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2013 National Kaumātua Service Providers’ Conference

2013 National Kaumātua Service Providers’ Conference. Hei Manaaki Ngā Kaumātua Trust Wednesday 6 th to Thursday 7 th November 2013 Travelodge Hotel, Palmerston North. The presentation. What can be learned by Māori service providers from … Te puāwaitanga o ngā tapuwae

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2013 National Kaumātua Service Providers’ Conference

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  1. 2013 National Kaumātua Service Providers’ Conference Hei Manaaki Ngā Kaumātua Trust Wednesday 6th to Thursday 7th November 2013 Travelodge Hotel, Palmerston North

  2. The presentation What can be learned by Māori service providers from … Te puāwaitanga o ngā tapuwae kia ora tonuLife and living in advanced age: a cohort study in New Zealand, LiLACS NZ

  3. Te puāwaitanga o ngā tapuwae kia ora tonu Life and living in advanced age: a cohort study in New Zealand, LiLACS NZ Treaty Partners Participation, Protection, Partnership

  4. In Aotearoa, New Zealand: context • The population of Māori men and women aged 65 years and over is increasing faster than non-Māori people. • The number of Māori aged 80 + years old will triple by 2026. • The advanced aged cohort will increase from 1% to 8% of NZ’s population by 2050.

  5. What factors predict successful advanced ageing for older Māori and non-Māori? What pathways do these people in advanced age take? What is the relative importance of health, frailty, cultural, social & economic factors (and others) to relevant outcomes? Health status of these people in advanced age? Objectives …

  6. LiLACS NZ has asked about … • Socio-demographic, economic resources • Family, whānau composition, contact, and support • Social support: perceived and actual • Cultural practices & attitudes • Health • General function – NEADL, Physical activity, Cardiovascular disease, Nutrition, Bones and injuries • Medications • cognition • Quality of life – SF-12 • Health services, access and use • Environmental- locality, accessibility, paths, supermarkets Measured • BP, FEV-1, height, weight, walking speed, grip strength • Blood tests for markers

  7. Questions • What are the factors in living well in advanced age? • How do whānau support and engage with their relatives 80 plus years old? • What important roles and functions are carried out by the octogenarians in their whānau and communities? • Shared wisdom and knowledge •  Health needs and concerns •  Help with current and future planning

  8. Te puāwaitanga o ngā tapuwae kia ora tonuLife and living in advanced age: a cohort study in New Zealand, LiLACS NZ The only longitudinal study of Māori aged 80 to 90 years old

  9. No routinely collected data on Māori LiLACS NZ is the world’s first longitudinal study of an indigenous population aged 80 plus years old During any one year of LiLACS NZ, one in ten of the cohort will die and one in five will be hospitalised for cardiovascular disease. Indigenous Māori ageing in Aotearoa

  10. A narrow age band, 80 to 90yrs for Māori To make recruitment easier 85yrs for non-Māori. Designed to study environmental, social, cultural, health, family and whānau. Designed to study issues associated with ageing, wellbeing, and quality of life. LiLACS NZ commenced in 2010 preceded by the feasibility study, Reaching Advanced Age

  11. Bay of Plenty region, North Island, NZ Equal explanatory power Māori and non-Māori Visit the participants every year until all of the participants have died Where and how?

  12. Research methodology scientific inquiry • First and foremost LiLACS NZ is a quantitative study located in the Dept of General Practice & Primary Health Care. • A collaboration of Māori and non-Māori investigators and community partners. • A collective of individuals and individual organisations contracted by the University of Auckland e.g. Māori and non-Māori coordinators, research fellows, data entry people, nurses, interviewers, and candidates-Masters & PhDs.

