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Background Understanding and supporting sleep is important across the life span. Disparities in sleep status are well documented in mid-life but under-explored among older populations. Methods Data from 40,659 adults pooled from the New Zealand Health Surveys were used; 24.2% were “older adults” (aged ≥65 years), 57% were female, and 20.5% of Māori ethnicity. “Long,” “short,” or “typical” sleep categories were based on age-related National Sleep Foundation guidelines. Multinomial logistic regression examined predictors of atypical sleep, including sociodemographic characteristics, lifestyle factors, and health status. Results Prevalence of short and long sleep among older adults was 296 (3.0%) and 723 (7.4%), respectively. Correspondingly, prevalence among younger adults was 2 521 (8.2%) and 364 (1.2%). Atypical sleep was more significantly associated with indicators of reduced socioeconomic status and ethnicity among younger rather than older adults. Within both age groups, lower physical activity was associated with long sleep status. Higher physical activity and smoking were related to short sleep status among younger adults only. Within both age groups, atypical sleep was associated with SF-12 scores indicating poorer physical and mental health. Having ≥3 health conditions was related to short sleep among the older adults, while for young adults, it was related to both atypical durations. Conclusions Indicators of negative lifestyle and health factors remain consistent predictors of atypical sleep with aging. However, demographic disparities are less apparent among older atypical sleepers. This study highlights individual and contextual factors associated with atypical sleep patterns which may be important for age-appropriate recognition and management of sleep problems.

Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60 + years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.

Massey University staff used a New Zealand indigenous (M?ori) engagement framework, developed for working with at-risk youth, to restructure the content and student engagement for an online introductory course with a non-traditional student cohort. Each online teaching page embedded three sections reflecting the concepts of Whakapiri (Engagement), Whakam?rama (Enlightenment) and Whakamana (Empowerment). This sequenced content provision for students, guiding them through an initial topic overview and learning outcomes through to core teaching content and learning activities and finally onto assessments, putting their learning to practice. This framework also underpinned staff engagement approaches with students, focusing on ensuring staff presence online, proactive contact, recognition for learning illustrated, encouragement of class engagement, clarity in course guidance and assessment feedback that praised and empowered change. Compared to the old course, subsequent deliveries showed greater course engagement, improved class GPA of 36%-50%, and feedback confirms a consistently positive and connected student learning experience.

Maintaining or improving quality of life (QoL) in later life has become a major policy objective. Yet we currently know little about how QoL develops at older ages. The few studies that have modelled QoL change across time for older adults have used ‘averaged’ trajectories. However, this ignores the variations in the way QoL develops between groups of older adults. We took a theoretically informed ‘capabilities approach’ to measuring QoL. We used four waves of data, covering 6 years, from the New Zealand Health, Work and Retirement Study (NZHWR) (N = 3223) to explore whether distinct QoL trajectories existed. NZHWR is a nationally representative longitudinal study of community-dwelling adults aged 50 + in New Zealand. Growth mixture modelling was applied to identify trajectories over time and multinomial regressions were calculated to test baseline differences in demographic variables (including age, gender, ethnicity, education and economic living standards). We found five QoL trajectories: (1) high and stable (51.94%); (2) average and declining (22.74%); (3) low and increasing (9.62%); (4) low and declining (10.61%); (5) low and stable (5.09%). Several differences across profiles in baseline demographic factors were identified, with economic living standards differentiating between all profiles. The trajectory profiles demonstrate that both maintaining and even improving QoL in later life is possible. This has implications for our capacity to develop nuanced policies for diverse groups of older adults.

Objective To determine the nutrition risk prevalence and associated health and social risk factors amongst community-living Māori and non-Māori older adults in New Zealand. Methods As part of the 2014 Health, Work and Retirement postal survey, 2914 community-living older adults (749 Māori) aged 49-87 years completed the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II-AB) to determine nutrition risk status and sociodemographic and health measures. Results Half (50.2%) of Māori and 32.7% of non-Māori were at nutrition risk. Independent risk factors were as follows: for Māori, being unpartnered and rating general health as fair, and for non-Māori, being unpartnered and rating general health as fair or poor, lower life satisfaction, higher number of health conditions and emotional loneliness. Conclusions Findings highlight the need for culturally appropriate intervention strategies, which provide opportunity for older adults to eat with others, especially for those who are unpartnered and lonely.

