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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: The development of frailty tools from electronically recorded healthcare data allows frailty assessments to be routinely generated, potentially beneficial for individuals and healthcare providers. We wished to assess the predictive validity of a frailty index (FI) derived from interRAI Community Health Assessment (CHA) for outcomes in older adults residing in retirement villages (RVs), elsewhere called continuing care retirement communities. Design: Prospective cohort study. Setting and participants: 34 RVs across two district health boards in Auckland, Aotearoa New Zealand (NZ). 577 participants, mean age 81 years; 419 (73%) female; 410 (71%) NZ European, 147 (25%) other European, 8 Asian (1%), 7 Māori (1%), 1 Pasifika (<1%), 4 other (<1%). Methods: interRAI-CHA FI tool was used to stratify participants into fit (0–0.12), mild (>0.12–0.24), moderate (>0.24–0.36) and severe (>0.36) frail groups at baseline (the latter two grouped due to low numbers of severely frail). Primary outcome was acute hospitalization; secondary outcomes included long-term care (LTC) entry and mortality. The relationship between frailty and outcomes were explored with multivariable Cox regression, estimating hazard ratios (HRs) and 95% confidence intervals (95%CIs). Results: Over mean follow-up of 2.5 years, 33% (69/209) of fit, 58% (152/260) mildly frail and 79% (85/108) moderate-severely frail participants at baseline had at least one acute hospitalization. Compared to the fit group, significantly increased risk of acute hospitalization were identified in mildly frail (adjusted HR = 1.88, 95%CI = 1.41–2.51, p<0.001) and moderate-severely frail (adjusted HR = 3.52, 95%CI = 2.53–4.90, p<0.001) groups. Similar increased risk in moderate-severely frail participants was seen in LTC entry (adjusted HR = 5.60 95%CI = 2.47–12.72, p<0.001) and mortality (adjusted HR = 5.06, 95%CI = 1.71–15.02, p = 0.003). Conclusions and implications: The FI derived from interRAI-CHA has robust predictive validity for acute hospitalization, LTC entry and mortality. This adds to the growing literature of use of interRAI tools in this way and may assist healthcare providers with rapid identification of frailty. [ABSTRACT FROM AUTHOR]

Introduction: acute exacerbation of COPD (AECOPD) is a major cause of hospital admission, and predicts subsequent medium-term mortality. We aimed to examine mortality predictors in patients discharged from hospital after AECOPD. Methods: we obtained baseline demographic and clinical data from 100 patients (mean age (range)=73 (60-98) years; 48 males) admitted with AECOPD. All completed the following validated questionnaires: a quality of life questionnaire (Breathing Problems Questionnaire; BPQ); a screening questionnaire for depression (Brief Assessment Schedule Depression Cards; BASDEC); a disability questionnaire (Manchester Respiratory Activities of Daily Living questionnaire; MRADL). Following discharge all were prospectively followed and survival/mortality at 12 months confirmed from hospital notes and by contacting general practitioners. Results: the prevalence of depression at recruitment was 56%. One-year mortality in the whole group was 36%. Odds ratios (95% confidence intervals) for mortality predictors (univariate logistic regression analysis) were: use of long-term oxygen therapy = 2.72 (1.06-6.97); subsequent readmission = 2.57 (1.08-6.12); MRADL score = 0.87 (0.80-0.94) (disability predicting death); BASDEC score= 1.13 (1.02-1.26) (depression predicting death); BPQ score-l.08 (1.04-1.12) (low quality of life predicting death); length of original hospital stay = 1.03 (1.00-1.07). On multivariate logistic regression analysis the only mortality predictor was BPQ with an odds ratio (95% confidence limits) of 1.13 (1.04-1.22). In terms of mortality prediction for individuals, a threshold MRADL score of < 12 gave a sensitivity of 86%, specificity of 55%, positive predictive value of 88% and negative predictive value of 52%, with similar predictive values using BPQ as an independent variable. Conclusions: 1-year mortality after AECOPD admission is high. The presence of depressive illness (which is extremely common), and levels of both disability and impairment of quality of life are univariate predictors of 1-year mortality in this patient group. This model may be useful in predicting prognosis for individuals and thus in guiding treatment decisions. [ABSTRACT FROM AUTHOR]

Assesses the test-retest reliability of the Manchester Respiratory Activities of Daily Living as a postal questionnaire and compares face-to-face administration by a physiotherapist with postal completion. Design of the study; Results of the study; Conclusion.

