Epidemiology of Faecal Incontinence for People with Dementia Living in the Community in New Zealand: A Retrospective Cohort Study Using interRAI Home Care Assessment Data.

INTRODUCTION: Globally, there are few studies but wide variation in the epidemiology of faecal incontinence (FI) for people living with dementia in the community. Our objectives are to identify 1-year period prevalence, 5-year incidence, and risks for FI for people living with dementia. METHODS: A retrospective cohort study comprising the International Residential Assessment Instrument Home Care version (interRAI-HC) assessments in a 5-year period in New Zealand (N = 109,964). For prevalence analysis, we selected a dementia cohort for a 1-year period from August 1, 2020, to July 31, 2021 (n = 7,775). For the incidence analysis, participants in the dementia cohort were followed up from the day of the first dementia diagnosis during the period August 1, 2016, and July 31, 2021. Dementia was identified by combining diagnosis of "Alzheimer's disease" and "Dementia other than Alzheimer's disease." Participants were coded with faecal incontinence if they were continent with a stoma, seldom incontinent, occasionally incontinent, often incontinent and incontinent. RESULTS: One year period (1 August 2020-31 July 2021) prevalence of FI was 26.7% (2,082/7,775) of people with dementia. 5-Year incident FI rate was 19.0 per 100 person-years for people with dementia and 12.3 per 100 person-years for people without dementia. Controlling for risk factors for FI in both groups the hazard ratio for FI was 1.7 for people with dementia. CONCLUSION: FI affects a significant proportion of people with dementia in New Zealand. interRAI-HC data could facilitate global epidemiological studies to estimate service or intervention needs for people with dementia to redress or manage FI.

Identifying Frailty in Older Adults Receiving Home Care Assessment Using Machine Learning: Longitudinal Observational Study on the Role of Classifier, Feature Selection, and Sample Size.

BACKGROUND: Machine learning techniques are starting to be used in various health care data sets to identify frail persons who may benefit from interventions. However, evidence about the performance of machine learning techniques compared to conventional regression is mixed. It is also unclear what methodological and database factors are associated with performance. OBJECTIVE: This study aimed to compare the mortality prediction accuracy of various machine learning classifiers for identifying frail older adults in different scenarios. METHODS: We used deidentified data collected from older adults (65 years of age and older) assessed with interRAI-Home Care instrument in New Zealand between January 1, 2012, and December 31, 2016. A total of 138 interRAI assessment items were used to predict 6-month and 12-month mortality, using 3 machine learning classifiers (random forest [RF], extreme gradient boosting [XGBoost], and multilayer perceptron [MLP]) and regularized logistic regression. We conducted a simulation study comparing the performance of machine learning models with logistic regression and interRAI Home Care Frailty Scale and examined the effects of sample sizes, the number of features, and train-test split ratios. RESULTS: A total of 95,042 older adults (median age 82.66 years, IQR 77.92-88.76; n=37,462, 39.42% male) receiving home care were analyzed. The average area under the curve (AUC) and sensitivities of 6-month mortality prediction showed that machine learning classifiers did not outperform regularized logistic regressions. In terms of AUC, regularized logistic regression had better performance than XGBoost, MLP, and RF when the number of features was ≤80 and the sample size ≤16,000; MLP outperformed regularized logistic regression in terms of sensitivities when the number of features was ≥40 and the sample size ≥4000. Conversely, RF and XGBoost demonstrated higher specificities than regularized logistic regression in all scenarios. CONCLUSIONS: The study revealed that machine learning models exhibited significant variation in prediction performance when evaluated using different metrics. Regularized logistic regression was an effective model for identifying frail older adults receiving home care, as indicated by the AUC, particularly when the number of features and sample sizes were not excessively large. Conversely, MLP displayed superior sensitivity, while RF exhibited superior specificity when the number of features and sample sizes were large.

