Findings from LiLACS NZ Te Puwaitanga o Ng Tapuwae Kia Ora Tonu. Life - - PowerPoint PPT Presentation

Findings from LiLACS NZ

Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu. Life and Living in Advanced Age: a Cohort Study in New Zealand

26 January 2016

Background

Longitudinal cohort study of advanced ageing Objective: to establish the predictors of successful ageing for Māori and non- Māori

Fastest growing age group (increasing from 1 to 6 percent of the total population by 2050)

Age distribution: two populations

Reference: Ministry of Health. 2011. Tatau Kura Tangata: Health of Older Māori Chart Book 2011. Wellington: Ministry of Health.

7-8 year disparity in longevity

7-8 year disparity in longevity

Research aims

Aim 1. Health status Aim 2. Predictors of successful ageing Aim 3. Trajectories in function and transitions in care Aim 4. Importance of health, frailty, cultural, social, economic and other environmental factors in predicting relevant outcomes

LiLACS NZ Leadership team

Ngaire Kerse, Ruth Teh, Anna Rolleston, Marama Muru- Lanning

Te Rōpū Kaitiaki o Ngā Tikanga Māori Provide cultural and ethical guidance Co-investigators

Karen Hayman, Carol Wham, Martin Connolly, Tim Wilkinson, Valerie Wright St.Clair, Avinesh Pillai, Janine Wiles, Sally Keeling, Santosh Jatrana, Ian Reid, Robert Doughty, Joanna Broad, Oliver Menzies, Thomas Lumley

Community partners

Western Bay of Plenty Research Centre (WBOPPHO), Nga Matapuna Oranga PHO, (Ngati Awa Research Archives, Awanuiarangi), Ngati Irapuia, Ngati Pikiao/ Korowai Aroha, RAPHS.

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Cultural and academic guidance

When did we start?

• 2010 (baseline)

How many people were recruited?

• 421 out 766 Māori (56%)
• 516 out of 870 Non Māori (59%)
• TOTAL: 937 participants

Where were do the participants live?

• Bay of Plenty and Lakes DHBs (excluding

Taupo) Measures – Core and Full Questionnaires

• Diagnoses
• Social and cultural
• Nutritional intake
• Mental health
• Health: Quality of life – SF-12, Mortality

Snapshot

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Least Most Least Most

Māori Non-Māori

Deprivation index

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Education

Māori Non-Māori

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Māori Non-Māori Total 254/421 400/516 654/937 Age (sd) 82.7 (2.8) 84.6 (0.5) 83.8 (2.1) Gender Men 176 (42%) 237 (46%) 413 (44%) Residential Care 30 (7%) 44 (9%) 74(8%) Lives alone 110 (41%) 195 (48%) 305 (46%) Fell 138 (34%) 205 (40%) 343 (37%) Physical activity PASE 111 (81) 99 (66) 104 (73) Disability 0-14/22 NEADL 44 (17%) 63 (16%) 107 (16%) N meds 5.0 (3.3) 5.4 (3.5) 5.2 (3.4) Comorbidity score 4.7 (2.5) 4.9 (2.2) 4.8 (2.3) Driving 148 (59%) 287 (73%)

Characteristics

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Māori Non-Māori Total 254/421 400/516 Hospital admissions 148 (40%) 89 (34%) Medication 5 (0,14) 5 (1, 18) Depressive sx 38 (15%) 42 (11 %) Grip str M 31, W 20 M 30, W 18.5 Gait sp 0.7 (0.3) 0.8 (0.3) Physical activity PASE M 113, W 89 M 107, W 77 Visual disability 150 (37%) 147 (29%) Hearing disability 128 (31%) 133 (26%) Pack yr Hx* 9.3 M 11.5 W 7.9 6.6 M 10.4 W 3.7 Mortality (2.5 years) 100 (24%) 109 (21%) 209 (22%)

Characteristics:

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10 20 30 40 50 60 70 80 90 100

Women Men Women Men Māori Non-Māori

Percent

No association with HRQOL

Stayed the same

• r improved

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LiLACS NZ first wave of data collection

