Development and validation of a frailty index compatible with three interRAI assessment instruments

BACKGROUND: a Frailty Index (FI) calculated by the accumulation of deficits is often used to quantify the extent of frailty in individuals in specific settings. This study aimed to derive a FI that can be applied across three standardised international Residential Assessment Instrument assessments (interRAI), used at different stages of ageing and the corresponding increase in support needs. METHODS: deficit items common to the interRAI Contact Assessment (CA), Home Care (HC) or Long-Term Care Facilities assessment (LTCF) were identified and recoded to form a cumulative deficit FI. The index was validated using a large dataset of needs assessments of older people in New Zealand against mortality prediction using Kaplan Meier curves and logistic regression models. The index was further validated by comparing its performance with a previously validated index in the HC cohort. RESULTS: the index comprised 15 questions across seven domains. The assessment cohort and their mean frailty (SD) were: 89,506 CA with 0.26 (0.15), 151,270 HC with 0.36 (0.15) and 83,473 LTCF with 0.41 (0.17). The index predicted 1-year mortality for each of the CA, HC and LTCF, cohorts with area under the receiver operating characteristic curves (AUCs) of 0.741 (95% confidence interval, CI: 0.718-0.762), 0.687 (95%CI: 0.684-0.690) and 0.674 (95%CI: 0.670-0.678), respectively. CONCLUSIONS: the results for this multi-instrument FI are congruent with the differences in frailty expected for people in the target settings for these instruments and appropriately associated with mortality at each stage of the journey of progressive ageing.</p

The Drug Burden Index and Level of Frailty as Determinants of Healthcare Costs in a Cohort of Older Frail Adults in New Zealand

OBJECTIVES: Frailty is common in older people and is associated with increased use of healthcare services and ongoing use of multiple medications. This study provides insights into the healthcare cost structure of a frail group of older adults in Aotearoa, New Zealand. Furthermore, we investigated the relationship between participants' anticholinergic and sedative medication burden and their total healthcare costs to explore the viability of deprescribing interventions within this cohort.METHODS: Healthcare cost analysis was conducted using data collected during a randomized controlled trial within a frail, older cohort. The collected information included participant demographics, medications used, frailty, cost of service use of aged residential care and outpatient hospital services, hospital admissions, and dispensed medications.RESULTS: Data from 338 study participants recruited between 25 September 2018 and 30 October 2020 with a mean age of 80 years were analyzed. The total cost of healthcare per participant ranged from New Zealand $15 (US dollar$10) to New Zealand $270 681 (US dollar$175 943) over 6 months postrecruitment into the study. Four individuals accounted for 26% of this cohort's total healthcare cost. We found frailty to be associated with increased healthcare costs, whereas the drug burden was only associated with increased pharmaceutical costs, not overall healthcare costs.CONCLUSIONS: With no relationship found between a patient's anticholinergic and sedative medication burden and their total healthcare costs, more research is required to understand how and where to unlock healthcare cost savings within frail, older populations.</p

Frailty of Māori, Pasifika, and non-Māori/non-Pasifika older people in New Zealand: a national population study of older people referred for home care services

Little is known about the prevalence of frailty in indigenous populations. We developed a frailty index for older New Zealand Māori and Pasifika who require publicly funded support services.A frailty index (FI) was developed for New Zealand adults aged ≥65 years who had an interRAI-Home Care assessment between 1 June 2012 and 30 October 2015. A frailty score for each participant was calculated by summing the number of deficits recorded and dividing by the total number of possible deficits. This created a FI with a potential range from 0 to 1. Linear regression models for FIs with ethnicity were adjusted for age and sex. Cox proportional hazards models were used to assess the association between the FI and mortality for Māori, Pasifika, and non-Māori/non-Pasifika.Of 54,345 participants, 3,096 (5.7%) identified as Māori, 1,846 (3.4%) were Pasifika, and 49,415 (86.7%) identified as neither Māori nor Pasifika. New Zealand Europeans (48,178, 97.5%) constituted most of the latter group. Within each sex, the mean FIs for Māori and Pasifika were greater than the mean FIs for non-Māori and non-Pasifika, with the difference being more pronounced in females. The FI was associated with mortality (Māori SHR 2.53, 95% CI 1.63 to 3.95; Pasifika SHR 6.03, 95% CI 3.06 to 11.90; non-Māori and non-Pasifika SHR 2.86, 95% 2.53 to 3.25).This study demonstrated differences in FI between the ethnicities in this select cohort. After adjustment for age and sex, increases in FI were associated with increased mortality. This suggests that FI is predictive of poor outcomes in these ethnic groups