Using interRAI Assessment for Research: Developing a National Research Agenda in Aotearoa New Zealand.

interRAI provides a suite of standardized, validated instruments used to assess health and psychosocial well-being, and to inform person-centered care planning. Data obtained from these standardized tools can also be used at a population level for research and to inform policy, and interRAI is currently used in more than 40 countries globally. We present a brief overview of the use of interRAI internationally within research and policy settings, and then introduce how interRAI is used within the universal public health system in Aotearoa New Zealand (NZ), including considerations relating to Maori, the Indigenous people of NZ. In NZ, improvement in interRAI data utilization for research purposes was called for from aged care, health providers, and researchers, to better use these data for quality improvement and health advancement for New Zealanders. A national research network has been established, providing a medium for researchers to form relationships and collaborate on interRAI research with a goal of translating routinely collected interRAI data to improve clinical care, patient experience, service development, and quality improvement. In 2023, the network members met (hybrid: in-person and online) and identified research priorities. These were collated and developed into a national interRAI research agenda by the NZ interRAI Research Network Working Group. Research priorities included reviewing the interRAI assessment processes, improving methods for data linkage to national data sets, exploring how Indigenous Data Sovereignty can be upheld, as well as a variety of clinically focused research topics. Implications for Practice, Policy, and Research: This appears to be the first time national interRAI research priorities have been formally identified. Priorities identified have the potential to inform quality and clinical improvement activities and are likely of international relevance. The methodology described to cocreate the research priorities will also be of wider significance for those looking to do so in other countries.

Reliability and reproducibility of CBCT assessment of mandibular changes before and after treatment for Class III growing patients - an easy and quick way for evaluation.

The objective of this study was to evaluate intraobserver reliability and inter-observer reproducibility of a 3-dimensional (3D) assessment method for mandibular changes of growing patients after orthodontic treatment for Class III malocclusion.Methods Cone-beam computed tomography (CBCT) scans were performed before and after orthodontic treatment for 27 patients. During the scan, the patient was positioned such that his/her mandibular plane was parallel to floor. Three observers independently worked on the DICOM data, reconstructed the pre- and post-treatment 3D models in software, selected the stable anatomical structures (basal bone area from the lingual surface of the symphysis to the distal aspect of the first molars) to guide the automated superimposition process. Then, each observer registered 14 anatomical landmarks on the virtual models, for three times after suitable interval, to generate 3 sets of coordinates; the mean was taken as the coordinates for that particular landmark. The intraobserver reliability and inter-observer reproducibility of the method were analyzed.Results The ICCs was > 0.90 for 25 (92.6%) of the intraobserver assessments. The precision of the measurement method was < 0.3 mm in 24 (88.9%) cases. The interobserver reproducibility errors were < 0.3 mm in 21 of the 27 cases.Conclusions The intraobserver reliability and inter-observer reproducibility of 3D assessment of mandibular changes using the virtual models were excellent.

Health professionals' understanding and attitude towards the End of Life Choice Act 2019: a secondary analysis of Manatu Hauora - Ministry of Health workforce surveys.

AIM: To determine socio-demographic factors associated with health professionals' understanding of the End of Life Choice Act (the Act), support for assisted dying (AD), and willingness to provide AD in New Zealand. METHOD: Secondary analysis of two Manatu Hauora - Ministry of Health workforce surveys conducted in February and July 2021. RESULTS: Our analysis showed (1) older health professionals (age>55) had a better overall understanding of the Act than their young colleagues (age⁢35), (2) female health professionals were less likely to support and be willing to provide AD, (3) Asian health professionals were less likely to support AD compared to their Pakeha/European counterparts, (4) nurses were more likely to support AD and be willing to provide AD when compared to medical practitioners, and (5) pharmacists were more willing to provide AD when compared to medical practitioners. CONCLUSION: Several socio-demographic factors, including age, gender, ethnicity, and professional background, are significantly associated with health professionals' support and willingness to provide AD, with likely consequences for the AD workforce availability and service delivery in New Zealand. Future review of the Act could consider enhancing the roles of those professional groups with higher support and willingness to assist in providing AD services in caring for people requesting AD.

What do health care professionals want to know about assisted dying? Setting the research agenda in New Zealand.

BACKGROUND: New Zealand recently introduced law permitting terminally ill people to request and receive assisted dying (AD) in specified circumstances. Given the nature and complexity of this new health service, research is vital to determine how AD is operating in practice. OBJECTIVE: To identify research priorities regarding the implementation and delivery of AD in New Zealand. METHODS: Using an adapted research prioritisation methodology, the researchers identified 15 potential AD research topics. A mixed-methods survey of health professionals was undertaken where respondents were asked to rate the 15 topics according to the relative importance for research to be conducted on each issue. Respondents could also suggest additional research areas, and were invited to participate in a follow-up interview. RESULTS: One hundred and nineteen respondents completed the survey. 31% had some experience with AD. The highest rated research topic was the 'effectiveness of safeguards in the Act to protect people'; the lowest rated topic was research into the 'experiences of non-provider (e.g., administrative, cleaning) staff where assisted dying is being provided'. Respondents suggested 49 other research topics. Twenty-six interviews were conducted. Thematic analysis of interview data and open-ended survey questions was undertaken. Six research themes were identified: general factors related to the wider health system; the experiences of health care providers at the bedside; medico-legal issues; the impact of AD; experiences on the day of dying; and the overall effectiveness of the AD system. Key issues for stakeholders included safety of the AD service; ensuring access to AD; achieving equity for 'structurally disadvantaged' groups; and ensuring the well-being of patients, families/whanau, providers and non-providers. CONCLUSIONS: Based on early experiences of the implementation of the AD service, health professionals provide important insights into what research should be prioritised post-legalisation of AD. These findings can be used to shape the research agenda so that research may inform law, policy and best practice.

