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A mixed-methods evaluation of an intervention for enhancing alcohol screening in adults aged 50+ attending primary health care
(CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners, 2025-01-02) Towers A; Newcombe D; White G; McMenamin J; Sheridan J; Rahman J; Moore A; Stokes T
Introduction Adults aged 50 years and over are drinking more than ever but primary health care (PHC) professionals find it challenging to screen them for alcohol-related harm, despite being at greater risk for harm than younger drinkers. Aim This intervention aimed to enhance alcohol screening for this cohort by (a) introducing an algorithm in the patient management system to automate detection of alcohol risk in patients and (b) providing training to support health professionals' practice of, knowledge about, and comfort with alcohol screening in this cohort. Methods Eleven PHC practices in Aotearoa New Zealand took part in this intervention, including 41 PHC health professionals. Development and integration of the automated alcohol screening process within PHC patient management systems was undertaken in parallel with health professional training approaches. Results Screening rates increased substantially at intervention initiation but fell immediately with the onset of the New Zealand COVID-19 national lockdown. Two-thirds of health professionals identified the system screening prompts, over 40% felt this changed their screening practice, and 33% increased their awareness of - and felt more comfortable screening for - alcohol-related risk in those aged 50+. Discussion We illustrated an initial increase in alcohol screening rates in those aged 50+ as a result of this intervention, but this increase could not be sustained in part due to COVID-19 disruption. However, health professionals indicated that this intervention helped many change their practice and enhanced their awareness of such risk and comfort in screening for alcohol-related risk in those aged 50+.
The Whakapiri framework in higher education: nurturing relational teaching
(SAGE Publications, 2025-01-10) Moriarty H; Severinsen C; Rowe L; Towers A
A growing body of research suggests that utilising Indigenous frameworks grounded in relational connection and multi-modal knowledge acquisition has numerous benefits for both Indigenous and non-Indigenous communities. This article focuses on the Whakapiri framework, and its application at Te Kunenga ki Pūrehuroa Massey University, Aotearoa New Zealand, within a new undergraduate mental health and addiction programme. This programme aims to equip graduates in the field, providing them with the foundational knowledge and engagement competencies necessary for working with both Māori (Indigenous people of New Zealand) and non-Māori. The Whakapiri framework enhances student engagement, fosters relational teaching practices, and designs effective online learning curricula. The framework also informs the design of online learning curricula, acknowledging the unique challenges and opportunities of digital education environments. Through its emphasis on engaging, enlightening, and empowering, the Whakapiri framework offers professional guidance and enriches student engagement, teaching methodologies, and the development of online learning curricula.
Prevalence of unmet health care need in older adults in 83 countries: measuring progressing towards universal health coverage in the context of global population ageing.
(BioMed Central Ltd, 2023-09-15) Kowal P; Corso B; Anindya K; Andrade FCD; Giang TL; Guitierrez MTC; Pothisiri W; Quashie NT; Reina HAR; Rosenberg M; Towers A; Vicerra PMM; Minicuci N; Ng N; Byles J
Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60+ years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.
Malnutrition Risk: Four Year Outcomes from the Health, Work and Retirement Study 2014 to 2018
(MDPI (Basel, Switzerland), 2022-05-26) Wham C; Curnow J; Towers A
This study aimed to determine four-year outcomes of community-living older adults identified at 'nutrition risk' in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49-87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time.
The drinking patterns of older New Zealanders: National and international comparisons
(Health promotion Agency, 2017-12-01) Towers A; Sheridan J; Newcombe D
The prevalence of hazardous drinking in older New Zealanders
(Health Promotion Agency, 2018-09-12) Towers A; Sheridan J; Newcombe D; Szabo A
In a national survey of older adults, we compared the classification of hazardous versus non-hazardous drinkers based on the AUDIT-C and the Comorbidity Alcohol Risk Evaluation Tool (CARET). The CARET is an older adult-specific alcohol screen that assesses alcohol-related risks both based on consumption levels and the presence of factors increasing potential harm, including health conditions associated with alcohol use (such as diabetes), the use of alcohol-interacting medication (such as pain medications), symptoms of health issues or frailty (such as low mood, memory problems, and falls), and alcohol risk behaviours (such as drink-driving).
