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The demographic ageing of the New Zealand population is most marked for those in advanced age (85 years and over) as this population group will increase six-fold by 2050.1 Older people contribute to society in many ways and valued contributions continue into advanced age.2-7 Those in advanced age also utilise the highest per capita public expenditure, mostly on health and disability support.8 Knowing more about the health, cultural profile and social status of those in advanced age will help health planners, society, families and older people prepare for the projected increase in those of advanced age.The life in years (quality of life), rather than years of life (quantity of life), may be particularly relevant for older people, thus quality of life (QoL) is the topic of this paper. Those in advanced age may have higher life satisfaction than the younger old9 and certain factors including social support are more important to QoL for the very old than for younger age groups.10 Economic resources,11 cannot be ignored and there is a complex interaction between economic hardships and social supports.12In New Zealand the material wellbeing of older people has been examined13 and qualitative research has outlined contributions to QoL.14,15 Stephens et al described associations between more and stronger age-related social networks and higher wellbeing16 in those aged 55-70 than was found for younger cohorts. Other research explores the social context of ageing in New Zealand,17,18 but there is a lack of specific information about the octogenarian population. Culture, beliefs and religion also influence successful ageing.19 It is known that social relationships sustain wellbeing, prevent depression,20 aid longevity,21 and interconnect with economic wellbeing in complex ways. A better understanding of the current amount and type of social support for those in advanced age is needed.Te Puwaitanga o Nga Tapuwae Kia ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand, (LiLACS NZ) was funded to describe the health, social and cultural status and to identify predictors of successful advanced ageing of Mori and non-Mori. In acknowledgement of the disparity in longevity for Mori22 and the need for equal explanatory power to establish predictors, two inception cohorts were recruited in 2010; Mori aged 80-90 years (a birth decade) and non-Mori aged 85 years (a single year birth cohort).This paper presents the demographic, social and cultural characteristics and aims to identify correlates of health-related QOL (HRQoL) for the non-Mori cohort. A companion paper reports the Mori data.23MethodsThe detail of LiLACS NZ recruitment and assessment schedule has been described elsewhere.24,25 Eligibility included living in the geographic boundaries of the Bay of Plenty District Health Board and Lakes District Health Board (excluding Taupo region) of the North Island of New Zealand, and being born in the calendar year of 1925. A comprehensive list of all persons in the age group was compiled from the New Zealand General Electoral Roll, primary health care databases, residential care lists and word of mouth. Participants were recruited by personal invitation from their general practitioner, a person known to them or by a letter from the University of Auckland. Those interested were visited or telephoned by a researcher and they or a family member gave written informed consent. Ethical approval for this study was given by the Northern X Regional Ethics Committee NXT09/09/88.A comprehensive baseline assessment was undertaken to assess the health, social, economic, cultural and physical status of participants25 and is briefly summarised here. In this paper socio-demographic information, family contact and support, and cultural practices are reported along with the main outcome of HRQoL.Demographic information: age, gender, marital status, type of house, home ownership, education, living arrangement, main lifetime occupation of participant and partner, religion and income data were gathered using standardised questions. Self-perceived economic wellbeing was assessed with the question: Thinking of your money situation right now, would you say: I can t make ends meet, I have just enough to get along on, or I am comfortable? Socioeconomic deprivation related to their residential address at the time of interview was achieved by the geocoded New Zealand Deprivation Index (NZDep).26Ethnicity was self-identified using the 2001 NZ census question27 and where several ethnicities were identified, New Zealand European was prioritised over other European . Where very small numbers were reported they were grouped for analysis.Size of family, number of living children and number of grandchildren was recorded.Social support was assessed using the approach from the MacArthur studies28 with these questions with a yes or no response: When you need extra help, can you count on anyone to help with daily tasks like grocery shopping, cooking, house cleaning, telephoning, give you a ride? In the last year who has been the most helpful with these daily tasks? Could you have used more help with daily tasks than you received? Can you count on anyone to provide you with emotional support? In the last year who has been most helpful in providing you with emotional support? Could you have used more emotional support than you received? Questions about culture asked of all participants were based on a measure developed in New Zealand29 and by Te R\u014dp\u016bKaitiaki o ng tikanga Mori (Protectors of principles of conduct in Mori research in LiLACS NZ), a cultural guidance and governance group gathered together for LiLACS NZ: Do you live in the same area as your Hap\u016b (Mori term for extended family)/extended family/where you come from? Have you ever been to a marae (sacred Mori meeting place) at all? How often in the last year have you been to a marae? In general, would you say that your contacts are with: mainly Mori, some Mori, few Mori, no Mori? Could you have a conversation about a lot of everyday things in Mori or another language? How important is your language and culture to your wellbeing? Questions about life roles and the importance of aspects of life to wellbeing were asked: Roles within the whnau and family (Yes, No) Role within the community and neighbourhood (Yes, No) Satisfaction with those roles (extremely to not at all) The importance of family to wellbeing (extremely to not at all) Importance of faith to wellbeing (extremely to not at all) All participants were asked about discrimination using standard questions from the 2006/2007 New Zealand Health Survey:30 Have you ever been the victim of an ethnically motivated attack in New Zealand? (verbal or physical; further ago or within 12 months) Have you ever been treated unfairly by a service agency (eg WINZ) because of your ethnicity in New Zealand? Have you ever been treated unfairly when renting or buying housing because of your ethnicity in New Zealand? Have you ever been treated unfairly by a health professional because of your ethnicity in New Zealand? Discrimination questions were collapsed into 'ever' vs 'never experienced' discrimination.HRQoL was assessed with the SF-12 Version 2\u00ae including the summary scores for physical and mental HRQoL.31 Scores vary between 0 (worst health/QoL) and 100 (best health/QoL) with a mean score of 50. The Nottingham Extended Activities of Daily Living (NEADL) was used to assess functional status.32 Scores range from 0 to 22 with higher being better.The questionnaire was undertaken with the participant by trained lay and nurse interviewers using standardised techniques and took a minimum of two hours. For some participants two or more visits were required for full completion. Each completed questionnaire was quality checked by two different coordinators, and any queries referred back to the interviewer for rectification and contact with the participant if required.Analyses. Descriptive statistics showed status of participants on demographic, social, economic and cultural variables. Generalised linear models or the Cochran-Mantel-Haenszel test were used to compare status by gender as appropriate.Functional status was a priori selected as being known to be highly correlated with HRQoL, and HRQoL differed between genders. Gender and functional status (NEADL score) were considered confounding variables. Each variable in Tables 1, 2 and 3 was tested against mental HRQoL and physical HRQoL adjusting for gender and functional status in a brief model . For those variables showing a significance of p<0.1 models were further adjusted for the early life socioeconomic status (SES) marker of highest education level, midlife marker of main family occupation ascertained by the higher occupational status of participant or lifetime partner, and current SES marker reflected by perceived economic wellbeing in a full model . Adjusted means are presented for the models. Interactions between gender and marital status and gender and living arrangement were explored.ResultsOf all eligible non-Mori available in the study area, 59% (516 participants) agreed to participate. All completed a core set of questions (shown in Tables 1 & 2 with shading) and 404 completed the full questionnaire with additional questions expanding on the core set, one participant did not complete the questionnaire because of change of mind. Those completing the full questionnaire differed from those completing only the core. Firstly core questionnaire participants were more likely to be living in residential care 24/111 (22%) of core respondents were in residential care and 23/404 (3%) of those completing the full questionnaire were in residential care) (p<0.001). Secondly core questionnaire respondents were more likely to have the questionnaire completed by a proxy 17/111 (15%) of those completing the core questions were represented by a proxy and 16/404 (4%) of those completing the full questionnaire were represented by a proxy) (p<0.0001). Thirdly, core respondents were more likely to be dependent in personal care, toileting, getting in and out of bed, making a hot drink, doing shopping and using the phone (p<0.001 on each).Socio-demographic and economic characteristicsTable 1 provides an overview of the socio-demographic and economic characteristics of the sample. About 80% were born in New Zealand and half of those born overseas identified as New Zealand European. Other countries of birth included: Australia (4), England (including northern Ireland, 58), Scotland (12), Ireland or Wales (3), Netherlands (7), Other Central or Western European countries (6), Indonesia (3), Sri Lanka, Japan, Fiji, Canada or Brazil (6). Self-identified ethnicity for non-Mori consists of those who identified as New Zealand European (89%), other European (10%), and other being Pacific (3), Asian, Middle Eastern or South African (4).Table 1: Socio-demographic, economic and family makeup characteristics of non-Mori aged 85 years in LiLACS NZ. Men Women Total All participants\u2014core interview Full interview completed 237 (46%) 190 (47%) 278 (54%) 214 (53%) 515 404 Age, mean (sd) 84.6 (0.5) 84.6 (0.5) 84.6 (0.5) Country of birth, n (%) Born in NZ Born Overseas 185 (78) 52 (22) 229 (82) 49 (18) 414 (80) 101 (20) Ethnicity, n (%) NZ European Other European Other (Pacific, Asian, Middle Eastern) 213 (89) 23 (10) 2 (1) 251 (90) 22 (8) 5 (2) 462 (89) 45 (10) 7 (1) Childhood family size, mean (sd) Total family size Sisters Brothers Sisters still living Brothers still living 4.6 (2.8) 1.7 (1.6) 1.8 (1.8) 0.8 (1.0) 0.6 (0.9) 4.3 (2.6) 1.6 (1.7) 1.7 (1.6) 0.6 (0.8) 0.5 (0.9) 4.4 (2.7) 1.7 (1.7) 1.8 (1.7) 0.7 (0.9) 0.6 (0.9) Marital status, n (%) Never married Widowed Divorced Married/ partnered 10 (4) 73 (31) 14 (6) 137 (59) 8 (3) 184 (67) 17 (6) 67 (24) 18 (4) 257 (50) 31 (6) 204 (40)* Number living children, n (%) Number grandchildren, mean (sd) None 1-3 4-6 11 (6) 115 (61) 62 (33) 7 (6.3) 9 (4) 135 (63) 69 (32) 7.2 (5.3) 20 (5) 250 (62) 131 (33) 7.1 (5.8) Living arrangement, n (%) Alone With spouse With other If with other average number in house, mean (sd) 61 (32) 106 (56) 23 (12) 2.4 (1.0) 134 (63) 48 (22) 32 (15) 2.9 (1.2) 195 (48)* 154 (38) 55 (14) 2.7 (1.2) Type of house, n (%) Stand alone house Unit/apt Retirement village Residential care Other 115 (61) 26 (14) 35 (19) 9 (4) 5 (3) 121 (57) 33 (15) 39 (18) 15 (6) 6 (4) 236 (59) 60 (15) 74 (18) 23 (5) 11 (4) Home ownership, n (%) Owns own home outright Rental 155 (89) 20 (11) 170 (90) 20 (11) 325 (89) 40 (11) Deprivation, NZDep area score, n (%) 1-4 Low 5-7 Med 8-10 High 34 (14) 123 (52) 80 (34) 41 (15) 146 (53) 91 (33) 75 (15) 269 (52) 171 (33) Income, n (%) NZ Superannuation (NZS) only Other income as well as NZS 49 (26) 137 (74) 69 (32) 144 (68) 118 (30) 281 (70) Main family occupation\u00a7, n (%) Professionals Technicians Clerks 93 (39) 38 (16) 106 (45) 107 (38) 49 (18) 122 (44) 200 (39) 87 (17) 228 (44) Thinking for your money situation right now\u2014(%) Can t make ends meet Just enough I am comfortable 2 (1) 38 (20) 149 (79) 0 49 (23) 163 (77) 2 (.5) 87 (22) 312 (78) Education, n (%) Tertiary Trade Any secondary Primary only or none 38 (16) 26 (11) 125 (54) 44 (19) 30 (11) 34 (13) 170 (62) 39 (14) 68 (13) 60 (12) 295 (58) 83 (16) Shaded items show core questions included in the core interview answered by all and unshaded are questions in the full interview. Childhood family size is siblings only, not including parents.\u00a7Professional: -Legislators, Administrators, Professionals, Agricultural and Fishery WorkersTechnicians:- technicians, Associate Professionals and Trades WorkersNon-technical :- Clerks, Service Workers, Sales Workers, Plant/Machine Operators, Assemblers, Elementary Workers. * significant difference between men and women p<0.05More men were married (59% cf 24% of women, p<0.001) and more women were living alone (63% cf 32% of men, p<0.001) with 32 (15%) women living with others and 12 (6%) women living in residential aged care. Overall, 4% had never married and 5% had no children.Most (89%) owned their own home and income from non-New Zealand Superannuation (NZS) sources included other superannuation (eg workplace schemes) 11%, other pensions 12%, investments 50%, with less than 5% receiving income from salary and wages, tribal land trusts or inheritance.Table 2 shows social support, importance of faith, QoL and functional status. Religious affiliation was recorded with 68 (17%) reporting no religion (not in Table) and 13% reporting that faith was not at all important to their wellbeing. No non-Mori participated in Mori faith. Other religions included Baptist (11), Christian (8), open Brethren (3), Salvation army (4), Seventh Day Adventist, Jehovah s Witness, Protestant and Pentecostal (2 each). Four did not answer the question about religion and one each reported religion as: all encompassing, belief in the creator, interdenominational, Liberal Christian, non-conformist, non-denominational, Spiritual Church, and Theosophical Society.Table 2: Social support, importance of faith, QoL and functional status of LiLACS NZ non-Mori participants. Men Women Total Full interview completed 190 (47%) 214 (53%) 404 Religion, n (%) Anglican Catholic Presbyterian Methodist Other 59 (41) 14 (10) 43 (30) 6 (4) 22 (15) 78 (42) 19 (10) 53 (28) 12 (6) 26 (14) 137 (41) 33 (10) 96 (29) 18 (5) 48 (15) Importance of faith to your wellbeing, n (%) Not at all A little Moderately Very Extremely 33 (18) 13 (7) 39 (21) 67 (36) 32 (17) 19 (9) 16 (8) 40 (19) 86 (41) 51 (24) 52 (13) 29 (7) 79 (20) 153 (39) 83 (21) Anyone to help with daily tasks? n (%) Yes No I don t need help 145 (77) 6 (3) 37 (20) 175 (83) 11 (5) 25 (12) 320 (80) 17 (4) 62 (16) Who has been the most helpful? n (%) Spouse Daughter Son Other relative Other 65 (43) 23 (15) 10 (7) 7 (5) 48 (31) 34 (19) 61 (35) 22 (13) 7 (4) 51 (29) 99 (30) 84 (26) 32 (10) 14 (4) 99 (30) Could have used more practical help? n (%) Yes 14 (8) 28 (14) 42 (11) Count on anyone to provide emotional support? n (%) No Yes I don t need emotional support 7 (4) 142 (76) 37 (20) 14 (7) 177 (85) 17 (8) 21 (5) 319 (81) 54 (14) Who most helpful? n (%) Spouse Daughter Son Other relative Other 78 (55) 22 (16) 15 (11) 5 (4) 21 (15) 30 (18) 68 (40) 24 (14) 10 (6) 39 (23) 108 (35) 90 (29) 39 (13) 15 (5) 60 (19) Could have used more emotional support? n (%) Yes 7 (4) 15 (7) 22 (6) *** difference between men and women p<0.001NEADL Nottingham Extended Activity of Daily Living scale. QoL = quality of life.\u2014a higher score means better QoL, range 0-100.Social support was reported as present by most with 20% of men reporting that they did not need help. A daughter was the main support for women and the spouse for men for both practical and emotional support. Thirty and 19% of non-Mori received practical and emotional support, respectively, from others which included formal paid support workers, 14% of women and 8% of men (p=0.051) reported an unmet need for practical help.Function and QoLTable 2 shows a mean score of 41 for physical HRQoL which indicates that HRQoL is below the mean for a standard older population33 and was higher (better) in men (p=0.005). Mental HRQoL was slightly higher than physical HRQoL, and was similar in men and women.Functional status was similar between men and women and varied according to living arrangement. Those living with others, including those in residential care, had the lowest NEADL scores with a mean of 13.1 (sd 7.0) compared with means of 17.9 (sd 3.0) for those living with their spouse and 18.7 (sd 2.6) for those living alone (p<0.001). Neither physical HRQoL nor mental HRQoL varied by living arrangement when adjusted for SES and functional status.Just under a third of non-Mori in advanced age had mainly or some Mori contacts (Table 3). While the majority (69%) had been to a marae, few (14%) had been once or more in the last year.Table 3: Socio-cultural characteristics of LiLACS NZ non-Mori participants. Men Women Total All participants\u2014core interview, n (%) Full interview completed, n (%) 237 (46%) 190 (47%) 278 (54%) 214 (53%) 515 404 Do you live in the same area as your hpu/ extended family/where you come from? No Yes 219 (93) 16 (7) 247 (89) 29 (11) 466 (91) 45 (9) Have you ever been to a marae at all? No Yes 51 (27) 139 (73) 74 (35) 138 (65) 125 (31) 277 (69) How often in the last 12 months have you been to a marae? Less than yearly* Once A few times Several times, more than monthly 156 (82) 26 (14) 5 (3) 3 (2) 193 (91) 15 (7) 3 (1) 1 (0) 349 (87) 41 (10) 8 (2) 4 (1) Are your contacts with Mainly Mori Some Mori Few/no Mori 1 (1) 51 (27) 137 (72) 2 (1) 71 (33) 140 (66) 3 (1) 122 (30) 277 (69) Importance of language and culture to wellbeing Not at all/moderately Very Extremely 64 (35) 103 (56) 17 (9) 70 (33) 120 (56) 23 (11) 134 (34) 223 (56) 40 (10) Importance of family to wellbeing Not at all/moderately Very Extremely 27 (15) 105 (56) 54 (29) 13 (6) 105 (49) 95 (45) 40 (10) 210 (53) 149 (37) Specific role in local community/ neighbourhood No Yes 160 (85) 29 (15) 177 (83) 35 (17) 337 (84) 64 (16) How satisfied with role in local community/neighbourhood? Not at all/moderately Very Extremely 9 (29) 18 (58) 4 (13) 7 (20) 25 (71) 3 (9) 16 (24) 43 (65) 7 (11) Do you have a specific role in your family? No Yes 75 (40) 113 (60) 69 (33) 141 (67) 144 (36) 254 (64) Satisfaction with role in your family? Not at all/moderately Very Extremely 11 (10) 88 (77) \

