Introduction: A compromised quality of life (QOL) as a result of haemodialysis (HD) is a rising global issue. Elderly HD patients face more challenges than younger counterparts. This study determined the association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with QOL, among elderly HD patients. Methods: A cross-sectional study was conducted among 112 HD elderly patients in selected dialysis centres in Selangor, Malaysia. The patients completed interview-based questionnaires on socio-demographic characteristics, risk of malnutrition (Dialysis Malnutrition Score, DMS), depression (Patient Health Questionaire-9, PHQ-9) and QOL (KDQOL-36). Anthropometric measurements, 24-hour dietary recall and food intake information were obtained from them and biochemical data from their medical records. Results: Just over half (50.9%) of the patients had a normal body mass index while 85.7% had optimal albumin levels. The proportion of patients who met the recommended energy and protein intakes were 19.0% and 3.4%, respectively. Patients were at moderate risk of malnutrition, had minimal depression level and perceived better QOL in terms of effects and symptoms of kidney disease. There was a significant positive correlation between protein intake and the physical domain of QOL (p=0.02) and negative correlation between risk of malnutrition with physical and mental composites of QOL (p<0.001). There was significant negative correlation between depression and physical composite, mental composite, burden, effects and the symptoms of kidney disease (p<0.001). Conclusion: The present findings provide better insight on QOL for future screening, preventive measures and intervention. Further investigation regarding factors associated with QOL among elderly patients is recommended.

Introduction:The aging population is a matter of global concern. Age-related physiological, pathological, psychosocial, economic, cultural and environmental changes are common and may greatly influence the quality of life of the elderly. The aim of this review was to explore the determinants and motivations that drive the elderly in making food choices. Methods: The search strategy of this literature review used the PRISMA protocol. Potential literature that was related to food choices was identified using two different combinations of keywords and two major electronic search engines, namely Pubmed and Science Direct. The articles that were selected for this review had to be in the English language, open-accessed and published between January 2007 and December 2017. Results: From a search of 1398 articles, 15 articles (seven quantitative and eight qualitative) were identified that were related to food choices among the elderly. The key factor that determined food choices among the elderly population was identified to be health. Others included convenience, sensory appeal, price, early food experience and more. The limitations of these studies that were reported were the small sample size and the reliance on self-reporting. The conclusions that were drawn were for specific groups that were studied in this review should be extrapolated or generalised with caution. Conclusion:Strategies for intervention programmes should be undertaken in collaboration with health professionals, researchers, policymakers, and the food industry. Future research is needed in the elderly who have chronic diseases, are dependent or who have disabilities.

The ageing process has been associated with various geriatric issues including frailty. Without early prevention, frailty may cause multiple adverse outcomes. However, it potentially may be reversed with appropriate interventions. The aim of the study is to assess the effectiveness of nutritional education and exercise intervention to prevent frailty among the elderly. A 3-month, single-blind, two-armed, cluster randomized controlled trial of the frailty intervention program among Malaysian pre-frail elderly will be conducted. A minimum of total 60 eligible respondents from 8 clusters (flats) of Program Perumahan Rakyat (PPR) flats will be recruited and randomized to the intervention and control arm. The intervention group will receive a nutritional education and a low to moderate multi-component exercise program. To date, this is the first intervention study that specifically targets both the degree of frailty and an improvement in the outcomes of frailty using both nutritional education and exercise interventions among Malaysian pre-frail elderly. If the study is shown to be effective, there are major potential benefits to older population in terms of preventing transition to frailty. The findings from this trial will potentially provide valuable evidence and serve as a model for similar future interventions designed for elderly Malaysians in the community.

1) Background: Structured nutrition therapy (NT) is essential for the management of type 2 diabetes (T2D), but the optimal delivery during Ramadan fasting remains unclear. The present study aimed to evaluate the effect of structured NT program versus standard care in patients with T2D during Ramadan.(2) Methods: The present study was an 8-week, parallel, non-randomized study with patients' preference design involving 64 patients with T2D. The participants were asked to choose their preferred group, i.e., structured NT (Structured Ramadan NT, sRNT) or standard care (SC). The participants in the sRNT group received a Ramadan-focused nutrition plan, including a diabetes-specific formula throughout the study, whereas the patients in the SC group received standard nutrition care. Study outcomes included clinical outcomes and quality of life (QoL). Data was analyzed using two-way repeated-measures ANOVA and linear mixed-effects model. (3) Results: More than half of the participants (n = 38, 63%) chose sRNT as their preferred group. Both groups had comparable baseline characteristics. After 8-weeks of the respective intervention, participants in the sRNT group had lower levels of fasting plasma glucose (−0.9 ± 0.3 mmol/L vs. 0.2 ± 0.3 mmol/L, p < 0.05), triglycerides (−0.21 ± 0.08 mmol/L vs. 0.20 ± 0.17 mmol/L, p < 0.05), and self-monitoring glucose at pre-dawn (6.9 mmol/L vs. 7.8 mmol/L, p < 0.05) and pre-bedtime (7.6 mmol/L vs. 8.6 mmol/L, p < 0.05) than participants in the SC group. Although not different between groups, HbA1c levels decreased significantly in the sRNT (−0.72 ± 0.16%, p < 0.001) but not in the SC group (−0.35 ± 0.24%, p = 0.155). QoL and satisfaction scores improved significantly in sRNT group, but not in SC group.(4) Conclusions: The structured NT regimen for Ramadan is a feasible and beneficial program for T2D patients observing Ramadan fasting as it showed an improvement in clinical outcomes and QoL.

