Ethnic and Gender Differences in Preferred Activities among Maori and non-Maori of Advanced age in New Zealand.

This study explored active aging for older Maori and non-Maori 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. Maori aged 80 to 90 and non-Maori 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 Maori 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 Maori men, and gardening for Maori women. Somewhat similar, activity preferences for non-Maori featured gardening, reading, and sports. Again, gendered differences showed for non-Maori, 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 Maori and non-Maori. For Maori, 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-Maori. These findings reveal fundamental ethnic divergences in preferences for active aging with implications for enabling participation, support provision and community design.

Life and living in advanced age: a cohort study in New Zealand--e Puawaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: study protocol.

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 Maori, 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 Maori and non-Maori in New Zealand. METHODS/DESIGN: A total population cohort study of those of advanced age. Two cohorts of equal size, Maori aged 80-90 and non-Maori 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. Runanga (Maori 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 Maori 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.

Health equity in the New Zealand health care system: a national survey.

INTRODUCTION: In all countries people experience different social circumstances that result in avoidable differences in health. In New Zealand, Maori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity and inequitable health outcomes. Whilst the health system can enable a fairer distribution of good health, limited national data is available to measure health equity. Therefore, we sought to find out whether health services in New Zealand were equitable by measuring the level of development of components of chronic care management systems across district health boards. Variation in provision by geography, condition or ethnicity can be interpreted as inequitable. METHODS: A national survey of district health boards (DHBs) was undertaken on macro approaches to chronic condition management with detail on cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke and diabetes. Additional data from expert informant interviews on program reach and the cultural needs of Maori and Pacific peoples was sought. Survey data were analyzed on dimensions of health equity relevant to strategic planning and program delivery. Results are presented as descriptive statistics and free text. Interviews were transcribed and NVivo 8 software supported a general inductive approach to identify common themes. RESULTS: Survey responses were received from the majority of DHBs (15/21), some PHOs (21/84) and 31 expert informants. Measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Maori is embedded in policy, this is not so for other ethnic groups or by geography. Populations that conventional practitioners find hard to reach, despite recognized needs, are often underserved. Nurses and community health workers carried a disproportionate burden of care. Cultural and diversity training is not a condition of employment. CONCLUSIONS: There is a struggle to put equity principles into practice, indicating will without enactment. Equity is not addressed systematically below strategic levels and equity does not shape funding decisions, program development, implementation and monitoring. Equity is not incentivized although examples of exceptional practice, driven by individuals, are evident across New Zealand.

Dietary intakes of European, Maori, Pacific and Asian adults living in Auckland: the Diabetes, Heart and Health Study.

OBJECTIVE: To compare dietary intakes of European, Maori, Pacific, and Asian men and women living in Auckland. METHODS: Daily nutrient intakes were calculated from a self-administered food frequency questionnaire from participants in a cross-sectional health screening study carried out between 2002 and 2003. Participants were 4,007 Maori, Pacific, Asian and European people (1,915 men, 2,092 women) aged 35 to 74 years. RESULTS: Compared with Europeans, Maori and Pacific men had higher total energy intakes per day, while Asians had lower intakes. A similar pattern was observed for carbohydrate and fat consumption. While protein and cholesterol consumption tended to be lower in Europeans than the other three ethnic groups, alcohol consumption and calcium intakes were highest among Europeans. Many of the differences between ethnic groups were attenuated when nutrient consumption was expressed as their percentage contribution to total energy intake suggesting that total food consumption was the major determinant of ethnic differences in nutrient intakes. CONCLUSIONS: There were substantial differences in dietary habits, food selections and cooking practices between European, Maori, Pacific and Asian participants. However, the observed differences were in the area of serving sizes and frequency of consumption of certain foods than to major differences in the range of foods and nutrients consumed or the percentage contribution of carbohydrate, fat or protein to total energy intake. IMPLICATIONS: The development of strategies to reduce serving sizes and the frequency of consumption of certain foods will be required to help address the major nutrition-related health problems in New Zealand.

Quality of hospital care for Maori patients in New Zealand: retrospective cross-sectional assessment.

