Date of Award

4-29-2025

Thesis Type

PhD

Document Type

Thesis

Divisions

Faculty of Medicine

Department

Department of Social and Preventive Medicine

Institution

Universiti Malaya

Abstract

With rapid population ageing, frailty poses a major challenge to public health and the healthcare system. Recent studies have emphasised the significance of frailty among middle-aged adults, as it can manifest earlier in life and lead to poor health outcomes, which could increase the healthcare demands and burdens. This study aimed to determine the prevalence and factors associated with frailty among community-dwelling middle-aged and older adults in Malaysia through a three-phase research approach. First, a systematic review was conducted to review the existing evidence on the prevalence of frailty among community-dwelling middle-aged adults globally. Second, a Frailty Index (FI) was constructed using health-related variables from the Malaysia Ageing and Retirement Survey (MARS) database, which included 5592 community-dwelling middle-aged and older adult participants aged 40 years and above. The characteristics of the constructed MARS-FI were analysed. The Cox proportional hazards ratio analysis was performed to evaluate its predictive mortality among 4454 participants who were followed up over 2.5 years. In the third phase, the prevalence of frailty and associated factors were determined by complex sampling descriptive analyses and complex sampling multinomial logistic regression. The findings from the systematic review highlighted that frailty was identified in middle-aged adults, with the prevalence ranging from 2.4% to 15.4%, irrespective of the frailty assessment approach. A 40-item MARS-FI was constructed and exhibited a typical right-skewed distribution, with a 99th percentile of 0.61 and a non-linear relationship with age (quadratic R² of 0.238, p < 0.001). The MARS-FI score was strongly associated with all-cause mortality among middle-aged and older adult populations (HR 1.64, 95% CI 1.49-1.82). The overall prevalence of frailty was 19.5% (95% CI 18.0-21.1), representing about 1.9 million middle-aged and older adults in Malaysia. About two-thirds were prefrail, with a prevalence of 64.1% (95% CI 62.0, 66.2). The prevalence of frailty increases with age and was higher among females than their age-matched males. Among older adults (≥60 years), 38.6% (95% CI 35.9-41.4) were frail, and 56.2% were in the prefrail state. Meanwhile, 10.4% (95% CI 9.1, 12.0) and 67.9% (95% CI 65.1, 70.6) of middle-aged adults (40-< 60 years) were frail and prefrail, respectively. Age, ethnicity, low education attainment and moderate to very poor self-rated health were consistently associated with frailty and prefrailty among middle-aged and older adults. Marital status was linked to frailty, with significant association only among older adults. Additionally, low income levels and abdominal obesity were significantly associated with both frailty and prefrailty among middle-aged adults, whereas a history of previous falls was linked only to frailty in this age group. The findings of this study emphasise the need to address frailty as an emerging public health priority in Malaysia, requiring urgent attention from healthcare professionals and policymakers. Recommendations include developing effective policies, incorporating frailty screening in clinical settings, tailoring evidence-based guidelines to the local context, and implementing effective prevention and intervention strategies.

Initial

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Additional Information

Thesis (PhD) – Faculty of Medicine, Universiti Malaya, 2025.

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