In Aotearoa New Zealand (NZ), ethnic inequities in health outcomes exist. Non-Māori experience better access to healthcare than Māori, including access to the quality use of medicines. Quality medicines use requires that medicines provide maximal therapeutic benefit with minimal harm. As older adults are more at risk of harm from medicines, and, because inequities are compounded with age, Māori older adults may be at more risk of medicines-related harm than younger and non-Māori populations. This narrative review examined ethnic variation in the quality use of medicines, including medicines utilisation and associated clinical outcomes, between Māori and non-Māori older adult populations in NZ. The review was structured around prevalence of medicine utilisation by medicine class and in particular disease states; high-risk medicines; polypharmacy; prevalence of potentially inappropriate prescribing (PIP); and association between PIP and clinical outcomes. 22 studies were included in the review. There is ethnic variation in the access to medicines in NZ, with Māori older adults often having reduced access to particular medicine types, or in particular disease states, compared with non-Māori older adults. Māori older adults are less likely than non-Māori to be prescribed medicines inappropriately, as defined by standardised tools; however, PIP is more strongly associated with adverse outcomes for Māori than non-Māori. This review identifies that inequities in quality medicines use exist and provides a starting point to develop pro-equity solutions. The aetiology of inequities in the quality use of medicines is multifactorial and our approaches to addressing the inequitable ethnic variation also need to be. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Residents of long-term care facilities have highly complex care needs and quality of care is of international concern. Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization. The Residential Aged Care Integration Program ( RACIP) is a quality improvement intervention to support residential aged care staff and includes on-site support, education, clinical coaching, and care coordination provided by gerontology nurse specialists ( GNSs) employed by a large district health board. The effect of the outreach program was evaluated through a randomized comparison of hospitalization 1 year before and after program implementation. The sample included 29 intervention facilities (1,425 residents) and 25 comparison facilities (1,128 residents) receiving usual care. Acute hospitalization rate unexpectedly increased for both groups after program implementation, although the rate of increase was significantly less for the intervention facilities. The hospitalization rate after the intervention increased 59% for the comparison group and 16% for the intervention group (rate ratio ( RR) = 0.73, 95% confidence interval ( CI) = 0.61-0.86, P < .001). Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group (13% increase) than the comparison group (69% increase) ( RR = 0.67, 95% CI = 0.56-0.82, P < .001). Conversely, there was no significant difference in the RR for surgical admissions between the intervention and comparison groups ( RR = 1.0, 95% CI = 0.68-1.46, P = .99). The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health. [ABSTRACT FROM AUTHOR]

Background. Testosterone increases lean mass and may help to counter the changes in muscle architecture associated with sarcopenia. This study was designed to investigate the effects of testosterone replacement therapy on skeletal muscle architecture in intermediate-frail and frail elderly men. Methods. A subgroup of 30 intermediate-frail and frail elderly men (65–89 years) with low to borderline-low testosterone levels were enrolled from a single-center randomized, double-blind placebo-controlled trial. Participants received either a transdermal testosterone (50 mg) or placebo gel daily for 6 months. Architecture (muscle thickness, fascicle length, and pennation angle) of the gastrocnemius medialis muscle was assessed by ultrasound imaging at baseline and after 6 months of treatment. Results. Serum testosterone increased from 11.6 ± 3.5 to 18.0 ± 8.1 nmol/L by 10 days after randomization in the active group (but not the placebo group) and was maintained throughout the treatment period. Testosterone treatment resulted in a preservation of muscle thickness at 6 months while it decreased in the placebo group (effect size 1.4 [95% confidence interval = 0.3–2.5; p = .015]). There was no significant effect of treatment on fascicle length (effect size 1.9 mm [95% confidence interval = −1.2 to 5.0 mm; p = .22]) or pennation angle (effect size 1.2° [95% confidence interval = −1.3 to 3.7°; p = .32]). Conclusions. Testosterone replacement in intermediate-frail and frail elderly men is associated with preservation of muscle thickness. The results suggest that testosterone mitigates sarcopenia by improving muscle tissue to maintain a state of normality in aging men. [ABSTRACT FROM PUBLISHER]

Provides information on a study using the Barthel index and the Nottingham extended activities of daily living (ADL) scale in elderly people with and without chronic airflow limitation. Methodology used to conduct the study; Characteristics of the patients used in the study; Findings of the study.