Background The cumulative, negative health effects of alcohol consumption are exacerbated in older adulthood. We used a ‘life course epidemiology’ approach to explore how alcohol use trajectories develop across the lifespan, what early life events influence these trajectories and their associations with late-life health. Methods Survey data combined with retrospective life course history interviews were collected from 749 non-lifetime alcohol abstainer adults aged 61–81 years (51 % female). Frequency and quantity items of the AUDIT-C assessed alcohol use across each decade of life. Early life factors were childhood socioeconomic status, parental health behaviours, and age of drinking onset. Health outcomes were alcohol-related conditions. Results Latent class growth analysis yielded two life course trajectories for women: consistently infrequent, low quantity drinking (Group 1: 48 %) and increasingly frequent, low quantity drinking (Group 2: 52 %). Men showed three trajectories: consistently infrequent, low quantity drinking (Group 3: 36 %); increasingly frequent, low quantity drinking (Group 4: 51 %); and drinking with increasing frequency and quantity until midlife, after which consumption gradually declined (Group 5: 13 %). Better childhood socioeconomic status was associated with Groups 2 and 4. Later drinking onset was associated with Groups 1 and 3. Parental alcohol misuse, early drinking initiation and childhood socioeconomic adversity were predictive of Group 5. Those in Group 5 were five-to-seven times more likely to have alcohol-related comorbidities. Conclusions Early life experiences influence life course hazardous alcohol use. Interventions across the life course, from childhood, when drinking may be initiated, through to older adulthood, when sensitivity to alcohol increases, are needed.

This study aimed to determine four-year outcomes of community-living older adults identified at ‘nutrition risk’ in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49–87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time.

Pressure injuries, incontinence, malnutrition, and falls are important indicators of the quality of care in healthcare settings, particularly among older people, but there is limited information on their prevalence in New Zealand (NZ). The aim of this study was to establish the prevalence of these four problems among older people in nursing home facilities. The cross-sectional study was an analysis of data collected on a single day for the 2016 National Care Indicators Programme-New Zealand (NCIP-NZ). The sample included 276 people ages 65 and older who were residents in 13 nursing home facilities in a geographically diverse area of central NZ. Data were analyzed with descriptive statistics. Prevalence rates in these nursing home settings was pressure injuries 8%; urinary incontinence 57%; fecal incontinence 26%; malnutrition 20%, and falls 13%, of which half resulted in injuries. As people age, complex health issues can lead to increasing care dependency and more debilitating and costly health problems. Measuring the prevalence of basic care problems in NZ healthcare organizations and contributing to a NZ database can enable monitoring of the effectiveness of national and international guidelines.

Objectives: The study compared the proportion of older adults identified as drinking hazardously based on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) with the older adult-specific Comorbidity Alcohol Risk Evaluation Tool (CARET) and investigated whether sociodemographics, comorbidities, health, medication use, and alcohol-related risk behaviors explained discrepancies between the screens in classification of hazardousness. Method: The AUDIT-C and the CARET were administered to 3,673 adults aged 55 to 89 years. Classification agreement between the screens was evaluated using Cohen’s kappa. Hazardous drinking groups were compared using logistic regression. Results: Analysis indicated moderate agreement between the screens. Drinkers classified as “hazardous on the CARET only” consumed less alcohol, but were more likely to drink-drive. Introducing a drink-driving criterion into the calculation of hazardousness on the AUDIT-C substantially decreased the classification discrepancy between the measures. Discussion: Standard screening can be improved by investigating comorbidities, medication use, and alcohol-related risk behaviors in those initially identified as nonhazardous drinkers.

