Table No. 1 presents the socio-demographic characteristics of the study participants. A total of 1,006 participants were interviewed out of the all participants of the LRGS TUA longitudinal community based study, with 66.18% response rate. 730 respondents fulfilled the inclusion criteria for the study. Participants were from Malay, Chinese, and Indian ethnicities (64.5%, 31.6%, and 3.9%, respectively). The prevalence of frailty was 8.1% (n = 59) among the study participants. It was noticeable that state of Kelantan reported 67.8% (n = 40) of frail cases from all types. More specifically, the prevalence of cognitive frailty was 4.5% (n = 33), while other types of frailty represented 3.6% (n = 26) out of the study participants. Cognitive frail participants were from state of Kelantan, Selangor and Perak (69.6%, 15.2%, and 15.2%, respectively), no cognitive frail cases were from Johor. Males represented 66.6% of the total sample. None of the single participants were diagnosed as cognitive frail cases. Participants with cognitive frailty were almost distributed evenly among age groups starting from 65 to 80 years old (n = 11, 9, 11). Out of the cognitive frail cases, 72.7% (n = 24) were with school level of education; the majority of the cognitive frail participants (97%, n = 32) were not working and are categorized under low income group of people.
Table No. 2 shows the co-morbidities among the study participants. Hypertension, high cholesterol level, vision problems, and diabetes mellitus were the most common chronic diseases among elderly people in Malaysia (54.9%, 52.2%, 35.8% and 27.7%, respectively). More specifically, hypertension, high cholesterol level, joint pain, diabetes mellitus, and vision problems, were the most common chronic diseases among cognitive frail elderly in Malaysia (69.7%, 66.7%, 48.5%, 39.4% and 39.4%, respectively). It was noticeable that hypertension, high cholesterol level were more prevalent (73.1% and 69.2%, respectively) among elderly with other frailty types compared to not frail, pre-frail, and cognitive frail elderly. Additionally, 78.8% of cognitive frail participants expressed well health during the last two weeks. Furthermore, 15% of cognitive frail participants reported seeking health care at public and private clinics, none of them sought hospital care during past two weeks.
Table 3 shows the outpatient health care utilization findings of the study participants during the past six months. In total, 81.8% (n = 27) of the cognitive frail patients reported a mean of 2.26 visits (with a maximum of 5 visits) for health care facilities seeking for treatment during the last 6 months. One way Anova test was conducted to examine the presence of significant differences between cognitive frail participants and other groups of elderly participants, namely: not frail, pre-frail, and other frailties. No statistically significant difference found in the number of visits among all participants (F = 2.451, P value = 0.062). During the past six months, cognitive frail patients utilized outpatient care at the governmental clinic, governmental hospitals, and private clinics (60.6%, 21.2%, and 21.2%, respectively); none of them sought outpatient care at private hospital, traditional medicine healers, and alternative health care. Around half of the cognitive frail patients (45.4%; n = 15) visited governmental clinic more than one time (with a maximum of 3 visits). Only 18.1% (n = 6) of the cognitive frail patients visited outpatient clinic at governmental hospitals more than one time (with a maximum of 3 visits). All cognitive frail patients whom visited private clinic (n = 7, 21.2%) did that one time only.
Table 1
Socio-demographic characteristics of the study participants
| | Not frail N (%)* | Pre-frail N (%)* | Other frailty N (%)* | Cognitive frailty N (%)* | Total N (%) |
State | Perak | 41 (5.6) | 134 (18.4) | 2 (0.3) | 5 (0.7) | 182 (24.9) |
Selangor | 30 (4.1) | 154 (21.1) | 3 (0.4) | 5 (0.7) | 192 (26.3) |
Kelantan | 29 (4.0) | 177 (24.2) | 17 (2.3) | 23 (3.2) | 246 (33.7) |
