Publications by authors named "Tan Maw Pin"

116 Publications

Interdisciplinary Differences in Patient Safety Culture within a Teaching Hospital in a South East Asia.

Int J Clin Pract 2021 May 10:e14333. Epub 2021 May 10.

Department of Emergency Medicine, Faculty of Medicine, University of Malaya.

Background: Patient safety represents a global issue which leads to potentially avoidable morbidity and mortality. The healthcare providers perception and their role are utmost important in delivering quality care and patient safety. This study aimed to determine the interdisciplinary differences in patient safety culture in a tertiary university hospital.

Method: A cross-sectional study using the Safety Attitude Questionnaire (SAQ) self-administered electronically in the English and Malay languages to evaluate safety culture domains. A positive percentage agreement scores of 60% was considered satisfactory. Comparisons were made between doctors, nurses, allied health professionals, nursing assistants and support staff.

Results: Of 6562 respondents, 5724 (80.4%) completed the questionnaire; 3930 (74.5%) women, 2263 (42.9%) nurses, and 1812 (34.2%) had 6-10 years of working experience. The mean overall positive percentage agreement scores were 66.2 (range=31.1 to 84.7%), with job satisfaction (72.3±21.9%) and stress recognition (58.3±25.6%) representing the highest and lowest mean domain scores, respectively. Differences were observed between all five job categories. Linear regression analyses revealed that the other four job categories scored lower in teamwork, safety climate, job satisfaction, and working conditions compared to nurses.

Conclusions: The overall mean SAQ score was above the satisfactory level, with unsatisfactory percentage agreement scores in the stress recognition domain. Interventions to improve patient safety culture should be developed, focusing on stress management.
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http://dx.doi.org/10.1111/ijcp.14333DOI Listing
May 2021

Healthcare Utilization and Knee Osteoarthritis Symptoms among Urban Older Malaysian.

Int J Environ Res Public Health 2021 Apr 4;18(7). Epub 2021 Apr 4.

Allied Health and Human Performance, City East Campus, University of South Australia, Adelaide 5000, Australia.

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 ( < 0.01). Outpatient usage was higher ( < 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, < 0.01) and pharmacotherapy (OR: 10.439, 95% CI: 1.187-91.812, < 0.05), while females were less likely to utilize inpatient care services (OR: 0.126, 95% CI: 0.021-0.746, < 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.
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http://dx.doi.org/10.3390/ijerph18073777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038539PMC
April 2021

Supporting family doctors to address elder abuse: a quasi-experimental study in Malaysia.

J Elder Abuse Negl 2021 Apr 25:1-17. Epub 2021 Apr 25.

Department of Public Health, Ministry of Health, Putrajaya, Malaysia.

This quasi-experimental study examined the effect of Supporting Family Doctors to Address Elder Abuse (SAFE) educational intervention among family doctors practicing at public primary care clinics in Malaysia. SAFE is an intensive, multimodal, locally tailored, and culturally sensitive face-to-face educational intervention on elder abuse. A significant mean score improvement of knowledge [Baseline: 5.33 (SD:1.33) to 6-month post-intervention: 6.45 (SD: 1.35); p<0.001] and perceived behavioral control [Baseline: 50.83 (SD: 8.87) to six-month post-intervention: 56.16 (SD: 9.56); p<0.001] observed in the intervention group compared to the control group. No significant difference in attitude, subjective norm, and practice scores between the two groups over time. SAFE educational intervention for family doctors was effective to improve but not sustainable knowledge and perceived behavioral control toward elder abuse identification and management. We recommend SAFE educational intervention as part of the continuous medical education for family doctors supplemented with a change in organization and national policy.
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http://dx.doi.org/10.1080/08946566.2021.1919272DOI Listing
April 2021

A national survey on the teaching provision of undergraduate geriatric medicine in Malaysia.

Gerontol Geriatr Educ 2021 Apr 26:1-12. Epub 2021 Apr 26.

Department of Healthcare of Older People, Nottingham University Hospital NHS Trust, Nottingham, UK.

Malaysia is becoming an aging nation, with 32 medical schools providing 5,000 graduates every year. The extent these graduates have been trained in core concepts in geriatric medicine remains unclear. This work aims to describe the current state of teaching provision on aging and geriatric medicine to the medical undergraduates in Malaysia. A survey was developed by geriatric medicine experts from the Malaysian Society of Geriatric Medicine (MSGM) to review the teaching provision based on the recommended MSGM Undergraduate Geriatric Medicine Curriculum and was sent to all medical schools across the country. The response rate was 50% (16 out of 32 medical schools). Among 16 medical schools, 10 (62.5%) delivered the learning outcomes as part of an integrated curriculum, and five via a mixed geriatric and integrated curriculum at varying degrees of completeness, ranging from 19% to 94%. One particular medical school did not deliver any of the core topics as part of its undergraduate curriculum. It has been identified that the strongest barrier to delivery was lack of expertise, followed by the fact that the topics were not included in the current curriculum. Improvement in teaching provision should be implemented through a concerted effort to adopt a geriatric medical curriculum nationwide, while future research should aim at the interventions taken to address the barriers in its provision.
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http://dx.doi.org/10.1080/02701960.2021.1914027DOI Listing
April 2021

Virtual Group Exercises and Psychological Status among Community-Dwelling Older Adults during the COVID-19 Pandemic-A Feasibility Study.

Geriatrics (Basel) 2021 Mar 22;6(1). Epub 2021 Mar 22.

Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur 50603, Malaysia.

