{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:55:20Z","timestamp":1769151320255,"version":"3.49.0"},"reference-count":48,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2019,11,26]],"date-time":"2019-11-26T00:00:00Z","timestamp":1574726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004515","name":"Universiti Kebangsaan Malaysia","doi-asserted-by":"publisher","award":["DCP-2017-002\/2, Komuniti-2013-027, LRGS\/BU\/2012\/UKM-UKM\/K\/01"],"award-info":[{"award-number":["DCP-2017-002\/2, Komuniti-2013-027, LRGS\/BU\/2012\/UKM-UKM\/K\/01"]}],"id":[{"id":"10.13039\/501100004515","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Aim: There is limited information about the association between frailty, cognitive status and functional fitness in older adults living in institutions. We aimed to determine the prevalence of frailty and its association with cognitive status and functional fitness among pre-frail and frail Malaysian older adults residing in institutions on the west coast of Peninsular Malaysia. Methods: This study included 302 ambulating Malaysian institutionalised older adults. Frailty was identified using Fried\u2019s frailty criteria. Cognitive status was assessed using the Mini Mental State Examination and Addenbrooke\u2019s Cognitive Examination. Functional fitness was assessed using the Senior Fitness test. The association between frailty groups, cognitive status and functional fitness was analysed using binary logistic regression. Results: Prevalence of frailty, prefrailty and robustness in the older adults was 56.6%, 40.7% and 2.9%, respectively. Frailty was found to be associated with hypertension (OR 2.15, 95% CI: 1.11\u20134.16, p = 0.024), lower cognitive status (Addenbrooke\u2019s Cognitive Examination) (OR 0.98, 95% C.I: 0.96\u20130.99, p = 0.038), and lower dynamic balance and mobility (Timed Up and Go test) (OR 1.09, 95% CI: 1.01\u20131.16, p = 0.024). Conclusion: Frailty is highly prevalent among Malaysian institutionalised older adults. Hypertension, cognitive impairment and lower dynamic balance and mobility were found to be risk factors of frailty. Screening of frailty and its associated factors should be prioritized among institutionalised older adults in view of early prevention and rehabilitation.<\/jats:p>","DOI":"10.3390\/ijerph16234716","type":"journal-article","created":{"date-parts":[[2019,11,26]],"date-time":"2019-11-26T10:57:27Z","timestamp":1574765847000},"page":"4716","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Prevalence of Frailty and its Association with Cognitive Status and Functional Fitness among Ambulating Older Adults Residing in Institutions within West Coast of Peninsular Malaysia"],"prefix":"10.3390","volume":"16","author":[{"given":"Resshaya Roobini","family":"Murukesu","sequence":"first","affiliation":[{"name":"Physiotherapy Programme & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devinder Kaur Ajit","family":"Singh","sequence":"additional","affiliation":[{"name":"Physiotherapy Programme & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ponnusamy","family":"Subramaniam","sequence":"additional","affiliation":[{"name":"Health Psychology Programme & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xee Vern","family":"Tan","sequence":"additional","affiliation":[{"name":"Physiotherapy Programme & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibtisam Arfah","family":"Mohamd Izhar","sequence":"additional","affiliation":[{"name":"Physiotherapy Programme & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pavapriya","family":"Ponvel","sequence":"additional","affiliation":[{"name":"Physiotherapy Programme & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanif Farhan","family":"Mohd Rasdi","sequence":"additional","affiliation":[{"name":"Occupational Therapy Programme & Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,26]]},"reference":[{"key":"ref_1","unstructured":"United Nations (2017). World Population Ageing 2017\u2014Highlights, Department of Economic and Social Affairs, Population Division."},{"key":"ref_2","unstructured":"(2019, October 17). Official Portal of Public Service Department Malaysia, Available online: http:\/\/www.jpapencen.gov.my\/english\/senior_citizen.html."},{"key":"ref_3","first-page":"1","article-title":"The problems and challenges of the aging population of Malaysia","volume":"7","author":"Mafauzy","year":"2000","journal-title":"Malays. J. Med. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","article-title":"Frailty in elderly people","volume":"381","author":"Clegg","year":"2013","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s12603-012-0040-1","article-title":"Frailty and aging","volume":"16","author":"Sourdet","year":"2012","journal-title":"J. Nutr. Health Aging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1111\/jgs.15928","article-title":"Moving frailty toward clinical practice: NIA intramural frailty science symposium summary","volume":"67","author":"Walston","year":"2019","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: Evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.jamda.2015.02.004","article-title":"Global Prevalence of physical frailty by Fried\u2019s criteria in community-dwelling elderly with national population-based surveys","volume":"16","author":"Choi","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1111\/j.1532-5415.2012.04054.x","article-title":"Prevalence of frailty in community-dwelling older persons: A systematic review","volume":"60","author":"Collard","year":"2012","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1519\/JPT.0000000000000097","article-title":"Frailty as a Predictor of Nursing Home Placement Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis","volume":"41","author":"Kojima","year":"2018","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1111\/cpf.12300","article-title":"Reliability of muscle strength measures obtained with a hand-held dynamometer in an elderly population","volume":"37","author":"Buckinx","year":"2017","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.archger.2017.07.007","article-title":"Associations between multidimensional frailty and quality of life among Dutch older people","volume":"73","author":"Gobbens","year":"2017","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1007\/s12603-011-0096-3","article-title":"Frailty, cognitive impairment and mortality among the oldest old","volume":"15","author":"Jacobs","year":"2011","journal-title":"J. Nutr. Health Aging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"231","DOI":"10.3233\/JAD-161280","article-title":"Dynamics of Frailty and Cognition after Age 50: Why It Matters that Cognitive Decline is Mostly Seen in Old Age","volume":"58","author":"Godin","year":"2017","journal-title":"J. Alzheimers Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.arr.2013.06.004","article-title":"Frailty and cognitive impairment-A review of the evidence and causal mechanisms","volume":"12","author":"Robertson","year":"2013","journal-title":"Ageing Res. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/gerona\/gln001","article-title":"Physical activity as a preventative factor for frailty: The health, aging, and body composition study","volume":"64","author":"Peterson","year":"2009","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1177\/0031512517709915","article-title":"Physical fitness and frailty syndrome in institutionalised older women","volume":"124","author":"Furtado","year":"2017","journal-title":"Percept. Mot. Ski."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s11556-009-0051-z","article-title":"Effect of age and physical activity level on functional fitness in older adults","volume":"6","author":"Tuna","year":"2009","journal-title":"Eur. Rev. Aging Phys. Act."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1123\/japa.7.2.129","article-title":"Development and validation of a functional fitness test for community-residing older adults","volume":"7","author":"Rikli","year":"1999","journal-title":"J. Aging Phys. Act."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ramnath, U., Rauch, L., Lambert, E.V., and Kolbe-Alexander, T.L. (2018). The relationship between functional status, physical fitness and cognitive performance in physically active older adults: A pilot study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0194918"},{"key":"ref_21","unstructured":"(2019, October 17). Official Portal Department of Social Welfare, Available online: http:\/\/www.jkm.gov.my\/jkm\/index.php?r=portal\/left&id=M2k3Q2xST0JJWE9Qa2Z2L253VDl2dz09."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/0022-3956(82)90033-4","article-title":"Development and validation of a geriatric depression screening scale: A preliminary report","volume":"17","author":"Yesavage","year":"1982","journal-title":"J. Psychiatr. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1136\/bmj.h176","article-title":"Managing patients with multimorbidity in primary care","volume":"350","author":"Wallace","year":"2015","journal-title":"BMJ"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/014662167700100306","article-title":"The CES-D scale: A self-report depression scale for research in the general population","volume":"1","author":"Radloff","year":"1977","journal-title":"Appl. Psychol. Meas."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/0895-4356(93)90053-4","article-title":"The Physical Activity Scale for the Elderly (PASE): Development and evaluation","volume":"46","author":"Washburn","year":"1993","journal-title":"J. Clin. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"Mini Mental State: A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1159\/000203888","article-title":"Validation study of the Mini-Mental State Examination in a Malay-speaking elderly population in Malaysia","volume":"27","author":"Ibrahim","year":"2009","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1159\/000351671","article-title":"Validation of the Addenbrooke\u2019s Cognitive Examination III in Frontotemporal Dementia and Alzheimer\u2019s Disease","volume":"36","author":"Hsieh","year":"2013","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1159\/000495107","article-title":"Validation of the Malay Version of Addenbrooke\u2019s Cognitive Examination III in Detecting Mild Cognitive Impairment and Dementia","volume":"9","author":"Kan","year":"2019","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref_30","unstructured":"Tabachnick, B.G., and Fidell, L.S. (2013). Using Multivariate Statistics, Pearson\/Allyn & Bacon. [6th ed.]