Johor Total | 36 (4.9) 136 (18.6) | 70 (9.6) 535 (73.3) | 4 (0.5) 26 (3.6) | - 33 (4.5) | 110 (15.1) 730 (100) |
Gender | Male | 44 (6) | 270 (37) | 17 (2.3) | 22 (3) | 353 (48.4) |
Female | 92 (12.6) | 265 (36.3) | 9 (1.2) | 11 (1.5) | 377 (51.6) |
Ethnicity | Malay | 62 (8.5) | 361 (49.5) | 22 (3) | 26 (3.6) | 471 (64.5) |
Chinese | 69 (9.5) | 156 (21.4) | 2 (0.3) | 4 (0.5) | 231 (31.6) |
Indian | 5 (0.7) | 18 (2.5) | 2 (0.3) | 3 (0.4) | 28 (3.9) |
Marital status | Single | - | 9 (1.2) | - | - | 9 (1.2) |
Married | 95 (13) | 367 (50.3) | 19 (2.6) | 19 (2.6) | 500 (68.5) |
Others | 41 (5.6) | 159 (21.8) | 7 (1) | 14 (1.9) | 221 (30.3) |
Age | 65–70 Years | 83 (11.4) | 213 (29.2) | 9 (1.2) | 11 (1.5) | 316 (43.3) |
71–75 Years | 37 (5.1) | 179 (24.5) | 11 (1.5) | 9 (1.2) | 236 (32.3) |
76–80 Years | 15 (2.1) | 101 (13.8) | 2 (0.3) | 11 (1.5) | 129 (17.7) |
81–85 Years | 1 (0.1) | 38 (5.2) | 3 (0.4) | 2 (0.3) | 44 (6) |
> 85 Years | - | 4 (0.5) | 1 (0.1) | - | 5 (0.7) |
Education level | No Education | 21 (2.9) | 77 (10.5) | 1 (0.1) | 7 (1) | 106 (14.5) |
School level | 113 (15.5) | 431 (59) | 25 (3.4) | 24 (3.3) | 593 (81.2) |
Higher education | 2 (0.3) | 26 (3.6) | - | - | 28 (3.9) |
Others | - | 1 (0.1) | - | 2 (0.3) | 3 (0.4) |
Current job | Not working | 110 (15.1) | 448 (61.4) | 23 (3.2) | 32 (4.4) | 613 (84.0) |
Working | 26 (3.6) | 87 (11.9) | 3 (0.4) | 1 (0.1) | 117 (16.0) |
Monthly income | < RM 700 | 60 (8.2) | 200 (27.4) | 11 (1.5) | 19 (2.6) | 290 (39.7) |
RM 701–1400 | 30 (4.1) | 128 (17.5) | 11 (1.5) | 8 (1.1) | 177 (24.2) |
RM 1401–2100 | 20 (2.7) | 103 (14.1) | 2 (0.3) | 5 (0.7) | 130 (17.8) |
RM 2101–2800 | 4 (0.5) | 30 (4.1) | 1 (0.1) | - | 35 (4.8) |
RM 2801–3500 | 13 (1.8) | 33 (4.5) | - | - | 46 (6.3) |
> RM 3500 | 9 (1.2) | 41 (5.6) | 1 (0.1) | 1 (0.1) | 52 (7.1) |
* Percentage out of total sample. |
Table 2
Co-morbidities among the study participants
| Not frail N (%)† | Pre-frail N (%)† | Other frailty N (%)† | Cognitive frailty N (%)† | Total N (%) | P-Value |
Hypertension | 68 (50) | 291 (54.4) | 19 (73.1) | 23 (69.7) | 401 (54.9) | 0.051 |
High cholesterol | 63 (46.3) | 278 (52) | 18 (69.2) | 22 (66.7) | 381 (52.2) | 0.053 |
Diabetes mellitus | 26 (19.1) | 156 (29.2) | 7 (26.9) | 13 (39.4) | 202 (27.7) | 0.050* |
Stroke | 3 (2.2) | 21 (3.9) | 2 (7.7) | 2 (6.1) | 28 (3.8) | 0.478 |
Joint pain | 46 (33.8) | 177 (33.1) | 9 (34.6) | 16 (48.5) | 248 (34) | 0.349 |
Heart disease | 9 (6.6) | 50 (9.3) | 7 (26.9) | 3 (9.1) | 69 (9.5) | 0.014* |
Vision problems | 51 (37.5) | 191 (35.7) | 6 (23.1) | 13 (39.4) | 261 (35.8) | 0.534 |
hearing problems | 17 (12.5) | 70 (13.1) | 6 (23.1) | 7 (21.2) | 100 (13.7) | 0.279 |
Renal failure | 2 (1.5) | 16 (3) | 4 (15.4) | 4 (12.1) | 26 (3.6) | 0.000* |
Chronic lung disease | 3 (2.2) | 5 (0.9) | - | - | 8 (1.1) | 0.507 |
Constipation | 15 (11) | 79 (14.8) | 10 (38.5) | 10 (30.3) | 114 (15.6) | 0.000* |
Gastric ulcer | 10 (7.4) | 77 (14.4) | 6 (23.1) | 4 (12.1) | 97 (13.3) | 0.074 |
Cancer | 4 (2.9) | 15 (2.8) | - | - | 19 (2.6) | 0.632 |
Urinary problems | 9 (6.6) | 70 (13.1) | 7 (26.9) | 9 (27.3) | 95 (13) | 0.002* |
† Percentage out of subgroups. |
* Statistically significant relationship. |
Table 3
Outpatient health care utilization findings of the study participants during the past six months
| Not frail N (%)* | Pre-frail N (%)* | Other frailty N (%)* | Cognitive frailty N (%)* | Total N (%) |
Did you seek any treatment as an outpatient for the illness that you suffered in the last six months? |
No | 32 (4.4) | 111 (15.2) | 3 (0.4) | 6 (0.8) | 152 (20.8) |
Yes | 104 (14.2) | 424 (58.1) | 23 (3.2) | 27 (3.7) | 578 (79.2) |
Where did you seek treatment in the last six months? |
Government clinic | 67 (9.2) | 275 (37.7) | 15 (2.1) | 20 (2.7) | 377 (51.6) |
Government hospital | 21 (2.9) | 126 (17.3) | 7 (1) | 7 (1) | 161 (22.1) |
Private clinic | 24 (3.3) | 68 (9.3) | 3 (0.4) | 7 (1) | 102 (14) |
How many times did you get treatment in government clinic during the last 6 months? |
One visit | 34 (4.7) | 93 (12.7) | 8 (1.1) | 5 (0.7) | 140 (19.2) |