Social isolation, magnified by the restriction of movement order during the COVID-19 pandemic, may lead to negative psychosocial health impacts among community-dwelling older adults. We, therefore, aimed to evaluate recruitment rates, data collection, and group exercises conducted through virtual technology among individuals aged 60 years and over in Malaysia. Participants were recruited from the Promoting Independence in Seniors with Arthritis (PISA) pilot cohort through social media messaging. A four-week course of virtual group exercise was offered. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS) during the last attended follow-up of the cohort study (pre-pandemic), pre-intervention, and post-intervention. Exercise adherence was recorded using diaries with daily entries and attendance to the virtual group exercise sessions were also captured electronically daily. The outcomes of interest were changes in anxiety and depression scores from baseline to pre-intervention (pandemic-related) and post-intervention (virtual exercise related). Forty-three individuals were recruited. A significant increase in anxiety scores from baseline to pre-intervention was observed. Comparisons using repeated-measures analysis of variance between those who attendance ≥14 and <14 group exercise sessions revealed no between-within subject differences in depression scores. There was a 23% dropout rate in the post intervention survey and 60.5% of diaries were returned. Virtual group exercises could be conducted among older adults residing in a middle-income country, though recruitment would have been limited to those with internet access.
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http://dx.doi.org/10.3390/geriatrics6010031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005958PMC
March 2021

Comparison of Retrospective and Prospective Falls Reporting Among Community-Dwelling Older People: Findings From Two Cohort Studies.

Front Public Health 2021 12;9:612663. Epub 2021 Mar 12.

Faculty of Medicine, University of Malaya, Kuala Lampur, Malaysia.

While prospective recording is considered as the gold standard, retrospective recall is widely utilized for falls outcomes due to its convenience. This brings about the concern on the validity of falls reporting in Southeast Asian countries, as the reliability of falls recall has not previously been studied. This study aimed to evaluate the reliability of retrospective falls recall compared to prospective falls recording. A secondary analysis of data from two prospective recording methods, falls diary and falls calendar, from two different research projects were obtained and analyzed. Retrospective falls recall was collected either through phone interview or follow-up clinic by asking the participants if they had fallen in the past 12 months. Two-hundred-sixty-eight and 280 elderly participated in the diary and calendar groups, respectively. Moderate (46%) and poor (11%) return rates were found on completed diary and calendar recording. Under-(32%) and overreporting (24%) of falls were found in diary compared to only 4% of overreporting for the calendar. Retrospective recall method achieved 57% response rate for the diary group (followed up at clinic) and 89% for the calendar group (followed up via telephone interview). Agreement between retrospective and prospective reporting was moderate for the diary (kappa =0.44; < 0.001) and strong for the calendar (kappa = 0.89; < 0.001). Retrospective recall is reliable and acceptable in an observation study within healthy community older adults, while the combination of retrospective and prospective falls recording is the best for an intervention study with frailer older population. Telephone interview is convenient, low cost, and yielded a high response rate.
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http://dx.doi.org/10.3389/fpubh.2021.612663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994342PMC
March 2021

2019 revised algorithm for the management of knee osteoarthritis: the Southeast Asian viewpoint.

Aging Clin Exp Res 2021 May 28;33(5):1149-1156. Epub 2021 Mar 28.

College of Medicine University of the Philippines, Manila, Philippines.

Background: Since 2014, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide.

Aim: Based on this document, a Southeast Asia Working Group (SEAWG) wished to see how the new ESCEO algorithm developed in 2019 was perceived by Southeast Asian experts and how it was integrated into their clinical practice.

Methods: A SEAWG was set up between members of the international ESCEO task force and a group of Southeast Asian experts.

Results: Non-pharmacological management should always be combined with pharmacological management. In step 1, symptomatic slow-acting drugs for osteoarthritis are the main background therapy, for which high-quality evidence is available only for the formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. In step 2, oral NSAIDs are a useful option, considering the cardiovascular/renal/gastrointestinal profiles of the individual patient. Intra-articular hyaluronic acid and corticosteroids are a possible alternative to oral NSAIDs, but limited evidence is available. If steps 1 and 2 do not give adequate relief of symptoms, tramadol can be used, but its safety is debated. In general, the indications of the ESCEO algorithm are important in Southeast Asian countries, but the reimbursement criteria of local health systems are an important aspect for adherence to the ESCEO algorithm.

Conclusion: This guidance provides evidence-based and easy-to-follow advice on how to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in Southeast Asian countries.
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http://dx.doi.org/10.1007/s40520-021-01834-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081679PMC
May 2021

Escalating progression of mental health disorders during the COVID-19 pandemic: Evidence from a nationwide survey.

PLoS One 2021 25;16(3):e0248916. Epub 2021 Mar 25.

Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Since the first nationwide movement control order was implemented on 18 March 2020 in Malaysia to contain the coronavirus disease 2019 (COVID-19) outbreak, to what extent the uncertainty and continuous containment measures have imposed psychological burdens on the population is unknown. This study aimed to measure the level of mental health of the Malaysian public approximately 2 months after the pandemic's onset. Between 12 May and 5 September 2020, an anonymous online survey was conducted. The target group included all members of the Malaysian population aged 18 years and above. The Depression Anxiety Stress Scale (DASS-21) was used to assess mental health. There were increased depressive, anxiety and stress symptoms throughout the study period, with the depression rates showing the greatest increase. During the end of the data collection period (4 August-5 September 2020), there were high percentages of reported depressive (59.2%) and anxiety (55.1%) symptoms compared with stress (30.6%) symptoms. Perceived health status was the strongest significant predictor for depressive and anxiety symptoms. Individuals with a poorer health perception had higher odds of developing depression (odds ratio [OR] = 5.68; 95% confidence interval [CI] 3.81-8.47) and anxiety (OR = 3.50; 95%CI 2.37-5.17) compared with those with a higher health perception. By demographics, young people-particularly students, females and people with poor financial conditions-were more vulnerable to mental health symptoms. These findings provide an urgent call for increased attention to detect and provide intervention strategies to combat the increasing rate of mental health problems in the ongoing COVID-19 pandemic.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248916PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993793PMC
April 2021

Incidence and multidimensional predictors of occasional and recurrent falls among Malaysian community-dwelling older persons.

