Comparing four frailty assessment tools against seven-year mortality in the Malaysian elders longitudinal research study

AIM

Several frailty assessment tools are currently used in clinics and research, however, there appears to be a lack of head-to-head comparisons between these tools among older adults in developing countries. This study compared the Cardiovascular Health Study, Study of Osteoporotic Fractures, the Tilburg Frailty Indicator and the Canadian Study of Health and Aging frailty assessment tools and evaluated performance of these individual frailty assessment tools with mortality.

METHODS

This prospective cohort study utilized stratified simple random sampling to recruit 1614 participants from the Malaysian Elders Longitudinal Research aged above 55 years within the Klang Valley region from 2013 to 2015. Individual items for the frailty tools, alongside baseline physical and cognitive measures were extracted from the initial survey. Mortality data up to 31 December 2020 were obtained through data linkage from the death registry data obtained from the Malaysian National Registration Department.

RESULTS

Data were available for over 1609 participants, age (68.92 ± 7.52) years and 57 % women, during recruitment. Mortality data revealed 13.4 % had died as of 31 December 2020. Five to 25 % of our study population fulfilled the criteria for frailty using all four frailty tools. This study found an increased risk of mortality with frailty following adjustments for potential factors of falls, total number of illnesses and cognitive impairment, alongside moderate to strong correlation and agreement between frailty tools.

CONCLUSION

Frailty was associated with increased mortality. All four frailty assessment tools can be used to assess frailty within the Malaysian older adult population. The four available tools, however, may not be interchangeable.

Cognitive frailty and its association with depression, anxiety and stress during the COVID-19 pandemic among older adults in the transforming cognitive frailty into later-life self-sufficiency (AGELESS) study

BACKGROUND

Cognitive frailty describes the co-occurrence of cognitive impairment and physical frailty and is classified into reversible and irreversible phenotypes. Data on the impact of COVID-19 pandemic imposed lockdowns, locally known as the Movement Control Order (MCO), on the psychological status of cognitively frail older adults remain scarce. Therefore, this study aimed to determine the relationship between depression, anxiety, stress and cognitive frailty among older adults during the MCO.

METHOD

Participants aged above 60 years from three ageing cohorts in Malaysia were interviewed virtually. The Fatigue, Resistance, Ambulation, Illness and Loss of Weight scale, blind Montreal Cognitive Assessment, 15-item Geriatric Depression Scale, anxiety subscale of Depression, Anxiety and Stress Scale and four-item Perceived Stress Scale measured frailty, mild cognitive impairment (MCI), depression, anxiety and stress, respectively.

RESULTS

Cognitive frailty data were available for 870 participants, age (mean ± SD) = 73.44 ± 6.32 years and 55.6% were women. Fifty-seven (6.6%) were robust, 24 (2.8%) had MCI, 451 (51.8%) were pre-frail, 164 (18.9%) were pre-frail+MCI, 119 (13.7%) were frail and 55 (6.3%) were frail+MCI. There were significant differences in depression and anxiety scores between the controlled MCO and recovery MCO. Using multinomial logistic regression, pre-frail (mean difference (95% confidence interval, CI) = 1.16 (0.932, 1.337), frail (1.49 (1.235, 1.803) and frail+MCI (1.49 (1.225, 1.822)) groups had significantly higher depression scores, frail (1.19 (1.030, 1.373)) and frail+MCI (1.24 (1.065, 1.439)) had significantly higher anxiety scores and pre-frail (1.50 (1.285, 1.761)), frail (1.74 (1.469, 2.062)) and frail+MCI (1.81 (1.508, 2.165)) had significantly higher stress scores upon adjustments for the potential confounders. The MCO was a potential confounder in the relationship between depression and prefrail+MCI (1.08 (0.898, 1.340)).