Introduction: Increasing trends of hypertension has been recognised as a common disease among the elderly. This study aimed to determine the prevalence of hypertension and factors associated with blood pressure among hospitalised elderly. Methods: This was a cross-sectional study involving 124 patients in Hospital Serdang, Selangor, Malaysia. Data on socio-demography, medical background, anthropometry, blood biochemistry and lifestyle were collected through face-to-face interviews and medical records. Dietary intake was obtained through two days of food history. Malnutrition risks and stress level were determined using the Mini Nutritional Assessment Short-Form (MNA-SF) and the Geriatric Depression Scale (GDS). Results: There were 59.7% males and 40.3% females with mean age of 66.81±5.35 years. Majority were found to have hypertension (72.6%). Approximately 38.7% had normal body mass index (BMI). Most of them reported insufficient dietary intakes except for trans fats, sodium, and caffeine. Nearly 62.1% were engaged with physical activity, 23.4% were smoking, and 4.8% were taking alcohol. Approximately 66.1% and 86.3% were classified as having normal nutritional status and normal stress levels. In this study, the prevalence of hypertension among elderly patients warded in Hospital Serdang, Selangor was 72.6% and factors such as length of stay, number of co-morbidities, number of medications, having co-morbidities of hypertension, dyslipidaemia and diabetes mellitus, polypharmacy, height, BMI, fibre, polyunsaturated fat, dietary cholesterol, caffeine, and duration of physical activity were found to be associated with blood pressure. Conclusion: The present study found that majority of patients (72.6%) had hypertension. Future studies regarding factors associated with blood pressure are recommended

Introduction: It is widely recognised that health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous studies were conducted among the younger adult population and there is limited information on the elderly population. This study aimed to determine the COPD assessment test (CAT) score in the elderly with COPD. Methods: This was a crosssectional study involving 140 elderly patients who had been diagnosed with COPD at two selected government institutions. Data on socio-demographic and health status were collected by interviewing patients and reviewing their medical records. The HRQOL was measured using CAT. The independence sample t-test and one-way ANOVA were conducted to compare the CAT scores with socio-demographic and health status. Results: The socio-demographic and health characteristics of the patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay (59%), married (75%), ex-smokers (72%), had attained primary education (48%), had co-morbidities (54%), no history of hospitalisation or visits to the emergency department due to COPD (57%), and were in moderate stage of airflow obstruction (53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were classified as having worst symptoms of COPD (93%) as they had high CAT score which was ≥ 10. Conclusion: Majority of the patients in this study had high scores of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared to non-smokers. More attention need to be given to these subgroups in order to increase their quality of life.

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The prevalence of malnutrition in hospitalised older adults over 75 years in the UK has been reported to be 21 % (1) . The nutritional status of older people is an important determinant of quality of life, morbidity and mortality (2) . The aim of this study was to determine the nutritional status and factors affecting satisfaction with food-related quality of life in hospitalised older adults. Twenty-five older patients 75 years old or above were recruited from Royal Surrey County Hospital to participate in this study. Data were collected at two time points to complete the Mini Nutritional Assessment (MNA), the satisfaction with food-related life (SWFL) questionnaire (3) , three 24 h diet recalls and the Food Access in Hospital questionnaire (4) . The data were analysed by Dietplan 6 and SPSS (v16).The subjects comprised fourteen females and eleven males with a mean age of 86.7 (SD 5.6) years and 80.7 (SD 4.1) years, respectively. The mean BMI was 22.9 kg/m 2 (SD 5.7) and 21.9 kg/m 2 (SD 3.1) for females and males, respectively. There were no significant differences in weight, BMI, calf circumferences (CC), mid-arm circumference (MAC) and hand grip measurement between males and females (P > 0.05). The majority (60%) of patients were of normal weight, 32 % underweight and 8 % overweight. MNA results indicated 56 % were at risk of malnutrition, 24 % were malnourished and 20 % were well nourished. Females were more satisfied than males for three of the five items on the SWFL questionnaire (NS) and no significant differences were identified in satisfaction between malnourished, at risk and well nourished subjects (P > 0. This has identified that in this study, a large number of older patients (76 %) were at the risk of malnutrition or are already malnourished; however, the sample is small. This data will be used to further understand the pathogenesis of malnutrition by comparison with that already collected and presented (5) from free-living older adults and those in care homes.