Introduction: Home visits are complex processes for clients and occupational therapists. Despite the benefits of home visits, the numbers of home visits being conducted are decreasing in international settings due to service constraints or client reluctance. Published international studies may not be applicable to Malaysia due to cultural and geodemographic differences relating to the home context. This study aimed to explore the experience of occupational therapists in Malaysia in conducting home visits. Materials and Methods: A focus group discussion was conducted with seven occupational therapists in one teaching hospital in Kuala Lumpur. The group session was audio-recorded, transcribed, summarised and analysed using thematic analysis. Results: Themes developed were: i) client factors inhibiting effective service provision, ii) uninformed policies and guidelines, and iii) professional identity and growth. Conclusions: Our study has revealed major challenges for Malaysian occupational therapists with regards to conducting home visits. Future studies should now evaluate factors underlying reluctance to participate in home visits and effective strategies to overcome these difficulties.
House Calls ; Occupational Therapy

Introduction: Home medication review (HMR) involves a patient-centered approach, extending continuity of care to the community setting with the intention of improving medication use and health outcome. The delivery of HMR services in Malaysia remains limited to urban hospitals and clinics. Current study aimed to explore the perception and acceptability of HMR in older adults. Methods: In-depth individual interviews were conducted among adults aged ≥65 years old, taking ≥5 medications, recruited from geriatrics clinics at a tertiary teaching hospital. Home interviews were conducted among 12 older adults and care givers between April to June 2019. Interviews were audio-taped, transcribed verbatim and analysed through descriptive interpretive approach of qualitative data analysis. Results: HMR provided participants with opportunities to discuss medication-related issues with pharmacists in conducive environments. Pharmacists provided information which improved knowledge on indications, dosages and safe storage of medications through HMR. Participants experienced relief and developed confidence in medication self-management. Conclusion: The importance of follow-up visits to ensure adequate monitoring and continuity of care were emphasized. Larger quantitative studies are required to determine the clinical impact and cost-effectiveness of HMR to justify the implementation and expansion of this service

Online health information have a role in enhancing health in older adults. However, age-related physiological changes and non-senior friendly websites proved to be a challenge for older adults. Research investigating older adults’ preferences of features in health information websites is limited. Thus, in this review, we aim to summarize older adults’ preferences regarding the design and content of health websites. Medline, CINAHL, Cochrane Library, Scopus, Journal of Medical Internet Research (JMIR) and Google Scholar were searched for relevant articles in February 2018, using key words ‘older adults’, ‘Internet’, ‘health information’ and ‘usability’. The methodological quality of included studies was evaluated using the McMaster critical appraisal tools by two independent reviewers. Individual study design, participants’ characteristics, and identified preferences for health website features were extracted and summarized narratively. (PROSPERO registration number: CRD42018096281). Five studies (3 qualitative, 2 quantitative) were included in this review. The quality appraisal score ranged from 32% to 83%. The web feature preferences of older adults were grouped into three domains: web presentation factors, web navigation factors and health information preferences. The results highlight older adults have specific preferences when engaging with online content. This review suggests that readable text, simple design, consistent layout and straightforward web navigation are the preferred priorities for a health information website for older adults. Findings from this review may be useful to healthcare professionals and developers to understand older adults’ preferences pertaining to web design and contents in health websites specifically designed for this population.

Introduction: The population of Malaysia is ageing rapidly. Due to the relatively greater incidence of noncommunicable diseases among older adults, polypharmacy is highly prevalent in this population. This polypharmacy along with other age-related factors increases the risk of drug-related problems to several folds. Currently, no study in Malaysia or even Asia has determined the type and nature of drug-related problems among non-institutionalised older adults. Therefore, this study aims to highlight common drug-related problems among community-dwelling older persons (≥ 65 years) with polypharmacy. Materials and Methods: A cross-sectional exploratory study was carried out where in-depth home medication reviews were carried out by two pharmacists. Participants were recruited from geriatric and fall clinics of the University of Malaya Medical Centre located in the urban area of the Federal Territory of Malaysia. The total numbers of drug-related problems were classified using the Pharmaceutical Care Network Europe (PCNE) classification V9.0. Recommendations and referral letters were provided based on the pharmaceutical care issues identified. Results: Thirty participants were recruited, among whom 178 drug-related problems were identified with a median value of six [range 1-11] drug-related problems per participant. The majority of problems were related to the effectiveness of prescribed treatment (69.1 %), followed by the possibility of adverse effects (28.7 %). Conclusion Home medication review identifies numerous medication-related issues and allows for patient education and detailed counselling in an informal and patient-friendly manner. Future studies to determine the longitudinal effect of home medication review on patient outcome, cost implications, and overall healthcare utilization are now indicated.
Medication Review ; Aged ; Pharmacist

INTRODUCTIONHand strength is a good indicator of physical fitness and frailty among the elderly. However, there are no published hand strength references for Malaysians aged > 65 years. This study aimed to establish normative data for hand grip strength (HGS) and key pinch strength (KPS) for Malaysians aged ≥ 60 years, and explore the relationship between hand strength and physical ability.

METHODSHealthy participants aged ≥ 60 years with no neurological conditions were recruited from rural and urban locations in Malaysia. HGS and KPS were measured using hand grip and key pinch dynamometers. Basic demographic data, anthropometric measures, modified Barthel Index scores and results of the Functional Reach Test (FRT), Timed Up and Go (TUG) test and Jebsen-Taylor Hand Function Test (JTHFT) were recorded.

RESULTS362 subjects aged 60-93 years were recruited. The men were significantly stronger than the women in both HGS and KPS (p < 0.001). The hand strength of the study cohort was lower than that of elderly Western populations. Significant correlations were observed between hand strength, and residential area (p < 0.001), FRT (r = 0.236, p = 0.028), TUG (r = -0.227, p = 0.009) and JTHFT (r = -0.927, p < 0.001).