CONCLUSION

Frail individuals with or without MCI had significantly higher depression, anxiety and stress than those who were robust. Increased depression and stress were also observed in the pre-frail group. Interventions to address psychological issues in older adults during the COVID-19 pandemic could target prefrail and frail individuals and need further evaluation.

A Malaysian consensus recommendation for the prevention of influenza in older persons

BACKGROUND

Older persons are at high-risk of developing severe complications from influenza. This consensus statement was developed to provide guidance on appropriate influenza prevention strategies relevant to the Malaysian healthcare setting.

METHODS

Under the initiative of the Malaysian Influenza Working Group (MIWG), a panel comprising 11 multi-speciality physicians was convened to develop a consensus statement. Using a modified Delphi process, the panellists reviewed published evidence on various influenza management interventions and synthesised 10 recommendations for the prevention of influenza among the aged population via group discussions and a blinded rating exercise.

RESULTS

Overall, annual influenza vaccination is recommended for individuals aged ≥ 60 years, particularly those with specific medical conditions or residing in aged care facilities (ACFs). There is no preference for a particular vaccine type in this target population. Antiviral agents can be given for post-exposure chemoprophylaxis or when vaccine contraindication exists. Infection control measures should serve as adjuncts to prevent the spread of influenza, especially during Hajj.

CONCLUSION

This consensus statement presents 10 evidence-based recommendations that can be adopted by healthcare providers to prevent influenza among the aged population in Malaysia. It could also serve as a basis for health policy planning in other lower- and middle-income countries.

Cognitive frailty and 5-year adverse health-related outcomes for the Malaysian elders longitudinal research (MELoR) study

PURPOSE

To determine the risk of adverse outcomes among prefrail and frail individuals with and without cognitive impairment as well as those with isolated cognitive impairment compared to robust individuals without cognitive impairment.

METHODS

Data from the Malaysian elders longitudinal research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted interviews and hospital-based health-checks from 2013 to 2015. Protocol of MELoR study has been described in previous study (Lim in PLoS One 12(3):e0173466, 2017). Follow-up interviews were conducted in 2019 during which data on the adverse outcomes of falls, sarcopenia, hospitalization, and memory worsening were obtained. Sarcopenia at follow-up was determined using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire.

RESULTS

Follow-up data was available for 776 participants, mean (SD) age 68.1 (7.1) years and 57.1% women. At baseline, 37.1% were robust, 12.8% had isolated cognitive impairment, 24.1% were prefrail, 1.0% were frail, 20.2% were prefrail with cognitive impairment, and 4.8% had CF. Differences in age, ethnicity, quality of life, psychological status, function and comorbidities were observed across groups. The association between CF with hospitalisation and falls compared to robust individuals was attenuated by ethnic differences. Pre-frail individuals were at increased risk of memory worsening compared robust individuals [aOR(95%CI) = 1.69 (1.09-2.60)]. Frail [7.70 (1.55-38.20)], prefrail with cognitive impairment [3.35 (1.76-6.39)] and CF [6.15 (2.35-16.11)] were significantly more likely to be sarcopenic at 5-year follow-up compared to the robust group.

CONCLUSIONS

Cognitive frailty was an independently predictor of sarcopenia at 5-year follow-up. The relationship between CF with falls and hospitalization, however, appeared to be accounted for by ethnic disparities. Future studies should seek to unravel the potential genetic and lifestyle variations between ethnic groups to identify potential interventions to reduce the adverse outcomes associated with CF.

Effects of the COVID-19 Pandemic on Psychological Status and Quality of Life among Participants of the Malaysian Elders Longitudinal Research (MELoR) Study

BACKGROUND

This study aimed to identify differences in quality of life before and during the coronavirus disease 2019 (COVID-19) pandemic and determine the influence of psychological status on the observed changes in the quality of life among older adults.

