Effects of an Exercise Program to Reduce Falls in Older People Living in Long-Term Care: A Randomized Controlled Trial.

OBJECTIVES: To investigate the effect of an exercise program on falls in intermediate and high-level long-term care (LTC) residents and to determine whether adherence, physical capacity, and cognition modified outcomes. DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS: Residents (n = 520, aged 84 ± 8 years) from 25 LTC facilities in New Zealand. METHODS: Individually randomized to Staying UpRight, a physical therapist-led, balance and strength group exercise program delivered for 1 hour, twice weekly over 12 months. The control arm was dose-matched and used seated activities with no resistance. Falls were collected using routinely collected incident reports. RESULTS: Baseline fall rates were 4.1 and 3.3 falls per person-year (ppy) for intervention and control groups. Fall rates over the trial period were 4.1 and 4.3 falls ppy respectively [P = .89, incidence rate ratio (IRR) 0.98, 95% CI 0.76, 1.27]. Over the 12-month trial period, 74% fell, with 63% of intervention and 61% of the control group falling more than once. Risk of falls (P = .56, hazard ratio 1.08, 95% CI 0.85, 1.36) and repeat falling or fallers sustaining an injury at trial completion were similar between groups. Fall rates per 100 hours walked did not differ between groups (P = .42, IRR 1.15, 95% CI 0.81, 1.63). Program delivery was suspended several times because of COVID-19, reducing average attendance to 26 hours over 12 months. Subgroup analyses of falls outcomes for those with the highest attendance (≥50% of classes), better physical capacity (Short Physical Performance Battery scores ≥8/12), or cognition (Montreal Cognitive Assessment scores ≥ 18/30) showed no significant impact of the program. CONCLUSIONS/IMPLICATIONS: In intermediate and high-level care residents, the Staying UpRight program did not reduce fall rates or risk compared with a control activity, independent of age, sex, or care level. Inadequate exercise dose because of COVID-19-related interruptions to intervention delivery likely contributed to the null result.

Process evaluation of the Safer Prescribing and Care for the Elderly (SPACE) cluster randomised controlled trial in New Zealand general practice.

Introduction The Safer Prescribing and Care for the Elderly (SPACE) cluster randomised controlled trial in 39 general practices found that a search of the practice database to identify and generate for each general practitioner (GP) a list of patients with high-risk prescribing, pharmacist-delivered one-on-one feedback to GPs, and electronic tick-box for GPs to select action for each patient (Patient letter; No letter but possible medication review when patient next in; No action), prompted safer prescribing at 6 months but not at 1 year. Aim This process evaluation explores research participation, intervention uptake and effect on GPs. Methods Mixed methods were used including quantitative data (log of practice recruitment, demographic data, intervention delivery and GP responses including tick-box selections) and qualitative data (trial pharmacist reflective journal). Data were analysed using descriptive statistics and general inductive analysis, respectively. Results Recruitment of general practices was challenging, with only 39% of eligible practices agreeing to participate. Those who declined were often 'too busy'. Engagement was also challenging, especially in larger practices, with the trial pharmacist managing to meet with only 64% of GPs in the intervention group. The GPs who did engage were positive about the intervention, but elected to send letters to only 23% of patients with high-risk prescribing, either because the high-risk prescribing had already stopped, the GP did not agree the prescribing was 'high-risk' or the GP was concerned a letter would upset the patient. Conclusions Effectiveness of the SPACE cluster randomised controlled trial could be improved by changes including ensuring searches are current and relevant, repeating cycles of search and feedback, and integrating pharmacists into general practices.

Safer Prescribing and Care for the Elderly (SPACE): a cluster randomised controlled trial in general practice.

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

Modifiable Risk Factors and Change in Cognition of Maori and Non-Maori in Advanced Age: LiLACS NZ.