Older persons with visual impairments are consistently found to score lower on measures of qualify of life (QOL) than their sighted peers regardless of the type of measure used (such as measures of PQOL, health-related QOL or vision-related QOL; Bekibele & Gureje, 2008; Chia et al., 2004; Frost et al., 2001; La Grow, Alpass, Stephens, & Towers, 2011; La Grow, Sudnongbua, & Boddy, 2011). These lower scores are generally attributed to a number of factors associated with late-onset visual impairment, including increasing age, decreased physical and mental health, the onset of functional limitations including a reduction in independent mobility, reduced economic status, higher rates of social isolation, and lowered levels of satisfaction with life (Frost et al., 2001; La Grow, Alpass et al., 2011). Interestingly, all of these factors, as well as the onset of visual impairment, are also associated with increased rates of loneliness in the older population in general (Heylen, 2010; Luanaigh & Lawlor, 2008; Prieto-Flores, Forjaz, Fernandez-Mayoralas, Rojo-Perez, & MartinezMartin, 2011; Routasalo & Pitkala, 2003). As such, it is logical to assume that rates of loneliness would be higher among older persons who are visually impaired than among those who are not. Also, since loneliness has been identified as a fundamental contributor to decreased QOL in older adults in general (Hawton et al., 2011), it is logical to assume that this relationship exists for the subpopulation of older visually impaired people as well. There is some evidence to suggest that the rates of loneliness are higher in people with visual impairments (Alma et al., 2011; Verstraten, Brinkmann, Stevens, & Schouten, 2005). However, there is little to no evidence regarding an association between loneliness and PQOL in this population, nor is there any evidence that loneliness differentially impacts on the PQOL of visually impaired and sighted older adults. There appear to be two primary reasons that informative research in these areas has been stifled. First, research with older adults has often conceptualized loneliness in objective terms (that is, quantity of social contacts, or levels of social isolation; La Grow, Alpass et al., 2011). However, this research differs from the subjective experience of loneliness (that is, the quality of social relationships regardless of their frequency or volume), since it is commonly defined in the literature (de Jong Gierveld, 1998; Peplau & Perlman, 1982) and is known to affect perceived well-being in older adulthood (Golden et al., 2009). Second, while some previous research has explored QOL in older visually impaired people, the QOL measures utilized were predominantly either vision-related (Hernandez, Trillo, & Dickinson, 2012), health-related (Crews, Chou, Zhang, Zack, & Saadine, 2014), or proxy indicators (Lewis, Brown, & Barrett, 2011), rather than being measures of PQOL. Such measures simply define QOL as the impact of disease, while measures of PQOL provide a much broader assessment of general well-being and social satisfaction that is foundational for understanding successful aging in visually impaired and sighted older adults (Gabriel & Bowling, 2004; Renaud et al., 2010). The consistent use of condition-specific or proxy QOL indicators in research on visually impaired populations means that there is little understanding of the level of PQOL in older visually impaired people living in the community; that levels of PQOL and loneliness in visually impaired and sighted populations cannot be compared; and that it is not possible, therefore, to identify whether perceived loneliness differentially predicts PQOL for visually impaired or sighted people. With older adults (those aged 65 and older) constituting the majority of the visually impaired population globally (WHO, 2012), there is growing need for robust, high-quality studies to explore the role loneliness plays in the PQOL of those who are visually impaired (Nyman, Gosney, & Victor, 2010). …

ObjectiveLongitudinal cohort studies remain important sources of information in health and epidemiological research and represent a significant investment of resources. The maintenance of these cohorts over time and the representativeness of retained participants are important considerations for researchers. For those weighting the benefits of augmenting a longitudinal cohort study with data linkage to national health records, the potential for bias in consent and match rates and the utility of the newly obtained data are also key considerations. This study presents an analysis of bias associated with consent to participate and record matching in an established longitudinal cohort of older persons. We present the unique outcomes generated from this national health record data linkage project and the opportunities such variables present for longitudinal cohort studies.ApproachThe New Zealand Health, Work and Retirement study is a biennial survey of persons aged 55-85 which commenced in 2006. Over the past decade, additional cohorts have been recruited to the study, with n = 9003 older New Zealand residents participating to the year 2015. In 2013 the study began an approach to active survey participants for consent to link their longitudinal survey data to national health record data held by the New Zealand Health Information Service, including data related to hospital events, the New Zealand Cancer Registry, pharmaceutical data and mental health data. We compare self-reported longitudinal health trends associated with consent/declination to participate as well as for record match success and failure. Key outcomes derived from these national datasets for the purposes of the Health, Work and Retirement Study are described.ResultsConsent (62.5%) and declination (8.9%) to participate in the data linkage project are described in terms of the corresponding longitudinal self-reported health and socio-demographic trends for these groups. Successful and unsuccessful matches of participants to national health record data are also described. The calculation of outcomes from each of the linked datasets obtained and their potential utility in building upon existing longitudinal cohort data are also presented.ConclusionsNational health record data linkage presents a potentially valuable source of data to supplement and replicate findings related to health outcomes and expenditure derived from longitudinal cohort surveys. The challenges and successes of the New Zealand Health, Work and Retirement survey data linkage project touch upon considerations pertinent to evaluating the value of augmenting existing and ongoing longitudinal survey cohort for other researchers.