Two visits | 27 (3.7) | 126 (17.3) | 4 (0.5) | 11 (1.5) | 168 (23.0) |
Three visits | 7 (1) | 46 (6.3) | 3 (0.4) | 4 (0.5) | 60 (8.2) |
How many times did you get treatment in government hospital during the last 6 months? |
One visit | 12 (1.6) | 64 (8.8) | 3 (0.4) | 1 (0.1) | 80 (11) |
Two visits | 6 (0.8) | 44 (6) | 5 (0.7) | 4 (0.5) | 59 (8.1) |
Three visits | 2 (0.3) | 18 (2.5) | 0 (0) | 2 (0.3) | 22 (3) |
How many times did you get treatment in private clinic during the last 6 months? |
Non | 112 (15.3) | 463 (63.4) | 23 (3.2) | 26 (3.6) | 624 (85.5) |
One visit | 17 (2.3) | 51 (7) | 3 (0.4) | 7 (1) | 78 (10.7) |
* Percentage out of total sample. |
It was noticeable that cognitive frail patients are not utilizing inpatients hospital care, only 3.0% of cognitive frail patients (n = 1) were admitted to governmental hospitals during last year, myocardial infarction was the diagnosis for this admission, no cognitive frail participants were admitted to private hospitals.
Figure 1 shows the type of vehicles used for transport to outpatient health care facilities during the past six months. The most common type of vehicles used among cognitive frail elderly and all elderly categories (Not frail, pre-frail, other frailties) were private cars and motorcycles, while public transport was not commonly used.
Figure 2 shows the study participant`s total spending categories out of their pockets for seeking of care during past six months. As shown in Fig. 2, more than half of the study participants (52.5%) were spending less than RM 100 per six months for seeking of care services of their pockets, while 26.4%, 12.7%, 8.4% of the study participants were spending RM 101 to RM 200, RM 201 to RM 300, and > RM 300 every six months of their pockets, respectively. Chi-Square test was conducted to examine the presence of significant OOP payment differences between cognitive frail participants and other groups of elderly participants. No statistically significant difference was noticed in the total OOP payments between all groups (Sig = 0.085)
The mean total OOP payments for seeking of care among elderly Malaysians was RM 155.9 every six months. It was noticed that RM 34, RM 14, RM 59, RM 36, RM 26, RM 80, were the mean OOP spending for transport fare, meals, medication charges, Chinese medicine, traditional medicine, and special food treatments, respectively, for elderly Malaysians whom sought health care services during past six months. The mean OOP payment of six months care for elderly Malaysian with cognitive frailty was around RM 84 (SD = 96.0). One way Anova test was conducted to examine the presence of significant differences between cognitive frail participants and other groups of elderly participants in the payments at different items. No significant difference was noticed in the OOP payments for transport fare, meals, drug charges, clinic charges, traditional medicine, special food, and total OOP payments for seeking care during the past six months among cognitive frail, other frailty types, pre-frail, and not frail participants of the study, (F = 0.409, P value = 0.746; F = 2.161, P value = 0.091; F = 0.279, P value = 0.840; F = 1.186, P value = 0.314; F = 0.516, P value = 0.672; F = 0.546, P value = 0.651; F = 1.026, P value = 0.381), respectively. A significant difference was noticed only in the OOP payment for Chinese medicine among the study participants, (F = 5.062, P value = 0.002). Post Hoc - Bonfirroni test has revealed a statistically significant difference in the OOP payment of Chinese medicine between not frail, cognitive frail, and pre-frail participants only. Not frail were using Chinese medicine more than both cognitive frail and pre-frail participants (Sig.=0.022, and Sig.=0.009), respectively.
Figure 3 shows the type and percentage of spending of the study participants out of their pockets for seeking health care during the past six months. As shown in Fig. 3, the biggest payment driver components of care for elderly patients are special food cost (37.0%) and clinic charges (31.1%).