Dr Joanne Allen

Older adults represent a large and growing section of Aotearoa New Zealand's population. Longitudinal research on experiences of later life enables understanding of both the capabilities with which people are ageing, and their determinants. The Health, Work, and Retirement (HWR) study has to date conducted eight biennial longitudinal postal surveys of health and well-being with older people (n = 11,601 respondents; 49.4% of Maori descent). Survey data are linked at the individual-level to other modes of data collection, including cognitive assessments, life course history interviews, and national health records. This article describes the HWR study and its potential to support our understanding of ageing in Aotearoa New Zealand. We present an illustrative analysis of data collected to date, using indicators of physical health-related functional ability from n = 10,728 adults aged 55¿80 to describe mean trajectories of physical ability with age, by birth cohort and gender. As the original participant cohort recruited in 2006 reach ages 71¿86 in 2022, future directions for study include expanding the study's core longitudinal measures to include follow-up assessments of cognitive functioning to understand factors predicting cognitive decline, and linkage to national datasets to identify population-level profiles of risk for conditions such as frailty.

Background and Objectives: Neighborhood environments are an important aspect of well-being for older people. Developments of the general ecological model recognize older people as active agents who adapt their environments to fit their changing needs. We provide empirical support for a model suggested by Wahl et al., by examining interactions between neighborhood environments, personal situations, relocation, and quality of life (QoL) among older people. Research Design and Methods: Two statistical models were tested with a sample of community-dwelling participants (aged 55-89) in the New Zealand Health, Work, and Retirement longitudinal surveys conducted in 2016 (T1) and 2018 (T2). Multiple linear regression assessed the association of perceptions of housing and neighborhood with QoL at T1 (n = 3682). Results: QoL was predicted by housing satisfaction, and neighborhood satisfaction, accessibility, and trust (controlling for age, gender, marital status, home ownership, socioeconomic status, physical health, and mental health). Mixed analysis of variance showed that those who moved house between T1 and T2 reported lower housing and neighborhood satisfaction than nonmovers at T1. Over time T1-T2, movers reported less decline in housing satisfaction, and more positive change on all neighborhood perceptions, with higher perceptions of neighborhood accessibility than nonmovers at T2. Discussion and Implications: These findings support the theoretical model and provide the impetus for a more detailed study of the effects of the environment on well-being in older age. Housing and neighborhood environments are a very practical focus for social policy change at local and national levels.

Objectives: To assess the impact of providing care and conditions of care on psychological wellbeing among older informal caregivers following the initial period of COVID-19 pandemic restrictions in Aotearoa New Zealand. Methods: Data were from population-based cohorts of older adults participating in the 2020 Health, Work and Retirement longitudinal survey (n = 3839, 17.4% informal caregivers). Changes in symptoms of depression and anxiety over 2018¿2020 surveys associated with sociodemographic factors, caregiving, cohabitation with the care recipient, assistance provided with activities of daily living, support in providing care, and opportunity cost of care were assessed. Results: Increased depression, but not anxiety, was associated with providing informal care. Among caregivers, lower living standards and cohabitation were associated with increased depression. Lower living standards, unemployment, and lower help from friend/family networks were associated with increased anxiety. Discussion: Economic hardship and social capital provide targets for supporting psychological wellbeing of older caregivers during periods of pandemic restrictions.

Climate change and population growth will increase vulnerability to natural and human-made disasters or pandemics. Longitudinal research studies may be adversely impacted by a lack of access to study resources, inability to travel around the urban environment, reluctance of sample members to attend appointments, sample members moving residence and potentially also the destruction of research facilities. One of the key advantages of longitudinal research is the ability to assess associations between exposures and outcomes by limiting the influence of sample selection bias. However, ensuring the validity and reliability of findings in longitudinal research requires the recruitment and retention of respondents who are willing and able to be repeatedly assessed over an extended period of time. This study examined recruitment and retention strategies of 11 longitudinal cohort studies operating during the Christchurch, New Zealand earthquake sequence which began in September 2010, including staff perceptions of the major impediments to study operations during/after the earthquakes and respondents' barriers to participation. Successful strategies to assist recruitment and retention after a natural disaster are discussed. With the current COVID-19 pandemic, longitudinal studies are potentially encountering some of the issues highlighted in this paper including: closure of facilities, restricted movement of research staff and sample members, and reluctance of sample members to attend appointments. It is possible that suggestions in this paper may be implemented so that longitudinal studies can protect the operation of their research programmes.