BACKGROUND: New Zealand has a substantial indigenous minority--the Maori--that has considerably worse health status than the majority population. We aimed to assess possible disparities in quality of hospital care for Maori with data on preventable adverse events as an indicator of suboptimum treatment. METHODS: We undertook a nationally representative cross-sectional survey of admissions to general public hospitals with more than 100 beds providing acute care. A sample of 6579 patients admitted in 1998 to 13 hospitals was selected by stratified systematic list sample. We did a two-stage retrospective assessment of records by structured implicit review. Outcome measures were occurrence, effect, and preventability of adverse events. FINDINGS: Maori accounted for just greater than 15% of admissions and were on average younger, were more likely to be from from deprived areas, had a different case mix, and were in hospital for a shorter stay compared with patients of non-Maori/non-Pacific origin. Overall, after age standardisation, 14% of admissions for Maori were associated with an adverse event, compared with 11% for non-Maori/non-Pacific patients (p=0.01 for difference between groups). For preventable, in-hospital events, this disparity persisted after controlling for age, other sociodemographic factors, and case mix (adjusted odds ratio 1.47; p=0.05). Analysis of potential causal factors showed no markedly or consistently different pattern between the groups. INTERPRETATION: Despite a predominantly publicly funded hospital system, our findings suggest that hospital care received by Maori is marginally poorer than that received by New Zealand citizens of non-Maori/non-Pacific origin. Although no cause specific to Maori was evident, various policy and system issues can be addressed.

Ethnic disparities in incidence of stroke subtypes: Auckland Regional Community Stroke Study, 2002-2003.

BACKGROUND: Limited population-based data exist on differences in the incidence of major pathological stroke types and ischaemic stroke subtypes across ethnic groups. We aimed to provide such data within the large multi-ethnic population of Auckland, New Zealand. METHODS: All first-ever cases of stroke (n=1423) in a population-based register in 940 000 residents (aged 15 years) in Auckland, New Zealand, for a 12-month period in 2002-2003, were classified into ischaemic stroke, primary intracerebral haemorrhage (PICH), subarachnoid haemorrhage, and undetermined stroke, according to standard definitions and results of neuroimaging/necropsy (in over 90% of cases). Ischaemic stroke was further classified into five subtypes. Ethnicity was self-identified and grouped as New Zealand (NZ)/European, Maori/Pacific, and Asian/other. Incidence rates were standardised to the WHO world population by the direct method, and differences in rates between ethnic groups expressed as rate ratios (RRs), with NZ/European as the reference group. FINDINGS: In NZ/European people, ischaemic stroke comprised 73%, PICH 11%, and subarachnoid haemorrhage 6%, but PICH was higher in Maori/Pacific people (17%) and in Asian/other people (22%). Compared with NZ/European people, age-adjusted RRs for PICH were 2.7 (95% CI 1.8-4.0) and 2.3 (95% CI 1.4-3.7) among Maori/Pacific and Asian/other people, respectively. The corresponding RR for ischaemic stroke was greater for Maori/Pacific people (1.7 [95% CI 1.4-2.0]), particularly embolic stroke, and for Asian/other people (1.3 [95% CI 1.0-1.7]). The onset of stroke in Maori/Pacific and Asian/other people began at significantly younger ages (62 years and 64 years, respectively) than in NZ/Europeans (75 years; p<0.0001). There were ethnic differences in the risk factor profiles (such as age, sex, hypertension, cardiac disease, diabetes, hypercholesterolaemia, smoking status, overweight) for the stroke types and subtypes. INTERPRETATION: Compared to NZ/Europeans, Maori/Pacific and Asian/other people are at higher risk of ischaemic stroke and PICH, whereas similar rates of subarachnoid haemorrhage were evident across ethnic groups. The ethnic disparities in the rates of stroke types could be due to substantial differences found in risk factor profiles between ethnic groups. This information should be considered when planning prevention and stroke-care services in multi-ethnic communities.

Sleep of Māori and non-Māori of Advanced Age.

AIM: To estimate prevalence and identify predictors and outcomes of reporting sleep problems in Māori and non-Māori of advanced age. METHOD: Participants were 251 Māori, and 398 non-Māori adults (79-90 years) from Te Puāwaitanga o Ngā 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. RESULTS: 26.3% of Māori and 31.7% of non-Māori reported a current sleep problem. Reporting a current sleep problem was associated with ethnicity (non-Māori, 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. CONCLUSION: Sleep problems are commonly reported and associated with poorer health. Early recognition and management of sleep problems could improve physical and mental health.

Vitamin D status of Maori and non-Maori octogenarians in New Zealand: a Cohort Study (LiLACS NZ).