  13. The community partners • 9 interviewers • 5 Māori & • 4 non-Māori • 8 nurses • 5 Māori & • 3 non-Māori • Western Bay of Plenty PHO: Lynda Hare-Rangitauira & Denise Green • Ngā Matāpuna Oranga Kaupapa Māori PHO: Janice Kuka • Te Rūnanga o Ngāti Awa: Kiri Martin • Te Rūnanga o Irapuaia: Hine Loughlin • Te Kaha: Gail Keepa & Latham Rodgers • Te Korowai Aroha Trust: Bella Moke & Carolyn Hall • Te Rūnanga o Ngāti Pikiao: Bella Moke & Carolyn Hall • Rotorua Area Primary Health Services: Jennifer Anastasi (non-Māori)

  14. 421 out 766 Māori, 80 to 90 years old (56%) Non-Maori 516 out of 870, 85 years old(59%) A total of 937 participants were recruited in 2010 Using scientific inquiry & kaupapa Māori

  15. 421 (56%) participated & 255 (61%) completed the comprehensive interview Using scientific inquiry & kaupapa Māori

  16. Kaupapa Māori approach to research is … a political method promoting and supporting research and education [health] for Māori by Māori, conducted in Māori ways including using te reo Māori me ngā tikanga/Māori language and culture. Reference Ngāha, A.B. (2011). Te Reo, a language for Māori alone? An investigation into the relationship between the Māori language and Māori identity. PhD Thesis. Māori Studies: University of Auckland (my brackets)

  17. Kaupapa Māori involves … Actively involving the participants in the ongoing design and implementation of the study through ... • Annual Hui/meetings of the participants and the research team. • Pānui/newsletter. • Morning teas in the research sites organised by the community partner. • Training Hui held in the research sites organised by the University and community partners • Review Hui held in the research sites organised by the University and the community partners. • Annual Hui to disseminate the new innovation

  18. Kaupapa Māori involves .. Te RōpūKaitiaki o Ngā Tikanga Māori/Protectors of principles in the conduct of Māori research • Betty McPherson, Te Rārawa’ • Paea Smith, Ngāti Apa and Ngāti Kahungunu; • Leianna Reynolds, Ngāti Rehia and Ngāti Tūwharetoa; • Hone Kameta, Whakatōhea, Ngāi Tūhoe, and Te Arawa; • Florence Kameta, Ngāi Tai and Ngāti Pōrou; and • Dr Waiora Port, Te Rārawa and Te Aupouri. Role: Governors, advisors, designers, translators, authors, presenters, parents, tribal leaders, community leaders, grandparents, great grand parents, & parents

  19. 421 Māori participants aged 80 plus years enrolled in 2010 • Average age 83.2 (2.7%) • Gender n % men 172 (42.7%) • Residential care n% 20 (4.9%) • Retirement village 7 (2.7%) • Live alone n% 108 (41.2%)

  20. Deprivation index Māori Non-Māori Least Most Least Most

  21. Education Māori Non-Māori

  22. Other relevant characteristics of the 421 Māori participants • 1 in 3 Māori reported a fall in the last year • 1 in 30 Māori reported a fall • Up to 4% of Māori were hospitalised during Wave 1 • Up to 5% of Māori were hospitalised during Wave 2 • The worst consequence of a fall is a hip fracture • Falls remain an issue for the age group

  23. Regular support services used by Māori • 44.8% of participants living in Tauranga • 33.9% of participants living in Rotorua • 50.8% of participants living in other areas (Whakatāne and Ōpotiki)

  24. Marae contact

  25. In the Bay of Plenty • 52 % of Māori aged 80 to 90 years old converse in Māori language about everyday things. • Māori reported understanding te reo Māori me ngā tikanga well. • Māori octegarians live a higher quality of life when they engage with whānau and hapū on marae more frequently. • Māori language, culture, and quality of life are closely bound e.g. participation in gatherings on their marae/sacred gathering place. • Key to kaupapa Māori is revitalising Māori language and culture.

  26. Te reo Māori me ngā tikanga Commentary • Māori aged 80 to 90 years old are native speakers and they continue to use te reo Māori daily. • Te reo Māori me ngā tikanga is at the heart of a long, happy and healthy life. • Māori grandparents who are users of te reo Māori me ngā tikanga are at the heart of revitalising Māori language and culture; whānau ora/happy, healthy, wise extended Māori families.

  27. LiLACS NZ data and information … • Frail but not stupid. • Actively involve Māori and non-Māori people in the ongoing design and implementation of age care service. • Māori language, culture, and quality of life are closely bound. • Assume the same bond for groups of international migrants.

