Intervention on Reducing Risk of Falls Among Community Dwelling Older Adults in Selangor

Risk of sarcopenia among the older adults will be determined according to the Asian Working Group for Sarcopenia (AWGS) Criteria 2014. This is to be ascertained on muscle mass, handgrip strength and gait speed. The skeletal muscle mass will be accessed in gram using the InBody Body Impedance Analyzer (BIA) (S10 model) to help derive the skeletal muscle mass index. Grip strength will be measured using a Jamar dynamometer. Three measurements of hand grip strength will be taken for the dominant hand, with the mean value of three measurements to be recorded. For gait speed, respondents are required to walk on six meters of a straight path (about 20 feet) with time taken will be taken. The faster time of two trials will be recorded.

Risk of sarcopenia among the older adults will be determined according to the Asian Working Group for Sarcopenia (AWGS) Criteria 2014. This is to be ascertained on muscle mass, handgrip strength and gait speed. Grip strength will be measured in kilograms (kg) using a Jamar dynamometer. Three measurements of hand grip strength will be taken for the dominant hand, with the mean value of three measurements to be recorded.

Risk of sarcopenia among the older adults will be determined according to the Asian Working Group for Sarcopenia (AWGS) Criteria 2014. This is to be ascertained on muscle mass, handgrip strength and gait speed. For gait speed, respondents are required to walk on six meters of a straight path (about 20 feet) with time taken will be taken. The faster time of two trials will be recorded.

Three-day 24 hours dietary recall will be used to obtain the dietary data of older adults. Respondents are required to recall the food and beverages taken in the previous 24 hours for two weekdays and one weekend day. Time of consumption, type of food, serving size and size of household units will be recorded in the diet recall form through face-to-face interview. Household measures such as plates, bowls and spoons of different sizes will be used during data collection to quantify food intake of the respondents. Nutritionist Pro will be used to analyze energy intake in kcal with the use of several databases including Malaysian Food Composition Database, USDA Standard Reference Database, Food and Nutrient Database for Dietary Studies and others.

Three-day 24 hours dietary recall will be used to obtain the dietary data of older adults. Respondents are required to recall the food and beverages taken in the previous 24 hours for two weekdays and one weekend day. Time of consumption, type of food, serving size and size of household units will be recorded in the diet recall form through face-to-face interview. Household measures such as plates, bowls and spoons of different sizes will be used during data collection to quantify food intake of the respondents. Nutritionist Pro will be used to analyze protein intake in gram (g) with the use of several databases including Malaysian Food Composition Database, USDA Standard Reference Database, Food and Nutrient Database for Dietary Studies and others.

Three-day 24 hours dietary recall will be used to obtain the dietary data of older adults. Respondents are required to recall the food and beverages taken in the previous 24 hours for two weekdays and one weekend day. Time of consumption, type of food, serving size and size of household units will be recorded in the diet recall form through face-to-face interview. Household measures such as plates, bowls and spoons of different sizes will be used during data collection to quantify food intake of the respondents. Nutritionist Pro will be used to analyze calcium intake in gram (g) with the use of several databases including Malaysian Food Composition Database, USDA Standard Reference Database, Food and Nutrient Database for Dietary Studies and others.

Three-day 24 hours dietary recall will be used to obtain the dietary data of older adults. Respondents are required to recall the food and beverages taken in the previous 24 hours for two weekdays and one weekend day. Time of consumption, type of food, serving size and size of household units will be recorded in the diet recall form through face-to-face interview. Household measures such as plates, bowls and spoons of different sizes will be used during data collection to quantify food intake of the respondents. Nutritionist Pro will be used to analyze vitamin D intake in microgram (mcg) with the use of several databases including Malaysian Food Composition Database, USDA Standard Reference Database, Food and Nutrient Database for Dietary Studies and others.

Seca 803 Digital Weight Scale will be used to measure body weight of the respondents in light clothing (without shoes) to the nearest 0.1 kilogram, using standardized protocol.