METHODS

The Malaysian Elders Longitudinal Research study recruited Malaysians aged at least 55 years from 2013 to 2015. Follow-ups were conducted between September and December 2020. Quality of life was determined using the 12-item Control, Autonomy, Self-Realization, and Pleasure questionnaire. Psychological statuses were assessed using the 21-item Depression Anxiety and Stress Scale, 15-item Geriatric Depression Scale, and 4-item Perceived Stress Scale.

RESULTS

This study included data from 706 individuals (mean age, 73.3±6.8 years). We observed reduced quality of life and increased anxiety among 402 (43.1%) and 144 (20.9%) participants, respectively. Participants felt "out of control," "left out," "short of money," and "life was full of opportunities" less often and could "please themselves with what they did" more often. Multivariate analyses revealed increased depression, anxiety, and stress as independent risk factors for reduced quality of life.

CONCLUSION

Individuals with increased depression, anxiety, and stress levels during the pandemic experienced a worsening quality of life. Thus, the development of effective strategies to address the mental health of older adults is needed to mitigate the effects of the pandemic on their quality of life.

Mediation effect of coping strategies on general psychological health among middle-aged and older adults during the COVID-19 pandemic

OBJECTIVE

In this study, we aim to assess general psychological health, associated factors, and the potential of coping strategies as a mediator for middle-aged and older Malaysian adults during the COVID-19 pandemic.

METHODS

A total of 535 individuals aged 52 years and above from the previous cohort and interventional studies in Peninsular Malaysia were contacted during the Movement Control Order (MCO) issued during the COVID-19 pandemic. Telephonic interviews were conducted to obtain participant information concerning socio-demography, physical activity, subjective well-being (SWB) as assessed using flourishing scale, coping strategies, and general psychological health (GHQ-12). Simple linear regression (SLR) and multiple linear regression (MLR) analyses were performed to identify the factors associated with GHQ-12. The associated factors were further analysed using mediation analysis to determine the potential of coping strategies as a mediator.

RESULTS

It was observed that participants had a low mean GHQ-12 score (M = 0.80, SD = 2.19), indicating good psychological health. Living arrangement, physical activity, and flourishing scale were associated with psychological health (R² = 0.412, p < 0.05) in MLR. Positive reinterpretation, emotional support, instrumental support, humour, denial, and self-blame appear to partially mediate the relationship between socio-demography, physical activity, flourishing scale and GHQ-12, with lower coefficient values.

CONCLUSION

Middle-aged and older adults in Malaysia had good psychological health during the COVID-19 pandemic, especially when living with family, physically active, and having good subjective well-being. These findings provide the initial evidence to help promote the ageing population's general well-being and mental health and enable them to cope with change during the COVID-19 pandemic.

Clinical Pathway for Influenza in the Elderly: A comprehensive management protocol of Malaysia

Introduction: The clinical pathway (CP) is one of the most recommended tools for ensuring the best quality of care and has been proven to reduce the cost and time spent in hospital. The development of a CP for influenza is crucial, especially for the elderly, as they are vulnerable to influenza-related complications. The main aim of this study was to provide a comprehensive protocol for each component of influenza management among the elderly in Malaysia. Methods: An expert group meeting was conducted involving family medicine specialists, public health specialists, geriatricians, respiratory physicians and infectious disease physicians. The CP was designed following a 6-step protocol: 1) Selection of expert panel, 2) discussion and information gathering, 3) development of CP draft, 4) refinement of CP draft, 5) implementation of CP, and 6) finalisation of CP. The CP for influenza was designed based on service type and disease severity. Results: The panel described both outpatient and inpatient CPs for managing elderly patients with influenza. The outpatient CP covered mild and moderate influenza cases, while the inpatient CP addressed the management of moderate and severe influenza. The estimated length of hospital stay for moderate and severe influenza cases with pneumonia was 6 and 14 days, respectively. Conclusions: The CP for influenza supports existing treatment according to illness severity leveraged on current clinical practice guidelines and the best-care practices in primary and tertiary care settings. Continuous use of the CP is required to assess its effectiveness, thereby enabling optimisation of the healthcare process in influenza treatment.

