Matrix of determinants and its measurement
| Determinants | Measurement |
|---|---|
| Individual (elderly) | |
| Age | The age will be estimated based on the date of birth as recorded in the Malaysian National Registration Identification Card (NRIC). Where necessary, verification with other documents such as driving license, pension book or other government documents is performed |
| Sex | Male or female as recorded in the NRIC |
| Ethnicity | Ethnic status will be collected as recorded in the NRIC, mainly classified as Bumiputra Malay, Bumiputra non-Malay, Chinese, Indian or other |
| Marital status | Based on current marital status as reported by the elderly, which will be categorised into married, single, divorced or widowed |
| Living arrangement | Living arrangement to be classified as own home, or other, which includes children's home or relatives’ or other persons’ home |
| Education | Elderly's level of formal schooling; categorised as none, primary, secondary or higher |
| Income | Elderly financial status will be measured by asking the amount of funding received every month in Ringgit Malaysia. Various sources of support are recorded, such as current monthly income if working, monthly pension if pensionable, financial aid received through government, NGOs or official sources or estimated amount, if any, received from family members |
| Current employment status | Elderly will be asked if they are currently employed in any capacity |
| Comorbidities (chronic diseases | Elderly will be asked if they have been diagnosed by a physician for any chronic illness, which includes high-blood pressure, heart problems or blood circulation problems, stroke, joint pains or arthritis, Parkinson's disease, diabetes, breathing problems (asthma, lung infections) and cancer |
| Physical disability | The Katz Index of Independence in Activities of Daily Living (Katz ADL), and Lawton Instrumental Activities of Daily Living Scale (Lawton IADL), are used to assess an older adult's ability to independently perform self-care and maintenance. Katz activity of daily living has six items scored on a 3-point response scale (independent, some assistance or dependent). Higher score indicates elderly's independence.27 Lawton IADL has eight items that assess independent living skills that are considered more complex than basic ADL. A summary score ranges from 0 (dependent) to eight (independent)28 |
| Physical function | Two aspects of physical function of the elderly will be measured.
|
| Cognitive impairment | The Elderly Cognitive Assessment Questionnaire is a quantitative assessment of cognitive impairment among elderly people. A score lower than 6 is categorised as being cognitively impaired29 |
| Individual (caregiver) | |
| Caregiver demographic | Caregiver's age, sex, education, employment and household income level will be collected. Education, employment and income will be used as indicators to determine the socioeconomic status of the caregiver |
| Caregiver's substance abuse | Two items to measure caregivers’ substance use including of alcohol and drugs will be included |
| Caregiver's mental illness or aggressive behaviour | The elderly will be asked if their caregiver has any form of mental illness or presents aggressive behaviour |
| Caregiver caregiving and coping skills | Caregiver reactive assessment with 24 items designed to assess specific aspects of the caregiving situation, including both negative and positive dimensions of caregiving reactions, will be conducted30 |
| Caregiver's prior history of abuse | Caregivers will be asked if they had, while growing up, experienced any form of child abuse or domestic violence |
| Relationship | |
| Caregiver–elderly relationship | The quality of the caregiver–care recipient relationship will be assessed through measurements of the quality of the current relationship in relation to general closeness, communication, similarity of views about life and degree of getting along It has four items on a 4-point Likert scale response31 |
| Living arrangement | Current living arrangement will be categorised as own home, or other, which includes children's home, relative's or other person's home |
| Caregiver depression | Depression Anxiety Stress scale is 21 item self-report scale designed to measure the negative emotional states of depression, anxiety and stress experienced by the caregiver32 |
| Caregiver burden | Brief COPE is a brief measure with 28 items assessing caregiver's burden and coping mechanism. Higher scores indicate ineffective coping mechanism33 |
| Dependency of elderly or caregiver | Two items that measure elderly's fear of abandonment, loneliness and tolerance towards aggressive behaviour |
| Religious commitment | A salience in religious commitment scale is used to measure the extent to which elderly and their caregiver consider their religious beliefs to be important both in general and in decision-making. The scale has only three items on a 4-point Likert-type scale. Total scores range from 3 to 1134 |
| Community and societal | |
| Social support | The Duke Social Support Index has 11 items that measure social support received by the elderly. The higher the score, the greater the support perceived by the elderly35 |
| Social isolation | The Lubben Social Network Scale (LSNS-6) is used to screen for social isolation among community-dwelling elders. A score of 11 or less on the LSNS-6 indicates social isolation36 |
| Social cohesion | The social cohesion and trust domain from the Collective Efficacy Scale is utilised. It is a 5-item Likert-type scale asking how strongly participants agreed with the statements regarding people around their neighbourhood37 |