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Bloomfield K, Wu Z, Boyd M, Broad JB, Hikaka J, Peri K, Bramley D, Tatton A, Calvert C, Higgins AM, Connolly MJ. Changes in hospitalisation rates in older people before and after moving to a retirement village. Australas J Ageing 2023; 42:660-667. [PMID: 37036833 DOI: 10.1111/ajag.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/31/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES An increasing proportion of older people live in Retirement Villages ('villages'). This population cites support for health-care issues as one reason for relocation to villages. Here, we examine whether relocation to villages is associated with a decline in hospitalisations. METHODS Retrospective, before-and-after observational study. SETTING Retirement villages, Auckland, New Zealand. PARTICIPANTS 466 cognitively intact village residents (336 [72%] female); mean (SD) age at moving to village was 73.9 (7.7) years. Segmented linear regression analysis of an interrupted time-series design was used. MAIN OUTCOME MEASURES all hospitalisations for 18 months pre- and postrelocation to village. SECONDARY OUTCOME acute hospitalisations during the same time periods. RESULTS The average hospitalisation rate (per 100 person-years) was 44.9 (95% confidence interval [CI] = 36.3-55.6) 18-10 months before village relocation, 58.9 (95% CI = 48.3-72.0) 9-1 months before moving, 47.9 (95% CI = 38.8-59.1) 1-9 months after moving and 62.4 (95% CI = 51.2-76.0) 10-18 months after moving. Monthly average hospitalisation rate (per 100 person-years) increased before relocation to village by an average of 1.2 (95% CI = 0.01-1.57, p = .04) per month from 18 to 1 month before moving, and there was a change in the level of the monthly average hospitalisation rate immediately after relocation (mean difference [MD] = -18.4 per 100 person-years, 95% CI = -32.8 to -4.1, p = .02). The trend change after village relocation did not differ significantly from that before moving. CONCLUSIONS Although we cannot reliably claim causality, relocation to a retirement village is, for older people, associated with a significant but non-sustained reduction in hospitalisation.
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Affiliation(s)
- Katherine Bloomfield
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna Hikaka
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
| | - Annie Tatton
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Cheryl Calvert
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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Varghese C, Wu Z, Bissett IP, Connolly MJ, Broad JB. Seasonal variations in acute diverticular disease hospitalisations in New Zealand. Int J Colorectal Dis 2023; 38:46. [PMID: 36795135 PMCID: PMC9935723 DOI: 10.1007/s00384-023-04338-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Seasonal variation of acute diverticular disease is variably reported in observational studies. This study aimed to describe seasonal variation of acute diverticular disease hospital admissions in New Zealand. METHODS A time series analysis of national diverticular disease hospitalisations from 2000 to 2015 was conducted among adults aged 30 years or over. Monthly counts of acute hospitalisations' primary diagnosis of diverticular disease were decomposed using Census X-11 times series methods. A combined test for the presence of identifiable seasonality was used to determine if overall seasonality was present; thereafter, annual seasonal amplitude was calculated. The mean seasonal amplitude of demographic groups was compared by analysis of variance. RESULTS Over the 16-year period, 35,582 hospital admissions with acute diverticular disease were included. Seasonality in monthly acute diverticular disease admissions was identified. The mean monthly seasonal component of acute diverticular disease admissions peaked in early-autumn (March) and troughed in early-spring (September). The mean annual seasonal amplitude was 23%, suggesting on average 23% higher acute diverticular disease hospitalisations during early-autumn (March) than in early-spring (September). The results were similar in sensitivity analyses that employed different definitions of diverticular disease. Seasonal variation was less pronounced in patients aged over 80 (p = 0.002). Seasonal variation was significantly greater among Māori than Europeans (p < 0.001) and in more southern regions (p < 0.001). However, seasonal variations were not significantly different by gender. CONCLUSIONS Acute diverticular disease admissions in New Zealand exhibit seasonal variation with a peak in Autumn (March) and a trough in Spring (September). Significant seasonal variations are associated with ethnicity, age, and region, but not with gender.
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Affiliation(s)
- Chris Varghese
- Department of Geriatric Medicine, The University of Auckland, PO Box 93 503, 124 Shakespeare Road, Takapuna, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Geriatric Medicine, The University of Auckland, PO Box 93 503, 124 Shakespeare Road, Takapuna, Auckland, New Zealand.
- School of Population Health, The University of Auckland, Auckland, New Zealand.
| | - Ian P Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Department of Geriatric Medicine, The University of Auckland, PO Box 93 503, 124 Shakespeare Road, Takapuna, Auckland, New Zealand
- Waitematā District Health Board, Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Department of Geriatric Medicine, The University of Auckland, PO Box 93 503, 124 Shakespeare Road, Takapuna, Auckland, New Zealand
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Tatton A, Wu Z, Bloomfield K, Boyd M, Broad JB, Calvert C, Hikaka J, Peri K, Higgins AM, Connolly MJ. The prevalence and intensity of pain in older people living in retirement villages in Auckland, New Zealand. Health Soc Care Community 2022; 30:e4280-e4292. [PMID: 35543587 DOI: 10.1111/hsc.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/26/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
Chronic pain is common in older people. However, little is known about how pain is experienced in residents of retirement villages ('villages'), and how pain intensity and associations are experienced in relation to characteristics of residents and village living. We thus aimed to examine pain levels, prevalence and associated factors in village residents. The current paper is a cross-sectional analysis of baseline data from the 'Older People in Retirement Villages' study in Auckland, New Zealand. Between July 2016 and August 2018, 578 village residents were interviewed face-to-face by gerontology nurse specialists, using interRAI Community Health Assessment (CHA) and customised survey. We used a validated pain scale and multivariable logistic regression analyses adjusted for pre-specified confounders. Residents' median age was 82 years; 420 (73%) were female; 270 (47%) exhibited/reported daily pain, and in 11% this was severe. After controlling for confounders, daily pain was positively associated with self-reported arthritis (OR = 3.88, 95% CI = 2.57-5.87), poor/fair self-reported health (OR = 3.19, 95% CI = 1.29-7.93), having no health clinic on-site (OR = 1.76, 95% CI = 1.10-2.83), and minimal fatigue (diminished energy but completes normal day-to-day activities) (OR = 1.77, 95% CI = 1.11-2.81). Similar associations were observed for levels of pain. We conclude that levels of pain and prevalence of daily pain are high in village residents. Self-reported arthritis, self-reported poor/fair health, no health clinic on-site and minimal fatigue are all independently associated with a higher risk of daily pain and with levels of pain. This study suggests potential opportunities for villages to better provide on-site support to decrease prevalence and severity of pain for their residents, and thus potentially increase wellbeing and quality-of-life, though as we cannot prove causality, more research is needed.
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Affiliation(s)
- Annie Tatton
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Katherine Bloomfield
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Cheryl Calvert
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Kathy Peri
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Ann-Marie Higgins
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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Bloomfield K, Wu Z, Broad JB, Tatton A, Calvert C, Hikaka J, Boyd M, Peri K, Bramley D, Higgins AM, Connolly MJ. Factors associated with healthcare utilization and trajectories in retirement village residents. J Am Geriatr Soc 2021; 70:754-765. [PMID: 34910296 DOI: 10.1111/jgs.17602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/01/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To study healthcare utilization and trajectories, and associated factors, in older adults in retirement villages (RVs), also known as continuing care retirement communities. METHODS Prospective cohort study of 578 cognitively intact residents from 34 RVs in Auckland, New Zealand (NZ). MEASUREMENT InterRAI-Community Health Assessment (includes core items that may trigger functional supplement (FS) completion in those with higher needs, and generates clinical assessment protocols (CAPs) in those with potential unmet needs). OUTCOMES time to acute hospitalization, long-term care (LTC), and death during average 2.5 years follow-up. RESULTS Three hundred seven (53%) residents had acute hospitalizations, 65 (11%) moved to LTC, and 51 (9%) died over a mean of 2.5 years. Factors associated with increased risk of acute hospitalization included CAP-falls (high risk) triggered, number of comorbidities, not having left RV in 2 weeks prior, moderate/severe hearing impairment, CAP-cardiorespiratory conditions triggered, acute hospitalization in year prior and age, with significant hazard ratios (HR) ranging between 1.03 and 2.90. Factors associated with reduced risk of hospitalization included other (non-NZ) European ethnicity (HR 0.73, 95% CI 0.55-0.98, p = 0.04), presence of on-site clinic (HR 0.62, 95% CI 0.45-0.85, p = 0.003), no influenza vaccination (HR 0.56, 95% CI 0.38-0.83, p = 0.004). Factors associated with LTC transition included FS triggered (HR 3.84, 95% CI 1.92-7.66, p < 0.001), CAP-instrumental activities of daily living (IADL) (HR 2.62, 95% CI 1.22-5.62, p = 0.01), CAP-social relationship triggered (HR 2.00, 95% CI 1.13-3.55, p = 0.02), and age (HR 1.13, 95% CI 1.07-1.18 p < 0.001). Factors associated with mortality included number of comorbidities (HR 3.75, 95% CI 1.54-9.10, p = 0.004 for 3-5 comorbidities), CAP-IADL triggered (HR 3.05, 95% CI 1.30-7.16, p = 0.01), and age (HR 1.11, 95% CI 1.05-1.18, p < 0.001). CONCLUSION A large proportion of cognitively intact RV residents are admitted to hospital in mean 2.5 years of follow-up. Multiple factors were associated with acute hospitalization risk. On-site clinics were associated with reduced risk and should be considered in RV development.
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Affiliation(s)
- Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Cheryl Calvert
- Community and Long Term Conditions, Auckland District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
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Bloomfield K, Wu Z, Broad JB, Tatton A, Calvert C, Hikaka J, Boyd M, Peri K, Bramley D, Higgins AM, Connolly MJ. Learning from a multidisciplinary randomized controlled intervention in retirement village residents. J Am Geriatr Soc 2021; 70:743-753. [PMID: 34709659 DOI: 10.1111/jgs.17533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/16/2021] [Accepted: 10/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Retirement villages (RVs), also known as continuing care retirement communities, are an increasingly popular housing choice for older adults. The RV population has significant health needs, possibly representing a group with needs in between community-dwelling older adults and those in long-term residential care (LTC). Our previous work shows Gerontology Nurse Specialist (GNS)-facilitated multidisciplinary team (MDT) interventions may reduce hospitalizations from LTC. This study tested whether a similar intervention reduced hospitalizations in RV residents. METHODS Open-label randomized controlled trial in which 412 older residents of 33 RVs were randomized (1:1) to an MDT intervention or usual care. SETTING RVs across two District Health Boards in Auckland, New Zealand. Residents were eligible if considered high risk of health/functional decline (triggering ≥3 interRAI Clinical Assessment Protocols or needing special consideration identified by GNS). INTERVENTION GNS-facilitated MDT intervention, including geriatrician/nurse practitioner and clinical pharmacist, versus usual care. Primary outcome was time from randomization to first acute hospitalization. Secondary outcomes were rate of acute hospitalizations, LTC admission, and mortality. Twelve residents died before randomization; all others (n = 400: MDT intervention = 199; usual care = 201) were included in intention-to-treat analyses. RESULTS Mean (SD) age was 82.2 (6.9) years, 302 (75.5%) were women, and 378 (94.5%) were European. Over median 1.5 years follow-up, no difference was found in hazard of acute hospitalization between the MDT intervention (51.8%) and usual care (49.3%) groups (Hazard ratio [HR] = 1.01, 95% CI = 0.77-1.34). No difference was found in the incidence rate of acute hospitalizations between the MDT intervention (0.69 per person-year) and usual care (0.86 per person-year) groups (incidence rate ratio = 0.81, 95% CI = 0.59-1.10). Similar results were seen for the proportion of residents with LTC transition (HR = 1.18, 95% CI = 0.65-2.11) and mortality (HR = 0.70, 95% CI = 0.36-1.35). CONCLUSION Further studies are needed to assess the effects of other patient-centered interventions and outcomes with adequate primary care integration.