Summary

Abstract

Aim

To establish socioeconomic and cultural profiles and correlates of quality of life (QoL) in non-Mori of advanced age.

Method

Method: A cross sectional analysis of the baseline data of a cohort study of 516 non-Mori 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

Results: Of the 516 non-Mori 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

Conclusion

Conclusion: Amongst our sample of non-Mori people of advanced age, those with unmet support needs reported low HRQoL. Functional status was most strongly associated with mental and physical HRQoL.

Author Information

Ngaire Kerse, Professor and Head, School of Population Health, Tmaki, University of Auckland; Ruth Teh, Senior Lecturer, Department of General Practice and Primary Health Care, School of Population Health, Tmaki, University of Auckland; Simon A Moyes, Statistician, Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland; Lorna Dyall, Senior Lecturer, Department of General Practice and Primary Health Care, School of Population Health, Tmaki, University of Auckland; Janine L. Wiles, Senior Lecturer, Social and Community Health, School of Population Health, Tmaki Campus, University of Auckland; Mere K\u0113pa, Honorary Senior Research Fellow, Department of General Practice and Primary Health Care, School of Population Health, Tmaki Campus, University of Auckland; Carol Wham, Senior Lecturer, Institute of Food, Nutrition and Human Health, Massey University, Auckland; Karen Hayman, Research Fellow, Department of General Practice and Primary Health Care, School of Population Health, Tmaki Campus, University of Auckland; Martin Connolly, Freemasons Professor of Geriatric Medicine, Freemason s Department of Geriatric Medicine, University of Auckland and Waitemata District Health Board; Tim Wilkinson, Professor of Medicine, Department of Medicine, University of Otago, Christchurch, New Zealand; Valerie Wright St Clair, Associate Professor, School of Occupational Science and Therapy, and Co-Director Active Ageing Research Group Auckland University of Technology, New Zealand; Sally Keeling, Senior Lecturer, Department of Medicine, University of Otago, Christchurch, New Zealand; Joanna Broad, Senior Research Fellow, Freemason s Department of Geriatric Medicine, North Shore, University of Auckland; Santosh Jatrana, Associate Professor, Alfred Deakin Institute for Citizenship & Globalisation, Deakin University Waterfront Campus, Geelong, Victoria, Australia. Honorary Senior Research Fellow, University of Otago, Wellington; Thomas Lumley, Professor of Biostatistics, Department of Statistics, University of Auckland.

Acknowledgements

We acknowledge the expertise of our subcontractors: the Western Bay of Plenty Primary Health Organisation, Ng Matpuna Oranga Kaupapa Mori Primary Health Organisation, Te Korowai Aroha Trust, Te R\u016bnanga o Ngati Pikiao, Rotorua Area Primary Health Services, Ngati Awa Research & Archives Trust, Te R\u016bnanga o Ngati Irapuaia and Te Whanau a Apanui Community Health Centre in conducting the study through the Bay of Plenty and Rotorua. We thank all participants and their Whnau for participation, and the local organisations that promoted the study. We thank the R\u014dpuKaitiaki: Hone and Florence Kameta, Betty McPherson, Paea Smith, Leiana Reynolds and Waiora Port for their guidance. Funding for this study was from a programme grant from the Health Research Council of New Zealand, a project grant from Ng Pae o te Mramatanga. The Rotorua Energy Charitable Trust supported meetings and activities in Rotorua. The Ministry of Health provides funds for ongoing data collection and we acknowledge their support for manuscript production. Newcastle University provided academic accommodation for NK during finalisation of the manuscript.

Correspondence

Ngaire Kerse, University of Auckland, School of Population Health, Private Bag 92019, Auckland.

Correspondence Email

n.kerse@auckland.ac.nz

Competing Interests

Dr Hayman and Dr Kerse report grants from the Health Research Council of New Zealand and the Ministry of Health during the conduct of the study; Dr Wiles reports grants from HRC during the conduct of the study.

'-- Statistics New ealand. Demographic Trends: 2012. Wellington, New Zealand: Statistics New Zealand, 2012. Wiles J. Age cannot wither her, nor custom stale her infinite variety. Elder Care. 1999 Jul-Aug;11(5):10-4. Bondevik M. Historical, cr

