Search

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. [ABSTRACT FROM AUTHOR]

Introduction: The common assumption that urinary incontinence occurs in osteoarthritis (OA) due to poor mobility is supported by limited evidence. The influence of gender in such associations is also yet to be elucidated. Objective: This study, therefore, identified any potential associations between knee OA symptoms and urinary incontinence and further explore sex differences in the associations. Design: Cross‐sectional study. Setting: University Hospital. Participants: This was a cross‐sectional study from a longitudinal research study comprising 1221 community‐dwelling older persons (57% women), mean age (SD) 68.95 (7.49) years. Main Outcome Measure(s): Presence of urinary incontinence: mixed, stress and urge symptoms. Physical performance and C‐reactive protein levels were also assessed. Results: Two hundred and seventy‐seven (22.83%) individuals reported the presence of urinary incontinence: mixed (41.5%), stress (30%), and urge (28.5%) symptoms. In an unadjusted analysis, stratified by gender, the association between knee pain and urinary incontinence was only present in women with mixed symptoms. After further adjustment of demographics differences and body mass index, the association between knee pain with any urinary incontinence and mixed symptoms remained significant with the odds ratios (95% confidence interval): 1.48 (1.02–2.15) and 1.73 (1.06–2.83), respectively. This relationship was attenuated after further adjustment for waist circumference and impaired lower limb mobility. Conclusion: Our study refutes previous assumptions that urinary incontinence in individuals with OA is attributed to impaired mobility alone, but introduces the role of abdominal obesity in this relationship, particularly in women. Future studies should assess the temporal relationship between body fat distribution and OA with urinary incontinence. [ABSTRACT FROM AUTHOR]

Several cardiometabolic factors such as diabetes, hypertension and dyslipidemia which are prevalent in older adults with increased body mass index (BMI) may play an important role in sarcopenia development.[[2], [7]] Excess fat mass interrupts the blood glucose pathway and triggers insulin resistance which may then further enhance the development of sarcopenia. Hospitalization rates over 5 years among individuals with BMI >= 30 kg/m SP 2 sp compared to those with normal BMI following adjustments in Model 2 and remained significant with slight attenuation after differences in diabetes status were accounted for [RR (95%CI): 1.90 (1.11-3.28), Model 3]. The direct effect of BMI categories on the risk of all outcomes (Y1, Y2, Y3) was significant for BMI >= 30 kg/m SP 2 sp but not BMI < 18.5 or BMI: 25-29.9 kg/m SP 2 sp compared to those the BMI: 18.5-25 kg/m SP 2 sp group, suggesting the potential mediating role of FBG (Figure 2A-C). [Extracted from the article]

Introduction: The two‐minute step test (2MST) has been used to estimate cardiorespiratory fitness and optimum scores are needed for performing activities of daily living with ease among older persons. However, there is limited information on the mediating role of cognitive impairment on 2MST performance and the 2MST normative data. Hence, we aim to identify the mediating role of cognitive status on performance in the 2MST among community‐dwelling older adults and to establish the normative values of the 2MST. Methods: Participants aged 60 years and above were recruited through multistage random sampling from four states in Malaysia. The participants performed the 2MST using standard protocols. Mean comparison was done using an independent sample t‐test or one‐way analysis of variance. The 2MST normative values were then outlined descriptively. Results: Older age groups (60–69 years: 65.4 ± 21.9 times; 70–79 years: 61.7 ± 22.9 times; ≥80 years: 51.6 ± 24.5 times) had significantly lower levels of 2MST performance (p < 0.001). Women (56.6 ± 20.9 times) and participants with mild cognitive impairment (MCI) (58.7 ± 21.7 times) also had significantly lower levels of 2MST performance (p < 0.001) compared with men (69.1 ± 20.7 times) and participants with normal cognition (63.7 ± 21.6 times). Cognitive status had a significant mediation effect for age and sex on 2MST performance (p < 0.001). Therefore, the 2MST normative values were stratified according to cognitive status, sex, and age groups. Conclusion: Validation of these findings in a larger number of older populations with MCI may provide directions for cardiorespiratory fitness training to be emphasised among older persons with MCI. Geriatr Gerontol Int 2022; 22: 950–955. [ABSTRACT FROM AUTHOR]

