Abstracts for Knowledge Exchange 2024

Posted by Karen Mumme on 5 April 2024

Tags: Knowledge Exchange, abstracts, Research on Ageing

Abstracts for Knowledge Exchange 2024

Friday, 12^th April 2024 at University of Auckland

Programme can be downloaded here.

Session 1:

Integrating oral care into nursing practice from home to hospital care with interprofessional collaboration and education

Keiko Oda¹, Noor Nazahiah Bakri^3,4, Sarah Majeed^1,2, Shennae Bartlett^1,2, William M Thomson⁴, John Parsons¹, Michal Boyd¹, Anna Ferguson², Moira Smith²

¹Faculty of Medical and Health Sciences, University of Auckland, New Zealand

²Department of Public Health, University of Otago Wellington, New Zealand

³Centre of Population Oral Health and Clinical Prevention Studies, Universiti Teknologi MARA, (Malaysia) 

⁴Sir John Walsh Research Institute, University of Otago (New Zealand) 

Introduction: My research aimed to integrate oral health care into daily nursing care practice from home to hospital care through interprofessional collaboration and education (IPC/IPE), and ultimately, to improve older adults’ oral health and their quality of life.

Research Summary: Three stages of improving nursing oral health care practice for older adults, from home care to hospital care by utilising mixed method with participatory action studies is described in this thesis. First, I developed a conceptual framework of the importance of oral care as a measure of halting older adults’ deconditioning in hospital settings. I determined that my research sites is community settings, and I conducted a literature review on nursing oral health care practice in aged residential care facilities (ARC). Second, I co-developed with older adults, health professionals, and carer stakeholders an oral health assessment guideline, called the Oral Health Assessment Care and Planning (OHCAP) Tool, and a training module called Nursing Oral Health Assessment (NOHAT) with IPC/IPE with oral health professionals. The aim of OHCAP and NOHAT was to improve nursing oral care provision among nursing staff who work in home care to ARCs with IPC. Third, I tested the effect of OHCAP and NOHAT with student nurses in the University of Auckland, and home care and ARC nurses to determine their effectiveness in improving nursing oral health care in their clinical settings. OHCAP and NOHAT are well-accepted by nursing staff, and their confidence and self-efficacy in oral health care practice improved. Some nursing staff emerged as potential oral health champions who could work to improve nursing oral health care practice.

Future directions: Further research is required to determine whether nursing oral health care practice that can support older adults’ oral health and overall health in primary health settings becomes normalized as a result of OHCAP and NOHAT.

Does a vegan diet support healthy ageing?

Karen Mumme, Rebecca Paul, Hajar Mazahery, Kathryn Beck, Cathryn Conlon, Marlena C Kruger, Pamela von Hurst.

College of Health, Massey University.

Introduction: The New Zealand population is ageing. A vegan diet excludes animal products and key nutrients required in healthy ageing. This cross-sectional study describes nutrient intakes, body composition and metabolic and bone health in older adults eating a vegan diet.

Methods: Vegans (2+ years) were recruited in Auckland, New Zealand. Researchers collected blood (lipids, HbA₁C, 25(OH)D, calcium) and measured body composition and bone mineral density using DeXA. The Omega-3 Index was calculated. Participants recorded a 4-day food diary.

Results: The study was completed by 212 participants (males 27%). Older participants (n=49, males 29%, mean [SD] age 57 [6] yrs), compared to younger (34 [8] yrs), had higher blood pressure (systolic 124 [14] v 115 [12]; diastolic 77 [10] v 71 [8]; both p<0.001), waist circumference (86 [9] v 81 [11] cm p<0.001), BMI (24.7 [2.7] v 23.7 [3.2] kg/m² p=0.02), body fat% (34 [8] v 29 [7] % p<0.001), cholesterol:HDL ratio (3.1 [0.8] v 2.6 [0.7] p<0.001), triglycerides (1.7 [1] v 1.3 [0.6] mmol/L p=0.001), HbA₁C (33.5 [4.8] v 31.7 [2.9] mmol/L p=0.10), Omega-3 Index (3.3 [0.7] v 3.1 [0.7]% p=0.03) and lower protein intake (72 [28] v 79 [28] g/day p<0.001). Fewer older participants met the Estimated Average Requirement (EAR) for calcium (males 840mg [<70yrs], 1100mg [70+ yrs]; females 840mg [<50yrs], 1100mg [50+yrs]) than younger (27% v 50% p=0.004). Differences between younger and older participants were more obvious in older females than males for blood pressure, waist circumference, BMI, body fat%, cholesterol:HDL ratio, triglycerides and meeting calcium EAR (all p<=0.01) and in older males than females for Omega-3 Index (p=0.01).

