HOPE Foundation Newsletter September 2022
Healthy ageing and housing – trouble ahead?
HEALTHY AGEING comes from the foundations and building blocks we put in place during our life journey. Having a safe sound home is one of those essentials and is associated with better physical and mental health. The current older population is doing well in having high home ownership, high satisfaction with their homes and those who do rent are more likely to rent social housing which has a more secure tenure. What will the housing outlook for our next generations of older people be like?
The impact of good housing on the quality of life in old age starts early.
Our current children are more likely to live in rented homes, and move more often disrupting their education. 1 in 5 houses suffer from damp and mould and proportionally more so in rented housing. 1 in 9 new Zealanders live in overcrowded houses and these later two factors impact health status. Educational disruption and poorer health then impacts on employment and inequities widen.
Home ownership has reduced overall to 64.5% the lowest rate since 1951 with the greatest reductions in those in their late 30s to 50’s. This group is also supporting a greater proportion of children over 17 who are not leaving home until later in their twenties partly because of housing affordability and availability – potentially diminishing their own retirement planning.
Lower home ownership as one hits retirement age may lead to housing and financial insecurity. Will there be adequate renting options? Will there be security of tenure? It is one thing to move when you are fit and able – quite another challenge in later years. Will the current model of retirement villages be sustainable? Who will pick up residential care costs? Who is building/providing the aged care facilities for those who cannot afford premium room rates?
What innovative options are there? Many older people live alone and have spare bedrooms? Is flatting, having a boarder, dividing the house an option? Are city planning and mixed housing developments a way ahead? Currently development seems random and less sustainable with larger buildings covering most of the land with no visual appeal.
Who is looking at the unintended impacts of policy decisions on specific population groups?
For those who want to read more Stats New Zealand have more detail in their report Housing in Aotearoa 2020. See https://www.stats.govt.nz/reports/housing-in-aotearoa-2020
As you can see there are many research questions. We need to develop the researchers and researchers will need funding. This is just one area that is important in ageing. The HOPE Foundation still has work to do, so please support us on our journey.
Ways you can help
- Spread the word and share the newsletter.
- Join the Friends and help plan a social activity with some fund raising built in.
- Donate to us.
- Consider leaving a bequest.
Knowledge Exchange: Save the Date
November 18 2022
The next Knowledge Exchange where our researchers get together to present their work will be November 18th at the Faculty of Medical and Health Sciences, University of Auckland.
More information to come.
Enquiries to Mareet@adhb.govt.nz
2022 Hope Foundation Scholars
We have been very fortunate due to the generosity of our sponsors, to be able to award 9 University HOPE scholarships for 2022. These are all very worthy recipients and hopefully their work will make a difference to the lives of New Zealanders in the future. Enjoy reading their inspiring projects.
Exploring the contribution of built environments and mobility to older adults’ positive ageing in place
Tessa Pocock, PhD study in Community Health, School of Nursing, University of Auckland
For older adults ageing in place, the home and local built environment can become the platform for socialisation, meaningful engagement, and move- ment. My PhD research focuses on exploring ‘positive ageing in place’ for community-dwelling older adults, while also considering the unique contribution of built environment and mobility. To date, my PhD research has encompassed two major reviews. In these reviews, I established a conceptual model of positive ageing and subsequently worked to understand the role of mobility in positive ageing.
In the final stage of my research, I will use participatory and creative approaches to further explore older adults’ perceptions of positive ageing, built environment, and mobility.
Ultimately, I hope my research findings can inform initiatives aimed at creating enriching, engaging, and meaningful environments for older adults.
Designing a protocol to fast-track research into a new cancer drug target
Victoria Gibbs - Master of Science (Biological Science) Supervised by Assoc Prof Evelyn Sattlegger, Massey University
Aotearoa has an ageing population, and this heralds an increase in cancer diagnoses in the coming years. Cancer plays a significant physical and emotional burden on patients and their families, with treatments often having undesirable side effects and variable success rates. This makes finding new ways to fight cancer of paramount importance.
