Search

Background: Targeted deprescribing of anticholinergic and sedative medications in older people may improve their health outcomes. This trial will determine if pharmacist-led reviews lead to general practitioners deprescribing anticholinergic and sedative medications in older people living in the community.Methods and Analysis: The standard protocol items: Recommendations for Interventional Trials (SPIRIT) checklist was used to develop and report the protocol. The trial will involve older adults stratified by frailty (low, medium, and high). This will be a pragmatic two-arm randomized controlled trial to test general practitioner uptake of pharmacist recommendations to deprescribe anticholinergic and sedative medications that are causing adverse side effects in patients.Study Population: Community-dwelling frail adults, 65 years or older, living in the Canterbury region of New Zealand, seeking publicly funded home support services or admission to aged residential care and taking at least one anticholinergic or sedative medication regularly.Intervention: New Zealand registered pharmacists using peer-reviewed deprescribing guidelines will visit participants at home in the community, review their medications, and recommend anticholinergic and sedative medications that could be deprescribed to the participant's general practitioner. The total use of anticholinergic and sedative medications will be quantified using the Drug Burden Index (DBI).Outcomes: The primary outcome will be the change in total DBI between baseline and 6-month follow-up. Secondary outcomes will include entry into aged residential care, prolonged hospitalization, and death.Data Collection Points: Data will be collected at the time of interRAI assessments (T0), at the time of the baseline review (T1), at 6 months following the baseline review (T2), and at the end of the study period, or end of study participation for participants admitted into aged residential care, or who died (T3).Ethics and Dissemination: Ethical approval has been obtained from the Human, Disability and Ethics Committee: ethical number (17CEN265).Trial Registration: ClinicalTrials.gov ACTRN12618000729224 . Registered on May 2, 2018, with the Australian New Zealand Clinical Trials Registry. [ABSTRACT FROM AUTHOR]

Background Little is known about the prevalence of frailty in indigenous populations. We developed a frailty index (FI) for older New Zealand Māori and Pasifika who require publicly funded support services. Methods An FI was developed for New Zealand adults aged 65 and older who had an interRAI Home Care assessment between June 1, 2012 and October 30, 2015. A frailty score for each participant was calculated by summing the number of deficits recorded and dividing by the total number of possible deficits. This created a FI with a potential range from 0 to 1. Linear regression models for FIs with ethnicity were adjusted for age and sex. Cox proportional hazards models were used to assess the association between the FI and mortality for Māori, Pasifika, and non-Māori/non-Pasifika. Results Of 54 345 participants, 3096 (5.7%) identified as Māori, 1846 (3.4%) were Pasifika, and 49 415 (86.7%) identified as neither Māori nor Pasifika. New Zealand Europeans (48 178, 97.5%) constituted most of the latter group. Within each sex, the mean FIs for Māori and Pasifika were greater than the mean FIs for non-Māori and non-Pasifika, with the difference being more pronounced in women. The FI was associated with mortality (Māori subhazard ratio [SHR] 2.53, 95% CI 1.63–3.95; Pasifika SHR 6.03, 95% CI 3.06–11.90; non-Māori and non-Pasifika SHR 2.86, 95% CI 2.53–3.25). Conclusions This study demonstrated differences in FI between the ethnicities in this select cohort. After adjustment for age and sex, increases in FI were associated with increased mortality. This suggests that FI is predictive of poor outcomes in these ethnic groups. [ABSTRACT FROM AUTHOR]

Objectives: To develop and validate a frailty index (FI) from interRAI‐Community Health Assessments (CHA) on older adults in retirement villages (RVs). Methods: This is a cross‐sectional analysis of a current RV research study. A FI was generated using the cumulative deficit model. Health‐care utilisation measures were acute, and all, hospitalisations 12 months before baseline assessment. Associations between FI and hospitalisations were explored using multivariable logistic regression to estimate odds ratio (OR). Results: Of 577 included residents, mean (SD) age was 81 (7) and 419 (73%) were female. Mean (SD) FI was 0.16 (0.09); 260 (45%) were mildly frail, and 108 (19%) moderate‐severely frail. In multivariate‐adjusted analysis, odds of acute hospitalisation for mild (OR = 3.3, P <.001) and moderate‐severely frail (OR = 6.4, P <.001) were significantly higher than fit residents. Higher odds were also observed for all hospitalisations. Conclusion: A considerable proportion of RV residents were moderately‐severely frail. FI was associated with acute and all hospitalisations. [ABSTRACT FROM AUTHOR]

