Freemasons' Department of Geriatric Medicine

International trends in place of death

Supervisor

Joanna Broad

Discipline

Freemasons' Department of Geriatric Medicine

Project code: MHS028

Westernisation of a country brings changes, amongst other things in place of death. With population ageing, societies change how they provide care for people late in life. In 2013 we published a paper that showed that among over 16 million deaths in 47 populations, just over half (54%) occurred in acute care hospitals (range 11% in Albania to 78% in Japan). A median of 12% died in residential aged care facilities. About 32% did at home or in other settings (in workplaces, roads etc). Of those reporting deaths of people aged 65 years and over, New Zealand and Iceland had the highest proportion of deaths in residential care at 38%, with Norway also reporting a high proportion. Clear patterns exist with age and sex.

The paper has been much used in academic work and in a wide range of policy settings. While the paper provided a point-in-time picture, it did not show how populations were changing over time. At the time we noted that there were intriguing changes occurring, presumably reflecting both societal values and speed of population ageing.

This project aims to collect new data in order to describe recent trends in place of death for different populations. It will involve ferreting out data from a range of sources (mostly online), assembling and making sense of the numbers, preparing a written and visual summary of trends.

The scholar will value numbers and images, but complex statistical skills are not needed. Students will enjoy observing care systems in different societies (from afar – no travel offered!), and will consider how this is reflected in statistical reports. They will come to appreciate how the numbers may be used to inform policy and practice. Personal experiences and observations of a variety of cultural perspectives, and being able to read and write in languages other than English, would be valuable but not essential. The student’s course of study will probably be health sciences, statistics, sociology or social policy, but others will be considered. A draft academic research publication will follow.

The studentship will be located on the UoA site at North Shore Hospital in Milford.

Reporting use of medications in old/vulnerable people - a comparison of needs assessments reports and community prescribing records

Supervisor

Joanna Broad

Discipline

Freemasons' Department of Geriatric Medicine

Project code: MHS204

Older people needing support in New Zealand are assessed using a mandatory suite of assessment tools, interRAI. Functional status, diagnoses and medications are included in the assessment. At assessment, medications reported include self-reported and database look-ups, but it is unknown how well prescribed medications are recorded. In order to understand how reliable reports are that come from interRAI, it would be helpful to understand how well the interRAI record matches community dispensing records. Inappropriate use of medications (over-use or under-use) can lead to poor outcomes.

As part of a related project, we have records extracted for over 33,000 people having needs assessments, and also have records of medications dispensed near the time of assessment. This project would compare the two to characterise the overall level of agreement of interRAI and dispensing data, describe the use of non-prescribed medications, and identify which medication types dispensed tend to be under-recorded in interRAI.

Students will need to recognise medications used most commonly in older people for chronic conditions. Pharmacy or medical students are therefore most likely to be able to undertake that project. Applicants should be interested in the potential of existing databases for informing policy and practice, and to learn some methods of making statistical comparisons. Support for use of analytical software will be available.

Residential Aged Care in Auckland: Changes in bed numbers, level of care and affiliation between 1988 to 2018