Examines the prevalence of depressive symptoms in elderly patients with chronic obstructive pulmonary disease (COPD), while highlighting a study conducted. Methodology used to conduct the study; Chief symptoms associated with COPD; Range of reported prevalance rate for depression in COPD; Findings of the study.

Background Cognitive impairment is common in people living with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF); however, accurate estimates of prevalence are lacking. To date, there are no meta-analyses that have specifically investigated prevalence of mild cognitive impairment (MCI) in this particular population. Our aim was to undertake a systematic review and apply meta-analytic methods to estimate the prevalence of MCI and any cognitive impairment (ACI) in people with COPD and CHF. Methods We identified relevant studies for COPD and CHF by searching the published literature from inception to February 2016 using the MEDLINE and Web of Science databases. Studies were included if they documented the prevalence of MCI and/or cognitive impairment for COPD and CHF patients without dementia. Results Seventeen studies including people with CHF (n = 29,456) and 14 studies including people with COPD (n = 23,116) were included. The pooled mean age for COPD was 66.3 years and for CHF, 75.6 years. The pooled prevalence of MCI in the COPD was 25% (95% CI: 23%, 42%) and ACI, 32% (95% CI: 18%, 38%). Correspondingly, the pooled prevalence of MCI in those with CHF was 32% (95% CI: 22%, 43%) and ACI, 31% (95% CI: 23%, 40%). Conclusions One in 4 people with COPD and 1 in 3 people with CHF had MCI, respectively. The overall prevalence of ACI for COPD was 32% and for CHF, 31%. Future work should consider ways of detecting, managing, or improving cognitive function and other cognition-related outcomes in this group of people. [ABSTRACT FROM AUTHOR]

Objectives: Housing quality has significant impact on the wider determinants of health and quality of life (QoL). Retirement villages are considered age-friendly accommodation for community-dwelling older people, offering a variable range of services and supports. We wished to explore the relationship among frailty, QoL, and resilience in older people residing in retirement villages., Design: Cross-sectional analysis within a longitudinal study., Setting and Participants: Residents from 33 retirement villages in Auckland, Aotearoa, New Zealand., Methods: Frailty [using an interRAI-Community Health Assessment-based frailty index FI)], QoL [World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) and WHOQOL-Older Adults Module (WHOQOL-OLD)], and resilience [Brief Resilience Scale (BRS)]. Associations among frailty, QoL, and resilience were examined using regression analysis adjusting for confounders., Results: Mean (SD): FI 0.2 (0.1) in 479 residents, BRS 3.7 (0.8) in 395 residents, WHOQOL-OLD total score 69.9 (12.2). FI was inversely related to BRS [adjusted mean difference (MD) -0.35; 95% CI -0.43 to -0.26; P < .001] and WHOQOL-OLD (MD, -5.45; 95% CI -6.89 to 4.01; P < .001). FI inverse relationship was seen across all facets of WHOQOL-OLD and all WHOQOL-BREF facets except psychological., Conclusions and Implications: Frailty was inversely related to resilience and multiple domains of QoL in those living in presumed age-friendly and relatively resource-rich environments. Studies exploring causal relationships between these facets could inform interventions necessary to improve QoL and resilience in those living with frailty. Specific multidimensional needs, wishes, and concerns of older people living with frailty needs to be explored in order to potentially intervene on frailty, QoL, and resilience., Competing Interests: Disclosures The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

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., (© 2023 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

Introduction Physical activity (PA) in older people is associated with improved morbidity and mortality outcomes. Increasing numbers of older people are choosing to live in retirement villages, many of which promote themselves as providing opportunities for activity. Aim To explore the characteristics of PA village residents were undertaking and the associated individual and village factors. Methods Health, functional and wellbeing information was collected from 577 residents recruited from 34 villages in Auckland, New Zealand, using an International Resident Assessment Instrument and customised survey tools containing items on self-reported PA. Managers from villages completed a survey on village characteristics and facilities. Results The mean age (s.d.) of village residents was 82 (7) years, and 325 (56%) reporting doing one or more hours of PA in the 3 days prior to assessment. Moderate exercise was performed by 240 (42%) village residents, for a mean (s.d.) of 2.7 (3.4) h per week. The most common activities provided by villages included: bowls/petanque (22, 65%) and exercise classes (22, 65%), and walking was the most common activity undertaken (348, 60%). Factors independently associated with PA included individual factors (gender, fatigue, constipation, self-reported health, number of medications, moving to village for safety and security, utilising village fitness programme, use of the internet, and satisfaction with opportunities to be active) and village-related factors (access to unit, and ownership model). Discussion PA uptake is determined by many factors at both personal (physical and psychosocial) and environmental levels. Clinicians should focus on individualised PA promotion in those with identified risk factors for low levels of PA.

