Fall Risk Factors Among Malaysians Health And Social Care Essay

The population of Malaysia is multi-racial, made up of legion cultural groups, consisting of Malays and other native groups ( 63 % ) , Chinese ( 24 % ) , Indians ( 7 % ) and 1 % “ Others ” , every bit good as over 5 % of non-Malaysian citizens who chiefly comprise immigrant labor. Significant alterations have taken topographic point in the Malayan population construction over the last few decennaries chiefly as a consequence of the ‘demographic passage ‘ experient since the 1960 ‘s and 1970 ‘s which saw diminution in birth rates from 36.1 in 1965 to 23.2 in 2002. Bettering wellness conditions has besides resulted in longer life anticipations and the one-year human death rate has dropped from 7.5 in 1965 to 4.4 in 2002.

Harmonizing to National Council of Senior Citizens Organizations Malaysia – NACSCOM ( 2007 ) , Malaysia presently has a population of about 26 million, of which 1.6 million or 6.5 % is of age above 60 old ages. With a jutting population growing of 2 % yearly, the population is expected to make about 34 million in 2020, of which 3.2 million or 9.5 % is expected to be above the age of 60 old ages. In the twelvemonth 2035 the state is expected to hold a population of about 46 million, of which 6.9 million or 15 % will be above 60 old ages. This proves that, Malaysia ‘s demographic ripening form is emerging. The United Nations, in its guidelines, classs any state with 10 % of its population above the age of 60 old ages as an ageing state. Hence, by 2035 or possibly, even earlier, Malaysia would fall within that class.

Tinetti et. Al, ( 1994 ) said that, as the figure of people 65 old ages and older additions, so does the figure of people who fall. Stevens ( 2005 ) found that, the rates of falls and a fall-related decease in older grownups has increased, over the last decennary. A autumn is an event ensuing in the individual or a body portion of the individual accidentally coming to rest on the land or other surface lower than the organic structure ( Nevitt, Cummings, & A ; Hudes, 1991 ) .

The hazard of falls additions dramatically with age where approximately 25 % to 35 % of people over the age of 65 old ages experiences one or more autumn ( Shumway-Cook et al. , 1997 ) .


Fallss are the taking cause of injury deceases among people age 65 and older. In 2002, there were 12,800 fall-related deceases. Fall rates increased aggressively with progressing age ( Centers for Disease Control and Prevention – CDC, 2004 ) and the overall decease rate for work forces was about 60 % higher than the rate for adult females. The implicit in causes for this unsimilarity are imprecise. Work force may prolong more terrible hurts than adult females because they fall from greater highs such as from ladders or more implicit in chronic conditions than adult females of comparable age, be in poorer wellness, and be less able to last a fall-related hurt.

Fallss are multi-causal, and hence there are legion hazard factors for falls among older grownups. Harmonizing to Tinetti ( 2003 ) , the causes of falls are frequently multiple factors and the complex interactions between single and environmental factors.

Prevention schemes for falls at the population degree have yet to be decently studied. It is hence of import to place those people most at hazard of falling in order to maximise the effectivity of any proposed intercession. Published surveies have identified specific hazard factors for falls and related hurts. However, direct comparing of surveies is hampered by a figure of methodological issues, including the usage of different survey populations, deficiency of lucidity and consistence in definitions, variableness in periods of follow up, and the inevitable troubles of retrospective callback of events. Furthermore, there is a complex causal interaction between hazard factors and autumn happening.

Hazard factors for falls can be classified into two classs which are intrinsic factors and extrinsic factors. Below are the possible hazard factors in each of these classs: –

Intrinsic hazard factors:

A history of falls is related with increased hazard ( Tinetti, 1988 ) .

Age: the incidence of falls additions with age ( Campbell, Spears & A ; Borrie, 1990 ) .

Gender: autumn rates for work forces and adult females are similar for the younger old, but among the older old, adult females fall more frequently than work forces ( Robbins et al. , 1989 ) and are far more likely to incur breaks when they fall.