Background: Moral distress has been described as a major problem for the nursing profession, and in recent years, a considerable amount of research has been undertaken to examine its causes and effects. However, few research projects have been performed that examined the moral distress of an entire nation’s nurses, as this particular study does. Aim/objective: The purpose of this study was to determine the frequency and intensity of moral distress experienced by registered nurses in New Zealand. Research design: The research involved the use of a mainly quantitative approach supported by a slightly modified version of a survey based on the Moral Distress Scale–Revised. Participants and research context: In total, 1500 questionnaires were sent out at random to nurses working in general areas around New Zealand and 412 were returned, giving an adequate response rate of 27%. Ethical considerations: The project was evaluated and judged to be low risk and recorded as such on 22 February 2011 via the auspices of the Massey University Human Ethics Committee. Findings: Results indicate that the most frequent situations to cause nursing distress were (a) having to provide less than optimal care due to management decisions, (b) seeing patient care suffer due to lack of provider continuity and (c) working with others who are less than competent. The most distressing experiences resulted from (a) working with others who are unsafe or incompetent, (b) witnessing diminished care due to poor communication and (c) watching patients suffer due to a lack of provider continuity. Of the respondents, 48% reported having considered leaving their position due to the moral distress. Conclusion: The results imply that moral distress in nursing remains a highly significant and pertinent issue that requires greater consideration by health service managers, policymakers and nurse educators.

Objective: The demographic and health aspects of ageing populations in Australia and New Zealand (NZ) are described. These data are relevant to compare impacts of policy and context in each country. Methods: Secondary analysis of international (Organization for Economic Co-operation and Development, United Nations and World Health Organization) and domestic population and health data. Results: Both countries will experience a greater than 80% increase in the population aged 60-plus years between 2013 and 2050. The increase in the 80-plus population will be 200% or higher, resulting in 2.8 million Australians and more than 510,000 New Zealanders in this age group by 2050. The speed of ageing in both countries is higher than the average rate of increase in developed countries. Average life expectancy at birth and age 60 is higher in Australia than NZ, with the differences increasing slightly by 2050, and gaps between men and women consistently smaller in NZ than in Australia. However, a higher proportion of older Australians report living with a disability (53%) than older New Zealanders (45%). Conclusions: Australia and NZ are well aged in the context of a youthful Oceania region, with more similarities than differences between the countries. Implications: Both countries need to continue to monitor health trends, unravel the major population attributable risks, and identify preventative and other interventions that can stimulate and support declines in disability in older populations in the future, particularly for non-indigenous older persons.

Several theories have been proposed to account for variation in the intensity of life regrets. Variables hypothesized to affect the intensity of regret include: whether the regretted decision was an action or an inaction, the degree to which the decision was justified, and the life domain of the regret. No previous study has compared the effects of these key predictors in a single model in order to identify which are most strongly associated with the intensity of life regret. In this study, respondents (N = 500) to a postal survey answered questions concerning the nature of their greatest life regret. A Bayesian regression analysis suggested that regret intensity was greater for—in order of importance—decisions that breached participants’ personal life rules, decisions in social life domains than non-social domains, and decisions that lacked an explicit justification. Although regrets of inaction were more frequent than regrets of action, regrets relating to actions were slightly more intense.

Objective: The purpose of this cross-sectional study was to determine the extent and manner in which mobility is related to quality of life (QOL) in a representative sample of older adults. Method: Two models were assessed using structured equation modeling. The first hypothesized that mobility would have a direct effect on QOL along with other variables, including; number of health conditions and satisfaction with functional capacity, life essentials (e.g., transport, access to health services, and conditions of living space) and personal relationships. The second hypothesized that mobility would have its greatest influence on QOL through satisfaction with functional capacity. Results: While both models found that mobility and all three measures of life satisfaction were significantly associated with QOL, goodness of fit indices were higher for the second model. Discussion: The findings from this study suggest that mobility interventions designed to enhance QOL should address satisfaction with functional capacity as well.

Despite the apparent importance of International Classification of Functioning, Disability and Health (ICF) framework in influencing the relationships between participation and quality of life (QoL), limited research has been given to comprehensive modelling of their influence. The purpose of this study was to explore the relationships between ICF components, participation factors and QoL among young adults with disabilities.This study tested a theoretically and empirically based explanatory model on 119 young adults with disabilities to examine how the variables of functional impact, financial behaviour, self-efficacy, neighbourhood environment, social support, social and community participation, satisfaction with participation influenced QoL. Analyses were performed with AMOS maximum likelihood parameter estimation.The final model accepted in this study showed a well-fitted model, which explained 65% of the variance in QoL. Results from the statistical modelling indicated that all the ICF components and satisfaction with participation influenced the level of QoL in young adults with disabilities in either a direct or indirect manner.These findings provide evidence that young adults with disabilities have a very complex interaction of their activity participation, social membership, community connectedness, life satisfaction, suggesting that their context of QoL is shaped by how they make sense not only with their functional status, but also the social and community environment. Current findings further demonstrate that the ICF model of functioning and disability should be thought of as multidimensional and more than instrumental in character when being used by health and rehabilitation professionals.This study supports the ICF model to include the concept of QoL as the outcome. Rehabilitation practitioners are encouraged to view the ICF model as multidimensional when designing interventions. Social context and support should be included when developing strategies to enhance QoL in youth transition to adulthood.

