Factors associated with frailty among postmenopausal Chinese women from selected senior citizen associations in Kuala Lumpur and Selangor, Malaysia

Frailty is defined as a decline in physiological condition and immunity against stressors events, which is common among the elderly population. Mounting evidence shows frailty among older person is highly associated with higher risk of cardiovascular and cardiovascular-related diseases, fall, physical disability, poor quality of life, increased mortality and morbidity. With the increase of proportion of older person in Malaysia attributed to longevity, it is expecting that frailty will continue to rise. Chinese female, with the longest life expectancy among different ethnicities in Malaysia, is expected to have a higher prevalence of frailty. Recognizing the importance of identifying factors associated frailty in promoting healthy ageing, the present study was undertaken to determine the prevalence of frailty and factors contributing to the risk of frailty among free-living postmenopausal Chinese women in Kuala Lumpur and Selangor. A total of 220 postmenopausal Chinese women were recruited from seven affiliates under Kuala Lumpur and Selangor branch of National Council of Senior Citizen Organisation (NACSCOM). Frailty status was ascertained based on five assessments, namely unintentional weight loss, self-reported exhaustion, slow gait speed, weak handgrip strength and low physical activity level. Respondents with one to two components was classified as pre-frailty, while those with at least three components were classified as frailty. Several anthropometry assessments (weight, height, waist circumference (WC), percentage of body fat (PBF)) and blood pressure (BP) were performed according to standard protocols while skeletal muscle mass was computed accordingly. Sociodemographic background (age, duration of menopause, duration of education and education level, marital status, occupation and monthly household income) of respondents were obtained through self-administered questionnaire, while sleeping quality, smoking behaviour, sedentary time were determined using Pittsburgh Sleeping Quality Index (PSQI) Questionnaire, Global Adults Tobacco Survey (GATS), and Global Physical Activity Questionnaire (GPAQ), respectively. Nutrients intake of respondents were quantified using a validated food frequency questionnaire while diet quality was ascertained according to compliance of intakes with Malaysian Dietary Guidelines. A total of 5 ml fasting blood samples was drawn for analysis of fasting blood glucose (FBG) and lipid profile to ascertain the presence of metabolic syndrome (MS) among the respondents. Data obtained was analyzed using IBM SPSS Statistic 22.0. Independent-sample t-test was used to determine the mean differences between respondents with and without the risk of frailty, while Pearson Chi-Square (χ2) was used to determine the association between two categorical variables. Binary logistic regression was used to determine the factors that contribute to the risk of frailty. The prevalence of pre-frailty and frailty were 64.5% and 7.3% respectively, and weak handgrip strength was most common among the respondents (51.8%) as compared to other assessment criteria. The mean age and duration of menopause for respondents were 66.47±6.62 and 16.07±7.77 years respectively, with the majority of them were married (77.7%), had formal education (87.7%), and from either low (43.6%) or middle (36.8%) economic group. With regards to anthropometry assessment, more than half of the respondents (56.8%) had normal body weight of 24.48±4.28 kg/m2, but majority (75.0%) high level of PBF of 35.14±5.13%. Overall, the majority of the respondents (87.3%) required improvement in their dietary quality, and special attention should be given to vegetables, fish, as well as milk and dairy products. The majority of the respondents (98.2%) were non-smokers, and spent approximately four hours on sedentary behaviour. Despite overall sleep quality was satisfactory, one in two respondents (53.6%) had problem with sleep latency, while about 20% complained with daytime dysfunction. The prevalence of MS was 52.3%, with increased BP as most common (75.0%), while only a minority (11.4%) presented with reduced High-Density Lipoprotein (HDL) level. Results showed that a high proportion of the respondents did not receive treatment for increased FBG (87.7% or BP (60.9%). On the other hand, respondents with risk of frailty were significantly older, had a longer duration of menopause and shorter year of education. There were significant associations between adequacy intakes of cereal and grains, adequacy of poultry, meat and eggs, and daytime dysfunction with risk of frailty in the present study. Among all the studied variables, only four factors (dietary quality, waist circumference, increased FBG and skeletal muscle mass) were found to contribute to risk of frailty among postmenopausal Chinese women, with the final model explaining 12.5% of the variance. On the other hand, age, marital status, year of education, HDL, triglyceride, BP, MS, smoking behaviour, sleeping quality, sedentary behaviour, body mass index and PBF failed to contribute to risk of frailty. In summary, frailty affected approximately one in thirteen of respondents, while almost two-thirds of the respondents were pre-frail. More than half of the respondents had MS, with a high prevalence of undiagnosed diabetes mellitus and hypertension cases. Although the majority had normal body weight, a high proportion of them had high PBF, and this issue should be addressed accordingly. Meanwhile adequate attention should be given on the improvement of dietary quality, emphasizing on meeting the recommendation for fish, vegetables and dairy products. The presence of pre-frailty and frailty and identification of several modifiable factors contributed to the risk of frailty in this present study signified the need for more work including appropriate intervention to reduce and prevent the onset of frailty among the postmenopausal women.

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