Aims: Frailty within the older adult rehabilitation population is relatively under-explored. We aimed to derive a frailty index (FI) from electronic routinely collected data to determine frailty prevalence, and to assess its ability to predict adverse outcomes in the rehabilitation setting., Methods: A FI was derived and retrospectively applied to electronically recorded health information of older adults admitted for inpatient rehabilitation. For analysis, subjects were allocated into frailty score (FS) groups (0-5). Primary outcome was a six-month hospitalistion rate, and other outcomes were: mortality, entrance into long-term care (LTC) at one year, length of stay (LOS), 30- and 90-day hospitalistions. Univariate and multivariable logistic regressions analysed associations between frailty and outcomes., Results: One hundred and sixty-two patient electronic notes were reviewed. Mean (SD) age was 86 (8.2) years, 147 (90.7%) were considered frail (FS>0.25). The most frail group (FS 5) had higher risk of six-month hospitalisations (OR=6.19; 95%CI=1.82, 21.13; p=0.004). A higher frailty score was associated with shorter LOS compared to lowest frailty scores (15.7 days vs 25.4 days; p=0.04). No relationship was found with shorter-term outcomes., Conclusion: Prevalence of frailty is high in the rehabilitation setting. Association of frailty with shorter LOS and lack of association found with shorter-term outcomes warrant further study., Competing Interests: Nil., (© PMA.)

Objectives: As people age, they are more likely to require support to maintain activities of daily living. Referral for formal assessment of need (assessed using the 'international Resident Assessment Instrument' [interRAI]) is the first step to access publicly funded services in Aotearoa New Zealand (NZ). It is unclear whether ethnic access inequities present in other areas of the NZ health system occur in this referral process. This exploratory research aimed to explore ethnic variation in referrals for interRAI assessment, and associated factors., Methods: A retrospective cohort study of all new referrals for aged care services for those 55-plus, received in 2018 by Waitematā District Health Board (WDHB), was conducted. The primary outcome was referral outcome (assessment and no assessment). Secondary outcomes included time from referral to assessment, reason for referral, mortality and, in the assessed cohort, assessment outcome., Results: New referrals (n = 3263) were ethnically representative of the general older adult population in WDHB. Māori were younger and more likely to be referred for higher-level care needs than non-Māori, non-Pasifika (NMNP) (p = 0.03). There was no significant difference in referral outcome, time to assessment or mortality between ethnicities. NMNP were more likely to access lower-level care services than Māori or Pasifika older adults (p = 0.002)., Conclusions: Ethnicity was not associated with aged care service assessment access once people were referred for publicly funded services, nor was it associated with time to assessment or mortality in this exploratory study. Māori had higher care needs than NMNP at the time of referral., (© 2022 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc.)

Objectives: 11% of drivers aged 65+ report moderate to extreme driving anxiety, with associated reduction in driving. Knowledge about the relationships of driving anxiety with health and quality of life for older people is minimal. The present study examined these relationships., Method: 1170 community dwelling drivers aged 65+ in New Zealand completed a population survey., Results: After adjusting for socio-demographic variables, higher driving anxiety was associated with lower quality of life and lower odds of 'very good' self-reported health, but no difference in odds of multi-comorbidity., Discussion: Further research is needed to examine the influence of driving anxiety on health and quality of life outcomes with a broader range of older people who experience more challenges to their health and wellbeing, especially to mental health.

INTRODUCTION te Tiriti o Waitangi guarantees Māori the right to: self-determination, equitable health outcomes, be well informed, health care options, including kaupapa Māori and culturally safe mainstream services, and partnership in the health care journey. Despite integration of these principles into policy, there remains a lack of application in health service development, and health inequities remain. AIM We aimed to use te Tiriti o Waitangi to structure the development of a culturally safe health intervention, using as an exemplar pharmacist-facilitated medicines review for Māori older adults. METHODS Previous research undertaken by our group (a systematic review, and interviews with stakeholders including Māori older adults) was used to inform the aspects to include in the intervention. Kaupapa Māori theory was used to underpin the approach. Intended outcomes, requirements for change, and outcome measures to assess change were mapped to te Tiriti o Waitangi principles as a way to structure the pharmacist-facilitated medicines review intervention and research processes. RESULTS Findings from our previous research identified 12 intended intervention outcomes, including that the intervention be flexible to adapt to diverse needs in a way that is acceptable and culturally safe for Māori and that it supports Māori older adults to control and have confidence in their medicine treatment and wellbeing. DISCUSSION We present an approach to the development of a pharmacist-facilitated medicines review intervention for Māori older adults, structured around the principles of te Tiriti o Waitangi, to support the implementation of a culturally safe, pro-equity intervention.