OBJECTIVE: This study investigated whether previously identified modifiable risk factors for dementia were associated with cognitive change in Maori (indigenous people of New Zealand) and non-Maori octogenarians of LiLACS NZ (Life and Living in Advanced Age; a Cohort Study in New Zealand), a longitudinal study. METHOD: Multivariable repeated-measure mixed effect regression models were used to assess the association between modifiable risk factors and sociodemographic variables at baseline, and cognitive change over 6 years, with p values of <.05 regarded as statistically significant. RESULTS: Modifiable factors associated with cognitive change differed between ethnic groups. Depression was a negative factor in Maori only, secondary education in non-Maori was protective, and obesity predicted better cognition over time for Maori. Diabetes was associated with decreased cognition for both Maori and non-Maori. CONCLUSION: Our results begin to address gaps in the literature and increase understanding of disparities in dementia risk by ethnicity. These findings have implications for evaluating the type and application of culturally appropriate methods to improve cognition.

Costs of inpatient hospitalisations in the last year of life in older New Zealanders: a cohort study.

BACKGROUND: Rapidly ageing populations means that many people now die in advanced age. This paper investigated public hospital and long-term care home costs in the 12 months before death in Maori and non-Maori of advanced age in New Zealand. METHODS: Data from an existing longitudinal study (LiLACS NZ) was used, in which 937 older New Zealanders were enrolled in 2010. At the time of this study, 213 Maori and 241 non-Maori in the cohort had died. National Health Index numbers were linked to the hospitalisation National Minimum Dataset to ascertain public hospitalisation and care home costs in the last year of life. RESULTS: The average total publicly funded hospital and long-term care home costs in the 12 months prior to death were $16,211 and $17,351 for Maori and non-Maori respectively. Non-Maori tended to have long lengths of stay in their last year of life, and non-Maori men had the highest proportion with high costs and long lengths of stay in care homes. Costs in the last year of life were 8.1 times higher in comparison to costs for individuals who did not die in the same time period. CONCLUSION: Despite New Zealand's commitment to providing an equitable level of healthcare, this study illustrated that ethnic and gender disparities are still apparent at the end of life. This raises questions as to whether money at the end of life is being spent appropriately, and how it could potentially be more equitably targeted to meet the diverse needs of older people and their families.

Association between dietary protein intake and change in grip strength over time among adults of advanced age: Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ).

OBJECTIVE: To determine the association between dietary protein intake and change in grip strength (GS) over time among Maori and non-Maori of advanced age. METHODS: Protein intake was estimated from 2×24h multiple pass recall (MPR) in 554 participants, and GS was measured yearly over five years. Anthropometric, physical activity and health data were collected. RESULTS: The median weight-adjusted protein intake was low (for Maori and non-Maori men 1.05 and 0.98g/kg/day; for Maori and non-Maori women 0.87 and 0.91g/kg/day, respectively). There was a general decrease in GS over five years (mean % change of -2.38 ± 15.32 and -4.49 ± 21.92 for Maori and non-Maori women and -5.47 ± 16.09 and -1.81 ± 13.16 for Maori and non-Maori men yearly). Intake of protein was not related to GS at any of the five-year assessment points nor was it related to change over time. CONCLUSION: Protein intake was low in this cohort of octogenarians and was not protective against loss of GS over five years.

Dietary Protein Intake and Determinants in Maori and Non-Maori Octogenarians. Te Puawaitanga o Nga Tapuwae Kia Ora Tonu: Life and Living in Advanced Age: A Cohort Study in New Zealand.

Protein intake, food sources and distribution are important in preventing age-related loss of muscle mass and strength. The prevalence and determinants of low protein intake, food sources and mealtime distribution were examined in 214 Maori and 360 non-Maori of advanced age using two 24 h multiple pass recalls. The contribution of food groups to protein intake was assessed. Low protein intake was defined as ≤0.75 g/kg for women and ≤0.86 g/kg for men. A logistic regression model was built to explore predictors of low protein intake. A third of both women (30.9%) and men (33.3%) had a low protein intake. The main food group sources were beef/veal, fish/seafood, milk, bread though they differed by gender and ethnicity. For women and men respectively protein intake (g/meal) was lowest at breakfast (10.1 and 13.0), followed by lunch (14.5 and 17.8) and dinner (23.3 and 34.2). Being a woman (p = 0.003) and having depressive symptoms (p = 0.029) were associated with consuming less protein. In adjusted models the odds of adequate protein intake were higher in participants with their own teeth or partial dentures (p = 0.036). Findings highlight the prevalence of low protein intake, uneven mealtime protein distribution and importance of dentition for adequate protein intake among adults in advanced age.

