Changes in indicators of well-being on moving from home to long-term care for Māori in Aotearoa New Zealand: A retrospective cohort study.

Objective: To investigate changes in well-being measures for older Māori after moving from community to long-term care (LTC).

Methods: We undertook a retrospective cohort study of older Māori in New Zealand (NZ) who had received assessments for their health needs whilst living at home (interRAI-HC assessment) as well as a subsequent assessment after moving into a care facility (interRAI-LTCF). All interRAI-HC assessments from 01 July 2013 to 21 December 2018 were identified and matched to LTCF assessments that were undertaken at least 6 months later.

Drug Burden Index Is a Modifiable Predictor of 30-Day Hospitalization in Community-Dwelling Older Adults With Complex Care Needs: Machine Learning Analysis of InterRAI Data.

Background: Older adults (≥65 years) account for a disproportionately high proportion of hospitalization and in-hospital mortality, some of which may be avoidable. Although machine learning (ML) models have already been built and validated for predicting hospitalization and mortality, there remains a significant need to optimize ML models further. Accurately predicting hospitalization may tremendously affect the clinical care of older adults as preventative measures can be implemented to improve clinical outcomes for the patient.

A multistate transition model of changes in loneliness and carer stress among community-dwelling older adults in Aotearoa New Zealand.

Objectives: To identify changes in loneliness and carer stress between two time points for older people of different ethnicities who had repeated interRAI home care assessments.

Methods: Participants consisted of community-dwelling older adults across New Zealand who received two interRAI-HC assessments between 5 July 2012 and 31 December 2019. Two multistate models were developed: the first model was not lonely versus lonely, and the second model was no carer stress versus carer stress.

The Drug Burden Index and Level of Frailty as Determinants of Healthcare Costs in a Cohort of Older Frail Adults in New Zealand.

Objectives: Frailty is common in older people and is associated with increased use of healthcare services and ongoing use of multiple medications. This study provides insights into the healthcare cost structure of a frail group of older adults in Aotearoa, New Zealand. Furthermore, we investigated the relationship between participants' anticholinergic and sedative medication burden and their total healthcare costs to explore the viability of deprescribing interventions within this cohort.

Falls Risk in Long-Term Care Residents With Cognitive Impairment: Effects of COVID-19 Pandemic.

Objectives: The aim of this study was to investigate the impact of the COVID-19 pandemic on falls rates in long-term care residents with cognitive impairment.

Design: An observational study using routinely collected national interRAI data.

Setting And Participants: Participants were from long-term care residents (age ≥60 years) who received an interRAI Long Term Care Facility assessment anywhere in New Zealand between August 17, 2018, and August 16, 2022.

Multimorbidity associated with urinary incontinence among older women and men with complex needs in Aotearoa | New Zealand.

Aims: To investigate the association between multimorbidity and urinary incontinence (UI) among community living older adults with complex needs in sex-specific crude and adjusted analyses.

Methods: Since 2012 in Aotearoa | New Zealand (NZ) all community-living older people with complex needs who require publicly funded assistance undergo a comprehensive standardized geriatric needs assessment using the interRAI-HC instrument. Consenting adults aged ≥65 years who undertook this assessment between July 5, 2012 and December 31, 2020 were investigated.

Utility of Big Data to Explore Medication Adherence in Māori and Non-Māori Community-Dwelling Older Adults with Heart Failure in Aotearoa New Zealand: A Cross-sectional Study.

Background: Medication adherence improves morbidity and mortality-related outcomes in heart failure, and knowledge of patterns of medication adherence supports patient and clinician decision-making. Routinely collected national data facilitate the exploration of medication adherence and associated factors in older adults with heart failure, including the association between ethnicity and adherence. There are known inequities in access to medicines between Māori (Indigenous People of Aotearoa New Zealand) and non-Māori, yet ethnic variation in medicines adherence in community-dwelling older adults with heart failure has not been explored.

Post Hoc Analyses of a Randomized Controlled Trial for the Effect of Pharmacist Deprescribing Intervention on the Anticholinergic Burden in Frail Community-Dwelling Older Adults.

Objectives: Anticholinergic burden is detrimental to cognitive health. Multiple studies found that a high anticholinergic burden is associated with an increased risk for dementia, changes to the brain structure, function, and cognitive decline. We performed a post hoc analysis of a randomized controlled deprescribing trial.

Chronic health conditions and mortality among older adults with complex care needs in Aotearoa New Zealand.

Background: Older people have more comorbidities than younger groups and multimorbidity will increase. Often chronic conditions affect quality of life, functional ability and social participation. Our study aim was to quantify the prevalence of chronic conditions over a three-year period and their association with mortality after accounting for demographics.

Dementia and cataract surgery in Australia and New Zealand.

Background: Cataract surgery improves quality of life and reduces cognitive deterioration.

Objectives: This paper discusses the health implications of low vision, commonly related to cataracts, in older adults. A recent publication reported that cataract surgery reduces the risk of dementia by 30% over 10 years.

The association between anticholinergic burden and mobility: a systematic review and meta-analyses.

Background: As people age, they accumulate several health conditions, requiring the use of multiple medications (polypharmacy) to treat them. One of the challenges with polypharmacy is the associated increase in anticholinergic exposure to older adults. In addition, several studies suggest an association between anticholinergic burden and declining physical function in older adults.

Deprescribing Anticholinergic and Sedative Drugs to Reduce Polypharmacy in Frail Older Adults Living in the Community: A Randomized Controlled Trial.

