The prevalence of nutrition risk and associated risk factors among older adults recently admitted to age-related residential care within the Waitemata District Health Board region : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Auckland, New Zealand

Background: New Zealand has a rapidly growing ageing population, aligned with the ageing population trend occurring globally. Older adults account for a significant proportion of the government health care expenditure, primarily due to higher needs for disability services and a higher level of care, such as residential care. Malnutrition is multi-factorial and may result in disability and poor health contributing to a significant decline in the independence in older adults. Internationally, previous research has found a high prevalence of malnutrition among older adults in the residential care setting. This study aims to investigate the prevalence of malnutrition and associated risk factors among older adults (aged 64 to 84 years) newly admitted to residential care facilities across the Waitemata District Health Board (WDHB) region. Methods: A cross-sectional study was undertaken among older adults newly admitted to WDHB residential care facilities. A questionnaire was used to assess participant sociodemographic and health characteristics. Anthropometric and body composition measurements were recorded. Grip strength was measured using a handgrip dynamometer and gait speed was measured by a 2.4m walk test. Nutrition risk was assessed using the Mini Nutritional Assessment- Short Form (MNASF), dysphagia risk was determined from the 10-item Eating Assessment Tool (EAT-10) and the Montreal Cognitive Assessment (MoCA) examined cognitive function. Results: The mean age of participants was 78.7 ± 5.0 years. Of 77 participants, just under half (45.5%) were malnourished with a further 49.4% were at high nutrition risk. Over a third (37.7%) of participants were at dysphagia risk. Malnourished participants were more likely to require daily help prior to admission (p=0.011) and have a slower gait speed (p=0.014). A higher nutrition risk (lower MNA-SF score) was strongly correlated with a lower BMI (r=0.274, p=0.024), grip strength (r=0.368, p=0.001), higher dysphagia risk (r=-0.248, p=0.029) and higher medication use (r=-0.213, p=0.043). Conclusion: Nearly half the participants were malnourished, and over a third were at risk of dysphagia. This study highlights that low BMI, grip strength and higher dysphagia risk and medication use are potential risk factors for malnutrition. Findings highlight the importance of malnutrition and dysphagia screening among older adults upon admission to residential care. This will ensure appropriate diagnosis and treatment for those identified at risk

Briefing Paper on Taking stock of the Tsunami recovery process

Promoting positive action towards disaster risk reduction and advising future recovery policies and practices when communities face the aftermath of a major disaster, a briefing paper has been launched on Taking stock of the Tsunami recovery process in Sri Lanka: 2004 to 2014. A conference taking stock of the Tsunami recovery in Sri Lanka was held in Colombo in December 2014 organized by GDRC at Hudderfield, UK, University of Colombo and University of Moratuwa in Sri Lanka to coincide with the tenth anniversary of the unprecedented disaster. A number of papers dealing with diverse aspects of the disaster and its aftermath were presented, followed by a panel discussion that examined the policy implications of research findings presented by various authors and the discussions that followed. While some of the papers looked at broader issues of disaster risk reduction, others embodied analyses of data collected through recent field research in different parts of the country affected by the Tsunami. This brief policy statement is based on the deliberations throughout the conference involving researchers, public officials and other participants

Industrial pollution in economic development: Kuznets revisited

Using new international data, the authors test for an inverse U-shaped, or"Kuznets,"relationship between industrial water pollution and economic development. They measure the effect of income growth on three proximate determinants of pollution: the share of manufacturing in total output, the sectoral composition of manufacturing, and the intensity (per unit of output) of industrial pollution at the"end of pipe."They find that the manufacturing share of output follows a Kuznets-type trajectory, but the other two determinants do not. Sectoral composition gets"cleaner"through middle-income status and then stabilizes. At the end of the pipe, pollution intensity declines strongly with income. The authors attribute this partly to stricter regulation as income increases and partly to pollution-labor complementarity in production. When they combine the three relationships, they do not find a Kuznets relationship. Instead, total industrial water pollution rises rapidly through middle-income status and remains roughly constant thereafter. To explore the implications of their findings, the authors stimulate recent trends in industrial water pollution for industrial economies in the OECD (Organization for the Economic Cooperation and Development), the newly industrialized countries, Asian developing countries, and ex-COMECON (Poland and former Soviet Union) economies. They find roughly stable emissions in the OECD and ex-COMECON economies, moderate increases in the newly industrialized countries, and rapidly growing pollution in the Asian developing countries. Their estimates for the 1980s suggest that Asian developing countries displaced the OECD economies as the greatest generators of industrial water pollution. Generally, however, the negative feedback from economic development to pollution intensity was sufficient to hold total world pollution growth toabout 15 percent over the 12-year sample period.Water and Industry,Public Health Promotion,Environmental Economics&Policies,Sanitation and Sewerage,Pollution Management&Control,Environmental Economics&Policies,Water and Industry,TF030632-DANISH CTF - FY05 (DAC PART COUNTRIES GNP PER CAPITA BELOW USD 2,500/AL,Sanitation and Sewerage,Pollution Management&Control

