Helping to better understand the needs of an ageing population, and their ongoing well being, could well be in these peoples’ hands as finalists in the HOPE Selwyn Scholarship. The HOPE Selwyn Foundation is a registered charitable trust established in 1996 to assist the funding of research and education essential to the health and welfare of older people in New Zealand.
The Foundation’s vision is to see a cadre of research scientists in a variety of disciplines such as the social sciences, business and economics, architecture and planning, and health, committed to performing essential research that will add to the information base the country needs.
Fatemeh Faeze Yavari
Victoria University of Wellington
Housing alternatives for an ageing population in New Zealand: a resource assessment
There has been much discussion in the literature both overseas and in New Zealand on how older people should make appropriate housing choices but there is little information on designing appropriate housing to allow people to age in place in their communities. This study is a first step in this direction, and is happening at a time when climate change mitigation is also of vital importance. Therefore, this paper aims to link different issues including the New Zealand housing stock (need for more age-friendly houses), ageing population (New Zealand population is ageing) and environmental issues (finite resources) in order to:
Make better use of existing housing in New Zealand
Provide a better quality of wellbeing and independence for those aged 65+
Ensure older people have houses they can afford to heat and maintain
Reduce resource use and consequently, the environmental impact of older people’s housing in New Zealand
The aim of my research is to reveal the housing options which have the lowest resource use and consequently are the more environmentally friendly and sustainable options but that are also most beneficial for the ageing population.
Two New Zealand housing types are being investigated (early 20th century villas with a central corridor and 1940-60s single storey state houses). Three designs have been produced for each house, ranging from subdivision (conversion to two smaller units), to having some shared spaces such as a guest bedroom, to private en-suite bedsitting rooms and all living spaces shared. To meet the needs of the ageing population, New Zealand level 3 Lifemark standards have been incorporated in all designs. The proposed conversions have been examined by an expert panel and in a survey of New Zealanders aged 55-85. All final designs will be subject to life-cycle energy (LCE) and cost analysis (LCC) and the results compared with new small houses. The outcomes of this evaluation will identify whether, in terms of resource and energy consumption as well as costs, ageing in the community is a viable option of New Zealand.
Auckland University of Technology
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. In September 2017 the residents moved to The CARE Village. Based on the Hogeweyk model, The CARE Village accommodates people in domestic scale environments with like-minded others.
The aim of the research is to explain the resettlement of Whare Aroha Care residents into the village and the effects of the resettlement on the lives of the residents. The study utilises a critical realist methodology and a single 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 is being collected using interviews, focused observation and key relevant documents.
Phase one data collection, prior to the move from Whare Aroha CARE to The CARE Village has been completed. Preliminary findings indicate that the management of Whare Aroha CARE have facilitated the transition to the CARE village in a number of ways. Strong themes at this stage of analysis include communicating the vision of how resident life will be in the CARE village, changing the organizational culture to support the new model of care and fostering relationships to enable the transition to take place.
University of Victoria
Assessing medication appropriateness in the geriatric population, and the development of an appropriate prescribing tool in the elderly
Several medications have to be prescribed with caution in the elderly due to their compromised biological functions that can impact and reduce drug clearance. Population level studies conducted across New Zealand have evaluated the prescribing patterns in the elderly, of which, one study highlighted that 3 quarters of the geriatric population in New Zealand were prescribed potentially inappropriate medications.
The objective of my study is to systematically review the available literature on prescribing criteria and indicators, and to develop a composite rating scale of the medications, which are termed inappropriate by majority of the existing criteria. Based on the findings, a composite tool for appropriate prescribing for common ailments affecting the elderly will be developed and validated.
The research is being conducted within the framework of a population based retrospective cohort study using New Zealand’s vast health administrative and population database. Eligible patients aged over 65 years, who were issued more than one prescription are included in the study. The implementation of an appropriate prescribing tool has the potential to reduce adverse drug outcomes and costs associated with inappropriate prescribing in a vulnerable population of elders.
University of Auckland
Studying the relationship between hydration state obtained by MRI and vision quality of the human lens in vivo to predict the onset and progression rate of cataract
Cataract is an age-related opacification of the lens in the eye, which eventually leads to vision loss. At present, surgical extraction is the only treatment available, placing a heavy financial burden on the public healthcare system. Consequently there is an increasing impetus for novel medical therapies to slow cataract progression or delay the need for surgical intervention.
Research on animal models have identified regulatory water transport pathways in the lens which are thought to maintain lens transparency and therefore, overall vision quality. My research is based on the hypothesis that these pathways are relevant to the human lens, and opacification results from an age-related decline in water transport within the lens.
