2019 HOPE Foundation Scholarships

Posted by on 25 February 2019

Through the generosity of our sponsors and the Friends of HOPE, we have been able to award each of the following scholars $6000, to support their work on an ageing related topic of research.

Please enjoy reading about their projects.

University of Waikato

Pita Shelford - PhD in Leadership/School of Management and Marketing

Hauora Kaumatua Maori, Mai I Te Wheiao Ki Te Ao Marama - Older Maori Health and Wellbeing in Life Transitions

My research explores hauora kaumātua Māori (health and wellbeing of older Māori) in terms of life changes, and seeks to explore the views and experiences of ageing among our kaumātua within rural, marae, and whānau settings. This study examines the adaption of a Tuakana-teina peer support programme/model, into the rural community of Mitimiti, that enables kamātua to help, support, and guide other kaumātua going through life changes in older age. The research takes a community and kaupapa Māori approach and undertakes a series of one-on-one conversations and wānanga (focus group/learning forum) with Kaumātua and their whānau from Mātihetihe Marae. Ultimately, this research is kaumātua and community/whānau driven and informed, which helps guides and determines the research process.

---

University of Canterbury

Sarah Howe - PhD in Bioengineering/ Department of Mechanical Engineering

Measuring lung mechanics during tidal breathing

Respiratory disease is a major public health problem globally. Chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases and pulmonary hypertension, are all chronic lung diseases with annual costs of ~1% GDP in many countries. COPD alone results in over 3 million deaths per year.

Pulmonary function testing diagnoses the type and severity of respiratory disease. Spirometry is the most common test and the current gold standard for assessing lung function in outpatient care. It analyses flow and volume during specific peak effort breathing manoeuvres to provide information about lung condition. However, peak breathing efforts are not representative of the average effort the patient is able to produce, which is more critical to understanding the patient’s ability to function in life. Additionally, some patients, such as the elderly and very young, are unable to manage spirometry, and are therefore excluded from lung function testing.

My research focus is on creating a new lung function test which requires lower patient breathing effort and cooperation. The research will extend and optimise a lung mechanics model for use with novel spirometers. This model is clinically accepted and able to monitor lung health in mechanically ventilated patients. Successful outcomes will provide the foundation to provide a consistent representation of lung mechanics and lung function across a wide range of respiratory care, from ICU to outpatient care. This model is being developed with the use of lab data from chronic respiratory failure patients, provided by collaborators at the University of Liege, Belgium, while the spirometer technologies are being developed at the University of Canterbury.

Lachlan McKenzie - 2nd Year PhD in Biomedical Engineering/Department Mechanical Engineering

Post-Stroke hand rehabilitation through hybrid assist -as-need exoskeleton

Approximately 9000 New Zealanders have a stroke each year. For those who experience stroke, the impact on themselves, their family, and wider community, is substantial. These impacts can range from physical deficits to psychological and financial strain. A great number of people display minimal levels of recovery post-stroke. This can be due to a lack of rehabilitation resources, both in clinical and outpatient settings. As population ages the impact of stroke on society will increase. New technologies are needed to counteract the demand for rehabilitation resources. The introduction of alternative rehabilitation technologies can make therapy more accessible, helping to reduce mismatch between its recommended and actual delivery. Two forefront technologies are robotic devices and functional electrical stimulation (FES), both proven beneficial to stroke rehabilitation. Inherent limitations, however, restrict the isolated usage of these technologies.

My research involves development of a hybrid device towards post-stroke hand rehabilitation, specifically basic pinch and grasp functions. The device will utilize the reliable nature of robotic-controlled motion, with additional benefits from FES direct muscle activation. Separate prototypes of robotic and FES components have been designed and constructed. In the future, these prototypes will be integrated to form one system. Balanced hybrid support can reduce requirements on stimulation intensities and robotic forces: this can lead to enhancement of robotic-device portability, and reduction of FES-based discomfort and fatigue.
The realization of my design will create a rehabilitation device that is easily accessible and available outside of clinical settings for functional rehabilitation. These features will ultimately promote maximal therapeutic effect and drive higher recovery rates for stroke survivors.

