Objectives: To examine the association between elder abuse and poor sleep using a Malay validated version of Pittsburgh Sleep Quality Index (PSQI). Design: This study was divided into two phases. Phase I tested the construct validity and reliability of the Malay version of PSQI. Phase II was a population-based, cross-sectional study with a multi-stage cluster sampling method. Home-based interviews were conducted by trained personnel using a structured questionnaire, to determine exposure and outcome. Setting: Kuala Pilah, a district in Negeri Sembilan which is one of the fourteen states in Malaysia. Participants: 1648 community-dwelling older Malaysians. Results: The Malay version of PSQI had significant test re-test reliability with intra-class correlation coefficients of 0.62. Confirmatory factor analyses revealed that one factor PSQI scale with three components (subjective sleep quality, sleep latency, and sleep disturbances) was most suitable. Cronbach’s Alpha was 0.60 and composite reliability was 0.63. PSQI scores were highest among neglect (4.11), followed by physical (4.10), psychological (3.96) and financial abuse (3.60). There was a dose-response relationship between clustering of abuse and PSQI scores; 3.41, 3.50 and 3.84 for “no abuse”, “1 type of abuse” and “2 types or more”. Generalized linear models revealed six variables as significant determinants of sleep quality–abuse, co-morbidities, self-rated health, income, social support and gait speed. Among abuse subtypes, only neglect was significantly associated with poor sleep. Conclusion: The Malay PSQI was valid and reliable. Abuse was significantly associated with poor sleep. As sleep is essential for health and is a good predictor for mortality among older adults, management of abuse victims should entail sleep assessment. Interventions or treatment modalities which focus on improving sleep quality among abuse victims should be designed.

Aim: Elder abuse is a significant public health problem. This study aims to estimate its prev-alence and associated factors, using representative national Malaysian data.Methods: A nationwide population-based survey involving 3977 community-dwelling olderpersons aged ≥60 years was conducted via face-to-face interview, of whom 3466 older personswere eligible for screening using a locally validated tool. Elder abuse was defined as any oneoccurrence of neglect, financial, psychological, physical or sexual abuse perpetrated by some-one in a position of trust that was experienced in the past 12 months.Results: About 9.0% of older persons in Malaysia have experienced elder abuse in the past12 months, with neglect being the commonest type experienced (7.5%; 95% confidenceinterval [CI]: 5.54, 10.07). There is no significant difference by age group and geographicallocation. Males (adjusted odds ratio [aOR] 1.7; 95% CI: 1.06, 2.60), poorer social support(aOR 5.0; 95% CI: 2.25, 11.22), dependency in activities of daily living (aOR 2.1; 95% CI:1.23, 3.44) and a previous history of abuse (aOR 10.1; 95% CI: 4.50, 22.86) show higher oddsof experiencing elder abuse. Almost 5% of abused older persons reported experiencing multi-ple types of abuse. Reporting is low at 19.3% with none reporting to healthcare personnel.Conclusions: The prevalence of elder abuse in this study is lower than global estimates, butsimilar to local studies. Preventive measures and programs are crucial to overcoming elderabuse and need to be carried out at multiple levels – the individual, community, healthcareand other stakeholders.

Despite being now recognised as a global health concern, there is still an inadequate amount of research into elder mistreatment, especially in low and middle-income regions. The purpose of this paper is to report on the design and methodology of a population-based cohort study on elder mistreatment among the older Malaysian population. The study aims at gathering data and evidence to estimate the prevalence and incidence of elder mistreatment, identify its individual, familial and social determinants, and quantify its health consequences.

Our study aims at describing mortality among reported elder abuse experiences in rural Malaysia. This is a population-based cohort study with a multistage cluster sampling method. Older adults in Kuala Pilah (n = 1,927) were interviewed from November 2013 to May 2014. Mortality was traced after 2 years using the National Registration Department database. Overall, 139 (7.2%) respondents died. Fifteen (9.6%) abuse victims died compared to 124 (7.0%) not abused. Mortality was highest with financial abuse (13%), followed by psychological abuse (10.8%). There was a dose-response relationship between mortality and clustering of abuse: 7%, 7.7%, and 14.0% for no abuse, one type, and two types or more, respectively. Among abuse victims, 40% of deaths had ill-defined causes, 33% were respiratory-related, and 27% had cardiovascular and metabolic origin. Results suggest a link between abuse and mortality. Death proportions varied according to abuse subtypes and gender. Keywords: Abuse outcome; Malaysia; descriptive study; effects of elder abuse; elder mistreatment; exploratory; family violence; mortality.

Background: Waterpipe tobacco smoking has becoming popular especially among young people worldwide. Smokers are attracted by its sweeter, smoother smoke, social ambience and the misconception of reduced harm. The objective of this study was to systematically review the effects of waterpipe tobacco policies and practices in reducing its prevalence. Materials and Methods: A systematic review was conducted electronically using the PubMed, OVID, Science Direct, Proquest and Embase databases. All possible studies from 1980 to 2013 were initially screened based on titles and abstracts. The selected articles were subjected to data extraction and quality rating. Results: Three studies met the inclusion criteria and were eligible for this review. Almost all of the waterpipe tobacco products and its accessories did not comply with the regulations on health warning labelling practices as stipulated under Article 11 of WHO FCTC. In addition, the grisly new warning labels for cigarettes introduced by Food and Drug Administration did not affect hookah tobacco smoking generally. Indoor air quality in smoking lounges was found to be poor and some hookah lounges were operated without smoke shop certification. Conclusions: Our findings revealed the availability of minimal information on the practices in controlling waterpipe smoking in reducing its prevalence. The lack of comprehensive legislations or practices in controlling waterpipe smoking warrants further research and policy initiatives to curb this burgeoning global epidemic, especially among the vulnerable younger population.

Background: As Malaysia is fast becoming an ageing nation, the health, safety and welfare of elders are major societal concerns. Elder abuse is a phenomenon recognised abroad but less so locally. This paper presents the baseline findings from the Malaysian Elder Mistreatment Project (MAESTRO) study, the first community-based study on elder abuse in Malaysia. Design: Cross-sectional study, analysing baseline findings of a cohort of older adults. Setting: Kuala Pilah district, Negeri Sembilan state, Malaysia. Objectives: To determine the prevalence of elder abuse among community dwelling older adults and its associated factors. Participants: A total of 2112 community dwelling older adults aged 60 years and above were recruited employing a multistage sampling using the national census. Primary and secondary outcome measures: Elder abuse, measured using a validated instrument derived from previous literature and the modified Conflict Tactic Scales, similar to the Irish national prevalence survey on elder abuse with modification to local context. Factors associated with abuse and profiles of respondents were also examined. Results: The prevalence of overall abuse was reported to be 4.5% in the past 12 months. Psychological abuse was most common, followed by financial, physical, neglect and sexual abuse. Two or more occurrences of abusive acts were common, while clustering of various types of abuse was experienced by one-third of abused elders. Being male (adjusted OR (aOR) 2.15, 95%CI 1.23 to 3.78), being at risk of social isolation (aOR 1.96, 95%CI 1.07 to 3.58), a prior history of abuse (aOR 3.28, 95%CI 1.40 to 7.68) and depressive symptomatology (aOR 7.83, 95%CI 2.88 to 21.27) were independently associated with overall abuse. Conclusion: Elder abuse occurred among one in every 20 elders. The findings on elder abuse indicate the need to enhance elder protection in Malaysia, with both screening of and interventions for elder abuse.