Education According to Puteh et al. (2015) higher prevalence

Education level might be the factor that differentiates the ADL dependency among ethnic. Puteh et al. (2015) presented that almost 70% elderly Chinese had a higher educational level which is secondary and tertiary level as compared to 49.5% of the Malays and 40% of the Indians. Hairi (2010) found that Indians have the highest prevalence of self-reported of physical disability followed by Malays and Chinese. According to Puteh et al. (2015) higher prevalence of ADL was due to the less number of publicly institutionalized for elderly in Malaysian population as these government funded the institutions are strictly reserved for the elderly without homes, heirs or family.



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 . In Malaysia, the First National Health and Morbidity Survey (NHMS 1) that had been conducted in 1986 had reported that the prevalence of diabetes mellitus is 6.3% and in the prevalence had risen to 8.2% on Second National Health and Morbidity Survey (NHMS2) in 1996 (Mafauzy 2006). Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation (WHO 2017).  Diabetic peripheral neuropathy is a common diabetic complication that affects peripheral neuropathy due to longer duration of diabetic peripheral neuropathy and age (WHO 2017). DPN will lead to painful DPN that commonly affect the peripheral. The pain varies for every people.

The study in Japan shows that patients with DPN had poorer QOL and more in the depressive state compared to those without DPN (Tsuji 2013). The study done by Riandini et al. (2017) shows that patient with DPN have significantly lower HRQoL which explained by a reduction in balance confidence and increase in body sway velocity. According to Malik (2017) physicians believed that PDPN had a greater impact on QOL than without PDPN.

A study done by Sherina (2004) shows that elderly suffered from the chronic disease had a higher proportion of functional dependence such as diabetic mellitus, hypertension, ischemic heart problem, gout and respiratory problem. Painful diabetic peripheral neuropathy is one of chronic disease that affects neuropathy that will increase in functional status. Based on Jambart et al. (2011), PDPN is associated with increases in functional impairment, impairment in health-related quality of life and activities of daily living. The study done by Riandini et al. (2017) proposed that PDPN leads to specific sensorimotor deficits with limitations in balance or postural stability, functional strength, gait, and mobility.

 There is no specific study that proves the effect of PDPN on functional status among elderly. Most of the study done on PDPN was only focus on general not specific to older people. Most of the study shows that poor quality of life may lead to a deficit in functional status Hairi et al (2010) mentioned that the prevalence of disability and functional limitation is increasing in age. Hence, the number of aging population with PDPN was predictable to increase in the number of functional status limitation and physical disability.