BMC Geriatr 2021 03 2;21(1):154. Epub 2021 Mar 2.

Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.

Background: Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. In this study, we aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls. This was done in the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians.

Methods: Data from 1,763 Malaysian community-dwelling older persons aged ≥ 60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up.

Results: Three hundred and nine (17.53 %) participants reported fall occurrences at an 18-month follow-up, of whom 85 (27.51 %) had two or more falls. The incidence rate for occasional and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being female (OR: 1.57; 95 % CI: 1.04-2.36), being single (OR: 5.31; 95 % CI: 3.36-37.48), having history of fall (OR: 1.86; 95 % CI: 1.19-2.92) higher depression scale score (OR: 1.10; 95 % CI: 1.02-1.20), lower hemoglobin levels (OR: 0.90; 95 % CI: 0.81-1.00) and lower chair stand test score (OR: 0.93; 95 % CI: 0.87-1.00) remained independent predictors of occasional falls. While, having history of falls (OR: 2.74; 95 % CI: 1.45-5.19), being a stroke survivor (OR: 8.57; 95 % CI: 2.12-34.65), higher percentage of body fat (OR: 1.04; 95 % CI: 1.01-1.08) and lower chair stand test score (OR: 0.87; 95 % CI: 0.77-0.97) appeared as recurrent falls predictors.

Conclusions: Having history of falls and lower muscle strength were predictors for both occasional and recurrent falls among Malaysian community-dwelling older persons. Modifying these predictors may be beneficial in falls prevention and management strategies among older persons.
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http://dx.doi.org/10.1186/s12877-021-02103-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927222PMC
March 2021

Peak expiratory flow rate and sarcopenia risk in older Indonesian people: A nationwide survey.

PLoS One 2021 9;16(2):e0246179. Epub 2021 Feb 9.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Reduced peak expiratory flow is a common physiological change in older individuals and age is an important predictor for sarcopenia. We analyzed nationwide survey data to determine the relationship between peak expiratory flow rate and sarcopenia in older Indonesians. Community-dwelling Indonesian individuals aged ≥60 years (n = 2422; mean age = 67.21 y) from the fifth-wave data of the Indonesian Family Life Survey was selected. Sarcopenia was diagnosed based on handgrip strength, gait speed, and appendicular skeletal muscle mass measurements. Peak expiratory flow rates (PEFRs) were categorized according to their percentage of predicted flow rates as <50%, 50% to 80%, and >80%. Confounders previously determined to be associated with sarcopenia occurrence were included. Sarcopenia prevalence was 50.25%. After adjustment for confounders, PEFRs of <50% and 50% to 80% were associated with an increased sarcopenia risk (odds ratio = 5.22 and 1.88, respectively) compared with PEFRs of >80%. Poor lung function was independently associated with sarcopenia occurrence. Future studies should explore the usefulness of PEFR as a risk factor of sarcopenia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246179PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872226PMC
February 2021

Home Hazards With Fear of Falling: Findings From the Baseline Study of the Malaysian Elders Longitudinal Research (MELoR).

Front Public Health 2020 12;8:612599. Epub 2021 Jan 12.

Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Fear of falling (FoF) is a common issue among older people, impacting on psychological health, functional performance and mortality. Many factors associated with fear of falling have been investigated but little is known about the role of home hazards. Home hazards can be due to unsafe environmental and functional features. This study is aims to evaluate the association between home hazards with fear of falling among community-dwelling individuals aged 55 years and over. Baseline data with 1,489 older individuals from the Malaysian Elders Longitudinal Research (MELoR) study were analyzed. Home visits for interview and observations in the home were conducted with the participants. FoF was established with a single-item question and home hazards with the Home Falls and Accidents Screening Tool (HOME FAST). The majority (76.4%) of older participants experienced FoF. The history of falls was not associated with FoF ( = 0.868), but FoF was associated with participants limiting their daily activities ( < 0.001). Home hazards were less likely ( = 0.023) and functional issues were more likely ( < 0.001) to be associated with a high degree of FoF. However, both home hazards domains were not associated with activity restriction due to FoF. Education about home hazards from the perspective of person-environment interaction may encourage home hazards management and reduce FoF which should be evaluated in future studies.
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http://dx.doi.org/10.3389/fpubh.2020.612599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835712PMC
January 2021

Contrast sensitivity is associated with frailty.

Eur Geriatr Med 2021 Apr 24;12(2):313-319. Epub 2021 Jan 24.

Department of Ophthalmology, University of Malaya Eye Research Centre, University of Malaya, 59100, Kuala Lumpur, Malaysia.

Purpose: Using data from the Malaysian Elders Longitudinal Research (MELoR), this study investigated the association between visual function (visual acuity and contrast sensitivity) and frailty in a group of urban-dwelling older adults.