Objectives. We examined the interrelationships between ethnicity, gender, and caregiving on the health of older New Zealanders. We hypothesized that those providing higher levels of care and more care across time would have poorer health outcomes and that these relationships would be moderated by ethnicity and gender. Method. A representative sample of participants ( N = 2,155) aged 54–70 years from the first 2 waves of the New Zealand Health, Work and Retirement study completed postal surveys in 2006 and 2008. Caregiving questions were adapted from the Australian Women’s Health study, and health measures were derived from the SF36 Health Survey. Results. Women and M āori (indigenous New Zealanders) were more likely to provide care than men and nonMāori. Respondents providing higher levels of care reported poorer mental health and this was particularly true of Māori and female caregivers. Male M āori caregivers providing the highest level of care reported the poorest mental health. Level of care was unrelated to physical health. There was minimal evidence for changes in health over time based on caregiver status. Discussion. The poorer health of caregivers supports previous findings on the detrimental health effects of caregiving. Caregiving may have more detrimental effects on M āori health outcomes due to existing inequalities in health, barriers to formal support services, and the multiple roles of elder M āori.

A model of vision rehabilitation that assumes that functional ability will affect the emotional and psychosocial adjustment of older persons with visual impairments, and ultimately their quality of life, was assessed using structured equation modeling. The proposed model was upheld. In addition, the ability to get around was found to contribute to both functional ability and quality of life. ********** Independent, self-directed movement (or way finding) is a fundamental human activity culminating in one's ability to get around natural and built environments (Darken & Peterson, 2002; Mast & Zaehle, 2008). Although this is generally considered a visually directed, physical activity, those who are visually impaired (that is, are blind or have low vision) can learn the skills required to successfully navigate environments of various levels of complexity (Rieser, 2008). These skills are collectively known as orientation and mobility (OM Hill & Ponder, 1976; Jacobson, 1993; La Grow & Weessies, 1994). Instruction in OM Ponchillia & Ponchillia, 1996; Welsh, 2010). The instructional systems that are used to teach OM Ponchillia & Ponchillia, 1996). These benefits include increased confidence, self-esteem, opportunities to engage or participate in meaningful activities, and ultimately emotional and psychological adjustment to and an acceptance of the onset of a significant visual impairment (Crews & Luxton, 1992; Davis, Lovie-Kitchen, & Thompson, 1995; Elliott & Kuyk, 1994; La Grow & Humphries, 1998; Stuen, 2000; Zarit, 1992). These benefits are collectively thought to affect one' s overall quality of life and, therefore, fit with what Crews and Long (1997) claimed to be the fundamental reason to provide a rehabilitation service: to improve the lives of those served (increase both their quality of and satisfaction with their lives). In addition to the functional disabilities associated with the onset of a significant visual impairment, those who have difficulty seeing have been found to be worse off financially, to have poorer physical and mental health, and to experience more social isolation or loneliness than does the population in general (Branch, Horowitz, & Carr, 1989; Crews, 1994; Horowitz, Brennan, & Reinhardt, 2005; Jin & Wong, 2008; LaForge, Spector, & Sternberg, 1992; La Grow, Alpass, & Stephens, 2009). All these things appear to have some effect on the quality of life of this population, which has been consistently found to be lower than that of those who do not have difficulty seeing (Bekibele & Gureje, 2008: Good, La Grow, & Alpass, 2008; La Grow, Alpass, Stephens, & Towers, 2011). Thus, it is difficult to know to what extent enhancing one's ability to perform activities of daily living in general and O&M specifically will ultimately have an impact on one's quality of life. In an earlier study (La Grow et al., 2011), we used standard multiple regression to investigate the impact of nine variables that are thought to affect the quality of life of this population. These variables were: satisfaction with the ability to perform activities of daily living, the ability to get around, the economic standard of living, the total number of diagnosed health conditions, physical health status, mental health status, social isolation, satisfaction with life at present, and perceived quality of life. …