CONCLUSIONThis study established reference ranges for the HGS and KPS of rural and urban elderly Malaysian subpopulations. These will aid the use of hand strength as a screening tool for frailty among elderly persons in Malaysia. Future studies are required to determine the modifiable factors for poor hand strength.

Age Factors ; Aged ; Aged, 80 and over ; Anthropometry ; Asian Continental Ancestry Group ; Female ; Hand ; physiology ; Hand Strength ; Healthy Volunteers ; Humans ; Malaysia ; Male ; Middle Aged ; Pinch Strength ; Reference Values ; Sex Factors

Introduction: Hyponatraemia is the commonest electrolyte abnormality and has major clinical implications. However, few studies of hyponatraemia in the primary care setting has been published to date. OBJECTIVES: To determine the prevalence, potential causes and management of hyponatraemia and to identify factors associated with severity of hyponatraemia among older persons in a primary care setting. Methods: Electronic records were searched to identify all cases aged ≥60 years with a serum sodium <135mmol/l, attending outpatient clinic in 2014. Patients’ medical records with the available blood test results of glucose, potassium, urea and creatinine were reviewed. Results: Of the 21,544 elderly, 5873 patients (27.3%) had electrolyte profile tests. 403 (6.9%) had hyponatraemia in at least one blood test. Medical records were available for 253, mean age 72.9±7.3 years, 178 (70.4%) had mild hyponatraemia, 75 (29.6%) had moderate to severe hyponatraemia. Potential causes were documented in 101 (40%). Patients with moderate to severe hyponatraemia were five times more likely to have a cause of hyponatraemia documented (p<0.01). Medications were the commonest documented cause of hyponatraemia (31.7%). Hydrochlorothiazide use was attributed in 25 (78.1%) of 32 with medication-associated hyponatraemia. Repeat renal profile (89%) was the commonest management of hypotonic hyponatraemia.

Self-management education program (SMEP) is essential in the knee osteoarthritis (OA) management. While the benefits of tailored SMEP have been highlighted in the literature, evidence on the effects of tailored knee OA SMEP for multiethnic populations, such as in Malaysia, remains limited. Therefore, the aim of this study was to conduct an intervention study on a tailored SMEP among Malaysian older adults who aged 60 years and above with knee OA. Participants aged 60 years and over with a diagnosis of knee OA were recruited. The intervention comprised four weekly structured group SMEP which was developed specifically for the multicultural population in Malaysia. Symptom’s severity and functional performance were assessed at baseline and six-week follow-up using the Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS), 30 seconds sit to stand (30sST), time up and go (TUG), chair sit and reach (CSR), back stretch (BS), handgrip strength (HGS) and two-minute walk (2MW) tests. Of the 32 individuals recruited, 30 participants, mean age of 66.77 (±6.42) years, completed the post-intervention assessment. Improvements in mean KOOS domains scores were observed by between 1.3% - 8.6% from baseline to follow-up. Significant differences between baseline and followup scores were identified for 30sST (p < 0.05), TUG ( p < 0.001) and 2MW (p < 0.001) tests. A 4-week tailored SMEP delivered face to face by a physiotherapist, improved lower limb muscle strength, mobility, balance and endurance. Larger randomized controlled trials regarding the long-term effects of SMEP for older adults with OA is warranted.

Background: Background: Urinary incontinence is a common problem among older women. The objective of this study was to determine the prevalence of urinary incontinence among older women aged 55 years and over in the Klang valley, the most densely populated urban area in Malaysia, and to determine any potential ethnic differences. Methods: This study used cross-sectional data from the Malaysian Elders Longitudinal Research (MELoR) study. A total of 863 participants were included, with a mean age of 67.97 ± 7.50 (S.D.). They were selected by simple random sampling from the electoral rolls of three parliamentary constituencies. Results: The prevalence of urinary incontinence was 30.8%. Mixed urinary incontinence (UI) was present in 44.7%, stress UI in 39.1% and urge UI in 16.2%. Ethnic Malays (38%) were more likely than ethnic Indians (32.3%) and Chinese (29.7%) to have UI. Ethnic Malays were also more likely to have stress UI and Indians were more likely to have urge UI . Conclusion The prevalence of UI in this study was comparable to other Asian and worldwide studies. The significant association between ethnicity and UI, however, has not been reported in any previous studies. Further studies should identify factors which may determine these ethnic differences in UI.
Urinary Incontinence ; Aged ; Lower Urinary Tract Symptoms ; Ethnicity

Migration is a widespread phenomenon throughout the world and it has been under way since time immemorial. While studies have focused on the causes of migration and the impact of migrants, studies focusing on the emotional experience of the left-behind older persons’ adjustments in their twilight years after the departure of their adult children, are few and far between. Thus, the perspectives of these left-behind older parents/ persons are less understood. This paper aims to contribute to the literature by addressing the gap which will be filled through the experiences of left-behind Malaysian older persons. Drawing on in-depth interviews extracted from a qualitative study that focused on the strength of long-term marriages among Malaysian Chinese couples, this paper captures four older couples’ experiences that depict their feelings about their adult children’s migration. Analysis suggests that the children’s migration was induced by a lack of support and resources, followed by unequal educational opportunities. To deal with the gap left by their children, these older urban parents depend on kinship connection and community support in times of need. Government initiatives may also be able to empower the community in innovating and implementing plans which are tailored to the needs of the older parents left behind by children who have migrated. The living arrangements and recent bereavement experiences captured from the older couples can serve as cues for healthcare professionals and social support providers to assess the risks of social isolation and suicide among these left-behind older parents.
Malaysia