Characteristics of atypical sleep durations among older compared to younger adults: Evidence from New Zealand Health Survey
(Oxford University Press on behalf of The Gerontological Society of America, 2023-02-02) Gibson R; Akter T; Jones C; Towers A
BACKGROUND: Understanding and supporting sleep is important across the lifespan. Disparities in sleep status are well documented in mid-life but under-explored among older populations. METHODS: Data from 40,659 adults pooled from the New Zealand Health Surveys was used; 24.2% were 'older adults' (aged ≥65 years), 57% were female, and 20.5% of Māori ethnicity). 'Long', 'short', or 'typical' sleep categories were based on age-related National Sleep Foundation guidelines. Multinomial logistic regression examined predictors of atypical sleep, including sociodemographic characteristics, lifestyle factors, and health status. RESULTS: Prevalence of short and long sleep among older adults was 296 (3.0%) and 723 (7.4%), respectively. Correspondingly, prevalence among younger adults was 2521 (8.2%) and 364 (1.2%). Atypical sleep was more significantly associated with indicators of reduced socioeconomic status and ethnicity among younger rather than older adults. Within both age groups, lower physical activity was associated with long sleep status. Higher physical activity and smoking were related to short sleep status among younger adults only. Within both age groups, atypical sleep was associated with SF-12 scores indicating poorer physical and mental health. Having ≥3 health conditions was related to short sleep among the older adults, while for young adults, it was related to both atypical durations. CONCLUSIONS: Indicators of negative lifestyle and health factors remain consistent predictors of atypical sleep with ageing. However, demographic disparities are less apparent among older atypical sleepers. This study highlights individual and contextual factors associated with atypical sleep patterns which may be important for age-appropriate recognition and management of sleep problems.
Economic hardship among older people in New Zealand: The effects of low living standards on social support loneliness and mental health
(New Zealand Psychological Society, 2010) Stephens C; Alpass F; Towers A
By 2026 people aged 65 and over are projected to make up approximately 20% of the population of New Zealand. A focus on the positive aspects of ageing includes consideration of the factors that promote good mental health in the population. In the present study of early old age (65-70 years) we highlight factors that are amenable to social and structural change in order to support positive ageing as people move into retirement. Analysis of cross-sectional survey data from 1761 people aged 65-70 was used to test the prediction that economic living standards are related to social support and loneliness (taking into account gender and ethnicity differences) and these factors in turn will affect mental health. Multiple regression analysis showed that lower living standards are both independently related to mental health and also contribute to diminished opportunities for social support. Social support and loneliness in turn, are related to mental health. Such observations suggest the importance of changes in social attitudes and social policy to build societies in which older people are valued and supported both economically and socially.
What makes for the most intense regrets? Comparing the effects of several theoretical predictors of regret intensity
(Frontiers in Psychology, 15/12/2016) Towers A; Williams MN; Hill SR; Philipp MC; Flett R
Several theories have been proposed to account for variation in the intensity of life regrets. Variables hypothesized to affect the intensity of regret include: whether the regretted decision was an action or an inaction, the degree to which the decision was justified, and the life domain of the regret. No previous study has compared the effects of these key predictors in a single model in order to identify which are most strongly associated with the intensity of life regret. In this study, respondents (N D 500) to a postal survey answered questions concerning the nature of their greatest life regret. A Bayesian regression analysis suggested that regret intensity was greater for—in order of importance—decisions that breached participants’ personal life rules, decisions in social life domains than non-social domains, and decisions that lacked an explicit justification. Although regrets of inaction were more frequent than regrets of action, regrets relating to actions were slightly more intense.
The longitudinal patterns of alcohol use in older New Zealanders
(New Zealand Health Promotion Agency, 2018-09-27) Towers A; Sheridan J; Newcombe D; Szabo A
In this report, distinct groups of older adults were identified based on their drinking patterns, and then investigated to see whether they could be differentiated based on their sociodemographic and health characteristics. Five drinking profiles for older adults were found, with 13% of older adults having alcohol consumption patterns that posed a serious and immediate risk to their health (ie drank with moderate or high frequency and consumed many drinks on each occasion). It was also found that older adults were likely to drink with higher frequency if they were male; at the younger stage of older adulthood (around 60-70 years); have a moderate to high level of education; and have a higher economic living standard

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