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Objectives: To assess agreement between ethnicity as recorded by two independent databases in New Zealand, PREDICT and the National Health Index (NHI), and to assess sensitivity of ethnic-specific measures of health outcomes to either ethnicity record. Method: Patients assessed using PREDICT form the study cohort. Ethnicity was recorded for PREDICT and an associated NHI ethnicity code was identified by merge-match linking on an encrypted NHI number. Agreement between ethnicity measures was assessed by kappa scores and scaled rectangle diagrams. Results: A cohort of 18,239 individuals was linked in both PREDICT and NHI databases. The agreement between ethnicity classifications was reasonably good, with overall kappa coefficient of 0.82. There was better agreement for women than men and agreement improved with age and with time since the PREDICT system has been operational. Ethnic-specific cardiovascular (CVD) hospital admission rates were sensitive to ethnicity coding by NHI or PREDICT; rate ratios for ethnic groups, relative to European, based on PREDICT were attenuated towards the null relative to the NHI classification. Conclusions: Agreement between ethnicity was moderately good. Discordances that do exist do not have a substantial effect on prevalence-based measures of effect; however, they do on measurement of the admission of CVD. Implications: Different categorisations of ethnicity data from routine (and other) databases can lead to different ethnic-specific estimates of epidemiological effects. There is an imperative to record ethnicity in a rational, systematic and consistent way. Key words: Cardiovascular diseases, incidence, prevalence, databases, ethnic groups, computer system.

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]

Introduction Rehabilitation assessment and programmes after stroke pay little attention to the so-called `good side', the side ipsilateral to the cerebral infarct. None the less, stroke patients may report clumsiness [...]

Objectives: The number of older people choosing to relocate to retirement villages (RVs) is increasing rapidly. This choice is often a way to decrease social isolation while still living independently. Loneliness is a significant health issue and contributes to overall frailty, yet RV resident loneliness is poorly understood. Our aim is to describe the prevalence of loneliness and associated factors in a New Zealand RV population.Design: A resident survey was used to collect demographics, social engagement, loneliness, and function, as well as a comprehensive geriatric assessment (international Resident Assessment Instrument [interRAI]) as part of the "Older People in Retirement Villages Study."Setting: RVs, Auckland, New Zealand.Participants: Participants included RV residents living in 33 RVs (n = 578).Measurements: Two types of recruitment: randomly sampled cohort (n = 217) and volunteer sample (n = 361). Independently associated factors for loneliness were determined through multiple logistic regression with odds ratios (ORs).Results: Of the participants, 420 (72.7%) were female, 353 (61.1%) lived alone, with the mean age of 81.3 years. InterRAI assessment loneliness (yes/no question) was 25.8% (n = 149), and the resident survey found that 37.4% (n = 216) feel lonely sometimes/often/always. Factors independently associated with interRAI loneliness included being widowed (adjusted OR 8.27; 95% confidence interval [CI] 4.15-16.48), being divorced/separated/never married (OR 4.76; 95% CI 2.15-10.54), poor/fair quality of life (OR 3.37; 95% CI 1.43-7.94), moving to an RV to gain more social connections (OR 1.55; 95% CI 0.99-2.43), and depression risk (medium risk: OR 2.58, 95% CI 1.53-4.35; high risk: OR 4.20, 95% CI 1.47-11.95).Conclusion: A considerable proportion of older people living in RVs reported feelings of loneliness, particularly those who were without partners, at risk of depression and decreased quality of life and those who had moved into RVs to increase social connections. Early identification of factors for loneliness in RV residents could support interventions to improve quality of life and positively impact RV resident health and well-being. [ABSTRACT FROM AUTHOR]

Abstract Background For residents of long term care, hospitalisations can cause distress and disruption, and often result in further medical complications. Multi-disciplinary team interventions have been shown to improve the health of Residential Aged Care (RAC) residents, decreasing the need for acute hospitalisation, yet there are few randomised controlled trials of these complex interventions. This paper describes a randomised controlled trial of a structured multi-disciplinary team and gerontology nurse specialist (GNS) intervention aiming to reduce residents’ avoidable hospitalisations. Methods/Design This Aged Residential Care Healthcare Utilisation Study (ARCHUS) is a cluster- randomised controlled trial (n = 1700 residents) of a complex multi-disciplinary team intervention in long-term care facilities. Eligible facilities certified for residential care were selected from those identified as at moderate or higher risk of resident potentially avoidable hospitalisations by statistical modelling. The facilities were all located in the Auckland region, New Zealand and were stratified by District Health Board (DHB). Intervention The intervention provided a structured GNS intervention including a baseline facility needs assessment, quality indicator benchmarking, a staff education programme and care coordination. Alongside this, three multi-disciplinary team (MDT) meetings were held involving a geriatrician, facility GP, pharmacist, GNS and senior nursing staff. Outcomes Hospitalisations are recorded from routinely-collected acute admissions during the 9-month intervention period followed by a 5-month follow-up period. ICD diagnosis codes are used in a pre-specified definition of potentially reducible admissions. Discussion This randomised-controlled trial will evaluate a complex intervention to increase early identification and intervention to improve the health of residents of long term care. The results of this trial are expected in early 2013. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN 12611000187943

Abstract 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.