Topographic point of abode ( Populating entirely ) : Wickham et Al. ( 1989 ) found that populating entirely has been shown to be a hazard factor for falls, although portion of this consequence appears to be related to certain types of lodging older grownup may populate in.

Ethnicity: Harmonizing to Friedman et Al. ( 2002 ) , grounds from the United Kingdom and the United States suggests Caucasian cultural groups fall more often than Afro-Caribbeans, Hispanics or South Asians.

Medicines: Ray, Thapa & A ; Gideon ( 2000 ) indicated that benzodiazepine usage in older people is related with an addition of every bit much as 44 % in the hazard of hip break and dark falls.

Medical conditions: Lawlor, Patel & A ; Ebrahim ( 2003 ) found that, circulative disease, chronic clogging pneumonic disease, depression and arthritis are each associated with an increased hazard of 32 % meanwhile harmonizing to Tinetti ( 2003 ) , depression and incontinency are besides often present in populations of lumbermans.

Impaired mobility and pace: Harmonizing to Skelton ( 2001 ) , the diminution in strength and endurance after the age of 30 ( 10 % loss per decennary ) and musculus power ( 30 % loss per decennary ) consequence in physical operation dropping below the threshold where activities of day-to-day populating become hard and so impossible to transport out – this can happen in early old age for those who have been sedentary most of their lives. When strength, endurance, musculus power and hence map declines sufficiently, one is unable to forestall a faux pas, trip or stumble going a autumn. Muscle failing is a important hazard factor for falls, as is gait shortage, balance shortage and the usage of an assistive device ( American Geriatrics Society, 2001 ) .

Sedentary behavior: Skelton ( 2001 ) , in his survey, said that lumbermans tend to be less active and may inadvertently do farther wasting of musculus around an unstable articulation through neglect. Those who are inactive autumn more than those who are reasonably active or really active, but do so in safe environments ( Gregg, Pereira & A ; Caspersen, 2000 ) .

Psychological position – fright of falling: Harmonizing to Arfken et Al. ( 1994 ) , up to 70 % of recent lumbermans and up to 40 % of those non describing recent falls acknowledge fright of falling. Up to 50 % of people who are fearful of falling bound or cut down the societal and physical activities because of that fright ( Tinetti, 1988 ) .

Nutritional lacks: a low organic structure mass index proposing malnutrition is associated with increased hazard ( Tinetti, 1996 ) . Vitamin D lack is peculiarly common in older people in residential attention installations and may take to unnatural pace, musculus failing, osteomalacia and osteoporosis ( Larsson, 1990 ) .

Impaired knowledge: cognitive shortage is clearly associated with increased hazard, even at a comparatively modest degree ( short of aureate dementedness ) . Nursing place occupants with diagnosed dementedness autumn twice every bit frequently as those with normal knowledge but there was no difference in badness of hurt between the groups ( Van et al. , 2003 ) .

Ocular damages: ocular sharp-sightedness, contrast sensitiveness, ocular field, cataract, glaucoma and macular devolution all contribute to hazard of falls ( Jack et al. , 1995 ) as do bifocal or multifocal lenses ( Lord, Dayhew & A ; Howland, 2002 ) .

Foot jobs: Based on Tinetti, Speechley & A ; Ginter ( 1998 ) , survey, bunions, toe malformations, ulcers, deformed nails and general hurting in walking addition balance troubles and hazard of falls. Footwear is besides of import ( Lord & A ; Bashford, 1996 ) .

Extrinsic hazard factors

Feder et Al. ( 2000 ) said that, the size of the impact environmental factors have on the hazard of falling among older people is unsure. Some surveies have reported that between 30 % and 50 % of falls among community brooding older people are due to environmental causes and others that 20 % of falls are due to major external factors ( those that would do any healthy grownup to fall ) . Older people frequently have jobs stealing or stumbling, missing good balance or compensating mechanisms for forestalling the autumn. Extrinsic hazards include:

Environmental jeopardies ( hapless lighting, slippery floors, uneven surfaces, etc. ) ( Lord, Sherrington & A ; Menz, 2000 ) .