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Affiliation(s)
- Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Cheryl Calvert
- Community and Long Term Conditions, Auckland District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
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Holdaway M, Wiles J, Kerse N, Wu Z, Moyes S, Connolly MJ, Menzies O, Teh R, Muru-Lanning M, Gott M, Broad JB. Predictive factors for entry to long-term residential care in octogenarian Māori and non-Māori in New Zealand, LiLACS NZ cohort. BMC Public Health 2021; 21:34. [PMID: 33407278 PMCID: PMC7788817 DOI: 10.1186/s12889-020-09786-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term residential care (LTC) supports the most vulnerable and is increasingly relevant with demographic ageing. This study aims to describe entry to LTC and identify predictive factors for older Māori (indigenous people of New Zealand) and non-Māori. METHODS LiLACS-NZ cohort project recruited Māori and non-Māori octogenarians resident in a defined geographical area in 2010. This study used multivariable log-binomial regressions to assess factors associated with subsequent entry to LTC including: self-identified ethnicity, demographic characteristics, self-rated health, depressive symptoms and activities of daily living [ADL] as recorded at baseline. LTC entry was identified from: place of residence at LiLACS-NZ interviews, LTC subsidy, needs assessment conducted in LTC, hospital discharge to LTC, and place of death. RESULTS Of 937 surveyed at baseline (421 Māori, 516 non-Māori), 77 already in LTC were excluded, leaving 860 participants (mean age 82.6 +/- 2.71 years Māori, 84.6 +/- 0.52 years non-Māori). Over a mean follow-up of 4.9 years, 278 (41% of non-Māori, 22% of Māori) entered LTC; of the 582 who did not, 323 (55%) were still living and may yet enter LTC. In a model including both Māori and non-Māori, independent risks factors for LTC entry were: living alone (RR = 1.52, 95%CI:1.15-2.02), self-rated health poor/fair compared to very good/excellent (RR = 1.40, 95%CI:1.12-1.77), depressive symptoms (RR = 1.28, 95%CI:1.05-1.56) and more dependent ADLs (RR = 1.09, 95%CI:1.05-1.13). For non-Māori compared to Māori the RR was 1.77 (95%CI:1.39-2.23). In a Māori-only model, predictive factors were older age and living alone. For non-Māori, factors were dependence in more ADLs and poor/fair self-rated health. CONCLUSIONS Non-Māori participants (predominantly European) entered LTC at almost twice the rate of Māori. Factors differed between Māori and non-Māori. Potentially, the needs, preferences, expectations and/or values may differ correspondingly. Research with different cultural/ethnic groups is required to determine how these differences should inform service development.
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Affiliation(s)
- Marycarol Holdaway
- Department of Geriatric Medicine, University of Auckland, C/- Waitematā District Health Board, Takapuna, PO Box 93 503, Auckland, New Zealand
| | - Janine Wiles
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Geriatric Medicine, University of Auckland, C/- Waitematā District Health Board, Takapuna, PO Box 93 503, Auckland, New Zealand
| | - Simon Moyes
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Department of Geriatric Medicine, University of Auckland, C/- Waitematā District Health Board, Takapuna, PO Box 93 503, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
| | | | - Ruth Teh
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Marama Muru-Lanning
- James Henare Māori Research Centre, University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Department of Geriatric Medicine, University of Auckland, C/- Waitematā District Health Board, Takapuna, PO Box 93 503, Auckland, New Zealand.
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Broad JB, Wu Z, Bloomfield K, Hikaka J, Bramley D, Boyd M, Tatton A, Calvert C, Peri K, Higgins AM, Connolly MJ. Health profile of residents of retirement villages in Auckland, New Zealand: findings from a cross-sectional survey with health assessment. BMJ Open 2020; 10:e035876. [PMID: 32948550 PMCID: PMC7511621 DOI: 10.1136/bmjopen-2019-035876] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Retirement villages (RV) have expanded rapidly, now housing perhaps one in eight people aged 75+ years in New Zealand. Health service initiatives might better support residents and offer cost advantages, but little is known of resident demographics, health status or needs. This study describes village residents-their demographics, socio-behavioural and health status-noting differences between participants who volunteered and those who were sampled. DESIGN Cross-sectional study of village residents. The cohort formed will also be used for a longitudinal study and a randomised controlled trial. Village managers (sometimes after consulting residents) decided if representative sampling could be undertaken in each village. Where sampling was not approved, volunteers were sought. SETTING 33 RV were included from a total of 65 villages in Auckland, New Zealand. PARTICIPANTS Residents (n=578) were recruited either by sampling (n=217) or as volunteers (n=361) during 2016-2018. Each completed a survey and an International Resident Assessment Instrument (interRAI) health needs assessment with a gerontology nurse specialist. RESULTS Median age of residents was 82 years, 158 (27%) were men; 61% lived alone. Downsizing (77%), less stress (63%) and access to healthcare assistance (61%) were most common reasons for entry. During the 2 weeks prior to survey, 34% received home supports and 10% personal care. Hypertension, heart disease, arthritis and pain were reported by over 40%. Most common unmet needs related to managing cardiorespiratory symptoms (50%) and pain (48%). Volunteers and sampled residents differed significantly, mainly in socio-behavioural respects. CONCLUSIONS Common conditions including hypertension, arthritis and atrial fibrillation, are recorded in interRAI as text, and thus overlooked in interRAI reports. Levels of unmet need indicate opportunities to improve health services to better manage chronic conditions. Healthcare service providers and village operators could cooperate to design and test service initiatives that better meet residents' needs and offer cost benefits. TRIAL REGISTRATION NUMBER ACTRN12616000685415.
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Affiliation(s)
- Joanna B Broad
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Katherine Bloomfield
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Health of Older People, Waitematā District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Department of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Executive Leadership Team, Waitematā District Health Board, Auckland, Auckland, New Zealand
| | - Michal Boyd
- Health of Older People, Waitematā District Health Board, Auckland, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Health of Older People, Waitematā District Health Board, Auckland, New Zealand
| | | | - Kathy Peri
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Ann-Marie Higgins
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Health of Older People, Waitematā District Health Board, Auckland, New Zealand
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Peri K, Broad JB, Hikaka J, Boyd M, Bloomfield K, Wu Z, Calvert C, Tatton A, Higgins AM, Bramley D, Connolly MJ. Study protocol: older people in retirement villages. A survey and randomised trial of a multi-disciplinary invention designed to avoid adverse outcomes. BMC Geriatr 2020; 20:247. [PMID: 32680465 PMCID: PMC7367387 DOI: 10.1186/s12877-020-01640-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background There is increasing interest among older people in moving into retirement villages (RVs), an attractive option for those seeking a supportive community as they age, while still maintaining independence. Currently in New Zealand there is limited knowledge of the medical, service supports, social status and needs of RV residents. The objective of this study is to explore RV facilities and services, the health and functional status of RV residents, prospectively study their healthcare trajectories and to implement a multidisciplinary team intervention to potentially decrease dependency and impact healthcare utilization. Methods All RVs located in two large district health boards in Auckland, New Zealand were eligible to participate. This three-year project comprised three phases: The survey phase provided a description of RVs, residents’ characteristics and health and functional status. RV managers completed a survey of size, facilities and recreational and healthcare services provided in the village. Residents were surveyed to establish reasons for entry to the village and underwent a Gerontology Nurse Specialist (GNS) assessment providing details of demographics, social engagement, health and functional status. The cohort study phase examines residents’ healthcare trajectories and adverse outcomes, over three years. The final phase is a randomised controlled trial of a multidisciplinary team intervention aimed to improve health outcomes for more vulnerable residents. Residents who triggered potential unmet health needs during the assessment in the survey phase were randomised to intervention or usual care groups. Multidisciplinary team meetings included the resident and support person, a geriatrician or gerontology nurse practitioner, GNS, pharmacist and General Practitioner. The primary outcome of the randomised controlled trial will be first acute hospitalization. Secondary outcomes include all acute hospitalizations, long-term care admissions, and all-cause mortality. Discussion This paper describes the study protocol of this complex study. The study aims to inform policies and practices around health care services for residents in retirement villages. The results of this trial are expected early 2020 with publication subsequently. Trial registration Australia and New Zealand Clinical Trials Registry: ACTRN12616000685415. Registered 25.5.2016. Universal Trial Number (UTN): U111–1173-6083.
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Affiliation(s)
- K Peri
- School of Nursing, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - J Hikaka
- Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand.,Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - C Calvert
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Auckland District Health Board, Private Bag 92 024, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - A Tatton
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - A-M Higgins
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - D Bramley
- Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - M J Connolly
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand. .,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.
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9
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Cardwell K, Kerse N, Hughes CM, Teh R, Moyes SA, Menzies O, Rolleston A, Broad JB, Ryan C. Does potentially inappropriate prescribing predict an increased risk of admission to hospital and mortality? A longitudinal study of the 'oldest old'. BMC Geriatr 2020; 20:28. [PMID: 31992215 PMCID: PMC6986145 DOI: 10.1186/s12877-020-1432-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Potentially inappropriate prescribing (PIP) is associated with negative health outcomes, including hospitalisation and mortality. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is a longitudinal study of Māori (the indigenous population of New Zealand) and non-Māori octogenarians. Health disparities between indigenous and non-indigenous populations are prevalent internationally and engagement of indigenous populations in health research is necessary to understand and address these disparities. Using LiLACS NZ data, this study reports the association of PIP with hospitalisations and mortality prospectively over 36-months follow-up. Methods PIP, from pharmacist applied criteria, was reported as potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). The association between PIP and hospitalisations (all-cause, cardiovascular disease-specific and ambulatory-sensitive) and mortality was determined throughout a series of 12-month follow-ups using binary logistic (hospitalisations) and Cox (mortality) regression analysis, reported as odds ratios (ORs) and hazard ratios (HRs), respectively, and the corresponding confidence intervals (CIs). Results Full demographic data were obtained for 267 Māori and 404 non-Māori at baseline, 178 Māori and 332 non-Māori at 12-months, and 122 Māori and 281 non-Māori at 24-months. The prevalence of any PIP (i.e. ≥1 PIM and/or PPO) was 66, 75 and 72% for Māori at baseline, 12-months and 24-months, respectively. In non-Māori, the prevalence of any PIP was 62, 71 and 73% at baseline, 12-months and 24-months, respectively. At each time-point, there were more PPOs than PIMs; at baseline Māori were exposed to a significantly greater proportion of PPOs compared to non-Māori (p = 0.02). In Māori: PPOs were associated with a 1.5-fold increase in hospitalisations and mortality. In non-Māori, PIMs were associated with a double risk of mortality. Conclusions PIP was associated with an increased risk of hospitalisation and mortality in this cohort. Omissions appear more important for Māori in predicting hospitalisations, and PIMs were more important in non-Māori in predicting mortality. These results suggest understanding prescribing outcomes across and between population groups is needed and emphasises prescribing quality assessment is useful.