Methods: This was a cross-sectional study. 1332 participants aged ≥ 55 years were selected by random sampling from the parliamentary electoral register. Only 1274 participants completed the frailty assessment and 1278 participants completed the contrast sensitivity assessment. Impaired vision was defined as a Snellen visual acuity of worse than 6/12 in the better eye. Poor contrast sensitivity was defined as a score on the Pelli Robson chart of lower than 1.65. Frailty was defined with the Fried's phenotype criteria. Inter-group comparisons were determined with the independent T-test for continuous variables and the Pearson's Chi-squared test for categorical variables. The odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the cross-sectional association between frailty and visual function.

Results: The mean age of participants was 68.8 ± 7.5 years, of which 58.1% (774) were women. Impaired vision and poor contrast sensitivity were present in 187 (14%) and 271 (21.2%) subjects respectively. 73 (5.8%) individuals were classified as frail, 1161 (91.0.%) pre-frail, and 40 (2.8%) non-frail. There was no significant difference in frailty phenotypes between those with good and impaired vision (p = 0.241). Fried's component of handgrip strength, gait speed and exhaustion were significantly better in those with good visual function (p < 0.05). Participants with poor contrast sensitivity were significantly more likely to be frail (OR: 5.34, p = 0.004).

Conclusion: Poor contrast sensitivity was significantly associated with frailty. This highlights the importance of incorporating assessment of contrast sensitivity in those at risk of frailty.
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http://dx.doi.org/10.1007/s41999-021-00450-2DOI Listing
April 2021

The Malaysian Elders Longitudinal Research (MELoR): Prevalence and Factors Associated With Vision Impairment in an Urban Population in Malaysia.

Asia Pac J Public Health 2020 Dec 29:1010539520983667. Epub 2020 Dec 29.

UM Eye Research Centre, Department of Ophthalmology, University of Malaya, Malaysia.

Low vision and blindness are major health issues affecting ageing population. This cross-sectional study aims to determine the prevalence of visual impairment (VI) in Petaling Jaya North, Petaling Jaya South, and Lembah Pantai using data from the Malaysian Elders Longitudinal Research. There were 1322 participants aged ≥55 years selected by random sampling from parliamentary electoral rolls. Visual acuity was assessed using the logarithm of the minimum angle of resolution chart at 4 m distance. The overall population-adjusted prevalence of VI was 9.0%. The estimated prevalence of VI was highest in Malays followed by Indians and Chinese. Following adjustments for ethnic discrepancies in age, marital status, education level, gender and medical illness, the Malay ethnicity remained an independent association for VI. Education level was associated with Indian ethnicity. In conclusion, the Malay ethnicity and lower education level among Indian ethnicity were found to be associated with VI among the older population in Malaysia. The Malay ethnicity showed the highest prevalence of VI followed by Indians and Chinese.
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http://dx.doi.org/10.1177/1010539520983667DOI Listing
December 2020

Prevalence and factors associated with falls among older persons in Malaysia.

Geriatr Gerontol Int 2020 Dec;20 Suppl 2:33-37

Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia.

Aim: Falls are a common problem among older people, leading to major morbidity and increased mortality. The study aimed to determine the prevalence of falls among older persons in Malaysia and its associated factors.

Methods: Data were obtained from the National Health and Morbidity Survey 2018 (NHMS 2018), a cross-sectional study using stratified cluster sampling design. Older persons were defined as aged ≥60 years in this study. Descriptive and logistic regression analyses were conducted using SPSS version 25.0.

Results: Overall, 14.1% (95% confidence interval [CI]: 12.46, 15.84) of older persons reported having experienced at least one fall during the past 12 months. Univariate analyses revealed an association between the history of falls with not being employed (odds ratio [OR]: 1.35 [95% CI: 1.03, 1.77]), diabetes mellitus (OR: 1.65 [95% CI: 1.33, 2.04]), limitation in activities of daily living (ADL) (OR: 1.90 [95% CI: 1.43, 2.54]) or instrumental ADL (OR: 1.47 [95% CI: 1.16, 1.84]). Multiple logistic regression revealed that falls were positively associated with those who had diabetes mellitus (OR: 1.55 [95% CI: 1.23, 1.94]) and limitation in ADL (OR: 1.56 [95% CI: 1.14, 2.15]); 43.9% of falls occurred outdoors.

Conclusion: One in six older Malaysian people experience at least one fall over a 12-month period. Diabetes mellitus and limitation in ADL were the factors associated with falls among older persons. A comprehensive and targeted program designed to reduce risk of falls is urgently needed. Future research should identify suitable programs for our setting to reduce the potential society burden of falls in older Malaysians. Geriatr Gerontol Int 2020; 20: 33-37.
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http://dx.doi.org/10.1111/ggi.13980DOI Listing
December 2020

Relationship between urinary incontinence and quality of life of older persons in Malaysia.

Geriatr Gerontol Int 2020 Dec;20 Suppl 2:38-42

Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia.

Aims: As the Malaysian population is aging rapidly, there is an urgent need for an effective management plan for healthy aging, to extend life expectancy and to improve quality of life (QoL). Urinary incontinence (UI), which is common in older persons, is often linked to reduced QoL. This study aimed to determine the effects of UI on QoL among older persons in Malaysia.

Methods: This study was based on data obtained from 3716 Malaysians aged ≥60 years as part of the National Health and Morbidity Survey (NHMS) 2018. QoL was measured using the Control, Autonomy, Self-realization and Pleasure 19-item (CASP-19) questionnaire. UI was measured using the Questionnaire Urinary Incontinence Diagnosis (QUID) score. Association between UI and QoL were examined using linear regression analysis, after controlling socio-demographic variables and comorbidities.