Adaptation models, barriers, and facilitators for cultural safety in telepsychiatry: A systematic scoping review.

Introduction: Indigenous peoples, and racial and ethnic minorities around the world experience significant mental health inequities. Telepsychiatry can contribute to addressing these inequities among these populations. However, it is first crucial to ensure the cultural safety of this tool as a critical step toward health equity. This review aimed to collate evidence regarding cultural adaptations, barriers, opportunities, and facilitators for telepsychiatry services supporting minority groups. Method: Using the PRISMA extension for scoping reviews (PRISMA-ScR) guideline, we conducted a systematic scoping review and thematic analysis. Six databases were searched using the PICO framework, i.e., population, intervention, comparison, and outcomes.. Additional literature was identified through reference lists screening. We developed a table for data extraction, and the extracted data were further analyzed following Braun and Clarke's approach for thematic analysis. Results: A total of 1514 citations were screened with a final total of 58 articles included in the review. The themes related to telepsychiatry cultural adaptations emphasize the crucial role of community involvement and quality service delivery. Identified barriers were associated with service and infrastructure, and service users' socioeconomic and cultural contexts. Opportunities and facilitators for telepsychiatry were enhanced access and rapport, and multi-organizational collaborations and partnerships. Discussion: This review identified factors that can guide the adaptation of telepsychiatry evidence-based interventions to meet the needs of Indigenous peoples and racial and ethnic minorities. Telepsychiatry programs must be specifically designed for the population they seek to serve, and this review offers emerging insights into critical factors to consider in their development.

Performance of the Cognitive Performance Scale of the Resident Assessment Instrument (interRAI) for Detecting Dementia amongst Older Adults in the Community.

The Cognitive Performance Scale (CPS) in the widely used interRAI suite of instruments is of interest to clinicians and policy makers as a potential screening mechanism for detecting dementia. However, there has been little evaluation of the CPS in home care settings. This retrospective diagnostic study included 134 older adults (age ≥ 65) who were discharged from two acute psychogeriatric inpatient units or assessed in two memory clinics. The reference test was a diagnosis of clinical dementia, and the index test was interRAI CPS measured within 90 days of discharge. The overall accuracy of the CPS was good, with an area under the Receiver Operating Characteristic curve of 0.82 (95% CI = 0.75-0.89). The optimal cut point was 1/2, coinciding with the recommended cut point, with good sensitivity (0.90, 95% CI = 0.81-0.96) but poor specificity (0.60, 95% CI = 0.46-0.72). Positive predictive value improved from 0.72 (95% CI = 0.66-0.78) to 0.89 (95% CI = 0.75-0.96) when using a cut point of 2/3 instead of 1/2. If the results of the present study are replicated with more generalisable interRAI samples, older adults with a CPS of 3 or above, but without a formal diagnosis of dementia, should be referred for further cognitive assessment.

Using Big Data to Estimate Dementia Prevalence in New Zealand: Protocol for an Observational Study.