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Affiliation(s)
- Karen Cardwell
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
| | - Ruth Teh
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Simon A Moyes
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Oliver Menzies
- Older People's Health, Auckland District Health Board, Auckland, New Zealand
| | | | - Joanna B Broad
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Cristín Ryan
- School of Pharmacy & Pharmaceutical Science, Trinity College Dublin, The University of Dublin, College Green, Dublin, Dublin 2, Ireland
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10
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Wu Z, Kim MS, Broad JB, Zhang X, Bloomfield K, Connolly MJ. Association between post-discharge secondary care and risk of repeated hospital presentation, entry into long-term care and mortality in older people after acute hospitalization. Geriatr Gerontol Int 2019; 19:1048-1053. [PMID: 31475414 DOI: 10.1111/ggi.13766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022]
Abstract
AIM Hospitalizations are frequent among acutely ill older people, and might be reduced by post-discharge secondary care (PDSC). We aimed to determine the proportion of older patients planned to receive or attending PDSC after acute hospitalization and the association with undesirable outcomes. METHODS A retrospective observational study was carried out using an electronic health record system in two hospitals in New Zealand. Patients were aged ≥75 years, initially presented at an emergency department (ED) and were discharged from medical, surgical, geriatrics or orthopedics wards in three 2-week periods. Planned PDSC at discharge, attended PDSC, ED presentation, long-term care (LTC) admission and death in 90 days after discharge were obtained through the health record system. Proportional hazards regression assessed the associations of planned or attended PDSC with undesirable outcomes (ED presentation, LTC admission and death) within 90 days of discharge. RESULTS Clinical records for 1085 patients were extracted, 963 were eligible. Of these, 413 (42.9%) had planned PDSC in discharge summaries, and 573 (59.5%) actually attended in 90 days. Patients planned for PDSC had a similarly adjusted hazard of ED presentation (HR 0.99, P = 0.92), LTC admission (HR 0.73, P = 0.25) and death (HR 0.80, P = 0.34) within 90 days of discharge, compared with those not planned. Similar non-significant associations were observed between attended PDSC and undesirable outcomes. CONCLUSIONS In patients aged ≥75 years in New Zealand, we did not find "planned PDSC" at discharge or "attended PDSC" after an acute hospitalization to be associated with ED presentation, LTC admission and death within 90 days after discharge. Other potential benefits of planned or attended PDSC require further investigation. Geriatr Gerontol Int 2019; 19: 1048-1053.
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Affiliation(s)
- Zhenqiang Wu
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Min Soo Kim
- Auckland District Health Board, Auckland, New Zealand
| | - Joanna B Broad
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Xian Zhang
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Katherine Bloomfield
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Martin J Connolly
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
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11
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Broad JB, Wu Z, Ng J, Arroll B, Connolly MJ, Jaung R, Oliver F, Bissett IP. Diverticular disease management in primary care: How do estimates from community-dispensed antibiotics inform provision of care? PLoS One 2019; 14:e0219818. [PMID: 31314796 PMCID: PMC6636816 DOI: 10.1371/journal.pone.0219818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 07/03/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The literature regarding diverticular disease of the intestines (DDI) almost entirely concerns hospital-based care; DDI managed in primary care settings is rarely addressed. AIM To estimate how often DDI is managed in primary care, using antibiotics dispensing data. DESIGN AND SETTING Hospitalisation records of New Zealand residents aged 30+ years during 2007-2016 were individually linked to databases of community-dispensed oral antibiotics. METHOD Patients with an index hospital admission 2007-2016 including a DDI diagnosis (ICD-10-AM = K57) were grouped by acute/non-acute hospitalisation. We compared use of guideline-recommended oral antibiotics for the period 2007-2016 for these people with ten individually-matched non-DDI residents, taking the case's index date. Multivariable negative binomial models were used to estimate rates of antibiotic use. RESULTS From almost 3.5 million eligible residents, data were extracted for 51,059 index cases (20,880 acute, 30,179 non-acute) and 510,581 matched controls; mean follow-up = 8.9 years. Dispensing rates rose gradually over time among controls, from 47 per 100 person-years (/100py) prior to the index date, to 60/100py after 3 months. In comparison, dispensing was significantly higher for those with DDI: for those with acute DDI, rates were 84/100py prior to the index date, 325/100py near the index date, and 141/100py after 3 months, while for those with non-acute DDI 75/100py, 108/100py and 99/100py respectively. Following an acute DDI admission, community-dispensed antibiotics were dispensed at more than twice the rate of their non-DDI counterparts for years, and were elevated even before the index DDI hospitalisation. CONCLUSION DDI patients experience high use of antibiotics. Evidence is needed that covers primary-care and informs self-management of recurrent, chronic or persistent DDI.
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Affiliation(s)
- Joanna B. Broad
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Jerome Ng
- Institute for Innovation and Improvement, Waitematā District Health Board, Auckland, New Zealand
| | - Bruce Arroll
- Department of General Practice and Primary Healthcare, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Martin J. Connolly
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Rebekah Jaung
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Frances Oliver
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Ian P. Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
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12
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Connolly MJ, Hikaka J, Bloomfield K, Broad JB, Wu Z, Boyd M, Peri K, Calvert C, Tatton A, Higgins AM, Bramley D. 83RESEARCH IN THE RETIREMENT VILLAGE COMMUNITY: DOES THE RECRUITED SAMPLE REFLECT THE RESIDENT POPULATION? Age Ageing 2019. [DOI: 10.1093/ageing/afz061.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M J Connolly
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - J Hikaka
- Waitemata District Health Board, Auckland, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, Grafton, New Zealand
| | - K Peri
- School of Nursing, University of Auckland, Grafton, New Zealand
| | - C Calvert
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - A Tatton
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - A -M Higgins
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - D Bramley
- Waitemata District Health Board, Auckland, New Zealand
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13
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Broad JB, Wu Z, Ng J, Arroll B, Connolly MJ, Jaung R, Oliver F, Bissett IP. 79USE OF BIG DATA TO GUIDE RESEARCH DIRECTIONS IN DIVERTICULAR DISEASE OF THE INTESTINES (DDI): PRIMARY CARE MANAGEMENT OF DDI IS COMMON, YET EVIDENCE IS LACKING AND GUIDELINES ARE SILENT. Age Ageing 2019. [DOI: 10.1093/ageing/afz060.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J B Broad
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - J Ng
- Institute for Innovation and Improvement, Waitemata District Health Board, Takapuna, New Zealand
| | - B Arroll
- Department of General Practice and Primary Healthcare, School of Population Health, University of Auckland, Tamaki, New Zealand
| | - M J Connolly
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Takapuna, New Zealand
| | - R Jaung
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - F Oliver
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - I P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
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14
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Broad JB, Wu Z, Clark TG, Musson D, Jaung R, Arroll B, Bissett IP, Connolly MJ. Diverticulosis and nine connective tissue disorders: epidemiological support for an association. Connect Tissue Res 2019; 60:389-398. [PMID: 30719942 DOI: 10.1080/03008207.2019.1570169] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: An underlying connective tissue disorder (CTD) may predispose to formation of intestinal diverticula. We assess the association of diverticulosis with nine selected CTDs, to inform the pathophysiology of diverticula. Methods: A population-based period-prevalence study. Individuals (3.5 million New Zealand residents born 1901-1986) with a health system record 1999-2016 were grouped into those with a hospital diagnosis of diverticulosis or diverticulitis (ICD-10-AM K57), and those without. Also recorded were any hospital diagnoses of nine selected CTDs. The association of exposure to diverticulosis and each CTD was assessed using logistic regressions adjusted for age, gender, ethnicity and region. Results: In all, 85,958 (2.4%) people had a hospital diagnosis of diverticulosis. Hospitalisation with diverticulosis was highly significantly associated with rectal prolapse (adjusted odds ratio [OR] = 3.9), polycystic kidney disease (OR = 3.8), heritable syndromes (Marfan or Ehlers-Danlos) (OR = 2.4), female genital prolapse (OR = 2.3), non-aortic aneurysm (OR = 2.3), aortic aneurysm (OR = 2.2), inguinal hernia (OR = 1.9) and dislocations of shoulder and other joints (OR = 1.7), but not subarachnoid haemorrhage (OR = 1.0). Conclusion: People with diverticulosis are more likely to have colonic extracellular matrix (ECM)/connective tissue alterations in anatomical areas other than the bowel, suggesting linked ECM/connective tissue pathology. Although biases may exist, the results indicate large-scale integrated studies are needed to investigate underlying genetic pathophysiology of colonic diverticula, together with fundamental biological studies to investigate cellular phenotypes and ECM changes.
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Affiliation(s)
- Joanna B Broad
- a Freemasons' Department of Geriatric Medicine , University of Auckland , Auckland , New Zealand
| | - Zhenqiang Wu
- a Freemasons' Department of Geriatric Medicine , University of Auckland , Auckland , New Zealand
| | - Taane G Clark
- b Faculty of Epidemiology and Population Health & Faculty of Infectious and Tropical Diseases , London School of Hygiene and Tropical Medicine , London , UK
| | - David Musson
- c Department of Medicine , University of Auckland , Auckland , New Zealand
| | - Rebekah Jaung
- d Department of Surgery , University of Auckland , Auckland , New Zealand
| | - Bruce Arroll
- e Primary Care, Department of General Practice and Primary Healthcare , University of Auckland , Auckland , New Zealand
| | - Ian P Bissett
- d Department of Surgery , University of Auckland , Auckland , New Zealand
| | - Martin J Connolly
- f Waitemata District Health Board , University of Auckland, and Geriatrician , Auckland , New Zealand
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15
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Connolly MJ, Broad JB, Bish T, Zhang X, Bramley D, Kerse N, Bloomfield K, Boyd M. Reducing emergency presentations from long-term care: A before-and-after study of a multidisciplinary team intervention. Maturitas 2018; 117:45-50. [PMID: 30314560 DOI: 10.1016/j.maturitas.2018.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/20/2018] [Accepted: 08/31/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The complexity of care required by many older people living in long-term care (LTC) facilities poses challenges that can lead to potentially avoidable referrals to a hospital emergency department (ED). The Aged Residential Care Intervention Project (ARCHIP) ran an implementation study to evaluate a multidisciplinary team (MDT) intervention supporting LTC facility staff to decrease potentially avoidable ED presentations by residents. METHODS ARCHIP (conducted in 21 facilities [1,296 beds] with previously noted high ED referral rates) comprised clinical coaching for LTC facility staff by a gerontology nurse specialist (GNS) and an MDT (facility senior nurse, resident's general practitioner, GNS, geriatrician, pharmacist) review of selected high-risk residents' care-plans. A before-after repeated measures analysis was conducted for 9 months before and 9 months after intervention commencement (a 29-month period because of staggered facility enrolment). Modelling was adjusted for time trend, seasonality, facility size, and cluster effect. RESULTS ED admission rate ratio post- versus pre-intervention was 0.75 (95% C.I. 0.63, 0.89, p-value = 0.0008), a 25% reduction in ED presentations post-intervention. A sensitivity model used a shorter, staggered time period centred on intervention start (9 months pre-intervention and 9 months post-intervention) for each facility, and a four-level categorical intervention variable testing intervention effect over time. The sensitivity test showed a 24% reduction in ED presentations in months 1-3 post-intervention (p-value = 0.07), a 34% reduction in months 4-6 (p-value = 0.01), and a 32% reduction in ED presentations in months 7-9 (p-value = 0.03). However, when the higher ED referral rates for 3 months immediately pre-intervention were modelled, the impact of the intervention on ED presentation rates reverted almost to previous levels. KEY CONCLUSIONS A GNS-led MDT outreach intervention, targeted at selected conditions, decreases avoidable ED admissions of high-risk residents from selected facilities.