Magnetic Resonance Imaging (MRI) techniques have previously been used to study water concentration gradients and the directionality of water fluxes in isolated lenses. My PhD project aims to develop a suite of MRI protocols to monitor lens water transport non-invasively in living human subjects, something no one has done to date. Studying how lens water transport and vision quality vary with age may create opportunities for therapies targeting lens water transport regulation to be developed, ultimately alleviating the financial burden currently associated with cataract surgery.
University of Auckland
Redefining age-related swallowing changes through videofluoroscopy
Consequences of dysphagia (swallowing difficulties) include malnutrition, dehydration, aspiration pneumonia and poor quality of life, and the prevalence of swallowing difficulties increases with age. It is fundamental to understand normal swallowing changes that occur from ageing, to better differentiate pathology from normal variance. Previous international swallowing studies carry limitations, primarily caused by an underrepresentation from adults over 80 years old. It is misleading to equate swallowing physiology from a person in their 60s to that of someone in their 90s.
In a University of California, Davis / University of Auckland collaboration, 139 participants without swallowing complaints were recruited: 20–39yrs (N=36); 40–64yrs (N=36); 65–79yrs (N=33); 80+yrs (N=34) including eight nonagenarians (90, 91, 95, 96, 97, 98, 99 and 99 years old). Each participant completed swallowing questionnaires and underwent a swallowing xray (videofluoroscopy) with objective, quantitative measures of anatomical structures, swallowing timing and displacement. This is the largest international cohort of quantitative parameters in healthy adults (N=226), with a particular focus on over 65 year olds (N=154).
The development of a normative swallowing database will assist with differentiating normal ageing from dysphagia symptoms and will therefore have invaluable clinical implications for speech-language therapists both nationally and internationally.
University of Canterbury
Electroencephalogram biomarkers for cognition in Parkinson’s disease
The New Zealand Brain Research Institute (NZBRI) has shown that the number of cases with Parkinson’s disease (PD) in New Zealand will double to almost 20,000 by 2040, with an incidence that rises sharply after 55 years of age. Intensive research is investigating biomarkers that predict a patient’s progression to Parkinson’s disease with dementia (PD-D), to identify patients at risk and establish methods to enhance PD patient’s cognitive ability and improve their overall well-being.
The research will address a new hypothesis in the PD literature, which claims that there may be a dual-syndrome hypothesis that suggests severe cognitive impairment and dementia are caused by disruption in posterior brain function whereas other cognitive changes in PD are independently associated with the frontal dysfunction and motor impairment. Therefore finding biomarkers to test this dual-syndrome hypothesis may therefore improve our detection of Parkinson’s disease with mild cognitive impairment (PD-MCI) that is specifically related to PD-D risk. We aim to examine using electroencephalogram (EEG), whether there are any correlations between directional effective connectivity, global cognitive deficits in PD, or clinical disease severity and executive function in those with PD.
University of Canterbury
Post-Stroke Hand Rehabilitation through Hybrid Assist-as-Need Exoskeleton
Stroke is one of the global leading causes of disability, often inﬂicting adverse physical, ﬁnancial, and psychological effects. As our population ages, the impact of stroke on society increases: if new technologies are not produced to counteract this increased demand, the lives of many people will be severely negatively affected.
Functional post-stroke rehabilitation is facilitated through learning-related neural plasticity. Research has long indicated that therapy, delivered in high dosages, high intensity, and of a task-orientated nature, have been linked to more extensive functional recovery. Despite these ﬁndings, traditional therapy is still not delivered accordingly: this is due to a restriction of rehabilitation resources.
Through the introduction of alternative rehabilitation technologies, common therapy restrictions may be alleviated. Two forefront technologies are robotic devices and functional electrical stimulation (FES), however the isolated application of these technologies is restricted due to their inherent disadvantages. The conjunction of robotic and FES modalities has been seen to reduce exoskeleton size, weight, and energy consumption; however, the hybrid nature of the devices have not been fully exploited: in many cases, issues such as the patient’s fatigue and voluntary capacity have not been addressed.
The objective of this research is to develop a hybrid, assist-as-need exoskeleton that will utilise both FES and robotic support. The system is being designed for post-stroke rehabilitation of the hand and will be controlled through a dynamic cooperative control scheme, which will account for patient fatigue. The developed system will provide a more customised, effective, and accessible therapy for stroke patients.
Information processing and purchase behaviour of older consumers
The mature market represents an increasingly important economic segment for marketers, managers and policy makers due to the ageing population. Older consumers are now wealthier and have greater purchasing power than ever before. Despite the clear importance of older consumers, academics acknowledge that there is a lack of understanding of the mature market and indicate that more research is needed.
