Report finds our aging population will need increased levels of care

21 April 2017
LiLCas end3
From left to right: Florence Kameta (below), Dr Mere Kēpa, Betty McPherson (below), Dr Marama Muru Lanning (Maori Advisor to the study).

New Zealand’s aging population will lead to a substantial increase in the need to provide daily and weekly care for the elderly, a University of Auckland study has found.

By 2026 the number of older Māori needing care on a more than daily basis could increase by more than 200 percent.

The findings are from the Te Puāwaitanga O Ngā Tapuwae Kia Ora Tonu: Life and Living in Advanced Age, a Cohort Study in New Zealand, otherwise known as LiLACS NZ. The study is the first longitudinal study in the world of an indigenous population in advanced age. Its strength is the nearly equal numbers in the Māori and non-Māori cohorts, allowing for both meaningful comparisons between the two groups and ethnic specific analyses.

The longitudinal study of elderly New Zealanders started in 2010. All Māori aged 80 to 90 years and all non-Māori aged 85 years within the Bay of Plenty District Health Board (DHB) and Lakes DHB areas (excluding Taupo region) were asked to participate in an interview and physical assessment, and give a blood sample.

Those who agreed (421 Māori and 516 non-Māori) formed the two inception cohorts of LiLACS NZ, and were first interviewed in 2010.

The study measures the needs of older people for care and assistance in several ways. The most common way is as a scale of activities of daily living (ADL), required for basic personal care, toileting, eating, getting out of bed and dressing; and instrumental or more demanding activities of daily living (IADL), such as shopping, cooking, transport outside the home and clothes washing that are needed to maintain independent living. Another way is to look at the frequency that people need care – or interval of care need. Those with a ‘critical’ interval need assistance more than daily, such as with feeding, toileting and getting in and out of a chair. Those with ‘short’ interval need require care on a daily basis, such as with meal preparation, dressing or bathing, and those with ‘long’ interval need require care weekly. Independent means being able to manage most things without the assistance of another person.

The report was commissioned by the Ministry of Health and produced in the School of Population Health, Faculty of Medical and Health Sciences, University of Auckland.

The report was published today and details five Key Findings about the future needs for care for the elderly.

Significantly, a key finding is the increases in care needed for both populations by 2026.

In 2010 the NZ Māori population aged 80+ was just under 4,000 people. By 2026, this is projected to increase by 190 percent, to just under 12,000 people. The number aged 80+ who are likely to be independent in 2026 will increase by 174 percent from 2010 figures, or 2,907 people.

But of Māori aged 80+ in 2026, 195 percent more than in 2010 will have ‘long’ and ‘short’ interval care needs, or an increase of 3,175 and 805 people. By 2026, 772 more aged 80+ will have a ‘critical’ interval of care need than in 2010, a 242 percent increase.

The total non-Māori population aged 80+ is projected to increase by 74 percent from 2010 to 2026.

While the number that are independent will increase by 74 percent by 2026, the number needing long interval care is estimated to increase by 74 percent from 50,605 in 2010 to 93,161 people in 2026.

The number of non-Māori needing short interval care is likely to increase by 75 percent (an increase from 9,481 in 2010 to 16,546 in 2026). The number needing critical interval care will increase by 74 percent by 2026, corresponding to an increase of 5,728 people.

Head of Population Health, Professor Ngaire Kerse, says the findings are significant because planning for the future service provision is needed to allow people to manage at home. “It is clear from this report that the rate of change in the population is greatest for Māori, and this will present challenges for Māori society. The greatest numbers are in the older non-Māori population.”

The report has also found the number of older Māori and non-Māori with cardiovascular disease and/or diabetes mellitus diagnoses is projected to increase by up to 200 and 75 percent respectively, adding to the need for increased levels of care in both groups.

Another key finding of the report included how 17 percent of Māori and 15 percent of non-Māori in advanced age need at least some sort of daily help with getting in and out of bed, brushing their hair and teeth and making hot drinks and carrying them to another room. This is called a short interval of care need.

A further 7 percent of Māori and non-Māori needed assistance several times a day with toileting and feeding, or a critical interval of care need. These participants also needed daily help with personal care and weekly help with household duties.

Fifty-seven percent of Māori and 67 percent of non-Māori reported a need for help at least weekly for shopping, clothes washing and housework. This is called a long interval of care need.

But a large proportion of both cohorts, 43 percent of Māori and 33 percent of non-Māori, were independent and needed no regular assistance or less than weekly assistance.

The report has also found that overall, Māori with critical and short intervals of care need are significantly less likely to be living in residential care than non-Māori.

However, the report also found that trends in dependency suggest that more recent cohorts of older people generally appear to have better levels of function than the earlier ones. Long term, it seems possible that with resource-intensive physical activity interventions, there is a potential for recovery in function over time even in advanced age. Increased activity and better health care throughout the lifespan may also mean future generations will reach older age in better shape.

The report is one of a series commissioned by the Ministry of Health to inform policy and planning of services for people of advanced age, including their carers and health practitioners.

Read more about the Te Puāwaitanga O Ngā Tapuwae Kia Ora Tonu: Life and Living in Advanced Age, a Cohort Study in New Zealand

 

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