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Affiliation(s)
- M J Connolly
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, New Zealand
| | - T Bish
- Waitemata District Health Board, Auckland, New Zealand
| | - X Zhang
- Department of Geriatric Medicine, University of Auckland, New Zealand
| | - D Bramley
- Waitemata District Health Board, Auckland, New Zealand
| | - N Kerse
- School of Population Health, University of Auckland, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand
| | - M Boyd
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand; School of Nursing, University of Auckland, New Zealand
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16
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Chen H, Cheng M, Zhuang Y, Broad JB. Multimorbidity among middle-aged and older persons in urban China: Prevalence, characteristics and health service utilization. Geriatr Gerontol Int 2018; 18:1447-1452. [PMID: 30178629 DOI: 10.1111/ggi.13510] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/08/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
AIM The knowledge on multimorbidity and its impact on healthcare systems is lacking in low- and middle-income countries. We aimed to estimate the prevalence of multimorbidity, and analyze the health service use of middle-aged and older persons with multimorbidity in urban China. METHODS Study participants included 3737 urban residents aged ≥45 years from the China Health and Retirement Longitudinal Study 2011. A total of 16 pre-specified self-reported chronic conditions were used to measure multimorbidity, which was defined as having two or more conditions. Logistic regression was used to analyze the characteristics and health service use of persons with multimorbidity. Analyses were weighted to adjust for sampling design and non-response. RESULTS Of the study population, 51.9% were men and 20.1% were aged >70 years. Hypertension (33.1%) was the most prevalent condition, followed by arthritis (25.4%), digestive disease (18.7%), dyslipidemia (18.3%) and heart disease (17.7%). The prevalence of multimorbidity was 45.5% (95% CI 41.4-49.7%). Multivariate analyses showed that the prevalence of multimorbidity was significantly higher in respondents who are older and socioeconomically disadvantaged than that in their counterparts. Multimorbid patients used 72.7% of outpatient services and 77.3% of inpatient services. After controlling for demographic, socioeconomic, health behavior and health insurance factors, condition counts still had a positive relationship with outpatient or inpatient service use. CONCLUSIONS The burden of multimorbidity is high among the middle-aged and older urban Chinese population. Management of multimorbidity therefore deserves more attention from health policymakers, providers and educators of health professionals in China and in other low- and middle-income countries. Geriatr Gerontol Int 2018; 18: 1447-1452.
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Affiliation(s)
- He Chen
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Mengling Cheng
- Department of Sociology, Peking University, Beijing, China
| | - Yu Zhuang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Joanna B Broad
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
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17
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Teh RO, Menzies OH, Connolly MJ, Doughty RN, Wilkinson TJ, Pillai A, Lumley T, Ryan C, Rolleston A, Broad JB, Kerse N. Patterns of multi-morbidity and prediction of hospitalisation and all-cause mortality in advanced age. Age Ageing 2018; 47:261-268. [PMID: 29281041 DOI: 10.1093/ageing/afx184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Indexed: 11/14/2022] Open
Abstract
Background multi-morbidity is associated with poor outcomes and increased healthcare utilisation. We aim to identify multi-morbidity patterns and associations with potentially inappropriate prescribing (PIP), subsequent hospitalisation and mortality in octogenarians. Methods life and Living in Advanced Age; a Cohort Study in New Zealand (LiLACS NZ) examined health outcomes of 421 Māori (indigenous to New Zealand), aged 80-90 and 516 non-Māori, aged 85 years in 2010. Presence of 14 chronic conditions was ascertained from self-report, general practice and hospitalisation records and physical assessments. Agglomerative hierarchical cluster analysis identified clusters of participants with co-existing conditions. Multivariate regression models examined the associations between clusters and PIP, 48-month hospitalisations and mortality. Results six clusters were identified for Māori and non-Māori, respectively. The associations between clusters and outcomes differed between Māori and non-Māori. In Māori, those in the complex multi-morbidity cluster had the highest prevalence of inappropriately prescribed medications and in cluster 'diabetes' (20% of sample) had higher risk of hospitalisation and mortality at 48-month follow-up. In non-Māori, those in the 'depression-arthritis' (17% of the sample) cluster had both highest prevalence of inappropriate medications and risk of hospitalisation and mortality. Conclusions in octogenarians, hospitalisation and mortality are better predicted by profiles of clusters of conditions rather than the presence or absence of a specific condition. Further research is required to determine if the cluster approach can be used to target patients to optimise resource allocation and improve outcomes.
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Affiliation(s)
- Ruth O Teh
- Department of General Practice and Primary Health Care, University of Auckland
| | | | - Martin J Connolly
- Freemasons’ Department of Geriatric Medicine, University of Auckland
| | - Rob N Doughty
- Auckland Hospital, University of Auckland and Heart Foundation Professor
| | | | | | | | - Cristin Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin
| | | | - Joanna B Broad
- Freemasons’ Department of Geriatric Medicine, University of Auckland
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, University of Auckland
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18
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Connolly MJ, Kerse N, Wilkinson T, Menzies O, Rolleston A, Chong YH, Broad JB, Moyes SA, Jatrana S, Teh R. Testosterone in advance age: a New Zealand longitudinal cohort study: Life and Living in Advanced Age (Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu). BMJ Open 2017; 7:e016572. [PMID: 29133315 PMCID: PMC5695316 DOI: 10.1136/bmjopen-2017-016572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Serum testosterone (T) levels in men decline with age. Low T levels are associated with sarcopenia and frailty in men aged >80 years. T levels have not previously been directly associated with disability in older men. We explored associations between T levels, frailty and disability in a cohort of octogenarian men. SETTING Data from all men from Life and Living in Advanced Age Cohort Study in New Zealand, a longitudinal cohort study in community-dwelling older adults. PARTICIPANTS Community-dwelling (>80 years) adult men excluding those receiving T treatment or with prostatic carcinoma. OUTCOMES MEASURES Associations between baseline total testosterone (TT) and calculated free testosterone (fT), frailty (Fried scale) and disability (Nottingham Extended Activities of Daily Living scale (NEADL)) (baseline and 24 months) were examined using multivariate regression and Wald's χ2 techniques. Subjects with the lowest quartile of baseline TT and fT values were compared with those in the upper three quartiles. RESULTS Participants: 243 men, mean (SD) age 83.7 (2.0) years. Mean (SD) TT=17.6 (6.8) nmol/L and fT=225.3 (85.4) pmol/L. On multivariate analyses, lower TT levels were associated with frailty: β=0.41, p=0.017, coefficient of determination (R2)=0.10 and disability (NEADL) (β=-1.27, p=0.017, R2=0.11), low haemoglobin (β=-7.38, p=0.0016, R2=0.05), high fasting glucose (β=0.38, p=0.038, R2=0.04) and high C reactive protein (CRP) (β=3.57, p=0.01, R2=0.06). Low fT levels were associated with frailty (β=0.39, p=0.024, R2=0.09) but not baseline NEADL (β=-1.29, p=0.09, R2=0.09). Low fT was associated with low haemoglobin (β=-7.83, p=0.0008, R2=0.05) and high CRP (β=2.86, p=0.04, R2=0.05). Relationships between baseline TT and fT, and 24-month outcomes of disability and frailty were not significant. CONCLUSIONS In men over 80 years, we confirm an association between T levels and baseline frailty scores. The new finding of association between T levels and disability is potentially relevant to debates on T supplementation in older men, though, as associations were not present at 24 months, further work is needed.
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Affiliation(s)
- Martin J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Tim Wilkinson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Oliver Menzies
- Geriatric Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Anna Rolleston
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yih Harng Chong
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Simon A Moyes
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Santosh Jatrana
- Centre for Social Impact, Faculty of Business and Law, Swinburne University of Technology, Melbourne, Australia
- University of Otago, Wellington, New Zealand
| | - Ruth Teh
- School of Population Health, University of Auckland, Auckland, New Zealand
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Hayman KJ, Kerse N, Dyall L, Kepa M, Teh R, Wham C, Clair VWS, Wiles J, Keeling S, Connolly MJ, Wilkinson TJ, Moyes S, Broad JB, Jatrana S. Erratum to: Life and living in advanced age: a cohort study in New Zealand -Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: study protocol. BMC Geriatr 2017. [PMID: 28629315 PMCID: PMC5477101 DOI: 10.1186/s12877-017-0517-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Karen J Hayman
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, Auckland, 92109, New Zealand.
| | - Ngaire Kerse
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, Auckland, 92109, New Zealand
| | - Lorna Dyall
- Te Kupenga Hauora, Department of Māori Studies, University of Auckland, Auckland, New Zealand
| | - Mere Kepa
- Te Kupenga Hauora, Department of Māori Studies, University of Auckland, Auckland, New Zealand
| | - Ruth Teh
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, Auckland, 92109, New Zealand
| | - Carol Wham
- Institute of Food, Nutrition and Human Health, Massey University, Auckland, New Zealand
| | - Valerie Wright-St Clair
- School of Rehabilitation & Occupation Studies, Auckland University of Technology, Auckland, New Zealand
| | - Janine Wiles
- Department of Community Health, University of Auckland, Auckland, New Zealand
| | - Sally Keeling
- Dept of Medicine, University of Otago, Christchurch, New Zealand
| | - Martin J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Tim J Wilkinson
- Dept of Medicine, University of Otago, Christchurch, New Zealand
| | - Simon Moyes
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, Auckland, 92109, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Santosh Jatrana
- Alfred Deakin Research Institute, Deakin University, Sydney, Australia
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Wright-St Clair VA, Rapson A, Kepa M, Connolly M, Keeling S, Rolleston A, Teh R, Broad JB, Dyall L, Jatrana S, Wiles J, Pillai A, Garrett N, Kerse N. Ethnic and Gender Differences in Preferred Activities among Māori and non-Māori of Advanced age in New Zealand. J Cross Cult Gerontol 2017; 32:433-446. [PMID: 28597090 DOI: 10.1007/s10823-017-9324-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Valerie A Wright-St Clair
- School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Angela Rapson
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Mere Kepa
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Martin Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Sally Keeling
- Department of Medicine, The Princess Margaret Hospital, University of Otago Christchurch, Christchurch, New Zealand
| | - Anna Rolleston
- Te Kupenga Hauora Māori, General Practice & Primary Care, University of Auckland, Auckland, New Zealand
| | - Ruth Teh
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Lorna Dyall
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Santosh Jatrana
- Centre for Social Impact-Swinburne, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Janine Wiles
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Avinesh Pillai
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Nick Garrett
- Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
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Broad JB, Lumley T, Ashton T, Davis PB, Boyd M, Connolly MJ. Transitions to and from long-term care facilities and length of completed stay: Reuse of population-based survey data. Australas J Ageing 2017; 36:E1-E7. [PMID: 28319325 DOI: 10.1111/ajag.12378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This article estimates length of completed stay and resident transitions for RAC residents over 12 months in Auckland. METHODS Data from a census-type survey of nursing home residents (n = 6816) were linked with national mortality data. Transitions described include entry to residential aged care (RAC), movement between RAC facilities and deaths. RESULTS When reweighted for missing data and adjusted for length bias, an estimated 9676 residents (95% CI 8368-10 985) used care over a 12-month period. Half of new residents entered RAC via an acute hospital. Median survival was 2.0 years; 17% died within 3 months, and 23% survived over 5 years. CONCLUSION Cross-sectional survey data, when appropriately adjusted for length-biased sampling, enable estimates of period prevalence and transition probabilities that are useful for simulation studies. Given population ageing and the costs of ongoing care, these results can inform policy and planning for long-term care needs of older people.
