Browsing by Author "Alpass F"

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    Area-based socioeconomic deprivation is associated with cognitive decline in midlife to early late-life New Zealanders without cognitive impairment
    (Wiley Periodicals LLC on behalf of Alzheimer's Association, 2025-01-09) Röhr S; Gibson R; Alpass F
    Background Research identified individual-level socioeconomic factors as key determinants of cognitive health. This study investigated the effect of area-based socioeconomic deprivation on cognitive outcomes in midlife to early late-life New Zealanders without cognitive impairment. Understanding geographical dimensions of socioeconomic determinants of cognitive health is important from an equity perspective. Method Data stemmed from a subsample of the New Zealand Health, Work and Retirement Study, a cohort study on ageing. In 2010, 1,001 participants aged 49-84 years completed face-to-face interviews and were reassessed two years later. Cognitive functioning was measured using Addenbrooke’s Cognitive Examination–Revised, adapted for culturally acceptable use in New Zealand. Area-based socioeconomic deprivation was assessed using the New Zealand Deprivation Index (NZDep2006). Linear mixed-effects models analysed the association between area-based socioeconomic deprivation and cognitive outcomes, controlling for individual-level socioeconomic (age, age², gender, education, ethnicity [Māori, Indigenous people of New Zealand, and Non-Māori, mostly of European descent], marital status, employment, net personal income), lifestyle and health variables (Lifestyle for Brain Health/LIBRA index, social loneliness). Result The analysis included 783 participants (54.7% female, mean age 62.7 years, 25.0% Māori). Individuals with cognitive impairment at baseline (n = 69) and older than 75 years were excluded (n = 79). Further attrition was due to missing data. At baseline, 39.7% resided in low deprivation areas, 39.0% in moderate, and 21.3% in high deprivation areas. The unadjusted model indicated a significant association between higher area-based socioeconomic deprivation and lower cognitive functioning (B = -0.16, 95%CI: -0.22,-0.10; p < .001) and cognitive decline (B = -0.12, 95%CI: -0.21;-0.03; p = .015). The adjusted model yielded similar results for cognitive functioning (B = -0.08, 95%CI: -0.15;-0.01; p = .050) and cognitive decline (B = -0.12, 95%CI: -0.20;-0.04, p = .013) (Fig. 1). Influential covariates included gender, education, and lifestyle (LIBRA). Conclusion This study demonstrated a relationship between higher area-based socioeconomic deprivation and lower cognitive functioning, along with cognitive decline, in cognitively unimpaired New Zealanders aged 48 to 75 years. These findings emphasize the importance of considering neighbourhood characteristics and broader socioeconomic factors in strategies aimed at mitigating cognitive health disparities and reducing the impact of dementia in disadvantaged communities.
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    Becoming an informal care-giver: The role of work status incongruence
    (Cambridge University Press, 2022-02-10) Koreshi SY; Alpass F
    The ageing of the workforce suggests that many older adults will be combining work and care. While there is extensive evidence for the impact of informal care-giving on paid employment, there is less research on how work status may influence the provision of informal care. It has also yet to be established whether work preferences may influence the uptake of care-giving responsibilities, particularly for older workers. We investigated the impact of work status congruence on taking up informal care at two-year follow-up. A sample of 1,211 employed participants aged 55–70 years was surveyed over two consecutive waves. Involuntary part-time workers were more likely to provide care at Time 1 than involuntary full-timers, voluntary part-timers and voluntary full-timers. Participants were more likely to take up care if the opportunity costs of doing so were low, however, only for those whose preferences for more work were not met. There were no moderating effects of gender and economic living standards on the relationship between work status incongruence and provision of care-giving. Understanding the decision-making processes older workers undertake when taking up informal care are complex and must consider the influence of personal work preferences. These findings have implications for care and work-based policy given the importance of informal care in sustaining ageing-in-place policies.
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    Daytime fatigue as a predictor for subsequent retirement among older New Zealand workers
    (Elsevier Inc on behalf of National Sleep Foundation, 2021-12) Myllyntausta S; Gibson R; Salo P; Allen J; Gander P; Alpass F; Stephens C
    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.
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    Lifestyle for brain health and cognitive functioning in midlife to early late-life New Zealanders: Utility of the LIBRA index.