There is general acknowledgement of the importance of early diagnosis of dementia, yet there are still high rates of undetected dementia internationally. The aim of this cross-sectional study was to determine the sociodemographic characteristics associated with possible undetected dementia in a large sample of community-dwelling older New Zealanders. The sample consisted of older people (age ≥ 65) who had received the homecare version of the international Residential Home Care Assessment version 9.1 over a two-year period and who were screened positive for possible dementia on the international Residential Assessment's Cognitive Performance Scale. People with possible alternative explanations for impaired cognitive performance such as depression and other neurological conditions were excluded from analysis. The 5202 eligible individuals were categorized into two groups: (1) those with a recorded diagnosis of dementia (64%) and (2) those without a recorded diagnosis of dementia (i.e. possible undetected dementia group) (36%). Logistic regression was used to evaluate the association between individual characteristics and possible undetected dementia. Significant risk factors for being in the possible undetected dementia group included Asian ethnicity, living alone, not having participated in long-standing social activities recently, major life stressors, and limited accessibility of their house. The knowledge gained from this study could enable targeting of services and resources for the groups at risk of undetected dementia to have a more equitable access to early diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: Research on the prevalence of communication disability among community living older adults is scant, and often suffers from limitations. Using a national database, this study presents an epidemiological profile of communication disability in older community residents within New Zealand and examines whether ethnic populations are disproportionately represented. Method: Since 2012, all New Zealand community care recipients have undergone a standardised needs assessment, which includes questions directed at expressive and receptive language abilities. Those assessed between 1 September 2012 and 31 January 2016, aged ≥65 years, and who provided consent were included. Directly standardised prevalence estimates were calculated and logistic regression used to investigate age, sex and ethnic differences. Result: Overall, 71 859 people were eligible (mean age = 82.7 years, 61% female, 89.2% European/other), with 30.6% and 36.2% exhibiting at least some expression and comprehension communication disability, respectively. Māori, Pasifika and Asian people, males and those who were older were more likely to have at least some communication disability compared to their European/other, female and younger counterparts. Conclusion: Communication disability is common among older adults. With the increased provision of home-based integrated models of care, the impact of communication disability on service seeking and delivery must be recognised and accommodated. [ABSTRACT FROM AUTHOR]

Background: The Drug Burden Index (DBI) calculates the total sedative and anticholinergic load of prescribed medications and is associated with functional decline and hip fractures in older adults. However, it is unknown if confounding factors influence the relationship between the DBI and hip fractures. The objective of this study was to evaluate the association between the DBI and hip fractures, after correcting for mortality and multiple potential confounding factors.Methods: A competing-risks regression analysis conducted on a prospectively recruited New Zealand community-dwelling older population who had a standardized (International Resident Assessment Instrument) assessment between September 1, 2012, and October 31, 2015, the study's end date. Outcome measures were survival status and hip fracture, with time-varying DBI exposure derived from 90-day time intervals. The multivariable competing-risks regression model was adjusted for a large number of medical comorbidities and activities of daily living.Results: Among 70,553 adults assessed, 2,249 (3.2%) experienced at least one hip fracture, 20,194 (28.6%) died without experiencing a fracture, and 48,110 (68.2%) survived without a fracture. The mean follow-up time was 14.9 months (range: 1 day, 37.9 months). The overall DBI distribution was highly skewed, with median time-varying DBI exposure ranging from 0.93 (Q1 = 0.0, Q3 = 1.84) to 0.96 (Q1 = 0.0, Q3 = 1.90). DBI was significantly related to fracture incidence in unadjusted (p < .001) and adjusted (p < .001) analyses. The estimated subhazard ratio was 1.52 (95% confidence interval: 1.28-1.81) for those with DBI > 3 compared with those with DBI = 0 in the adjusted analysis.Conclusions: In this study, increasing DBI was associated with a higher likelihood of fractures after accounting for the competing risk of mortality and adjusting for confounders. The results of this unique study are important in validating the DBI as a guide for medication management and it could help reduce the risk of hip fractures in older adults. [ABSTRACT FROM AUTHOR]