Footwear and vesture ( Lord, Sherrington & A ; Menz, 2000 ) .

Inappropriate walking AIDSs or assistive devices ( Dean & A ; Ross, 1993 ) .

Morse ( 1997 ) indicated that the job of falls can be address in a assortment of ways. One of the most common ways is the development of a autumn bar plan to diminish the hazard of falls and fall-related hurts. The first measure in diminishing an older grownup hazard for falls and fall-related hurts is by profiling persons ‘ degree of autumn hazard. The hazard profiling requires consistent application of a valid, dependable autumn hazard appraisal tool that identifies older grownup at hazard. Once there are identified, community, nursing staff or decision makers can so place the specific schemes to forestall falls and integrate these into the program of attention. To the best of our cognition, until now there are deficiencies of Malayan prevalence figures for falls in community brooding older grownup and because of that, the research worker tend to measure and better the parametric quantities that associated with autumn hazard. In other words, this survey will be conducted to find the prevalence of autumn hazard factors and the degree of autumn hazard among Malayan older grownup.


The intent of this survey is to roll up all the information on autumn hazard factors and degree of autumn hazard in order to make a profile of falls among older grownup across 4 zones which are north, south, east and west in Peninsular of Malaysia.


The aims of the survey are listed below: –

To measure the Overall Stability Index ( OSI ) of Malayan older grownups harmonizing to their gender.

To measure the Overall Stability Index ( OSI ) of Malayan older grownups harmonizing to their races.

To measure the Overall Stability Index ( OSI ) of Malayan older grownups harmonizing to their topographic point of abode.

To measure the Overall Stability Index ( OSI ) of Malayan older grownups harmonizing to their life agreements.

To place the autumn hazard factors faced by Malayan older grownups.

To measure the degree of autumn hazard of Malayan older grownups.



The falling history and past experience of the aged will non be counted as a factor in this survey.

Injury face by the participants prior to the trial.

Boundary lines

This survey will be delimited to the aged grownup who were 65 old ages and above who past the Elderly Cognitive Assessment Questionnaire ( ECAQ ) .

Chronic pathologic and chronic dementedness people will be excluded.

This survey confined to aged people who lived in Peninsular Malaysia.

Aged people who are wheel-chair edge or who are wholly incapable of walking


The proposed research would hold these undermentioned hypotheses and research inquiries.

1 ) There is no important difference between male and female in footings of their Overall Stability Index.

2 ) There is no important difference between rural and urban in footings of their Overall Stability Index.

3 ) There is no important difference between races and Overall Stability Index.

4 ) There is no important difference between populating agreement and Overall Stability Index.

What are the autumn hazard factors faced by the Malayan older grownup?

Significance OF STUDY

Public Health

The profile of this survey is utile for the public wellness for improved ways to plan effectual intercession at the person and community degree.


This survey will supply information on autumn hazard factors and degree of autumn hazard.

Create Awareness

To assist and make consciousness about the of import of the physical activity particularly for the older grownup.


Older grownup i? Peoples who are 65 old ages old and above that do n’t hold a chronic pathological disease and chronic dementedness disease.





Overall Stability Index ( OSI )


i? Intrinsic Factors

i? Extrinsic Factors

The survey will analyze whether there is connexion or non between the exogenic variables with the endogenous variables that represent the Fall Risk Assessment.


Research Design

For this proposed research, the research worker will use the Ex Post Facto Design. The end of the design is to show the possible cause and consequence relationships by detecting an bing status or province of personal businesss and seeking back in clip for plausible causal factors.

This design consists of 3 parts which are Part 1, Part 2 and Part 3. For Part 1, the research worker will utilize Aged Cognitive Assessment Questionnaire ( ECAQ ) ( refer appendix I ) . The intent of utilizing this questionnaire is to test the aged people whether they have chronic dementedness disease or non. If they pass the ECAQ trial, it can be concluded that they do n’t hold chronic dementedness disease. Therefore, they will be selected to take part in this proposed survey. The marking for the ECAQ trial will be explained subsequently in Instrumentation portion.