Cancer hijacks the cell’s starvation sensor protein GCN2 to meet its nutrient requirements, promoting growth and survival. GCN2 needs to bind to a supporting protein (SP) to function. Designing a drug to block this interaction could therefore prevent GCN2 activity, in turn reducing the ability of cancer cells to survive. Features that mediate GCN2-SP binding have been identified in yeast. Understanding characteristics of the human interaction, including whether it is similar to that in yeast, is the vital next step towards designing an inhibitor of this binding site.
I will develop a yeast two-hybrid protocol to study the human GCN2-SP interaction in yeast. Using yeast will accelerate research into this target as they are more amenable to lab techniques than human cell lines. Using this protocol, I will test which residues are vital for binding by mutating them, and also whether the yeast and human interaction is similar enough that the proteins from each species can bind each other. These results will enable me to predict how a drug could be designed to block this interaction.
Evaluating the spread effects of standardized behavioural treatment approach in improving swallow and cough function in individuals with Parkinson’s Disease
Fathima Shakeela Abdul Saleem. Third-year PhD candidate at the University of Auckland supervised by Dr Anna Miles and Dr Jacqui Allen.
Parkinson’s Disease(PD) is a neuromotor progressive degenerative disorder affecting one in 500 New Zealanders and projected to be double the amount by 2040. Difficulties with communication, swallowing and cough function are common clinical features among individuals with PD. These clinical complications negatively affect quality of life and aspiration pneumonia is reported to be one of theleading causes of death in PD. Our research study aims to evaluate the spread effects of Lee Silverman Voice Treatment (LSVT LOUD) and Expiratory Muscle Strength Training (EMST) treatment programmes on talking, eating and drinking, and cough strength to determine who benefits most from LSVT LOUD and EMST.
These treatments are standardized, globally validated treatments that are clinically proven to improve voice, swallow, and cough functions in people with Parkinson’s disease. Improvement in voice, swallow, and cough function will improve social communication and mealtime safety and enjoyment which can lead to an improved quality of life, confidence, and active societal participation. Validation of LSVT LOUD and EMST through randomized two treatment clinical trials, as therapies for voice and swallow dysfunction in people with PD, will offer a safe, non-invasive option to the current range of treatments available.
Voices in Harmony: Singing groups for adults with acquired neurogenic communication difficulties
Alison Talmage. Final year of PhD study University of Auckland
“Neurological choirs” offer a social connection, strategies for communication maintenance/recovery, and an enjoyable shared activity for adults with acquired neurological conditions, such as post-stroke aphasia, Parkinson’s or dementia. As a music therapist and PhD candidate, my action research study aims to improve my own practice and to provide guidelines and resources for similar groups.
To date, I have completed an audiovisual analysis of singing sessions and a qualitative document analysis of choir-related materials, and then used reflexive thematic analysis to create a draft manual for choral singing therapy. I am now testing this manual in my own practice and in collaboration with a locum music therapist.
The next steps will be seeking feedback from my wider community of practice and choir participants through focus groups. The pandemic has offered both challenges and opportunities, particularly developing creative approaches for online music therapy and an increased emphasis on songwriting as well as singing.
Creating a model for effective Client-Led Integrated Care (CLIC) in general practice
Anna Askerud. PhD study University of Otago
I am a registered nurse with a background working in general practice and in hospital care. I worked for many years developing a long-term conditions programme at a large primary care practice working with many older adults in the practice. I began my research into effective models of care for those with chronic conditions in 2009 and completed a masters project on nurse case management from my experiences working with people in this practice.
I began working on this current project in 2019 which examines care planning in a model of care called Client Led Integrated Care (CLIC) in general practice currently in use across Otago and Southland. The research brings together data measuring health outcomes for those enrolled in this programme, and interviews with health consumers and health professionals. I have also talked to health funders and planners responsible for developing this programme.
The research aims to gain a clear understanding of where this model of care is working well, and to identify areas where programme modifications could further enhance the intervention for people struggling with the burden of multiple health issues, many of whom are in the older age group.
It is hoped that research into this model of care for those with long term conditions, most of whom are older New Zealanders, may contribute to an understanding of the active parts of the care planning process and the usefulness of providing a personalised care plan. This may inform future practice in our district and across NZ.
Understanding the underlying brain changes of patients with Parkinson’s Disease
Nicky Slater PhD study, University of Canterbury
Parkinson’s disease (PD) is the second most common neurodegenerative disorder of the human brain behind Alzheimer’s disease.
