Mere Kepa

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.

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.

Descriptive Epidemiology of Physical Activity Levels and Patterns in New Zealanders in Advanced Age.

BACKGROUND Little is known about the physical activity levels and behaviors of advanced age New Zealanders. METHODS A cross-sectional analysis of data from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ), Te Puawaitanga O Nga Tapuwae Kia ora Tonu, measures of physical activity (PASE) (n = 664, aged 80-90 [n = 254, Maori, aged 82.5(2), n = 410 non-Maori, aged 85(.5)]) was conducted to determine physical activity level (PAL). A substudy (n = 45) was conducted to attain detailed information about PAL and behaviors via the Multimedia Activity Recall for Children and Adults (MARCA) and accelerometry. The main study was analyzed by sex for Maori and non-Maori. RESULTS Men consistently had higher levels of physical activity than women for all physical activity measures. Sex was significant for different domains of activity.BACKGROUND Little is known about the physical activity levels and behaviors of advanced age New Zealanders. METHODS A cross-sectional analysis of data from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ), Te Puāwaitanga O Nga Tapuwae Kia ora Tonu, measures of physical activity (PASE) (n = 664, aged 80-90 [n = 254, Māori, aged 82.5(2), n = 410 non-Māori, aged 85(.5)]) was conducted to determine physical activity level (PAL). A substudy (n = 45) was conducted to attain detailed information about PAL and behaviors via the Multimedia Activity Recall for Children and Adults (MARCA) and accelerometry. The main study was analyzed by sex for Māori and non-Māori. RESULTS Men consistently had higher levels of physical activity than women for all physical activity measures. Sex was significant for different domains of activity.

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.

E kore e ngāro ngā kākano i ruia mai i Rangiātea: The language and culture from Rangiātea will never be lost in health and ageing research

People are living longer, healthier lives. International evidence suggests relatively high levels of wellbeing among people aged 85 and over; however, little is known about this advanced aged group in Aotearoa New Zealand, particularly indigenous Māori. Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu/Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ) is an investigation of non-Māori aged 85 years old and Māori aged 80 to 90 years old being undertaken by Māori and non-Māori qualitative and quantitative investigators. From 2010 to 2011, 421 of 766 (56%) eligible Māori and 516 of 870 (59%) eligible non-Māori were enrolled in the cohort study. Wave 5 of the study commenced in March 2014. This article describes the translation of scientific documentation drawing on the prodigious bicultural knowledge and bilingual skills of Te RōpūKaitiaki o ngā tikanga Māori (The protectors of principles of conduct in LiLACS NZ). The process ensures that the Māori participants understand the quantitative investigation and that the official status of Māori language and culture is acknowledged in the prevailing English-speaking, Christo-European, technocratic New Zealand society.

Ethnic and Gender Differences in Preferred Activities among Māori and non-Māori of Advanced age in New Zealand

This study explored active aging for older Māori and non-Māori by examining their self-nominated important everyday activities. The project formed part of the first wave of a longitudinal cohort study of aging well in New Zealand. Māori aged 80 to 90 and non-Māori aged 85 were recruited. Of the 937 participants enrolled, 649 answered an open question about their three most important activities. Responses were coded under the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), Activities and Participation domains. Data were analyzed by ethnicity and gender for first in importance, and all important activities. Activity preferences for Māori featured gardening, reading, walking, cleaning the home, organized religious activities, sports, extended family relationships, and watching television. Gendered differences were evident with walking and fitness being of primary importance for Māori men, and gardening for Māori women. Somewhat similar, activity preferences for non-Māori featured gardening, reading, and sports. Again, gendered differences showed for non-Māori, with sports being of first importance to men, and reading to women. Factor analysis was used to examine the latent structural fit with the ICF and whether it differed for Māori and non-Māori. For Māori, leisure and household activities, spiritual activities and interpersonal interactions, and communicating with others and doing domestic activities were revealed as underlying structure; compared to self-care, sleep and singing, leisure and work, and domestic activities and learning for non-Māori. These findings reveal fundamental ethnic divergences in preferences for active aging with implications for enabling participation, support provision and community design.