Western and Ayurvedic Systems of Medicine in Sri Lanka: Some Preliminary Observations

Introduction of Western medicine to Sri Lanka resulted in the marginalization of Ayurveda which was the mainstay of traditional empirical medicine among the Sinhalese. In spite of the emergence of a vibrant Sinhalese-Buddhist nationalist movement in the late 19th century in opposition to the erosion of traditional values and institutions such as Buddhism and Ayurvedic medicine, the dominance of the Westernized, propertied and professional elite could not 'be checked. Introduction of democratic institutions and subsequent political independence, however allowed marginalized native groups such as Ayurvedic physicians to come forward and win certain privileges which were hitherto denied to them. Even though the events have not reversed the ,historical trend, they have nevertheless been significant ,developments with implications for rhe present and future position of Ayurveda within the healthcare system of Sri Lanka

An integrated social response to disasters: the case of the Indian Ocean Tsunami in Sri Lanka

Purpose: The impact of natural disasters on people in affected communities is mediated by a whole range of circumstances such as the intensity of the disaster, type and nature of the community affected and the nature of loss and displacement. The main purpose of this paper is to demonstrate the need to adopt a holistic or integrated approach to assessment of the process of disaster recovery, and to develop a multidimensional assessment framework. Design/methodology/approach: The study on which the paper is based was designed as a novel qualitative assessment of the recovery process using qualitative data collection techniques from a sample of communities affected by the Indian Ocean Tsunami in eastern and southern Sri Lanka. Findings: The key finding of the study is that the outcome of the interventions has varied widely depending on such factors as the nature of the community, nature of the intervention and mode of delivery of donor support. The surveyed communities are ranked in terms of the nature and extent of recovery. Originality/value: The approach adopted is new to post disaster recovery assessments and is useful for monitoring and evaluation of recovery processes. It also fits into the social accountability model as the assessment is based on community experience with the recovery process. Practical implications: The indices of recovery developed constitute a convenient tool of measurement of effectiveness and limitations of external interventions. The assessment used is multidimensional and socially inclusive

The role of accountability within disaster risk governance

During the decade that followed the adoption of the Hyogo Framework for Action in 2005, calls for greater public, private and civic accountability to reduce risk and vulnerability became increasingly vocal. It also provded guidance to the focal point on Disaster Risk Reduction at the central government level on how to improve leadership in risk governance, transparency, sharing of risk information, stakeholder participation and public awareness and encouraging and action on stakeholder feedback. Accountability in disaster risk reduction is intended to enable scrutiny and understanding of actions taken at different levels, and of those responsible for such actions. Article 19(e) of the Sendai Framework articulates the principle that disaster risk reduction depends on coordination mechanisms within and across sectors, full engagement and clear responsibilities of all State institutions and stakeholders, to ensure mutual accountability. In contributing to this agenda, a workshop on “Ensuring Accountability in Disaster Risk Management and Reconstruction” was organised as a part of a global, regional and national partnership. This workshop and the subsequent policy dialogue had the participation of disaster risk management experts and state and non-state stakeholders to deliberate on and develop a possible framework for social accountability to be considered for inclusion in a national disaster management plan

Book of Abstracts on Ensuring Accountability in Disaster Risk Management and reconstruction

This book of abstracts incorporates the key note synopsis and all presented abstracts at the international workshop on Ensuring Accountability in Disaster Risk Management and reconstruction held in Colombo, Sri Lanka on the 8th December 2015 with the participation of disaster risk management experts and state and non-state stakeholders to deliberate on and develop a possible framework for social accountability to be considered for inclusion in a national disaster management plan. Our aim was to incorporate social accountability into disaster management to improve significantly the outcomes of external interventions leading to an improvement of life chances and quality of life of potential and actual victims of disasters