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Objectives: To characterise unintentional injury‐related hospitalisation and mortality amongst older adults (aged 50+ years) in the Lakes and Bay of Plenty District Health Boards of Aotearoa New Zealand and to examine whether hospitalisation patterns differed by ethnicity. Methods: This observational study analysed unintentional injury‐related hospitalisations and deaths among older adults between 2014 and 2018. Routinely collected national data sets were used to calculate annualised, age‐standardised injury rates. The independent variable of interest was ethnicity (Māori or non‐Māori). Results: There were 11,834 unintentional injury‐related hospitalisations in the study period (n = 1444 for Māori). Overall, there was no significant difference in the age‐standardised hospitalisation rate between Māori and non‐Māori (Standardised Rate Ratio [SRR] = 0.96 [95% CI 0.90, 1.02]). Falls were the most common mechanism of injury among Māori and non‐Māori overall (50% and 71%) and relative risks of falls increased with age. Non‐Māori were 57% less likely to be hospitalised for unintentional poisoning than Māori (SRR = 0.43, [0.34, 0.59]). Conclusions: The mechanisms of injury, and variation in unintentional injury‐related hospitalisation rates between Māori and non‐Māori, change throughout older age, and incidence increase0073 with age. Falls cause significant injury‐related hospitalisations for older Māori and responsive injury prevention and rehabilitation efforts are warranted to achieve equitable health outcomes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Older people with frailty and multimorbidity are at high risk of problematic polypharmacy. Community pharmacists have a key role in medication safety for older people. Aim: The aim of this study was to investigate the perspectives of older people with frailty, multimorbidity, and polypharmacy, and their family caregivers or whānau on the role of community pharmacists, including in situ pharmacist care practices. Method: This study was part of a larger video reflexive ethnography (VRE) study to explore medication safety and wellbeing for older people with frailty across care transitions including hospital, home, aged residential care, primary care, and outpatient care. This paper reports data from the interview, participant observation, and filming phases of the study. Results: Community pharmacists play a significant role in the medication safety of older people with frailty and polypharmacy. Analysis resulted in three main themes: (1) the older person–determined role of the pharmacist, (2) the 'taken for granted' safety work of the pharmacist, and (3) collective agency and medication safety. Conclusion: In circumstances where older people and their family caregivers or whānau had a trusted relationship with a community pharmacist, the pharmacist played a key role as mediator of medication safety and was central to older people's care. This key role as a member of the multidisciplinary team in the care of older people with frailty and multimorbidity should be better recognised and legitimised by clinicians and policy makers and resourced accordingly. [ABSTRACT FROM AUTHOR]

Background: Safer prescribing in general practice may help to decrease preventable adverse drug events (ADE) and related hospitalisations. Aim: To test the effect of the Safer Prescribing and Care for the Elderly (SPACE) intervention on high-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelet medicines and related hospitalisations. Design & setting: A pragmatic cluster randomised controlled trial in general practice. Participants were patients at increased risk of ADEs from NSAIDs and/or antiplatelet medicines at baseline. SPACE comprises automated search to generate for each GP a list of patients with high-risk prescribing; pharmacist outreach to provide education and one-on-one review of list with GP; and automated letter inviting patients to seek medication review with their GP. Method: The primary outcome was the difference in high-risk prescribing of NSAIDs and/or antiplatelet medicines at 6 months. Secondary outcomes were high-risk prescribing for gastrointestinal, renal, or cardiac ADEs separately, 12-month outcomes, and related ADE hospitalisations. Results: Thirty-nine practices were recruited with 205 GPs and 191 593 patients, of which 21 877 (11.4%) were participants. Of the participants, 1479 (6.8%) had high-risk prescribing. High-risk prescribing improved in both groups at 6 and 12 months compared with baseline. At 6 months, there was no significant difference between groups (odds ratio [OR] 0.99; 95% confidence intervals [CI] = 0.87 to 1.13) although SPACE improved more for gastrointestinal ADEs (OR 0.81; 95% CI = 0.68 to 0.96). At 12 months, the control group improved more (OR 1.29; 95% CI = 1.11 to 1.49). There was no significant difference for related hospitalisations. Conclusion: Further work is needed to identify scalable interventions that support safer prescribing in general practice. The use of automated search and feedback plus letter to patient warrants further exploration. [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]