BACKGROUND AND OBJECTIVES: 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. METHODS AND STUDY DESIGN: Serum 25- hydroxyvitamin D [25(OH)D] concentration was measured in 209 Maori (aged 80-90 years) and 357 non-Maori (85 years), along with demographic, lifestyle, supplement use and other health data. RESULTS: Mean [95% CI] 25(OH)D concentration was 69 [67 to 72] nmol/L, with 15% >100 nmol/L and 6 individuals >150 nmol/L. Concentrations in Maori (59 [55 to 62] 4 nmol/L) were lower than in non-Maori (75 [72 to 78] nmol/L; p<0.001), 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%; p<0.001) and of non-Maori (24%) than Maori (7%; p<0.001). Of those taking vitamin D, 49% took high oral doses (>=25 µg/day or equivalent) and five individuals took >50 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 Maori ethnicity (10 nmol/L lower concentration than for non-Maori), and female gender (11 nmol/L lower). CONCLUSIONS: Vitamin D status in New Zealand octogenarians appears higher than previously reported, particularly in non-Maori compared to Maori. Prescribed and non-prescribed oral vitamin D supplementation is prevalent in this group and a strong indicator of vitamin D status.

Socioeconomic correlates of quality of life for non-Maori in advanced age: Te Puawaitanga o Nga Tapuwae Kia ora Tonu. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ).

AIM: To establish socioeconomic and cultural profiles and correlates of quality of life (QoL) in non-Maori of advanced age. METHOD: A cross sectional analysis of the baseline data of a cohort study of 516 non-Maori aged 85 years living in the Bay of Plenty and Rotorua areas of New Zealand. Socioeconomic and cultural characteristics were established by face-to-face interviews in 2010. Health-related QoL (HRQoL) was assessed with the SF-12. RESULTS: Of the 516 non-Maori participants enrolled in the study, 89% identified as New Zealand European, 10% other European, 1% were of Pacific, Asian or Middle Eastern ethnicity; 20% were born overseas and half of these identified as 'New Zealand European.' More men were married (59%) and more women lived alone (63%). While 89% owned their own home, 30% received only the New Zealand Superannuation as income and 22% reported that they had 'just enough to get along on'. More than 85% reported that they had sufficient practical and emotional support; 11% and 6% reported unmet need for practical and emotional support respectively. Multivariate analyses showed that those with unmet needs for practical and emotional support had lower mental HR QoL (p<0.005). Reporting that family were important to wellbeing was associated with higher mental HR QoL (p=0.038). Those that did not need practical help (p=0.047) and those that reported feeling comfortable with their money situation (0.0191) had higher physical HRQoL. High functional status was strongly associated with both high mental and high physical HR QoL (p<0.001). CONCLUSION: Among our sample of non-Maori people of advanced age, those with unmet support needs reported low HRQoL. Functional status was most strongly associated with mental and physical HRQoL.

Dementia: continuation of health and ethnic inequalities in New Zealand.

Dementia has been framed and seen as a condition associated with ageing and in particular with advanced age, especially amongst those over 80 years of age. For Maori and Pacific peoples in New Zealand dementia is not necessarily associated with age but is directly related to our respective histories within this country, patterns of migration and the socioeconomic determinants of health for both populations from different tribes and nations. Issues are discussed in relation to Maori and Pacific development and the importance of prevention and early detection of chronic health conditions. Whanau Ora is proposed as a developing indigenous and Pacific model with one of its purposes being is to support individuals and families involved in the management of one or more of the chronic health conditions, that may lead onto dementia as part of the end of life process. This paper proposes that the needs of Maori and Pacific, especially, in the Tamaki Makaurau area (Auckland region) must be included in the planning and decision making of policy and services related to dementia. The health and social inequalities of these populations during life and across generations also need to be considered in planning to prevent dementia from occurring early or in midlife.

Self-rated health, health-related behaviours and medical conditions of Maori and non-Maori in advanced age: LiLACS NZ.

AIMS: To establish self-rated health, health-related behaviours and health conditions of Maori and non-Maori in advanced age. METHOD: 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. RESULTS: 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 (p<0.01). 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. CONCLUSION: 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.

Cultural and social factors and quality of life of Maori in advanced age. Te puawaitanga o nga tapuwae kia ora tonu - Life and living in advanced age: a cohort study in New Zealand (LiLACS NZ).