Other measures were no different with age: vitamin D (serum 25(OH)D 65 [23] nmol/L), serum adjusted calcium (2.2 [0.3] mmol/L), lumbar spine z-scores (-0.29 [1.1]), femoral neck z-scores ( -0.24 [0.9]), energy intake (males 11.3 [2.7] MJ/day; females 8.3 [1.9] MJ/day), and intakes of dietary fibre (males 55 [18] g/day; females 43 [13] g/day) and calcium (males 1052 [367] mg/day; females 868 [327] mg/day).

Conclusion: Three quarters of older participants did not meet the EAR for calcium intake though bone health was normal for age and sex parameters. Age affected females more than males. Further research is required in a larger cohort of older males consuming a vegan diet.

Insights into hospitalised-fracture incidence among octogenarians: Data from LiLACS NZ Study

¹C J Bacon, ²S A Moyes, R Teh, ³J Hikaka, ^{2, 3}N Kerse.

¹School of Nursing, University of Auckland, Grafton Road, Auckland.

²General Practice and Primary Healthcare, University of Auckland.

³Centre for Co-Created Ageing Research, University of Auckland.

Introduction: Fractures cause substantial disability and cost and are most prevalent in people over 80 years, often requiring hospitalization in this group. This study examines longitudinal shifts in risk of hospitalised fractures in advanced age.

Methods: Hospital discharge records from participants in a prospective cohort study of 421 Māori (mean±SD 82.6±2.8 years) 517 non-Māori (84.6±0.5 years) were utilised to determine the incidence of hospitalised fractures for 5 years before and 5 years after enrolment.

Results: From the initial cohort, hospitalisation data were available for 378 Māori and 498 non-Māori. In the 5 years prior to enrolment, 22 (5.8%) Māori and 43 (8.6%) non-Māori were hospitalised at least once for fracture, increasing to 29 (7.7%) and 62 (12.4%), respectively, in the subsequent 5 years. Fracture incidence increased 17% and 20% in Māori and non-Māori men and 62% and 61% in Māori and non-Māori women before to after enrolment; pelvis/femoral fractures accounting for almost half (47%) of these. Fracture-related hospital nights/1000 person-years increased from 320 before to 543 after enrolment, more than doubling (107% increase) in non-Māori, but increasing only 1.7% in Māori. The proportion of all hospital nights that were due to fractures rose from 13.9% to 16.5% from before to after enrolment in non-Māori, though reduced in Māori (10.7% to 6.4%). For all Māori and all men, current compared to past smoking was independently associated with increased risk of fracture hospitalisation, and for all men high deprivation and fewer falls in the previous 12 months were additionally associated with increased subsequent fracture risk.

Conclusions: Among octogenarians, the risk of hospitalised fractures markedly escalates with 5 years of ageing, particularly in women, almost doubling the total duration of fracture-related hospitalisation. Projections of fracture burden in advanced age need to account for the swiftly changing risk with minimal age increments.

The experiences of restorative care of older adults living in aged residential care.

Chante Cooper & Trip, H.

Department of Nursing- Te Tari Tapuhi, Christchurch.

Introduction: New Zealand mirrors global population dynamics experiencing an unprecedented growth in the number of older adults with an increased need for care provision. Literature and policy have seen a fundamental shift from a dependency to a restorative style of care, focused on maximising one’s level of function. However, a gap exists regarding the experiences of restorative care (RC) of older adults living in aged residential care (ARC) and the extent of its implementation. This research aimed to obtain the qualitative experiences of RC of older adults living in ARC.

Methods: A qualitative descriptive research methodology was used with purposive sampling, one-on-one semi-structured interviews, and thematic data analysis.

Results: The analysis revealed the pivotal role of the ARC environment and employed Healthcare Professionals (HCPs), ranging from positively enhancing RC through passive enablement, reactive enablement, and active facilitation to the prevention of RC through inherent barriers and limitations, a prevailing dependency-style-of-care and active disablement. Older adults and their external ecosystem played a significant role in implementing RC. The impacts of care experiences on older adults encompassed both positive and negative holistic effects, often influenced by the circumstances of their transition to ARC.