Retirement planning is a widely promoted activity to enhance wellbeing for aging populations. However, there is limited follow-up data to understand the antecedents of multi-dimensional retirement planning activities, the resources such activities produce or the explanatory mechanisms. This research draws on recent theorizing, which suggests that retirement planning may play a mediating role in explaining how pre-retirement antecedents are transformed into retirement resources. Antecedents, planning and retirement resources were examined using 3 waves of follow-up data collected in 2006, 2008, and 2014. Four hundred thirty-five people originally employed in 2008 and retired by 2014 participated in the study. Health, income, and a positive retirement attitude (T1) were the strongest predictors of retirement planning (T2), but job satisfaction and occupation also played smaller predictive roles. Financial planning (T2) predicted health, psychosocial, and financial resources in retirement (T3). However, health, lifestyle, and psychosocial planning played a minimal role in explaining retirement resources, and only financial planning demonstrated noteworthy evidence of mediation. Findings can help to inform policy decisions by identifying those at greatest risk of not planning, and to isolate the factors most likely to explain the longer-term effects of planning. Understanding which resources are predicted by different domains of planning will also help inform the targeting of interventions.

Objective: To assess the characteristics of carers and the caregiving situation associated with return to paid employment among older unemployed carers in New Zealand. Methods: A baseline sample of 280 unemployed carers was identified from responses by people aged 55-70 to the 2012-2016 biennial waves of the New Zealand Health, Work and Retirement longitudinal survey. Multiple logistic regression analysis was used to assess characteristics uniquely predicting employment status at two-year follow-up. Results: Sixteen percent were employed at follow-up. Economic living standards, physical health and preference to be in paid employment were positively associated with being employed at follow-up. There were no statistical differences according to age, gender, ethnicity, marital status, education and care characteristics. Conclusion: Individual preferences were the strongest predictor of return to paid employment. Despite New Zealand employment legislation allowing all employees to request flexible working arrangements, economic and health differences in workforce retention among carers persist.

Objectives: There is limited information on the role of fatigue on retirement, either independently or in association with poor sleep. The aim of this study was to examine the prospective association between daytime fatigue, measured as feeling tired or feeling worn out, independently and in relation to dissatisfaction with sleep, and subsequent retirement among 960 older workers in New Zealand. Methods: Data from 2 consecutive surveys (2008 and 2010) of the New Zealand Health, Work, and Retirement Longitudinal Study were used. Poisson regression was used to investigate whether feeling tired and feeling worn out in 2008, along with dissatisfaction with sleep, were associated with self-reported retirement either due to health reasons or other reasons by 2010. Results: The risk for retirement due to health reasons during a 2-year follow-up was 1.80-fold (95% confidence interval [CI] 1.16-2.45) among those who felt tired and 1.99-fold (95% CI 1.34-2.64) among those who felt worn out when compared to those not tired or not feeling worn out after adjusting for several sociodemographic, work characteristics and self-rated health. The risk for retirement due to health reasons was even higher when participant experienced both tiredness and feeling worn out. Dissatisfaction with sleep did not predict retirement due to health or other reasons. Conclusions: Our results highlight that workers at risk of subsequent retirement due to health reasons may be identified with rather simple questions on tiredness and feeling worn out even among generally healthy older workers.

As workforces age, organizations are challenged to provide human resource management policies and practices that are responsive to the needs of older workers. Flexible work arrangements (FWAs) - practices that allow workers to influence when, where, and how work is completed - have been promoted as enabling older workers to maintain work engagement by decreasing demands of the work role, providing the autonomy to balance work and nonwork commitments, and signalling the value of workers to employers. The current study aimed to examine whether FWAs were effective in alleviating key challenges to work among older workers by assessing the impact of FWAs on the associations of physical health, mental health, and negative age-related stereotypes about older workers, with work engagement. Data were obtained from 1,834 workers aged 55-82 (age M = 63.3, 54% female) from a general random sample of older adults. Greater mental health and lower negative stereotypes predicted higher work engagement. Greater physical and mental health conveyed an indirect impact on engagement via lower perception of negative stereotypes. Greater FWAs displayed a weak negative association with the perception of negative stereotypes about older workers and reduced the association of negative stereotypes with work engagement. Access to FWAs may have a minor role in alleviating key risks to work engagement associated with mental and social challenges for an aging workforce. Considerations for future investigations of FWAs and their impact on risks to engagement among older workers are discussed.

