PONE-D-23-00513

The burden of non-disabled frailty and its associated factors among older adults in Bangladesh

PLOS ONE

Dear Dr. Mistry,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Detailed comments from both reviewers and especially reviewer 2, should help the authors to improve the manuscript. Although detailed and many, the comments should not very difficult to address. I encourage the authors to address all the comments sincerely. 

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Please submit your revised manuscript by Jul 14 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
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If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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We look forward to receiving your revised manuscript.

Kind regards,

Shahriar Ahmed, MBBS, MHE

Academic Editor

PLOS ONE

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We will update your Data Availability statement on your behalf to reflect the information you provide.

4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors estimated both non-disabled frailty and disability using the FiND questionnaire but I am not clear on the reasons for the inclusion of the questions about disability or the inclusion in the results of disability and robustness.

The authors give some prominence to the male/female difference in non-disabled frailty yet the difference is small and does not reach statistical significance. I would recommend not giving this finding such prominence as it would be difficult to recommend policy based on this.

Minor issues: Conclusions in the abstract; should read "present" rather than "preset".

Figure 1; "Disable" should read "Disabled".

Figure 1, the Y=axis needs label (presumably %?)

Reviewer #2: External Reviewer

This research on non-disabled frailty among older adults is very important for health and well-being of elderly populations and for that I think this is an important study.

I have a few comments/questions that I think should be addressed properly.

Comments:

Abstract:

1. Results: Revision of the results section required for further clarity. Please check for grammatical issues also.

2. Conclusion: Your conclusion should be based on the findings of the study (Please revise). What do you mean by “comprehensive support care package”? Typographical errors (tense, spelling, etc).

Introduction:

3. Frailty suddenly appeared in the last sentence of first paragraph and the link between first and second paragraph not properly done. Revision required.

4. Last sentence of the second paragraph was hard to grasp on what you were trying to convey.

5. Last paragraph requires attention and significant revision. Sentences beginning with “Thus” appeared in almost everywhere.

6. There are typographical errors (tense, spelling, grammar) that could be fixed to improve the readability of the manuscript (Introduction, Methodology, Results and Discussion). Introduction part requires significant rearrangement. Rationale should be done properly based on the objective.

7. Referencing should be done properly.

Methods and materials:

8. Sampling framework hard to make any senses. Please revise

9. Sample size based on the “response rate” and overall “response rate “creating confusion. Please revise accordingly.

10. “The inclusion criterion was the minimum age of 60 years” of whom? Please check the whole manuscript for sentence making so that conveying messages make senses.

11. First sentence of the outcome measure is hard to grasp. Please revise.

12. Multiple grammatical errors in this section.

13. What is “robust”?

14. Explanatory variables- what do you mean by “without partner” in the “marital status (married/without a partner)” variable?

15. How many research assistants you had recruited for the study? Did you provide any training before the actual data collection? If yes, how long?

16. Data collection tools and techniques require significant revision.

17. Statistical analyses lack proper guidance what you have done in the paper.

18. Ethics approval: “All procedures performed in studies….” Did not understand? Second sentence failed to convey messages properly. Please revise.

Results:

19. Characteristics of the participants- Please revise with most important information that aligns with your objectives.

20. 19.7% were considered disabled (more than 200 people out of 1045!). This is huge number. Can you please share what types of disability you found in this study?

21. “perceiving family members to be non-responsive to their needs (RRR= 1.47, 95% CI: 1.06-2.03)….” what do you mean by “perceiving family members”?

22. What is “concentration”? Provide the definitions of “low memory” and “concentration”.

23. Please revise this statement- “participants who reported a feeling of loneliness had a significantly higher risk of frailty compared to those who did not feel so”.

Discussion:

24. Did not understand the first paragraph of the discussion section. Please revise to convey the messages properly.

25. “The discrepancies in frailty prevalence between the study and the literature may be attributable to methodological factors such as…” and after that you provided examples of determinants not the methodological factors. This paragraph requires significant revision.

26. “In our study, the odds of frailty were higher in the higher age group ….” In the results, you mentioned about RRR. Here you are talking about odds? Why, revise accordingly.

27. “Like many other countries of the world, Bangladesh is also facing an epidemiological transition” What are the countries you are talking about? Rich, poor, developing, developed?

28. “We found that older adults living in a large family and reported having their family members nonresponsive to their care had a higher chance of frailty. These two things are interlinked….” How they are interlinked? Did you analyze that? Did you mention that in the results?

29. Explanation of the fourth paragraph of the discussion section is not comprehensive and logical enough. Please provide scientific explanations with relevant references.

30. “After a certain period of life, depending financially, emotionally, and physically on children and receiving care from there is culturally expected and appropriate.” Don’t understand what you are trying to convey here?

31. Need more elaborations on limitations of the study.

Conclusion:

32. “Overall, the findings of the study suggest analyzing and understanding frailty and its associated components is an essential first step toward that preventive goal” What are the associated components you are trying to imply here?

33. Please revise the conclusion section for better understanding.

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Calum Mattocks

Reviewer #2: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-23-00513R1The burden of non-disabled frailty and its associated factors among older adults in BangladeshPLOS ONE

Dear Dr. Mistry,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

We believe that the first revision was comprehensive and was able to address most of the comments from the reviewers. However, the comments from reviewer 2 should not be very difficult to address and we believe that doing so will significantly improve the quality and acceptability of the manuscript. We look forward to receiving your prompt response.

==============================

Please submit your revised manuscript by Oct 01 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Shahriar Ahmed, MBBS, MHE

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear authors, thank you for submitting the manuscript for consideration. We are happy to see that the overall quality of the manuscript has much improved during the first revision. We believe that you will be able to address the rest of the comments from one of the reviewers and we will be able to move forward with a final decision soon.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: Please see the comments provided in the pdf. The author need to address the comments properly in the revised version for further clarification.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Calum Mattocks

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: PONE-D-23-00513_R1_MMR.pdf

The burden of non-disabled frailty and its associated factors among older adults in Bangladesh

PONE-D-23-00513R2

Dear Dr. Mistry,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Shahriar Ahmed, MBBS, MHE, MPhil

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear authors,

Thank you for your patience with us. This manuscript can now be accepted with minor revisions, mostly related to language edits. We believe that you have benefitted from the review process although it took longer than we would like. However, we are happy that we have been able to recommend a decision to the Editor. We wish you best of luck.

Thank you!

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PONE-D-23-00513_R2_MMR.pdf