Does potentially inappropriate prescribing predict an increased risk of admission to hospital and mortality? A longitudinal study of the 'oldest old'.

BACKGROUND: Potentially inappropriate prescribing (PIP) is associated with negative health outcomes, including hospitalisation and mortality. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is a longitudinal study of Maori (the indigenous population of New Zealand) and non-Maori octogenarians. Health disparities between indigenous and non-indigenous populations are prevalent internationally and engagement of indigenous populations in health research is necessary to understand and address these disparities. Using LiLACS NZ data, this study reports the association of PIP with hospitalisations and mortality prospectively over 36-months follow-up. METHODS: PIP, from pharmacist applied criteria, was reported as potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs). The association between PIP and hospitalisations (all-cause, cardiovascular disease-specific and ambulatory-sensitive) and mortality was determined throughout a series of 12-month follow-ups using binary logistic (hospitalisations) and Cox (mortality) regression analysis, reported as odds ratios (ORs) and hazard ratios (HRs), respectively, and the corresponding confidence intervals (CIs). RESULTS: Full demographic data were obtained for 267 Maori and 404 non-Maori at baseline, 178 Maori and 332 non-Maori at 12-months, and 122 Maori and 281 non-Maori at 24-months. The prevalence of any PIP (i.e. ≥1 PIM and/or PPO) was 66, 75 and 72% for Maori at baseline, 12-months and 24-months, respectively. In non-Maori, the prevalence of any PIP was 62, 71 and 73% at baseline, 12-months and 24-months, respectively. At each time-point, there were more PPOs than PIMs; at baseline Maori were exposed to a significantly greater proportion of PPOs compared to non-Maori (p = 0.02). In Maori: PPOs were associated with a 1.5-fold increase in hospitalisations and mortality. In non-Maori, PIMs were associated with a double risk of mortality. CONCLUSIONS: PIP was associated with an increased risk of hospitalisation and mortality in this cohort. Omissions appear more important for Maori in predicting hospitalisations, and PIMs were more important in non-Maori in predicting mortality. These results suggest understanding prescribing outcomes across and between population groups is needed and emphasises prescribing quality assessment is useful.

The Association Between Drug Burden Index (DBI) and Health-Related Outcomes: A Longitudinal Study of the 'Oldest Old' (LiLACS NZ).