Aim: To identify factors associated with prescribing potentially inappropriate medications (PIMs) in older adults (≥65 years) with complex care needs, who have undertaken a comprehensive geriatric risk assessment.Methods: A nationwide cross-sectional (retrospective, observational) study was performed. The national interRAI Home Care assessments conducted in New Zealand in 2015 for older adults were linked to the national pharmaceutical prescribing data (PHARMS). The 2015 Beers criteria were applied to the cross-matched data to identify the prevalence of PIMs. The factors influencing PIMs were analyzed using a multinomial logistic regression model.Results: In total, 16,568 older adults were included in this study. Individuals diagnosed with cancer, dementia, insomnia, depression, anxiety, and who were hospitalized in the last 90 days were more likely to be prescribed PIMs than those who were not diagnosed with the above disorders, and who were not hospitalized in the last 90 days. Individuals over 75 years of age, the Māori ethnic group among other ethnicities, individuals who were diagnosed with certain clinical conditions (diabetes, chronic obstructive pulmonary disease, stroke, or congestive cardiac failure), individuals requiring assistance with activities of daily living, and better self-reported health, were associated with a lesser likelihood of being prescribed PIMs.Conclusion: The study emphasizes the identification of factors associated with the prescription of PIMs during the first completed comprehensive geriatric assessment. Targeted strategies to reduce modifiable factors associated with the prescription of PIMs in subsequent assessments has the potential to improve medication management in older adults. [ABSTRACT FROM AUTHOR]

Objective: To identify the prevalence and predictors of prescribing potentially inappropriate medications (PIMs) in a nationwide cohort of community dwellers with dementia requiring complex care needs.Methods: A cross-matched data of the International Resident Assessment Instrument-Home Care (9.1) (interRAI-HC) and prescribing data obtained from the Pharmaceutical Claims Data Mart (Pharms) extract files for older adults (≥65 y) requiring complex care needs were utilized for this study. The 2015 Beers criteria were applied to identify the prevalence of PIMs in older adults with dementia. Sociodemographic and clinical predictors of PIMs were analysed using a logistic regression model.Results: The study population consisted of 16 568 individuals who had their first interRAI assessment from 1 January 2015 to 31 December 2015. The estimated prevalence of dementia was 13.2% (2190/16 568). 66.9% (1465/2190) of the older adults diagnosed with dementia were prescribed PIMs, of which anticholinergic medications constituted 59.6% (873/1465). Males and individuals who were prescribed a greater number of medications were more likely to be prescribed PIMs. Individuals over 85 years of age, Māori ethnic group of individuals, older adults who were being supervised with respect to their activities of daily living, and individuals who reported good or excellent self-reported health had a lesser likelihood of being prescribed PIMs.Conclusion: We found that PIMs are prescribed frequently in older adults with dementia. Comprehensive geriatric assessments can serve as a potential tool to decrease the occurrence of PIMs in vulnerable groups with poor functional and cognitive status. [ABSTRACT FROM AUTHOR]

Aims: To determine if urinary incontinence (UI) was an independent risk factor for falls and hip fractures in community‐dwelling older men and women with complex needs, after controlling for confounders. Methods: Since 2012, all community care recipients in New Zealand have undergone standardized needs assessments using the Home Care International Residential Assessment Instrument (interRAI‐HC). The interRAI‐HC elicits information over multiple domains, including UI frequency and falls. Those aged 65+ years with assessment between July 1, 2012 and May 31, 2014 without collection devices or indwelling catheters were matched to hospital, mortality, and pharmaceutical databases, and apposite regression models applied. Results: Overall, 25 257 (37.5%) men and 42 032 (62.5%) women were eligible, with average age of 82.7 years (range: 65, 106 years). Incontinence was reported by 34.3% of men and 42.6% of women, falls within 90 days by 42.7% of men and 39.1% of women; and fractures recorded for 2.5% of men and 3.7% of women. In multivariable analysis, UI was significantly associated with falls (P < 0.001), and differentially related by sex (P < 0.001). Compared to continent participants, the odds of increasing falls risk was 1.69 (95% CI: 1.57, 1.82) for men with frequent incontinence and 1.53 (95% CI: 1.43, 1.64) for men with occasional continence; higher than the 1.39 (95% CI: 1.32, 1.46) and 1.33 (95% CI: 1.26, 1.39), respectively, for women. UI was not associated with hip fractures. Conclusion: UI is a common independent risk factor for falls but not hip fractures. Patterns are different between men and women with complex needs. [ABSTRACT FROM AUTHOR]

