Table 1.

Prevalence of frailty and its standardised assessment tools among Malaysian older person

No	Article	Participant (age, N, location)	Prevalence of frailty	Standardised assessment tools (frailty)	Other standardised assessment tools	Result	Strength and limitation
1.	Ahmad et al. (8)	Age ≥ 60 years old N = 2,413 Location Kuala Pilah a district in the state of Negeri Sembilan, Malaysia	Overall 9.4% (95% CI: 7.8, 11.2) Men = 37.9% Women = 62.1%	Modified Fried’s frailty phenotype  Weight loss (self-reported)  Exhaustion (retrieved from Geriatric Depression Scale [GDS])  Low activity (assessed using Physical Activity Scale for Elderly [PASE])  Weakness (handgrip [Jammar dynamometer])  Slowness (4-metre walk test)	-	Frailty was significantly associated with older age, women and respondents with a higher number of chronic diseases, poor cognitive function and low socioeconomic status (P < 0.05)	Strength  Large sample size and objective measurements of grip strength and walking speed Limitation  Missing data
2.	Sathasivam et al. (15)	Age (mean ± SD) years old 69.6 ± 7.2 N = 789 Location An urban district in Malaysia	Overall 5.7% Men = 28.9% Women = 71.1%	Physical phenotype (Fried’s criteria)  Multidimensional deficit accumulation model (FI)	-	Physical disability falls, and cognition is important determinants for frailty	Strength  Identifies potential risk factors for frailty and provide early preventive measures for prefrail state individual Limitation  Multistage cross-sectional study: causal relationship could not be established
3.	Mohd Hamidin et al. (16)	Aged (mean ± SD) years old 73.32 ± 6.05 N = 279 Location Districts of Terengganu, Malaysia.	Overall 18.3% Men = 41.2% Women = 58.8%	Modified Fried’s frailty phenotype.  Unintentional loss of weight  Feeling of exhaustion from Centre for Epidemiologic Studies Depression (CES-D) scale  Weakness was defined as mean grip strength  Slowness was defined as usual walking speed  Low physical activity level assessed by Rapid Assessment of Physical Activity (RAPA) questionnaires	-	The frail older adults were positively associated with advanced age, being unmarried, hospitalisation in the previous year, poor self-rated health, and lower body mass index	Strength  Baseline data and deepen the knowledge of frailty Limitation  A cross-sectional study: causal relationship could not be established  A small number of participants limit the generalisability
4	Badrasawi et al. (17)	Age ≥ 60 years old Men 68.9 ± 5.9 Women 67.3 ± 5.7 N = 473 Location Klang Valley of Malaysia	Overall 8.9% Men = 26.2% Women = 73.8%	Fried’s criteria  Unintentional weight loss of 5 kg and above over the last year  Weakness (handgrip)  Exhaustion and poor endurance and energy from the CES-D scale  Slowness (gait speed)  Low physical activity of the PASE	-	Binary logistic regression analyses showed that female gender, abdominal obesity, low peak respiratory flow rate score and slower rapid pace gait speed were significant predictors of frailty	Strength  The study has highlighted the prevalence and risk factors of frailty from a wide range of determinants Limitation  A cross-sectional study: causal relationship could not be established  The study did not explore this relationship as it. focused on frailty as an outcome and not as a disability
5.	Norazman et al. (18)	Age ≥ 60 years old N = 301 Location Older person residing at People Housing Project (Projek Perumahan Rakyat (PPR) at Kuala Lumpur	Overall 15.9% Men = 22.9% Women = 77.1%	The standardised phenotype of frailty proposed by Fried	-	Frailty can be predicted by increasing age, low household. income, being at risk of malnutrition, as well as having a low skeletal muscle mass and high serum CRP level	Strength  Identifies prevalence of frailty among urban community elderly with low socioeconomic background and the multiple components of the frailty syndrome Limitation  The prevalence values reported in these studies are the representative sample of the older adult population  The nature of an observational study is limited to the interpretation and the cause-effect mechanism of the current findings