Results: Overall, the prevalence of UI was 5.2%. By subtypes, the prevalence of stress UI and urge UI were both 2.0%, while that of mixed UI was 1.3%. The UI group rated their lives more negatively in all four domains of QoL compared with non-UI group. Those who were incontinent had lower standardized scores on control and autonomy domains of CASP-19 as well as total score. Results from linear regression analysis indicated that UI had a significantly negative impact on control and autonomy domains of QoL after controlling for socio-demographic factors and comorbidities.

Conclusion: UI contributes to a significant reduction on QoL of older persons. Healthcare providers need to be sensitive in evaluating and discussing UI, particularly with their older patients. Geriatr Gerontol Int 2020; 20: 38-42.
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http://dx.doi.org/10.1111/ggi.14028DOI Listing
December 2020

Prevalence of dementia and quality of life of caregivers of people living with dementia in Malaysia.

Geriatr Gerontol Int 2020 Dec;20 Suppl 2:16-20

Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia.

Aim: Dementia is the major cause of disability among older persons and leading physical and psychological sequelae for both the person living with dementia (PLwD) and their caregivers. The aim of this study was to determine the prevalence of dementia in Malaysia and identify the factors influencing quality of life (QoL) of caregivers of PLwD.

Methods: A nationwide survey was conducted among individuals aged ≥60 years. Cognition was assessed with the Identification and Intervention for Dementia in Elderly Africans (IDEA) tool. QoL of older caregivers was assessed using the Control, Autonomy, Self-Realization and Pleasure (CASP-19) questionnaire.

Results: The prevalence of dementia among older adults aged ≥60 years in Malaysia was found to be 8.5%. The prevalence was found to be higher among females, those with no formal education and those in rural areas in Malaysia. The mean QoL of family caregivers of PLwD was significantly lower than the caregivers of older adults without dementia were (P < 0.001). Multivariable linear regression analysis on the subpopulation of PLwD showed that inability to carry out activities of daily living among PLwD (P = 0.014) and low to fair social support for the caregivers (P < 0.001) were negatively associated with QoL of caregivers of PLwD.

Conclusions: The high prevalence of dementia among older adults in Malaysia emphasizes the need for affirmative action in Malaysia. The functional capacity of the PLwD and social support determines the QoL of caregivers of PLwD in Malaysia. Thus, the community as a whole needs to provide support to PLwD and their caregivers. Geriatr Gerontol Int 2020; 20: 16-20.
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http://dx.doi.org/10.1111/ggi.14031DOI Listing
December 2020

Influence of social support on limitation in daily living among older persons in Malaysia.

Geriatr Gerontol Int 2020 Dec;20 Suppl 2:26-32

Research Policy and Planning Division, National Institutes of Health, Ministry of Health, Selangor, Malaysia.

Aim: Studies on the influence of social support on activity limitation among older persons remain limited. A better understanding of this relationship will help with resource planning and policy making aimed to reduce burden of care. The objective of this study was to assess the influence of social support on limitation in daily living among older persons in Malaysia.

Methods: Data from the National Health and Morbidity Survey 2018, a nation-wide, cross-sectional survey using a two-stage stratified sampling design, were analyzed. A representative sample of individuals aged ≥60 years identified through national sampling frames throughout Malaysia was included. Face-to-face interviews were conducted using validated questionnaires on activities of daily living (ADL) and instrumental ADL (IADL). Social support was measured using the Duke Social Support Index.

Results: The overall prevalence of the presence of any limitations in ADL and IADL was 17.0% and 42.9% respectively. Overall prevalence of the older persons with low to fair social support was 30.8% and high to very high social support was 69.2%. Logistic regression analysis identified the following factors as being associated with limitations in ADL and IADL: being female, of older age, having a monthly income
Conclusion: Low social support was associated with limitation in daily living among older persons in Malaysia. Future studies should consider evaluating the potential benefits of increasing social support on the activity limitation of our older population. Geriatr Gerontol Int 2020; 20: 26-32.
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http://dx.doi.org/10.1111/ggi.14029DOI Listing
December 2020

Quality of life and its associated factors among older persons in Malaysia.

Geriatr Gerontol Int 2020 Dec;20 Suppl 2:92-97

Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia.

Aim: Quality of life (QoL) among the older persons provides valuable insights into the potential modifiable risk factors that affect well-being in later life. This study aimed to describe the QoL and psychosocial factors of QoL of older persons in Malaysia.

Methods: We used the 19-item Control, Autonomy, Self-realization and Pleasure scale, a validated instrument that measures psychological well-being related to QoL in older persons. Scores range from 0 to 57, and higher scores indicate better QoL. We included several factors as covariates. Analysis of complex samples was carried out using Stata 15. Descriptive analysis was carried out to determine QoL by sociodemographic characteristics and other factors. Linear regression analysis was used to identify psychosocial factors that influence QoL.

Results: A total of 3444 individuals aged ≥60 years completed all 19-item Control, Autonomy, Self-realization and Pleasure items. The estimated mean QoL score was 47.01 (95% CI 46.30-47.72). Adjusted for confounders, QoL was lower among individuals with no formal education (-2.554, 95% CI -3.684, -1.424), probable depression (-1.042, 95% CI -1.212, -0.871) and food insecurity (-0.815, 95% CI -1.083, -0.548). QoL continued to improve with improved ADL score (0.302, 95% CI 0.052, 0.552), IADL score (0.646, 95% CI 0.382, 0.909) and better social support (0.308, 95% CI 0.187, 0.429).