26 51 33 65 38 19 58 24 10 5 6 3 26 25 3 8

10 20 30 40 50 60 70 80 90 100 Men Women Men Women Māori non-Māori

Others Spouse&others Spouse Alone

Living arrangement

Wave 1

Extra practical support-unmet need

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More Māori men living with ‘other’ expressed unmet need More Non-Māori men nominated home help as main support

Daughters and spouses main supporters Unmet need assoc with HRQOL

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16 43 33 40 52 10 8 7 7 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Maori non-Maori

Critical Short Long Independent

Care need

Critical need – more than daily personal care, short-daily, long-weekly

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10 20 30 40 50 60 70 80 ResCare Support Servics ResCare Support Services Māori Non-Māori Proportion Critical Short Long

Needs and residential care placement

More Māori with critical needs in the community setting

2000 4000 6000 8000 10000 12000 14000

2010 2012 2014 2016 2018 2020 2022 2024 2026

Year

Maori

critical short long independent

50000 100000 150000 200000 250000

Year

non Maori

critical short long independen t

Projections

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Men Women OR (95% CI)§ Gender (Ref: Men) OR (95% CI)§† Ethnicity (Ref: Māori)

Māori Non-Maori Māori Non-Maori

HTN

138 (78%) 188 (79%) 215 (88%) 238 (85%) 1.88 (1.31-2.71) 0.82 (0.54-1.25)

Any CVD

119 (68%) 158 (67%) 160 (66%) 169 (61%) 0.87 (0.66-1.14) 0.87 (0.62-1.20)

CAD

88 (50%) 110 (46%) 105 (43%) 106 (38%) 0.73 (0.56-0.96) 0.83 (0.61-1.14)

CHF

63 (36%) 48 (20%)** 65 (27%) 60 (22%) 0.82 (0.61-1.12) 0.58 (0.41-0.82)

CVA

34 (19%) 57 (24%) 66 (27%) 79 (28%) 1.41 (1.04-1.92) 1.23 (0.86-1.76)

PVD

30 (17%) 41 (17%) 35 (15%) 27 (10%) 0.67 (0.46-0.98) 0.96 (0.52-1.49)

Any AF

58 (35%) 51 (22%)** 62 (27%) 54 (20%) 0.80 (0.59-1.09) 0.62 (0.43-0.89)

AF on ECG

28 (27%) 27 (15%)* 23 (16%) 21 (11%) 0.61 (0.39-0.94) 0.56 (0.32-0.96)

Cardiovascular disease

Men Women OR (95% CI)§ Gender (Ref: Men) OR (95% CI)§† Ethnicity (Ref: Māori)

Māori Non-Maori Māori Non-Maori Eye disease 70 (41%) 151 (65%)** 132 (55%) 186 (68%)** 1.52 (1.14-2.02) 1.62 (1.17-2.25) Asthma or Chronic lung disease 62 (36%) 57 (24%)** 78 (34%) 77 (29%) 1.29 (0.95-1.76) 0.64 (0.45-0.89) Type II diabetes 49 (28%) 40 (17%)** 73 (31%) 41 (15%)** 1.04 (0.75-1.45) 0.53 (0.36-0.78) Any arthritis 50 (30%) 93 (40%)* 96 (43%) 124 (46%) 1.49 (1.12-1.97) 1.29 (0.93-1.79) Osteoarthritis 38 (23%) 85 (36%)** 75 (33%) 115 (43%)* 1.44 (1.08-1.92) 1.63 (1.16-2.29) Rheumatoid arthritis 22 (13%) 21 (9%) 50 (22%) 31 (12%)** 1.62 (1.07-2.43) 0.59 (0.37-0.93) Depression 38 (22%) 54 (23%) 71 (30%) 71 (26%) 1.34 (0.98-1.83) 1.19 (0.82-1.71) Anaemia 30 (33%) 50 (28%) 15 (13%) 25 (14%) 0.36 (0.23-0.56) 0.84 (0.49-1.44) Osteoporosis 11 (6%) 17 (7%) 53 (23%) 89 (33%)* 5.37 (3.48-8.31) 1.33 (0.87-2.03) Dementia

a

31 (18%) 22 (9%)** 33 (15%) 25 (9%) 0.97 (0.63-1.49) 0.59 (0.37-0.95) Thyroid disease 5 (3%) 7 (3%) 10 (4%) 31 (12%)** 3.01 (1.55-5.86) 2.14 (1.03-4.44) Chronic conditions 5 (0, 13) 5 (0, 12) 5 (0, 12) 5 (0, 12) 0.04 (-0.02-0.10) 0.02 (-0.05-0.09)