BACKGROUND: Dementia describes a cluster of symptoms that includes memory loss; difficulties with thinking, problem solving, or language; and functional impairment. Dementia can be caused by a number of neurodegenerative diseases, such as Alzheimer disease and cerebrovascular disease. Currently in New Zealand, most of the systematically collected and detailed information on dementia is obtained through a suite of International Residential Assessment Instrument (interRAI) assessments, including the home care, contact assessment, and long-term care facility versions. These versions of interRAI are standardized comprehensive geriatric assessments. Patients are referred to have an interRAI assessment by the Needs Assessment and Service Coordination (NASC) services after a series of screening processes. Previous estimates of the prevalence and costs of dementia in New Zealand have been based on international studies with different populations and health and social care systems. This new local knowledge will have implications for estimating the demographic distribution and socioeconomic impact of dementia in New Zealand. OBJECTIVE: This study investigates the prevalence of dementia, risk factors for dementia, and drivers of the informal cost of dementia among people registered in the NASC database in New Zealand. METHODS: This study aims to analyze secondary data routinely collected by the NASC and interRAI (home care and contact assessment versions) databases between July 1, 2014, and July 1, 2019, in New Zealand. The databases will be linked to produce an integrated data set, which will be used to (1) investigate the sociodemographic and clinical risk factors associated with dementia and other neurological conditions, (2) estimate the prevalence of dementia using weighting methods for complex samples, and (3) identify the cost of informal care per client (in number of hours of care provided by unpaid carers) and the drivers of such costs. We will use design-based survey methods for the estimation of prevalence and generalized estimating equations for regression models and correlated and longitudinal data. RESULTS: The results will provide much needed statistics regarding dementia prevalence and risk factors and the cost of informal care for people living with dementia in New Zealand. Potential health inequities for different ethnic groups will be highlighted, which can then be used by decision makers to inform the development of policy and practice. CONCLUSIONS: As of November 2020, there were no dementia prevalence studies or studies on informal care costs of dementia using national data from New Zealand. All existing studies have used data from other populations with substantially different demographic distributions. This study will give insight into the actual prevalence, risk factors, and informal care costs of dementia for the population with support needs in New Zealand. It will provide valuable information to improve health outcomes and better inform policy and planning. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/20225.

A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide.

OBJECTIVES: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD: The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. RESULTS: This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION: Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.

Scoping Review: Intergenerational Resource Transfer and Possible Enabling Factors.

We explore the intergenerational pattern of resource transfer and possible associated factors. A scoping review was conducted of quantitative, peer-reviewed, English-language studies related to intergenerational transfer or interaction. We searched AgeLine, PsycINFO, Social Work Abstracts, and Sociological Abstracts for articles published between Jane 2008 and December 2018. Seventy-five studies from 25 countries met the inclusion criteria. The scoping review categorised resource transfers into three types: financial, instrumental, and emotional support. Using an intergenerational solidarity framework, factors associated with intergenerational transfer were placed in four categories: (1) demographic factors (e.g., age, gender, marital status, education, and ethno-cultural background); (2) needs and opportunities factors, including health, financial resources, and employment status; (3) family structures, namely, family composition, family relationship, and earlier family events; and (4) cultural-contextual structures, including state policies and social norms. Those factors were connected to the direction of resource transfer between generations. Downward transfers from senior to junior generations occur more frequently than upward transfers in many developed countries. Women dominate instrumental transfers, perhaps influenced by traditional gender roles. Overall, the pattern of resource transfer between generations is shown, and the impact of social norms and social policy on intergenerational transfers is highlighted. Policymakers should recognise the complicated interplay of each factor with different cultural contexts. The findings could inform policies that strengthen intergenerational solidarity and support.

Factors Associated With Terminally Ill People Who Want to Die.

CONTEXT: The decision to request and proceed with euthanasia or physician-assisted dying is complex, and predictors of such decisions are heterogeneous with regard to physical health, psychological, and social factors. Local research is therefore needed. OBJECTIVES: To examine the interplay of demographic, clinical, and psychosocial factors routinely collected by a standardized clinical instrument, the interRAI Resident Assessment Instrument for Palliative Care (interRAI-PC), in people with a prognosis of less than 12 months who wanted to die. METHODS: All New Zealanders who had an interRAI-PC in 2018 were included. The outcome variable was the single item Wants to die now. Independent variables included biopsychosocial factors and health index scales generated by interRAI-PC. A binary logistic regression was used to determine the predictive factors of Wants to die now (yes vs. no). RESULTS: There were 771 individuals included (mean age 76.0 years; SD 11.6; female 50.1%); 9.3% of whom reported yes to Wants to die now, 59.8% no, and for 30.9%, the assessor was unable to determine. The factors with the largest odds ratios (ORs) were awareness of terminal prognosis (OR 4.8; 95% CI 2.2-10.3), high level of depression (OR 4.6; 95% CI 1.7-12.6), not finding meaning in day-to-day life (OR 3.8; 95% CI 1.8-8.1), and pain (less than severe: OR 3.7; 95% CI 1.3-10.4 and severe to excruciating: OR 3.5; 95% CI 1.1-10.7). CONCLUSION: Addressing the significant factors we identified should form part of a multidisciplinary assessment when terminally ill patients express a wish to die, to ensure their physical, psychological, and existential needs are adequately met.