6.	Murukesu et al. (19)	Aged ≥ 60 years old N = 302 Location Older person residing at Projek Perumahan Rakyat (PPR) at Kuala Lumpur	Overall 40.7% Men = 31.1% Women = 68%	Fried’s criteria using cut of points as outlined in the cardiovascular health study	GDS score  The Mini-Mental State Examination (MMSE) Addenbrooke’s Cognitive Examination (ACE-III).  Functional fitness status was determined using the senior fitness test	Frailty is highly prevalent among Malaysian institutionalised older adults. Hypertension, cognitive impairment and lower dynamic balance and mobility were found to be risk factors of frailty	Strength  The study provides insight into the prevalence of frailty, its associated factors, and the cognitive and functional status among the ethnically diverse Malaysian older adults residing in institutions Limitation  The causal relationship between the significant factors associated with frailty could not be formed due to the cross-sectional study design
7.	Rivan et al. (22)	Age (mean ± SD) years old 67.00 ± 4.98 N = 282 Location Selangor and Perak (representing central and northern regions of Malaysia)	Overall 35.5% Men = 37% Women = 63%	Standardised phenotype of frailty proposed by Fried	PASE  Cognitive assessments (MMSE, MoCA, Digit span, RAVLT, Digit symbol, VR I, and VR II)	Advancing age and depression have a significant role in the development of CF. Ageing is an established predominant risk factor for both frailty and cognitive impairment A one-unit increase in the TUG test significantly increases the odds of developing CF among an older population Physical frailty predicts CF better than MCI does	Strength  Report on the incidence rate of cognitive frailty among older adults in Malaysia using longitudinal data  The study involved a wide range of parameters with a detailed protocol covering several domains: fitness, cognitive function, nutrient intake, anthropometric measurements, body composition, psychosocial function, and biochemical indices as predictors of cognitive frailty Limitation  The study only involved. Two out of 14 states in Malaysia, with a smaller sample size at the follow-up, do not match the Malaysian population’s national composition
8.	Hasan et al. (20)	Aged ≥ 65 years old N = 202 Location A total of 17 private aged care homes around Klang Valley in Malaysia	Overall 76%	Groningen Frailty Indicator (GFI)	Potentially Inappropriate Prescribing (PIP)  Potentially Inappropriate Medication (PIM)	The number of medications used per participant correlated significantly and positively (0.21, P = 0.002) with a GFI score	Strength  Identification of medication appropriateness and frailty among residents of aged care homes in Malaysia Limitation  Cross-sectional the design does not allow the establishment of any cause-effect relationship  The small number of participants from aged care homes in urban central Peninsular Malaysia
9.	Kumar et al. (23)	Aged mean ± SD (74.5 ± 8.4) years old N = 151 Location Residents of 11 aged care homes in three states in Malaysia	Overall 75.5%	GFI	Pittsburgh Sleep Quality Index (PSQI) Drug burden index (DBI) PIM PIP	The study population with very poor sleep quality (VPSQ) had the highest mean GFI score (4.9 ± 2.5), followed by participants with moderately poor sleep quality (MPSQ) (4.5 ± 2.8) and participants with normal sleep quality (NSQ) (2.3 ± 2.4).	Strength  The study establishes a relationship between sleep quality and frailty, a physical health outcome Limitation  It is a convenience sampling that may lead to selection bias  The study has a small number of non-Chinese participants limits generalisability to the (whole) Malaysian population
10.	Hasan et al. (20)	Aged ≥ 65 years old N = 202 Location A total of 17 private aged care homes around Klang Valley in Malaysia	Overall 46.9%	GFI	KATZ ADL index, Medication Appropriateness Index (MAI) and PIM	There is a high prevalence of frailty in residents taking CNS medications The level of medication appropriateness assessed using the MAI was higher among frail participants	Strength  This study confirms the GFI’s construct validity and internal consistency for measuring frailty in elderly residents of aged care homes Limitation  Unable able to establish causal relationships between frailty and medication appropriateness