PD prevalence increases substantially with age and will almost double by 2040 in Aotearoa New Zealand due to our ageing population and improving health care that increases life expectancy. An estimated 11,000 New Zealanders are currently living with PD.
Primarily thought of as a motor disorder, PD is increasingly recognised as a heterogeneous condition that causes pathology in many brain regions and neural pathways. This widespread neuropathology produces a variety of non-motor symptoms, the most disruptive of which being cognitive impairment.
While neuropsychological assessment is an extremely informative tool to assess cognition, we believe understanding the underlying brain changes of PD patients may better explain the range of severity of cognitive impairment observed in PD.
This research will use magnetic resonance imaging (MRI) and electroencephalogram (EEG) to ascertain brain measures that distinguish different levels of cognitive status in PD at baseline, and will follow up patients to determine the best predictors of future decline.
As the population ages, PD and other neurodegenerative disorders are predicted to become an increasing burden on the health system. The establishment of brain measures that indicate early PD pathology may help with assessment of people who are at risk of future PD, which in turn may help the development of treatments that can delay the onset of PD, thereby decreasing the number of years someone would experience the burden of PD, and/ or lessen the severity of PD.
Maintaining social inclusion for people with dementia
Annabel Grant – PhD study, Massey University
People living with dementia may experience social connections shrinking due to the stigma of the disease or changes in their communication, social cognition and behaviour.
Social connection is a core psychological need and conversation skills are important for remaining socially active, but currently people recently diagnosed with dementia are not provided with support to maintain these skills and live as well as possible. Using qualitative methods, this study aims to find out how people with dementia and their friends experience their social citizenship and whanaungatanga, and how the values, perspectives, and experiences of people with dementia inform our understanding of rehabilitation needs for maintaining social connections.
The knowledge generated can be used for enhanced service planning for the future needs of people with dementia on optimal ways to maintain social engagement and live as well as possible.
Creating a model for effective Client-Led Integrated Care (CLIC) in general practice
Keiko Oda PhD study, University of Auckland
While working as a nurse, I noticed the importance of oral health for the wellbeing of care-dependent older adults as a tangible measure to prevent aspiration pneumonia and deconditioning through nursing oral care delivery.
Given that New Zealanders suffer a high rate of tooth loss and with the exponential growth of care-dependent older adults under the current pandemic, my research is challenging yet timely. Currently, I amfocusing on developing continuity of nursing oral care protocols to support older adults’ oral health in the community and aged residential care facilities (ARCs) with interprofessional collaboration (IPC). The IPC research team work on the oral care protocol development with an aim of providing continuity of oral care along the continuum of aged care by developing universal oral care assessment tools, care interventions, and evaluations of intervention efficacy.
The aim of the community-based project is to test the effect of the oral care protocol on nursing staff awareness of oral health for dependent OAs, while the AWESSoM (Ageing Well through Eating, Sleeping, Socialising, and Mobilising) Care Home project aims to revise the oral care protocol and evaluate its feasibility and acceptability among staff and residents in two ARC
Equitable access in the event of flooding for people who face mobility barriers
Emily Ward, Master of Urban Resilience and Renewal, University of Canterbury
A transportation network is a foundation of a city, however, not all transport networks provide equitable access to amenities including food, education and employment, and can become even less equitable in the event of natural hazards. By catering for the needs of those that face mobility barriers, resilience for everyone will be enhanced (especially for Aotearoa’s aging population), and will also make transport systems more equitable.
My research aims to measure the resilience to flooding through the lens of access to amenity for people that face mobility barriers in Ōtautahi. I also aim to identify transport-related solutions to improve inclusion and resilience in flooding situations. I will use spatial analysis to examine proximity to amenities for both people with disability and older people, factoring in public transport. The resulting proximity evaluation will then be compared with analysis of proximity when applied with flooding scenarios in Ōtautahi. There may be opportunity to engage with people who face mobility barriers to test any assumptions made in the modelling and to further understand how transport network resilience can be enhanced.
Tips to keep your mind sharp
From Professor Cathy Stinear (Neuroscientist Auckland Faculty of Medical and Health Sciences)
Move it - being physically active improves blood flow to your brain, even when you’re resting.
Rest it - sleep is when waste products, including proteins linked to the development of dementia, are removed from the brain.