Endoscopic findings among geriatric patients with anaemia and chronic kidney disease at a tertiary teaching hospital in Malaysia

BACKGROUND

Older people with chronic kidney disease (CKD) may be anaemic due to various reasons, and they are vulnerable to various consequences. One of the most important causes of anaemia to be recognised in this population is gastrointestinal loss. The outcome can be improved by early detection, careful investigation, and suitable therapies. There is currently no standardised grading scale or reliable indicators to assist clinicians on handling gastrointestinal workup in elderly CKD patients who are anaemic.

METHODS

A cross-sectional study of 171 people aged 60 and over who had CKD (stages 3-5), including those on Renal Replacement Therapy (RRT) and anaemia. Using oesophagogastroduodenoscopy, colonoscopy, and double balloon endoscopy, we analysed the endoscopic findings and calculated the prevalence of anaemia secondary to gastrointestinal disease. Haemoglobin, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), mean cell haemoglobin (MCH), iron panels, and immuno-faecal occult blood test (iFOBT) were evaluated to predict the diagnostic utility of each parameter in relation to gastrointestinal disorder in the elderly CKD population.

RESULTS

Abnormal endoscopic findings were obtained by upper and lower endoscopy in 98 individuals (57.3%). Upper endoscopy revealed the most prevalent lesions to be gastritis, gastric ulcer, and duodenal ulcer. The upper and lower endoscopies revealed a total of 14.0% malignant and pre-malignant lesions. T-test and receiver-operating characteristic (ROC) curve were performed on all haematological parameters and iron panels. Low ferritin level (less than 100 ng/mL) and combination with low transferrin saturation (less than 20%) have a significant p value less than 0.05. None of these variables had a significant area under the curve (AUC) of more than 0.75.

CONCLUSION

Positive endoscopic findings of anaemia are common in the older population at various stages of CKD, regardless of age, gender, or race. Malignant and premalignant lesions are not uncommon in older CKD patients. In the older CKD population, GI inflammation and ulceration are common lesions. Serum ferritin and TSAT levels are useful indicators of GI disorder in this population. Endoscopic evaluation as part of anaemia workup in the older people with CKD should not be ruled out.

Cognitive frailty is a robust predictor of falls, injuries, and disability among community-dwelling older adults

Background

Cognitive frailty, a combination of physical frailty and cognitive impairment, is associated with functional decline in older adults. However, there is limited information if cognitive frailty predicts the incidence of falls, injuries, and disability. In this study, we aimed to determine the ability of cognitive frailty in predicting the incidence of falls, injuries and disability among multi-ethnic older adults in Malaysia at 5 years follow-up.

Methods

In this prospective cohort study, a total of 400 participants aged 60 years and above were successfully followed up at 5 years. Participants’ socio-demographic, medical history, psycho-social, physical, cognitive and dietary intake information was obtained. Cognitive frailty was defined as comorbid physical frailty (> 1 Fried criteria) and mild cognitive impairment (Petersen criteria). Univariate analysis was performed for all variables, followed by hierarchical binary logistic regression (BLR) analysis to identify the ability of CF in predicting the incidence of falls, injuries, and disability. The significant value was set at p < 0.05.

Results

Cognitive frailty was found to be associated with greater risk of adverse consequences after adjusting for covariates. Both cognitive frailty (Adjusted Odd ratio (Adj OR) = 2.98, 95% confidence interval (CI): 1.78–4.99, p < 0.05) and physical frailty (Adj OR = 2.88, 95% CI: 1.19–6.99, p < 0.05) were significant predictors of incidence of falls. Risk of injuries was also significantly increased with the presence of cognitive frailty (Adj OR = 3.06, 95% CI: 1.23–7.60, p < 0.05) and physical frailty (Adj OR = 3.04, 95% CI: 1.75–5.28, p < 0.05). In addition, cognitive frailty (Adj OR = 5.17, 95% CI: 1.11–24.21, p < 0.05) and physical frailty (Adj OR = 4.99, 95% CI: 1.11–22.57, p < 0.05) were shown to significantly predict the incidence of disability among older adults.

