Karen Hayman

Depression in Older People: Visual Impairment and Subjective Ratings of Health

Purpose. The aim of this study was to establish the prevalence of depression in a sample of older adults with impaired vision and investigate associations between physical and visual disability and depression. Methods. We analyzed cross-sectional baseline data from 391 participants aged ≥75 years with visual acuity of 6/24 (20/80) or less, recruited for a randomized controlled trial of interventions to prevent falls (the VIP trial). Measures included the geriatric depression scale (GDS-15), the state-trait anxiety index, activities of daily living (Nottingham extended ADL scale), physical activity (human activity profile), an index of visual functioning (VF-14), health-related quality of life (SF-36), objective measures of physical ability, and a measure of visual acuity. Regression models were developed to investigate the association between depression scores and physical, psychological, and visual disability. Results. About 29.4% (115 of 391) of participants were identified as potentially depressed (GDS-15 score >4). Physical function, physical activity, physical ability, visual function, anxiety, and self-reported physical and mental health were significantly worse for those with depressive symptomatology. Physical, visual, and psychological factors collectively explained 41% of the variance in the depression score in a linear regression model (R2 = 0.421, adjusted R2 = 0.410, F (7,382) = 39.680, p < 0.001). Depression was not related to age, gender, living situation, ethnicity, or number of prescription or antidepressant medications taken. Conclusions. Depression was common in this population of older adults with severe visual impairment. Impaired visual and physical functions were associated with symptoms of depression. The effect of visual disability was independent of the effect of physical disability. The strength of this relationship, and the results of the regression analyses, indicate that a person who is visually or physically disabled is more likely to suffer from depression.

Home-based activity program for older people with depressive symptoms: DeLLITE--a randomized controlled trial.

PURPOSE We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms. METHODS We undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months’ follow-up. RESULTS The mean age of the participants was 81 years, and 59% were women. All participants scored in the at–risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups. CONCLUSION The DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control.

Life and Living in Advanced Age: A Cohort Study in New Zealand -Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: Study protocol

BackgroundThe number of people of advanced age (85 years and older) is increasing and health systems may be challenged by increasing health-related needs. Recent overseas evidence suggests relatively high levels of wellbeing in this group, however little is known about people of advanced age, particularly the indigenous Māori, in Aotearoa, New Zealand. This paper outlines the methods of the study Life and Living in Advanced Age: A Cohort Study in New Zealand. The study aimed to establish predictors of successful advanced ageing and understand the relative importance of health, frailty, cultural, social & economic factors to successful ageing for Māori and non-Māori in New Zealand.Methods/designA total population cohort study of those of advanced age. Two cohorts of equal size, Māori aged 80–90 and non-Māori aged 85, oversampling to enable sufficient power, were enrolled. A defined geographic region, living in the Bay of Plenty and Lakes District Health Board areas of New Zealand, defined the sampling frame. Rūnanga (Māori tribal organisations) and Primary Health Organisations were subcontracted to recruit on behalf of the University. Measures - a comprehensive interview schedule was piloted and administered by a trained interviewer using standardised techniques. Socio-demographic and personal history included tribal affiliation for Māori and participation in cultural practices; physical and psychological health status used standardised validated research tools; health behaviours included smoking, alcohol use and nutrition risk; and environmental data included local amenities, type of housing and neighbourhood. Social network structures and social support exchanges are recorded. Measures of physical function; gait speed, leg strength and balance, were completed. Everyday interests and activities, views on ageing and financial interests complete the interview. A physical assessment by a trained nurse included electrocardiograph, blood pressure, hearing and vision, anthropometric measures, respiratory function testing and blood samples.DiscussionA longitudinal study of people of advanced age is underway in New Zealand. The health status of a population based sample of older people will be established and predictors of successful ageing determined.

DeLLITE Depression in late life: an intervention trial of exercise. Design and recruitment of a randomised controlled trial

BackgroundPhysical activity shows potential in combating the poor outcomes associated with depression in older people. Meta-analyses show gaps in the research with poor trial design compromising certainty in conclusions and few programmes showing sustained effects.Methods/designThe Depression in Late Life: an Intervention Trial of Exercise (DeLLITE) is a 12 month randomised controlled trial of a physical activity intervention to increase functional status in people aged 75 years and older with depressive symptoms. The intervention involves an individualised activity programme based on goal setting and progression of difficulty of activities delivered by a trained nurse during 8 home visits over 6 months. The control group received time matched home visits to discuss social contacts and networks. Baseline, 6 and 12 months measures were assessed in face to face visits with the primary outcome being functional status (SPPB, NEADL). Secondary outcomes include depressive symptoms (Geriatric Depression Scale), quality of life (SF-36), physical activity (AHS Physical Activity Questionnaire) and falls (self report).DiscussionDue to report in 2008 the DeLLITE study has recruited 70% of those eligible and tests the efficacy of a home based, goal setting physical activity programme in improving function, mood and quality of life in older people with depressive symptomatology. If successful in improving function and mood this trial could prove for the first time that there are long term health benefit of physical activity, independent of social activity, in this high risk group who consume excess health related costs.Trial registrationAustralian and New Zealand Clinical Trials Register ACTRN12605000475640

Engagement and recruitment of Māori and non-Māori people of advanced age to LiLACS NZ

Objectives : Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ) aims to determine the predictors of successful advanced ageing and understand the trajectories of wellbeing in advanced age. This paper reports recruitment strategies used to enrol 600 Māori aged 80–90 years and 600 non‐Māori aged 85 years living within a defined geographic boundary.