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Affiliation(s)
- Joanna B Broad
- Freemasons' Department of Geriatric Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Toni Ashton
- Health Systems, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter B Davis
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Freemasons' Department of Geriatric Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,School of Nursing, University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Martin J Connolly
- Freemasons' Department of Geriatric Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
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Baskett JJ, Broad JB, Reekie G, Hocking C, Green G. Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke. Clin Rehabil 2016. [DOI: 10.1177/026921559901300104] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke, supervised once a week by therapists. Design: A randomized controlled trial of 100 patients discharged from hospital after a stroke, requiring ongoing therapy. The control group received outpatient or day hospital therapy; the experimental group were visited once a week by an occupational and/or physiotherapist who prescribed a programme of exercises and activities for the following week. Subjects were studied for the first three months after discharge from hospital. Setting: A district general hospital, or the homes of subjects randomized to the experimental group, in New Zealand. Main outcome measures: (1) Characteristics of the groups, (2) gait speed, limb function, activities of daily living, (3) time with therapists, (4) mood of both subjects and caregivers, (5) anticipation of outcome at entry, compared with perceived outcome at exit. Results: No statistical differences between the control and experimental groups in characteristics, or in any outcomes measured, except that the contact time period, but not the number of visits, was longer in the experimental group (p = 0.003). Conclusions: A supervised home-based programme is as effective as outpatient or day hospital therapy.
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Affiliation(s)
- Jonathan J Baskett
- University Geriatric Unit, North Shore Hospital, Takapuna,
Auckland, New Zealand
| | - Joanna B Broad
- University Geriatric Unit, North Shore Hospital, Takapuna,
Auckland, New Zealand
| | - Gabrielle Reekie
- University Geriatric Unit, North Shore Hospital, Takapuna,
Auckland, New Zealand
| | - Clare Hocking
- University Geriatric Unit, North Shore Hospital, Takapuna,
Auckland, New Zealand
| | - Geoff Green
- University Geriatric Unit, North Shore Hospital, Takapuna,
Auckland, New Zealand
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23
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Broad JB, Dunstan K, Claridge A, Harris R. Am I too old for this, Doctor? Using population life expectancy to guide clinical decision-making. Australas J Ageing 2016; 36:60-64. [PMID: 27785890 DOI: 10.1111/ajag.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Prognostication is important in clinical decision-making, especially for older people. The aim was to present estimates of life expectancy for older people in New Zealand. METHODS Statistics New Zealand age-sex-specific death rates were used to derive quartiles of expected years of life remaining in people aged over 65 years. RESULTS Given current patterns and trends in New Zealand death rates, 50% of women reaching age 80 years in 2016 can expect to live at least another 10.5 years, 25% will live over 14.7 years, and 25% will die within 6.2 years. Comparable results for men reaching age 80 years in 2016 are 8.5 years, 12.7 years and 4.6 years, respectively. Of those reaching age 90 years in 2016, median expected years of life left is 4.2 years for women and 3.4 years for men. CONCLUSION Demographic norms are useful as a guide when specific predictive tools are unavailable.
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Affiliation(s)
- Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Kim Dunstan
- Statistics New Zealand, Christchurch, New Zealand
| | - Annabelle Claridge
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Roger Harris
- Auckland District Health Board, Auckland, New Zealand
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24
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Boyd M, Broad JB, Zhang TX, Kerse N, Gott M, Connolly MJ. Hospitalisation of older people before and after long-term care entry in Auckland, New Zealand. Age Ageing 2016; 45:558-63. [PMID: 27055876 DOI: 10.1093/ageing/afw051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/09/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION global population projections forecast large growth in demand for long-term care (LTC) and acute hospital services for older people. Few studies report changes in hospitalisation rates before and after entry into LTC. This study compares hospitalisation rates 1 year before and after LTC entry. METHODS the Older Persons' Ability Level (OPAL) study was a 2008 census-type survey of LTC facilities in Auckland, New Zealand. OPAL resident hospital admissions and deaths were obtained from routinely collected national databases. RESULTS all 2,244 residents (66% = female) who entered LTC within 12 months prior to OPAL were included. There were 3,363 hospitalisations, 2,424 in 12 months before and 939 in 12 months after entry, and 364 deaths. In the 6 to 12 months before LTC entry, the hospitalisation rate/100 person-years was 67.3 (95% confidence interval [CI] 62.5-72.1). Weekly rates then rose steeply to over 450/100 person-years in the 6 months immediately before LTC entry. In the 6 months after LTC entry, the rate fell to 49.1 (CI 44.9-53.3; RR 0.73 (CI 0.65-0.82, P < 0.0001)) and decreased further 6 to 12 months after entry to 41.1 (CI 37.1-45.1; rate ratio [RR] 0.61 (CI 0.54-0.69, P < 0.0001)). CONCLUSIONS increased hospitalisations a few months before LTC entry suggest functional and medical instability precipitates LTC entry. New residents utilise hospital beds less frequently than when at home before that unstable period. Further research is needed to determine effective interventions to avoid some hospitalisations and possibly also LTC entry.
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Connolly MJ, Broad JB, Boyd M, Zhang TX, Kerse N, Foster S, Lumley T, Whitehead N. The 'Big Five'. Hypothesis generation: a multidisciplinary intervention package reduces disease-specific hospitalisations from long-term care: a post hoc analysis of the ARCHUS cluster-randomised controlled trial. Age Ageing 2016; 45:415-20. [PMID: 27021357 DOI: 10.1093/ageing/afw037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/15/2016] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION long-term care (LTC) residents have higher hospitalisation rates than non-LTC residents. Rapid decline may follow hospitalisations, hence the importance of preventing unnecessary hospitalisations. Literature describes diagnosis-specific interventions (for cardiac failure, ischaemic heart disease, chronic obstructive pulmonary disease, stroke, pneumonia-termed 'big five' diagnoses), impacting on hospitalisations of older community-dwellers, but few RCTs show reductions in acute admissions from LTC. METHODS LTC facilities with higher than expected hospitalisations were recruited for a cluster-randomised controlled trial (RCT) of facility-based complex, non-disease-specific, 9-month intervention comprising gerontology nurse specialist (GNS)-led staff education, facility benchmarking, GNS resident review and multidisciplinary discussion of residents selected using standard criteria. In this post hoc exploratory analysis, the outcome was acute hospitalisations for 'big five' diagnoses. Re-randomisation analyses were used for end points during months 1-14. For end points during months 4-14, proportional hazards models are adjusted for within-facility clustering. RESULTS we recruited 36 facilities with 1,998 residents (1,408 female; mean age 82.9 years); 1,924 were alive at 3 months. The intervention did not impact overall rates of acute hospitalisations or mortality (previously published), but resulted in fewer 'big five' admissions (RR = 0.73, 95% CI = 0.54-0.99; P = 0.043) with no significant difference in the rate of other acute admissions. When considering events occurring after 3 months (only), the intervention group were 34.7% (HR = 0.65; 95% CI = 0.49-0.88; P = 0.005) less likely to have a 'big five' acute admission than controls, with no differences in likelihood of acute admissions for other diagnoses (P = 0.96). CONCLUSIONS this generic intervention may reduce admissions for common conditions which the literature shows are impacted by disease-specific admission reduction strategies.
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Affiliation(s)
- Martin J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand Waitemata District Health Board, Auckland, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand Waitemata District Health Board, Auckland, New Zealand Department of Nursing, University of Auckland, Auckland, New Zealand
| | - Tony Xian Zhang
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Susan Foster
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand Waitemata District Health Board, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Noeline Whitehead
- Department of Nursing, University of Auckland, Auckland, New Zealand
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Heppenstall CP, Broad JB, Boyd M, Hikaka J, Zhang X, Kennedy J, Connolly MJ. Medication use and potentially inappropriate medications in those with limited prognosis living in residential aged care. Australas J Ageing 2015; 35:E18-24. [PMID: 26416493 DOI: 10.1111/ajag.12220] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To compare the prevalence in residential aged care (RAC) of preventative and potentially inappropriate medications (PIMs) in those who died within 12 months versus those alive after 12 months. METHODS Firstly, a cross-sectional survey of 6196 people living in RAC in Auckland. Secondly, a research physician searched electronic hospital records in one District Health Board for a sub-sample (n = 222) of these residents. Classes of medications and dates of death were obtained from the Ministry of Health databases. Those who died versus those alive at 12 months were compared. RESULTS Over half of the 6196 participants received antihypertensives and/or antiplatelet agents. Cardiovascular preventative medications were significantly more common in those who died within 12 months. Seventy percent in high-level care received psychotropics. PIMs were commonly used. CONCLUSIONS Use of preventative medications is common in RAC, especially during the last year of life. Psychotropics are very commonly used, despite being potentially inappropriate.
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Affiliation(s)
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Joanna Hikaka
- Aged Residential Care, Inpatient Pharmacy, Waitemata District Health Board, Auckland, New Zealand
| | - Xian Zhang
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Julia Kennedy
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand.,Department of Geriatric Medicine, Waitemata District Health Board, Auckland, New Zealand
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Broad JB, Ashton T, Gott M, McLeod H, Davis PB, Connolly MJ. Likelihood of residential aged care use in later life: a simple approach to estimation with international comparison. Aust N Z J Public Health 2015; 39:374-9. [DOI: 10.1111/1753-6405.12374] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/01/2014] [Accepted: 01/01/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Joanna B. Broad
- Freemasons' Department of Geriatric Medicine, Faculty of Medicine and Health Sciences; University of Auckland; New Zealand
| | - Toni Ashton
- Health Systems, School of Population Health; University of Auckland; New Zealand
| | - Merryn Gott
- School of Nursing; University of Auckland; New Zealand
| | - Heather McLeod
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3); University of Otago; New Zealand
| | - Peter B. Davis
- COMPASS Research Centre, University of Auckland; New Zealand
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Heppenstall CP, Broad JB, Boyd M, Gott M, Connolly MJ. Progress towards predicting 1-year mortality in older people living in residential long-term care. Age Ageing 2015; 44:497-501. [PMID: 25652076 DOI: 10.1093/ageing/afu206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 09/11/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND frail older people living in residential long-term care (LTC) have limited life expectancy. Identifying those with poor prognosis may improve management and facilitate transition to a palliative approach to care. OBJECTIVE to develop methods for predicting mortality in LTC. DESIGN a population-based cohort study. SETTING LTC facilities, Auckland, New Zealand. SUBJECTS five hundred randomly selected older people in a census-type survey of those living in LTC in 2008. METHODS mortality data were obtained from New Zealand Ministry of Health. Two methods for assessing mortality risk were developed using demographic, functional and health service information: (i) two geriatricians blinded to identifying data and to mortality, independently reviewed survey, medications and pre-survey hospitalisations data, and grouped residents according to perceived risk of death within 12 months; (ii) multivariate logistic regression model used the same survey and medication items as the geriatricians. RESULTS for the geriatricians' assessment, each quintile of perceived risk was associated with a significant increase in mortality (P < 0.001). Area under the curve (AUC) for both physicians was 0.64. The logistic regression model included age, gender, assistance with feeding and requiring night attention, all variables which are easily available from LTC records. AUC for the model was 0.70, but when validated against the entire OPAL cohort, it was 0.65. When either or both geriatrician and the model together predicted high risk of death, 1-year mortality was >50%. CONCLUSION two methods with the potential to identify older people with limited prognosis are described. Use of these methods allowed identification of over half of those who died within 12 months.