Ability of the Maze Navigation Test, Montreal Cognitive Assessment, and Trail Making Tests A & B to predict on-road driving performance in current drivers diagnosed with dementia.

AIM: This study aimed to evaluate the ability of the Maze Navigation Test (MNT), Montreal Cognitive Assessment (MoCA) and Trail Making Tests A & B (TMT A & B) to predict on-road driving performance in current drivers diagnosed with dementia. METHODS: Current drivers with a diagnosis of dementia in whom there were clinical concerns about their driving safety were invited to participate between December 2014 and February 2018. Participants completed the MNT, MoCA and TMT A & B, then underwent a blinded specialist Occupational Therapy & Rehabilitation Service (OTRS) off-road and on-road driving assessment. RESULTS: Of the 34 participants, 19 (55.9%) retained their full license and 15 (44.1%) received driving restrictions (including cessation). Only completion time for the MNT (AUC .737, p=.019), the MoCA domain of attention (AUC .809, p=.003) and a combination of the MoCA domain of attention and visuospatial/executive (AUC .783, p=.006) predicted outcome. Derived optimal cut-scores were <443s for MNT completion time (sensitivity 73.3%, specificity 68.4%), <5/6 for MoCA-attention (sensitivity 73.3%, specificity 72.2%) and <8/11 for MoCA-visuospatial/executive+attention (sensitivity 80%, specificity 66.7%). Using these derived cut-scores, MNT completion time predicted poor performance during the on-road assessment in the domains of speed control (p=.039), planning/judgement (p=.004) and vehicle position (p=.028). CONCLUSION: Results of this study indicate MNT completion time and the MoCA domains of attention and visuospatial/executive could be used to inform driving ability and further referral for a specialist driving assessment.

General practitioners and decision-making capacity assessment: the experiences and educational needs of New Zealand general practitioners.

BACKGROUND: Assessing decision-making capacity to health care is within the scope of practice for all doctors, yet the experience of GPs in this area is unknown. OBJECTIVE: To explore the experiences, perspectives, approaches and challenges for GPs in New Zealand when conducting decision-making capacity assessments. METHODS: Qualitative study design comprising individual in-depth semi-structured interviews conducted with a convenience sample of GPs. Interview transcripts were transcribed verbatim and analysed using a thematic analysis approach. RESULTS: Twelve participants were recruited. The following themes emerged: (i) GPs' roles and responsibilities in decision-making capacity assessments; (ii) GPs lack formal training, knowledge, and confidence in decision-making capacity assessments; (iii) the legal interface of decision-making capacity assessments; (iv) GPs' relationships with specialists and the resulting impact on their confidence in decision-making capacity assessments; and (v) opportunities to improve GPs' knowledge and confidence in decision-making capacity assessments. CONCLUSIONS: GPs take responsibility for decision-making capacity assessments; however, assessments can be complex. There is a need to develop specific curriculum and training resources for GPs to improve their clinical skills and legal knowledge in decision-making capacity assessments.

Financial difficulty and biopsychosocial predictors of loneliness: A cross-sectional study of community dwelling older adults.

AIM: To investigate the interplay of sociodemographic, health, functional and psychosocial factors in predicting loneliness in community dwelling older adults accessing home support services and long-term aged residential care. METHODS: Older New Zealanders (age 65+), who had their first interRAI Home Care assessment between July 2014 and June 2016, were included. The outcome variable was the binary interRAI item "Lonely". The predictor variables included sociodemographics, hearing, vision, self-reported health, activities of daily living, social interaction and support, and depression. RESULTS: Data from 51,239 assessments of older adults (mean age: 82.3 years; female: 61%; European: 87.3%) were analysed. Loneliness was reported in 21%. A stepwise logistic regression model explained 12.1% of the variance and was statistically significant (Chi2 = 3501.0.8, df = 22; p < 0.001). The factors with the largest odds ratios (OR > 1.5) were depression, living alone, being Asian, financial difficulty and not in a relationship. Functional impairment was negatively associated with loneliness. CONCLUSIONS: Determining the predictors of older adults' loneliness is complex, multi-factorial, with each factor having a small, additive effect on the development of loneliness. Depression, social factors and financial difficulty are the strongest predictors but much of the variance remains unexplained. These factors could be targeted as modifiable risk factors for addressing loneliness in older adults.

Self-harm in adults: a comparison between the middle-aged and the elderly.

