Analysing Realistic effects of modifiable risk factors for dementia in a large National Dataset.

BACKGROUND: Modifiable risk factors affect 40% of dementia risk thus creating an opportunity for prevention or delay. The risk factor life-course model of dementia prevention by the Lancet Commission has yet to be tested in the general populations. We aimed to assess the model's assumptions in a large national dataset of older adults assessed for support services. METHODS: The interRAI assessment is a comprehensive evidence-based tool encompassing 236 items that is mandatory in New Zealand (NZ) for older adults providing a standardized national dataset. We tested the Lancet model of dementia prevention in a sample of 66,638 participants who underwent an interRAI assessment during the period 2013-2018. There were 59% female interviewees; mean age was 82 years (range: 65-107). Our cross-sectional dataset analysis was performed in using a logistic regression model with diagnosis of dementia as the primary outcome. RESULTS: The Lancet prevention model was supported in part. Hypertension, Hearing Impairment and past or present Depression increase risk of dementia. Age - increased risk demonstrated until 85 years; Gender - females at increased risk; BMI - initial effect of high BMI increases risk of dementia. However, exercise, diabetes, vision impairment and smoking as modifiable factors were not associated with dementia risk as predicted by the Lancet model. CONCLUSIONS: Limitations of the dataset analysed may have affected our findings. Nevertheless, important modifiable factors are herein confirmed as increasing dementia risk. BMI, hypertension, hearing impairment and depression are risks confirmed in the older NZ population lending credibility to prevention efforts targeted at these variables.

Creating opportunities to improve detection of older adult abuse: a national interRAI study.

Despite being recognized as a major global health issue, older adult abuse (OAA) remains largely undetected and under-reported. Most OAA assessment tools fail to capture true prevalence. Follow up of patients where abuse exposure is not easily determined is a necessity. The interRAI-HC (International Resident Assessment Instrument-Home Care) currently underestimates the extent of abuse. We investigated how to improve detection of OAA using the interRAI-HC. Analysis of 7 years of interRAI-HC data from an Aotearoa New Zealand cohort was completed. We identified that through altering the criteria for suspicion of OAA, capture rates of at-risk individuals could be nearly doubled from 2.6% to 4.8%. We propose that via adapting the interRAI-HC criteria to include the "unable to determine" whether abuse occurred (UDA) category, identification of OAA sufferers could be substantially improved. Improved identification will facilitate enhanced protection of this vulnerable population.

Older adults abuse: analysis of a New Zealand national dataset.

Older adult abuse (OAA), defined as abuse, neglect, or mistreatment of persons aged 65 years or older, is a globally pervasive concern, with severe consequences for its victims. While internationally reported rates of OAA are in the range of 5-20% per annum, New Zealand lacks the necessary data to quantify the issue. However, with a growing aging population, an increase in the prevalence of OAA is predicted. We investigated the extent of OAA in New Zealand, utilizing the mandatory interRAI-HC (International Resident Assessment Instrument-home care assessment) dataset, which included 18,884 interviewees from the Southern District Health Board between 2013 and 2019. Findings confirmed our hypothesis that the interRAI assessment is neither sufficiently sensitive nor specific capturing only 3% from a population of increased frailty and thus at higher risk of abuse. We characterized OAA victims as relatively younger males, depressed, and with impaired decision-making capacity. If the interRAIs were to serve as a preliminary screening tool for OAA in New Zealand, it would be germane to implement changes to improve its detection rate. Further studies are urgently called for to test changes in the interRAI that will aid in identifying often missed cases of OAA better and thus offer protection to this vulnerable population.

Fatigue, sleep and depression: An exploratory interRAI study of older adults.

An association between fatigue and depression was reported for older adults. We examined the association between fatigue, sleep and depression from interRAI-HC assessments of community dwelling older people (65+ years). Interview data from 5,950 participants who completed their first interRAI-HC assessment was analysed (mean age, 81.3 ± 7.1 years; 60.2% female). Only 873 (15%) reported "severe" fatigue. Nearly half reported minor sleep problems. Depression was diagnosed in 693 participants (11.6%). Depression explained only 0.2% of fatigue. This calls for further studies that may help in understanding the relationship between fatigue and depression across the life-cycle.

