AimsThe aim of this study was to establish ‘Timed up and Go’ test (TUG) normative data among community dwelling older adults stratified based on cognitive status, gender and age groups.MethodsA total of 2084 community dwelling older adults from wave I and II were recruited through a multistage random sampling method. TUG was performed using the standard protocol and scores were then stratified based on with and without mild cognitive impairment (MCI), gender and in a 5-year age groups ranging from ages of 60’s to 80’s.Results529(16%) participants were identified to have MCI. Past history of falls and medical history of hypertension, heart disease, joint pain, hearing and vision problem, and urinary incontinence were found to have influenced TUG performance. Cognitive status as a mediator, predicted TUG performance even when both gender and age were controlled for (B 0.24, 95% CI (0.02–0.47), β 0.03, t 2.10, p = 0.36). Further descriptive analysis showed, participants with MCI, women and older in age took a longer time to complete TUG, as compared to men with MCI across all age groups with exceptions for some age groups.ConclusionThese results suggested that MCI needs to be taken into consideration when testing older adults using TUG, besides age and gender factors. Data using fast speed TUG may be required among older adults with and without MCI for further understanding.

BackgroundEarly detection of falls risk among older adults using simple tools may assist in fall prevention strategies. The aim of this study was to identify the best parameters associated with previous falls, either the timed up and go (TUG) test combined with sociodemographic factors and a self-rated multifactorial questionnaire (SRMQ) on falls risk or the TUG on its own. Falls risk was determined based on parameters associated with previous falls.DesignThis was a retrospective cohort study.SettingThe study was conducted in a community setting.ParticipantsThe participants were 1,086 community-dwelling older adults, with mean age of 69.6±5.6 years. Participants were categorized into fallers and nonfallers based on their history of falls in the past 12 months.MethodParticipants’ sociodemographic data was taken, and SRMQ consisting of five falls-related questions was administered. Participants performed the TUG test twice, and the mean was taken as the result.ResultsA total of 161 participants were categorized as fallers (14.8%). Multivariate logistic regression analysis showed that the model (χ2(6)=61.0, p<0.001, Nagelkerke R2=0.10) consisting of the TUG test, sociodemographic factors (gender, cataract/glaucoma and joint pain), as well as the SRMQ items “previous falls history” (Q1) and “worried of falls” (Q5), was more robust in terms of falls risk association compared to that with TUG on its own (χ2(1)=10.3, p<0.001, Nagelkerke R2=0.02).ConclusionCombination of sociodemographic factors and SRMQ with TUG is more favorable as an initial falls risk screening tool among community-dwelling older adults. Subsequently, further comprehensive falls risk assessment may be performed in clinical settings to identify the specific impairments for effective management.

Background: Cognitive frailty (CF) is identified as one of the main precursors of dementia. Multidomain intervention has been found to delay or prevent the onset of CF. Objective: The aim of our present study is to determine the effectiveness of a comprehensive, multidomain intervention on CF; to evaluate its cost effectiveness and the factors influencing adherence toward this intensive intervention. Methods: A total of 1,000 community dwelling older adults, aged 60 years and above will be screened for CF. This randomized controlled trial involves recruitment of 327 older adults with CF from urban, semi-urban, and rural areas in Malaysia. Multidomain intervention comprised of physical, nutritional, cognitive, and psychosocial aspects will be provided to participants in the experimental group (n = 164). The control group (n = 164) will continue their usual care with their physician. Primary outcomes include CF status, physical function, psychosocial and nutritional status as well as cognitive performance. Vascular health and gut microbiome will be assessed using blood and stool samples. A 24-month intensive intervention will be prescribed to the participants and its sustainability will be assessed for the following 12 months. The effective intervention strategies will be integrated as a personalized telerehabilitation package for the reversal of CF for future use. Results: The multidomain intervention developed from this trial is expected to be cost effective compared to usual care as well as able to reverse CF. Conclusion: This project will be part of the World-Wide FINGERS (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) Network, of which common identifiable data will be shared and harmonized among the consortia.