Meanwhile, for Part 2, the research worker will utilize the Fall Risk Factors Questionnaire ( refer appendix II ) . This questionnaire comprises of 2 subdivisions, which is Section A and Section B. Section A will be used to find the intrinsic and extrinsic factors while Section B will measure on Activity of Daily Living ( ADL ) .

In Part 3, an initial Biodex Balance System SD device ( Biodex Medical Systems, Inc. , Shirley, New York ) will be used. The intent of utilizing the device system is to mensurate the Overall Stability Index ( OSI ) . During proving, the participants undergo three tests of 20 seconds each at degree six with 10 2nd remainder periods in between each test. The participants will stand bilaterally with pess shoulder width apart over the midplane of the board. At the completion of the trial a Fall Risk Assessment Report can be printed with a mark compared to normative informations. Scores higher than normative values suggest farther appraisal for lower appendage strength, proprioception, and vestibular or ocular lacks. It means, hapless balance is a major subscriber to falls and the consequences besides can be viewed on the screen.

Description of the Sample

For this proposed survey, the sample will be indiscriminately selected from the entire population. The research worker will split the Peninsular of Malaysia into 4 zones which are north, south, east and west. The existent figure for the participants will be determined after flying the survey.

Sampling Technique

Harmonizing to Sekaran ( 2000 ) , trying is the procedure of choosing a sufficient figure of elements from the population so that by analyzing the sample, and understanding the belongingss or the features of the sample topic, it will be possible to generalise the belongingss or features to the population elements.

Sampling technique can be divided into two attacks which are chance and non-probability. For this proposed research, the sample will be selected with voluntary footing and purposive random trying method will be used under the non-probability sampling technique because the research worker knows that specific features exist in certain section of population. The participants that fulfil the scope of age which is 65 old ages old and above will be selected for this survey.

Estimating Power and Effect Size

The existent figure for the participants will be determined after flying the survey.

Research Cogency

By utilizing the Ex Post Facto Design, research worker has little to no control over independent variables. Because of that, there is merely one factor that research worker feel might be the menace to internal cogency which is experimental mortality. It means loss of research participants from the survey. The experimental mortality besides non a large issue because the informations aggregation procedure merely takes 30 proceedingss. The advantage of this design is researcher can be added he participants if needed or researcher will get down the survey with a big figure of participants.


Instrumentality is divided into three parts as listed below: –

Part 1: Aged Cognitive Assessment Questionnaire ( for the showing intent merely )

Part 2: Fall Hazard Factors Questionnaire

Part 3: Fall Risk Balance Testing ( Biodex Balance System SD )

Part 1

The intent of this questionnaire is to choose the participants who did non hold a chronic dementedness disease.

The questionnaire consists of 10 points of Elderly Cognitive Assessment Questionnaire ( ECAQ ) ( refer appendix I ) . The questionnaire besides utilizes the Malay Version. The ECAQ will measure two aspects of cognitive maps, viz. memory and orientation-information.

The mark for the ECAQ 0 – 4 Probable instance

5 – 6 Borderline instance

& gt ; 7 Normal

Merely participants who past the showing trial ( normal ) will be selected to affect in the survey.

Part 2

The constructions of the questionnaire consist of 2 subdivisions which are: –

Section A: Fall Hazard Factors

For this subdivision, it has 22 points of inquiries ( mention appendix II ) . Questions sing the sociodemographic, intrinsic and extrinsic factors of autumn hazard will be asked.

Section B: Activity of Daily Living ( ADL )

For this subdivision, it has 6 points of inquiries ( mention appendix II ) .