Background: Adverse outcomes associated with advanced diseases are often exacerbated by polypharmacy.Objectives: The current study investigated an association between exposure to anticholinergic and sedative medicines and falls in community-dwelling older people, after controlling for potential confounders.Methods: We conducted a retrospective cross-sectional study of a continuously recruited national cohort of community-dwelling New Zealanders aged 65 years and over. Participants had an International Resident Assessment Instrument–Home Care (interRAI-HC) assessment between 1 September 2012 and 31 January 2016. InterRAI-HC is a comprehensive, multi-domain, standardised assessment. This study captured 18 variables, including fall frequency, from the interRAI. These data were deterministically matched with the Drug Burden Index (DBI) for each participant, derived from an anonymised national dispensed pharmaceuticals database. DBI groupings were statistically ascertained, and ordinal regression models employed.Results: Overall, there were 71,856 participants, with a mean age of 82.7 years (range 65–106); 43,802 (61.0%) were female, and 63,578 (88.5%) were New Zealand European. In unadjusted and adjusted analyses, DBI groupings were related to falls (p < 0.001). A DBI score > 3 was associated with a 41% increase in falls compared with a DBI score of 0 (p < 0.001). There was a ‘dose-response’ relationship between DBI levels and falls risk.Conclusions: DBI was found to be independently and positively associated with a greater risk of falls in this cohort after adjustment for 18 known confounders. We suggest that the DBI could be a valuable tool for clinicians to use alongside electronic prescribing to help reduce falls in older people. [ABSTRACT FROM AUTHOR]

Aims To determine if urinary incontinence (UI) and fecal incontinence (FI) were independent risk factors for aged resident care (ARC) admissions for older people, after controlling for confounders and applying apposite statistical methods. Methods Since 2012, all community care recipients in New Zealand have undergone a standardized needs assessment using the Home Care International Residential Assessment Instrument (interRAI-HC). The interRAI-HC instrument elicits information on 236 questions over 20 domains, including UI and FI frequency within the last 3 days. Those aged 65+ years with an interRAI-HC assessment between July 1, 2012 and May 31, 2014 were matched to national mortality and ARC databases, and competing-risk regression models applied to those without collection devices or indwelling catheters who were admitted to ARC or alive 30+ days after their interRAI-HC assessment. Results Overall, 32 285 people were eligible, with average age of 82.1 years (range 65, 105 years) of whom 20 627 (63.9%) were female. UI and FI was reported by 36.4% and 12.9% of people, respectively. By June 30, 2014, 5993 (18.6%) had an ARC admission and 5443 (16.9%) had died before any such admission. In the multivariable analysis, the subhazard ratio (SHR) for ARC admission was significant for UI (SHR = 1.11, 95%CI: 1.05, 1.18) but not for FI (SHR = 1.07, 95%CI: 0.99, 1.16). Conclusions UI is a common, independent risk factor for ARC admissions. Identifying the extent of incontinence and its impact on ARC admissions is the first vital step in addressing the burgeoning need for better community continence services. [ABSTRACT FROM AUTHOR]

Objective: To investigate changes in well-being measures for older Māori after moving from community to long-term care (LTC)., Methods: We undertook a retrospective cohort study of older Māori in New Zealand (NZ) who had received assessments for their health needs whilst living at home (interRAI-HC assessment) as well as a subsequent assessment after moving into a care facility (interRAI-LTCF). All interRAI-HC assessments from 01 July 2013 to 21 December 2018 were identified and matched to LTCF assessments that were undertaken at least 6 months later. Odds ratios (OR) and 95% confidence interval (CI) were calculated to determine the difference in proportion of variables of interest (indicative of movement, socialising, sleep and nutrition, alongside general physical and mental health status) between participants' HC and subsequent LTCF assessments., Results: Changes in well-being measures were investigated among 1531 Māori (mean age 76.2 years, 61% female). Odds of having a fall (OR: 0.40 [95% CI 0.34, 0.48]), being lonely (OR: 0.13 [95% CI 0.09, 0.18]), sleeping difficulty (OR: 0.74 [95% CI 0.60, 0.91]) and fatigue (OR: 0.18 [95% CI 0.14, 0.23]) reduced on moving to LTC. However, the presence of depression (OR 3.96 [95% CI 2.58, 6.09]) and dependence with locomotion (OR 1.56 [95% CI 1.23, 1.97]) significantly increased when moving from home to LTC., Conclusion: Despite some indicators of functional and health-related decline, significant improvements are also apparent across multiple domains of well-being. Further investigation of resident and family perceptions of well-being in association with a move to LTC is warranted., (© 2024 The Author(s). Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)