Findings from LiLACS NZ Te Puwaitanga o Ng Tapuwae Kia Ora Tonu. Life - PowerPoint PPT Presentation

Findings from LiLACS NZ Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu. Life and Living in Advanced Age: a Cohort Study in New Zealand 26 January 2016

Background Fastest growing age group (increasing from 1 to 6 percent of the total population by 2050) Longitudinal cohort study of advanced ageing Objective: to establish the predictors of successful ageing for Māori and non- Māori

Age distribution: two populations 7-8 year disparity in longevity 7-8 year disparity in longevity Reference: Ministry of Health. 2011. Tatau Kura Tangata: Health of Older Māori Chart Book 2011. Wellington: Ministry of Health.

Research aims Aim 1. Health status Aim 2. Predictors of successful ageing Aim 3. Trajectories in function and transitions in care Aim 4. Importance of health, frailty, cultural, social, economic and other environmental factors in predicting relevant outcomes

Cultural and academic guidance LiLACS NZ Leadership team Ngaire Kerse, Ruth Teh, Anna Rolleston, Marama Muru- Lanning Te Rōpū Kaitiaki o Ngā Tikanga Māori Provide cultural and ethical guidance Co-investigators Karen Hayman, Carol Wham, Martin Connolly, Tim Wilkinson, Valerie Wright St.Clair, Avinesh Pillai, Janine Wiles, Sally Keeling, Santosh Jatrana, Ian Reid, Robert Doughty, Joanna Broad, Oliver Menzies, Thomas Lumley Community partners Western Bay of Plenty Research Centre (WBOPPHO), Nga Matapuna Oranga PHO, (Ngati Awa Research Archives, Awanuiarangi), Ngati Irapuia, Ngati Pikiao/ 5 Korowai Aroha, RAPHS.

Snapshot When did we start? 2010 (baseline)  How many people were recruited? 421 out 766 Māori (56%)  516 out of 870 Non Māori (59%)  TOTAL: 937 participants  Where were do the participants live? Bay of Plenty and Lakes DHBs (excluding  Taupo) Measures – Core and Full Questionnaires Diagnoses  Social and cultural  Nutritional intake  Mental health  Health: Quality of life – SF-12, Mortality 

Deprivation index Māori Non- Māori Least Most Least Most 7 2/03/2016

Education Non- Māori Māori 8 2/03/2016

Characteristics Māori Non- Māori Total 254/421 400/516 654/937 Age (sd) 82.7 (2.8) 84.6 (0.5) 83.8 (2.1) Gender Men 176 (42%) 237 (46%) 413 (44%) Residential Care 30 (7%) 44 (9%) 74(8%) Lives alone 110 (41%) 195 (48%) 305 (46%) Fell 138 (34%) 205 (40%) 343 (37%) Physical activity PASE 111 (81) 99 (66) 104 (73) Disability 0-14/22 NEADL 44 (17%) 63 (16%) 107 (16%) N meds 5.0 (3.3) 5.4 (3.5) 5.2 (3.4) Comorbidity score 4.7 (2.5) 4.9 (2.2) 4.8 (2.3) Driving 148 (59%) 287 (73%) 9 2/03/2016

Characteristics: Māori Non- Māori Total 254/421 400/516 Hospital admissions 148 (40%) 89 (34%) Medication 5 (0,14) 5 (1, 18) Depressive sx 38 (15%) 42 (11 %) Grip str M 31, W 20 M 30, W 18.5 Gait sp 0.7 (0.3) 0.8 (0.3) Physical activity PASE M 113, W 89 M 107, W 77 Visual disability 150 (37%) 147 (29%) Hearing disability 128 (31%) 133 (26%) Pack yr Hx* 9.3 M 11.5 W 7.9 6.6 M 10.4 W 3.7 Mortality (2.5 years) 100 (24%) 109 (21%) 209 (22%) 10 2/03/2016

11 2/03/2016

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Stayed the same or improved Percent 100 90 80 70 60 50 40 30 20 10 0 Women Men Women Men Māori Non-Māori No association with HRQOL 13 2/03/2016