BACKGROUND: This study aimed to provide hazardous and binge drinking prevalence, odds and risk attributable to specific demographic correlates in community dwelling older adults using both the standard and new older-specific AUDIT-C thresholds. METHODS: Hazardous drinking was assessed using the AUDIT-C in a cross-sectional postal survey of 6662 New Zealanders aged 55-70 years old (m=60.94, SD=4.70) randomly selected from the New Zealand Electoral Roll. Prevalence data is presented for whole sample and stratified by key demographic correlates using standard and older-specific threshold scores on the AUDIT-C. Hazardous drinking prevalence using the standard AUDIT-C threshold was 56.01%, as compared to 42.28% and 50.20% under two older-specific thresholds. RESULTS: Being younger, male, and wealthy were consistent drinking predictors across thresholds but the older-specific thresholds substantially altered the prevalence and risk for females, Asians, and poorer people. Past-month binge prevalence of 18.18% was considerably lower than the past-year prevalence of 33.51%, but change from past-month to past-year binge threshold had no significant effect on the demographic composition of binge drinkers. The standard AUDIT-C threshold over-estimates hazardous drinking prevalence in older adults by up to 33%, but even the most conservative rates in this study are cause for concern regarding the level of drinking by older people in New Zealand. CONCLUSION: Older hazardous drinkers are predominantly younger, wealthier, white, partnered males, whichever threshold is used, but binge drinkers are more likely to be rural, Māori, and lack tertiary education. Further efforts are needed to determine factors underpinning hazardous drinking, especially in older Māori. Language: en

This study examines suggestions that inequalities in health related to socioeconomic status (SES) will increase in older age. A representative sample of the New Zealand population aged 55–70 years (N = 6662) responded to a postal questionnaire with measures of health (SF-36), SES, and health-related behaviours. Hierarchical multiple regressions supported predictions that the SES of working life will continue to influence physical and mental health in early old age. The strongest predictor was self-reported economic living standards. This subjective measure of SES is an important construct for future investigations of health and wellbeing among older people in an ageing population.

Objectives: To use an ecological model of ageing ( Berkman, Glass, Brissette, & Seeman, 2000 ) which includes upstream social context factors and downstream social support factors to examine the effects of social networks on health. Method: Postal survey responses from a representative population sample of New Zealanders aged 55 to 70 years ( N = 6,662). Results: Correlations and multiple regression analyses provided support for a model in which social context contributes to social network type, which affects perceived social support and loneliness, and consequent mental and physical health. Ethnicity was related to social networks and health but this was largely accounted for by other contextual variables measuring socioeconomic status. Gender and age were also significant variables in the model. Discussion: Social network type is a useful way to assess social integration within this model of cascading effects. More detailed information could be gained through the development of our network assessment instruments for older people.

BACKGROUND: driving anxiety and fear can have a marked impact on mobility and independence, although there is no data on the prevalence of this problem, and specific information about the rate of driving anxiety and fear in older adults is unknown. METHODS: the present study examines the prevalence of self-reported driving anxiety and fear in a sample of 2,491 adults aged 55-72 from a longitudinal survey of health and ageing in New Zealand. RESULTS: most of the sample (90%) described themselves as drivers who drove daily or weekly. Around 70% of the sample reported no driving anxiety or fear, yet 17-20% endorsed a mild and 4-6% rated a moderate to severe level of driving anxiety and fear. Women reported higher levels of anxiety and fear about driving than men, but there were no age differences. Those who reported some level of driving anxiety engaged various alternative modes of transport, and a small number (2.4%) reported that their driving anxiety had affected their usual activities or work for at least a day in the previous month. Duration of driving anxiety was highly variable, from relatively recent onset to being present for much of some participants' lifetimes. CONCLUSION: driving anxiety and fear may be a significant problem for some young older adults that is likely to affect their independence and mobility. Further research to clarify the content and nature of driving anxiety, pathways to driving anxiety and the effect of factors associated with ageing on driving anxiety is needed in order to better understand this experience for older adults and develop effective interventions. Language: en

A 23-item difficulty with mobility questionnaire (DMQ) was piloted with 32 persons who had participated in a one-week orientation and...

Background Alcohol use is a well-known risk factor for injury. However, information is needed about alcohol drinking patterns and the risk of injury among older adults in low- and middle-income countries as this population grows. We aimed to examine the influence of drinking patterns on the burden of injury and investigate factors associated with different types of injury in older populations in six emerging economies. Methods Data from more than 37,0 adults aged 50 years and older were included from the Study on Global AGEing and Adult Health (SAGE) Wave 1 conducted in six emerging economies, namely, China, Ghana, India, Mexico, Russia, and South Africa. We investigated past-year reported injuries from falls, traffic accidents, and being hit or stabbed. Alcohol drinking patterns were measured as lifetime abstinence, ever but not past- week use, and gender-specific past-week low-risk and high-risk use. We stratified by gender and used logistic regression models to observe the association between alcohol drinking pattern and risk of injury by controlling for other factors. Results During the year prior to interview, 627 (2.2%) subjects reported bodily injury resulting from a car accident, 1,156 (4.2%) from a fall, and 339 (.9%) from being hit or stabbed during the past year. For women, only being a high-risk drinker increased the risk of being hit or stabbed, whereas for men, all levels of drinking were associated with an increased risk of being hit or stabbed. We observed a higher risk of being hit or stabbed from past-week high-risk drinking among women (odds ratio [OR] = 6.09, P < 0.01) than among men (OR = 3.57, P < 0.01). We observed no association between alcohol drinking pattern and injury due to car accidents for either women or men. Conclusions The risk of experiencing injury due to violence increased with level of alcohol exposure of the victim. The increase in alcohol use in emerging economies calls for further study into the consequences of alcohol use and for public health initiatives to reduce the risk of violence in older adult populations, with special attention to the experience of older adult women.