Objective Aged pension schemes aim to support material and non-material well-being of older populations. The current work aimed to describe dominant trajectories of material living standards in the decades prior to and following eligibility for an aged pension, and describe associated trajectories of physical and mental health. Methods Longitudinal data on living standards and indices of health Short Form 12 were collected over 2-12 years follow-up from 4811 New Zealand adults aged 55-76. Growth mixture models were used to identify dominant trajectories of living standards with age. Latent growth curve models were used to describe trajectories of physical and mental health associated with each living standards trajectory class. Results A group characterised by good living standards with age (81.5%) displayed physical and mental health scores comparable to those of the general adult population. Smaller groups experienced hardship but increasing living standards (11.8%) and hardship and declining living standards (6.8%). While both groups in hardship experienced poor health in the decade prior pension eligibility, mental health improved among those with increasing living standards, while physical and mental health declined among those with declining living standards. Conclusion Under the current policy settings, a majority of older adults in New Zealand maintain a good level of living standards and health in later life. However, significant proportions experience material hardship and poor health in the decade prior to pension eligibility. Alleviation of material hardship may reduce health inequalities in later life.

Objectives: Following the WHO 2015 policy framework, we tested the effects of older people's intrinsic capacity and their perceptions of their neighborhood environments on mental and physical health-related quality of life (QoL) outcomes across two years. Study design: Participants (mean age = 66) were drawn from two waves of a longitudinal study of aging (n = 2910) in 2016 and 2018. Regression analyses tested the main and interaction effects of intrinsic capacity and neighborhood factors on health-related QoL at T2 (controlling for T1). Main outcome measures: Intrinsic capacity was assessed with number of chronic conditions. Neighborhood perceptions was assessed with measures of housing suitability, neighborhood satisfaction, and neighborhood social cohesion. Health-related QoL was assessed with SF12 physical and mental health component scores. Results: Perceptions of greater neighborhood accessibility and more trust among neighbours were associated with better mental health-related QoL two years later, but not to changes in physical health-related QoL. A significant interaction between intrinsic capacity and neighborhood access to facilities on physical health-related QoL over time showed that those reporting lower neighborhood access experienced a stronger impact of intrinsic capacity on physical health-related QoL. Conclusions: The neighborhood environment is important to the wellbeing of older people and is amenable to policy interventions. We need more work on the aspects of the immediate environment that support QoL in older age. This study points to the need for accessible facilities and cohesive neighborhoods to support health.

This article describes data utilised in article C. Stephens, J. Allen, N. Keating, A. Szabó, F. Alpass, Neighborhood environments and intrinsic capacity interact to affect health related quality of life of older people in New Zealand, Maturitas 139 (2020) 1-5. Data represent self-report responses to a longitudinal postal survey of health and ageing in Aotearoa New Zealand, conducted as part of the Health, Work and Retirement study. Respondents were derived from a large random sample of older adults drawn from a nationally representative sampling frame. Data were collected in 2016 (n = 4029 respondents) and with follow-up conducted in 2018 (n = 3207 respondents from 2016 wave; 79.6% response rate). The dataset comprises responses from all participants in the 2016 survey wave, including those that did not meet criteria for inclusion in the research article. Additional data on sensory impairments, depression, health behaviours, material resources, survey design and response weights are included to facilitate future research. The data article presents tables charting the longitudinal indicators related to the WHO definition of Healthy Ageing collected in the 2016 and 2018 omnibus surveys and made available in the dataset, as well as indicating those to be assessed in the 2020 survey wave. As work is ongoing to identify key domains and indices of Healthy Ageing, provision of these data with relevant materials, metadata and analyses scripts support current research findings, and enable use of these data in future research.