Conclusions: This research responds to global and national calls for data collection, analysis and reporting of the progress and implementation of strategies on healthy ageing. It suggests that while aspects of RC are being implemented to some extent, this is hindered by systemic environmental barriers and a dependency style of care prevails. Future recommendations include transitioning towards a relational autonomy approach and education and training sessions on RC for HCP’s, older adults, and families alongside broader cultural and environmental shifts.

Healthy ageing in adults with cerebral palsy

Woroud Alzaher¹, S Williams^1,2, S Stott^3,4, A Hogan⁵

¹Liggins Institute, University of Auckland, New Zealand

²School of Allied Health, Curtin University, Australia

³Department of Surgery, University of Auckland, New Zealand

⁴Department of Surgery, Starship Hospital, New Zealand

⁵New Zealand Cerebral Palsy Society, New Zealand

Introduction. Cerebral palsy (CP) is the most common childhood onset physical disability occurring in 1-2 births per 1000, with an estimated population of 7,500 adults and 2,500 children in New Zealand.  Although traditionally researched as a paediatric condition, two thirds of the population are adults. Adults with CP can experience changes in physical functioning, including mobility, as early as in their 20’s and 30’s, and a higher prevalence of preventable chronic conditions. Despite these health concerns, information about ageing with CP is scarce. The World Health Organization’s (WHO) Healthy Ageing model is a strength-based framework that identifies a person’s core reserves (intrinsic capacity) and their environmental interactions as the main determinants of their functional ability. This is highly relevant to persons with CP who routinely use environmental adaptations (e.g. wheelchairs) to increase their functional ability and facilitate full participation in society. The Healthy Ageing model has been used in ageing research but not yet applied to evaluate and plan for healthy aging for adults with CP.

Research summary. A series of 4 studies are planned to investigate (1) a systematic review of what is currently known about  intrinsic capacity in adults with CP, (2) qualitative ageing experiences and applicability of the Healthy Ageing model to adults with CP, (3) demographic and clinical descriptors of the adult CP population in NZ, and (4) general practitioners views on Healthy Ageing in relation to providing primary care for adults with a childhood onset disability and utility of the intrinsic capacity screening tool (ICOPE).

Future directions.  This work aims to describe the evolving health care needs, identify healthy ageing priorities across the lifespan and relevant measures for healthy ageing for adults with CP. A better understanding of ageing needs will aid targeted preventative healthcare and improve health outcomes for adults with CP.

Session 2:

Fostering rescue cats as health promotion for older people

Christine Roseveare, Mary Breheny, Juliana Mansvelt, Linda Murray, Marg Wilkie.

Massey University

Research Idea: There is growing interest in the health promoting potential of human-companion animal relationships and acknowledgment of barriers to ownership, particularly for older adults.

Supporting evidence: Companion animal fostering for rescue organisations is a promising alternative that supports relationships with animals while promoting health. However, little is known about older people’s experiences of companion animal fostering and the benefits fostering may have for wellbeing. My research explores companion animal fostering by older people from a broad health promotion perspective based on the Ottawa Charter for Health Promotion and Sir Mason Durie’s model Te Whare Tapa Wha.

I am also considering using a capability approach to ageing (Stephens et al. 2015) to theorise companion animal fostering as an example of capability to contribute to the community. The Capability Approach evaluates wellbeing in term of the capability to achieve a life that people have reason to value. In term of companion animal fostering, this might be the capability to contribute to one’s community or  to engage with other species. The Capability Approach has substantial theoretical overlap with strengths-based approaches to health promotion. They both reject deficit models and view older people as capable and resilient while still accommodating physical changes of ageing. This concept fits well with the Ottawa Charter idea that caring relationships (including caring for animals) is part of what keeps people healthy.

Questions for audience: Is there something about being older that shapes what kind of contribution companion animal fostering makes to wellbeing, how much it's valued, or fits into older people's lives?

How can we understand companion animal fostering in terms of contribution to community and other species?

What other approaches or concepts might I consider?

Reference:  Stephens, C., Breheny, M., & Mansvelt, J. (2015). Healthy ageing from the perspective of older people: A capability approach to resilience. Psychology & Health, 30(6), 715-731.

What are the barriers to accessing interventions for people with Parkinson’s Disease in Tāmaki Makaurau, Auckland?

Sonja P Neef

School of Psychology, The University of Auckland Waipapa Taumata Rau.