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The demographic ageing of the New Zealand population is most marked for those in advanced age (85 years and over) as this population group will increase six-fold by 2050.1 Older people contribute to society in many ways and valued contributions continue into advanced age.2-7 Those in advanced age also utilise the highest per capita public expenditure, mostly on health and disability support.8 Knowing more about the health, cultural profile and social status of those in advanced age will help health planners, society, families and older people prepare for the projected increase in those of advanced age.The life in years (quality of life), rather than years of life (quantity of life), may be particularly relevant for older people, thus quality of life (QoL) is the topic of this paper. Those in advanced age may have higher life satisfaction than the younger old9 and certain factors including social support are more important to QoL for the very old than for younger age groups.10 Economic resources,11 cannot be ignored and there is a complex interaction between economic hardships and social supports.12In New Zealand the material wellbeing of older people has been examined13 and qualitative research has outlined contributions to QoL.14,15 Stephens et al described associations between more and stronger age-related social networks and higher wellbeing16 in those aged 55-70 than was found for younger cohorts. Other research explores the social context of ageing in New Zealand,17,18 but there is a lack of specific information about the octogenarian population. Culture, beliefs and religion also influence successful ageing.19 It is known that social relationships sustain wellbeing, prevent depression,20 aid longevity,21 and interconnect with economic wellbeing in complex ways. A better understanding of the current amount and type of social support for those in advanced age is needed.Te Puwaitanga o Nga Tapuwae Kia ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand, (LiLACS NZ) was funded to describe the health, social and cultural status and to identify predictors of successful advanced ageing of Mori and non-Mori. In acknowledgement of the disparity in longevity for Mori22 and the need for equal explanatory power to establish predictors, two inception cohorts were recruited in 2010; Mori aged 80-90 years (a birth decade) and non-Mori aged 85 years (a single year birth cohort).This paper presents the demographic, social and cultural characteristics and aims to identify correlates of health-related QOL (HRQoL) for the non-Mori cohort. A companion paper reports the Mori data.23MethodsThe detail of LiLACS NZ recruitment and assessment schedule has been described elsewhere.24,25 Eligibility included living in the geographic boundaries of the Bay of Plenty District Health Board and Lakes District Health Board (excluding Taupo region) of the North Island of New Zealand, and being born in the calendar year of 1925. A comprehensive list of all persons in the age group was compiled from the New Zealand General Electoral Roll, primary health care databases, residential care lists and word of mouth. Participants were recruited by personal invitation from their general practitioner, a person known to them or by a letter from the University of Auckland. Those interested were visited or telephoned by a researcher and they or a family member gave written informed consent. Ethical approval for this study was given by the Northern X Regional Ethics Committee NXT09/09/88.A comprehensive baseline assessment was undertaken to assess the health, social, economic, cultural and physical status of participants25 and is briefly summarised here. In this paper socio-demographic information, family contact and support, and cultural practices are reported along with the main outcome of HRQoL.Demographic information: age, gender, marital status, type of house, home ownership, education, living arrangement, main lifetime occupation of participant and partner, religion and income data were gathered using standardised questions. Self-perceived economic wellbeing was assessed with the question: Thinking of your money situation right now, would you say: I can t make ends meet, I have just enough to get along on, or I am comfortable? Socioeconomic deprivation related to their residential address at the time of interview was achieved by the geocoded New Zealand Deprivation Index (NZDep).26Ethnicity was self-identified using the 2001 NZ census question27 and where several ethnicities were identified, New Zealand European was prioritised over other European . Where very small numbers were reported they were grouped for analysis.Size of family, number of living children and number of grandchildren was recorded.Social support was assessed using the approach from the MacArthur studies28 with these questions with a yes or no response: When you need extra help, can you count on anyone to help with daily tasks like grocery shopping, cooking, house cleaning, telephoning, give you a ride? In the last year who has been the most helpful with these daily tasks? Could you have used more help with daily tasks than you received? Can you count on anyone to provide you with emotional support? In the last year who has been most helpful in providing you with emotional support? Could you have used more emotional support than you received? Questions about culture asked of all participants were based on a measure developed in New Zealand29 and by Te R\u014dp\u016bKaitiaki o ng tikanga Mori (Protectors of principles of conduct in Mori research in LiLACS NZ), a cultural guidance and governance group gathered together for LiLACS NZ: Do you live in the same area as your Hap\u016b (Mori term for extended family)/extended family/where you come from? Have you ever been to a marae (sacred Mori meeting place) at all? How often in the last year have you been to a marae? In general, would you say that your contacts are with: mainly Mori, some Mori, few Mori, no Mori? Could you have a conversation about a lot of everyday things in Mori or another language? How important is your language and culture to your wellbeing? Questions about life roles and the importance of aspects of life to wellbeing were asked: Roles within the whnau and family (Yes, No) Role within the community and neighbourhood (Yes, No) Satisfaction with those roles (extremely to not at all) The importance of family to wellbeing (extremely to not at all) Importance of faith to wellbeing (extremely to not at all) All participants were asked about discrimination using standard questions from the 2006/2007 New Zealand Health Survey:30 Have you ever been the victim of an ethnically motivated attack in New Zealand? (verbal or physical; further ago or within 12 months) Have you ever been treated unfairly by a service agency (eg WINZ) because of your ethnicity in New Zealand? Have you ever been treated unfairly when renting or buying housing because of your ethnicity in New Zealand? Have you ever been treated unfairly by a health professional because of your ethnicity in New Zealand? Discrimination questions were collapsed into 'ever' vs 'never experienced' discrimination.HRQoL was assessed with the SF-12 Version 2\u00ae including the summary scores for physical and mental HRQoL.31 Scores vary between 0 (worst health/QoL) and 100 (best health/QoL) with a mean score of 50. The Nottingham Extended Activities of Daily Living (NEADL) was used to assess functional status.32 Scores range from 0 to 22 with higher being better.The questionnaire was undertaken with the participant by trained lay and nurse interviewers using standardised techniques and took a minimum of two hours. For some participants two or more visits were required for full completion. Each completed questionnaire was quality checked by two different coordinators, and any queries referred back to the interviewer for rectification and contact with the participant if required.Analyses. Descriptive statistics showed status of participants on demographic, social, economic and cultural variables. Generalised linear models or the Cochran-Mantel-Haenszel test were used to compare status by gender as appropriate.Functional status was a priori selected as being known to be highly correlated with HRQoL, and HRQoL differed between genders. Gender and functional status (NEADL score) were considered confounding variables. Each variable in Tables 1, 2 and 3 was tested against mental HRQoL and physical HRQoL adjusting for gender and functional status in a brief model . For those variables showing a significance of p<0.1 models were further adjusted for the early life socioeconomic status (SES) marker of highest education level, midlife marker of main family occupation ascertained by the higher occupational status of participant or lifetime partner, and current SES marker reflected by perceived economic wellbeing in a full model . Adjusted means are presented for the models. Interactions between gender and marital status and gender and living arrangement were explored.ResultsOf all eligible non-Mori available in the study area, 59% (516 participants) agreed to participate. All completed a core set of questions (shown in Tables 1 & 2 with shading) and 404 completed the full questionnaire with additional questions expanding on the core set, one participant did not complete the questionnaire because of change of mind. Those completing the full questionnaire differed from those completing only the core. Firstly core questionnaire participants were more likely to be living in residential care 24/111 (22%) of core respondents were in residential care and 23/404 (3%) of those completing the full questionnaire were in residential