Incidence and Predictors of Mortality among Community-Dwelling Older Adults in Malaysia: A 5 Years Longitudinal Study

Abstract

With older adults accounting for 10.7% of the Malaysian population, determining the predictors of mortality has now become crucial. Thus, this community-based longitudinal study aimed to investigate the predictors for mortality among community-dwelling older adults using a wide range of factors, including clinical or subclinical. A total of 2322 older adults were interviewed and assessed by trained fieldworkers using validated structured questionnaires. The questionnaire consisted of information on socio-demographic characteristics, health status, neuropsychological and psychosocial functions, lifestyle, dietary intake and biophysical measures. The incidence rate of mortality was 2.9 per 100 person-years. Cox regression analysis indicated that advancing age (Adjusted Hazard Ratio, Adj HR = 1.044, 95% CI: 1.024–1.064), male (Adj HR = 1.937, 95% CI: 1.402–2.675), non-married status (Adj HR = 1.410, 95% CI: 1.078–1.843), smoking (Adj HR = 1.314, 95% CI: 1.004–1.721), a higher fasting blood sugar (Adj HR = 1.075, 95% CI: 1.029–1.166), a lower serum albumin (Adj HR = 0.947, 95% CI: 0.905–0.990), a longer time to complete the TUG test (Adj HR = 1.059, 95% CI: 1.022–1.098), and a lower intake of total dietary fibre (Adj HR = 0.911, 95% CI: 0.873–0.980) were the predictors of mortality in this study. These findings provide an estimated rate of multiethnic mortality in middle-income countries and diet is one of the predictors. These predictors of mortality could be a reference in identifying new public health strategies to ensure longer healthier life spans with lower disability rate among community-dwelling older adults in Malaysia.

Total and different dietary fiber subtypes and the risk of all-cause, cardiovascular, and cancer mortality: a dose–response meta-analysis of prospective cohort studies

“…The followup duration of cohorts ranged from 5 to 40 years. Twenty-five studies reported the results for total fiber, [28][29][30][31][32][33][49][50][51][52][53][54][55][56][57][60][61][62][63][64][66][67][68][69][70] 10 studies reported the results for fruit and vegetable fiber, 30,31,33,50,54,56,57,[63][64][65] 10 for cereal fiber, 30,31,33,50,51,[56][57][58]64,65 eight for soluble fiber, 30,31,33,50,52,55,…”

“…30,31,33,[63][64][65] Fourteen studies were conducted in European countries, [28][29][30]33,49,53,56,[60][61][62][64][65][66][67] seven in the US, 51,52,55,58,59,63,69 and seven in Asia. 31,32,50,54,57,68,70 Three studies were conducted exclusively on women, 51,59,65 three on men, 28,64,67 and the others on both sexes. Nineteen studies used a food frequency questionnaire (FFQ) for dietary assessment, 28,30,31,[49][50][51]53,54,[56][57]…”

“…31,32,50,54,57,68,70 Three studies were conducted exclusively on women, 51,59,65 three on men, 28,64,67 and the others on both sexes. Nineteen studies used a food frequency questionnaire (FFQ) for dietary assessment, 28,30,31,[49][50][51]53,54,[56][57][58][59][60][61][62][63]65,66,68 three used 24 h dietary recall, 33,52,55 three used food records, 29,32,67 two used a dietary history questionnaire, 69,70 and one study implemented the cross-check dietary history method. 64 Of 28 prospective cohort studies, all studies were controlled for age and sex.…”

“…† Twelve prospective cohort studies were rated to have moderate risk of bias 28,30,31,33,53,55,56,58,59,62,63,68 and the remainders were judged to be at serious risk of bias. 29,32,[49][50][51][52]54,57,60,61,[64][65][66][67]69,70 Total fiber and all-cause mortality Twenty-one prospective cohort studies with 103 156 cases of all-cause mortality among 1 451 903 participants were entered into the analysis of dietary fiber and all-cause mortality risk. [28][29][30][31]33,49,52,53,[55][56][57][60][61][62][63][64][66][67][68][69][70] Comparing extreme categories ...…”

“…29,32,[49][50][51][52]54,57,60,61,[64][65][66][67]69,70 Total fiber and all-cause mortality Twenty-one prospective cohort studies with 103 156 cases of all-cause mortality among 1 451 903 participants were entered into the analysis of dietary fiber and all-cause mortality risk. [28][29][30][31]33,49,52,53,[55][56][57][60][61][62][63][64][66][67][68][69][70] Comparing extreme categories of dietary fiber intake, the HR of all-cause mortality was 0.83 (95% CI: 0.78, 0.88), with high heterogeneity, I 2 = 83%, P heterogeneity < 0.001 (ESI Fig. 2 and Table 1 †).…”