Conclusions: Lower education, depression, food insecurity, presence of limited functional status and poor social support negatively influenced QoL in older Malaysians. This study identified potentially modifiable factors that could be targeted for interventions to enhance QoL of older persons in Malaysia. Geriatr Gerontol Int 2020; 20: 92-97.
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http://dx.doi.org/10.1111/ggi.13961DOI Listing
December 2020

Fibrinogen isoforms as potential blood-based biomarkers of Alzheimer's disease using a proteomics approach.

Int J Neurosci 2020 Dec 15:1-12. Epub 2020 Dec 15.

Collaborative Drug Discovery Research (CDDR) and Brain Degeneration and Therapeutics Research Group, Faculty of Pharmacy, University Teknologi MARA (UiTM) Cawangan Selangor, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia.

Alzheimer's disease (AD), the commonest form of dementia which is characterized by progressive decline in cognitive function, can only be definitively diagnosed after death. Although biomarkers may aid diagnosis, currently available AD biomarkers, which are predominantly based on cerebrospinal fluid and neuroimaging facilities, are either invasive or costly. Blood-based biomarkers for AD diagnosis are highly sought after due to its practicality at the clinic. This study was undertaken to determine the differential protein expression in plasma amongst Malaysian AD, mild cognitive impairment (MCI) and non-AD individuals. A proteomic approach which utilized two-dimensional differential in gel electrophoresis (2 D DIGE) was performed for blood samples from 15 AD, 14 MCI and 15 non-AD individuals. Mass spectrometry (MS)-based protein identification via MALDI ToF/ToF showed that fibrinogen-β-chain (spot 64) and fibrinogen-γ-chain (spot 91) with differential expression ratio >1.5 were significantly upregulated ( < 0.05) in AD patients when compared to non-AD individuals. Further data analysis using Pearson correlation found that the upregulated fibrinogen-γ-chain was weakly but significantly ( < 0.05) and inversely correlated with cognitive decline. Fibrinogen isoforms may play important roles in the vascular pathology of AD as well as neuroinflammation. As such, fibrinogen appears to be a promising blood-based biomarker for AD. Further validation of the present findings in larger population is now warranted.
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http://dx.doi.org/10.1080/00207454.2020.1860038DOI Listing
December 2020

Impact of Knee Pain on Fear of Falling, Changes in Instrumental Activities of Daily Living, and Falls Among Malaysians Age 55 Years and Above.

Front Public Health 2020 14;8:571196. Epub 2020 Oct 14.

Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

To determine the temporal relationship between the presence of knee pain and knee pain severity identified at baseline with fall risk, fear of falling and changes in instrumental activity of daily living at 12-months follow-up. This was a prospective study from the Malaysian Elders Longitudinal Research (MELoR) study involving community dwelling older persons aged 55 years and older. The presence of one fall in the preceding 12 months, knee pain, and functional capacity were determined at baseline (2013-2015) and follow-up (2015-2016). Function was determined as loss of at least one of seven instrumental activities of daily living (IADL). Physical performance was evaluated at baseline using the timed-up-and-go (TUG) test. Fear of falling (FoF) was determined using the single question "Are you afraid of falling?" Data were available for 605 participants, mean () age = 69.10 (7.24) years. Knee pain was present in 30.2% at baseline. Neither the presence of knee pain nor knee pain severity at baseline were associated with falls at 1-year follow-up. Knee pain was significantly associated with FoF at follow-up [aRR (95%CI) = 1.76 (1.02-3.04)] but not changes in IADL. Among individuals with no falls at baseline, the presence of knee pain was protective of falls at follow-up after adjustment for baseline physical performance [adjusted rate ratio, aRR (95% confidence interval, CI) = 0.35 (0.13-0.97)]. Knee pain is associated with increased FoF at 1.5 years' follow-up within a multi-ethnic population aged 55 years, residing in an urban location in a middle-income South East Asian nation. Interestingly, after differences in muscle strength was accounted for, knee pain was protective against falls at follow-up. Our findings challenge previous assumptions on joint pain and falls and highlights the importance of large prospective studies and further mechanistic research incorporating psychological factors in this area of increasing prominence.
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http://dx.doi.org/10.3389/fpubh.2020.571196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591456PMC
May 2021

Falls, frailty, and metabolic syndrome in urban dwellers aged 55 years and over in the Malaysian elders longitudinal research (MELoR) study - a cross-sectional Study.

Postgrad Med 2021 Apr 3;133(3):351-356. Epub 2020 Nov 3.

Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Objectives: While metabolic syndrome, falls, and frailty are common health issues among older adults which are likely to be related, the potential interplay between these three conditions has not previously been investigated. We investigated the relationship between metabolic syndrome with falls, and the role of frailty markers in this potential relationship, among community-dwelling older adults.

Methods: Data from the first wave Malaysian Elders Longitudinal Research (MELoR) study comprising urban dwellers aged 55 years and above were utilized. Twelve-month fall histories were established during home-based, computer-assisted interviews which physical performance, anthropometric and laboratory measures were obtained during a hospital-based health check. Gait speed, exhaustion, weakness, and weight loss were employed as frailty markers.

Results: Data were available for 1415 participants, mean age of 68.56 ± 7.26 years, 57.2% women. Falls and metabolic syndrome were present in 22.8% and 44.2%, respectively. After adjusting for age, sex, and multiple comorbidities, metabolic syndrome was significantly associated with falls in the sample population [odds ratio (OR): 1.33, 95% confidence interval (CI): 1.03; 1.72]. This relationship was attenuated by the presence of slow gait speed, but not exhaustion, weakness, or weight loss.