care) (p<0.001). Secondly core questionnaire respondents were more likely to have the questionnaire completed by a proxy 17/111 (15%) of those completing the core questions were represented by a proxy and 16/404 (4%) of those completing the full questionnaire were represented by a proxy) (p<0.0001). Thirdly, core respondents were more likely to be dependent in personal care, toileting, getting in and out of bed, making a hot drink, doing shopping and using the phone (p<0.001 on each).Socio-demographic and economic characteristicsTable 1 provides an overview of the socio-demographic and economic characteristics of the sample. About 80% were born in New Zealand and half of those born overseas identified as New Zealand European. Other countries of birth included: Australia (4), England (including northern Ireland, 58), Scotland (12), Ireland or Wales (3), Netherlands (7), Other Central or Western European countries (6), Indonesia (3), Sri Lanka, Japan, Fiji, Canada or Brazil (6). Self-identified ethnicity for non-Mori consists of those who identified as New Zealand European (89%), other European (10%), and other being Pacific (3), Asian, Middle Eastern or South African (4).Table 1: Socio-demographic, economic and family makeup characteristics of non-Mori aged 85 years in LiLACS NZ. Men Women Total All participants\u2014core interview Full interview completed 237 (46%) 190 (47%) 278 (54%) 214 (53%) 515 404 Age, mean (sd) 84.6 (0.5) 84.6 (0.5) 84.6 (0.5) Country of birth, n (%) Born in NZ Born Overseas 185 (78) 52 (22) 229 (82) 49 (18) 414 (80) 101 (20) Ethnicity, n (%) NZ European Other European Other (Pacific, Asian, Middle Eastern) 213 (89) 23 (10) 2 (1) 251 (90) 22 (8) 5 (2) 462 (89) 45 (10) 7 (1) Childhood family size, mean (sd) Total family size Sisters Brothers Sisters still living Brothers still living 4.6 (2.8) 1.7 (1.6) 1.8 (1.8) 0.8 (1.0) 0.6 (0.9) 4.3 (2.6) 1.6 (1.7) 1.7 (1.6) 0.6 (0.8) 0.5 (0.9) 4.4 (2.7) 1.7 (1.7) 1.8 (1.7) 0.7 (0.9) 0.6 (0.9) Marital status, n (%) Never married Widowed Divorced Married/ partnered 10 (4) 73 (31) 14 (6) 137 (59) 8 (3) 184 (67) 17 (6) 67 (24) 18 (4) 257 (50) 31 (6) 204 (40)* Number living children, n (%) Number grandchildren, mean (sd) None 1-3 4-6 11 (6) 115 (61) 62 (33) 7 (6.3) 9 (4) 135 (63) 69 (32) 7.2 (5.3) 20 (5) 250 (62) 131 (33) 7.1 (5.8) Living arrangement, n (%) Alone With spouse With other If with other average number in house, mean (sd) 61 (32) 106 (56) 23 (12) 2.4 (1.0) 134 (63) 48 (22) 32 (15) 2.9 (1.2) 195 (48)* 154 (38) 55 (14) 2.7 (1.2) Type of house, n (%) Stand alone house Unit/apt Retirement village Residential care Other 115 (61) 26 (14) 35 (19) 9 (4) 5 (3) 121 (57) 33 (15) 39 (18) 15 (6) 6 (4) 236 (59) 60 (15) 74 (18) 23 (5) 11 (4) Home ownership, n (%) Owns own home outright Rental 155 (89) 20 (11) 170 (90) 20 (11) 325 (89) 40 (11) Deprivation, NZDep area score, n (%) 1-4 Low 5-7 Med 8-10 High 34 (14) 123 (52) 80 (34) 41 (15) 146 (53) 91 (33) 75 (15) 269 (52) 171 (33) Income, n (%) NZ Superannuation (NZS) only Other income as well as NZS 49 (26) 137 (74) 69 (32) 144 (68) 118 (30) 281 (70) Main family occupation\u00a7, n (%) Professionals Technicians Clerks 93 (39) 38 (16) 106 (45) 107 (38) 49 (18) 122 (44) 200 (39) 87 (17) 228 (44) Thinking for your money situation right now\u2014(%) Can t make ends meet Just enough I am comfortable 2 (1) 38 (20) 149 (79) 0 49 (23) 163 (77) 2 (.5) 87 (22) 312 (78) Education, n (%) Tertiary Trade Any secondary Primary only or none 38 (16) 26 (11) 125 (54) 44 (19) 30 (11) 34 (13) 170 (62) 39 (14) 68 (13) 60 (12) 295 (58) 83 (16) Shaded items show core questions included in the core interview answered by all and unshaded are questions in the full interview. Childhood family size is siblings only, not including parents.\u00a7Professional: -Legislators, Administrators, Professionals, Agricultural and Fishery WorkersTechnicians:- technicians, Associate Professionals and Trades WorkersNon-technical :- Clerks, Service Workers, Sales Workers, Plant/Machine Operators, Assemblers, Elementary Workers. * significant difference between men and women p<0.05More men were married (59% cf 24% of women, p<0.001) and more women were living alone (63% cf 32% of men, p<0.001) with 32 (15%) women living with others and 12 (6%) women living in residential aged care. Overall, 4% had never married and 5% had no children.Most (89%) owned their own home and income from non-New Zealand Superannuation (NZS) sources included other superannuation (eg workplace schemes) 11%, other pensions 12%, investments 50%, with less than 5% receiving income from salary and wages, tribal land trusts or inheritance.Table 2 shows social support, importance of faith, QoL and functional status. Religious affiliation was recorded with 68 (17%) reporting no religion (not in Table) and 13% reporting that faith was not at all important to their wellbeing. No non-Mori participated in Mori faith. Other religions included Baptist (11), Christian (8), open Brethren (3), Salvation army (4), Seventh Day Adventist, Jehovah s Witness, Protestant and Pentecostal (2 each). Four did not answer the question about religion and one each reported religion as: all encompassing, belief in the creator, interdenominational, Liberal Christian, non-conformist, non-denominational, Spiritual Church, and Theosophical Society.Table 2: Social support, importance of faith, QoL and functional status of LiLACS NZ non-Mori participants. Men Women Total Full interview completed 190 (47%) 214 (53%) 404 Religion, n (%) Anglican Catholic Presbyterian Methodist Other 59 (41) 14 (10) 43 (30) 6 (4) 22 (15) 78 (42) 19 (10) 53 (28) 12 (6) 26 (14) 137 (41) 33 (10) 96 (29) 18 (5) 48 (15) Importance of faith to your wellbeing, n (%) Not at all A little Moderately Very Extremely 33 (18) 13 (7) 39 (21) 67 (36) 32 (17) 19 (9) 16 (8) 40 (19) 86 (41) 51 (24) 52 (13) 29 (7) 79 (20) 153 (39) 83 (21) Anyone to help with daily tasks? n (%) Yes No I don t need help 145 (77) 6 (3) 37 (20) 175 (83) 11 (5) 25 (12) 320 (80) 17 (4) 62 (16) Who has been the most helpful? n (%) Spouse Daughter Son Other relative Other 65 (43) 23 (15) 10 (7) 7 (5) 48 (31) 34 (19) 61 (35) 22 (13) 7 (4) 51 (29) 99 (30) 84 (26) 32 (10) 14 (4) 99 (30) Could have used more practical help? n (%) Yes 14 (8) 28 (14) 42 (11) Count on anyone to provide emotional support? n (%) No Yes I don t need emotional support 7 (4) 142 (76) 37 (20) 14 (7) 177 (85) 17 (8) 21 (5) 319 (81) 54 (14) Who most helpful? n (%) Spouse Daughter Son Other relative Other 78 (55) 22 (16) 15 (11) 5 (4) 21 (15) 30 (18) 68 (40) 24 (14) 10 (6) 39 (23) 108 (35) 90 (29) 39 (13) 15 (5) 60 (19) Could have used more emotional support? n (%) Yes 7 (4) 15 (7) 22 (6) *** difference between men and women p<0.001NEADL Nottingham Extended Activity of Daily Living scale. QoL = quality of life.\u2014a higher score means better QoL, range 0-100.Social support was reported as present by most with 20% of men reporting that they did not need help. A daughter was the main support for women and the spouse for men for both practical and emotional support. Thirty and 19% of non-Mori received practical and emotional support, respectively, from others which included formal paid support workers, 14% of women and 8% of men (p=0.051) reported an unmet need for practical help.Function and QoLTable 2 shows a mean score of 41 for physical HRQoL which indicates that HRQoL is below the mean for a standard older population33 and was higher (better) in men (p=0.005). Mental HRQoL was slightly higher than physical HRQoL, and was similar in men and women.Functional status was similar between men and women and varied according to living arrangement. Those living with others, including those in residential care, had the lowest NEADL scores with a mean of 13.1 (sd 7.0) compared with means of 17.9 (sd 3.0) for those living with their spouse and 18.7 (sd 2.6) for those living alone (p<0.001). Neither physical HRQoL nor mental HRQoL varied by living arrangement when adjusted for SES and functional status.Just under a third of non-Mori in advanced age had mainly or some Mori contacts (Table 3). While the majority (69%) had been to a marae, few (14%) had been once or more in the last year.Table 3: Socio-cultural characteristics of LiLACS NZ non-Mori participants. Men Women Total All participants\u2014core interview, n (%) Full interview completed, n (%) 237 (46%) 190 (47%) 278 (54%) 214 (53%) 515 404 Do you live in the same area as your hpu/ extended family/where you come from? No Yes 219 (93) 16 (7) 247 (89) 29 (11) 466 (91) 45 (9) Have you ever been to a marae at all? No Yes 51 (27) 139 (73) 74 (35) 138 (65) 125 (31) 277 (69) How often in the last 12 months have you been to a marae? Less than yearly* Once A few times Several times, more than monthly 156 (82) 26 (14) 5 (3) 3 (2) 193 (91) 15 (7) 3 (1) 1 (0) 349 (87) 41 (10) 8 (2) 4 (1) Are your contacts with Mainly Mori Some Mori Few/no Mori 1 (1) 51 (27) 137 (72) 2 (1) 71 (33) 140 (66) 3 (1) 122 (30) 277 (69) Importance of language and culture to wellbeing Not at all/moderately Very Extremely 64 (35) 103 (56) 17 (9) 70 (33) 120 (56) 23 (11) 134 (34) 223 (56) 40 (10) Importance of family to wellbeing Not at all/moderately Very Extremely 27 (15) 105 (56) 54 (29) 13 (6) 105 (49) 95 (45) 40 (10) 210 (53) 149 (37) Specific role in local community/ neighbourhood No Yes 160 (85) 29 (15) 177 (83) 35 (17) 337 (84) 64 (16) How satisfied with role in local community/neighbourhood? Not at all/moderately Very Extremely 9 (29) 18 (58) 4 (13) 7 (20) 25 (71) 3 (9) 16 (24) 43 (65) 7 (11) Do you have a specific role in your family? No Yes 75 (40) 113 (60) 69 (33) 141 (67) 144 (36) 254 (64) Satisfaction with role in your family? Not at all/moderately Very Extremely 11 (10) 88 (77) \