Cohort Profile: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ)

Cohort Profile: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) Ngaire Kerse,* Ruth Teh, Simon A Moyes, Joanna Broad, Anna Rolleston, Merryn Gott, Mere Kepa, Carol Wham, Karen Hayman, Santosh Jatrana, Ashley Adamson and Thomas Lumley Department of General Practice and Primary Health Care, School of Population Health, Freemasons’ Department of Geriatric Medicine, School of Medicine, Te Kupenga Haoura Māori, School of Nursing, University of Auckland, Auckland, New Zealand, Institute of Food, Nutrition and Human Health, Massey University, Auckland, New Zealand, Alfred Deakin Research Institute, Geelong, VIC, Australia, Human Nutrition, Health and Society, Newcastle University, Newcastle, UK and Department of Statistics, University of Auckland, Auckland, New Zealand

Doing what's important: Valued activities for older New Zealand Māori and non-Māori

Aim:  This project explored the usability of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) for describing older Māori and non‐Māori peoples self‐nominated important activities.

Macronutrient intake in advanced age: Te Puāwaitanga o Ngā Tapuwae Kia ora Tonu, Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ).

As part of the 12-month follow-up of the longitudinal cohort study, Life and Living in Advanced Age: A Cohort Study in New Zealand, dietary intake was assessed in 216 Māori and 362 non-Māori octogenarians using repeat 24-h multiple pass recalls. Energy and macronutrient intakes were calculated, and food items reported were allocated to food groups used in the New Zealand Adult Nutrition Survey (NZANS). Intakes were compared with the nutrient reference values (NRV) for Australia and New Zealand. The median BMI was higher for Māori (28·3 kg/m2) than for non-Māori (26·2 kg/m2) P=0·007. For Māori, median energy intake was 7·44 MJ/d for men and 6·06 MJ/d for women with 16·3 % energy derived from protein, 43·3 % from carbohydrate and 38·5 % from fat. Median energy intake was 7·91 and 6·26 MJ/d for non-Māori men and women, respectively, with 15·4 % of energy derived from protein, 45 % from carbohydrate and 36·7 % from fat. For both ethnic groups, bread was the top contributor to energy and carbohydrate intakes. Protein came from beef and veal, fish and seafood, bread, milk and poultry with the order differing by ethnic groups and sex. Fat came mainly from butter and margarine. Energy-adjusted protein was higher for Māori than non-Māori (P=0·049). For both ethnic groups, the median energy levels were similar, percent carbohydrate tended to be lower and percent fat higher compared with adults aged >70 years in NZANS. These unique cross-sectional data address an important gap in our understanding of dietary intake in this growing section of our population and highlight lack of age-appropriate NRV.

Resilience in context: the special case of advanced age

Abstract Objectives: Advanced age is a time shaped by the current experience of physical, social and psychological characteristics associated with living into an eighth decade and beyond and also by reflection upon past experiences. Understanding the specific factors that contribute to ageing well is increasingly important as greater numbers of older people remain living independently in the community and may require targeted and sustainable support to do so. This paper offers a conceptualisation of resilience for advanced age (age 85+), a life stage currently under-researched. Method: We utilise a developmental and socio-historical context to develop key arguments about adversity, resources and positive outcomes that affect the experience of resilient ageing. Results: Very late life is characterised by a unique balance between losses, associated with vulnerability and resource restrictions, and potential gains based upon wisdom, experience, autonomy and accumulated systems of support, providing a specific context for the expression of resilience. Post-adversity growth is possible, but maintenance of everyday abilities may be more relevant to resilience in advanced age. Conclusion: An increasing life-span globally necessitates creative and conscientious thought about wellbeing, and resilience research has the important aim to focus health and wellness on success and what is possible despite potential limitations.

Vitamin D status of Māori and non-Māori octogenarians in New Zealand: a cohort study (LiLACS NZ)

BACKGROUND AND OBJECTIVES This study assessed vitamin D status and its determinants in a cohort of octogenarians living within New Zealands Bay of Plenty and Lakes Districts. METHODS AND STUDY DESIGN Serum 25- hydroxyvitamin D [25(OH)D] concentration was measured in 209 Māori (aged 80-90 years) and 357 non-Māori (85 years), along with demographic, lifestyle, supplement use and other health data. RESULTS Mean [95% CI] 25(OH)D concentration was 69 [67 to 72] nmol/L, with 15% >100 nmol/L and 6 individuals >150 nmol/L. Concentrations in Māori (59 [55 to 62] 4 nmol/L) were lower than in non-Māori (75 [72 to 78] nmol/L; p<0.001), a difference maintained when adjusted for day-of-year measured. Vitamin D supplementation was reported by 98 participants (18%): including a greater proportion of women (24%) than men (11%; p<0.001) and of non-Māori (24%) than Māori (7%; p<0.001). Of those taking vitamin D, 49% took high oral doses (>=25 μg/day or equivalent) and five individuals took >50 μg/day. Vitamin D supplement use strongly and independently predicted seasonally- adjusted 25(OH)D concentration and was associated with 28 nmol/L higher levels than non-use. Other predictors included Māori ethnicity (10 nmol/L lower concentration than for non-Māori), and female gender (11 nmol/L lower). CONCLUSIONS Vitamin D status in New Zealand octogenarians appears higher than previously reported, particularly in non-Māori compared to Māori. Prescribed and non-prescribed oral vitamin D supplementation is prevalent in this group and a strong indicator of vitamin D status.