Conclusion

Cognitive frailty is a robust predictor of falls, injuries, and disability in older adults. Possible early multi-domain preventive and management strategies of cognitive frailty that contribute to adverse consequences are required to decrease further functional decline and promote independence in older adults.

AB0155 COMPARATIVE ANALYSES OF SEROLOGICAL BIOMARKERS AND DISEASE CHARACTERISTICS BETWEEN ELDERLY ONSET RHEUMATOID ARTHRITIS (EORA) AND YOUNGER ONSET RHEUMATOID ARTHRITIS (YORA)

Background:

Several studies have reported differences in disease characteristics between elderly onset RA (EORA: age of onset > 60 years) and younger-onset RA (YORA). However, the findings across the studies have been rather inconsistent owing partially to the genetic variation across the populations studied. While a few studies have looked into the clinical aspects of EORA, there is a profound lack of comparative data on serological findings between EORA and YORA. Seropositive RA is known to be associated with more aggressive disease and the titres of the autoantibodies may predict the disease activity and the severity of radiographic progression.

Objectives:

The main aim of this study was to compare the levels of the autoantibodies namely anti–CCP (cyclic citrulinated peptide), IgA, IgM, IgG rheumatoid factors(RF) and disease characteristics between the EORA and YORA groups.

Methods:

We consecutively recruited a total of 151 female RA patients who were tested for IgA RF, IgG RF, IgM RF and anti CCP antibodies. Participants were aged above 18 years and met the 2010 ACR/EULAR RA criteria. Data on the disease characteristics (age at onset, disease activity at onset, disease duration and medications)were obtained by reviewing the medical records of the subjects. Subjects were divided into 2 groups i.e EORA and YORA based on age at onset of RA. All subjects were assessed for the severity of radiographic joint damage and functional disability based on Modified Sharp Score (MSS) and Health-assessment questionnaire-disability index (HAQ- DI), respectively. The EULAR response criteria was used to determine the subjects’ response to disease-modifying anti-rheumatic drugs.

Results:

The EORA group had 69 patients whereas the YORA group had 82 patients. The mean anti-CCP and IgA RF levels were significantly higher in the YORA group with p values of 0.002 and 0.035, respectively. The YORA group had significantly more severe disease at onset (p value for DAS 28 at onset was 0.009) with worse radiographic joint damage (p value for MSS was 0.006). In parallel with these findings, the YORA group had significantly higher ESR and CRP at onset with higher frequency of subjects requiring advanced therapies. The differences in frequency of RF positivity, disease duration, number of DMARDs, prednisolone dose and HAQ-Di scores between the groups did not reach statistical significance.

Conclusion:

EORA is characterized by lower levels of anti-CCP and IgA autoantibodies with less aggressive disease as compared to YORA.

References:

[1]Calvo-Alen J, Corrales A, et al.Clinical rheumatology 2005;24:485-9.

[2]Huscher D, Sengler C, Ochs W, et al. Clinical and experimental rheumatology 2013;31:256-62.

[3]Mueller RB, Kaegi T, et al. Rheumatology 2014;53:671-7.

Table 1.