Work Related Effects of an Awareness Training Programme: An investigation into training transfer and applicable criterion measures

This study investigated predictors for training transfer and their relationship with work related effectiveness measures of the group based awareness training The More To Life Weekend. The purposes of the study were to: (1) establish and test predictors for effective training transfer, (2) identify and test constructs for work-related effectiveness, and (3) provide direction for the design of an evaluation study. This study was conducted with past participants of the training, in a cross-sectional design using self-report surveys, and data was analysed using regression analyses. Instruments for measuring controlled and autonomous motivation to attend the training, the perceived utility of the training, utilisation of post-training support opportunities and the degree of on-going practice were developed for the study. The results indicate that perceived training utility is an important predictor for transfer. Controlled motivation to attend the training is showing the expected nil-relationship, while autonomous motivation is showing a relationship with transfer without reaching statistical significance. The results confirm a significant positive relationship between on-going practice of the trained techniques with positive psychological capital, whereas the relationship with a one-dimensional measure of mindful attention awareness did not reach levels of statistical significance. Utilisation of post-training support and on-going practice were confirmed as mediators between perceived training utility and the effectiveness measures of mindful awareness and positive psychological capital. Recommendations are made for using a multi-dimensional measurement of mindful awareness and the design of a future evaluation study on this training programme

ORCAN: A platform for complex parallel simulation software

based software platform for Simulation software. It enables to build applications out of runtime exchangeable components. One purpose of this framework is to introduce advanced software design techniques in simulation software for a longterm distributed development process. The other benefit of this framework is a predefined set of components for standard simulation purposes, which can be seen as a suggestion for a simulation middleware platform. In this paper we will present the basic design of ORCAN. As an example application we have implemented a parallel heat equation solver.

Evaluating the influence of social factors on aged residential care admission in a national home care assessment database of older adults

Objectives: Evaluate the influence of social factors on admission to aged residential care (ARC) facilities using a national comprehensive geriatric assessment database in New Zealand. Design: Time-to-event analysis of a continuously recruited national cohort. Participants and setting: An anonymized data extract from a large national database for home care assessments (June 2012–December 2015) was matched with data on mortality and admissions into ARC. Methods: Four key components of psychosocial risk in relation to ARC admission were used for analysis: living alone, negative social interactions, perceived loneliness, and carer stress. Exploratory data analysis was conducted for each of the variables of interest and demographics. Unadjusted and adjusted competing risk regressions were then performed with admission into ARC being the primary outcome, death the competing risk, and remaining at home the survival case. Results: After data cleaning, matching, and applying exclusions, the study population consisted of 54,345 eligible participants. Mean age of participants was 81.9 years (standard deviation 7.4), 62.1% were female, and 88.7% identified as European ethnicity. In the adjusted model, all 4 social factors remained significantly associated with ARC admission, namely: living alone [subhazard ratio (SHR) = 1.43 95% confidence interval (CI) 1.37–1.50]; negative social interactions (SHR = 1.22, 95% CI 1.15–1.30); perceived loneliness (SHR = 1.18, 95% CI 1.13–1.24); and carer stress (SHR = 1.28, 95% CI 1.23–1.34). Conclusions and implications: Interventions targeted at social factors in the context of delaying ARC admission merit further development and evaluation