Background and Objectives: The WHO "Framework for Policy for Healthy Ageing' (2015) focuses on the broader environment and the support it provides for everyday functioning of older people. The concept of "livability" supports this framework by providing a conceptualization of environments that support good quality of life. Research Design and Methods: This observational study used an ecological framework of livability to assess cross-sectional relationships between living environments and perceived quality of life among 4,028 respondents, aged 50¿89 years who were surveyed in 2016. A 4-step hierarchical model regressed quality of life on individual resources (health, chronic conditions, SES), contextual variables (distance to health care; rural/urban setting), perceptions of housing and neighborhood environments (housing satisfaction, neighborhood quality, neighborhood social cohesion), and interactions between these levels of the ecological model. Results: As predicted, housing and neighborhood perceptions contributed an additional 5% variance to the model which explained 49% of quality of life. There were significant interactions between the contextual variables and qualities of housing and neighborhood. Discussion and Implications: These findings support the importance of material and social provisions of housing and neighborhoods to quality of life among older people. The ecological model highlights critical information provided by taking different levels of the environment and personal circumstances into account. The concept of "livability," focusing on perceptions of the environment, can assist a shift from seeking the universal ideal neighborhood toward understanding the ways in which different communities may achieve quality of housing and neighborhood facilities that meet community members' needs.

OBJECTIVES: The incidence of multimorbidity (MM) and its correlates among older adults remain poorly understood. This study aimed to examine the socio-demographic and lifestyle factors associated with MM in New Zealand. METHODS: People aged 55-70 years were invited to participate in a population-based cohort study, the Health Work and Retirement Study, in 2006. Those who accepted the invitation and completed the baseline questionnaire were followed up on a biennial basis. Data on socio-demographic factors, health and lifestyle behaviours, and diagnoses of chronic diseases were obtained from baseline and 6 waves of follow-up. Generalised estimating equations (GEE) adjusted for both time-constant and time-varying factors were used to model factors associated with the onset of MM. RESULTS: A total of 1,673 participants (with 0 or 1 chronic condition) contributed to an overall 8,616 person-years of observation. There were 590 new cases of MM over 10 years of follow-up, corresponding to an overall incidence of 68.5 per 1,000 person-years. The results of the age- and sex-adjusted GEE analysis showed that age, ethnicity, living alone, obesity, hypertension, and having 1 chronic condition at baseline were significant predictors of MM onset. Higher education, income, physical activity, and regular alcohol consumption were protective factors. In a fully adjusted model, marital status (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01 to 1.37; p=0.039), hypertension (OR, 1.23; 95% CI, 1.02 to 1.48; p=0.032) and having 1 chronic condition at baseline (OR, 2.92; 95% CI, 2.33 to 3.67; p<0.001) remained significant. CONCLUSIONS: The higher incidence of MM among Maori people, socioeconomically disadvantaged groups, those with low physical activity, and obese individuals highlights the importance of targeted prevention strategies.

Participants from the longitudinal Health, Work and Retirement study of older New Zealanders (N=1,970), were surveyed in 2010, before the 2010 and 2011 Canterbury earthquake events, and again in 2012 and 2014. A variety of direct and indirect effects of the earthquakes were reported by older people across all of New Zealand and these persisted over three years. Although over a quarter of the study's participants reported effects of the earthquakes, these effects reduced with both physical and temporal distance from the earthquake events. Provision of social support to family and friends was widely reported, but decreased over time. Emotional and economic impacts were more likely to be reported in the longer term. After taking into account general changes in the health and wellbeing of older people over time, there was no effect of exposure to earthquake effects on health. However, there was a short term benefit on emotional loneliness for those affected by the earthquakes, with those who had experienced the earthquakes more likely to report reduced loneliness in 2012. This study is a reminder that through family and social connectedness, older people in New Zealand can be part of post-disaster recovery and resilience, in ways that are not simply related to immediate exposure.

Research investigating behavioural-variant frontotemporal dementia has concentrated on identifying and quantifying people's difficulties; yet few studies have considered how people with behavioural-variant frontotemporal dementia make sense of their difficulties. Five participants were interviewed and interpretive phenomenological analysis used to analyse the data. Two superordinate themes emerged: 'Bewilderment' and 'Relationships with others'. 'Bewilderment' reflected the feelings of the participants from the start of their dementia, and was divided into two main themes (1) 'Awareness of change: What's the problem? and (2) Threats to self: This is not me. The superordinate theme, 'Relationships with others', reflected difficulties with social relationships and comprised two main themes (1) 'Family and friends: Things haven't changed¿ but do I say anything wrong?' and (2) Coping with threats to self: Blame others or just avoid them. The themes were discussed in relation to literature evaluating the difficulties associated with behavioural-variant frontotemporal dementia together with implications for clinical practice.