Comparison of disease characteristics between EORA and YORA

ParameterEORA (n=69)YORA(n=82)p valueAge (years)*67.19± 2.4931.93± 5.10<0.050Disease duration (years)*8.06±5.048.70± 3.630.365DAS28 at onset*3.29± 1.373.96± 1.680.009RF positive at onset47 (68.11)62 (75.61)0.306Anti CCP titre*84.52±117.97151.14±138.020.002IgA RF titre*24.15±39.5443.14±64.820.035IgM RF titre*68.58±97.6572.74±93.280.789IgG RF titre*64.36±66.0170.88±69.580.558ESR at onset(mm/hr)*54.20± 20.5067.04± 23.600.001CRP at onset(mmol/L)*1.33± 1.373.79± 8.110.019No. of DMARDS 145 (65.21)41 (50.00) 216 (23.19)32 (39.02)0.106 38 (11.59)9 (10.98)On biologics & tsDMARD12 (17.39)35 (42.68)0.008Prednisolone dose (mg)*2.83 ± 3.32 2.77 ± 3.020.920Treatment Response Good50 (72.46)54 (65.86)0.487 Moderate15 (21.74)19 (23.17) None4 (5.80)9 (10.98)MSS*10.04±12.7917.49±19.040.006HAQ-DI*1.47±0.871.58±0.710.397

Data presented as either counts (percentages) or mean ± SD*

Disclosure of Interests:

None declared

The Impact of Poor Nutrient Intakes and Food Insecurity on the Psychological Distress among Community-Dwelling Middle-Aged and Older Adults during the COVID-19 Pandemic

This study aimed to investigate the impact of food insecurity and poor nutrient intake on the psychological health of middle-aged and older adults during the COVID-19 pandemic. A sub-sample of 535 individuals aged 52 years and above, from the earlier cohort and interventional studies (n = 4) from four selected states in Peninsular Malaysia, were recruited during the COVID-19 outbreak (April to June 2020). Telephone interviews were conducted by trained interviewers with a health sciences background to obtain participants' information on health status, physical activity, food security, and psychological health (General Health Questionnaire-12; normal and psychological distress). Univariate analyses were performed for each variable, followed by a logistic regression analysis using SPSS Statistics version 25.0. Results revealed food insecurity (OR = 17.06, 95% CI: 8.24-35.32, p < 0.001), low protein (OR = 0.981, 95% CI: 0.965-0.998, p < 0.05), and fiber intakes (OR = 0.822, 95% CI: 0.695-0.972, p < 0.05) were found to be significant factors associated with the psychological distress group after adjusting for confounding factors. The findings suggested that food insecurity and insufficiencies of protein and fiber intakes heightened the psychological distress during the COVID-19 pandemic. Optimal nutrition is vital to ensure the physical and psychological health of the older population, specifically during the current pandemic.

Frequency of Cognitive Impairment Among Malaysian Elderly Patients Following First Ischaemic Stroke—A Case Control Study

Background: Stroke is highly prevalent globally and is an important cause of cognitive impairment and dementia.

Aims: We determined the frequency of post-stroke cognitive impairment (PSCI) at 1, 3, and 6 months among patients with first clinical ischemic stroke compared to risk and age-matched controls.

Methods: This study involved 32 cases and 32 controls, and was conducted over 6 months. Cases were inpatients aged >60 with first clinical ischemic stroke. Controls were age-matched subjects without prior stroke. Montreal Cognitive Assessment (MoCA) was performed in all patients at 1, 3, and 6 month post stroke. A MoCA score of <26 was used for mild PSCI and <22 for moderate PSCI (post stroke dementia).

Results: Post-stroke dementia was detected in 12 patients (37.5%) at 1^st month, in 13 (40.6%) at 3^rd month and 15 (48.4%) at 6^th months. Mild PSCI was present in 7 patients (21.6%) at 1 month, 16 patients (50%) at 3 months, and 15 patients (48%) at 6 months. The odds ratio (OR) for post-stroke dementia was 3.2 (95%CI 0.98–10.68; p = 0.05) at 1 month; 3.69(95% CI 1.13–12.11; p = 0.031) at 3 months, and 4.88 (95% CI 1.49–15.99; p = 0.009) at 6 months. Years of education was an independent predictor for dementia (OR 0.60; p = 0.046). The OR for post-stroke dementia at 6^th month was 7.23 with education level adjusted (95%CI 1.46–35.86, p = 0.015).