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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To describe survival and six-month outcomes (residence, community supports) in the very old (≥80 years) admitted to intensive care in Waitemata District Health Board, New Zealand., Methods: Hospital records of patients 80 years and over admitted from August 2015 to June 2017 were reviewed., Results: One hundred and seventeen patients were admitted (median age: 83). Standard ICU risk scores predicted survival to hospital discharge. Patients admitted electively were more likely to survive to discharge than emergency ICU/HDU admissions (P = .007). Ninety-two (79%) survived to hospital discharge, and 84 (72%) survived to 6 months. Eighty-four were discharged home (91% of survivors), and 79 were living at home at 6 months (94% of survivors). Community supports increased from admission (34, 29%) to 6 months later (34, 43% of community dwellers). Forty-four (47.8% surviving to discharge) were readmitted within 6 months., Conclusions: Most patients are alive at discharge and 6 months, with a majority requiring no formal supports., (© 2020 AJA Inc.)

Background: Pharmacists have a role to play in supporting the optimal use of medicines to ensure older adults receive therapeutic benefit whilst minimising medicines-related harm. In Aotearoa New Zealand (NZ), Māori (Indigenous people of NZ) experience inequities in the determinants of health, including access to medicines, resulting in increased morbidity, earlier onset of chronic conditions and reduced life expectancy. This study aims to test the feasibility of a pharmacist-led medicines review intervention in community-dwelling Māori older adults., Method: This is a non-randomised, non-controlled feasibility study undertaken within a kaupapa Māori methodological framework which supports the right of Māori to be included throughout the research process and seeks to potentiate transformational, positive change for Māori. The research pharmacist will recruit 30 participants (Māori; 55 years or older; community-dwelling). Participants will undergo a medicines education session with the pharmacist (medicines reconciliation, medicines information, well-being goal setting), with the option to proceed to a medicines optimisation session that includes the participant, pharmacist and primary prescriber (review of potentially inappropriate prescribing (PIP); medicines management plan development). Primary outcomes: participant and prescriber acceptability of intervention. Secondary outcomes include baseline and post-intervention medicines knowledge, PIP and quality of life scores, and number of changes made to the medicines regimen., Ethics and Dissemination: Ethical approval was granted by the Northern B Health and Disability Committee (9/NTB/106). Study results will be disseminated to various stakeholders including Māori communities, health practitioners and providers, and researchers through meetings and conference presentations, lay summaries and peer-reviewed journals. This study is an example of health service design, delivery and evaluation, informed by Indigenous knowledge and methodology, developed explicitly to address inequities in health outcomes for, and with, Māori and will inform the decision to proceed to a randomised controlled trial to test the effect of this intervention., Trial Registration Number: ACTRN12619001070123., (Copyright © 2019. Published by Elsevier Inc.)

Aims: Falls are common in 80-plus year-olds and there is evidence available in terms of risk factors and prevention measures. We aimed to review falls risk factor assessment and secondary prevention strategies in patients in this age group presenting acutely to services other than older adult health services at Waitemata District Health Board., Methods: We retrospectively reviewed electronic hospital records of those >80 years presenting to acute services with a primary or secondary diagnosis of a fall, or fall-related injury. Admission characteristics, risk factor identification and subsequent referrals for falls prevention were recorded. Six-month outcomes including readmissions and mortality were assessed., Results: One hundred and thirty-eight discharge summaries were reviewed (71% female, median age 89). Thirty-one percent had a previous fall-related hospital admission in the six months prior. There was high prevalence of psychoactive medications (51%) and falls-related cardiovascular drugs (78%) at discharge. No patients were referred for falls prevention programmes or geriatric assessment at discharge. At six months 19% had died and 44% had been readmitted., Conclusions: There are inadequate falls prevention referrals, indicating a quality of care gap. The older age group presenting to acute services have high rates of polypharmacy, hospitalisations and death., Competing Interests: Mr Lau reports grants from The HOPE Foundation during the conduct of the study.