Summary

Abstract

Aim

To establish socioeconomic and cultural profiles and correlates of quality of life (QoL) in non-Mori of advanced age.

Method

Method: A cross sectional analysis of the baseline data of a cohort study of 516 non-Mori 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

Results: Of the 516 non-Mori 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

Conclusion

Conclusion: Amongst our sample of non-Mori people of advanced age, those with unmet support needs reported low HRQoL. Functional status was most strongly associated with mental and physical HRQoL.

Author Information

Ngaire Kerse, Professor and Head, School of Population Health, Tmaki, University of Auckland; Ruth Teh, Senior Lecturer, Department of General Practice and Primary Health Care, School of Population Health, Tmaki, University of Auckland; Simon A Moyes, Statistician, Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland; Lorna Dyall, Senior Lecturer, Department of General Practice and Primary Health Care, School of Population Health, Tmaki, University of Auckland; Janine L. Wiles, Senior Lecturer, Social and Community Health, School of Population Health, Tmaki Campus, University of Auckland; Mere K\u0113pa, Honorary Senior Research Fellow, Department of General Practice and Primary Health Care, School of Population Health, Tmaki Campus, University of Auckland; Carol Wham, Senior Lecturer, Institute of Food, Nutrition and Human Health, Massey University, Auckland; Karen Hayman, Research Fellow, Department of General Practice and Primary Health Care, School of Population Health, Tmaki Campus, University of Auckland; Martin Connolly, Freemasons Professor of Geriatric Medicine, Freemason s Department of Geriatric Medicine, University of Auckland and Waitemata District Health Board; Tim Wilkinson, Professor of Medicine, Department of Medicine, University of Otago, Christchurch, New Zealand; Valerie Wright St Clair, Associate Professor, School of Occupational Science and Therapy, and Co-Director Active Ageing Research Group Auckland University of Technology, New Zealand; Sally Keeling, Senior Lecturer, Department of Medicine, University of Otago, Christchurch, New Zealand; Joanna Broad, Senior Research Fellow, Freemason s Department of Geriatric Medicine, North Shore, University of Auckland; Santosh Jatrana, Associate Professor, Alfred Deakin Institute for Citizenship & Globalisation, Deakin University Waterfront Campus, Geelong, Victoria, Australia. Honorary Senior Research Fellow, University of Otago, Wellington; Thomas Lumley, Professor of Biostatistics, Department of Statistics, University of Auckland.

Acknowledgements

We acknowledge the expertise of our subcontractors: the Western Bay of Plenty Primary Health Organisation, Ng Matpuna Oranga Kaupapa Mori Primary Health Organisation, Te Korowai Aroha Trust, Te R\u016bnanga o Ngati Pikiao, Rotorua Area Primary Health Services, Ngati Awa Research & Archives Trust, Te R\u016bnanga o Ngati Irapuaia and Te Whanau a Apanui Community Health Centre in conducting the study through the Bay of Plenty and Rotorua. We thank all participants and their Whnau for participation, and the local organisations that promoted the study. We thank the R\u014dpuKaitiaki: Hone and Florence Kameta, Betty McPherson, Paea Smith, Leiana Reynolds and Waiora Port for their guidance. Funding for this study was from a programme grant from the Health Research Council of New Zealand, a project grant from Ng Pae o te Mramatanga. The Rotorua Energy Charitable Trust supported meetings and activities in Rotorua. The Ministry of Health provides funds for ongoing data collection and we acknowledge their support for manuscript production. Newcastle University provided academic accommodation for NK during finalisation of the manuscript.

Correspondence

Ngaire Kerse, University of Auckland, School of Population Health, Private Bag 92019, Auckland.

Correspondence Email

n.kerse@auckland.ac.nz

Competing Interests

Dr Hayman and Dr Kerse report grants from the Health Research Council of New Zealand and the Ministry of Health during the conduct of the study; Dr Wiles reports grants from HRC during the conduct of the study.

'-- Statistics New ealand. Demographic Trends: 2012. Wellington, New Zealand: Statistics New Zealand, 2012. Wiles J. Age cannot wither her, nor custom stale her infinite variety. Elder Care. 1999 Jul-Aug;11(5):10-4. Bondevik M. Historical, cr

