Predictive factors for entry to long-term residential care in octogenarian Māori and non-Māori in New Zealand, LiLACS NZ cohort.
Advanced age
Care transition
Ethnic differences
Health services
Indigenous peoples
Long-term care
Risk factors
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
06 01 2021
06 01 2021
Historique:
received:
07
10
2019
accepted:
28
10
2020
entrez:
7
1
2021
pubmed:
8
1
2021
medline:
15
5
2021
Statut:
epublish
Résumé
Long-term residential care (LTC) supports the most vulnerable and is increasingly relevant with demographic ageing. This study aims to describe entry to LTC and identify predictive factors for older Māori (indigenous people of New Zealand) and non-Māori. LiLACS-NZ cohort project recruited Māori and non-Māori octogenarians resident in a defined geographical area in 2010. This study used multivariable log-binomial regressions to assess factors associated with subsequent entry to LTC including: self-identified ethnicity, demographic characteristics, self-rated health, depressive symptoms and activities of daily living [ADL] as recorded at baseline. LTC entry was identified from: place of residence at LiLACS-NZ interviews, LTC subsidy, needs assessment conducted in LTC, hospital discharge to LTC, and place of death. Of 937 surveyed at baseline (421 Māori, 516 non-Māori), 77 already in LTC were excluded, leaving 860 participants (mean age 82.6 +/- 2.71 years Māori, 84.6 +/- 0.52 years non-Māori). Over a mean follow-up of 4.9 years, 278 (41% of non-Māori, 22% of Māori) entered LTC; of the 582 who did not, 323 (55%) were still living and may yet enter LTC. In a model including both Māori and non-Māori, independent risks factors for LTC entry were: living alone (RR = 1.52, 95%CI:1.15-2.02), self-rated health poor/fair compared to very good/excellent (RR = 1.40, 95%CI:1.12-1.77), depressive symptoms (RR = 1.28, 95%CI:1.05-1.56) and more dependent ADLs (RR = 1.09, 95%CI:1.05-1.13). For non-Māori compared to Māori the RR was 1.77 (95%CI:1.39-2.23). In a Māori-only model, predictive factors were older age and living alone. For non-Māori, factors were dependence in more ADLs and poor/fair self-rated health. Non-Māori participants (predominantly European) entered LTC at almost twice the rate of Māori. Factors differed between Māori and non-Māori. Potentially, the needs, preferences, expectations and/or values may differ correspondingly. Research with different cultural/ethnic groups is required to determine how these differences should inform service development.
Sections du résumé
BACKGROUND
Long-term residential care (LTC) supports the most vulnerable and is increasingly relevant with demographic ageing. This study aims to describe entry to LTC and identify predictive factors for older Māori (indigenous people of New Zealand) and non-Māori.
METHODS
LiLACS-NZ cohort project recruited Māori and non-Māori octogenarians resident in a defined geographical area in 2010. This study used multivariable log-binomial regressions to assess factors associated with subsequent entry to LTC including: self-identified ethnicity, demographic characteristics, self-rated health, depressive symptoms and activities of daily living [ADL] as recorded at baseline. LTC entry was identified from: place of residence at LiLACS-NZ interviews, LTC subsidy, needs assessment conducted in LTC, hospital discharge to LTC, and place of death.
RESULTS
Of 937 surveyed at baseline (421 Māori, 516 non-Māori), 77 already in LTC were excluded, leaving 860 participants (mean age 82.6 +/- 2.71 years Māori, 84.6 +/- 0.52 years non-Māori). Over a mean follow-up of 4.9 years, 278 (41% of non-Māori, 22% of Māori) entered LTC; of the 582 who did not, 323 (55%) were still living and may yet enter LTC. In a model including both Māori and non-Māori, independent risks factors for LTC entry were: living alone (RR = 1.52, 95%CI:1.15-2.02), self-rated health poor/fair compared to very good/excellent (RR = 1.40, 95%CI:1.12-1.77), depressive symptoms (RR = 1.28, 95%CI:1.05-1.56) and more dependent ADLs (RR = 1.09, 95%CI:1.05-1.13). For non-Māori compared to Māori the RR was 1.77 (95%CI:1.39-2.23). In a Māori-only model, predictive factors were older age and living alone. For non-Māori, factors were dependence in more ADLs and poor/fair self-rated health.
