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    WHO long form scoring, reliability, validity and norms for New Zealand : a thesis presented in fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington Campus, New Zealand
    (Massey University, 2006) Blakey, Karen Sarah
    Background Self-reported health measures provide information about a wider range of health outcomes than objective measures of health status, such as mortality and hospitalisation rates. National health surveys play a role in monitoring population health. The New Zealand Health Monitor (NZHM) is the organised, co-ordinated and integrated survey programme of the Ministry of Health in New Zealand. The New Zealand Health Survey (NZHS) is one of the chief surveys of the NZHM. One of the categories of information collected in the NZHM is health outcomes, and within this there is the subcategory of health status. The International Classification of Functioning and Disability (ICF) provides the framework to describe the critical elements of non-fatal health outcomes captured by health status instruments. NZHM is to collect data on most if not all of these 21 ICF dimensions. The WHO Long Form was developed as the health module in the WHO Multi-country Survey Study. The WHO Long Form is made up of 20 health domains, some overlapping with the eight SF-36 domains. The WHO Long Form did not have a set scoring system for scales, unlike the SF-36 instrument. The SF-36 has been previously tested and validated in New Zealand in the 1996/97 NZHS. Methods The 2002/03 NZHS used a complex sample design. A total of 12,929 people responded to the survey, with 12,529 respondents being included in the CURF dataset available for research. The health status section of the 2002/03 NZHS measures health-related quality of life (HRQL) covered 16 health and health-related domains. The questions were derived from the SF-36 and the WHO Long Form questionnaire on health status. The health domains covered in the 2002/03 NZHS were general health, vision, hearing, digestion, breathing, pain, sleep, energy and vitality, understanding, communication, physical functioning, self-care. The health-related domains covered in the 2002/03 NZHS were mental health, role-physical and role-emotional (usual activities), and social functioning. There were five key aims specific to the current thesis. First, to group the WHO Long Form items in the 2002/03 NZHS into scales for each health domain and develop standard scoring protocols for each scale. Second, to test the reliability of the scales using standard psychometric tests for the total NZ population and for major population subgroups. Third, to test the validity of the scales using the standard psychometric tests for the total NZ population and for major population subgroups. Fourth, to construct norms for the WHO Long Form scales for the NZ population. And finally, to provide recommendations for the health status component of future NZ health surveys. Results In summary, this thesis developed a method for producing scale scores for domains of health not previously measured in New Zealand Health Surveys, providing greater coverage of domains from the ICF. There were virtually no missing data for all items and subgroups within the questions used to develop the scales. The scaling approach was consistent with that for the SF-36, allowing the new scales to be presented alongside the SF-36 scales. All scales for the total population and major population subgroups met the required criterion for satisfactory psychometric properties, with the exception of digestion and bodily excretions scale. For the digestion and bodily excretions scale, the Cronbach's alpha was lower than that required for between group comparisons. The composite physical functioning and social functioning scales performed no better than the existing SF-36 scales and were highly correlated with these scales. Conclusion Notwithstanding the limitations of this study, key findings of interest are that the new WHO Long Form questions can be used to form scales that cover physical functioning, social functioning, vision, hearing, digestion and bodily excretions, breathing, self-care, understanding, communication and sleep. The majority of the questions and scales work for the NZ population and subgroups. All but one of the scales, digestion and bodily excretions, have satisfactory psychometric properties for the total population and major subpopulation groups of interest. The respondent burden is an important consideration for the NZHS, thus it cannot be argued that enough is gained from adding questions to the physical functioning and Social Functioning domains, thus it would be recommended that the SF-36 scales are used to measure there two domains of health. The new WHO Long Form scales can now be presented alongside the SF-36 scales and used in future analyses looking at interrelationships between factors such as health risk and health status.