Background: Blood pressure variability (BPV) is defined as fluctuations in blood pressure (BP) from visit‐to‐visit, day‐to‐day, hour‐to‐hour and beat‐to‐beat. While published evidence on visit‐to‐visit BPV have suggested an association between BPV and cognitive decline, but published research on beat‐to‐beat BPV and cognitive decline remains limited. This prospective study, therefore, aimed to determine the relationship between beat‐to‐beat BPV and changes in cognitive performance over a six‐year period. Method: The first and fourth wave data from Malaysian Elders Longitudinal Research (MELoR) study, which included community dwellers aged 55 years and over at recruitment, were utilized. Non‐invasive continuous beat‐to‐beat BP was recorded at baseline using the vascular unloading method (TaskforceTM,CNSystems). Systolic (SBPV) and diastolic (DBPV) BPV were calculated using standard deviation (SD), coefficient of variation (CV) and average real variability (ARV), which were then dichotomized using median cut‐offs. The Montreal Cognitive Assessment (MoCA) Blind instrument was utilized to allow for telephone‐based assessments at Wave 4 which occurred during the COVID‐19 pandemic. Cognitive decline was defined as 2 points reduction in MoCA. Result: Data were available from492 participants, mean (SD) age = 67.8 (6.8) years. Mean MoCA‐blinds scores had increased from 17.1 (3.0) to 18.6 (2.7) from baseline to follow‐up. Cognitive decline was observed in 65 (13%). Individuals with cognitive decline had lower depression scores at baseline. Lower SD‐DBPV (mean difference, MD (95%CI) = 0.56 (0.31,0.98) and CV‐DBPV (MD (95%CI) = 0.51 (0.28,0.91) were significantly increased cognitive change after adjustment for potential co‐founders. Conclusion: Lower BPV was associated with increased risk of cognitive decline in our population‐based study, which conflicted with available studies using primarily visit‐to‐visit and ambulatory BP measurements and involving mainly hospital‐based populations. Beat‐to‐beat BPV may be a measure of arterial stiffness which may is associated with increased risk of vasculopathy and development cognitive impairment. Future studies should determine whether interventions which lead to increased beat‐to‐beat BPV could reduce cognitive decline. [ABSTRACT FROM AUTHOR]

Aim: To determine the association between vitamin D and knee pain among participants of the Malaysian Elders Longitudinal Research (MELoR) study. Method: This was a cross-sectional study from the MELoR study consisting of a representative group of 1011 community-dwelling older persons (57% female), mean age 86.5 (54-94) years; 313 were Malays, 367 Chinese and 330 Indians. Participants were asked if they had knee pain. Levels of serum 25-hydroxy cholecalciferol (25- [OH]D), an indicator of vitamin D status, were measured using routine laboratory techniques. Results: In unadjusted analysis, presence of knee pain was significantly associated with vitamin D deficiency (odds ratio [OR] 1.42; 95% confidence interval (CI) 1.08-1.85, P 0.011). Vitamin D levels were significantly associated with ethnicity differences where Malays (OR 7.08; 95% CI 4.94-10.15) and Indians (OR 6.10; 95% CI 4.28-9.71) have lower levels of vitamin D compared to Chinese. Subsequent multivariate analysis revealed that the association between vitamin D deficiency and knee pain was confounded by ethnic differences. Conclusion: A previous study suggested that vitamin D deficiency was associated with knee pain. This relationship was reproduced in our study, but we further established that the association was explained by ethnic variations. As vitamin D status is dependent on skin tone, diet and sunlight exposure, which are all effected by ethnicity, future studies are now required to determine whether a true relationship exists between vitamin D and knee pain. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) is considered an established risk factor for falls. Published studies evaluating secondary falls prevention strategies among individuals with OA are limited.Objective: To evaluate the effect of a personalized home-based exercise program to improve postural balance, fear of falling, and falls risk in older fallers with knee OA and gait and balance problems.Design: Randomized controlled trial.Setting: University of Malaya Medical Centre.Participants: Fallers who had both radiological OA and a Timed Up and Go (TUG) score of over 13.5 seconds.Main Outcome Measure: Postural sway (composite sway) was quantified with the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) under 4 different sensory conditions: eyes open on firm surface, eyes closed on firm surface, eyes open on unstable foam surface, and eyes closed on unstable foam surface. Participants were asked to stand upright and to attempt to hold their position for 10 seconds for each test condition. The average reading for all conditions were calculated.Methods: Participants randomized to the intervention arm received a home-based modified Otago Exercise Program (OEP) as part of a multifactorial intervention, whereas control participants received general health advice and conventional treatment. This was a secondary subgroup analysis from an original randomized controlled trial, the Malaysian Falls Assessment and Intervention Trial (MyFAIT) (trial registration number: ISRCTN11674947). Posturography using a long force plate balance platform (Balancemaster, NeuroCom, USA), the Knee injury and Osteoarthritis Outcome Score (KOOS) and the short-form Falls Efficacy Scale-International (short FES-I) were assessed at baseline and 6 months.Results: Results of 41 fallers with radiological evidence of OA and impaired TUG (intervention, 17; control, 24) were available for the final analysis. Between-group analysis revealed significant improvements in the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), Limits of Stability (LOS), and short FES-I scores by the intervention group compared to the control group at 6 months. No significant difference in time to first fall or in fall-free survival between the intervention and control groups was found.Conclusion: Home-based balance and strength exercises benefited older fallers with OA and gait and balance disorders by improving postural control, with no observable trend in reduction of fall recurrence. Our findings will now inform a future, adequately powered, randomized controlled study using fall events as definitive outcomes.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]