Conclusion: The frequency of PSCI was high as early as 1 month after stroke. Stroke alone conferred a 7.2 times risk for post-stroke dementia compared to controls.

THU0283 DISTINCT CLINICAL FEATURES OF LATE–ONSET SYSTEMIC LUPUS ERYTHEMATOSUS AMONG MALAYSIAN MULTI-ETHNIC COHORT

Background:

Systemic Lupus Erythematosus (SLE) commonly affects young women in their reproductive age group. However, there is an increase prevalence of late-onset SLE, parallel to the higher life expectancies among general populations worldwide. It has been reported that up to 25% SLE populations have a later onset of disease and their disease expression and course may be different.

Objectives:

To determine the clinical features and outcomes of late-onset SLE patients in a multi-ethnic Malaysian cohort.

Methods:

Medical records of SLE patients who attended regular follow-up clinics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from 2011 until June 2019 were reviewed. Late-onset SLE was defined as the onset of SLE symptoms or diagnosis after the age of 50 years old. Information on their socio-demographics and disease characteristics were obtained from the clinical records. Disease damage was assessed using the SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index (SDI) scores. The disease characteristics and autoantibody profiles were compared between late-onset and younger onset patients. Damage accrual at disease onset and at 5 years was obtained and compared between the two groups.

Results:

A total of 429 patients were included and majority of them were Malays (n= 225, 52.4%) followed by Chinese (n=180, 42), Indian (n=21, 4.9%) and others (n=3,0.7%). This multi-ethnic SLE cohort was consisted of predominantyly female patients (n=372,86.7%) with disease duration of 9.9 years ± 6.8 years. A total of 13.8% (n=59) had late onset SLE with mean onset of disease at 58.1 ± 6.3 years while younger group was 27.2 ± 9.4 years. The commonest system involvement among the late-onset group was haematological manifestation (69.5%).Compared to the younger-onset SLE, late-onset SLE occurred significantly higher among the Chinese (66.1%) as compared to Malay (32.3%), Indians and other ethnics (1.7%), p<0.01. Patients with late-onset SLE also had significantly less musculoskeletal (37.3% vs 62.4%) and renal (23.7% vs 71.1%), p<0.001 and tend to have less muco-cutanoues manifestations (28.8 vs 42.4%, p=0.06). Meanwhile, pulmonary involvement was more common among the late onset SLE patients (11.9% vs 0.8%, p<0.001). Extractable nuclear antigen (ENA) results were available in 197 patients and patients with late-onset SLE had significantly higher rate of anti-RO positive (63% vs 3.9%), p=0.01. Otherwise, no significant difference in the other autoantibodies expressions including anti-La, anti-Sm, anti-RNP, anti-ribosomal P and anti-phospholipid antibodies. Patients with late-onset SLE tend to have more damage accrual at 5 years as compared to the younger age group (p=0.07). The mortality in the late onset group was 13.6% (n=8) as compared to 2.7% (n=10) in the younger age group, p=0.01. Majority of the cause of death in the later onset SLE was infection (87.5%) while in the younger age group was infection and active disease (90%).

Conclusion:

Late onset SLE occurs more commonly among Chinese ethnics in Malaysia and Malaysian SLE patients with late onset of the disease have distinct clinical manifestations. Damage accrual at 5 years tend to be higher in the late-onset group and the mortality is significantly higher with the major cause of death is infection. The different disease expression and outcome in late onset SLE suggest different factors in influencing the disease course and hence further studies including their genetic profiles are warranted.

References:

[1]Paula I. Burgos; Graciela S. Alarcón. Late-onset Lupus: Facts and Fiction. Future Rheumatol. 2008;3(4):351-356.

[2]S Stefanidou, C Gerodimos, A Benos et al. Clinical expression and course in patients with late onset systemic lupus erythematosus. Hippokratia. 2013; 17(2): 153–156.