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The demographic ageing of the New Zealand population is most marked for those in advanced age (85 years and over) as this population group will increase six-fold by 2050.1 Older people contribute to society in many ways and valued contributions continue into advanced age.2-7 Those in advanced age also utilise the highest per capita public expenditure, mostly on health and disability support.8 Knowing more about the health, cultural profile and social status of those in advanced age will help health planners, society, families and older people prepare for the projected increase in those of advanced age.The life in years (quality of life), rather than years of life (quantity of life), may be particularly relevant for older people, thus quality of life (QoL) is the topic of this paper. Those in advanced age may have higher life satisfaction than the younger old9 and certain factors including social support are more important to QoL for the very old than for younger age groups.10 Economic resources,11 cannot be ignored and there is a complex interaction between economic hardships and social supports.12In New Zealand the material wellbeing of older people has been examined13 and qualitative research has outlined contributions to QoL.14,15 Stephens et al described associations between more and stronger age-related social networks and higher wellbeing16 in those aged 55-70 than was found for younger cohorts. Other research explores the social context of ageing in New Zealand,17,18 but there is a lack of specific information about the octogenarian population. Culture, beliefs and religion also influence successful ageing.19 It is known that social relationships sustain wellbeing, prevent depression,20 aid longevity,21 and interconnect with economic wellbeing in complex ways. A better understanding of the current amount and type of social support for those in advanced age is needed.Te Puwaitanga o Nga Tapuwae Kia ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand, (LiLACS NZ) was funded to describe the health, social and cultural status and to identify predictors of successful advanced ageing of Mori and non-Mori. In acknowledgement of the disparity in longevity for Mori22 and the need for equal explanatory power to establish predictors, two inception cohorts were recruited in 2010; Mori aged 80-90 years (a birth decade) and non-Mori aged 85 years (a single year birth cohort).This paper presents the demographic, social and cultural characteristics and aims to identify correlates of health-related QOL (HRQoL) for the non-Mori cohort. A companion paper reports the Mori data.23MethodsThe detail of LiLACS NZ recruitment and assessment schedule has been described elsewhere.24,25 Eligibility included living in the geographic boundaries of the Bay of Plenty District Health Board and Lakes District Health Board (excluding Taupo region) of the North Island of New Zealand, and being born in the calendar year of 1925. A comprehensive list of all persons in the age group was compiled from the New Zealand General Electoral Roll, primary health care databases, residential care lists and word of mouth. Participants were recruited by personal invitation from their general practitioner, a person known to them or by a letter from the University of Auckland. Those interested were visited or telephoned by a researcher and they or a family member gave written informed consent. Ethical approval for this study was given by the Northern X Regional Ethics Committee NXT09/09/88.A comprehensive baseline assessment was undertaken to assess the health, social, economic, cultural and physical status of participants25 and is briefly summarised here. In this paper socio-demographic information, family contact and support, and cultural practices are reported along with the main outcome of HRQoL.Demographic information: age, gender, marital status, type of house, home ownership, education, living arrangement, main lifetime occupation of participant and partner, religion and income data were gathered using standardised questions. Self-perceived economic wellbeing was assessed with the question: Thinking of your money situation right now, would you say: I can t make ends meet, I have just enough to get along on, or I am comfortable? Socioeconomic deprivation related to their residential address at the time of interview was achieved by the geocoded New Zealand Deprivation Index (NZDep).26Ethnicity was self-identified using the 2001 NZ census question27 and where several ethnicities were identified, New Zealand European was prioritised over other European . Where very small numbers were reported they were grouped for analysis.Size of family, number of living children and number of grandchildren was recorded.Social support was assessed using the approach from the MacArthur studies28 with these questions with a yes or no response: When you need extra help, can you count on anyone to help with daily tasks like grocery shopping, cooking, house cleaning, telephoning, give you a ride? In the last year who has been the most helpful with these daily tasks? Could you have used more help with daily tasks than you received? Can you count on anyone to provide you with emotional support? In the last year who has been most helpful in providing you with emotional support? Could you have used more emotional support than you received? Questions about culture asked of all participants were based on a measure developed in New Zealand29 and by Te R\u014dp\u016bKaitiaki o ng tikanga Mori (Protectors of principles of conduct in Mori research in LiLACS NZ), a cultural guidance and governance group gathered together for LiLACS NZ: Do you live in the same area as your Hap\u016b (Mori term for extended family)/extended family/where you come from? Have you ever been to a marae (sacred Mori meeting place) at all? How often in the last year have you been to a marae? In general, would you say that your contacts are with: mainly Mori, some Mori, few Mori, no Mori? Could you have a conversation about a lot of everyday things in Mori or another language? How important is your language and culture to your wellbeing? Questions about life roles and the importance of aspects of life to wellbeing were asked: Roles within the whnau and family (Yes, No) Role within the community and neighbourhood (Yes, No) Satisfaction with those roles (extremely to not at all) The importance of family to wellbeing (extremely to not at all) Importance of faith to wellbeing (extremely to not at all) All participants were asked about discrimination using standard questions from the 2006/2007 New Zealand Health Survey:30 Have you ever been the victim of an ethnically motivated attack in New Zealand? (verbal or physical; further ago or within 12 months) Have you ever been treated unfairly by a service agency (eg WINZ) because of your ethnicity in New Zealand? Have you ever been treated unfairly when renting or buying housing because of your ethnicity in New Zealand? Have you ever been treated unfairly by a health professional because of your ethnicity in New Zealand? Discrimination questions were collapsed into 'ever' vs 'never experienced' discrimination.HRQoL was assessed with the SF-12 Version 2\u00ae including the summary scores for physical and mental HRQoL.31 Scores vary between 0 (worst health/QoL) and 100 (best health/QoL) with a mean score of 50. The Nottingham Extended Activities of Daily Living (NEADL) was used to assess functional status.32 Scores range from 0 to 22 with higher being better.The questionnaire was undertaken with the participant by trained lay and nurse interviewers using standardised techniques and took a minimum of two hours. For some participants two or more visits were required for full completion. Each completed questionnaire was quality checked by two different coordinators, and any queries referred back to the interviewer for rectification and contact with the participant if required.Analyses. Descriptive statistics showed status of participants on demographic, social, economic and cultural variables. Generalised linear models or the Cochran-Mantel-Haenszel test were used to compare status by gender as appropriate.Functional status was a priori selected as being known to be highly correlated with HRQoL, and HRQoL differed between genders. Gender and functional status (NEADL score) were considered confounding variables. Each variable in Tables 1, 2 and 3 was tested against mental HRQoL and physical HRQoL adjusting for gender and functional status in a brief model . For those variables showing a significance of p<0.1 models were further adjusted for the early life socioeconomic status (SES) marker of highest education level, midlife marker of main family occupation ascertained by the higher occupational status of participant or lifetime partner, and current SES marker reflected by perceived economic wellbeing in a full model . Adjusted means are presented for the models. Interactions between gender and marital status and gender and living arrangement were explored.ResultsOf all eligible non-Mori available in the study area, 59% (516 participants) agreed to participate. All completed a core set of questions (shown in Tables 1 & 2 with shading) and 404 completed the full questionnaire with additional questions expanding on the core set, one participant did not complete the questionnaire because of change of mind. Those completing the full questionnaire differed from those completing only the core. Firstly core questionnaire participants were more likely to be living in residential care 24/111 (22%) of core respondents were in residential care and 23/404 (3%) of those completing the full questionnaire were in residential