Ruth Teh

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.

Elderly Men Have Low Levels of Anti-Müllerian Hormone and Inhibin B, but with High Interpersonal Variation: A Cross-Sectional Study of the Sertoli Cell Hormones in 615 Community-Dwelling Men

The Sertoli cells of the testes secrete anti-Müllerian hormone (Müllerian inhibiting Substance, AMH) and inhibin B (InhB). AMH triggers the degeneration of the uterine precursor in male embryos, whereas InhB is part of the gonadal-pituitary axis for the regulation of sperm production in adults. However, both hormones are also putative regulators of homeostasis, and age-related changes in these hormones may therefore be important to the health status of elderly men. The levels of AMH in elderly men are unknown, with limited information being available about age-related changes in InhB. We have therefore used ELISAs to measure Sertoli cell hormone levels in 3 cohorts of community-dwelling men in New Zealand. In total, 615 men were examined, 493 of which were aged 65 or older. Serum AMH and InhB levels inversely correlated with age in men older than 50 years (p<0.001) but not in the younger men. A minority of elderly men had undetectable levels of AMH and InhB. The variation in hormone levels between similarly aged men increased with the age of men. AMH and InhB partially correlated with each other as expected (r = 0.48, p<0.001). However, the ratio of the two Sertoli hormones varied significantly between men, with this variation increasing with age. Elderly men selected for the absence of cardiovascular disease had AMH levels similar to those of young men whereas their InhB levels did not differ from aged-matched controls. These data suggests that Sertoli cell number and function changes with age, but with the extent and nature of the changes varying between men.

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

The BRIGHT Trial: What are the factors associated with nutrition risk?

OBJECTIVES To determine the nutrition risk status and factors associated with nutrition risk among older adults enrolled in the Brief Risk Identification Geriatric Health Tool (BRIGHT Trial). DESIGN A cluster randomised controlled trial. SETTING Three main centres in New Zealand. PARTICIPANTS A total of 3,893 older adults were recruited from 60 general practices in three of the District Health Board (DHB) regions aged 75 years and older (or 65 years and older if Māori). MEASUREMENTS Nutrition risk was assessed using the Australian Nutrition Screening Initiative (ANSI). Validated questionnaires were used to establish quality of life (WHOQOL-BREF), physical function (the Nottingham Extended Activities of Daily Living) and depressive symptoms (15 item Geriatric Depression Scale). Demographic, standard of living and health data were established. RESULTS Sixty two percent of participants were identified to be at moderate or high nutrition risk. The mean ANSI score was 4.9 (range 0-21, maximum 29). Factors which independently predicted moderate or high nutrition risk were female gender, being Māori and other ethnicities versus European, not being married, taking multiple medications, having more depressive symptoms, cardiovascular disease and diabetes. Protective factors independently related to low nutrition risk were living with others, higher physical and social health related QOL and higher functional status. WHOQOL environmental and psychological factors were not associated with nutrition risk when other predictive factors were taken into account. CONCLUSION Nearly two thirds of participants were identified to be at higher nutrition risk. Women, living alone, taking multiple medications, with depressive symptoms, cardiovascular disease and ndiabetes were factors associated with higher nutrition risk. Those at low nutrition risk had a better functional status and physical and social health related QOL.

Predicting Risk of Cognitive Decline in Very Old Adults Using Three Models: The Framingham Stroke Risk Profile; the Cardiovascular Risk Factors, Aging, and Dementia Model; and Oxi‐Inflammatory Biomarkers

To examine the Framingham Stroke Risk Profile (FSRP); the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) risk score, and oxi‐inflammatory load (cumulative risk score of three blood biomarkers—homocysteine, interleukin‐6, C‐reactive protein) for associations with cognitive decline using three cohort studies of very old adults and to examine whether incorporating these biomarkers with the risk scores can affect the association with cognitive decline.

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.

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.

Dietary protein intake may reduce hospitalisation due to infection in Māori of advanced age: LiLACS NZ.

Objective: To investigate factors related to hospital admission for infection, specifically examining nutrient intakes of Māori in advanced age (80+ years).