Acknowledgments:

This research was supported by the “Fundamental Research Grant Scheme (FRGS/1/2018/SKK02/UKM/03/1)” by Ministry of Education Malaysia

Disclosure of Interests:

Syahrul Sazliyana Shaharir: None declared, Mohd Shahrir Mohamed Said: None declared, Sakthiswary Rajalingham Speakers bureau: Pfizer (500USD), Hazlina Mahadzir: None declared, Ruslinda Mustafar: None declared, Asrul Abdul Wahab: None declared

Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study

(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.

112 Cognitive Frailty, Physical Frailty and Loneliness Predicts the Incidence of Falls among Community-Dwelling Older Adults

Background

Although frailty is a well-known risk factor for falls, the concomitant effects of physical frailty and cognitive impairments or known as cognitive frailty (CF), in predicting the incidence falls is not established.

Methods

In a prospective cohort study, we examined the predictive ability of CF towards the incidence of falls among older adults from Malaysian Towards Useful Aging (TUA) study. A total of 400 participants aged &gt; 60 years were successfully followed up at five years. Participants were interviewed on their sociodemographic data, medical and falls history. Assessments to examine cognitive function, physical functional status, psychosocial and dietary intake were conducted. Univariate analysis was performed for every variable, followed by hierarchical binary logistic regression (BLR) analysis to identify the ability of CF in predicting the incidence of falls.

Results

After adjusting for the covariates, CF (Odd Ratio (OR) = 2.976, 95% Confidence Interval (CI): 1.776-4.987, p&lt;0.05), physical frailty (OR = 2.882, 95% CI: 1.187-6.999, p&lt;0.05), women (OR = 2.229, 95% CI: 1.362-3.648, p&lt;0.05), and loneliness (OR = 1.329, 95% CI: 1.028-1.718, p&lt;0.05) were the significant predictors for the incidence of falls.

Conclusion

Both cognitive and physical frailty were significant predictors of future falls among community-dwelling older adults. It is important to provide an effective intervention to prevent falls in this high-risk group of older adults.

This study was funded by the Long-term Research Grant Scheme (LGRS) provided by the Ministry of Education Malaysia (LRGS/BU/2012/UKM-UKM/K/01) and Grand Challenge Grant funded by the National University of Malaysia (DCP-2017-002/1).

141 Fall-Risk Increasing Drugs use in Elderly with Fall-Related Fractures

Introduction

Elderly populations are at the highest risk of fatal falls and fracture is one of the fall-related injuries which results in high morbidity and mortality. A group of drugs have been identified as the fall risk increasing drugs (FRIDs) and listed as one of the modifiable extrinsic risk factors for falls. This study aimed to determine the use of FRIDs in fall-related fractures among elderly patients.

Method

Patients aged 65 years and above admitted to a tertiary teaching hospital due to falls were included. Falls were identified through a case-mix system using the ICD-10 codes of W01 and W18 (fall at the same level). Patient medical records were reviewed retrospectively and drugs use before the falls were analysed.

Results

Among the patients included (n=124), majority of them had fall-related fractures (83.1%) and hip fractures were among the highest type of fractures (67%). The older old (≥ 80 years) had recorded a significant higher incidence of hip fractures compared to the younger individuals (p=0.009). About 75% of the patients with fall-related fractures had recorded use of at least one FRID before the admission. The younger individuals had significantly higher use of FRIDs compared to the older old, particularly the anti-hypertensive drugs (p=0.017). Most of them (&gt;80%) still received FRIDs at discharge and deprescribing was commenced in less than one quarter of the patients. Furthermore, 32.6% of them had either an addition of new FRIDs or increased of the FRIDs dose at discharge.

Conclusion

In conclusion, fracture was the major reason of admissions among the elderly with falls. The older old recorded higher incidence of fall-related hip fractures. There was high usage of FRIDs before and after fall-related fractures. Deprescribing was not widely practiced in the elderly after the fall incidence.