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    Assessment of nutrition risk using the Mini-Nutritional Assessment Short-Form and biomarkers (prealbumin) in community-living older adults within Auckland : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand
    (Massey University, 2016) Sycamore, Emily Louise
    Background: The global population is ageing with New Zealand currently experiencing a large growth in those aged 65 years and older. Increasing age is associated with increasing use of health and disability support services. Vulnerable older adults are at high risk of malnutrition and may be high users of these services. With global ageing creating more economic and social pressures on countries, it is important that nutritional well-being, a key determinant of good health and healthy ageing, is maintained throughout life to sustain functional health and quality-of-life in older adults. Assessing nutrition status will help determine those at nutrition risk. Aim: To determine the prevalence of nutrition risk in community-living older adults enrolled with The Henderson Medical Centre, a general practice in West Auckland; to determine the prevalence of dysphagia risk; and to assess the potential of prealbumin (PAB) in conjunction with C-reactive protein (CRP) as biomarkers of nutrition risk. Method: Patients enrolled with Henderson Medical Centre were recruited into this cross-sectional study over a three-month period. Nutrition risk was determined by the Mini Nutritional Assessment Short-Form (MNA-SF), dysphagia risk by the 10-Item Eating Assessment Tool (EAT-10), and cognitive function by the Montreal Cognitive Assessment tool (MoCA). Demographic, living situation, co-morbidities, number of medications, and support services information was collected through a face-to-face interview. Serum PAB and CRP were measured and their relationship with the MNA-SF analysed. Results: Two hundred participants, mean age 80.9±4.5 years, were recruited. Women comprised 55.5%. Two participants were categorised by the MNA-SF as malnourished and 12% categorised as at risk of malnutrition. Dysphagia risk was observed in 7.5%. 131 participants received a blood test, with a mean PAB value of 0.27±0.06g/L and mean CRP value 4.66 ±11.81mg/L. 85% of participants had a normal PAB and CRP value. No significant association was found between serum PAB values and nutrition risk status when compared. Conclusion: One in seven community-living older adults were categorised as at risk of malnutrition. Our study found a low prevalence of nutrition and dysphagia risk indicating a generally ‘well’ study population. PAB and CRP did not significantly correlate with the MNA SF scores in this population. The results highlight the need for further studies investigating the use of PAB and CRP as nutrition biomarkers in community-living older adults. Key words: older adults, community-living, nutrition risk, dysphagia, prealbumin, C-reactive protein
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    Responsiveness of quality of life instruments : a thesis presented in partial fulfilment of the requirements for the degree of Master of Applied Statistics in Statistics at Massey University
    (Massey University, 2001) Weatherall, Mark
    Quality of life (QoL) is a phrase that is intuitively meaningful. As a concept it distinguishes between the mere duration of life and a life that is in some sense 'worthwhile'. QoL measurement is thought to be important in the assessment of chronic health conditions and their treatment. It is difficult to create an operational definition of QoL that takes into account different concepts of QoL as well as the heterogeneity of subjects and diseases. Responsiveness is one aspect of instruments which measure QoL. A responsive instrument captures the change in QoL in response to interventions which change underlying health conditions. Internal responsiveness, measured by a variety of standardised mean changes, reflects change in a QoL instrument score measured on subjects who 'should have' changed. External responsiveness relates change in a QoL instrument score to a change in external criteria. Methods of determining external responsiveness include receiver operating characteristic curves, correlation and simple regression. Simple linear regression can be extended using linear mixed models which can estimate parameters either by maximum likelihood or by Markov Chain Monte Carlo methods. This thesis critically examines methods of assessing responsiveness and demonstrates the methodology, including the extension to linear mixed models. The data set used for illustration is based on a study of subjects with rheumatoid arthritis who are assessed before and after a period of inpatient hospital treatment for their condition. Three new QoL instruments, the EuroQol, the Quality of Life Profile and the WHOQoL-Bref were found to be moderately responsive. However the available methodology and the extensions described in this thesis were unable to find any difference in responsiveness. Reasons for this could include that QoL instruments are relatively blunt instruments for the detection of change. The external criteria for change used may not have been ideal. The reasons for a choice of instrument for QoL assessment may be better related to ease of completion, interpretation and analysis, than on sophisticated assessment of responsiveness.
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    Validation of the nutrition screening tool 'Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II' among people in advanced age : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Human Nutrition at Massey University, Albany, New Zealand
    (Massey University, 2013) Redwood, Kristy Maree
    Background: This study aims to determine the validity of the nutrition screening tool ‘Seniors in the Community: Risk Evaluation for Eating and Nutrition’ (SCREEN II) among adults of advanced age in Life and Living in Advanced Age: a cohort study in New Zealand (LiLACS NZ). SCREEN II is widely used in Canada and has been found to be valid and reliable amongst well community living older people. As the LiLACS NZ participants are considerably older than those recruited in Canada it was important to validate the SCREEN II tool among participants in advanced age and in the New Zealand setting. Methods: Forty–five people, 85-86 years, were recruited on the basis of their baseline nutrition risk score. SCREEN II consists of 14 items with a total summed score ranging from 0 to 64. Equal proportions of participants were recruited at low (>54), medium (50-53) and high risk (<50). One year later participants completed a follow up SCREEN II assessment and underwent a dietitian’s nutrition risk rating assessment. The assessment included a medical history, anthropometric measures and a dietary assessment using three 24 hour multiple pass recalls. Using clinical judgement the dietitian ranked participants from low risk (score of 1) to high risk (score of 10). A Spearman’s correlation determined the association between the SCREEN II score and the dietitian’s risk score. Receiver operating characteristic (ROC) curves were completed to determine sensitivity and specificity of cut-offs. Results: There was no change in nutrition risk over the year. Participants who lived alone (p=0.02), were women (p=0.03), widowed (p=0.01), former or current smokers (p=0.03), took multiple medications (polypharmacy) (p=0.03), had depressive symptoms (p=0.02) were significantly more likely to be at nutrition risk. SCREEN II was significantly correlated with the dietitian’s risk rating (r= -0.73, p<0.01). A new cut-off of <49 was established for high nutrition risk based on ROC curves and was associated with high sensitivity 90% and specificity 86%. Conclusion: SCREEN II appears to be a valid tool for the identification of nutrition risk in community-living older adults 85 years and older using a cut-off of <49 for high nutrition risk. Key Words: SCREEN II, nutrition, screening tool, advanced age, older adults