Existing research has mainly focused on the differences in information gathering, information processing and purchase behaviour between older and younger consumers. Research has indicated that older consumers are more brand loyal and prefer to purchase well-established national brands in high-involvement categories, such as cars and perfume. However, there is mixed results for age-based purchase differences in low involvement product categories, such as FMCGs. Age is also shown to have a negative impact on consumers’ ability to gather and process information. Debate over the reasons for aged-based differences is still occurring with cognitive decline, social influence, risk aversion, category experience and familiarity, and attachment being among the possible explanations.
My PhD research aims to investigate the information processing and purchase behaviour of older consumers in comparison to younger consumers. The research will provide knowledge on product decision making that can assist companies, across a range of industries, to provide products and services that cater to the mature market. It will also advise policy makers on information processing that could be used to adjust product-packaging regulations to ensure elderly consumers can easily process product information.
The harms of Alcohol-medication interactions (AMIs)
Some medications can cause serious physical harm when used in combination with alcohol (alcohol-interactive medications). The harms of Alcohol-medication interactions (AMIs) include reducing the desired therapeutic effects of medications; causing adverse side effects such as gastrointestinal bleeding; and medication overdose and/or alcohol poisoning. Due to age related changes in body-mass, metabolism, and illness susceptibility, older adults are generally more sensitive to AMIs and more likely to use alcohol-interactive (AI) medications than younger or middle-aged adults.
While equivalent data relating to New Zealand’s older adult population is currently unavailable, survey research indicates approximately one-in-five older adults living in the United States (US) are at risk of experiencing an AMI. Given that older New Zealanders appear to use similar amounts of prescription medications and considerably more alcohol than their US counterparts, exposure to AMI may be a major public health concern for New Zealand’s older adult population. Research exploring both the prevalence and impact of combined alcohol/AI-medication use among older New Zealanders is therefore needed.
There is also a need to identify potential targets for interventions aimed at reducing AMI- related harm in older populations. One factor that could be implicated in combined alcohol/AI-medication use is depression, which appears to be associated with both harmful drinking behaviour and unsafe medication use.
This project will utilise data collected from a large sample of older New Zealanders in the New Zealand Health, Work, and Retirement (HWR) survey to explore 1) the prevalence of combined alcohol/AI-medication use; 2) the impact of combined alcohol/AI-medication use on health and healthcare utilization; and 3) the potential moderating role of depression in combined alcohol/AI-medication use. Data-linkage methods will be used to measure medication use (i.e., consenting participants’ survey data will be linked to their national pharmaceutical dispensing records), and the New Zealand Formulary will be used to determine whether medications used by participants are AI. Alcohol use, health, healthcare utilisation, and depression will be assessed using participants’ responses to the HWR survey.
Micronutrient intakes and outcomes in transitioning agers in New Zealand
SWe have a rapidly ageing population worldwide and in New Zealand. This carries important societal consequences due to the increased chronic disease risk that every individual faces with the ageing process. Nutrition has been widely acknowledged as a key environmental factor modulating this disease risk. In addition to the protein-energy malnutrition that we tend to associate with older adults, it is becoming increasingly apparent that even marginal micronutrient deficiencies, or suboptimal status, could have a significant impact on an individual’s long-term health outcomes. Despite the global demographic shift, and wide-spread micronutrient deficiencies reported in older adults through the literature, we don’t understand micronutrient status in the elderly population particularly well. Dietary assessment remains the pillar of monitoring micronutrient status despite its various complications, with speculation as to how this might be exacerbated in older age due to the onset of cognitive decline and poor health. Nutrient biomarkers are therefore an appealing option as they offer the advantage of objectivity. However these are rarely included in population surveys or largescale epidemiologic research, partly due to cost, but also due to the fact that the routine biomarkers that are currently available might not actually be the most accurate reflection of micronutrient status. My research aims to globally analyse micronutrient deficiencies reported in elderly populations through population surveys in developed countries, and to systematically review longitudinal studies of micronutrient intake in older adults to quantify how intake is altered with the ageing process. Further, I am particularly interested in B group vitamins and markers of one carbon metabolism, particularly given their role in diseases of ageing (including cardiovascular, cognitive, and bone health), as well as their potential as functional indices of B group vitamins. Accordingly, a platform to analyse one carbon metabolites will be established in our laboratory, allowing me to investigate the relationship between dietary intake, B group vitamins, markers of one carbon metabolism, and functional health outcomes in samples of older adults.
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