Background: Polypharmacy is associated with poor outcomes in older adults. Targeted deprescribing of anticholinergic and sedative medications may improve health outcomes for frail older adults. Our pharmacist-led deprescribing intervention was a pragmatic 2-arm randomized controlled trial stratified by frailty.

Evaluation of the added value of Brain Natriuretic Peptide to a validated mortality risk-prediction model in older people using a standardised international clinical assessment tool.

The ability to accurately predict the one-year survival of older adults is challenging for clinicians as they endeavour to provide the most appropriate care. Standardised clinical needs assessments are routine in many countries and some enable application of mortality prediction models. The added value of blood biomarkers to these models is largely unknown.

Carer distress among community living older adults with complex needs in the pre- and post-COVID-19 era: a national population study.

Carer distress is one important negative impact of caregiving and likely exacerbated by the novel coronavirus disease 2019 (COVID-19) pandemic, yet little population-based epidemiological information exists. Using national data from repeated standardized comprehensive geriatric needs assessments, this study aims to: describe the pattern of caregiver distress among those providing informal care to community-living adults aged ≥ 65 years with complex needs in New Zealand over time; estimate the COVID-19 effect on this temporal pattern; and, investigate relationships between participants' sociodemographic and selected health measures on caregiver distress. Fractional polynomial regression and multivariable multilevel mixed-effects models were employed.

Development and validation of a frailty index compatible with three interRAI assessment instruments.

Background: a Frailty Index (FI) calculated by the accumulation of deficits is often used to quantify the extent of frailty in individuals in specific settings. This study aimed to derive a FI that can be applied across three standardised international Residential Assessment Instrument assessments (interRAI), used at different stages of ageing and the corresponding increase in support needs.

Methods: deficit items common to the interRAI Contact Assessment (CA), Home Care (HC) or Long-Term Care Facilities assessment (LTCF) were identified and recoded to form a cumulative deficit FI.

An interRAI derived frailty index predicts acute hospitalizations in older adults residing in retirement villages: A prospective cohort study.

Objectives: The development of frailty tools from electronically recorded healthcare data allows frailty assessments to be routinely generated, potentially beneficial for individuals and healthcare providers. We wished to assess the predictive validity of a frailty index (FI) derived from interRAI Community Health Assessment (CHA) for outcomes in older adults residing in retirement villages (RVs), elsewhere called continuing care retirement communities.

Design: Prospective cohort study.

Impact of the first wave of COVID-19 on the health and psychosocial well-being of Māori, Pacific Peoples and New Zealand Europeans living in aged residential care.

Objective: To investigate the impact of New Zealand's (NZ) first wave of COVID-19, which included a nationwide lockdown, on the health and psychosocial well-being of Māori, Pacific Peoples and NZ Europeans in aged residential care (ARC).

Methods: interRAI assessments of Māori, Pacific Peoples and NZ Europeans (aged 60 years and older) completed between 21/3/2020 and 8/6/2020 were compared with assessments of the same ethnicities during the same period in the previous year (21/3/2019 to 8/6/2019). Physical, cognitive, psychosocial and service utilisation indicators were included in the bivariate analyses.

Factors associated with caregiver distress among home care clients in New Zealand: Evidence based on data from interRAI Home Care assessment.

Objective: To identify factors associated with caregiver distress among home care clients in New Zealand.

Methods: The cohort consisted of 105,978 community-dwelling people aged 65 years or older requiring home care services in New Zealand who had at least one informal caregiver. Bivariate and multivariable logistic regression analyses were used to identify factors associated with caregiver distress.

Risk factors for injuries in New Zealand older adults with complex needs: a national population retrospective study.

Background: Falls and falls-related injuries are common among older adults. Injuries in older adults lead to poor outcomes and lower quality of life. The objective of our study was to identify factors associated with fall-related injuries among home care clients in New Zealand.

Deprescribing to reduce polypharmacy: study protocol for a randomised controlled trial assessing deprescribing of anticholinergic and sedative drugs in a cohort of frail older people living in the community.

Background: Targeted deprescribing of anticholinergic and sedative medications in older people may improve their health outcomes. This trial will determine if pharmacist-led reviews lead to general practitioners deprescribing anticholinergic and sedative medications in older people living in the community.

Methods And Analysis: The standard protocol items: Recommendations for Interventional Trials (SPIRIT) checklist was used to develop and report the protocol.

It's about who they are and what they can do: Māori perspectives on frailty in later life.

Aim: This study aimed to explore Māori (the indigenous people of Aotearoa New Zealand) understandings of frailty.

Method: Focus groups were held with older Māori in supported living, health professionals working with older Māori and a rural community. A qualitative thematic analysis was conducted.

What Is Frailty? Perspectives from Chinese Clinicians and Older Immigrants in New Zealand.

This qualitative study explores the meanings of frailty held by Chinese New Zealanders and Chinese health care professionals with the aim of identifying commonalities as well as potential differences. Two guided focus groups with Mandarin and Cantonese speaking older adults (n = 10), one individual interview with a English speaking older Chinese, and one focus group with Chinese New Zealand health care professionals (n = 7) were held to obtain views on frailty in older adults, followed by transcribing and a thematic qualitative analysis. Three main themes emerged: (1) Frailty is marked by ill-health, multiple chronic and unstable medical comorbidities, and is a linked with polypharmacy; (2) Frailty can involve physical weakness, decline in physical function such as reduced mobility or poor balance, and declining cognitive function; and (3) Frailty is associated with psychological and social health including depression, reduced motivation, social isolation, and loss of confidence.