BACKGROUND: The prescribing of medications with anticholinergic and/or sedative properties is considered potentially inappropriate in older people (due to their side-effect profile), and the Drug Burden Index (DBI) is an evidence-based tool which measures exposure to these medications. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ) is an ongoing longitudinal study investigating the determinants of healthy ageing. Using data from LiLACS NZ, this study aimed to determine whether a higher DBI was associated with poorer outcomes (hospitalisation, falls, mortality and cognitive function and functional status) over 36 months follow-up. METHODS: LiLACS NZ consists of two cohorts: Maori (the indigenous population of New Zealand) aged ≥ 80 years and non-Maori aged 85 years at the time of enrolment. Data relating to regularly prescribed medications at baseline, 12 months and 24 months were used in this study. Medications with anticholinergic and/or sedative properties (i.e. medications with a DBI > 0) were identified using the Monthly Index of Medical Specialities (MIMS) medication formulary, New Zealand. DBI was calculated for everyone enrolled at each time point. The association between DBI at baseline and outcomes was evaluated throughout a series of 12-month follow-ups using negative binomial (hospitalisations and falls), Cox (mortality) and linear (cognitive function and functional status) regression analyses (significance p < 0.05). Regression models were adjusted for age, gender, general practitioner (GP) visits, socioeconomic deprivation, number of medicines prescribed and one of the following: prior hospitalisation, history of falls, baseline cognitive function [Modified Mini-Mental State Examination (3MS)] or baseline functional status [Nottingham Extended Activities of Daily Living (NEADL)]. RESULTS: Full demographic data were obtained for 671, 510 and 403 individuals at baseline, 12 months and 24 months, respectively. Overall, 31%, 30% and 34% of individuals were prescribed a medication with a DBI > 0 at baseline, 12 months and 24 months, respectively. At baseline and 12 months, non-Maori had a greater mean DBI (0.28 ± 0.5 and 0.27 ± 0.5, respectively) compared to Maori (0.16 ± 0.3 and 0.18 ± 0.5, respectively). At baseline, the most commonly prescribed medicines with a DBI > 0 were zopiclone, doxazosin, amitriptyline and codeine. In Maori, a higher DBI was significantly associated with a greater risk of mortality: at 36 months follow-up, adjusted hazard ratio [95% confidence interval (CI)] 1.89 (1.11-3.20), p = 0.02. In non-Maori, a higher DBI was significantly associated with a greater risk of mortality [at 12 months follow-up, adjusted hazard ratio (95% CIs) 2.26 (1.09-4.70), p = 0.03] and impaired cognitive function [at 24 months follow-up, adjusted mean difference in 3MS score (95% CIs) 0.89 (- 3.89 to - 0.41), p = 0.02). CONCLUSIONS: Using data from LiLACS NZ, a higher DBI was significantly associated with a greater risk of mortality (in Maori and non-Maori) and impaired cognitive function (in non-Maori). This highlights the importance of employing strategies to manage the prescribing of medications with a DBI > 0 in older adults.

Evaluating the effects of an exercise program (Staying UpRight) for older adults in long-term care on rates of falls: study protocol for a randomised controlled trial.

BACKGROUND: Falls are two to four times more frequent amongst older adults living in long-term care (LTC) than community-dwelling older adults and have deleterious consequences. It is hypothesised that a progressive exercise program targeting balance and strength will reduce fall rates when compared to a seated exercise program and do so cost effectively. METHODS/DESIGN: This is a single blind, parallel-group, randomised controlled trial with blinded assessment of outcome and intention-to-treat analysis. LTC residents (age ≥ 65 years) will be recruited from LTC facilities in New Zealand. Participants (n = 528 total, with a 1:1 allocation ratio) will be randomly assigned to either a novel exercise program (Staying UpRight), comprising strength and balance exercises designed specifically for LTC and acceptable to people with dementia (intervention group), or a seated exercise program (control group). The intervention and control group classes will be delivered for 1 h twice weekly over 1 year. The primary outcome is rate of falls (per 1000 person years) within the intervention period. Secondary outcomes will be risk of falling (the proportion of fallers per group), fall rate relative to activity exposure, hospitalisation for fall-related injury, change in gait variability, volume and patterns of ambulatory activity and change in physical performance assessed at baseline and after 6 and 12 months. Cost-effectiveness will be examined using intervention and health service costs. The trial commenced recruitment on 30 November 2018. DISCUSSION: This study evaluates the efficacy and cost-effectiveness of a progressive strength and balance exercise program for aged care residents to reduce falls. The outcomes will aid development of evidenced-based exercise programmes for this vulnerable population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618001827224. Registered on 9 November 2018. Universal trial number U1111-1217-7148.

Caregiving, ethnicity and gender in Maori and non-Maori New Zealanders of advanced age: Findings from LiLACS NZ Kaiawhina (Love and Support) study.

OBJECTIVE: This study investigates sex and ethnicity in relationships of care using data from Wave 4 of LiLACS NZ, a longitudinal study of Maori and non-Maori New Zealanders of advanced age. METHODS: Informal primary carers for LiLACS NZ participants were interviewed about aspects of caregiving. Data were analysed by gender and ethnic group of the LiLACS NZ participant. RESULTS: Carers were mostly adult children or partners, and three-quarters of them were women. Maori and men received more hours of care with a higher estimated dollar value of care. Maori men received the most personal care and household assistance. Carer employment, self-rated health, quality of life and impact of caring did not significantly relate to the gender and ethnicity of care recipients. CONCLUSIONS: Gender and ethnicity are interwoven in caregiving and care receiving. Demographic differences and cultural expectations in both areas must be considered in policies for carer support.