---

University of Otago

Navneet Lal - 3rd year PhD/MBChB Department of Physiology

Age -related changes in murine skeletal muscle

Our ability to move and to maintain our physical independence rests heavily upon the health and integrity of our skeletal muscles. As we age, we lose muscle mass and strength, and become frail. This constellation of symptoms has been termed Sarcopenia. The details of how this phenomenon occurs at the cellular level is presently unclear, and investigation of the biological mechanisms that drive age-related losses in muscle mass is difficult due to the complexity of skeletal muscle tissue.

The overall aim of my PhD is to extend our understanding of the drivers for age-related muscle atrophy and weakness. Numerous studies have already investigated myofibre atrophy and myofibre death in elderly skeletal muscle; however, these studies fail to reach a consensus on how much these factors contribute to age related muscular atrophy.

So far, I have found that passive tension contributes less to overall muscle force production in elderly animals compared to young animals. To further elucidate what may be occurring, a subset of the muscles that have been subjected to force production studies will be sent away for proteomic analysis. Proteomics is a cutting-edge technique that allows investigators to identify and quantify nearly every protein (approximately 3000-5000 in skeletal muscle) within a tissue; which in turn, can be used to compare proteomic differences between young and elderly animals.

Finally, I will attempt to reconcile all my separate anatomical, proteomic, ultrastructural and functional findings in order to identify signalling pathways that become problematic with age. This will be an instrumental step in formulating a pharmacological intervention which I hope to implement and test, as the final study within my PhD.

Sharmin Bala - 2nd year PhD Department of Preventive and Social Medicine

Assessing medication appropriateness among older adults in NZ and developing a tool to assess anti-cholinergic burden in individuals with dementia.

Older adults comprise a significant proportion of the population of New Zealand and are known to consume the highest number of medications. Several medications must be prescribed with caution in older adults due to their compromised biological functions that can impact and reduce drug clearance.

Dementia is one of the principal syndromes linked with disability and dependence among older adults, and is a major challenge to individuals, communities, and societies globally. The global incidence of dementia is expected to rise to 81 million by 2040, primarily due to the progressive nature of the disorder, which involves worsening neurocognitive impairment and loss of basic functions in daily life.

In one of our studies using the inter RAI-Home Care dataset, we observed that there is a high prevalence of prescription of potentially inappropriate anticholinergic medications in older adults with dementia, despite knowing that the prescription is associated with negative outcomes like the risk of delirium, worsening cognitive impairment, peripheral side effects, and increased mortality.

As a part of the big picture, I am focussing on delineating medications with anticholinergic properties which are commonly used for dementia. The overarching aim of my thesis is to assess medication appropriateness in the geriatric population of New Zealand with a view to developing an alternative prescribing tool for currently prescribed inappropriate anticholinergic medications in older adults diagnosed with dementia. A Delphi consensus will be utilized to validate the appropriate tool for prescribing medications; following which we intend to conduct a pilot study in residential aged care homes in New Zealand, to further enhance the validity and reliability of the tool for prescribing alternative medications to anticholinergics in dementia.

---

University of Auckland

Kristy Kang - Master of Health Sciences, School of Nursing

Exploring the effect of caring for a family/whānau member or friend with a life-limiting illness upon employment

There is an urgent need to respond to rising palliative and end-of-life care needs to support ageing populations. This is recognised by the World Health Organisation as one of the most significant public health challenges facing the 21st century. A key gap in current research includes the economic costs of caring for family members within a palliative care context. Informal carers, such as family members or friends, have a close, supportive role to the patient, provides vital care work and shares in the illness experience of the patient.

As well as physical, social, and mental costs, there are significant financial costs associated with caregiving. This can include a range of direct and indirect costs, including work-related costs, out-of-pocket expenses and carer time costs. However, little is known about the nature and extent of the economic costs of caring despite growing evidence that the palliative care context can exacerbate these costs. In particular, there are no reliable estimates around how caring for family members or friends with a life-limiting illness impacts on caregivers’ employment status in a New Zealand context.

My research project will build upon the work of an existing research project, Te Pākeketanga: Living and Dying in Advanced Age, which is aligned with Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). Qualitative analysis of interview transcripts will be conducted to examine how caregiving impacted carers’ work and employment. Interviews have been conducted with bereaved whānau and family with a near equal distribution of non-Māori and Māori participants. Findings from my research will help inform policy and practice to better support caregivers.