This study sought to assess the reliability, validity, and sensitivity of the Difficulty with Mobility Questionnaire (DMQ) to determine its applicability as an outcome measure for dog guide instruction. Forty-nine trainees receiving dog guide instruction from Leader Dogs for the Blind participated in this study. All rated their overall ability to get around (AGA) and the difficulty they experienced with 16 separate mobility related behaviours (DMQ-16) before and after training. The DMQ-16 was found to be reliable, valid, and sensitive enough to register change over time and therefore useful as an outcome measure. Dog guide instruction was found to result in changes in mean AGA, mean DMQ-16 and all but one of the 16 items this measure assesses

The present study investigated the transtheoretical model of behaviour change in relation to exercise adoption and maintenance in a sample of 140 women. The aim was to examine the relationship between the stages of exercise change, and the constructs of processes of change, costs and benefits of exercising, self-efficacy, and self-rated health. Analyses revealed that the processes, pros, cons, self-efficacy, and self-rated health were significantly associated with stage of exercise adoption. Specifically, the processes fluctuated, pros and self-efficacy increased, and cons decreased across the stages from precontemplation to maintenance. A stage exercise adoption perspective may be particularly useful for understanding how women adopt and sustain exercise regimes.

The stages of exercise adoption model was used to investigate exercise adoption and maintenance in a sample of 72 middle-aged men. The concepts of exercise self-efficacy, decisional balance, self-rated health, perceived stress, and health locus of control were evaluated in terms of their impact upon exercise adoption. Oneway ANOVA’s revealed that only exercise self-efficacy, the cons of exercise, and self-rated health were significantly associated with stage of exercise adoption. Participants in the first stage of exercise adoption rated the cons of exercise more influential, had lower levels of self-efficacy, and had worse self-rated health than participants in other stages. Results also revealed a high degree of relatedness between self-rated health, perceived stress, health locus of control, and the concepts of decisional balance and selfefficacy. Findings suggest that self-rated health is a significant barrier to exercise and that the antecedents of inactivity could be included in an expanded stages of exercise adoption model.

Older adults are at significant risk of harm from alcohol use but there is no consensus as to the general patterns and prevalence of drinking in this population, nor how such trends might differ between countries. A collaboration of international researchers harmonised alcohol use data from government-funded studies of ageing to investigate drinking patterns in older adults from nine countries around the world: United States, England, China, Ghana, India, Mexico, the Russian Federation, South Africa, and New Zealand. The results show substantial differences across countries in rates of abstinence, frequency of alcohol use, quantity consumed on a typical day, and rates of infrequent and frequent heavy drinking. Substantial gender differences in drinking patterns were evident both between and within countries. These findings suggest that drinking is common in older adult populations in most countries, that typical daily drinking amounts differ substantially between countries but that frequent heavy drinking is rare.

Research shows that ability to get around (AGA) is significantly associated with perceived quality of life (PQOL) among older persons with self-reported visual impairment. Much of this impact, however, is through satisfaction with one's functional capacity. Satisfaction with functional capacity is a construct composed of five items: satisfaction with (1) activities of daily living, (2) capacity to work, (3) self, (4) health and (5) sleep. At present, it is not known how AGA interacts individually with these items to influence PQOL.The purpose of this study is to investigate the extent to which AGA interacts with each of these five items to affect PQOL.Structural equation modelling was employed in a secondary-analysis of data from 356 persons (aged 56-72) with self-reported visual impairment to identify the pathways by which AGA affects PQOL.Satisfaction with self and health were the only items found to be both directly related to QOL and to provide a significant pathway between AGA and PQOL.AGA significantly affects PQOL both directly and indirectly through its impact on people's satisfaction with self and health. Lessons may be learnt from this to better focus mobility interventions to enhance PQOL in this population.

