Andy Towers

The effects of types of social networks, perceived social support, and loneliness on the health of older people: accounting for the social context.

Objectives: To use an ecological model of ageing (Berkman, Glass, Brissette, & Seeman, 2000) which includes upstream social context factors and downstream social support factors to examine the effects of social networks on health. Method: Postal survey responses from a representative population sample of New Zealanders aged 55 to 70 years (N = 6,662). Results: Correlations and multiple regression analyses provided support for a model in which social context contributes to social network type, which affects perceived social support and loneliness, and consequent mental and physical health. Ethnicity was related to social networks and health but this was largely accounted for by other contextual variables measuring socioeconomic status. Gender and age were also significant variables in the model. Discussion: Social network type is a useful way to assess social integration within this model of cascading effects. More detailed information could be gained through the development of our network assessment instruments for older people.

Independence, Well‐being, and Social Participation in an Aging Population

Abstract:  In 2005 the Health, Work, and Retirement (HWR) Longitudinal Study was established at Massey University in order to identify the later‐midlife factors that lay the basis for community participation, independence, and health in later life. Information was collected via postal questionnaire on physical and mental health, psychosocial factors, work and retirement attitudes, and socioeconomic and demographic indicators of a sample of 6662 community‐dwelling adults aged 55–70 years. This report provides an overview of these results, and highlights the impact that the transition from work to retirement has on the health and retirement adjustment of older people with respect to independence, well‐being, and social participation.

Researching moral distress among New Zealand nurses A national survey

Background: Moral distress has been described as a major problem for the nursing profession, and in recent years, a considerable amount of research has been undertaken to examine its causes and effects. However, few research projects have been performed that examined the moral distress of an entire nation’s nurses, as this particular study does. Aim/objective: The purpose of this study was to determine the frequency and intensity of moral distress experienced by registered nurses in New Zealand. Research design: The research involved the use of a mainly quantitative approach supported by a slightly modified version of a survey based on the Moral Distress Scale–Revised. Participants and research context: In total, 1500 questionnaires were sent out at random to nurses working in general areas around New Zealand and 412 were returned, giving an adequate response rate of 27%. Ethical considerations: The project was evaluated and judged to be low risk and recorded as such on 22 February 2011 via the auspices of the Massey University Human Ethics Committee. Findings: Results indicate that the most frequent situations to cause nursing distress were (a) having to provide less than optimal care due to management decisions, (b) seeing patient care suffer due to lack of provider continuity and (c) working with others who are less than competent. The most distressing experiences resulted from (a) working with others who are unsafe or incompetent, (b) witnessing diminished care due to poor communication and (c) watching patients suffer due to a lack of provider continuity. Of the respondents, 48% reported having considered leaving their position due to the moral distress. Conclusion: The results imply that moral distress in nursing remains a highly significant and pertinent issue that requires greater consideration by health service managers, policymakers and nurse educators.

An exploratory study examining the relationships between the personal, environmental and activity participation variables and quality of life among young adults with disabilities.

Abstract Purpose: Despite the apparent importance of International Classification of Functioning, Disability and Health (ICF) framework in influencing the relationships between participation and quality of life (QoL), limited research has been given to comprehensive modelling of their influence. The purpose of this study was to explore the relationships between ICF components, participation factors and QoL among young adults with disabilities. Methods: This study tested a theoretically and empirically based explanatory model on 119 young adults with disabilities to examine how the variables of functional impact, financial behaviour, self-efficacy, neighbourhood environment, social support, social and community participation, satisfaction with participation influenced QoL. Analyses were performed with AMOS maximum likelihood parameter estimation. Results: The final model accepted in this study showed a well-fitted model, which explained 65% of the variance in QoL. Results from the statistical modelling indicated that all the ICF components and satisfaction with participation influenced the level of QoL in young adults with disabilities in either a direct or indirect manner. Conclusions: These findings provide evidence that young adults with disabilities have a very complex interaction of their activity participation, social membership, community connectedness, life satisfaction, suggesting that their context of QoL is shaped by how they make sense not only with their functional status, but also the social and community environment. Current findings further demonstrate that the ICF model of functioning and disability should be thought of as multidimensional and more than instrumental in character when being used by health and rehabilitation professionals. Implications for Rehabilitation This study supports the ICF model to include the concept of QoL as the outcome. Rehabilitation practitioners are encouraged to view the ICF model as multidimensional when designing interventions. Social context and support should be included when developing strategies to enhance QoL in youth transition to adulthood.

Estimating older hazardous and binge drinking prevalence using AUDIT-C and AUDIT-3 thresholds specific to older adults