Background: Pharmacist involvement in medicines reviews for older adults can improve prescribing and reduce adverse drug reactions. Māori experience poorer health outcomes than non-Māori resulting, in part, from inequitable access to and quality of medicine-related care. Despite international data showing benefit, it is unclear whether pharmacist-led medicines review services can improve outcomes for Māori older adults., Objective: This systematic review aims to describe pharmacist-led medicines review services for community-dwelling adults in New Zealand, assess effectiveness of these interventions and identify their effect on health equity for Māori and older adults., Methods: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Equity (PRISMA-E 2012). Observational studies were included. The intervention in included studies had to involve a pharmacist, occur in the outpatient setting in New Zealand, and involve review of all medicines for an individual patient. At least one patient-related outcome had to be reported., Results: The search identified seven observational studies with 542 total participants. Study interventions included adherence-based reviews in community pharmacies and multi-step comprehensive clinical reviews in outpatient haemodialysis units. Medicines reviews identified up to a median of 3 drug-related problems per review. The effect of interventions on medicines adherence and knowledge was not clear. Māori may have been less likely than non-Māori to benefit from improved medicines knowledge as a result of interventions. None of the studies incorporated aspects in study design or delivery to address inequities for Māori., Conclusion: Further investigation is needed to understand whether the development of culturally safe pharmacist-led medicines review services, responsive to community identified needs, can help to achieve equity in health outcomes for Māori older adults., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Frailty is a multidimensional geriatric syndrome associated with functional loss. The Senior Chef (SC, nutrition) and SAYGO (strength and balance exercise) programmes are well accepted among older adults but the impact of each, or a combination of both, on the frailty syndrome in pre-frail older adults is unknown., Aims: To determine the effectiveness and cost-effectiveness of a complex intervention consisting of the SC and/or SAYGO programmes to prevent progression of frailty in pre-frail older adults., Methods: A multi-centre randomised controlled assessor-blinded study. The four intervention groups are SC, an 8-week nutrition education and cooking class; SAYGO, a 10-week strength and balance exercise class; SC plus SAYGO, and a social group (Control). Community-dwelling adults aged 75+ (60 + Māori and Pasifika) in New Zealand are recruited through health providers. Participants are not terminally ill or with advanced dementia, and have a score of 1 or 2 on the FRAIL questionnaire. Baseline assessments are completed using standardised questionnaires prior to randomisation. Four follow-up assessments are completed: immediately after intervention, 6, 12 and 24 months post-intervention. The primary outcome is frailty score, secondary outcomes are falls, physical function, quality of life, food intake, physical activity, and sustainability of the strategy. Study outcomes will be analysed using intention-to-treat approach. Cost analyses will be completed to determine if interventions are cost effective relative to the control group., Discussion: This trial is designed to be a real world rigorous assessment of whether the two intervention strategies can prevent progression of frailty in older people. If successful, this will generate valuable information about effectiveness of this nutrition and exercise strategy, and provide insights for their implementation., Trial Registration: Australian and New Zealand Clinical Trials Registry number-ACTRN12614000827639.

Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way healthcare is currently delivered. Currently hospital falls are a major healthcare concern worldwide because of the ageing population. Current observational data and vital signs give the critical information related to the patient's physiology, and motion data provide an additional tool in falls risk assessment. These data combined with the patient's medical history potentially may give the interpretation model high information accessibility to predict falls risk. This study aims to develop a robust falls risk assessment system, in order to avoid falls and its related long-term disabilities in hospitals especially among older adults. The proposed system employs real-time vital signs, motion data, falls history and other clinical information. The falls risk assessment model has been tested and evaluated with 30 patients. The results of the proposed system have been compared with and evaluated against the hospital's falls scoring scale.