Background: As research focuses on the concept of resilience, evidence suggests that greater levels of personal hope may have a mitigating effect on the mental health impact of adversity. In view of the adversity affecting rural communities, a better understanding of factors influencing personal hope may help identify foci for mental health promotion and mental illness prevention research and interventions. Aim: To explore the relationship between demographic, socioeconomic and mental health factors and personal hopefulness, including the influence of locality and remoteness. Method: Using data from two community-based longitudinal cohorts from New SouthWales ¿ one urban and one rural ¿ we analysed cross-sectional relationships between a range of factors and personal hopefulness using logistic regression techniques, as part of a common follow-up. Personal hopefulness was measured using a 12-item scale and scores were categorised as low (<2.5), medium (2.5¿3.4) and high (=3.5). Results: Of 2774 participants (53% female, mean age 69.1 years [SD 7.3, range 58¿91 years], 36% living outside metropolitan areas) 32% had low, 51% had medium and 17% had high personal hopefulness scores. Several factors displayed univariate associations with personal hopefulness. In the multivariate model, five factors were independently associated with lower personal hopefulness: being older, having lower perceived prosperity, less frequent socialisation, experiencing high psychological distress or psychological impairment. Hopefulness was not associated with geographical location. Conclusion: The impact of current psychological distress and aspects of adversity on personal hopefulness over time should be further investigated in longitudinal research. Personal hopefulness did not differ across geographical location.

Although there is an increasing focus on recovery within mental health services, there has been limited exploration of the applicability of these principles within forensic services. The authors draw on their experiences within forensic rehabilitation services to discuss the potential obstacles to secure recovery, exploring the systemic and risk management aspects of such a setting as well as considering attachment theory within this context. Some proposals based on clinical experience are given on how such obstacles are faced and tackled. LEARNING OBJECTIVES: ¿ To understand the limitations of the recovery approach in forensic settings. ¿ To understand how current risk assessment practice affects patients' autonomy and empowerment. ¿ To understand how the attachment histories of patients in forensic services affect their ability to recover.

In this article we address how relatives of people with frontal-variant frontotemporal dementia (fvFTD) experience the illness and how it impacts their lives. We interviewed 6 participants and carried out interpretative phenomenological analysis. We report on 11 themes that reflect distinctive challenges. Five themes relate to witnessing bizarre and strange changes: changed appetites and drives, loss of planning ability, loss of inhibition leading to social embarrassment, risky behavior, and communication problems. Four relate to managing these changes and two to the impact on the person and his or her relationships. Relatives must live with unusual changes in the person with fvFTD and the stigma this carries in social settings. They learn to act assertively for their relatives and put effort into promoting quality of life, using strategies adapted for fvFTD. Relatives grieve the loss of the person with fvFTD and their mutual relationship, but nonetheless find sources of solace and hope. © The Author(s) 2013.

Objectives. The aim of this study is to explore the meaning and significance of family interventions (FI) for the individual who experiences psychosis, and its significance for recovery. Design. A qualitative in-depth interview design was used to explore individuals' experience of FI and its meaning to them. Methods. Seven individuals recovering from psychosis attending integrated FI sessions were interviewed using a semi-structured interview schedule developed with service user input. Interviews were recorded, transcribed verbatim, and explored using Interpretative Phenomenological Analysis. Results. Three central themes highlighted the participants' experience: (1) They welcomed the shared experience with their families and felt contained and valued by the therapists; (2) They felt the sessions contributed to changed patterns of relating within the family and the creation of new meaning through the validation of multiple perspectives; and (3) They described how the family sessions supported a new positioning in the world, a sense of their own empowerment and personal responsibility, greater self-acceptance, an increased ability to manage emotions, and hope for the future. Conclusions. Conditions in the family sessions provided an environment for changes in patterns of relating, personal meaning, and emotions to take place. Recovery, for these individuals, appeared to be about repositioning themselves in the world. The shared experience of sessions and the recognition of multiple perspectives within a containing environment may be related to recovery via the development of new perspectives and a more robust sense of self. This has clinical implications for the focus of FI sessions. Practitioner Points This study supports the use of various elements of integrated family interventions. Understanding service-users' experience of family interventions and recovery processes can support the development of responsive clinicians and produce therapies that best support recovery processes. © 2012 The British Psychological Society.