Diagnostic accuracy of a global cognitive screen for Maori and non-Maori octogenarians.

INTRODUCTION: We assessed the sensitivity and specificity of the Modified Mini-Mental State Examination (3MS) in predicting dementia and cognitive impairment in Maori (indigenous people of New Zealand) and non-Maori octogenarians. METHODS: A subsample of participants from Life and Living in Advanced Age: a Cohort Study in New Zealand were recruited to determine the 3MS diagnostic accuracy compared with the reference standard. RESULTS: Seventy-three participants (44% Maori) completed the 3MS and reference standard assessments. The 3MS demonstrated strong diagnostic accuracy to detect dementia with areas under the curve of 0.87 for Maori and 0.9 for non-Maori. Our cutoffs displayed ethnic variability and are approximately 5 points greater than those commonly applied. Cognitive impairment yielded low accuracy, and discriminatory power was not established. DISCUSSION: Cutoffs that are not age or ethnically appropriate may compromise the accuracy of cognitive screens. Consequently, older age and indigeneity increase the risk of mislabeled cognitive status.

High nutrition risk related to dietary intake is associated with an increased risk of hospitalisation and mortality for older Maori: LiLACS NZ.

OBJECTIVES: To investigate the association between domains of nutrition risk with hospitalisations and mortality for New Zealand Maori and non-Maori in advanced age. METHODS: Within LiLACS NZ, 256 Maori and 399 non-Maori octogenarians were assessed for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II) questionnaire according to three domains of risk. Sociodemographic and health characteristics were established. Five years from inception, survival analyses examined associations between nutrition risk from the three domains of SCREEN II with all-cause hospital admissions and mortality. RESULTS: For Maori but not non-Maori, lower nutrition risk in the Dietary Intake domain was associated with reduced hospitalisations and mortality (Hazard Ratios [HR] [95%CI] 0.97 [0.95-0.99], p=0.009 and 0.91 [0.86-0.98], p=0.005, respectively). The 'Factors Affecting Intake' domain was associated with mortality (HR, [95%CI] 0.94 [0.89-1.00], p=0.048), adjusted for age, gender, socioeconomic deprivation, education, previous hospital admissions, comorbidities and activities of daily living. CONCLUSION: Improved dietary adequacy may reduce poor outcomes for older Maori. Implications for public health: Nutrition risk among older Maori is identifiable and treatable. Effort is needed to engage relevant community and whanau (family) support to ensure older Maori have food security and cultural food practices are met.

Testosterone in advance age: a New Zealand longitudinal cohort study: Life and Living in Advanced Age (Te Puawaitanga o Nga Tapuwae Kia Ora Tonu).

OBJECTIVES: Serum testosterone (T) levels in men decline with age. Low T levels are associated with sarcopenia and frailty in men aged >80 years. T levels have not previously been directly associated with disability in older men. We explored associations between T levels, frailty and disability in a cohort of octogenarian men. SETTING: Data from all men from Life and Living in Advanced Age Cohort Study in New Zealand, a longitudinal cohort study in community-dwelling older adults. PARTICIPANTS: Community-dwelling (>80 years) adult men excluding those receiving T treatment or with prostatic carcinoma. OUTCOMES MEASURES: Associations between baseline total testosterone (TT) and calculated free testosterone (fT), frailty (Fried scale) and disability (Nottingham Extended Activities of Daily Living scale (NEADL)) (baseline and 24 months) were examined using multivariate regression and Wald's χ2 techniques. Subjects with the lowest quartile of baseline TT and fT values were compared with those in the upper three quartiles. RESULTS: Participants: 243 men, mean (SD) age 83.7 (2.0) years. Mean (SD) TT=17.6 (6.8) nmol/L and fT=225.3 (85.4) pmol/L. On multivariate analyses, lower TT levels were associated with frailty: ß=0.41, p=0.017, coefficient of determination (R2)=0.10 and disability (NEADL) (ß=-1.27, p=0.017, R2=0.11), low haemoglobin (ß=-7.38, p=0.0016, R2=0.05), high fasting glucose (ß=0.38, p=0.038, R2=0.04) and high C reactive protein (CRP) (ß=3.57, p=0.01, R2=0.06). Low fT levels were associated with frailty (ß=0.39, p=0.024, R2=0.09) but not baseline NEADL (ß=-1.29, p=0.09, R2=0.09). Low fT was associated with low haemoglobin (ß=-7.83, p=0.0008, R2=0.05) and high CRP (ß=2.86, p=0.04, R2=0.05). Relationships between baseline TT and fT, and 24-month outcomes of disability and frailty were not significant. CONCLUSIONS: In men over 80 years, we confirm an association between T levels and baseline frailty scores. The new finding of association between T levels and disability is potentially relevant to debates on T supplementation in older men, though, as associations were not present at 24 months, further work is needed.

