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Background Prescribing for older people is complex, and many studies have highlighted that appropriate prescribing in this cohort is not always achieved. However, the long-term effect of inappropriate prescribing on outcomes such as hospitalisation and mortality has not been demonstrated. The aim of this study was to determine the level of potentially inappropriate prescribing (PIP) for participants of the Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ) study at baseline and examine the association between PIP and hospitalisation and mortality at 12-months follow-up. Methods PIP was determined using STOPP/START. STOPP identified potentially inappropriate medicines (PIMs) prescribed, START identified potential prescribing omissions (PPOs). STOPP/START were applied to all LiLACS NZ study participants, a longitudinal study of ageing, which includes 421 Māori aged 80–90 years and 516 non-Māori aged 85 years. Participants’ details (e.g. age, sex, living arrangements, socioeconomic status, physical functioning, medical conditions) were gathered by trained interviewers. Some participants completed a core questionnaire only, which did not include medications details. Medical conditions were established from a combination of self-report, review of hospital discharge and general practitioner records. Binary logistic regression, controlled for multiple potential confounders, was conducted to determine if either PIMs or PPOs were associated with hospital admissions and mortality (p Results Full data were obtained for 267 Māori and 404 non-Māori. The mean age for Māori was 82.3(±2.6) years, and 84.6(±0.53) years for non-Māori. 247 potentially inappropriate medicines were identified, affecting 24.3% Māori and 28.0% non-Māori. PIMs were not associated with 12-month mortality or hospitalisation for either cohort (p > 0.05; adjusted models). 590 potential prescribing omissions were identified, affecting 58.1% Māori and 49.0% non-Māori. PPOs were associated with hospitalisation (p = 0.001 for Māori), but were not associated with risk of mortality (p > 0.05) for either cohort within the 12-month follow-up (adjusted models). Conclusion PPOs were more common than PIMs and were associated with an increased risk of hospitalisation for Māori. This study highlights the importance of carefully considering all indicated medicines when deciding what to prescribe. Further follow-up is necessary to determine the long-term effects of PIP on mortality and hospitalisation.

This study explored active aging for older Māori and non-Māori by examining their self-nominated important everyday activities. The project formed part of the first wave of a longitudinal cohort study of aging well in New Zealand. Māori aged 80 to 90 and non-Māori aged 85 were recruited. Of the 937 participants enrolled, 649 answered an open question about their three most important activities. Responses were coded under the World Health Organization's International Classification of Functioning, Disability and Health (ICF), Activities and Participation domains. Data were analyzed by ethnicity and gender for first in importance, and all important activities. Activity preferences for Māori featured gardening, reading, walking, cleaning the home, organized religious activities, sports, extended family relationships, and watching television. Gendered differences were evident with walking and fitness being of primary importance for Māori men, and gardening for Māori women. Somewhat similar, activity preferences for non-Māori featured gardening, reading, and sports. Again, gendered differences showed for non-Māori, with sports being of first importance to men, and reading to women. Factor analysis was used to examine the latent structural fit with the ICF and whether it differed for Māori and non-Māori. For Māori, leisure and household activities, spiritual activities and interpersonal interactions, and communicating with others and doing domestic activities were revealed as underlying structure; compared to self-care, sleep and singing, leisure and work, and domestic activities and learning for non-Māori. These findings reveal fundamental ethnic divergences in preferences for active aging with implications for enabling participation, support provision and community design.

Objective Life expectancy is increasing. Sleep problems are more likely with advancing age however, are largely overlooked, and the longitudinal health impact of reported sleep problems is unclear. In this study, relationships were examined between reporting prior or current sleep problems with health outcomes, among Māori and non-Māori of advanced age. Method Data were available from 251 Māori and 398 non-Māori adults (79-90 years) from Wave 1 (W1) of Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu. Life and Living in Advanced Age: A Cohort Study in NZ (LiLACS NZ). Four years later (W5), data were available from 85 Māori and 200 non-Māori participants. Relationships between reporting problem sleep at W1 and cohort and health outcomes at W5 were investigated using generalised linear models and Cox proportional hazards models. Results Over 25% reported sleep problems at both waves. Mortality was associated with problem sleep for Māori but not non-Māori. Within the whole group, W1 problem sleepers were more likely to still have problems at W5, compared with nonproblem sleepers at W1. They also had poorer indicators of physical health and pain at W5. Problem sleepers at W5 had poorer concurrent mental health and increased likelihood of hospital admittance in the last year. Conclusion Sleep health is an important characteristic of ageing well, particularly for Māori. Early recognition and management of sleep problems could improve physical and mental health with advancing age.

Additional file 3. Appendix 1. Potentially inappropriate medicines (PIMs) identified by the STOPP criteria for the entire patient group, for Māori and non-Māori patients.