BACKGROUND This study aimed to provide hazardous and binge drinking prevalence, odds and risk attributable to specific demographic correlates in community dwelling older adults using both the standard and new older-specific AUDIT-C thresholds. METHODS Hazardous drinking was assessed using the AUDIT-C in a cross-sectional postal survey of 6662 New Zealanders aged 55-70 years old (m=60.94, SD=4.70) randomly selected from the New Zealand Electoral Roll. Prevalence data is presented for whole sample and stratified by key demographic correlates using standard and older-specific threshold scores on the AUDIT-C. Hazardous drinking prevalence using the standard AUDIT-C threshold was 56.01%, as compared to 42.28% and 50.20% under two older-specific thresholds. RESULTS Being younger, male, and wealthy were consistent drinking predictors across thresholds but the older-specific thresholds substantially altered the prevalence and risk for females, Asians, and poorer people. Past-month binge prevalence of 18.18% was considerably lower than the past-year prevalence of 33.51%, but change from past-month to past-year binge threshold had no significant effect on the demographic composition of binge drinkers. The standard AUDIT-C threshold over-estimates hazardous drinking prevalence in older adults by up to 33%, but even the most conservative rates in this study are cause for concern regarding the level of drinking by older people in New Zealand. CONCLUSION Older hazardous drinkers are predominantly younger, wealthier, white, partnered males, whichever threshold is used, but binge drinkers are more likely to be rural, Māori, and lack tertiary education. Further efforts are needed to determine factors underpinning hazardous drinking, especially in older Māori.

The Impact of Mobility on Quality of Life Among Older Persons

Objective: The purpose of this cross-sectional study was to determine the extent and manner in which mobility is related to quality of life (QOL) in a representative sample of older adults. Method: Two models were assessed using structured equation modeling. The first hypothesized that mobility would have a direct effect on QOL along with other variables, including; number of health conditions and satisfaction with functional capacity, life essentials (e.g., transport, access to health services, and conditions of living space) and personal relationships. The second hypothesized that mobility would have its greatest influence on QOL through satisfaction with functional capacity. Results: While both models found that mobility and all three measures of life satisfaction were significantly associated with QOL, goodness of fit indices were higher for the second model. Discussion: The findings from this study suggest that mobility interventions designed to enhance QOL should address satisfaction with functional capacity as well.

The Influence of Ethnicity and Gender on Caregiver Health in Older New Zealanders

OBJECTIVES We examined the interrelationships between ethnicity, gender, and caregiving on the health of older New Zealanders. We hypothesized that those providing higher levels of care and more care across time would have poorer health outcomes and that these relationships would be moderated by ethnicity and gender. METHOD A representative sample of participants (N = 2,155) aged 54-70 years from the first 2 waves of the New Zealand Health, Work and Retirement study completed postal surveys in 2006 and 2008. Caregiving questions were adapted from the Australian Womens Health study, and health measures were derived from the SF36 Health Survey. RESULTS Women and Māori (indigenous New Zealanders) were more likely to provide care than men and non-Māori. Respondents providing higher levels of care reported poorer mental health and this was particularly true of Māori and female caregivers. Male Māori caregivers providing the highest level of care reported the poorest mental health. Level of care was unrelated to physical health. There was minimal evidence for changes in health over time based on caregiver status. DISCUSSION The poorer health of caregivers supports previous findings on the detrimental health effects of caregiving. Caregiving may have more detrimental effects on Māori health outcomes due to existing inequalities in health, barriers to formal support services, and the multiple roles of elder Māori.

Mobility, satisfaction with functional capacity and perceived quality of life (PQOL) in older persons with self-reported visual impairment: The pathway between ability to get around and PQOL

Abstract Background: Research shows that ability to get around (AGA) is significantly associated with perceived quality of life (PQOL) among older persons with self-reported visual impairment. Much of this impact, however, is through satisfaction with one’s functional capacity. Satisfaction with functional capacity is a construct composed of five items: satisfaction with (1) activities of daily living, (2) capacity to work, (3) self, (4) health and (5) sleep. At present, it is not known how AGA interacts individually with these items to influence PQOL. Purpose: The purpose of this study is to investigate the extent to which AGA interacts with each of these five items to affect PQOL. Methods: Structural equation modelling was employed in a secondary-analysis of data from 356 persons (aged 56–72) with self-reported visual impairment to identify the pathways by which AGA affects PQOL. Results: Satisfaction with self and health were the only items found to be both directly related to QOL and to provide a significant pathway between AGA and PQOL. Conclusion: AGA significantly affects PQOL both directly and indirectly through its impact on people’s satisfaction with self and health. Lessons may be learnt from this to better focus mobility interventions to enhance PQOL in this population. Implications for Rehabilitation The findings of this study indicate that ability to get around (AGA) has a significant impact on perceived quality of life (PQOL): the stated goal of many rehabilitation programs for older persons who are visually impaired. The study also found that the primary pathway by which AGA influenced PQOL was indirect through its association with both satisfaction with one’s self and health rather than direct. Attempts to enhance PQOL by increasing AGA may be most effective if the focus of intervention was on restoring one’s sense of self and health as opposed to focusing on meeting practical needs.

Ageing across the Tasman Sea: the demographics and health of older adults in Australia and New Zealand

Objective: The demographic and health aspects of ageing populations in Australia and New Zealand (NZ) are described. These data are relevant to compare impacts of policy and context in each country.

The effects of socioeconomic inequalities of working life on health: implications for an ageing population

Abstract This study examines suggestions that inequalities in health related to socioeconomic status (SES) will increase in older age. A representative sample of the New Zealand population aged 55–70 years (N = 6662) responded to a postal questionnaire with measures of health (SF-36), SES, and health-related behaviours. Hierarchical multiple regressions supported predictions that the SES of working life will continue to influence physical and mental health in early old age. The strongest predictor was self-reported economic living standards. This subjective measure of SES is an important construct for future investigations of health and wellbeing among older people in an ageing population.