Feed it - a balanced diet high in fresh, unprocessods and low in salt and sugar.
Challenge it - being curious and learning new things gives your brain practice at forming new connections and memories.
Protect it - reduce the risk of head injury and loud noise exposure that can damage hearing.
Breathe - deep breathing can calm the mind and manage stress
Play - Have fun-connecting socially is essential for good brain health.
HOPE Foundation Friends
It was such a treat to be in a hall filled with music and beautiful singing . . .
Love, Compassion and HOPE for Ukraine
An Afternoon of Opera with The Friends of the HOPE Foundation.
IT WAS wonderful to welcome one hundred guests to a fund-raising Afternoon of Opera, after having had to cancel many planned events over the past two years.
I must admit that staging an event with Covid still circulating in our community, required thought and care mixed with anxiety, but seating was well spaced in the hall and guests wore their masks.
The Friends of the HOPE Foundation Committee’s goal is always to raise funds for research into ageing but when the world was shocked at the destruction in Ukraine and the devastating effects on all its people, it felt we could include them in our fundraising.
With assistance of Heather Pascual, an opera singer, what could be better than an Opera for Ukraine?
“One enchanted evening,” beautifully sung by Arthur Adams-Close, set the tone of the afternoon, it was so tempting to sing along with it. Clare Hood, a coloratura soprano filled the hall with her high notes. The programme
also included well known songs from Vaughan Williams, Strauss, Mozart and more. The best parts for me, were when Arthur and Clare sang and acted together in the “Take me as I am.” We were all invited to sing the chorus of Edelweiss, which stirred up memories for us all.
It was such a treat to be in a hall filled with music and beautiful singing. The musical programme, concluded with the audience standing, as the opera singers together with the Ukrainian consul and his wife, sang a stirring rendition of the Ukrainian national anthem. It was an emotional ending.
Afternoon tea with delicious bites, continued the conviviality.
Our funds will meet the needs of older people, such as food, shelter, and medicine in the city of Zhytomyr. This was the hometown of Mikhail Tablis and his wife, prior to coming to NZ. Many of you will have heard Mikhail play the piano at our events. We were able through them, to contact the city leaders. Zhytomyr was bombed on
25 May, when many people were displaced, schools, hospitals and cultural centres destroyed.
Thank you to all our supporters who attended and gave generously to the people of Zhytomyr.
We look forward to seeing you at our next fundraising event.
Follow-up and Value of University Summer Studentship research
We often get asked about the outcomes from our student’s research projects and if any do continue in the research field. Certainly, we know that undergraduates with research experi- ence are more likely to complete higher degrees, pursue academic careers and have more long- term success; with the students themselves also reporting the value of developing better interpersonal, professional, and scientific skills during their research experiences. The newslet- ter is a good opportunity to provide feedback from our most recent 4 Summer students on a HOPE scholarship, but also to feature Conor Nelson, one of our 2019 Summer students. Conor is an outstanding young man who has continued in immunotherapeutic research started as a summer student and is now pursuing a PhD in antibody therapy. This work may eventually help provide a treatment for such devastating neurodegenerative disorders as Alzheimer’s and Huntington’s disease.
An immunotherapeutic approach to treating cognitive decline
Conor is in his second year of PhD study, working in the Molecular Neurotherapeutics Laboratory at the University of Auckland, with supervisors Assoc Prof Debbie Young and Dr Angela Wu.
Their lab has developed an antibody-based immuno- therapy targeting the GluN1 subunit of NMDA glutamate receptors, that are essential to the process of learning and memory.
Previous studies have shown that these antibodies have neuroprotective and cognitive -enhancing properties in rodent models. Conor is further developing this work to see if these antibodies are also effective in treating neurodegenerative conditions, and will then try to optimise
them for clinical use The binding of these antibodies to a receptor can change the way the cells act and hopefully encourage them to survive. As Conor explains, “If targeted early enough, it may be possible to recover some functionality but even to be able to stop any further progression would be amazing, and miles beyond what we currently do.”
“For me, so much of what I think of myself comes down to my experiences, my memories, the things that I associate as being part of me and how much that’s just purely cognitive. The idea of having some sort of constant decline is honestly kind of terrifying. It would be amazing to be able to stop people from having to experience that.”