Living arrangement Wave 1 100 3 8 6 90 3 25 26 80 24 5 70 10 58 60 19 Others 50 Spouse&others 38 40 Spouse 65 Alone 30 51 20 33 26 10 0 Men Women Men Women Māori non-Māori LiLACS NZ first wave of data collection 14 2/03/2016

Extra practical support-unmet need Daughters and spouses main supporters More Non- Māori men nominated home help as main support More Māori men living with Unmet ‘other’ expressed unmet need need assoc with HRQOL 15 2/03/2016

Care need 100% 7 7 90% 8 10 80% 70% 40 60% 52 Critical 50% Short Long 40% Independent 30% 43 20% 33 10% 0% Maori non-Maori 16 2/03/2016 Critical need – more than daily personal care, short-daily, long-weekly

Needs and residential care placement 80 70 60 Proportion 50 40 Critical 30 Short 20 Long 10 0 ResCare Support ResCare Support More Māori with critical needs in the community setting Servics Services Māori Non-Māori 17 2/03/2016

Projections non Maori Maori 250000 14000 200000 12000 critical 10000 150000 short critical 8000 100000 short long 6000 4000 50000 long independen t 2000 independent 0 0 2010 2012 2014 2016 2018 2020 2022 2024 2026 Year Year

Cardiovascular disease Men Women OR (95% CI) § † OR (95% CI) § Ethnicity (Ref: Gender (Ref: Men) Māori) Māori Non-Maori Māori Non-Maori 138 188 215 238 1.88 0.82 HTN (78%) (79%) (88%) (85%) (1.31-2.71) (0.54-1.25) 119 158 160 169 0.87 0.87 Any CVD (68%) (67%) (66%) (61%) (0.66-1.14) (0.62-1.20) 88 110 105 106 0.73 0.83 CAD (50%) (46%) (43%) (38%) (0.56-0.96) (0.61-1.14) 63 48 65 60 0.82 0.58 CHF (36%) (20%)** (27%) (22%) (0.61-1.12) (0.41-0.82) 34 57 66 79 1.41 1.23 CVA (19%) (24%) (27%) (28%) (1.04-1.92) (0.86-1.76) 30 41 35 27 0.67 0.96 PVD (17%) (17%) (15%) (10%) (0.46-0.98) (0.52-1.49) 58 51 62 54 0.80 0.62 Any AF (35%) (22%)** (27%) (20%) (0.59-1.09) (0.43-0.89) 28 27 23 21 0.61 0.56 AF on ECG (27%) (15%)* (16%) (11%) (0.39-0.94) (0.32-0.96) 19 2/03/2016

Health conditions Men Women OR (95% CI) § † OR (95% CI) § Ethnicity (Ref: Gender (Ref: Men) Māori) Māori Non-Maori Māori Non-Maori 70 151 132 186 1.52 1.62 Eye disease (41%) (65%)** (55%) (68%)** (1.14-2.02) (1.17-2.25) 62 57 78 77 1.29 0.64 Asthma or Chronic lung (36%) (24%)** (34%) (29%) (0.95-1.76) (0.45-0.89) disease 49 40 73 1.04 0.53 41 (15%)** (28%) (17%)** (31%) (0.75-1.45) (0.36-0.78) Type II diabetes 50 93 96 124 1.49 1.29 Any arthritis (30%) (40%)* (43%) (46%) (1.12-1.97) (0.93-1.79) 38 85 75 1.44 1.63 115 (43%)* (23%) (36%)** (33%) (1.08-1.92) (1.16-2.29) Osteoarthritis 22 21 50 1.62 0.59 Rheumatoid 31 (12%)** (13%) (9%) (22%) (1.07-2.43) (0.37-0.93) arthritis 38 54 71 71 1.34 1.19 (22%) (23%) (30%) (26%) (0.98-1.83) (0.82-1.71) Depression 30 50 15 25 0.36 0.84 Anaemia (33%) (28%) (13%) (14%) (0.23-0.56) (0.49-1.44) 11 17 53 89 5.37 1.33 Osteoporosis (6%) (7%) (23%) (33%)* (3.48-8.31) (0.87-2.03) 31 22 33 25 0.97 0.59 (18%) (9%)** (15%) (9%) (0.63-1.49) ( 0.37-0.95) Dementia a 5 7 10 31 3.01 2.14 (3%) (3%) (4%) (12%)** ( 1.55-5.86) (1.03-4.44) Thyroid disease 5 5 5 5 0.04 0.02 (0, 13) (0, 12) (0, 12) (0, 12) (-0.02-0.10) (-0.05-0.09) Chronic conditions 20 2/03/2016