    (John Wiley and Sons, Inc., 2024-05-01) Röhr S; Stephens C; Alpass F
    OBJECTIVES: There is enormous potential to improve brain health and reduce the risk of cognitive decline and dementia based on modifiable risk factors. The Lifestyle for Brain Health (LIBRA) index was developed to quantify modifiable dementia risk or room for brain health improvement. The objective of the study was to investigate the utility of the LIBRA index in relation to cognitive functioning in a midlife to early late-life sample of New Zealanders. METHODS: A subsample (n = 1001) of the longitudinal New Zealand Health, Work and Retirement (NZHWR) study completed face-to-face cognitive assessments using the 'Kiwi' Addenbrooke's Cognitive Examination-Revised (ACE-R) in 2010 and again in 2012, in addition to completing biennial NZHWR surveys on socioeconomic, health and wellbeing aspects. The LIBRA index was calculated incorporating information on 8 out of 12 modifiable health and lifestyle factors for dementia. Unadjusted and adjusted regression models and mixed effects models were used to inspect associations of LIBRA with cognitive functioning, cognitive impairment, and cognitive decline. RESULTS: The analytical sample (n = 881 [88.0%], after considering exclusion criteria and missing data) had a mean age of 63.1 (SD = 6.5) years, 53.3% were female, 26.2% were Māori, and 61.7% were highly educated. Higher LIBRA scores (indicating higher modifiable dementia risk) were associated with lower cognitive functioning (B = -0.33, 95% CI = -0.52;-0.15, p < 0.001) and a higher likelihood of cognitive impairment (OR = 1.22, 95% CI = 1.04; 1.42, p = 0.013), but did not predict cognitive decline over 2 years (B = -0.03, 95% CI = -0.22; 0.16, p = 0.766), adjusted for age, age2, gender, education, and ethnicity. CONCLUSIONS: The LIBRA index indicated promising utility for quantifying modifiable dementia risk in midlife and early late-life New Zealanders. For local use, refinement of the LIBRA index should consider cultural differences in health and lifestyle risk factors, and further investigate its utility with a wider range of modifiable factors over a longer observation period.
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    Public Health.
    (2024-12) Röhr S; Gibson R; Alpass F
    BACKGROUND: High purpose in life - the extent of engagement in activities that are personally valued and give a sense of direction and meaning to life - has been associated with higher cognitive functioning and may protect against dementia. Less is known about gender differences in cognitive functioning regarding purpose in life. Understanding gender-specific links can inform tailored interventions aimed at promoting cognitive health. METHOD: A subsample (n = 875, aged 50-85 years) of the NZHWR study completed face-to-face cognitive assessments and postal surveys in 2012. Cognitive functioning was assessed with Addenbrooke's Cognitive Examination-Revised (ACE-R), adapted for culturally acceptable use in New Zealand. Purpose in life was measured with the Life Engagement Test. Linear regression analysis assessed associations of gender, purpose in life and their interaction with cognitive functioning, controlling for socioeconomic factors (age, age², education, ethnicity [Māori, Indigenous people of New Zealand, and Non-Māori, mostly of European descent], marital status, employment, individual-level economic hardship, area-based socioeconomic deprivation), lifestyle and health factors (smoking, alcohol consumption, physical activity, SF-12 physical and mental health, social engagement, social loneliness). RESULT: The analytical sample (n = 643) was M = 65.3 (SD = 7.4) years old; 53.3% women, 21.2% Māori. The ACE-R score was M = 92.9 (SD = 5.3). N = 55 (8.5%) scored ≥1.5SD below the mean, indicating cognitive impairment. Women had higher cognitive functioning (M = 93.7, SD = 4.6 vs. M = 92.0, SD = 5.8; Z = -3.88, p<.001) and purpose in life (M = 26.2, SD = 3.8 vs. M = 25.8, SD = 3.4; Z = -2.19, p = .029) than men. In the adjusted regression analysis (R² = 27.6%), higher purpose in life (B = 0.29, 95%CI = 0.12;0.46; p = .001) and female gender (B = 9.97, 95%CI = 4.71;15.24, p<.001) were associated with higher cognitive functioning. The association of purpose in life with cognitive functioning was less pronounced for women than men (B = -0.31, 95%CI = -0.51;-0.11; p = .003) (Fig. 1). Significant covariates included age², education, deprivation, and social loneliness. CONCLUSION: In this sample of older New Zealanders, a gender difference in cognitive functioning varied by level of purpose in life. Women had higher cognitive functioning than men, particularly at lower purpose in life, with the difference decreasing as purpose in life increases. Interventions to enhance purpose in life might particularly benefit men. Notably, cognitive functioning may also impact purpose in life, emphasising the need for longitudinal studies.
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    Reconciling Paid Work and Informal Caregiving Among Older Adults: Implications for Work Interference With Family.