Research Idea: What are the barriers to accessing interventions for people with Parkinson’s Disease (PwPs) in Tāmaki Makaurau, Auckland? Comparison of the different barriers to accessing interventions between PwPs in CeleBRation Choir, Counterpunch Parkinson’s and those not taking part in an intervention in Tāmaki Makaurau

Supporting evidence: Social exclusion and loneliness are common experiences among PwPs. Extensive research has suggested that social exclusion is associated with increased PD severity, progression of PD, increased mortality decreased quality of life, and decreased mental health (Ahn et al., 2022; Soundy et al., 2014; Prell et al., 2023; McDaniels & Subramanian, 2022). Supportive social interactions and social networks have been noted as protective factors (Subramanian et al., 2020). There are several social interventions currently available namely, CeleBRation Choir and Counterpunch Parkinson’s. Group choir singing has been shown to improve social unity, self-esteem, mood, and speech, (Fogg-Rogers et al., 2016; Irons et al., 2021) while non-contact boxing has been shown to improve balance, mobility, and motor skills (Patel et al., 2023; Brunet et al., 2022). There is scant research examining the barriers to accessing social interventions. Barriers may include geographical isolation, high PD severity, lack of family support, and lack of contact with Parkinson’s organisations. It is important to better understand the barriers to accessing interventions with the aim to improve accessibility and promote active participation in the community.

What are the barriers to accessing interventions for people with Parkinson’s Disease (PwPs) in Tāmaki Makaurau, Auckland?: Do you know someone who has Parkinson’s Disease, and how has their social life been affected by their diagnosis and symptom progression from your observations? How accessible do you think social interventions and community activities are in general for older adults and people with disabilities living in Tāmaki Makaurau Auckland? What cultural barriers do you think could play a role in the access of these interventions for PwPs?

Flourishing with age through nutritious food and exercise for the body and mind.

Jaimie Wilkie

University of Auckland.

Research Idea: I would like to form a transdisciplinary group of people who are interested in developing the research idea of how to nourish ourselves with good food and activity. The group might choose to develop what they want in the form of models of food-based connection in their culture, activities to support their desires to stay fit and mentally well, incorporate connection to communities, with residential care operations and funding opportunities that have holistic wellness at the heart.

As part of co-creating ways to support well-being, the group may decide to reciprocate knowledge across generations, sharing food knowledge, utilising local and seasonal foods, together with proven exercise methods that are fun, inclusive to all persons and increase physical strength, energy, flexibility, cognitive stimulation, and sociability.

Supporting evidence: CCREATE-AGE, in its vision to stimulate co-created ageing research, funds Research Development Groups (RDGs) up to $10,000 to support a transdisciplinary group of people to co-create a research proposal related to priorities identified by communities through CCREATE-AGE 2023 listening events. This research relates to these identified priorities:

1. Intergenerational relationships: support and strain
2. Resilience
3. Food & exercise
4. Maintaining garden

Questions for audience: Are you passionate about food? A foodie that cares about how we feed ourselves and others? Do you have thoughts and goals and hopes for connection and activity as we grow older?  Are you part of or know of groups in your community that you could introduce me to, who might be interested to work with me around activity and food-based ways for wellness?

Do you know of existing communities who you would be willing to introduce me to so I could possibly go meet them to see if they might be interested in being involved?

What value do you see in this project? Which funders do you think might see value in this project?

Who do you think might fund this project IF it had a specific focus or included specific kinds of co-creators; researchers and policy makers experienced in certain methodologies/disciplines?

Ageing well through producing food for home and community

Tamika LA Simpson

Centre for Co-Created Ageing Research (CCREATE-AGE), University of Auckland.

Research Idea: I wish to form a transdisciplinary group of people interested in finding ways for how as we get older, we can continue producing food at home. The research would privilege wellbeing and seeks positive change by developing models of operations and funding with our wellness as central. As part of Co-creating Ways to Continue Producing Food at Home, the group may decide to explore exchanging wisdom across generations, and sharing our gardening knowledge, physical flexibility, social networks and strengths.

Supporting evidence: CCREATE-AGE funds Research Development Groups up to $10,000 to support a transdisciplinary group of people to co-create a research proposal related to priorities identified by communities. This research relates priorities:

• Intergenerational relationships: support and strain
• Resilience
• Food & exercise
• Maintaining garden

People tell CCREATE AGE they want meaningful activities, to contribute and be connected to their communities. For myself, I wonder how I will continue producing food. I wonder who I might be without this way of being and belonging.