Marie Jardine - 2nd year PhD Speech Science

Deglutition (Swallowing) in Advanced Age

Eating and drinking are central to our lives.  For people with swallowing difficulties (dysphagia), they may experience serious physical and emotional consequences, such as malnutrition, dehydration, aspiration pneumonia, social withdrawal and reduced quality of life.  Swallowing difficulties are more prevalent in older age, due to age-related conditions, multimorbidity and polypharmacy.  Since our population is ageing, it is important that we better understand swallowing changes in advanced age.  However, it is a misconception that ageing alone causes dysphagia.

We recently published a study investigating older patients with new swallowing difficulties who were hospitalised for unrelated conditions.  Using quantitative measures, we compared video x-rays (videofluoroscopy) of patients and healthy older adults aged 70-100 years old.  Distinct swallowing changes for patients included reduced throat squeeze and more instances of liquid entering the airway.  Our findings further highlight that care must be taken not to oversimplify dysphagia complaints as part of the normal ageing process.  We suggested a combination of factors during hospitalisation (fatigue, low levels of alertness, delirium, reduced respiratory support and disuse atrophy) may tip the balance of any age-related swallowing compensations, resulting in swallowing difficulties.

In 2019, my PhD research will investigate healthy age-related swallowing changes in adults over 80 years old using videofluoroscopy and high resolution manometry with impedance (an emerging clinical tool that measures pressures in the throat).  Our findings aim to assist clinicians with differentiating pathology from normal variance and thereby prevent under-management or over-management of patients.  We are also conducting a prevalence study of self-reported swallowing status in older adults, which is the first of its kind in New Zealand.

Alyssa Lie - 2nd Year PhD School of Optometry and Vision Science

Studying the relationship between “hydration State” of the human lens obtained by MRI and vision quality. A novel method to predict the onset and progression rate of cataract.

Cataract is an opacification that develops in the eye’s lens that eventually results in vision loss. It mainly occurs due to changes in lens biology driven by ageing. Currently, visual impairment from cataract can only be addressed surgically, placing a heavy financial burden on the public healthcare system. As the cataract burden grows alongside the ageing population, there is an increasing impetus for alternative solutions to try and slow cataract progression and delay the need for surgery.

In the quest for novel effective anti-cataract therapies, my research focuses on using magnetic resonance imaging (MRI) techniques to monitor regulatory water transport pathways in the lenses of healthy adults with and without cataract. These pathways are thought to actively maintain the transparency and refractive index gradient of the lens, both vital properties for optimal vision quality. Because MRI can measure two parameters (water content and water:protein ratio) that reflect the functionality of the lens’ water transport system, we can quantify any age-dependent changes it undergoes and investigate if these result in cataract. These measurements will also be implemented into a customised computer model of the lens to determine how they impact on an individual’s vision quality.

Successfully establishing lens ‘hydration state’ as a biomarker for cataract will reveal the potential of pharmacologically enhancing the lens water transport system as an anti-cataract treatment option. This will be a step toward our goal of delaying/preventing cataract progression and reducing the need for cataract surgery.

---

Auckland University of Technology

Kay Shannon - 3rd Year PhD Department of Nursing

The transition of Whare Aroha Care residents to a new dementia-friendly village.

Rotorua Continuing Care Trust operated an aged residential care facility, Whare Aroha CARE, providing rest home, private hospital and secure dementia care. The trust built a village inspired by the Hogeweyk model, where people live in small houses with five or six others, primarily but not exclusively, for people with dementia.

The research aim is to explain the resettlement of Whare Aroha Care residents into The CARE Village and the effects of the resettlement on the lives of the residents. There are two thesis questions for the study: 1. Why and how has the decision for Whare Aroha Care to transition to a new facility been made and implemented, and: 2. How has the transition affected the way residents live their lives? The study utilises a critical realist methodology and a case study research design. Study participants are facility management, staff, residents and family members as well as other key informants from organisations such as the Ministry of Health. Study data are transcripts of interviews, focused observation records and key relevant documents.

Data collection for the study is complete and analysis is in progress. Preliminary results indicate the change in environment provides cues for residents, such as recognisable domestic features, the smell of food cooking, or a basket of washing ready to be folded. These, together with staff encouragement to maximise remaining abilities, facilitate resident participation in normal domestic activities as they are able and desire.