The purpose of the chapter is to articulate a cultural practice of Ako. Pedagogically, Ako underpins a Maori, Tongan, and Samoan way of teaching and learning through diverse languages and cultures in the English Language Teaching Unit (ELTU) and Po Ako at Mt Roskill Grammar School, Auckland city. In Aotearoa, New Zealand, since the 1970s, parents’ interest in schooling and education for their children through their own language and culture has surged. This article studies what insights and practices are revealed for this surge through the experiences of a community of Ako that supports diverse language and cultural schooling. The insights and practices are tentative and, consequently open to critique, but these are the experiences and practices that made a difference for the better for the community of teachers—Indigenous Maori and Indigenous migrants from Samoa and the Kingdom of Tonga—and the migrant students; 1987 to 1995.

Background:Little is known about the physical activity levels and behaviors of advanced age New Zealanders.Methods:A cross-sectional analysis of data from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ), Te Puāwaitanga O Nga Tapuwae Kia ora Tonu, measures of physical activity (PASE) (n = 664, aged 80–90 [n = 254, Māori, aged 82.5(2), n = 410 non-Māori, aged 85(.5)]) was conducted to determine physical activity level (PAL). A substudy (n = 45) was conducted to attain detailed information about PAL and behaviors via the Multimedia Activity Recall for Children and Adults (MARCA) and accelerometry. The main study was analyzed by sex for Māori and non-Māori.Results:Men consistently had higher levels of physical activity than women for all physical activity measures. Sex was significant for different domains of activity.

This study assessed vitamin D status and its determinants in a cohort of octogenarians living within New Zealand's Bay of Plenty and Lakes Districts.Serum 25- hydroxyvitamin D [25(OH)D] concentration was measured in 209 Māori (aged 80-90 years) and 357 non-Māori (85 years), along with demographic, lifestyle, supplement use and other health data.Mean [95% CI] 25(OH)D concentration was 69 [67 to 72] nmol/L, with 15%100 nmol/L and 6 individuals150 nmol/L. Concentrations in Māori (59 [55 to 62] 4 nmol/L) were lower than in non-Māori (75 [72 to 78] nmol/L; p0.001), a difference maintained when adjusted for day-of-year measured. Vitamin D supplementation was reported by 98 participants (18%): including a greater proportion of women (24%) than men (11%; p0.001) and of non-Māori (24%) than Māori (7%; p0.001). Of those taking vitamin D, 49% took high oral doses (=25 μg/day or equivalent) and five individuals took50 μg/day. Vitamin D supplement use strongly and independently predicted seasonally- adjusted 25(OH)D concentration and was associated with 28 nmol/L higher levels than non-use. Other predictors included Māori ethnicity (10 nmol/L lower concentration than for non-Māori), and female gender (11 nmol/L lower).Vitamin D status in New Zealand octogenarians appears higher than previously reported, particularly in non-Māori compared to Māori. Prescribed and non-prescribed oral vitamin D supplementation is prevalent in this group and a strong indicator of vitamin D status.背景与目的：本研究评估了队列研究中生活在新西兰湾和湖泊区域的八旬老人 的维生素D 状况及其决定因素。方法与研究设计：测量209 名毛利人（80-90 岁）和357 名非毛利人（85 岁）的血清25-羟维生素D（25(OH)D）的浓度， 同时收集研究对象的体格测量指标、生活方式、补充剂的应用和其它健康资 料。结果：平均25(OH)D 浓度为69（95% CI：67-72）nmol/L，其中15%的研 究对象100 nmol/L，6 个研究对象150 nmol/L。毛利人的25(OH)D 浓度（59 nmol/L，95% CI: 55-62 nmol/L）低于非毛利人（75 nmol/L，95% CI：72-78 nmol/L，p0.001），校正测量日期后，差异仍然存在。98 名（占18%）研究 对象报告补充了维生素D，女性中补充者所占的比例（24%）高于男性 （11%，p0.001），非毛利人中补充者所占的比例高于毛利人。补充维生素 D 的人中，49%的人摄入高剂量（每天=25 μg 或相当剂量），5 个研究对象每 天摄入维生素D=50 μg。维生素D 补充剂的应用能够强而独立地预测季节校正 的25(OH)D 浓度，并且使用者比不用者高28 nmol/L。其它预测指标包括毛利 族（比非毛利族低10 nmol/L）和女性性别（比男性低11 nmol/L）。结论：新 西兰八旬老人维生素D 浓度高于以前的报告，尤其是非毛利人。这个人群中 处方和非处方口服维生素D 补充剂普遍存在，并且是维生素状态的强预测指 标。.