Conclusion: Metabolic syndrome was independently associated with falls among older adults, and this relationship was accounted for by the presence of slow gait speed. Future studies should determine the value of screening for frailty and falls with gait speed in older adults with metabolic syndrome as a potential fall prevention measure.
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http://dx.doi.org/10.1080/00325481.2020.1842026DOI Listing
April 2021

Adult Endogenous Dopaminergic Neuroregeneration Against Parkinson's Disease: Ideal Animal Models?

Neurotox Res 2021 Apr 3;39(2):504-532. Epub 2020 Nov 3.

Collaborative Drug Discovery Research (CDDR) Group and Brain Degeneration and Therapeutics Group, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia.

Parkinson's disease (PD) is the second most common neurodegenerative disease. The etiology of PD remains an enigma with no available disease modifying treatment or cure. Pharmacological compensation is the only quality of life improving treatments available. Endogenous dopaminergic neuroregeneration has recently been considered a plausible therapeutic strategy for PD. However, researchers have to first decipher the complexity of adult endogenous neuroregeneration. This raises the need of animal models to understand the underlying molecular basis. Mammalian models with highly conserved genetic homology might aid researchers to identify specific molecular mechanisms. However, the scarcity of adult neuroregeneration potential in mammals obfuscates such investigations. Nowadays, non-mammalian models are gaining popularity due to their explicit ability to neuroregenerate naturally without the need of external enhancements, yet these non-mammals have a much diverse gene homology that critical molecular signals might not be conserved across species. The present review highlights the advantages and disadvantages of both mammalian and non-mammalian animal models that can be essentially used to study the potential of endogenous DpN regeneration against PD.
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http://dx.doi.org/10.1007/s12640-020-00298-7DOI Listing
April 2021

Contributing and Relieving Factors of Suffering in Palliative Care Cancer Patients: A Descriptive Study.

Omega (Westport) 2020 Jul 14:30222820942642. Epub 2020 Jul 14.

Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia.

To palliate suffering, understanding the circumstances leading to suffering and its amelioration could be helpful. Our study aimed to explore contributing and relieving factors of suffering in palliative care. Adult palliative care stage III or IV cancer in-patients were recruited from University of Malaya Medical Centre. Participants recorded their overall suffering score from 0 to 10 three times daily, followed by descriptions of their contributing and relieving factors. Factors of suffering were thematically analysed with NVIVO. Descriptive data were analysed with SPSS. 108 patients participated. The most common contributing factor of suffering was health factor (96.3%), followed by healthcare factor (78.7%), psychological factor (63.0%) and community factor (20.4%). The most common relieving factor was health factor (88.9%), followed by psychological factor (78.7%), community factor (75.9%) and healthcare factor (70.4%). Self-reported assessment of suffering offers a rapid approach to detect bothering issues that require immediate attention and further in-depth exploration.
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http://dx.doi.org/10.1177/0030222820942642DOI Listing
July 2020

Self-reported generalised pruritus among community-dwelling older adults in Malaysia.

BMC Geriatr 2020 06 24;20(1):223. Epub 2020 Jun 24.

Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Background: The ageing skin is more susceptible to pruritic dermatoses, which are associated with adverse psychosocial effects and reduced quality of life among older adults. This cross-sectional study aimed to identify the burden of pruritus and factors associated with its presence and severity among older adults recruited to the Malaysian Elders Longitudinal Research study.

Methods: Seven hundred seventy individuals aged 55 years (lower age limit) and above were interviewed as to whether they experienced pruritus during the preceding week and the locations involved if present. The association between generalised pruritus, sleep quality, and major systemic risk factors were explored.

Results: 5.97% of respondents reported generalised pruritus. Generalised pruritus was associated with poorer sleep quality, with Pittsburgh Sleep Quality Index score above 6. Mean haemoglobin level was lower in subjects with generalised pruritus (13.14 g/dL) but there was no significant difference in the frequency of generalised pruritus and severe generalized pruritus between subjects with clinically defined anaemia. Also, there were no significant associations between other major systemic risk factors and generalised pruritus in this population-based study. There was no association between generalised pruritus with depression, anxiety or stress.

Conclusion: The negative effect of pruritus on sleep quality suggests a possible deleterious effect of pruritus on health and quality of life. Further prospective research on the longer-term effects of pruritus on health status is now warranted. (222 words).
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http://dx.doi.org/10.1186/s12877-020-01610-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315470PMC
June 2020

Robust PPG motion artifact detection using a 1-D convolution neural network.

Comput Methods Programs Biomed 2020 Nov 11;196:105596. Epub 2020 Jun 11.

Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia. Electronic address:

Background And Objectives: Continuous monitoring of physiological parameters such as photoplethysmography (PPG) has attracted increased interest due to advances in wearable sensors. However, PPG recordings are susceptible to various artifacts, and thus reducing the reliability of PPG-driven parameters, such as oxygen saturation, heart rate, blood pressure and respiration. This paper proposes a one-dimensional convolution neural network (1-D-CNN) to classify five-second PPG segments into clean or artifact-affected segments, avoiding data-dependent pulse segmentation techniques and heavy manual feature engineering.

Methods: Continuous raw PPG waveforms were blindly allocated into segments with an equal length (5s) without leveraging any pulse location information and were normalized with Z-score normalization methods. A 1-D-CNN was designed to automatically learn the intrinsic features of the PPG waveform, and perform the required classification. Several training hyperparameters (initial learning rate and gradient threshold) were varied to investigate the effect of these parameters on the performance of the network. Subsequently, this proposed network was trained and validated with 30 subjects, and then tested with eight subjects, with our local dataset. Moreover, two independent datasets downloaded from the PhysioNet MIMIC II database were used to evaluate the robustness of the proposed network.