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Health conditions

Men Women OR (95% CI)§ Gender (Ref: Men) OR (95% CI)§† Ethnicity (Ref: Māori)

Māori Non-Maori Māori Non-Maori Eye disease 70 (41%) 151 (65%)** 132 (55%) 186 (68%)** 1.52 (1.14-2.02) 1.62 (1.17-2.25) Asthma or Chronic lung disease 62 (36%) 57 (24%)** 78 (34%) 77 (29%) 1.29 (0.95-1.76) 0.64 (0.45-0.89) Type II diabetes 49 (28%) 40 (17%)** 73 (31%) 41 (15%)** 1.04 (0.75-1.45) 0.53 (0.36-0.78) Any arthritis 50 (30%) 93 (40%)* 96 (43%) 124 (46%) 1.49 (1.12-1.97) 1.29 (0.93-1.79) Osteoarthritis 38 (23%) 85 (36%)** 75 (33%) 115 (43%)* 1.44 (1.08-1.92) 1.63 (1.16-2.29) Rheumatoid arthritis 22 (13%) 21 (9%) 50 (22%) 31 (12%)** 1.62 (1.07-2.43) 0.59 (0.37-0.93) Depression 38 (22%) 54 (23%) 71 (30%) 71 (26%) 1.34 (0.98-1.83) 1.19 (0.82-1.71) Anaemia 30 (33%) 50 (28%) 15 (13%) 25 (14%) 0.36 (0.23-0.56) 0.84 (0.49-1.44) Osteoporosis 11 (6%) 17 (7%) 53 (23%) 89 (33%)* 5.37 (3.48-8.31) 1.33 (0.87-2.03) Dementia

a

31 (18%) 22 (9%)** 33 (15%) 25 (9%) 0.97 (0.63-1.49) 0.59 (0.37-0.95) Thyroid disease 5 (3%) 7 (3%) 10 (4%) 31 (12%)** 3.01 (1.55-5.86) 2.14 (1.03-4.44) Chronic conditions 5 (0, 13) 5 (0, 12) 5 (0, 12) 5 (0, 12) 0.04 (-0.02-0.10) 0.02 (-0.05-0.09)

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Health conditions

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Groupings of conditions rather than number Clustered by person to identify profiles of conditions

Clusters of conditions

Multi-morbidity

Māori

18% Mort 67% Adm 27% Mort 83% Adm 31% Mort 82% Adm 34% Mort 78% Adm 41% Mort 86% Adm 39% Mort 91% Adm

Multi-morbidity

Non-Māori

30% Mort 82% Adm 12% Mort 65% Adm 26% Mort 83% Adm 31% Mort 86% Adm 29% Mort 76% Adm 32% Mort 79% Adm

• Individualised care is needed
• Cardiovascular disease morbidity and

mortality differs depending on the profiles

• f conditions rather than number
• Depression varies in its cluster partners

Multi-morbidity

Findings

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Demographics Māori (n=267) Non-Māori (n=404) P Value

Prescribed medicines per person mean (Range; ±SD)

4.63(0-14; ±3.24) 4.92 (0-15; ±3.18) 0.288 Inappropriate meds. PIM STOPP n (%) 65 (24.3) 113 (28.0) 0.171 Omissions PPO START n (%) 155 (58.1) 198 (49.0) 0.013 PIM or PPO n (%) 175 (65.5) 251 (62.1) 0.207

STOPP/START criteria in the LiLACS NZ cohort Key: PIM = Potentially inappropriate medicine; PPO = Potential prescribing omission; * =