To estimate prevalence and identify predictors and outcomes of reporting sleep problems in M#257;ori and non-M#257;ori of advanced age.Participants were 251 M#257;ori, and 398 non-M#257;ori adults (79-90 years) from Te Pu#257;waitanga o Ng#257; Tapuwae Kia Ora Tonu. Life and Living in Advanced Age: A Cohort Study in New Zealand. Multiple logistic regression identified predictors of reporting a current sleep problem and investigated relationships between current sleep problems and physical and mental health.26.3% of M#257;ori and 31.7% of non-M#257;ori reported a current sleep problem. Reporting a current sleep problem was associated with ethnicity (non-M#257;ori, adjusted OR=0.52, 95% CI=0.30-0.90), and reporting a past sleep problem (adjusted OR=2.67, 95% CI=1.25-5.72). Sleep problems were related to poorer physical and mental health, and falling.Sleep problems are commonly reported and associated with poorer health. Early recognition and management of sleep problems could improve physical and mental health.

Aim: This project explored the usability of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) for describing older Māori and non-Māori people's self-nominated important activities. Method: Within a feasibility-for-cohort study, 112 participants, 33 Māori, aged 75–79 years, and 79 non-Māori, aged 85 years, nominated their three most important activities. Verbatim responses were coded using the ICF classifications and described using non-parametric statistics. Results: Men and women mostly named domestic life, interpersonal relationships and recreation and leisure activities. While Māori frequently named extended family relationship activities as being most important, non-Māori named more recreation and leisure activities. Conclusions: The ICF is useful for classifying older New Zealanders' important activities, although some activities of older Māori were not specified in the original version used. While important activity patterns were similar for men and women, those related to ancestral connectivity and community collectivity were most important for Māori.

To establish self-rated health, health-related behaviours and health conditions of Maori and non-Maori in advanced age.LiLACS NZ is a longitudinal study. A total of 421 Maori aged 80-90 years and 516 non-Maori aged 85 years living in the Bay of Plenty and Rotorua district were recruited at baseline (2010). Socioeconomic-demographic characteristics and health-related behaviours were established using interviewer administered questionnaire. Self-rated health was obtained from the SF-12. Medical conditions were established from a combination of self-report, review of general practitioner and hospital discharge records, and analyses of fasting blood samples.61% Maori and 59% non-Maori rated their health from good to excellent. Eleven percent of Maori and 5% of non-Maori smoked; 23% Maori and 47% non-Maori had alcohol on at least 2 occasions per week. Physical activity was higher in Maori than non-Maori (p=0.035) and the relationship was attenuated when adjusted for age. More Maori (49%) than non-Maori (38%) were at high nutrition risk (p=0.005); and more non-Maori (73%) than Maori (59%) were driving (p0.01). The three most common health conditions were hypertension (83%), eye diseases (58%) and coronary artery disease (44%). The health profile differed by gender and ethnicity. Overall, participants had a median of five health conditions.Self-rated health is high in this sample considering the number of comorbidities. There are differences in health behaviours and health conditions between genders and by ethnicity in advanced age. The significance of health conditions in men and women, Maori and non-Maori in advanced age will be examined longitudinally.

Objectives : Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ) aims to determine the predictors of successful advanced ageing and understand the trajectories of wellbeing in advanced age. This paper reports recruitment strategies used to enrol 600 Māori aged 80–90 years and 600 non-Māori aged 85 years living within a defined geographic boundary. Methods : Electoral roll and primary health lists of older people were used as a base for identification and recruitment, supplemented by word of mouth, community awareness raising and publicity. A Kaupapa Māori method was used to recruit Māori with: dual Māori and non-Māori research leadership; the formation of a support group; local tribal organisations and health providers recruiting participants; and use of the Māori language in interviews. Non-Māori were recruited through local health and community networks. Six organisations used differing strategies to invite older people to participate in several ways: complete full or partial interviews; complete physical assessments; provide a blood sample and provide access to medical records. Results : During 14 months in 2010–2011, 421 of 766 (56%) eligible Māori and 516 of 870 (59%) eligible non-Māori were enrolled. Participation and contribution of information varied across the recruitment sites. Conclusion : Attention to appropriate recruitment techniques resulted in an acceptable engagement and recruitment for both Māori and non-Māori of advanced age in a longitudinal cohort study. Implications : There is high potential for meaningful results useful for participants, their whānau and families, health agencies, planners and policy.

This project explored the usability of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) for describing older Māori and non-Māori people's self-nominated important activities.Within a feasibility-for-cohort study, 112 participants, 33 Māori, aged 75-79 years, and 79 non-Māori, aged 85 years, nominated their three most important activities. Verbatim responses were coded using the ICF classifications and described using non-parametric statistics.Men and women mostly named domestic life, interpersonal relationships and recreation and leisure activities. While Māori frequently named extended family relationship activities as being most important, non-Māori named more recreation and leisure activities.The ICF is useful for classifying older New Zealanders' important activities, although some activities of older Māori were not specified in the original version used. While important activity patterns were similar for men and women, those related to ancestral connectivity and community collectivity were most important for Māori.

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.