AIM: In New Zealand, men aged 45-49 years and 85 years and above have one of the highest suicide rates. As the population in New Zealand ages, it is anticipated that the absolute number of late-life suicides will rise. Self-harm is one of the better predictors of future suicide. The aims of this study are to: (i) characterise middle-aged (45-64 years) and older-aged people (65+ years) who have self-harmed; and (ii) determine whether there are differences between the two age groups. METHOD: Clinical data were retrospectively collected on people aged 45+ years who presented with a self-harm attempt to a large emergency department in New Zealand from 2010 to 2013. Further clinical information for the 12-month period following their presentation was also collected. RESULTS: Three hundred and seventy-one middle-aged (56.6% female) and 49 older-aged (38.8% female) people presented with a total of 513 and 56 self-harm attempts respectively during the study period. The older-aged group was more likely to report physical illness as a stressor (p=0.001), have a history of depression (p<0.0001) and be diagnosed with depression at the time of their attempt (p<0.0001). Suicidal intent was more common among the older-aged people who have self-harmed (p=0.004), and they had lower survival rates in the 12 months after their self-harm attempt (risk ratio=7.5; 95% CI=3.1 to 18.1). CONCLUSION: The significant differences between older-aged and middle-aged people who have self-harmed highlights the need for age-specific suicide interventions, with particular focus on addressing physical illness and depression in older-aged people.

Late-life suicide in Asian people living in New Zealand: a qualitative study of coronial records.

BACKGROUND: There has been no previous study examining the phenomenon of suicide in older Asians in New Zealand. The aim of this study was to identify common factors and gain a better understanding of late-life suicide in Asian people living in New Zealand. METHODS: New Zealand Coronial Services provided records of all closed cases of late-life suicides (age ≥ 65 years) between July 2007 and December 2012. Out of the total of 225 cases, 15 were recorded as being of Asian ethnicity. These cases were reviewed in their entirety using a qualitative thematic analysis approach. RESULTS: Eight Asian men and seven Asian women completed suicide during this period. The majority (93%) lived with their families, and 80% were found by family after having completed suicide at home. Three main themes emerged from the thematic analysis: (i) suicide occurring in the context of a family; (ii) declining physical health; and (iii) a violent method of suicide. The role of the family has not been previously identified in other studies of late-life suicide in New Zealand. CONCLUSIONS: Further research is needed to identify ways Asian families can access culturally appropriate and accessible support and mental health services for their older members at risk of suicide. There is also a need for developing post-suicide interventions specifically for Asian families. The findings of this study have added to the growing evidence of declining physical health acting as a drive for late-life suicide.

Low-cost, flexible, disinfectant-free and regular-array three-dimensional nanopyramid antibacterial films for clinical applications.

In this work, a low-cost, scalable and highly repeatable approach was developed to prepare polystyrene films with three-dimensional nanopyramids on the surface. The nanopyramids have a tunable aspect ratio and more importantly, their anti-bacterial performance has been systematically studied. The effectiveness of the nanopyramids on E. coli growth inhibition and the role of the nanostructure aspect ratio were carefully studied through scanning electron microscopy and confocal laser scanning microscopy. The results showed an excellent antibacterial performance with more than 90% reduction in the E. coli population in all nanopyramid samples after a 168 h prolonged incubation time. The nanopyramid film developed here can be used for clinical and commercial applications to prevent the growth of pathogenic bacteria on various surfaces.

Do suicide characteristics differ by age in older people?

ABSTRACTBackground:Suicide rates increase with age in the population aged over 65 years. The aims of this study were to (i) report the characteristics of older people who died by suicide; and (ii) investigate whether these characteristics differ in three age bands: 65-74 years, 75-84 years, and 85+ years. METHODS: Using information from national coroner records, relevant socio-demographic and clinical factors in all suicides (age ≥ 65 years; n = 225) from July 2007 to December 2012 in New Zealand were analyzed and compared in the three age bands. RESULTS: We found the older the person, the more likely they are to be widowed but the less likely to have a past psychiatric admission or recent contact with psychiatric services in the month prior to suicide. However, most of the older people (61.7% of 65-74 years, 65.6% of 75-84 years, and 77.3% of 85+ years) had contact with their general practitioner within one month of suicide. Women were less likely to use violent methods than men in all three age bands but with increasing age, men were less likely to use violent methods. CONCLUSIONS: Suicide characteristics in older people differ by age. The oldest people who die by suicide are not necessarily under psychiatric services and may benefit from a primary care-based approach in which there is screening for depression and suicide risk.