Identifying hoarding disorder in the elderly using the interRAI.

OBJECTIVES: Hoarding disorder (HD) is prevalent in older adults and contributes to morbidity and mortality. We attempted to estimate rates of hoarding amongst the elderly using the international Residential Assessment Instrument - Home Care (interRAI-HC). SETTING: The interRAI is a mandatory prerequisite in New Zealand (NZ) for government-funded community support or for entry into aged residential care. PARTICIPANTS: All 50 years and older people who were assessed using the interRAI in the southern district health board of NZ. MEASUREMENTS: The age, gender, socially inappropriate or disruptive behaviour and squalor interRAI-HC items were analysed. RESULTS: During the 3 years study period (Jan., 2015 to Dec., 2017) 6655 people, mean age 81.4 + 7.6 years, 56% female, were assessed. The interRAI socially inappropriate behaviour (includes hoarding as one of its descriptors) was present in 233 people (3.5%), herein defined as suspected HD. Squalid conditions were present in 98 additional people (1.5%). Mean age for suspected HD group was significantly younger [76.1 + 6.3 years (p < 0.001)] and there were more males [57% (p < 0.05)] compared with the general interRAI group. CONCLUSIONS: Rates of HD estimated by using the interRAI are in line with published international data. As identification of HD with the interRAI is not straightforward it's use as a screening tool for identifying HD should be validated in future studies.

Comparison of Psychosocial Variables Associated With Loneliness in Centenarian vs Elderly Populations in New Zealand.

Importance: Loneliness is associated with reduced health-related quality of life and increased morbidity and mortality and typically worsens with aging. Objectives: To evaluate associations between demographic and psychosocial variables and loneliness, examine any age-specific associations, and compare centenarians (aged ≥100 years) with elderly people (aged 65-99 years). Design, Setting, and Participants: In this retrospective, observational, cross-sectional study, previously collected data from all New Zealanders 65 years and older who completed their first international Resident Assessment Instrument-Home Care (interRAI-HC) assessment during the study period (January 1, 2013, to November 27, 2017) were reviewed. Participants were people living independently in the community who were requesting or referred for assessment with a potential need for support services. Main Outcomes and Measures: The interRAI-HC is a 236-item, electronically recorded assessment that encompasses a comprehensive range of aspects of an older person's life, including physical, psychological, and cognitive domains. Eight main items from the interRAI-HC data set were analyzed to describe the population and evaluate the core psychosocial components of aging, namely, age, sex, race/ethnicity, marital status, living arrangements, family support, depression, and loneliness. Loneliness was evaluated by the participants' response to the assessment statement, "Says or indicates that he/she feels lonely." Results: A total of 73 286 New Zealanders (mean age, 81.4 years; age range, 65-109 years; 41 641 [56.9%] female) participated in the study. The assessments of 191 centenarians (mean [SD] age, 100.9 [1.2] years) and 73 095 elderly people (mean [SD] age, 81.4 [7.6] years) were analyzed. Centenarians vs elderly people were more likely to be female (136 [71.2%] vs 41 488 [56.8%]; P < .001), and the populations differed by marital status (widowed: 170 [89.0%] vs 31 554 [43.2%]; overall P < .001) and depression status (70.2% vs 59.5% free of depression; overall P = .008). Centenarians were less likely to be lonely compared with elderly people, with a 22% lower risk of loneliness for a typical centenarian (aged 100.9 years) compared with a typical elderly person (aged 81.4 years) in unadjusted analyses (relative risk, 0.78; 95% CI, 0.67-0.92; P = .002). In the fully adjusted model, there was a 32% reduction in loneliness for a centenarian compared with an elderly person (relative risk, 0.68; 95% CI, 0.58-0.79; P < .001). Living with others, having family support, and lacking depression were associated with lower risk of loneliness. Conclusions and Relevance: Centenarians are a unique group to study as a model of successful aging. The sample of centenarians in this study appeared to be less lonely than other groups studied internationally. The study identified multiple psychosocial variables that were associated with the risk of loneliness, including living arrangements, family support, and depression. Knowing these variables may help our society address risk factors for loneliness in older people.