Medication prescribing quality

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Hospitalisation at 12 months follow-up (n=99)

Unadjusted Adjusted*

OR (95% CI) P Value† OR (95% CI) P Value

†

Inappropriate meds

PIMs % Yes 24 1.47 (1.02, 2.13) 0.041 1.20 (0.59, 2.44) 0.619 No 76 Omissions PPOs % Yes 68 1.64 (1.29-2.07) 0.000 1.56 (1.20, 2.02) 0.001 No 32 PIMs or PPOs % Yes 55 1.48 (1.22-1.80) 0.000 1.43 (1.15, 1.78) 0.001 No 45

*Adjusted for age, gender, prior 12-month GP, deprivation, CHF, number of medication, NEADL activities of daily living

Medication and Hospitalisations

Māori Omission more closely related to outcomes than inappropriate meds

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Hospitalisation at 12 months follow-up

(n=99)

Unadjusted Adjusted*

OR (95% CI) P Value† OR (95% CI) P Value†

Inappropriate

PIMs % Yes 28 1.16 (0.89,1.51) 0.25 1.23 (0.85, 1.78) 0.28 No 72 Omissions PPOs % Yes 49 1.15 (0.95,1.41) 0.16 1.50 (1.16, 1.95) <0.01 No 51 PIMs or PPOs % Yes 62 1.15 (0.99-1.35) 0.08 1.39 (1.13, 1.72) <0.01 No 38

*Adjusted for age, gender, prior 12-month GP, deprivation, CHF, number of medication, NEADL activities of daily living

Medications and Hospitalisations

Non-Māori

Omission more closely related to outcomes than inappropriate meds

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10 20 30 40 50 60 70 80 90 100

notfrail prefrail frail percent

Non-Māori

4+ 2-3 1

10 20 30 40 50 60 70 80 90 100

notfrail prefrail frail percent

Māori

4+ 2-3 1

Frailty and falls

Greater frailty = more falls

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• Wave 4, 438 remained
• 162 Māori (62% women), 276 non-Māori

(54% women)

• 74% (319) consented to carer, 286 Kaiāwhina

interviews were completed

• 261 informal carers (91% of the interviewees)

and 25 formal carers (9%) were interviewed

Kaiāwhina/carers

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5 10 15 20 25 30 35 40 Women Men Women Men Māori Non-Māori Hours

Hours of care – informal

Care given to Māori Care given to non- Māori

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2 4 6 8 10 12 14 16 18 All carers Spouse Child Other

COPE Subscale Scores

Positive Value Negative Impact Quality of Support

Positive > negative

Caregiving experience more positive than negative

Carers knowledge of services (unprompted)

10 20 30 40 50 60 70 80 90 100 Percent of those answering question Māori non-Māori

Relatively low knowledge of service availability amongst carers when asked without prompting

Where got info about services (unprompted)

10 20 30 40 50 60 70 80 90 100

Percent

Māori non-Māori

How well informed are you ?

10 20 30 40 50 60 70 80 90 100

Not at all Slightly Moderately Quite a bit Extremely

Percent

Māori Women Māori Men non-Māori Women non-Māori Men

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Findings

• Functional recovery possible
• Patterns of care differ by living arrangement and ethnicity
• Unmet needs differ by gender and living arrangement

– Men living inter-generationally have higher unmet needs – Māori with high needs in the community may need more support

• Disparities in CVD persist into advanced age
• Outcomes from multi-morbidity vary by cluster rather than

condition

• Omissions of medications related to hospitalisation
• Frailty and falls closely related
• Caregivers wellbeing – knowledge gaps
• One size does not fit all
• Research reports -

https://www.fmhs.auckland.ac.nz/en/faculty/lilacs.html

Conclusions – LiLACS NZ

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Funders

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• Prof. Ngaire Kerse

School of Population Health, The University of Auckland Email n.kerse@auckland.ac.nz LiLACS NZ Website https://www.fmhs.auckland.ac.nz/en/faculty/lilacs.html Donations welcomed If you wish to make a donation please visit our website

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