Results: A 13 layer 1-D-CNN model was designed. Within our local study dataset evaluation, the proposed network achieved a testing accuracy of 94.9%. The classification accuracy of two independent datasets also achieved satisfactory accuracy of 93.8% and 86.7% respectively. Our model achieved a comparable performance with most reported works, with the potential to show good generalization as the proposed network was evaluated with multiple cohorts (overall accuracy of 94.5%).

Conclusion: This paper demonstrated the feasibility and effectiveness of applying blind signal processing and deep learning techniques to PPG motion artifact detection, whereby manual feature thresholding was avoided and yet a high generalization ability was achieved.
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http://dx.doi.org/10.1016/j.cmpb.2020.105596DOI Listing
November 2020

Proteomics as a reliable approach for discovery of blood-based Alzheimer's disease biomarkers: A systematic review and meta-analysis.

Ageing Res Rev 2020 07 12;60:101066. Epub 2020 Apr 12.

Faculty of Pharmacy, University Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, 42300 Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia; Collaborative Drug Discovery Research (CDDR) Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA (UiTM) Shah Alam, 40450 Shah Alam, Selangor Darul Ehsan, Malaysia. Electronic address:

In order to gauge the impact of proteomics in discovery of Alzheimer's disease (AD) blood-based biomarkers, this study had systematically reviewed articles published between 1984-2019. Articles that fulfilled the inclusion criteria were assessed for risk of bias. A meta-analysis was performed for replicable candidate biomarkers (CB). Of the 1651 articles that were identified, 17 case-control and two cohort studies, as well as three combined case-control and longitudinal designs were shortlisted. A total of 207 AD and mild cognitive impairment (MCI) CB were discovered, with 48 reported in >2 studies. This review highlights six CB, namely alpha-2-macroglobulin (α2M), pancreatic polypeptide (PP), apolipoprotein A-1 (ApoA-1), afamin, insulin growth factor binding protein-2 (IGFBP-2) and fibrinogen-γ-chain, all of which exhibited consistent pattern of regulation in >three independent cohorts. They are involved in AD pathogenesis via amyloid-beta (Aβ), neurofibrillary tangles, diabetes and cardiovascular diseases (CVD). Meta-analysis indicated that ApoA-1 was significantly downregulated in AD (SMD = -1.52, 95% CI: -1.89, -1.16, p < 0.00001), with low inter-study heterogeneity (I = 0%, p = 0.59). α2M was significantly upregulated in AD (SMD = 0.83, 95% CI: 0.05, 1.62, p = 0.04), with moderate inter-study heterogeneity (I = 41%, p = 0.19). Both CB are involved in Aβ formation. These findings provide important insights into blood-based AD biomarkers discovery via proteomics.
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http://dx.doi.org/10.1016/j.arr.2020.101066DOI Listing
July 2020

The knowledge and self-management educational needs of older adults with knee osteoarthritis: A qualitative study.

PLoS One 2020 30;15(3):e0230318. Epub 2020 Mar 30.

School of Health Sciences, City East Campus, University of South Australia, Adelaide, South Australia.

Knee osteoarthritis (KOA) is closely related with ageing, physical disability and functional dependency. The course of KOA is considered progressive and irreversible. Engagement with self-management may, however, minimize the impact of KOA. To be fully engaged with self-management activities, knowledge about KOA is a prerequisite. There is limited empirical data on older adults' understanding on KOA and their information needs about KOA. Therefore, the aims of this study were to explore older adults' knowledge about KOA and their perspectives on the information required to enable self-management. Three focus groups were conducted with 16 older adults with KOA. The sample consisted of three men and thirteen women with the mean age 73.2 years (range from 61 to 89). Thematic content analysis revealed two themes which were understanding about KOA and information needed about KOA. Participants' knowledge about KOA varied between individuals with many expressing that they needed more information about KOA. A targeted strategy is needed to educate older adults about KOA in order to support and prepare them for self-management.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230318PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105111PMC
June 2020

Standing Up for Frailty: Blood Pressure Changes Do Matter.

Authors:
Maw Pin Tan

J Am Heart Assoc 2020 04 30;9(7):e016222. Epub 2020 Mar 30.

Department of Medicine University of Malaya Kuala Lumpur Malaysia.

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http://dx.doi.org/10.1161/JAHA.120.016222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428605PMC
April 2020

Clinical recognition of elder maltreatment and intention to report among primary care doctors.

J Elder Abuse Negl 2020 Jan-Feb;32(1):72-83. Epub 2020 Feb 21.

Selangor Department of Health, Ministry of Health Malaysia, Selangor, Malaysia.

This study aimed to determine the primary care doctors' ability to recognize elder maltreatment and their intentions to report on such conditions. About 358 primary care doctors participated in this study. Outcomes were assessed using a validated five context-relevant clinical vignettes. Primary care doctor's recognition of sexual abuse was highest (91.0%); while the lowest (70.2%) in case signifying physical abuse. Despite being able to ascertain elder maltreatment, the intention to report the event is generally low even for cases exemplifying physical abuse, emotional abuse and neglect. However, intentions to report cases of sexual and financial abuse are 86.9% and 73.5% respectively. Findings highlighted the uncertainties of primary care doctors in distinguishing the clinical findings of non-accidental injuries and injuries due to acts of maltreatment. This provides support for educational intervention and guidelines or policies to improve the knowledge and skills of primary care doctors to intervene in elder maltreatment.
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http://dx.doi.org/10.1080/08946566.2020.1731640DOI Listing
December 2020