Potentially Inappropriate Medicine (PIM) use in hospitalised older adults with cardiovascular conditions
Student: Manvis Wong, University of Auckland
The HOPE Foundation generously provided $6500 as a stipend for my work as part of the 2021-2022 Summer Research Scholarships. My research supervisors were Dr Mohammed Mohammed and Dr Nataly Martini and I also received support from Dr Amy Chan from Auckland District Health Board (ADHB) to access ADHB electronic patient records.
I would like to begin by expressing my immense gratitude towards The HOPE Foundation for funding this research and providing me with the opportunity to undertake this rewarding learning experience. Throughout these 10 weeks, I have learnt invaluable skills that will serve me well for the rest of my studies and as a practicing pharmacist in the future.
The results from these findings show that PIMs are a common problem for many hospitalised older adults with long term conditions, which is consistent with previous literature. Our results show that there is a reduction in PIMs between admission and discharge which is most likely due to deprescribing that occurs during the patient’s hospital stay by the hospital
team. This could be further improved at ADHB by implementing a more structured approach to medicines optimisation using the STOPP criteria or other tools to facilitate deprescribing of PIM in acute settings.
From this research, I hope to foster discussion about the importance of the pharmacist as a member of the multi-disciplinary team. With the expansion of artificial intelligence and technology into the healthcare sector, some may argue that the role of the pharmacist could
be replaced by automation and software that could systematically apply prescribing tools to evaluate medication appropriateness.
However, during my experience this summer, it was clear that a large amount of clinical judgement was required to appropriately apply the STOPP criteria
to each patient. As a medicine expert, pharmacists have a key role in evaluating the benefits and risks of discontinuing or changing a patient’s medications taking into account the patients’ comorbidity, laboratory data, combined medication and the treatment schedule after hospitalization.
Can gait and balance be assessed remotely in people with Parkinson’s Disease?
Student: James Davies
Primary Supervisor: Dr Paulo Pelicioni
Department: Health Sciences, University of Otago Secondary Supervisor(s):
Dr Lara Vlietstra, Prof Debra Waters, Prof Leigh Hale
Funder: HOPE Foundation
There are several validated measures of balance and gait assessment for people with Parkinson’s Disease (PD). These are usually carried out by a health professional in-person. However, COVID-19 has increased isolation and reduced healthcare access. Validation of remote assessments is necessary to promote access and timely interventions. We tested the reliability of remote gait and balance assessment of people with PD via video conference. We carried out 14 basic tests such as transferring to and from a chair and walking 6 metres.
We found that most of the tests were reliable compared to in-person even when different people scored them. It may be feasible for health professionals to remotely assess people with PD.
However, some of the tests may need to be adjusted and a larger study done to improve the trustworthiness of results.
Exploring how baseline body composition and performance affect response to exercise in middle-aged adults
Student: Mathew Shuen Supervisors: Prof Debra Waters
Dr. Lara Vlietstra & Dr. Kim Meredith-Jones School:
University of Otago / Dunedin School of Medicine Department: Medicine, School of Physiotherapy Funder: HOPE Foundation
The primary aim of the analysis was to understand the factors effecting response to exercise. To do this, we assessed the relationship between pre-exercise body composition and functional measures with the change in muscle mass after 20-weeks of high-intensity aerobic and resistance exercise (HIART).
Methods: Using specialised scatterplots (Brinley plots) to see muscle mass change by the end of the exercise regime, compared with the baseline data for each individual. The dataset contained 39 middle- aged adults (34 female).
Results: Measures associated with positive response were high percentage body fat (BF%), low visceral adipose tissue (VAT) mass. Conclusion: High baseline BF%, low VAT mass, are associated with greater muscle mass change in response to HIART, while other variables show little or no correlation.
Soundscape as an avenue to mindfulness in hearing health
Student: Komal Rana, University of Auckland
This research project explores how one’s perception of the sound environment has the possibility to foster mindfulness of one’s hearing ability. Firstly, I would like to sincerely thank the HOPE Foundation for allowing me to take part in this summer research project. Without their support, I would have not been able to explore this research into the soundscape and how it can foster mindfulness in one’s hearing health. Pursuing answers into this growing area of research has harbored a deeper appreciation for the discoveries and complexities of research processes. I am grateful to have experienced challenges in thinking both logically and creatively as a researcher. The project was also made possible through the findings discovered in related studies by David Welch, Ravi Reddy, Kim Dirks, Daniel Shepherd, Mei Yan Tan, and Gavin Coad.