  28. How might LiLACS NZ improve aged care service delivery? LiLACS NZ can offer: • Data. • Community partners. • Researchers. • Practitioners, & • International networks.

  29. References Dyall, L., Kēpa, M., Teh, Ruth., Mules, R., Moyes, S., Wham, C., Hayman, K., Connolly, M., Keeling, S., Loughlin, H. Jatrana, S., & Kerse, N. (in review). Cultural and social factors and Quality of life of Māori in advanced age: Te Puāwaitanga o Ngā Tapuwae Kia ora Tonu. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). New Zealand Medical Journal Kēpa, M; Kēpa, C.A; McPherson, B; Kameta, H; Kameta, F; Port,W; Loughlin, H; Smith, P; & Reynolds, L. (in review) E kore e ngāro ngā kākano i ruia mai i Rangiātea: The language and culture from Rangiātea will never be lost in health and ageing research. Journal of the Canadian Health Libraries AssociationSpecial Issue on Aboriginal Health Kēpa, M., Kameta, F., McPherson, B., Smith, P., Reynolds, L., Dyall, L., Kerse, N., Hayman, K., & Moyes, S. (2013). Donating a sample of blood tissue to research: Where to from there? Pacific Edge Transforming Knowledge Into Innovative Practice.  Research papers from the fourth Health Research Council of New Zealand Pacific Health Research Fono pp. 100-107. ISBN 978-1-877495-10-6

  30. References Kēpa, M., Kerse, N., Dyall, L. (2012). Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu: Cultures and ageing. International Indigenous Research Development Conference Proceedings 2012, pp 158-166. Ngā Pae o te Māramatanga. ISBN 978-0-9864622-4-5. http://www.indigenousdevelopment2012.ac.nz Kēpa, M. Technical Report to Ngā Pae o te Māramatanga. Kaumātua: Taonga Aroha Project. The University of Auckland. http://www.ageconcern.org.nz/files/TechnicalReporttoNgaPaeoteMaramatangaJuly2011.pdf July 2011 Smith, G. H. (1997). The Development of Kaupapa Māori Theory and Praxis. Unpublished Doctoral Thesis. University of Auckland Smith, L.T. (1999) Decolonizing Methodologies. Research and Indigenous Peoples. University of Otago Press, Dunedin

  31. Rangahau houWhat happens when the urupā is nearly full? Implications for Whānauora?Roles and responsibilities of whānau, hapū, marae trustees, marae committees, kura kaupapa Māori, whare kura, whare wānanga, Health Organisations, Te Puni Kōkiri, Māori Studies Departments, Historical Society, and so forth.

  32. Message for Māori service providers … Please don’t end our lives in an undignified and monstrous way!

  33. A Prayer of Care & Service We offer you our handsto do your work.We offer you our feetto go your way.We offer you our eyesto see as you do.We offer you our tonguesto speak your words. We offer you our mindsthat you may think.Above all, we offer you our soulsthat you may love,your gods, god, ancestors and all people.We offer you our care and service… Kia ora

  34. Whakawhetaitanga Acknowledgements LiLACS NZ’s participants LiLACS NZ Te RōpūKaitiaki o ngā tikanga Māori: Hone Kameta, Florence Kameta, Leiana Reipae Reynolds, Dr Waiora Port, Betty McPherson, & Paea Smith LiLACS NZ community partners in Tauranga, Rotorua, Whakatāne, Ōpotiki and Te Kaha Professor Ngaire, Kerse, Dr Lorna Dyall, Dr Ruth Teh, Simon Moyes, Rangimarie Mules, Ruth Speck, Corinthia Kēpa, Karen Hayman, & Angela Robinson Dept of General Practice and Primary Health Care, School of Population Health, Faculty of Medicine and Health Sciences

  35. Kaiutu MajorFunders Health Research Council of New Zealand Ministry of Health, New Zealand Ngā Pae o te Māramatanga, New Zealand’s Indigenous Centre of Research Excellence hosted by the University of Auckland

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