Questions for audience: Are you a gardener who wants to continue producing food at home? Are you wondering or worrying about how you can continue as we get older?

Do you know of existing communities who you would be willing to introduce me to so I could meet them to see if they might be interested in being involved?

What value do you see in this project? Which funders do you think might see value in this project?

Who did you think might fund this project if it had a specific focus or included specific kinds of co-creators; researchers and policy makers experienced in certain methodologies/disciplines?

Age-friendly public spaces: An exploration of the role of public spaces in the well-being of older adults.

Sadiq R Younes

Wellington Faculty of Architecture and Design Innovation, School of Architecture

Introduction: Urbanisation and ageing are two challenging issues of the twenty-first century. The vast majority of population are living in urban areas globally. At the same time, the proportion of older adults is increasing in an unprecedented way.  In this global trend, Aotearoa New Zealand is not an exception and the number of older adults is exponentially increasing. With most New Zealanders living in urban areas, cities are under pressure to provide key amenities and services to their dwellers. Among those, urban public spaces are considered important for the health and well-being of older adults as they provide spaces for physical activity and social interaction. For older adults, social integration and the strength of social ties are profoundly important predictors of health and well-being. In the context of the capital city of Aotearoa New Zealand, Wellington’s city centre is an option for later-life accommodation due to cultural and entertainment venues and service availability. It is also a priority of the New Zealand government and local councils to encourage active participation of older adults as they are recognised as precious assets for their communities. This study aims to investigate the design of outdoor public spaces that foster well-being among older adults. This study is significant as it responds to the need of active participation of older adults in the community. In addition, it highlights the necessity for recognition of older adults as precious assets of the community as well as their role in the economy of the city.

Method: The current study will be undertaken by adopting a mixed methodology with four interrelated phases. The first phase will establish the context of the study and will be a basis for the selection of case studies. The case studies will be chosen by evaluating the study area against a set of criteria using GIS capabilities. The aim is to identify key places for further exploration. The next phase will involve observing older adults in the public spaces to explore and analyse their activities and behaviours in the public space. Qualitative phase will help to identify the needs and preference of older adults through an interview. 20 older adults will be interviewed and analysed by using interpretative phenomenological analysis. Finally, the last phase will involve engagement with older adults with respect to their preference based on findings of qualitative study. The findings of the research will inform the development of age-friendly communities and will have implications for designers, city planners, managers, and residents of age-friendly housing developments.

Session 3

Older Asian workers in New Zealand.

Rubina Bogati, V Burholt, J Parson, F Alpass.

School of Nursing, University of Auckland.

New Zealand (NZ) has an ageing workforce due to a drop in working-aged people and an ageing population. Due to this, in recent decades, more workforce involvement of older people has been promoted for economic sustainability. Simultaneously, the reliance on migrants to fill the gap in the workforce has increased the diversity of the population and the workforce. Asian countries are top contributors to NZ’s net migration gains. Statistics NZ has projected Asian people to be the second-largest ethnic group in NZ by 2043. The number of older Asian people and their involvement in the workforce will also increase in the future, but minimal research has been done to understand this group of workers. Research thus far has identified that the decision to work in later life is either driven by older people's need to work or their choice to work. As people live longer, they also choose to work longer, particularly if their health, social and workplace structure supports their working ability. However, working in later life is necessary for some older people with financial or social needs that require them to continue working. Some life-course factors, such as wealth and education, affect the decision to work in later life, which varies significantly among people from diverse ethnicities. Additionally, sociocultural differences between ethnic groups shape their decision to work in later life. For older Asian people, what keeps them in the workforce and expediates their retirement is under-researched. This lack of research leaves unanswered questions regarding their participation, motivations, barriers, cultural influences, necessities, and choices of working in later life. My PhD research aims to understand the later-life work decisions of older Asian workers in New Zealand.

Organisational support for older registered nurses' continuation of practice in inpatient hospital settings.

Chunxu Chen

Centre for Active Ageing, School of Clinical Sciences, Auckland University of Technology.