AIM: To establish 1) the socioeconomic and cultural profile and 2) correlates of quality of life (QOL) of Maori in advanced age. METHOD: A cross sectional survey of a population based cohort of Maori aged 80-90 years, participants in LiLACS NZ, in the Rotorua and Bay of Plenty region of New Zealand. Socioeconomic and cultural engagement characteristics were established by personal interview and QOL was assessed by the SF-12. RESULTS: In total 421 (56%) participated and 267 (63%) completed the comprehensive interview. Maori lived with high deprivation areas and had received a poor education in the public system. Home ownership was high (81%), 64% had more than 3 children still living and social support was present for practical tasks and emotional support in 82%. A need for more practical help was reported by 21%. Fifty-two percent of the participants used te reo Maori me nga tikanga (Maori language and culture) daily. One in five had experienced discrimination and one in five reported colonisation affecting their life today. Greater frequency of visits to marae/sacred gathering places was associated with higher physical health-related QOL. Unmet need for practical help was associated with lower physical health-related QOL. Lower mental health-related QOL was associated with having experienced discrimination. CONCLUSION: Greater language and cultural engagement is associated with higher QOL for older Maori and unmet social needs and discrimination are associated with lower QOL.

Navigation: process of building relationships with kaumatua (Maori leaders).

In the article the authors depict relations in sociocultural navigation by Maori researchers conducting research embedded in mutual trust; rather than instrumental navigation in linear time. A longitudinal study of Maori and non Maori men and women ageing successfully was planned; this feasibility stage tested whether engaging with koroua/older Maori men and kuia/older Maori women was possible. We document the process undertaken with Nga Pae o te Maramatanga New Zealand's Indigenous Centre of Research Excellence (hosted by the University of Auckland) to involve Maori people in the research, engaging with koroua and kuia aged 75 to 79 years old, developing focus groups to discuss questions specific to te reo Maori me nga tikanga/Maori language and culture, and building research capacity in Maori tribal and primary health organisations in the Bay of Plenty. In addition, engaging with Te Taura Whiri i te Reo Maori/ Maori Language Commission to translate the questions; recruiting the RopuKaitiaki o Nga Tikanga Maori/Protectors of Principles of Conduct in Maori Research, and naming the study will be discussed. The involvement of the kaumatua/older Maori people has been fundamental in laying the foundation of the Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ), Te Puawaitanga o Nga Tapuwae Kia Ora Tonu to study a group of Maori aged 80 to 90 years old.

Engagement and recruitment of Maori and non-Maori people of advanced age to LiLACS NZ.

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 Maori aged 80-90 years and 600 non-Maori 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 Maori method was used to recruit Maori with: dual Maori and non-Maori research leadership; the formation of a support group; local tribal organisations and health providers recruiting participants; and use of the Maori language in interviews. Non-Maori 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 Maori and 516 of 870 (59%) eligible non-Maori 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 Maori and non-Maori of advanced age in a longitudinal cohort study. IMPLICATIONS: There is high potential for meaningful results useful for participants, their whanau and families, health agencies, planners and policy.

Agreement between self-reports and medical records of cardiovascular disease in octogenarians.

OBJECTIVE: Self-reported health and disease status is a common method used in epidemiologic studies and surveys involving younger populations, but its reliability in octogenarians is unknown. The objective of the present study was to examine the level of agreement between self-reports and medical records on specific cardiovascular diagnoses. STUDY DESIGN AND SETTING: The Life and Living to Advanced Age: a Cohort Study in New Zealand recruited 937 octogenarians in New Zealand. Standardized questionnaires were administered to determine sociodemographic status and medical history. Diagnoses of myocardial infarction (MI), stroke, congestive heart failure (CHF), and hypertension were compared between self-reports and two combined sources of medical records. RESULTS: There were moderate levels of agreement between self-reports and medical records for MI, stroke, and hypertension (κ = 0.43-0.45) and low levels for CHF (κ = 0.19). The proportion of discordance for MI, stroke, CHF, and hypertension was 16%, 12%, 22%, and 27%, respectively. Adjusting for socioeconomic-demographic status and cognitive function, the number of comorbidities is highly associated with agreement between self-reports and medical records (P < 0.01). Gender, socioeconomic status, and cognitive function were also related to agreement between self-reports and medical records, but the strength of association was ethnic specific. CONCLUSION: Self-reported information on specific cardiovascular conditions has only modest reliability in octogenarians and is associated with number of comorbidities.

Why People Gamble: A Qualitative Study of Four New Zealand Ethnic Groups.

In multicultural countries such as New Zealand, it is particularly important that gambling research take into account possible cultural differences. Many New Zealanders come from cultures that do not have a history of gambling, including the Mäori (New Zealand indigenous people), Pacific Islanders, and recent migrants. Little research has examined the reasons why people start and continue to gamble, especially among different ethnic groups. This research project thus aimed to develop a framework to explain how environmental, cultural, and social factors interact with personal attributes to determine gambling behaviors. In a qualitative study, 131 people broadly representative of Mäori, Pacific, Asian, and Päkehä/New Zealand European groups residing in New Zealand were interviewed individually or in focus groups. They included social and problem gamblers, families of problem gamblers, and professionals. Different personal, socioeconomic, environmental, and cultural factors were identified, summarized in a developmental framework, and compared to factors found for ethnic groups in other countries. Public health policy issues were raised, including greater control of gambling promotion.