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Affiliation(s)
- Claire Patricia Heppenstall
- Department of Medicine, University of Otago, Christchurch, 1st Floor, Princess Margaret Hopital, PO Box 800, Christchurch 8140, New Zealand
| | - Joanna B Broad
- Freemasons Department of Geriatric Medicine, University of Auckland, Auckland 0740, New Zealand
| | - Michal Boyd
- Freemasons Department of Geriatric Medicine, University of Auckland, Auckland 0740, New Zealand Waitemata District Health Board, Auckland, New Zealand Department of Nursing, University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- Department of Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Freemasons Department of Geriatric Medicine, University of Auckland, Auckland 0740, New Zealand Waitemata District Health Board, Auckland, New Zealand
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Vather R, Broad JB, Jaung R, Robertson J, Bissett IP. Demographics and trends in the acute presentation of diverticular disease: a national study. ANZ J Surg 2015; 85:744-8. [PMID: 25925134 DOI: 10.1111/ans.13147] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diverticular disease (DD) is a major health problem in the Western world. The aim of this study was to describe demographics and trends in acute DD admissions in New Zealand. METHODS Information pertaining to acute hospital admissions between January 2000 and June 2012 for a primary diagnosis of large bowel DD was retrieved from a national database. RESULTS There were 25,167 admissions for acute DD. Mean age of presentation decreased from 65.9 years in 2000 to 64.1 years in 2012 (P < 0.001). Mean age was lower in men than women (61.4 versus 67.4 years, P < 0.001). Although men comprised 45.2% of the cohort they were over-represented in the 18-44 years stratum (68.6 versus 31.4%; P < 0.001). Europeans accounted for 84.8% of admissions and presented at an older age (65.8 years) than Māori (56.2 years), Pacific Islanders (58.4 years) or Asians (58.9 years) (P < 0.001). Acute DD admissions were higher in more deprived populations (P < 0.001). Mean length of hospital stay (LOS) reduced from 5.8 days in 2000 to 4.1 days in 2012 (P < 0.001). LOS increased with age (P < 0.001) and deprivation (P = 0.013), but did not differ between ethnicities (P = 0.088). Computed tomography scanning of acute admissions doubled from 2000 to 2012 (29.7-59.2%; P < 0.001) with a halving in the use of acute in-patient colonoscopy (26.1-13.2%; P < 0.001) and emergent surgery (14.8-7.2%; P < 0.001). Percutaneous drain use increased from 0.6% in 2000 to 1.1% in 2012 (P = 0.003). CONCLUSION Acute DD is a source of considerable morbidity in New Zealand and there have been significant changes in its admission demographics and trends over the last decade.
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Affiliation(s)
- Ryash Vather
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Rebekah Jaung
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Jason Robertson
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Connolly MJ, Boyd M, Broad JB, Kerse N, Lumley T, Whitehead N, Foster S. The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities. J Am Med Dir Assoc 2014; 16:49-55. [PMID: 25239019 DOI: 10.1016/j.jamda.2014.07.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/01/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. DESIGN Cluster randomized controlled trial. SETTING RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. PARTICIPANTS A total of 1998 residents of 18 intervention facilities and 18 control facilities. INTERVENTION A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. MAIN OUTCOME MEASURES Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. RESULTS The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85-1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76-1.61; P = .62). CONCLUSIONS This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943).
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Affiliation(s)
- Martin J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
| | - Michal Boyd
- Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand; Department of Nursing, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | | | - Susan Foster
- Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand
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Broad JB, Ashton T, Lumley T, Boyd M, Kerse N, Connolly MJ. Biases in describing residents in long-term residential aged care. N Z Med J 2014; 127:50-61. [PMID: 25228421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM In New Zealand, no reliable information describes use of long-term residential aged care. Instead, when estimating use, records of government subsidy payments are upscaled to adjust for private payers. This paper assesses consequential bias in reporting use of long-term care and considers the implications. METHODS Data from OPAL, a census-type survey of residents of aged-care facilities in Auckland in 2008, linked to routinely-collected hospitalisation, mortality and subsidy data from national databases. Demographic, functional and service use characteristics of unsubsidised residents were compared to subsidised. RESULTS Records of 5961 OPAL residents aged 65+ years were matched with subsidy data; 25% were unsubsidised. In low-level care (51% of all), unsubsidised residents had similar care needs to subsidised residents, but were 1.7 years older on average (p<0.001) with shorter length of stay. In high-level care (41% of all), unsubsidised residents had significantly lower care needs on six different measures and were less likely to die during the follow-up period. Upscaling yields undercounts at all care levels. CONCLUSIONS National reports derived from current upscaling methods undercount residents. Stratification by region and age group would improve estimates. Age and care needs are misrepresented. Population policies that depend upon upscaled counts should, where possible, ascertain the biases introduced.
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Affiliation(s)
- Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, C/- WDHB, Box 93503, Takapuna, Auckland 0740, New Zealand.
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Broad JB, Ashton T, Lumley T, Boyd M, Kerse N, Connolly MJ. Selecting long-term care facilities with high use of acute hospitalisations: issues and options. BMC Med Res Methodol 2014; 14:93. [PMID: 25052433 PMCID: PMC4118262 DOI: 10.1186/1471-2288-14-93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper considers approaches to the question "Which long-term care facilities have residents with high use of acute hospitalisations?" It compares four methods of identifying long-term care facilities with high use of acute hospitalisations by demonstrating four selection methods, identifies key factors to be resolved when deciding which methods to employ, and discusses their appropriateness for different research questions. METHODS OPAL was a census-type survey of aged care facilities and residents in Auckland, New Zealand, in 2008. It collected information about facility management and resident demographics, needs and care. Survey records (149 aged care facilities, 6271 residents) were linked to hospital and mortality records routinely assembled by health authorities. The main ranking endpoint was acute hospitalisations for diagnoses that were classified as potentially avoidable. Facilities were ranked using 1) simple event counts per person, 2) event rates per year of resident follow-up, 3) statistical model of rates using four predictors, and 4) change in ranks between methods 2) and 3). A generalized mixed model was used for Method 3 to handle the clustered nature of the data. RESULTS 3048 potentially avoidable hospitalisations were observed during 22 months' follow-up. The same "top ten" facilities were selected by Methods 1 and 2. The statistical model (Method 3), predicting rates from resident and facility characteristics, ranked facilities differently than these two simple methods. The change-in-ranks method identified a very different set of "top ten" facilities. All methods showed a continuum of use, with no clear distinction between facilities with higher use. CONCLUSION Choice of selection method should depend upon the purpose of selection. To monitor performance during a period of change, a recent simple rate, count per resident, or even count per bed, may suffice. To find high-use facilities regardless of resident needs, recent history of admissions is highly predictive. To target a few high-use facilities that have high rates after considering facility and resident characteristics, model residuals or a large increase in rank may be preferable.
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Affiliation(s)
- Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, C/- WDHB, Box 93503, Takapuna, Auckland 0740, New Zealand.
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Broad JB, Ashton T, Lumley T, Connolly MJ. Reports of the proportion of older people living in long-term care: a cautionary tale from New Zealand. Aust N Z J Public Health 2014; 37:264-71. [PMID: 23731110 DOI: 10.1111/1753-6405.12069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Population ageing is driving many countries to review health and social care policies. For many, an important component is residential long-term care (LTC). This study uses New Zealand to ascertain the extent different reports provide consistent and accurate estimates of LTC use. METHODS We searched for available cross-sectional information about use of LTC by people aged 65 years or over in NZ's population since 1988. In addition, for one geographic region, Auckland, we compared research survey data at three time-points with the nearest census estimates. RESULTS Fifty-eight national-level estimates (census, subsidy payments and population surveys) were found. Since 2000, estimates of the proportion of older people reportedly living in long-term care ranged from 3.4% to 9.2%. Comparisons with Auckland studies demonstrated improved reporting in the 2006 census. CONCLUSION Estimates of the proportion of people living in residential LTC varied widely. OECD reports, often used for cross-national comparisons, were particularly inconsistent. IMPLICATIONS While estimates of the proportion of people living in residential LTC in NZ are inconsistent, improvements are evident in census and subsidy data. Reconciling new data with previous reports prior to publication may reduce variations in reporting. Improved reliability will assist understanding of within-country trends and international comparisons, and better inform decisions shaping health services for older people.
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Affiliation(s)
- Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, New Zealand.
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Dyall L, Kepa M, Hayman K, Teh R, Moyes S, Broad JB, Kerse N. Engagement and recruitment of Māori and non-Māori people of advanced age to LiLACS NZ. Aust N Z J Public Health 2013; 37:124-31. [PMID: 23551470 DOI: 10.1111/1753-6405.12029] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
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. METHODS Electoral roll and primary health lists of older people were used as a base for identification and recruitment, supplemented by word of mouth, community awareness raising and publicity. A Kaupapa Māori method was used to recruit Māori with: dual Māori and non-Māori research leadership; the formation of a support group; local tribal organisations and health providers recruiting participants; and use of the Māori language in interviews. Non-Māori were recruited through local health and community networks. Six organisations used differing strategies to invite older people to participate in several ways: complete full or partial interviews; complete physical assessments; provide a blood sample and provide access to medical records. RESULTS During 14 months in 2010-2011, 421 of 766 (56%) eligible Māori and 516 of 870 (59%) eligible non-Māori were enrolled. Participation and contribution of information varied across the recruitment sites. CONCLUSION Attention to appropriate recruitment techniques resulted in an acceptable engagement and recruitment for both Māori and non-Māori of advanced age in a longitudinal cohort study. IMPLICATIONS There is high potential for meaningful results useful for participants, their whānau and families, health agencies, planners and policy.