Research Idea: This study aims to explore how older Registered Nurses (RNs) (65 years and over for Pakeha or Tauiwi RNs, and 55 years and over for Māori or Pasifika RNs) and organisational representatives perceive organisational support for their continuation of practice in inpatient hospital settings. Using interpretive description methodology, I aim to recruit ten older RNs and five organisational representatives from Te Whatu Ora-Waitematā for interviews. Currently in the recruitment stage, the study has locality approval from Te Whatu Ora-Waitematā. Data collection will follow an iterative approach, informing subsequent interviews until research questions are addressed. Thematic analysis will be employed to identify recurring patterns and themes, allowing for a comparative exploration of commonalities and disparities of perspectives across the two participant cohorts. This research will contribute to understanding the impact of organisational support on older nurses' decision to continue practising in New Zealand's inpatient hospital settings. Recommendations will be made to enhance support strategies for older nurses and address ageism within the nursing workforce.

Supporting evidence: The aging nursing workforce has profound implications for healthcare systems, with older nurses often encountering ageism in their workplace, negatively impacting their well-being and continuation of practice. Our systematic review published in the Journal of Clinical Nursing (Chen et al., 2024) identified and synthesised evidence concerning ageism in the practice settings of older regulated nurses. The findings indicated that ageism is prevalent in these settings. Moreover, the review suggested that effective interventions to address ageism should be led by organisations. This approach can foster meaningful relationships between older nurses, their colleagues, and managers, while also highlighting the need for policies and initiatives that promote an age-inclusive work environment to support an age-diverse nursing workforce.

Questions for audience: Overall comments on the research ideas. Insights or suggestion regarding the research methods employed in the study.

The experiences of grandfathers raising grandchildren: An integrative literature review

Michelle Adams¹, J Wiles², M Smith¹, M Honey¹.

¹Department of Nursing, University of Auckland.

² Department of Population Health, University of Auckland.

Introduction: When the welfare of a child(ren) requires placement away from parents, a grandparent is often the preferred choice for relocation. Placement is predominantly with grandmothers and the experiences of grandmothers in a parenting role have been well reported. The experiences of grandfathers parenting grandchildren, however, is less understood.

Research summary: An integrative review identified and synthesised current literature on the experiences of grandfathers in a parenting role. Four electronic data bases were searched: CINAHL Complete, Scopus, Pubmed and PsycInfo, plus google scholar and hand searching using keywords based on five key concepts, custodial, grandfather, role, and experience. Thirteen articles qualified for review. Thematic analysis identified two key themes: Role identity and navigating a non-normative life situation.

Future directions: Grandfathers parenting grandchildren face distinctive challenges. Social role identity is tested by loss of agency over lifestyle choices and deficits in parenting knowledge and skill. Health and wellbeing are impacted by factors unique to grandfathers. Further research to tailor supports specific to the needs of grandfathers is required.

Assessment of dietary intake in the ageing population in Fiji

Salanieta Musudole Corerega Naliva

Supervisors: M C Kruger, C Wham, T Havea

Massey University.

Good nutrition is related to better health and higher health-related quality of life in older people, yet little is known about the dietary intake of older Fijians. To identify nutritional inadequacies in older adults ≥55 years, their dietary intake will be investigated using retrospective data from a 2x24hr Multi Pass Recall method and Intake24 Fiji software. Data for the 2x24-hour Multi Pass Recall were collected by nutrition researchers at the George Institute for Global Health at UNSW, Australia in partnership with Fiji National University in 2022. Dietary intake inclusive of commonly consumed foods in Fiji was from 530 adults ≥18 years. A data-sharing agreement provides dietary intake for 138 older adults ≥55 years for assessment of nutrition status. Ethical approval was provided by the College Health Research Ethics Committee of Fiji National UniversityFNU (#184.20) and UNSW ethics committee (#HC200469).

Developing a handbook for neurological choir facilitators: Manualising practice within a person-centred approach

Alison Talmage

The University of Auckland School of Music and Centre for Brain Research

Introduction: This practice-based doctoral action research investigates the CeleBRation Choir and Sing Up Rodney, two “neurological choirs” or singing groups for adults with an acquired neurological conditions that impact communication abilities and social connectedness. Internationally, therapeutic choirs tend to cater for participants with a single diagnosis. The CeleBRation Choir, founded in 2009 by the University of Auckland Centre for Brain Research, and Sing Up Rodney, founded 2017, have an inclusive philosophy, valued by participants and emulated by other practitioners across the motu.