Nine participants took part in this soundscape study where they were prompted to engage with the sound- scape through a semantic differen- tial questionnaire. The questionnaire consisted of descriptive and internal response features of the soundscape. An interview was then conducted with each participant, and they were questioned further about their responses.
It is apparent that the soundscape can foster awareness and appreciation of one’s hearing. All participants thoroughly enjoyed the experience of learning about the sound environment around them. But more importantly, how they as individuals feel and respond to different sounds around them. The degree to which a practice like this elicits mindfulness, the lack of recognition about the physical process of hearing, and the potential impacts of COVID-19 upon one’s soundscape, are all new pieces of information that have emerged from this study.
This study is one of only a few that has attempted to look deeper into how mindful interactions with the soundscape can foster awareness and appreciation of one’s hearing. In an age where people are constantly being exposed to noise pollution, loud noises, and increasing engagement in technological devices, the ability to stop, listen, and be present within the soundscape is essential.
Encouraging people to value their hearing more would innately lead people to protect their hearing or at least be more mindful of which environment’s cause emotional distress, and vice versa, know which environment’s they find peace and comfort in. The research has offered encouraging data to support the need of a health promotion message that could encourage people to be more mindful, appreciative, and protective of their hearing.
In 2021, Dr Karen Mumme (PhD) was awarded our inaugural small project grant of $10,000. This was initiated by the HOPE Board as a way to support researchers and/or clinicians to undertake small projects in Gerontology and well being research. The aim being to encourage and develop research that may lead to larger projects on aspects of ageing, that will benefit New Zealanders.
Karen completed her PhD at Massey University in 2021. The PhD project covered the main objectives of the REACH study (Researching Eating, Activity, and Cognitive Health). These objectives examined the associations between dietary patterns (using a statistical approach) and their associations with cognitive function and metabolic syndrome in older, community dwelling adults in the New Zealand population.Prior to this, Karen worked as a corporate accountant but always had a strong interest in population health and food, which has led her to this path where she hopes to make a difference. Karen also writes about food and research in the New Zealand setting on her blog Food proof https://foodproof.co.nz).
Assessing diet quality in older New Zealand adults - and its association with metabolic syndrome and cognitive health
Principal Investigator: Karen Mumme
Key co-investigators: Kathryn Beck, Jamie de Seymour. College of Health, Massey University, Auckland
WE KNOW several things. Firstly, what we eat affects our health. Secondly, we have dietary guide- lines to guide our eating choices. Thirdly, our lifespan is increasing and fourthly the population in New Zealand is ageing.
Unfortunately, a longer lifespan does not always equate to a healthy longer lifespan and many people are living with metabolic disturbances and reduced cognitive function in their later years.
Healthy eating is related to health ageing. The recent NZ Ministry of Health guidelines suggest healthy eating patterns in older adults. At Massey University, these guidelines are currently being adapted to a dietary pattern index where an individual or population’s complete diet can be measured and scored by a questionnaire.
The index, an easy-to-use tool, can be used in both a research and clinical setting where the dietary factor is often overlooked. This project will be the first study to use this dietary pattern index to explore associations between the diet quality of older New Zealand adults and health outcomes.
The objectives of the project are to:
- apply, in a research setting, the newly developed index to measure diet quality in older adults.
- examine the association between the diet quality and metabolic syndrome and cognitive function in older adults.
- introduce the eating index and share the results with the public, health professionals, and other researchers of ageing.
We hypothesise good adherence to the New Zealand dietary guidelines, represented by higher scores on the dietary pattern index will be inversely associated with the risk of metabolic syndrome and positively associated with good cognitive health.
You can also help by
- Spreading the word about what we do / share this newsletter
- Donating your time to the Friends Supporters to help with fundraising and committee work
- Encouraging your children and grandchildren to invest in their futures by donating time and money (a baby girl born today has a 1 in 3 chance of living to 100 , a boy 1 in 4 and is likely to be fitter and healthier–think about the implications of that)
- Consider a bequest