Background: Several regions of the genome have shown to be associated with COPD in genome-wide association studies of common variants., Objective: To determine rare and potentially functional single nucleotide polymorphisms (SNPs) associated with the risk of COPD and severity of airflow limitation., Methods: 3226 current or former smokers of European ancestry with lung function measures indicative of Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2 COPD or worse were genotyped using an exome array. An analysis of risk of COPD was carried out using ever smoking controls (n=4784). Associations with %predicted FEV1 were tested in cases. We followed-up signals of interest (p<10(-5)) in independent samples from a subset of the UK Biobank population and also undertook a more powerful discovery study by meta-analysing the exome array data and UK Biobank data for variants represented on both arrays., Results: Among the associated variants were two in regions previously unreported for COPD; a low frequency non-synonymous SNP in MOCS3 (rs7269297, pdiscovery=3.08×10(-6), preplication=0.019) and a rare SNP in IFIT3, which emerged in the meta-analysis (rs140549288, pmeta=8.56×10(-6)). In the meta-analysis of % predicted FEV1 in cases, the strongest association was shown for a splice variant in a previously unreported region, SERPINA12 (rs140198372, pmeta=5.72×10(-6)). We also confirmed previously reported associations with COPD risk at MMP12, HHIP, GPR126 and CHRNA5. No associations in novel regions reached a stringent exome-wide significance threshold (p<3.7×10(-7))., Conclusions: This study identified several associations with the risk of COPD and severity of airflow limitation, including novel regions MOCS3, IFIT3 and SERPINA12, which warrant further study., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

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., (© 2015 AJA Inc.)

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., (© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Vital signs monitoring systems are rapidly becoming the core of today's healthcare deliveries. The paradigm has shifted from traditional and manual recording to computer based electronic records and further to handheld devices as versatile and innovative healthcare monitoring systems. Interpretation of vital signs to early detect multiple physical signs using a multifactorial and holistic approach is presented. A total of 30 patient data have been collected under local and national ethics approvals in New Zealand Hospitals. Ultimately, this system achieved a high level of agreement with clinicians' interpretation when assessing specific physical signs such as bradycardia, tachycardia, hypertension, hypotension, hypoxaemia, fever and hypothermia. The proposed vital signs interpretation system was validated through off-line as well as real-time tests with a high level of agreement between the system and the physician. The system achieved an accuracy of 95.83%, sensitivity of 100%, specificity of 93.15%, and predictability of 90.38% in compare with a clinician assessment for tachycardia, hypertension, hypotension, hypoxaemia and hypothermia.

Objectives: In New Zealand (NZ), place of death among decedents aged 65+ years has been reported as residential aged care (RAC, 38%), acute hospital (34%) or elsewhere (28%). However, lifetime risk of use of RAC (or nursing homes) is unknown. A simple method of estimation is demonstrated for NZ and Australia, with comparisons to other countries., Methods: Deaths of RAC residents in acute hospitals were estimated for NZ from four separate studies and added to deaths occurring in RAC, to derive the likelihood of using RAC after age 65 years. Academic and other sources were searched for comparative reports., Results: An estimated 18% of RAC residents died in acute hospital in NZ. When added to those who died in RAC, the proportion using RAC for late-life care was estimated at over 47% (66% if aged 85+ years). Of 12 US reports, the median report was 41%. Elsewhere, Finland was 47%, UK 28%, Australia 34% to 53%, and Germany 22% & 26%., Conclusions: Simple estimation using existing data demonstrates that RAC in late life is common., Implications: Late-life care services will continue to evolve. Monitoring RAC utilisation is necessary for informed debate about palliative care provision in RAC, use of hospital by RAC residents and for planning and policy setting., (© 2015 Public Health Association of Australia.)

Mobile phones are becoming increasingly important in monitoring and delivery of healthcare interventions. They are often considered as pocket computers, due to their advanced computing features, enhanced preferences and diverse capabilities. Their sophisticated sensors and complex software applications make the mobile healthcare (m-health) based applications more feasible and innovative. In a number of scenarios user-friendliness, convenience and effectiveness of these systems have been acknowledged by both patients as well as healthcare providers. M-health technology employs advanced concepts and techniques from multidisciplinary fields of electrical engineering, computer science, biomedical engineering and medicine which benefit the innovations of these fields towards healthcare systems. This paper deals with two important aspects of current mobile phone based sensor applications in healthcare. Firstly, critical review of advanced applications such as; vital sign monitoring, blood glucose monitoring and in-built camera based smartphone sensor applications. Secondly, investigating challenges and critical issues related to the use of smartphones in healthcare including; reliability, efficiency, mobile phone platform variability, cost effectiveness, energy usage, user interface, quality of medical data, and security and privacy. It was found that the mobile based applications have been widely developed in recent years with fast growing deployment by healthcare professionals and patients. However, despite the advantages of smartphones in patient monitoring, education, and management there are some critical issues and challenges related to security and privacy of data, acceptability, reliability and cost that need to be addressed.