Introduction: Cardiovascular health contributes significantly to the incidence of cognitive impairment. Prior to conducting exercise-related intervention, it is crucial to explore cardiovascular health blood parameters that have been commonly used as guidance for the purpose of monitoring. Information on the effectiveness of exercise on cardiovascular-related biomarkers is lacking, especially among older adults with cognitive frailty. Therefore, we aimed to review existing evidence on cardiovascular-related blood parameters and their changes following exercise intervention among older adults with cognitive frailty.Methods: A systematic search was conducted on PubMed, Cochrane, and Scopus databases. Related studies involving only human and full text in either English or Malay language were selected. Types of impairment were limited to cognitive impairment, frailty, and cognitive frailty. Studies were restricted to randomized controlled trial and clinical trial design studies. For charting purposes, all variables were extracted and tabulated. Trends in types of parameters studied were explored.Results: A total of 607 articles were screened, and the final 16 were included in this review. Four cardiovascular-related blood parameter categories were extracted: inflammatory, glucose homeostasis, lipid profile, and hemostatic biomarkers. The common parameters monitored were IGF-1 and HbA1c, glucose, and insulin sensitivity in some studies. Out of the nine studies on inflammatory biomarkers, exercise interventions showed a reduction in pro-inflammatory markers, namely, IL-6, TNF-α, IL-15, leptin, and C-reactive protein and an increase in anti-inflammatory markers, namely, IFN-γ and IL-10. Similarly, in all eight studies, glucose homeostasis-related biomarkers had improved with exercise intervention. The lipid profile was tested in five studies, with four studies showing improvements with exercise intervention via a decrease in total cholesterol, triglycerides, and low-density lipoprotein and an increase in high-density lipoprotein. A decrease in pro-inflammatory biomarkers and an increase in anti-inflammatory biomarkers were demonstrated with multicomponent exercise, including aerobic exercise in six studies and aerobic exercise on its own in the remaining two studies. Meanwhile, four out of six studies that yielded improvements in glucose homeostasis biomarkers involved only aerobic exercise and the remaining two studies involved multicomponent with aerobic exercise.Conclusion: The most consistent blood parameters studied were glucose homeostasis and inflammatory biomarkers. These parameters have been shown to improve with multicomponent exercise programs, particularly with the inclusion of aerobic exercise.

The aim of this study was to determine the incidence of physical inactivity and identify the predictors for low physical activity among community-dwelling older persons living in Malaysia in 3 years follow-up. In this prospective study, physical activity levels were measured using the Physical Activity Scale for the Elderly. The arbitrary cutoff for Physical Activity Scale for the Elderly in this study was ≤70.9 for low and >141 for high physical activity levels. Out of the 955 physically active participants at baseline, 555 of them (mean [SD] age 68.82 [4.92] years) were successfully followed up to 3 years. Cumulative incidence of being physically active was 21% with rate of 7 per 100 person-years. It was found that being older (<.001), from Malay ethnic group (<.05), smokers (<.01), having lower gait speed (<.001), and lower cognitive status (<.05) were predictors for physical inactivity among Malaysian community-dwelling older persons in 3 years follow-up. These factors should be taken into consideration when planning for intervention and promotion strategies to increase physical activity levels among Malaysian older persons.

Older adults who walk in their neighbourhood with greater street connectivity are reported to have lower limb physical performance decline. There is limited information regarding the association between built environment characteristics and physical performance in older adults. The aim of this study was to examine the association between built environment characteristics, physical performance, falls risk and functional mobility among older adults. Sixty four (27 men and 37 women) community dwelling older adults aged 60 years and above (mean 67.4 ± 7.1 years) from senior citizen clubs in Kuala Lumpur, Malaysia participated in this cross-sectional study. Built environment characteristics were assessed using an adapted Neighbourhood Environment Walkability Scale (NEWS). Physical performance and falls risk was measured using Short Physical Performance Battery (SPPB) and Profile Physiological Profile Assessment (PPA) respectively. Timed Up and Go (TUG) and gait speed tests were used to assess functional mobility. There was a significant correlation between built environment and physical performance (r = 0.43, p < 0.001) and functional mobility measured using gait speed test (r = 0.27, p < 0.05) among older adults. Built environment was identified as a significant determinant of physical performance (R 2 = 0.19, p < 0.001). Built environment characteristics is an important external factor in preserving physical performance in older adults. Programmes and policies for a more favourable built environment characteristics in the neighbourhoods should be encouraged to promote and maintain physical performance among older adults.

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 AE 21.9 times; 70-79 years: 61.7 AE 22.9 times; ≥80 years: 51.6 AE 24.5 times) had significantly lower levels of 2MST performance (p < 0.001). Women (56.6 AE 20.9 times) and participants with mild cognitive impairment (MCI) (58.7 AE 21.7 times) also had significantly lower levels of 2MST performance (p < 0.001) compared with men (69.1 AE 20.7 times) and participants with normal cognition (63.7 AE 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.

Older adults who walk in their neighbourhood with greater street connectivity are reported to have lower limb physical performance decline. There is limited information regarding the association between built environment characteristics and physical performance in older adults. The aim of this study was to examine the association between built environment characteristics, physical performance, falls risk and functional mobility among older adults. Sixty four (27 men and 37 women) community dwelling older adults aged 60 years and above (mean 67.4 ± 7.1 years) from senior citizen clubs in Kuala Lumpur, Malaysia participated in this cross-sectional study. Built environment characteristics were assessed using an adapted Neighbourhood Environment Walkability Scale (NEWS). Physical performance and falls risk was measured using Short Physical Performance Battery (SPPB) and Profile Physiological Profile Assessment (PPA) respectively. Timed Up and Go (TUG) and gait speed tests were used to assess functional mobility. There was a significant correlation between built environment and physical performance (r = 0.43, p < 0.001) and functional mobility measured using gait speed test (r = 0.27, p < 0.05) among older adults. Built environment was identified as a significant determinant of physical performance (R 2 = 0.19, p < 0.001). Built environment characteristics is an important external factor in preserving physical performance in older adults. Programmes and policies for a more favourable built environment characteristics in the neighbourhoods should be encouraged to promote and maintain physical performance among older adults.