Standing height of the respondents will be taken using SECA portable stadiometer (SECA-213 model) to the nearest 0.1 centimeter with the subject standing barefoot. The head will be kept in the Frankfurt plane and heels checked to make sure they were on the platform. Respondents who are found to have kyphosis problem or difficulty to stand straight will be not taken their standing height but replaced with alternative height (demi-span) measurement.

Calf circumference will be measured using a flexible non-stretchable tape (SECA-201 model). This is a recognized anthropometric parameter to indicate muscle loss especially in the lower limb and considered a pertinent marker of the nutritional status in the elderly. During measurement, the tape will be wrapped comfortably around the calf (non-dominant leg) at the widest part while respondents are sitting down and recorded to the nearest 0.1cm.

The level of physical activity among the respondents will be assessed using the Rapid Assessment of Physical Activity (RAPA), which is a user friendly and validated tool to assess levels of physical activity among older people aged 50 and above. It is made up of nine "Yes" or "No" questions to evaluate the amount and intensity of physical activity of the respondents. It is divided into two components, namely an assessment of aerobic activity from sedentary to moderate and vigorous sports as well as an evaluation of activities that increase strength and flexibility. For the first component on assessment of aerobic activity, respondents are required to choose one question which reflected their level of physical activity with affirmative response. The scores for aerobic activity would be increased if the amount, frequency and intensity of physical activity increased. The scores for these components ranged from 1 to 7 points.

Two questions will be developed for the assessment on strength

Nutritional status will be assessed using the short form of the Mini Nutritional Assessment (MNA-SF). The MNA-SF is an effective, easily administered tool designed to identify older adults who have or are at risk of developing malnutrition. This short-standardized questionnaire comprises six questions about food decline, weight loss in the last three months, mobility, actual disease/distress, psychological situation, and additionally anthropometric measures (body mass index or calf circumference). MNA-SF scores will be categorized into three different categories where score below eight indicates malnutrition, 8-11 indicates at risk of malnutrition and 12- 14 represents well-nourished status.

The well-established Lawton Instrumental Activities of Daily Living (IADL) questionnaire will be used to assess the respondents' ability to perform eight daily activities (i.e. ability to use telephone, shopping, preparing meals, housekeeping, doing laundry, using public transport, taking medications, and handling finances). Presence of 'functional disability' will be defined as having difficulty or needing help in at least one of these 8 items IADL activities, while normal functioning will be defined if one can perform all 8 activities independently.

The perceived quality of life of the respondents will be determined using Older Person Quality of Life (OPQOL) Questionnaire. This questionnaire consists of 35 statements with the participant being asked to indicate the extent to which he/she agrees with every single statement by choosing one of five possible options among "strongly disagree", "disagree", "neither agree nor disagree", "agree" and "strongly agree". Each of the five possible answers is given a score of 1 to 5 so that higher scores indicate a better QOL. Thus, the total score ranges from 35 (the worst possible QOL) to 175 (the best possible QOL). The 35 statements of the questionnaire consider the following aspects of QOL: life overall, health (score range 4-20), social relationships and participation, independence, control over life and freedom, home and neighbourhood, psychological and emotional well-being, financial circumstances, leisure, activities and religion.

Knowledge, attitude and practice on falls, nutrition and exercise of the respondents will be assessed sing a self-developed questionnaire. This questionnaire consists of 9 domains and 101 items related to KAP on Falls reduction, nutrition and exercise and have been undergone content and face validities. Higher score represent better knowledge, attitude and practice.

Sleeping quality of the respondents will be determined using Pittsburgh Sleep Quality Index (PSQI). PSQI is a structured, self-administered questionnaire that measures retrospective sleep quality and disturbances within the past month. The 7 self-rated questions assess a wide variety of factor related to sleep quality, including estimates of sleep duration and latency. These 7 items are grouped into five component scores, each weighted equally on a 0-3 scale. The five component scores are then summed to yield a sleep quality index score, which has a range of 0-15, with higher scores indicate worse sleep quality. The five components are subjective sleep quality, sleep latency, sleep duration, sleep disturbances and use of sleep medication.