."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.ijge.2016.07.006","article-title":"Risk Factors of Frailty among Multi-Ethnic Malaysian Older Adults","volume":"11","author":"Badrasawi","year":"2017","journal-title":"Int. J. Gerontol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ahmad, N.S., Hairi, N.N., Said, M.A., Kamaruzzaman, S.B., Choo, W.Y., Hairi, F., and Bulgiba, A. (2018). Prevalence, transitions and factors predicting transition between frailty states among rural community-dwelling older adults in Malaysia. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0206445"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/ageing\/afp202","article-title":"Prediction of institutionalization in the elderly. A systematic review","volume":"39","author":"Luppa","year":"2009","journal-title":"Age Aging"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1001\/archinternmed.2012.2555","article-title":"Rethinking the association of high blood pressure with mortality in elderly adults: The impact of frailty","volume":"172","author":"Odden","year":"2012","journal-title":"Arch. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1089\/rej.2016.1905","article-title":"Frailty and Risk of Cardiovascular Diseases in Older Persons: The Age, Gene\/Environment Susceptibility-Reykjavik Study","volume":"20","author":"Veronese","year":"2017","journal-title":"Rejuv. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"805","DOI":"10.2147\/CIA.S126526","article-title":"Effect of frailty syndrome on treatment compliance in older hypertensive patients","volume":"12","author":"Chudiak","year":"2017","journal-title":"Clin. Interv. Aging"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1161\/HYP.0000000000000066","article-title":"Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MD.0000000000002417","article-title":"Hypertension in Malaysia: An analysis of trends from the national surveys 1996 to 2011","volume":"95","author":"Naing","year":"2016","journal-title":"Medicine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"441","DOI":"10.2147\/NDT.S151253","article-title":"Addenbrooke\u2019s cognitive examination III in the diagnosis of dementia: A critical review","volume":"15","author":"Bruno","year":"2019","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3389\/fmed.2019.00026","article-title":"Frailty as a predictor of cognitive disorders: A systematic review and meta-analysis","volume":"6","author":"Borges","year":"2019","journal-title":"Front. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1111\/ggi.12891","article-title":"Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults","volume":"17","author":"Vaingankar","year":"2017","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The Timed \u201cUp & Go\u201d: A Test of Basic Functional Mobility for Frail Elderly Persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1519\/JPT.0000000000000162","article-title":"Performance of Different Timed Up and Go Subtasks in Frailty Syndrome","volume":"42","author":"Ansai","year":"2019","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1093\/gerona\/gls190","article-title":"Using timed up-and-go to identify frail members of the older population","volume":"68","author":"Savva","year":"2013","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_45","first-page":"5776","article-title":"Sarcopenia, Frailty and Dismobility","volume":"7","author":"Vereckei","year":"2018","journal-title":"Biomed. J. Sci. Tech. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1089\/rej.2012.1397","article-title":"Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: A systematic review","volume":"16","author":"Cadore","year":"2013","journal-title":"Rejuv. Res."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Ibrahim, A., Singh, D.K.A., and Shahar, S. (2017). \u2018Timed Up and Go\u2019 test: Age, gender and cognitive impairment stratified normative values of older adults. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0185641"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1007\/s12603-013-0367-2","article-title":"IANA\/IAGG. Cognitive frailty: Rational and definition from an (I.A.N.A.\/I.A.G.G.) international consensus group","volume":"17","author":"Kelaiditi","year":"2013","journal-title":"J. Nutr. Health Aging"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/23\/4716\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:37:44Z","timestamp":1760189864000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/23\/4716"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,26]]},"references-count":48,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["ijerph16234716"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16234716","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,26]]}}}