Research Summary: Action research methodology was selected as a pragmatic means of investigating and improving practice. This paradigm allows questions and methods to evolve as the study unfolds through iterative cycles of plan-implement-review. Five main cycles and one spin-off cycle have been completed: (1) audio-visual analysis (AVA) of in-person and online choir sessions, (Spin-Off Cycle 1S) qualitative document analysis (QDA) of documentation and publications. (2) manualisation through thematic analysis of the AVA and QDA findings, (3) manual testing with a locum practitioner, (4) manual testing with other neurological choir and aphasia choir facilitators, and (5) implementation analysis through choir member interviews and volunteer team focus groups. The main output of the study is a handbook (a participant-preferred term, rather than manual) for neurological choirs facilitated by a music therapist, speech-language therapist, or other practitioners with appropriate skills. The handbook is structured around the VOCCAL Framework, an original, flexible protocol encompassing Vision, Outcomes, Conventions, Communities, Administration and Leadership.

Future Directions: Plans are underway to publish the Handbook in digital and hard copy formats. The research findings and recommendations will be disseminated through journal and newsletter articles, presentations, workshops, and social media.

Session 4:

Investigating the link between head injuries and dementia.

Dr Helen Murray

Research Fellow, Department of Anatomy & Medical Imaging, University of Auckland.

Introduction: Contact sport athletes experience repeated and often asymptomatic head impacts over their sporting career, leading to an increased risk of developing neurodegenerative diseases such as Chronic Traumatic Encephalopathy (CTE). CTE can only be definitively diagnosed postmortem. Diagnosing CTE in living people and accurately distinguishing it from conditions such as Alzheimer’s disease (AD) is essential as the symptom progression, pathophysiology, and effectiveness of potential therapeutic agents will likely differ between diseases. Objective biomarkers of the underlying brain pathophysiology are needed to facilitate diagnosis and future therapeutic trials.

Research Summary: My team is investigating new biomarkers to aid postmortem and antemortem diagnosis of CTE. Our current projects are studying postmortem brain tissue from former athletes donated to the Neurological Foundation Human Brain Bank at the Centre for Brain Research. We are using state-of-the-art tissue labelling techniques to explore the microscopic changes that occur in CTE and how they differ from those seen in Alzheimer's disease and normal aging. Our preliminary results indicate that focal inflammation around blood vessels in the frontal cortex may be a key distinguishing factor between these conditions.

Future directions: Looking forward, we plan to establish the first New Zealand cohort of former contact-sport athletes who meet the criteria for probable CTE. We will work with the Dementia Prevention Research Clinics to conduct cognitive testing, neuropsychology assessments, MRI and blood collection every two years. Our study will compare these measures to control groups, and those with early Alzheimer's disease to identify potential biomarkers for CTE.  We also intend to follow the TES cohort longitudinally to investigate within-subject biomarker changes over time and eventually study the relationship between postmortem neuropathology, antemortem clinical features and blood biomarkers from the same person.

User-testing of the e-DiVA Website: An iSupport for Dementia adaptation for New Zealand carers

Tara Sani¹, Gary Cheung¹, Kathy Peri¹, Susan Yates¹, Hēmi Whaanga², Sarah Cullum¹. 

¹Faculty of Medical and Health Sciences, University of Auckland.

²Te Pūtahi-a-Toi – School of Māori Knowledge, Massey University.

Introduction: This study is part of Empowering Dementia Carers with an iSupport Virtual Assistant (e-DIVA). In 2022-2023, we co-designed the New Zealand (NZ) adaptation of the World Health Organisation’s iSupport with NZ carers and developed it into an online course hosted by the e-DIVA website. Here we aim to assess the usability and acceptability of this website.

Methods: The website was assessed using a semi-structured individual interview and a usability test with a Think Aloud approach with the participants. Inclusion criteria: 1) adults aged 18 or over residing in NZ, 2) have a device with an internet connection to access the website, 3) primary unpaid carers of a person diagnosed with dementia and had been providing care for at least six months; or 4) care professionals who have been working in dementia care/education for at least a year.

Results: Five carers (two Māori, three non-Māori) and five care professionals (two Māori, three non-Māori) used the website for at least one week and attended an individual Zoom usability test and feedback session. Both carers and care professionals identified potential technical issues. Māori carers felt that the website was culturally appropriate. To improve readability, acceptability, and usability, several suggestions were made, such as improving website design, providing the option to see relevant content based on the stage of dementia, and making minor changes in the language and content to improve cultural appropriateness. All participants would recommend the website to other carers, provided further refinement based on the feedback has been made.