Objectives To assess whether a relationship between alcohol use and health exists for older adults before and after controlling for proxy and full indicators of socioeconomic status (SES). Method Secondary analysis of data from 2,908 participants in the New Zealand Longitudinal Study of Ageing (2012) completing measures of alcohol use, health, SES proxies (income, education) and SES. Sample mean age was 65, 52% were female, more than 80% were drinkers, and more than 75% had educational qualifications. Results Moderate drinkers had better health and SES than heavier or nondrinkers. The positive influence of moderate alcohol consumption on health was observed for men and women when controlling for SES proxies, but was substantially reduced in women and completely disappeared for men when controlling for full SES. Discussion SES plays a key role in presumed "heath benefits" of moderate alcohol consumption for older adults. It accounts for any alcohol-health relationship in a sample of men of whom 45% consume at least one drink daily, and substantially attenuates the association between alcohol and health in a sample of women who are not frequent drinkers. Prior research may have missed the influence of SES on this alcohol-health relationship due to the use of incomplete SES measures.

Increasing life expectancies and uncertainty about future retirement incomes are likely to lead to various changes in behaviour. As expectations are revised, one potentially important adjustment mechanism is in labour force participation rates. There is already evidence these are rising for those beyond the age of eligibility for New Zealand Superannuation. This paper uses a new source of longitudinal data on the health, labour force participation and retirement decisions of older New Zealanders. The central question addressed is the extent to which labour force participation of older New Zealanders is influenced by their health status (both mental and physical), in addition to a wide range of economic, social and demographic variables. Discrete choice models are employed, and particular attention is given to the potential effects of unobserved heterogeneity. We find a range of factors to be associated with the decision to retire, notably health status, marital status and financial incentives. After accounting for the confounding influence of unobservables, we find that physical health remains a determinant of labour force exit for older males. Further, we estimate both the marginal and aggregate effects of specific chronic conditions on labour force participation.

Owing to an ageing population there is growing interest in research to improve the health of older New Zealanders. To facilitate the use of the internationally used SF-36 (version 2) measure of health and quality of life for this work in New Zealand we provide norms and comparative data from the first wave in a longitudinal study of a representative sample of New Zealanders aged 55-69 years. The use of the normative data from this study will facilitate comparisons of results from small clinical samples of older people with the general New Zealand population and international populations. The norms are also available for use in calculating summary physical and mental health summary scores for data from clinical trials and national surveys.

The purpose of this paper was to determine the extent to which factors thought to be related to quality of life (QoL) among older persons with a visual disability impact on their perceived QoL (PQol). Analysis was conducted on responses from the second wave of a large population-based longitudinal study of those aged 57–72 years (i.e., HWR Study). The sample was split between those who identified as having difficulty seeing newsprint (n = 265) and those who did not (n = 1987). The groups were compared on 11 variables thought to affect QoL plus their response to a single-item measure of PQoL. Variables found to differ across the groups were entered into a standard multiple regression to determine the extent to which they predicted PQoL among those who had difficulty seeing. Significant differences were found between the groups on PQoL and seven of the other variables assessed. Of those, three were found to make a significant and unique contribution to the prediction of PQoL. These were satisfaction with life, ability to get around, and number of diagnosed health conditions reported in that order. Together, they accounted for 64% of the observed variance in PQoL.

In 2005 the Health, Work, and Retirement (HWR) Longitudinal Study was established at Massey University in order to identify the later-midlife factors that lay the basis for community participation, independence, and health in later life. Information was collected via postal questionnaire on physical and mental health, psychosocial factors, work and retirement attitudes, and socioeconomic and demographic indicators of a sample of 6662 community-dwelling adults aged 55-70 years. This report provides an overview of these results, and highlights the impact that the transition from work to retirement has on the health and retirement adjustment of older people with respect to independence, well-being, and social participation.

To analyse the exercise patterns of Pacific women utilising the stage-of-exercise-adoption model, and to investigate how the pros and cons of exercising, exercise self-efficacy, self-reported health, and sociodemographic barriers to exercise influence exercise adoption.A non-random questionnaire survey of 106 Pacific women living in the North Island of New Zealand.Thirty percent of the sample was sedentary, 34% were participating in some exercise, and 35% were exercising regularly. The balance between pros and cons of exercise, exercise self-efficacy, self-rated health and levels of barriers reliably differentiated respondents at extreme stages of exercise adoption. In addition, two specific barriers to exercise (not having friends who exercise, and being unsatisfied with current income) were associated with reduced exercise self-efficacy.A large number of Pacific women are sedentary, but analysis of the factors associated with exercise adoption level and exercise-related self-confidence provides a platform for future intervention. Exercise adoption interventions tailored specifically to Pacific women should focus on broader community-based systems that include peer-group participation, and emphasise inexpensive options for exercise.