Health conditions Men Women OR (95% CI) § † OR (95% CI) § Ethnicity (Ref: Gender (Ref: Men) Māori) Māori Non-Maori Māori Non-Maori 70 151 132 186 1.52 1.62 Eye disease (41%) (65%)** (55%) (68%)** (1.14-2.02) (1.17-2.25) 62 57 78 77 1.29 0.64 Asthma or Chronic lung (36%) (24%)** (34%) (29%) (0.95-1.76) (0.45-0.89) disease 49 40 73 1.04 0.53 41 (15%)** (28%) (17%)** (31%) (0.75-1.45) (0.36-0.78) Type II diabetes 50 93 96 124 1.49 1.29 Any arthritis (30%) (40%)* (43%) (46%) (1.12-1.97) (0.93-1.79) 38 85 75 1.44 1.63 115 (43%)* (23%) (36%)** (33%) (1.08-1.92) (1.16-2.29) Osteoarthritis 22 21 50 1.62 0.59 Rheumatoid 31 (12%)** (13%) (9%) (22%) (1.07-2.43) (0.37-0.93) arthritis 38 54 71 71 1.34 1.19 (22%) (23%) (30%) (26%) (0.98-1.83) (0.82-1.71) Depression 30 50 15 25 0.36 0.84 Anaemia (33%) (28%) (13%) (14%) (0.23-0.56) (0.49-1.44) 11 17 53 89 5.37 1.33 Osteoporosis (6%) (7%) (23%) (33%)* (3.48-8.31) (0.87-2.03) 31 22 33 25 0.97 0.59 (18%) (9%)** (15%) (9%) (0.63-1.49) ( 0.37-0.95) Dementia a 5 7 10 31 3.01 2.14 (3%) (3%) (4%) (12%)** ( 1.55-5.86) (1.03-4.44) Thyroid disease 5 5 5 5 0.04 0.02 (0, 13) (0, 12) (0, 12) (0, 12) (-0.02-0.10) (-0.05-0.09) Chronic conditions 21 2/03/2016

Clusters of conditions Groupings of conditions rather than number Clustered by person to identify profiles of conditions 22 2/03/2016

Multi-morbidity Māori

31% Mort 18% Mort 27% Mort 82% Adm 67% Adm 83% Adm 39% Mort 34% Mort 41% Mort 91% Adm 78% Adm 86% Adm

Multi-morbidity Non- Māori

31% Mort 12% Mort 26% Mort 86% Adm 65% Adm 83% Adm 32% Mort 30% Mort 29% Mort 79% Adm 82% Adm 76% Adm

Multi-morbidity Findings • Individualised care is needed • Cardiovascular disease morbidity and mortality differs depending on the profiles of conditions rather than number • Depression varies in its cluster partners

Medication prescribing quality Demographics Māori (n=267) Non- Māori (n=404) P Value Prescribed medicines per person mean (Range; ±SD) 4.63(0-14; ±3.24) 4.92 (0-15; ±3.18) 0.288 Inappropriate meds. 65 (24.3) 113 (28.0) 0.171 PIM STOPP n (%) Omissions 155 (58.1) 198 (49.0) 0.013 PPO START n (%) PIM or PPO n (%) 175 (65.5) 251 (62.1) 0.207 STOPP/START criteria in the LiLACS NZ cohort Key: PIM = Potentially inappropriate medicine; PPO = Potential prescribing omission; * = 28 2/03/2016