care) (p<0.001). Secondly core questionnaire respondents were more likely to have the questionnaire completed by a proxy 17/111 (15%) of those completing the core questions were represented by a proxy and 16/404 (4%) of those completing the full questionnaire were represented by a proxy) (p<0.0001). Thirdly, core respondents were more likely to be dependent in personal care, toileting, getting in and out of bed, making a hot drink, doing shopping and using the phone (p<0.001 on each).Socio-demographic and economic characteristicsTable 1 provides an overview of the socio-demographic and economic characteristics of the sample. About 80% were born in New Zealand and half of those born overseas identified as New Zealand European. Other countries of birth included: Australia (4), England (including northern Ireland, 58), Scotland (12), Ireland or Wales (3), Netherlands (7), Other Central or Western European countries (6), Indonesia (3), Sri Lanka, Japan, Fiji, Canada or Brazil (6). Self-identified ethnicity for non-Mori consists of those who identified as New Zealand European (89%), other European (10%), and other being Pacific (3), Asian, Middle Eastern or South African (4).Table 1: Socio-demographic, economic and family makeup characteristics of non-Mori aged 85 years in LiLACS NZ. Men Women Total All participants\u2014core interview Full interview completed 237 (46%) 190 (47%) 278 (54%) 214 (53%) 515 404 Age, mean (sd) 84.6 (0.5) 84.6 (0.5) 84.6 (0.5) Country of birth, n (%) Born in NZ Born Overseas 185 (78) 52 (22) 229 (82) 49 (18) 414 (80) 101 (20) Ethnicity, n (%) NZ European Other European Other (Pacific, Asian, Middle Eastern) 213 (89) 23 (10) 2 (1) 251 (90) 22 (8) 5 (2) 462 (89) 45 (10) 7 (1) Childhood family size, mean (sd) Total family size Sisters Brothers Sisters still living Brothers still living 4.6 (2.8) 1.7 (1.6) 1.8 (1.8) 0.8 (1.0) 0.6 (0.9) 4.3 (2.6) 1.6 (1.7) 1.7 (1.6) 0.6 (0.8) 0.5 (0.9) 4.4 (2.7) 1.7 (1.7) 1.8 (1.7) 0.7 (0.9) 0.6 (0.9) Marital status, n (%) Never married Widowed Divorced Married/ partnered 10 (4) 73 (31) 14 (6) 137 (59) 8 (3) 184 (67) 17 (6) 67 (24) 18 (4) 257 (50) 31 (6) 204 (40)* Number living children, n (%) Number grandchildren, mean (sd) None 1-3 4-6 11 (6) 115 (61) 62 (33) 7 (6.3) 9 (4) 135 (63) 69 (32) 7.2 (5.3) 20 (5) 250 (62) 131 (33) 7.1 (5.8) Living arrangement, n (%) Alone With spouse With other If with other average number in house, mean (sd) 61 (32) 106 (56) 23 (12) 2.4 (1.0) 134 (63) 48 (22) 32 (15) 2.9 (1.2) 195 (48)* 154 (38) 55 (14) 2.7 (1.2) Type of house, n (%) Stand alone house Unit/apt Retirement village Residential care Other 115 (61) 26 (14) 35 (19) 9 (4) 5 (3) 121 (57) 33 (15) 39 (18) 15 (6) 6 (4) 236 (59) 60 (15) 74 (18) 23 (5) 11 (4) Home ownership, n (%) Owns own home outright Rental 155 (89) 20 (11) 170 (90) 20 (11) 325 (89) 40 (11) Deprivation, NZDep area score, n (%) 1-4 Low 5-7 Med 8-10 High 34 (14) 123 (52) 80 (34) 41 (15) 146 (53) 91 (33) 75 (15) 269 (52) 171 (33) Income, n (%) NZ Superannuation (NZS) only Other income as well as NZS 49 (26) 137 (74) 69 (32) 144 (68) 118 (30) 281 (70) Main family occupation\u00a7, n (%) Professionals Technicians Clerks 93 (39) 38 (16) 106 (45) 107 (38) 49 (18) 122 (44) 200 (39) 87 (17) 228 (44) Thinking for your money situation right now\u2014(%) Can t make ends meet Just enough I am comfortable 2 (1) 38 (20) 149 (79) 0 49 (23) 163 (77) 2 (.5) 87 (22) 312 (78) Education, n (%) Tertiary Trade Any secondary Primary only or none 38 (16) 26 (11) 125 (54) 44 (19) 30 (11) 34 (13) 170 (62) 39 (14) 68 (13) 60 (12) 295 (58) 83 (16) Shaded items show core questions included in the core interview answered by all and unshaded are questions in the full interview. Childhood family size is siblings only, not including parents.\u00a7Professional: -Legislators, Administrators, Professionals, Agricultural and Fishery WorkersTechnicians:- technicians, Associate Professionals and Trades WorkersNon-technical :- Clerks, Service Workers, Sales Workers, Plant/Machine Operators, Assemblers, Elementary Workers. * significant difference between men and women p<0.05More men were married (59% cf 24% of women, p<0.001) and more women were living alone (63% cf 32% of men, p<0.001) with 32 (15%) women living with others and 12 (6%) women living in residential aged care. Overall, 4% had never married and 5% had no children.Most (89%) owned their own home and income from non-New Zealand Superannuation (NZS) sources included other superannuation (eg workplace schemes) 11%, other pensions 12%, investments 50%, with less than 5% receiving income from salary and wages, tribal land trusts or inheritance.Table 2 shows social support, importance of faith, QoL and functional status. Religious affiliation was recorded with 68 (17%) reporting no religion (not in Table) and 13% reporting that faith was not at all important to their wellbeing. No non-Mori participated in Mori faith. Other religions included Baptist (11), Christian (8), open Brethren (3), Salvation army (4), Seventh Day Adventist, Jehovah s Witness, Protestant and Pentecostal (2 each). Four did not answer the question about religion and one each reported religion as: all encompassing, belief in the creator, interdenominational, Liberal Christian, non-conformist, non-denominational, Spiritual Church, and Theosophical Society.Table 2: Social support, importance of faith, QoL and functional status of LiLACS NZ non-Mori participants. Men Women Total Full interview completed 190 (47%) 214 (53%) 404 Religion, n (%) Anglican Catholic Presbyterian Methodist Other 59 (41) 14 (10) 43 (30) 6 (4) 22 (15) 78 (42) 19 (10) 53 (28) 12 (6) 26 (14) 137 (41) 33 (10) 96 (29) 18 (5) 48 (15) Importance of faith to your wellbeing, n (%) Not at all A little Moderately Very Extremely 33 (18) 13 (7) 39 (21) 67 (36) 32 (17) 19 (9) 16 (8) 40 (19) 86 (41) 51 (24) 52 (13) 29 (7) 79 (20) 153 (39) 83 (21) Anyone to help with daily tasks? n (%) Yes No I don t need help 145 (77) 6 (3) 37 (20) 175 (83) 11 (5) 25 (12) 320 (80) 17 (4) 62 (16) Who has been the most helpful? n (%) Spouse Daughter Son Other relative Other 65 (43) 23 (15) 10 (7) 7 (5) 48 (31) 34 (19) 61 (35) 22 (13) 7 (4) 51 (29) 99 (30) 84 (26) 32 (10) 14 (4) 99 (30) Could have used more practical help? n (%) Yes 14 (8) 28 (14) 42 (11) Count on anyone to provide emotional support? n (%) No Yes I don t need emotional support 7 (4) 142 (76) 37 (20) 14 (7) 177 (85) 17 (8) 21 (5) 319 (81) 54 (14) Who most helpful? n (%) Spouse Daughter Son Other relative Other 78 (55) 22 (16) 15 (11) 5 (4) 21 (15) 30 (18) 68 (40) 24 (14) 10 (6) 39 (23) 108 (35) 90 (29) 39 (13) 15 (5) 60 (19) Could have used more emotional support? n (%) Yes 7 (4) 15 (7) 22 (6) *** difference between men and women p<0.001NEADL Nottingham Extended Activity of Daily Living scale. QoL = quality of life.\u2014a higher score means better QoL, range 0-100.Social support was reported as present by most with 20% of men reporting that they did not need help. A daughter was the main support for women and the spouse for men for both practical and emotional support. Thirty and 19% of non-Mori received practical and emotional support, respectively, from others which included formal paid support workers, 14% of women and 8% of men (p=0.051) reported an unmet need for practical help.Function and QoLTable 2 shows a mean score of 41 for physical HRQoL which indicates that HRQoL is below the mean for a standard older population33 and was higher (better) in men (p=0.005). Mental HRQoL was slightly higher than physical HRQoL, and was similar in men and women.Functional status was similar between men and women and varied according to living arrangement. Those living with others, including those in residential care, had the lowest NEADL scores with a mean of 13.1 (sd 7.0) compared with means of 17.9 (sd 3.0) for those living with their spouse and 18.7 (sd 2.6) for those living alone (p<0.001). Neither physical HRQoL nor mental HRQoL varied by living arrangement when adjusted for SES and functional status.Just under a third of non-Mori in advanced age had mainly or some Mori contacts (Table 3). While the majority (69%) had been to a marae, few (14%) had been once or more in the last year.Table 3: Socio-cultural characteristics of LiLACS NZ non-Mori participants. Men Women Total All participants\u2014core interview, n (%) Full interview completed, n (%) 237 (46%) 190 (47%) 278 (54%) 214 (53%) 515 404 Do you live in the same area as your hpu/ extended family/where you come from? No Yes 219 (93) 16 (7) 247 (89) 29 (11) 466 (91) 45 (9) Have you ever been to a marae at all? No Yes 51 (27) 139 (73) 74 (35) 138 (65) 125 (31) 277 (69) How often in the last 12 months have you been to a marae? Less than yearly* Once A few times Several times, more than monthly 156 (82) 26 (14) 5 (3) 3 (2) 193 (91) 15 (7) 3 (1) 1 (0) 349 (87) 41 (10) 8 (2) 4 (1) Are your contacts with Mainly Mori Some Mori Few/no Mori 1 (1) 51 (27) 137 (72) 2 (1) 71 (33) 140 (66) 3 (1) 122 (30) 277 (69) Importance of language and culture to wellbeing Not at all/moderately Very Extremely 64 (35) 103 (56) 17 (9) 70 (33) 120 (56) 23 (11) 134 (34) 223 (56) 40 (10) Importance of family to wellbeing Not at all/moderately Very Extremely 27 (15) 105 (56) 54 (29) 13 (6) 105 (49) 95 (45) 40 (10) 210 (53) 149 (37) Specific role in local community/ neighbourhood No Yes 160 (85) 29 (15) 177 (83) 35 (17) 337 (84) 64 (16) How satisfied with role in local community/neighbourhood? Not at all/moderately Very Extremely 9 (29) 18 (58) 4 (13) 7 (20) 25 (71) 3 (9) 16 (24) 43 (65) 7 (11) Do you have a specific role in your family? No Yes 75 (40) 113 (60) 69 (33) 141 (67) 144 (36) 254 (64) Satisfaction with role in your family? Not at all/moderately Very Extremely 11 (10) 88 (77) \