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Affiliation(s)
- Lorna Dyall
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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Connolly MJ, Broad JB, Boyd M, Kerse N, Gott M. Residential aged care: The de facto hospice for New Zealand's older people. Australas J Ageing 2013; 33:114-20. [DOI: 10.1111/ajag.12010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Martin J Connolly
- Freemasons' Department of Geriatric Medicine; University of Auckland; Auckland New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine; University of Auckland; Auckland New Zealand
| | - Michal Boyd
- Freemasons' Department of Geriatric Medicine; University of Auckland; Auckland New Zealand
| | - Ngaire Kerse
- Department of General Practice; School of Population Health; University of Auckland; Auckland New Zealand
| | - Merryn Gott
- School of Nursing; University of Auckland; Auckland New Zealand
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Hayman KJ, Kerse N, Dyall L, Kepa M, Teh R, Wham C, Clair VWS, Wiles J, Keeling S, Connolly MJ, Wilkinson TJ, Moyes S, Broad JB, Jatrana S. Life and living in advanced age: a cohort study in New Zealand--e Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: study protocol. BMC Geriatr 2012; 12:33. [PMID: 22747503 PMCID: PMC3502153 DOI: 10.1186/1471-2318-12-33] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 06/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 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/DESIGN A 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. DISCUSSION A 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.
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Affiliation(s)
- Karen J Hayman
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, 92109, Auckland, New Zealand
| | - Ngaire Kerse
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, 92109, Auckland, New Zealand
| | - Lorna Dyall
- Te Kupenga Hauora, Department of Māori Studies, University of Auckland, Auckland, New Zealand
| | - Mere Kepa
- Te Kupenga Hauora, Department of Māori Studies, University of Auckland, Auckland, New Zealand
| | - Ruth Teh
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, 92109, Auckland, New Zealand
| | - Carol Wham
- Institute of Food, Nutrition and Human Health, Massey University, Auckland, New Zealand
| | - Valerie Wright-St Clair
- School of Rehabilitation & Occupation Studies, Auckland University of Technology, Auckland, New Zealand
| | - Janine Wiles
- Department of Community Health, University of Auckland, Auckland, New Zealand
| | - Sally Keeling
- Dept of Medicine, University of Otago, Christchurch, New Zealand
| | - Martin J Connolly
- Freemasons’ Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Tim J Wilkinson
- Dept of Medicine, University of Otago, Christchurch, New Zealand
| | - Simon Moyes
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, 92109, Auckland, New Zealand
| | - Joanna B Broad
- Freemasons’ Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Santosh Jatrana
- Alfred Deakin Research Institute, Deakin University, Sydney, Australia
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Boyd M, Bowman C, Broad JB, Connolly MJ. International comparison of long-term care resident dependency across four countries (1998-2009): a descriptive study. Australas J Ageing 2012; 31:233-40. [PMID: 23252981 DOI: 10.1111/j.1741-6612.2011.00584.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To describe an international comparison of dependency of long-term care residents. METHODS All Auckland aged care residents were surveyed in 1998 and 2008 using the 'Long-Term Care in Auckland' instrument. A large provider of residential aged care, Bupa-UK, performed a similar but separate functional survey in 2003, again in 2006 (including UK Residential Nursing Home Association facilities), and in 2009 which included Bupa facilities in Spain, New Zealand and Australia. The survey questionnaires were reconciled and functional impairment rates compared. RESULTS Of almost 90,000 residents, prevalence of dependent mobility ranged from 27 to 47%; chronic confusion, 46 to 75%; and double incontinence, 29 to 49%. Continence trends over time were mixed, chronic confusion increased, and challenging behaviour decreased. CONCLUSION Overall functional dependency for residents is high and comparable internationally. Available trends over time indicate increasing resident dependency signifying care required for this population is considerable and possibly increasing.
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Affiliation(s)
- Michal Boyd
- Freemasons' Department of Geriatric Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, New Zealand.
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Boyd M, Broad JB, Kerse N, Foster S, von Randow M, Lay-Yee R, Chelimo C, Whitehead N, Connolly MJ. Twenty-Year Trends in Dependency in Residential Aged Care in Auckland, New Zealand: A Descriptive Study. J Am Med Dir Assoc 2011; 12:535-40. [DOI: 10.1016/j.jamda.2011.01.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 01/27/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
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Broad JB, Boyd M, Kerse N, Whitehead N, Chelimo C, Lay-Yee R, von Randow M, Foster S, Connolly MJ. Residential aged care in Auckland, New Zealand 1988-2008: do real trends over time match predictions? Age Ageing 2011; 40:487-94. [PMID: 21628389 DOI: 10.1093/ageing/afr056] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND in Auckland, New Zealand in 1988, 7.7% of those aged over 65 years lived in licenced residential aged care. Age-specific rates approximately doubled for each 5-year age group after the age of 65 years. Even with changes in policies and market forces since 1988, population increases are forecast to drive large growth in demand. This study shows previously unrecognised 20-year trends in rates of care in a geographically defined population. METHODS four cross-sectional surveys of all facilities (rest homes and hospitals) licenced for long-term care of older people were conducted in Auckland, New Zealand in 1988, 1993, 1998 and 2008. Facility staff completed survey forms for each resident. Numbers of licenced and occupied beds and trends in age-specific and age-standardised rates in residential aged care are reported. RESULTS over the 20-year period, Auckland's population aged over 65 years increased by 43% (from 91,000 to 130,000) but actual numbers in care reduced slightly. Among those aged over 65 years, the proportion living in care facilities reduced from 1 in 13 to 1 in 18. Age-standardised rates in rest-home level care reduced from 65 to 33 per thousand, and in hospital level care, from 29 to 23 per thousand. Had rates remained stable, over 13,200 people, 74% more than observed, would have been in care in 2008. CONCLUSION growth predicted in the residential aged care sector is not yet evident. The introduction of standardised needs assessments before entry, increased availability of home-based services, and growth in retirement villages may have led to reduced utilisation.
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Affiliation(s)
- Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, New Zealand.
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Marshall RJ, Zhang Z, Broad JB, Wells S. Agreement between ethnicity recorded in two New Zealand health databases: effects of discordance on cardiovascular outcome measures (PREDICT CVD3). Aust N Z J Public Health 2007; 31:211-6. [PMID: 17679237 DOI: 10.1111/j.1753-6405.2007.00050.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To assess agreement between ethnicity as recorded by two independent databases in New Zealand, PREDICT and the National Health Index (NHI), and to assess sensitivity of ethnic-specific measures of health outcomes to either ethnicity record. METHOD Patients assessed using PREDICT form the study cohort. Ethnicity was recorded for PREDICT and an associated NHI ethnicity code was identified by merge-match linking on an encrypted NHI number. Agreement between ethnicity measures was assessed by kappa scores and scaled rectangle diagrams. RESULTS A cohort of 18,239 individuals was linked in both PREDICT and NHI databases. The agreement between ethnicity classifications was reasonably good, with overall kappa coefficient of 0.82. There was better agreement for women than men and agreement improved with age and with time since the PREDICT system has been operational. Ethnic-specific cardiovascular (CVD) hospital admission rates were sensitive to ethnicity coding by NHI or PREDICT; rate ratios for ethnic groups, relative to European, based on PREDICT were attenuated towards the null relative to the NHI classification. CONCLUSIONS Agreement between ethnicity was moderately good. Discordances that do exist do not have a substantial effect on prevalence-based measures of effect; however, they do on measurement of the admission of CVD. IMPLICATIONS Different categorisations of ethnicity data from routine (and other) databases can lead to different ethnic-specific estimates of epidemiological effects. There is an imperative to record ethnicity in a rational, systematic and consistent way.
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Affiliation(s)
- Roger J Marshall
- School of Population Health, University of Auckland, New Zealand.
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Carter K, Anderson C, Hacket M, Feigin V, Barber PA, Broad JB, Bonita R. Trends in Ethnic Disparities in Stroke Incidence in Auckland, New Zealand, During 1981 to 2003. Stroke 2006; 37:56-62. [PMID: 16339477 DOI: 10.1161/01.str.0000195131.23077.85] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although geographical variations in stroke rates are well documented, limited data exist on temporal trends in ethnic-specific stroke incidence.
Methods—
We assessed trends in ethnic-specific stroke rates using standard diagnostic criteria and community-wide surveillance procedures in Auckland, New Zealand (NZ) in 1981 to 1982, 1991 to 1992, and 2002 to 2003. Indirect and direct methods were used to adjust first-ever (incident) and total (attack) rates for changes in the structure of the population and reported with 95% CIs. Ethnicity was self-defined and categorized as “NZ/European,” “Maori,” “Pacific peoples,” and “Asian and other.”
Results—
Stroke attack (19%; 95% CI, 11% to 26%) and incidence rates (19%; 95% CI, 12% to 24%) declined significantly in NZ/Europeans from 1981 to 1982 to 2002 to 2003. These rates remained high or increased in other ethnic groups, particularly for Pacific peoples in whom stroke attack rates increased by 66% (95% CI; 11% to 225%) over the periods. Some favorable downward trends in vascular risk factors, such as cigarette smoking, were counterbalanced by increasing age, body mass index, and diabetes in certain ethnic groups.
Conclusions—
Divergent trends in ethnic-specific stroke incidence and attack rates, and of associated risk factors, have occurred in Auckland over recent decades. The findings provide mixed views as to the future burden of stroke in populations undergoing similar lifestyle and structural changes.
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Affiliation(s)
- Kristie Carter
- Clinical Trials Research Unit, School of Population Health, Faculty of Medicine and Health Sciences, The University of Auckland, New Zealand
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Abstract
BACKGROUND AND PURPOSE Long-term trends in stroke incidence in different populations have not been well characterized, largely as a result of the complexities associated with population-based stroke surveillance. METHODS We assessed temporal trends in stroke incidence using standard diagnostic criteria and community-wide surveillance procedures in the population (approximately 1 million) of Auckland, New Zealand, over 12-month calendar periods in 1981-1982, 1991-1992, and 2002-2003. Age-adjusted first-ever (incident) and total (attack) rates, and temporal trends, were reported with 95% confidence intervals (CIs). Rates were analyzed by sex and major age groups. RESULTS From 1981 to 1982, stroke rates were stable in 1991-1992 and then declined in 2002-2003, to produce overall modest declines in standardized incidence (11%; 95% CI, 1 to 19%) and attack rates (9%; 95% CI, 0 to 16%) between the first and last study periods. Some favorable downward trends in vascular risk factors such as cigarette smoking were counterbalanced by increasing age and body mass index, and frequency of diabetes, in patients with stroke. CONCLUSIONS There has been a modest decline in stroke incidence in Auckland over the last 2 decades, mainly during 1991 to 2003, in association with divergent trends in major risk factors.
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Affiliation(s)
- Craig S Anderson
- School of Population Health, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand.
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Abstract
Background and Purpose—
Limited information exists on the long-term outcome from stroke. We aimed to determine survival and health status at 21-year follow-up of patients who participated in a population-based stroke incidence study undertaken in Auckland, New Zealand.
Methods—
During 12 months beginning March 1, 1981, half of all residents of Auckland with acute first-ever or recurrent stroke (n=680) were assessed and followed up prospectively during the next 2 decades. In 2002, their vital status and health-related quality of life (HRQoL) using the 36-item short-form questionnaire (SF-36) were determined by telephone interviews. Kaplan–Meier survival probabilities for the stroke cohort were compared with life table estimates for the New Zealand population. The SF-36 profile of 21-year stroke survivors was compared with a standardized New Zealand population.