Part 3

The Biodex Balance System SD ( Biodex Medical Systems, Inc. , Shirley, New York ) will be used to quantify balance as the dependent variables of Overall Stability Index ( OSI ) . The least stable degree on the BBS is Level 1 and the most stable degree is Flat 12. The proving for this proposed survey will performed from Level 12 ( Static Level ) until Level 6 ( Moderate Dynamic Level ) .

Test Protocol for Fall Risk Balance Testing

The trial protocol will be used to compare participants of similar age ranges in a normative database.

Test Duration: 20 seconds

Degree: From Level 12 to Level 6

Stance Type: Bilateral

A lower limit of three trial tests should be used to avoid inordinate balance divergences.

Safety Precaution during Fall Risk Balance Testing

All participants should hold a verbal apprehension of the Balance System prior to stepping on the device.

A full organic structure harness will be used as a safety safeguard but did non hinder organic structure sway and the balance of the participants.

For optimum operation, guarantee the participants will stand at the Centre of the platform.

Position the show so that the participants can look directly at it. This will assist guarantee good position during the trial or exercising session.

To guarantee the participants safety, research worker will get down each session with the balance platform in the “ locked ” or inactive place.

Researcher will rede the participants to get down the trial period from “ hands-on ” to “ hands-off ” the support grip. This will guarantee that new or unstable participants have an equal apprehension of the Balance System and will assist to protect the participants against sudden or unexpected motion of the platform.

Pilot Testing

In order to suitably mensurate the intrinsic and extrinsic factors, the modified study questionnaire must be both valid and dependable. Babbie ( 2001 ) indicated that cogency refers to the extent to which an empirical step adequately reflects the existent significance of the construct under consideration. Harmonizing Morrow, Jackson, Disch & A ; Mood ( 2000 ) , the cogency of the questionnaire can be secured through the cooperation of experts in the country, executing pilot testing and guaranting namelessness of the participants. A pilot survey will be conducted to prove the dependability of the questionnaire with participants in Malaysia, before it will later utilize in the existent survey.

Four individuals will be indiscriminately selected from the entire population as a sample for the pilot survey. The pilot sample comprised of 2 males and 2 females. The research worker will choose the older people who is 60 old ages and above for the navigation intents.

Datas Analysis

Normal descriptive statistics, way analysis and independent sample t-test ( depending on farther research development ) will be used to analyse informations of the proposed research.

Multivariable logistic arrested development besides will be used to find factors that will independently associated with the Overall Stability Index.

Ethical Issues

Research worker will see all the undermentioned ethical issues stated below: –

1. Planing

i? The research worker will be after carefully the continuance of informations aggregation because there is merely one Biodex Balance SD device. In order to do certain the testing process run swimmingly, the research worker will make a clip tabular array for the testing day of the month and the sum of participants do the trial.

i? Engagements in the survey will be 100 % voluntary footing.

i? The informations gather from the participants will be purely confidential.

Capable hazard

i? The research worker will briefly explicate about the safety safeguard before the proving period to the participants.

i? The research worker will inspect the equipment and do certain the safety safeguards will be taken.

i? If there is an exigency, the research worker will supply a intervention ( First Aid merely ) .

3. Researcher duties

i? The research worker will supply a consent signifier ( mention appendix III ) to the participants.

4. Presentment

i? After the research worker distributes the consent signifier to the participants, the research worker will explicate the content of the consent signifier.

5. Consequence airing

i? Researcher will supply the testing and study consequence upon petition.

Work SCHEDULE ( 2010 )














Preparation of Research Proposal ( Chapter 1, 2 and 3 )

Pilot Study

Data Collection

Analyze the information

Data Interpretation / Finding ( Chapter 4 )

Discussion, Conclusion and Recommendation ( Chapter 5 )

Meet Supervisor

Work SCHEDULE ( 2011 )













Preparation of Research Proposal ( Chapter 1, 2 and 3 )

Pilot Study

Data Collection

Analyze the information

Data Interpretation / Finding ( Chapter 4 )

Discussion, Conclusion and Recommendation ( Chapter 5 )

Meet Supervisor