Summary

Abstract

Aim

To establish socioeconomic and cultural profiles and correlates of quality of life (QoL) in non-Mori of advanced age.

Method

Method: A cross sectional analysis of the baseline data of a cohort study of 516 non-Mori 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

Results: Of the 516 non-Mori 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

Conclusion

Conclusion: Amongst our sample of non-Mori people of advanced age, those with unmet support needs reported low HRQoL. Functional status was most strongly associated with mental and physical HRQoL.

Author Information

Ngaire Kerse, Professor and Head, School of Population Health, Tmaki, University of Auckland; Ruth Teh, Senior Lecturer, Department of General Practice and Primary Health Care, School of Population Health, Tmaki, University of Auckland; Simon A Moyes, Statistician, Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland; Lorna Dyall, Senior Lecturer, Department of General Practice and Primary Health Care, School of Population Health, Tmaki, University of Auckland; Janine L. Wiles, Senior Lecturer, Social and Community Health, School of Population Health, Tmaki Campus, University of Auckland; Mere K\u0113pa, Honorary Senior Research Fellow, Department of General Practice and Primary Health Care, School of Population Health, Tmaki Campus, University of Auckland; Carol Wham, Senior Lecturer, Institute of Food, Nutrition and Human Health, Massey University, Auckland; Karen Hayman, Research Fellow, Department of General Practice and Primary Health Care, School of Population Health, Tmaki Campus, University of Auckland; Martin Connolly, Freemasons Professor of Geriatric Medicine, Freemason s Department of Geriatric Medicine, University of Auckland and Waitemata District Health Board; Tim Wilkinson, Professor of Medicine, Department of Medicine, University of Otago, Christchurch, New Zealand; Valerie Wright St Clair, Associate Professor, School of Occupational Science and Therapy, and Co-Director Active Ageing Research Group Auckland University of Technology, New Zealand; Sally Keeling, Senior Lecturer, Department of Medicine, University of Otago, Christchurch, New Zealand; Joanna Broad, Senior Research Fellow, Freemason s Department of Geriatric Medicine, North Shore, University of Auckland; Santosh Jatrana, Associate Professor, Alfred Deakin Institute for Citizenship & Globalisation, Deakin University Waterfront Campus, Geelong, Victoria, Australia. Honorary Senior Research Fellow, University of Otago, Wellington; Thomas Lumley, Professor of Biostatistics, Department of Statistics, University of Auckland.

Acknowledgements

We acknowledge the expertise of our subcontractors: the Western Bay of Plenty Primary Health Organisation, Ng Matpuna Oranga Kaupapa Mori Primary Health Organisation, Te Korowai Aroha Trust, Te R\u016bnanga o Ngati Pikiao, Rotorua Area Primary Health Services, Ngati Awa Research & Archives Trust, Te R\u016bnanga o Ngati Irapuaia and Te Whanau a Apanui Community Health Centre in conducting the study through the Bay of Plenty and Rotorua. We thank all participants and their Whnau for participation, and the local organisations that promoted the study. We thank the R\u014dpuKaitiaki: Hone and Florence Kameta, Betty McPherson, Paea Smith, Leiana Reynolds and Waiora Port for their guidance. Funding for this study was from a programme grant from the Health Research Council of New Zealand, a project grant from Ng Pae o te Mramatanga. The Rotorua Energy Charitable Trust supported meetings and activities in Rotorua. The Ministry of Health provides funds for ongoing data collection and we acknowledge their support for manuscript production. Newcastle University provided academic accommodation for NK during finalisation of the manuscript.

Correspondence

Ngaire Kerse, University of Auckland, School of Population Health, Private Bag 92019, Auckland.

Correspondence Email

n.kerse@auckland.ac.nz

Competing Interests

Dr Hayman and Dr Kerse report grants from the Health Research Council of New Zealand and the Ministry of Health during the conduct of the study; Dr Wiles reports grants from HRC during the conduct of the study.

'-- Statistics New ealand. Demographic Trends: 2012. Wellington, New Zealand: Statistics New Zealand, 2012. Wiles J. Age cannot wither her, nor custom stale her infinite variety. Elder Care. 1999 Jul-Aug;11(5):10-4. Bondevik M. Historical, cr

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