Results—
Overall, 626 of the original cohort had died and 4 were lost to follow-up, leaving 50 (7%) individuals (57% male; mean age 70 years) available in 2002, of whom 12% were residents of an institutional care facility and 19% required help with everyday activities. The stroke cohort had nearly twice the mortality rate of the New Zealand population, but the SF-36 profile of very long-term stroke survivors was broadly similar to the general population.
Conclusions—
Because stroke is generally a disease of older people and has a high case fatality, it is not surprising that <1 in 10 people survive 2 decades after onset. However, of those who do, their HRQoL profile suggests that they meld relatively successfully within the general population, despite ongoing disability and a higher mortality risk.
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Affiliation(s)
- Craig S Anderson
- Clinical Trials Research Unit, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Baskett JJ, Broad JB, Wood PC, Duncan JR, Pledger MJ, English J, Arendt J. Does melatonin improve sleep in older people? A randomised crossover trial. Age Ageing 2003; 32:164-70. [PMID: 12615559 DOI: 10.1093/ageing/32.2.164] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVE to determine whether melatonin will improve quality of sleep in healthy older people with age-related sleep maintenance problems. DESIGN a double blind randomised placebo controlled crossover trial in healthy older volunteers. SETTING a largely urban population, Auckland, New Zealand. PARTICIPANTS participants were part of the larger Possible Role of Melatonin in Sleep of Elders study. People 65 years or more of age were recruited through widespread advertising. We screened 414 potential participants by mail using the Pittsburgh Sleep Quality Index, and selected 194 for clinic interview. Exclusions included depression, cognitive impairment, hypnosedative medications, sleep phase abnormalities, medical and/or environmental problems that might impair sleep. Twenty normal and 20 problem sleepers were randomly allocated for this study from a larger sample of 60 normal and 60 problem sleepers. MEASUREMENTS AND RESULTS 24-hour urine 6-sulphatoxymelatonin was measured to estimate melatonin secretion in each participant. Five milligrams of melatonin, or matching placebo were each taken at bedtime for 4 weeks, separated by a 4-week washout period. Sleep quality was measured using sleep diaries, the Leeds Sleep Evaluation Questionnaire, and actigraphy. There was a significant difference between the groups in self-reported sleep quality indicators at entry, but no difference in melatonin secretion. Melatonin did not significantly improve any sleep parameter measured in either group. CONCLUSION 5 mg of fast release melatonin taken at bedtime does not improve the quality of sleep in older people with age-related sleep maintenance problems.
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Affiliation(s)
- Jonathan J Baskett
- Home and Older Adults Services, Waitemata Health Ltd, Private Bag 93 503, Takapuna, Auckland, New Zealand.
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Baskett JJ, Wood PC, Broad JB, Duncan JR, English J, Arendt J. Melatonin in older people with age-related sleep maintenance problems: a comparison with age matched normal sleepers. Sleep 2001; 24:418-24. [PMID: 11403526 DOI: 10.1093/sleep/24.4.418] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To determine whether older people with age-related sleep maintenance problems have significantly lower melatonin levels than comparable normal sleepers. DESIGN Case-control study. SETTING A largely urban population, Auckland, New Zealand. PARTICIPANTS People over the age of 65 years, who either slept normally, or had age-related sleep maintenance problems. Participants were recruited through media advertising, and local interest groups. Initial screening was by mail (Pittsburgh Sleep Quality Index), followed by interviews at a hospital day clinic. Exclusions included those with depression, cognitive impairment, medical and/or environmental problems which might impair sleep. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS A metabolite of plasma melatonin, 6-sulphatoxymelatonin (aMT6s) was measured in the urine of 57 normal sleepers, and 53 people with age-related problems over 24 hours in three aliquots: 12:00-19:00h, 19:00-07:00h, 07:00-12:00h. There were clear differences in self reported quality of sleep but no difference in mean aMT6s 24 hour or total night excretory levels, or night/day ratios. CONCLUSIONS Older people with age-related sleep maintenance problems do not have lower melatonin levels than older people reporting normal sleep.
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Affiliation(s)
- J J Baskett
- Waitemata Health Ltd, Auckland, New Zealand.
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Feigin VL, Anderson CS, Anderson NE, Broad JB, Pledger MJ, Bonita R. Is there a temporal pattern in the occurrence of subarachnoid hemorrhage in the southern hemisphere? Pooled data from 3 large, population-based incidence studies in Australasia, 1981 to 1997. Stroke 2001; 32:613-9. [PMID: 11239176 DOI: 10.1161/01.str.32.3.613] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Publications on the temporal pattern of the occurrence of subarachnoid hemorrhage (SAH) have produced conflicting results. Variations between studies may relate to the relatively small numbers of SAH cases analyzed, including those in meta-analyses. METHODS We identified all cases of SAH from 3 well-designed population-based studies in Australia (Adelaide, Hobart, and Perth) and New Zealand (Auckland) during 3 periods between 1981 and 1997. The diagnosis of SAH was confirmed with CT, cerebral angiography, cerebrospinal fluid analysis, or autopsy in all cases. Information on the time of occurrence of each event was obtained. Risk ratios (RRs) and 95% CIs were calculated using Poisson regression, with age, sex, smoking status, and history of hypertension entered in the model as covariates. RESULTS A total of 783 cases of SAH were registered. Age- and sex-adjusted RRs of SAH occurrence were highest in the period between 6 AM and 12 MIDNIGHT (RR 3.2, 95% CI 2.4-4.3) and in winter and spring (RR 1.3, 95% CI 1.1-1.5; RR 1.3, 95% CI 1.1-1.5; respectively). No particular pattern of SAH occurrence was observed according to the day of the week. Restriction of the analyses to proved aneurysmal SAH did not substantially change the point estimates. CONCLUSIONS Circadian and circaseptan (weekly) fluctuations of SAH occurrence in the southern hemisphere are similar to those in the northern hemisphere, but the occurrence of SAH in Australasia exhibits clear seasonal (winter and spring) peaks.
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Affiliation(s)
- V L Feigin
- Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand.
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Hackett ML, Duncan JR, Anderson CS, Broad JB, Bonita R. Health-related quality of life among long-term survivors of stroke : results from the Auckland Stroke Study, 1991-1992. Stroke 2000; 31:440-7. [PMID: 10657420 DOI: 10.1161/01.str.31.2.440] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The consequences of stroke are a major health concern. This study was conducted to compare the health-related quality of life among long-term survivors of stroke with that of the general population. METHODS Our data are taken from a population-based case-control study of all 6-year survivors of stroke with an age- and sex-matched control population. SF-36 mean scores for cases were compared with raw and standardized control and New Zealand norm mean scores. RESULTS Of the original 1761 registered cases, 639 were still alive at 6-year follow-up, and all of these participated in the study. Case patients were more likely than control subjects to be dependent in all basic activities of daily living. Crude mean scores were lower for women; as age increased; for those living in institutions; when the SF-36 was completed by proxy; and when help was required with the activities of daily living. Cases had statistically lower mean scores than both the control group and New Zealand norms for physical functioning and general health. After standardization for age and sex, no differences were found between cases and controls in mental health and bodily pain. CONCLUSIONS Health-related quality of life appears to be relatively good for the majority of patients 6 years after stroke. Despite significant ongoing physical disability, survivors of stroke appear to adjust well psychologically to their illness.
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Affiliation(s)
- M L Hackett
- Clinical Trials Research Unit, Department of Medicine, The University of Auckland, New Zealand.
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Baskett JJ, Broad JB, Reekie G, Hocking C, Green G. Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke. Clin Rehabil 1999; 13:23-33. [PMID: 10327094 DOI: 10.1191/026921599701532090] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke, supervised once a week by therapists. DESIGN A randomized controlled trial of 100 patients discharged from hospital after a stroke, requiring ongoing therapy. The control group received outpatient or day hospital therapy; the experimental group were visited once a week by an occupational and/or physiotherapist who prescribed a programme of exercises and activities for the following week. Subjects were studied for the first three months after discharge from hospital. SETTING A district general hospital, or the homes of subjects randomized to the experimental group, in New Zealand. MAIN OUTCOME MEASURES (1) Characteristics of the groups, (2) gait speed, limb function, activities of daily living, (3) time with therapists, (4) mood of both subjects and caregivers, (5) anticipation of outcome at entry, compared with perceived outcome at exit. RESULTS No statistical differences between the control and experimental groups in characteristics, or in any outcomes measured, except that the contact time period, but not the number of visits, was longer in the experimental group (p = 0.003). CONCLUSIONS A supervised home-based programme is as effective as outpatient or day hospital therapy.
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Affiliation(s)
- J J Baskett
- University Geriatric Unit, North Shore Hospital, Takapuna, Auckland, New Zealand.
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Abstract
BACKGROUND AND PURPOSE To provide estimates of the prevalence of stroke and stroke-related disability for international comparisons and for planning purposes. METHODS Estimates of prevalence were derived from two population-based studies conducted 10 years apart in Auckland, New Zealand. The first, carried out in 1981, included information on survival and stroke-related disability to 14 years after stroke, and the second, undertaken in 1991 to 1992, included this information up to 3 years after stroke. An actuarial model was developed that took into account changes in incidence, long-term survival, and population structure. RESULTS Overall, it was estimated that 7491 people (3793 men and 3698 women) living in Auckland (total population 945,000) in 1991 had experienced a stroke at some stage in the past. This represents an age-standardized rate of 833 per 100,000 (991 per 100,000 in men and 706 per 100,000 in women) in the population aged 15 years and older. When only those who have made an incomplete recovery are considered, prevalence falls to 461 per 100,000. Of this group, one third (173 per 100,000 population 15 years and older) required assistance in at least one self-care activity. CONCLUSIONS Usual estimates of stroke prevalence, which include all people who have ever experienced a stroke, may overestimate by almost twofold the prevalence of stroke-related disability, since many have either recovered or have no continuing dependency related to stroke. Overall prevalence does not provide information with sufficient precision for planning and purchasing ongoing services for stroke patients.
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Affiliation(s)
- R Bonita
- North Shore Academic Unit, Faculty of Medicine and Health Science, University of Auckland, New Zealand.
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Abstract
BACKGROUND Studies of acute stroke management in stroke units and tertiary referral hospitals may not accurately reflect practice within the population. Reliable information on the management of stroke within a population is sparse. AIMS To compare clinical practice in acute stroke management in Auckland with guidelines for the management and treatment of stroke in other countries; to provide a baseline measure against which future changes in management can be evaluated. METHODS All new stroke events in Auckland residents in 12 months were traced through multiple case finding sources. For each patient, a record of investigations and treatment during the first week of hospital admission was kept. RESULTS One thousand eight hundred and three stroke events (including subarachnoid haemorrhages) occurred in 1761 patients in one year. Twenty-seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of the 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed tomography (CT). Of 376 validated ischaemic strokes, 44% were treated with aspirin and 12% with intravenous heparin. Of the 690 unspecified strokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 28 day in-hospital case fatality for all stroke events admitted to an acute hospital during the first week was 25%. CONCLUSIONS In Auckland, management of acute stroke differed from clinical guidelines in the high proportion of patients managed in the community, the low rate of neurological consultation, and the low frequency of CT scanning. Despite these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high proportion of cases evaluated by a neurologist and CT.
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