Doing what's important: valued activities for older New Zealand Maori and non-Maori.

AIM: This project explored the usability of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) for describing older Maori and non-Maori people's self-nominated important activities. METHOD: Within a feasibility-for-cohort study, 112 participants, 33 Maori, aged 75-79 years, and 79 non-Maori, 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 Maori frequently named extended family relationship activities as being most important, non-Maori named more recreation and leisure activities. CONCLUSIONS: The ICF is useful for classifying older New Zealanders' important activities, although some activities of older Maori 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 Maori.

Pinnacle of life--Maori living to advanced age.

AIM: The purpose of this feasibility study was to investigate whether Maori of advanced age would be interested in and able to take part in a quantitative study involving a comprehensive questionnaire, physical health assessment and blood analyses (a range of biological markers). The study also aimed to involve older Maori in all stages: development of research questions, review of assessment techniques and interpretation of results. METHOD: Maori aged 75-79 years living in the Bay of Plenty and Lakes DHB areas were invited to participate in a feasibility study covering a wide range of quantitative health related questions. After informed consent interviews and physical assessments were conducted in participants' homes or at a local clinic by Maori health providers contracted as a research partner. For those who gave informed consent specifically for blood analyses, bloods were taken and analysed for defined biological markers of inflammation and ageing. All physical assessments and blood analyses were forwarded to each participant's own general practitioner and relevant guidance was given by the research team. RESULTS: Collective results from 33 Maori participants are presented and cover: Te Reo Maori me ona tikanga (Maori language and cultural knowledge), tribal and whanau (extended family) links, cultural values and religion, whanau engagement and recreational activities, health status, healthy eating and discrimination. The Te Whare Tapa Wha model of health and the Poutama model of human development are utilised to provide an overall framework and context to present the results in respect of our participants and to celebrate their 'advanced' old age. CONCLUSION: The feasibility study has been successful in engagement with older Maori. It has paved the way to implement a subsequent longitudinal study which aims to enrol 600 Maori aged 80 to 90 years and 600 non-Maori aged 85 years in the Bay of Plenty and Lakes District Health Board areas (Tauranga, Rotorua, Whakatane, Opotiki and Te Kaha). The longitudinal study, "Life and Living in Advanced Age, the cohort study in New Zealand LILACS NZ - Te Puawaitanga o Nga Tapuwae Kia Ora Tonu", will record and observe participants' journeys to the end of their life. The LILACS Study NZ is at the stage of recruitment of participants and funding has been allocated for waves two and three and the next stage of the study will have an increased focus on dementia.

Nutrition risk: cultural aspects of assessment.

AIM: To assess a nutrition risk screening tool amongst Maori and non-Maori of advanced age. METHOD: A cross sectional feasibility study was conducted in three North Island locations. One hundred and eight community-living residents aged 75- 85 years were assessed for nutrition risk using 'the validated questionnaire 'Seniors in the Community: Risk Evaluation for Eating and Nutrition', Version II (SCREENII) and level of physical activity using the 'Physical Activity Scale for the Elderly' (PASE). Physical assessments included height and weight. RESULTS: Fifty-two percent of participants were assessed to be at high nutrition risk (SCREENII score <50; range 29-58; out of maximum score 64). Nutrition risk factors amongst Maori and non-Maori respectively differed for weight change in the previous six months (45.2% and 18.7%, p=0.005), skipping meals (54.8% and 13.3%, p<0.001), fruit and vegetable intake (77.4% and 18.7%, p<0.001) and the use of meal replacements (28.1% and 9.3%, p=0.013). Process evaluation showed that Maori took different meaning from the individual question items in SCREENII. Level of physical activity (PASE score) was higher for Maori, median (IQR): 125 (74) than non-Maori, 72 (74) (p<0.001) especially for leisure-time and household related activity. BMI was higher for Maori median (IQR): 31.5 kg/m2 (6.8) compared to non-Maori 24.7 kg/m2 (5.4) (p<0.001). CONCLUSIONS: The nutrition risk tool suggested that Maori were at high risk for malnutrition despite higher BMI and higher levels of activity. Several items of the screening tool were interpreted differently among Maori compared to non-Maori. Further development is needed to ensure accurate assessment.