the expiratory muscles also decreases). The article discusses the adaptation of the diaphragm muscle to ageing and some other ailments and co-morbidities, such as back pain, emotional alterations, motor incoordination, and cognitive disorders, which are related to breathing.

Health, access and nutritional issues among low-income population in Malaysia: introductory note

The current issue of BMC Public Health presents work by the Consortium of Low Income Population Research (CB40R), highlighting a comprehensive aspect of health, i.e., physical health, mental health, health behaviour and health financing; and also nutrition involving all stages of lifespan of the socioeconomic deprived group in Malaysia.Consortium of B40 Research (CB40R) reposited and harmonised shared, non-identifiable data from epidemiological studies involving low income population (B40) in Malaysia. CB40R also performed joint or mega-analyses using combined, harmonised data sets that yield collated results with enhanced statistical power, more variabilities (study population, geographical regions, ethnicities and sociocultural groups) to better understand the needs, characteristics and issues of B40 groups in Malaysia. It also aimed to develope a system/framework of minimum/standard variables to be collected in research involving B40 in future. For this special issues, members of the consortium have been invited to contribute an original article involving analysis of the health aspects, access to health and nutritional issues of the B40 samples.All the papers in this special issue have successfully highlighted the health and nutritional issues (i.e., non-communicable disease (NCD), inflammatory bowel disease (IBD), knowledge towards sexually transmitted disease (STD), low birth weight, Motoric Cognitive Risk (MCR) syndrome, urinary incontinence), mental health, oral health and inequalities among the low-income group in Malaysia, including the rural population and also the urban poor. The low-income population in Malaysia is also at risk of both under- and over nutrition, of which specific cost effective strategies are indeed needed to improve their quality of life.The low income population in Malaysia is facing various health challenges, particularly related to NCD and poor mental health, nutritional and physical function. There is a need for a sustainable intervention model to tackle the issues. It is also important to highlight that reducing SES disparities in health will require policy initiatives addressing the components of socioeconomic status (income, education, and occupation) as well as the pathways by which these affect health.