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Ambulatory sensitive hospitalizations (ASH) are those thought to be preventable by timely and effective primary health care. Better access to primary health care has been associated with lower ASH rates. Funding increases to primary health care in New Zealand beginning in 2001 led to an improvement in access. Analysis of hospitalizations to all New Zealand public hospitals revealed that, for most age groups, ASH rates did not show long-term reductions from 2001 to 2009, while socioeconomic differences in ASH rates widened across this period. We conclude that increasing funding and access to primary health care will not, by itself, reduce ASH rates.

To describe changes in aged care residents' dependency over a 20-year period.All residents in 1988, 1993, 1998, and 2008 were assessed using the same 23-item functional ability survey.Residential aged care facilities in Auckland, New Zealand.In 1988 there were 7516 participants (99% response rate), 6972 in 1993 (85% response rate), 5056 in 1998 (65% response rate), and 6828 in 2008 (89% response rate). Data were weighted to accommodate variation in response.A composite dependency score with 5 ordinal levels was derived from a census-type survey reporting mobility, activities of daily living ability, continence, and cognitive function.The proportion of "apparently independent" residents decreased from 18% in 1988 to 9% in 1993, 5% in 1998, and 4% in 2008, whereas those "highly dependent" increased from 16% in 1988, to 18% in 1993, 19% in 1998, to 21% in 2008. All functional indicators demonstrated increased dependency over the 20-year period (P.0001). However, between 1998 and 2008 there were significant increases in dependency for continence, mobility, self-care, and orientation, but no significant changes in memory and behavior.The increased dependency over 20 years directly affects care requirements for this population.

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.

We apply cohort techniques to monitor four indicators of socio-demographic risk crucial to family wellbeing; namely, income, employment, education, and housing. The data were derived from New Zealand’s five-yearly Census for the period 1981–2006. This allowed us to track birth cohorts of mothers (and their families) over six successive New Zealand censuses focusing on the main childrearing ages of 20–59. This produced ten cohorts—termed “open familial cohorts”—ranging from mothers born in the period 1932–1937 through to 1977–1981. We present age, period and cohort analyses. Families in which the mother is in her early 20s were the most vulnerable, with the lowest incomes, the greatest risk of worklessnes, and the lowest levels of home ownership. Of particular interest is that those in the most recent cohorts—born since 1967—were worse off compared to earlier cohorts. The period from the mid-1980s to the mid-to-late 1990s was one of greatest “socio-demographic risk”, with the lowest work, income and education prospects over the 25 years. The picture on generational profiles was mixed. Contrary to popular mythology the “baby-boomer” cohorts did not enjoy an unqualified advantage over others; indeed the most recent cohorts were doing well, with relatively high incomes, education and work levels. The analysis is successful in identifying age and period effects over a period of major social change, and in documenting cohort experiences for each indicator, thus demonstrating the potential of constructing cohorts from routinely-collected census micro-data for monitoring and policy purposes.

The authors describe the development of a microsimulation model of primary medical care in New Zealand for 2002 and demonstrate its ability to test the impact of demographic ageing, community support, and practitioner repertoire. Micro-level data were drawn from four sources: two iterations of the New Zealand Health Survey (NZHS 1996/1997 and 2002/2003); a national survey of ambulatory care in New Zealand (New Zealand National Primary Medical Care Survey [NPMCS] 2001/ 2002); and the Australian National Health Survey (ANHS). Data from the New Zealand surveys were statistically matched to create a representative synthetic base file of over 13,000 individuals. Probabilities of health experiences and general practitioner (GP) use derived from the ANHS, and of GP activity derived from the NPMCS were applied via a Monte Carlo process to create health histories for the individuals in the base file. Final health care outcomes simulated—the number of visits in a year, the distribution of health conditions, and GP activity levels—were validated against external benchmarks. Policy-relevant scenarios were demonstrated by a forward projection to 2021 and by implementing counterfactuals on key attributes of the synthetic population. The results showed little change in model-predicted health care outcomes. There is potential for this approach to address policy purposes.

To assess the effectiveness of an activity programme in improving function, quality of life, and falls in older people in residential care.Cluster randomised controlled trial with one year follow-up.41 low level dependency residential care homes in New Zealand.682 people aged 65 years or over.330 residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse, reinforced by usual healthcare assistants; 352 residents received social visits.Function (late life function and disability instruments, elderly mobility scale, FICSIT-4 balance test, timed up and go test), quality of life (life satisfaction index, EuroQol), and falls (time to fall over 12 months). Secondary outcomes were depressive symptoms and hospital admissions.473 (70%) participants completed the trial. The programme had no impact overall. However, in contrast to residents with impaired cognition (no differences between intervention and control group), those with normal cognition in the intervention group may have maintained overall function (late life function and disability instrument total function, P=0.024) and lower limb function (late life function and disability instrument basic lower extremity, P=0.015). In residents with cognitive impairment, the likelihood of depression increased in the intervention group. No other outcomes differed between groups.A programme of functional rehabilitation had minimal impact for elderly people in residential care with normal cognition but was not beneficial for those with poor cognition. Trial registration Australian Clinical Trials Register ACTRN12605000667617.

OBJECTIVES: To describe the recruitment strategy and association between facility and staff characteristics and success of resident recruitment for the Promoting Independence in Residential Care (PIRC) trial. DESIGN: Cross-sectional study of staff and facility characteristics and recruitment rates within facilities with calculation of cluster effects of multiple measures. SETTING AND PARTICIPANTS: Staff of low-level dependency residential care facilities and residents able to engage in a physical activity program in 2 cities in New Zealand. MEASURES: A global impression of staff willingness to facilitate research was gauged by research nurses, facility characteristics were measured by staff interview. Relevant outcomes were measured by resident interview and included the following: (1) Function: Late Life FDI scale, timed-up-and-go, FICSIT balance scale and the Elderly Mobility Scale; (2) Quality of Life: EuroQol quality of life scale, Life Satisfaction Index; and (3) falls were assessed by audit of the medical record. Correlation between recruitment rates, facility characteristics and global impression of staff willingness to participate were investigated. Design effects were calculated on outcomes. RESULTS: Forty-one (85%) facilities and 682 (83%) residents participated, median age was 85 years (range 65-101), and 74% were women. Participants had complex health problems. Recruitment rates were associated (but did not increase linearly) with the perceived willingness of staff, and were not associated with facility size. Design effects from the cluster recruitment differed according to outcome. CONCLUSIONS: The recruitment strategy was successful in recruiting a large sample of people with complex comorbidities and high levels of functional disability despite perceptions of staff reluctance. Staff willingness was related to recruitment success.