What is the relationship between visual impairment and cognitive function in octogenarians?

AIMS: To examine direct and indirect pathways between visual and cognitive function in advanced age. METHODS: We analysed cross-sectional baseline data from Life and Living in Advanced Age: A Cohort Study in New Zealand, which recruited equal sample sizes of Maori (n=421) and non-Maori (n=516) octogenarians. The Modified Mini-Mental State Examination assessed cognitive function. Vision was assessed with self-report and measured distance visual acuity. Associations between visual and cognitive function were explored using general linear models and structural equation modelling. RESULTS: Both Maori (mean age 82) and non-Maori (mean age 85) had good visual acuity [Maori: mean (standard deviation) 0.18 (0.20) logMAR; non-Maori 0.20 (0.17) logMAR] and cognitive function scores [Maori: median (interquartile range) 3MS=90 (11), non-Maori: 94 (8)]. Self-reported visual impairment was present almost 25% of the sample. Adjusting for confounders, no direct association was found between visual and cognitive function. For non-Maori, the path diagram showed the association between vision loss, and cognitive function was mediated by functional status. CONCLUSION: Findings indicate that cognitive function is a multifactorial entity; rather than a direct effect of vision loss, mediating factors appear to contribute to cognitive decline in advanced age.

Micronutrient intake 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).

A high prevalence of undernutrition has previously been reported in indigenous Maori (49 %) and non-Maori (38 %) octogenarians and may be associated with risk of micronutrient deficiencies. We examined vitamin and mineral intakes and the contributing food sources among 216 Maori and 362 non-Maori participating in Life and Living to Advanced age a Cohort Study in New Zealand, using a repeat 24-h multiple-pass recall. More than half of the Maori and non-Maori participants had intakes below the estimated average requirement from food alone for Ca, Mg and Se. Vitamin B6 (Maori women only), folate (women only), vitamin E (Maori women; all men) and Zn (men only) were low in these ethnic and sex subgroups. Women had intakes of higher nutrient density in folate, vitamin C, Ca, Mg, K, vitamin A (non-Maori) and ß-carotene (Maori) compared with men (P<0·05). When controlling for age and physical function, ß-carotene, folate, vitamin C, Ca and Mg were no longer significantly different, but vitamins B2, B12, E and D, Fe, Na, Se and Zn became significantly different for Maori between men and women. When controlling for age and physical function, vitamins A and C and Ca were no longer significantly different, but vitamin B2, Fe, Na and Zn became significantly different for non-Maori between men and women. For those who took nutritional supplements, Maori were less likely to be deficient in food alone intake of vitamin A, folate and Mg, whereas non-Maori were less likely to be deficient in intakes of Mg, K and Zn, but more likely to be deficient in vitamin B12 intake. A lack of harmonisation in nutrient recommendations hinders the interpretation of nutrient adequacy; nonetheless, Ca, Mg and Se are key micronutrients of concern. Milk and cheese were important contributions to Ca intake, whereas bread was a key source of Mg and Se. Examination of dietary intake related to biochemical status and health outcomes will establish the utility of these observations.

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.