CONCLUSIONS
Non-Māori participants (predominantly European) entered LTC at almost twice the rate of Māori. Factors differed between Māori and non-Māori. Potentially, the needs, preferences, expectations and/or values may differ correspondingly. Research with different cultural/ethnic groups is required to determine how these differences should inform service development.
Identifiants
pubmed: 33407278
doi: 10.1186/s12889-020-09786-z
pii: 10.1186/s12889-020-09786-z
pmc: PMC7788817
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
34Subventions
Organisme : Health Research Council of New Zealand
ID : HRC09/06B
Organisme : University of Auckland Ngā Pae o te Māramatanga
ID : -
Organisme : Ministry of Health (NZ)
ID : -
Références
Palliat Med. 2015 Jun;29(6):518-28
pubmed: 25680378
Aging Clin Exp Res. 2018 Aug;30(8):913-919
pubmed: 29222731
Soc Sci Med. 2017 Apr;178:87-94
pubmed: 28214449
J Clin Psychiatry. 2007 Sep;68(9):1392-8
pubmed: 17915978
J Am Med Dir Assoc. 2019 Nov;20(11):1419-1424
pubmed: 30926408
N Z Med J. 2016 Sep 09;129(1441):18-32
pubmed: 27607082
Age Ageing. 2007 Jul;36(4):424-30
pubmed: 17548425
J Am Med Dir Assoc. 2017 Jan;18(1):74-82
pubmed: 27815109
Palliat Med. 2018 Jun;32(6):1124-1132
pubmed: 29667475
J Am Med Dir Assoc. 2016 Jul 1;17(7):672.e1-5
pubmed: 27346651
Am J Public Health. 2008 Jul;98(7):1228-34
pubmed: 18511726
Aust N Z J Public Health. 2013 Jun;37(3):264-71
pubmed: 23731110
BMC Palliat Care. 2015 Dec 21;14:74
pubmed: 26691519
BMC Geriatr. 2012 Jun 29;12:33
pubmed: 22747503
J Am Med Dir Assoc. 2007 Jan;8(1):14-20
pubmed: 17210498
BMC Health Serv Res. 2017 Nov 9;17(1):709
pubmed: 29121916
N Engl J Med. 1997 Oct 30;337(18):1279-84
pubmed: 9345078
Aust N Z J Public Health. 2013 Apr;37(2):124-31
pubmed: 23551470
J Clin Epidemiol. 2005 Oct;58(10):974-81
pubmed: 16168342
J Am Med Dir Assoc. 2008 Oct;9(8):568-79
pubmed: 19083291
Aust N Z J Public Health. 2016 Aug;40(4):349-55
pubmed: 27197797
Eur J Ageing. 2017 Oct 28;15(2):143-153
pubmed: 29867299
Neurourol Urodyn. 2017 Aug;36(6):1588-1595
pubmed: 27778373
Popul Health Metr. 2017 Jul 4;15:25
pubmed: 28680369
J Am Med Dir Assoc. 2011 Sep;12(7):535-40
pubmed: 21450250
Med Care. 1997 May;35(5):522-37
pubmed: 9140339
Aust N Z J Public Health. 2015 Aug;39(4):374-9
pubmed: 26095070
Am J Epidemiol. 2003 May 15;157(10):940-3
pubmed: 12746247
Soc Psychiatry Psychiatr Epidemiol. 2012 Feb;47(2):263-70
pubmed: 21181110
Soc Sci Med. 1985;20(5):483-6
pubmed: 3992288
Community Dent Oral Epidemiol. 2017 Oct;45(5):434-441
pubmed: 28509420
N Z Med J. 2014 May 02;127(1393):62-79
pubmed: 24816957
Psychol Med. 1997 Mar;27(2):311-21
pubmed: 9089824
Australas J Ageing. 2020 Mar;39(1):e1-e8
pubmed: 31099137
J Aging Health. 2007 Apr;19(2):213-28
pubmed: 17413132
Int J Public Health. 2013 Apr;58(2):257-67
pubmed: 22892713
Age Ageing. 2010 Jan;39(1):31-8
pubmed: 19934075
J Gerontol B Psychol Sci Soc Sci. 2010 May;65B(3):370-80
pubmed: 20371551
Med Care. 2004 Sep;42(9):851-9
pubmed: 15319610
Am J Public Health. 2006 Apr;96(4):612-7
pubmed: 16507721