Conclusions: The e-DiVA website is a potential tool to provide resources for carers of people with dementia in NZ, but further refinements are needed to ensure its user-friendliness. For the next step, we will do a pilot randomised-controlled trial to understand its possible effect on reducing stress in carers.

Utilizing interRAI assessment for research: developing a national research agenda in Aotearoa New Zealand

Joanna Hikaka^1,2, Hamish Jamieson^2,3, Ngaire Kerse^1,2, Gabrielle Stent^2,4, Brigette Meehan^2,4, Gary Cheung^1,2

¹ The University of Auckland

² interRAI Research Network

³ The University of Otago

⁴ interRAI New Zealand

Introduction: interRAI provides a suite of standardised instruments for assessing health and psychosocial wellbeing and informing person-centered care planning. Data obtained from these standardised tools can also be used at a population level for research and to inform policy and interRAI is currently utilised in over 40 countries globally. We present a brief overview of the use of interRAI internationally within research and policy settings, and then introduce how interRAI is used within the universal public health system in Aotearoa New Zealand (NZ), including considerations relating to Māori, the Indigenous people of NZ.

Research Summary: In NZ, improvement in interRAI data utilisation for research purposes was called for from aged care, health providers, and researchers, to better utilise these data for quality improvement and health advancement for New Zealanders. A national research network has been established, providing a medium for researchers to form relationships and collaborate on interRAI research with a goal of translating routinely collected interRAI data to improve clinical care, patient experience, service development and quality improvement. In 2023, the network members met (hybrid: in-person and online) and identified research priorities. These were collated and developed into a national interRAI research agenda by the NZ interRAI Research Network Working Group. Research priorities included reviewing the interRAI assessment processes, improving methods for data linkage to national data sets, exploring how Indigenous Data Sovereignty can be upheld, as well as a variety of clinically focused research topics.

Implications for Practice, Policy, and Research: This appears to be the first time national interRAI research priorities have been formally identified. Priorities identified have the potential to inform quality and clinical improvement activities and are likely of international relevance. The methodology described to co-create the research priorities will also be of wider significance for those looking to do so in other countries.

interRAI dataset and how it can help with your research.

Karen Goymour

interRAI Services, Service Improvement and Innovation. Health New Zealand/ Te Whatu Ora

Introduction: interRAI is a suite of comprehensive clinical assessment instruments that have been in use in New Zealand since 2011. This is an international suite of assessment that are well-researched and validated against other gold standard assessments. interRAI is continuing to evolve as new research findings influence what is the health of individual needs that need to be reviewed. Currently interRAI New Zealand has a data warehouse of over 1.2 million assessments which increases by 100,000 assessments a year.

New Zealand based research has shown the value of this resource when making decisions about the health of elderly population not only here but globally. New Zealand is one of the few countries that use this assessment in the community, acute environments and aged residential care.

This presentation will show what is in an interRAI assessment, what some of the research projects that have been completed and showcased in the annual interRAI Knowledge Exchange. But also, how to access this information for your individual study area.

A pilot of paeārahi-facilitated needs assessment and care planning for older Māori

Joanna Hikaka

Te Kupenga Hauora Māori, University of Auckland.

Introduction: The interRAI Check-Up Self Report (CU-SR) is one of the tools in the suite of interRAI assessments and is used to gain a person’s perspective on their own health and wellbeing. The CU-SR differs from other interRAI tools as it does not require a trained health professional to complete the assessment. The CU-SR has not been used in NZ previously. Paeārahi (Whānau Ora navigators) have previously supported care access and navigation.

Objectives: i) to develop a process to support paeārahi-facilitated CU-SR in Te Whatu Ora Lakes region; ii) to test the feasibility and acceptability of paeārahi facilitated CU-SR assessment.

Method: Community-dwelling older Māori (55+) with no history of previous interRAI needs assessment were invited and consented to participate. Participants had the option of completing the assessment themselves or having a paeārahi support completion. Paeārahi developed care plans with participants based on the assessment. The primary outcome was holistic wellbeing pre- and post-intervention, measured using the Hua Oranga tool.

Results: We will present information regarding the intervention and study development including the co-creation of research outcomes and incorporation of te reo Māori into standardised assessment instruments. Interim findings and the potential of this work in informing policy change relevant to communities and populations experiencing inequities in access to aged care will also be discussed.