    (Oxford University Press, 2023-10-06) Koreshi SY; Alpass F; Leggett AN
    BACKGROUND AND OBJECTIVES: Many older adults who combine paid work and informal caregiving responsibilities are often in work arrangements that differ from their preference. There is reason to believe that such work status incongruence may lead to work interference with family (WIF). In response, many governments have policies that support flexible work arrangements (FWA) to help individuals manage work and family commitments. This paper examines whether work status preferences contribute to WIF for older adults who combine work and care and whether the use of flexible work arrangements moderates this relationship. RESEARCH DESIGN AND METHODS: The study included 610 informal caregivers (aged 55-70 years) in paid employment who participated in either the 2018 or 2020 waves of the New Zealand Health, Work and Retirement study. Using a simple moderation analysis with demographic controls, the effects of work status preferences and FWAs on WIF were estimated. RESULTS: After controlling for confounds, significant main effects were found for both work status preferences and flexible work arrangements on WIF. The moderation analysis revealed that involuntary part-timers using flexible time-off arrangements reported lower levels of WIF. However, other types of flexible work arrangements did not moderate the relationship between work status preferences and WIF. DISCUSSION AND IMPLICATIONS: These findings suggest that work status preferences can contribute to WIF, but not all types of flexible work arrangements alleviate it. Policy initiatives designed to reduce WIF for those combining work and care should consider accounting for differences in the work status preferences of older workers.
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    Social networks and social support of older immigrants in Aotearoa New Zealand
    (Cambridge University Press, 2024-10-01) Szabó Á; Stephens C; Alpass F
    Immigrants commonly report difficulties with developing social connections post-transition, which can lead to social isolation as they age. Understanding what factors promote/hinder the social integration of immigrants is an important public health objective. We tested the public health model of social integration of Berkman et al. in a sample of older immigrants. This model calls for considering both the social conditions in which social networks are embedded (upstream influences) and the levels of social support offered by different types of networks (downstream influences). First, we derived an empirical typology of social networks of older immigrants. Next, we tested associations of social networks with upstream and downstream influences. Data came from the New Zealand Health, Work and Retirement Study. The sample included 568 older adults (54% male) who immigrated as adults (mean length of stay = 28.5 years, standard deviation = 12.5). Latent profile analysis was employed on responses to the Practitioner Assessment of Network Type to identify social networks. Associations with upstream and downstream correlates were tested using logistic and multiple regression. Four network configurations emerged: ‘private-restricted’ (43.4%), ‘family-dependent’ (35.8%), ‘locally integrated’ (10.9%) and ‘wider community-based’ (9%). Having shorter length of residence and individualistic cultural background was predictive of being in a restricted network (private-restricted, family-dependent). Being in a restricted network was associated with lower levels of social support. Network type interacted with partner status: having a partner buffered the negative impact of having a restricted network on social support. Although restricted networks are common among older immigrants, they do not necessarily result in compromised social support. While we may see differences across countries regarding the impact of specific upstream and downstream influences, our findings highlight that both contextual and individual-level resources need to be considered alongside network structure to promote social integration of immigrants as they age.
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    The concurrent accuracy of the modified telephone interview for cognitive status and mini-mental state examination tools in detection of cognitive impairment among older adults
    (Scientific Electronic Library Online, 2022-09) Laghousi D; Aminisani N; Shamshirgaran SM; Javadpour A; Gholamnezhad Z; Gilani N; Asghari-Jafarabadi M; Alpass F
    Due to the need for face-to-face administration of many cognitive screening tests, it is not always feasible to screen large-scale samples. Objective: This study aimed to assess the discriminant validity of the Persian version of Telephone Interview for Cognitive Status (P-TICS-m) and Mini-Mental State Examination in the middle-aged Iranian population. Methods: The P-TICS-m and MMSE were administered to 210 randomly selected middle-aged community-dwelling adults who had been registered in the Neyshabur Longitudinal Study on Ageing. Participants also underwent psychological examination by two neurologists to assess cognitive impairment based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. To evaluate the discriminant validity of P-TICS-m and MMSE with DSM-V criteria, the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR+ and LR−) were calculated. Results: The mean age of the participants was 59.6±6.8 years. The TICS and MMSE were highly correlated (r=0.635, p<0.001). The sensitivity, specificity, PPV, NPV, LR+, and LR− to discriminate cognitive impairment were, respectively, 83%, 92%, 68%, 96%, 10, and 0.182 for MMSE and 100%, 13%, 19%, 100%, 1.16, and 0 for TICS-m. The receiver operating characteristic curve analysis results showed no statistically significant differences between P-TICS-m and MMSE. Conclusions: Our findings indicate that the TICS-m test can be used as a screening tool instead of the MMSE. Due to the low specificity and low PPV of the TICS-m compared to MMSE, the diagnosis should be confirmed using definitive diagnostic tests when a subject is classified as having cognitive impairment.
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    Understanding older Māori informal caregivers’ experiences during the COVID-19 pandemic through Te Whare Tapa Whā
    (Taylor and Francis Group, 2024-12-04) Barnard T; Uekusa S; Phibbs S; Matthewman S; Stephens C; Alpass F; Tamaira M
    Drawing upon Tā Mason Durie’s Te Whare Tapa Whā model, this research explores the impact of the COVID-19 pandemic on the health and wellbeing of older Māori informal caregivers in Aotearoa New Zealand. Utilising information from 35 in-depth interviews conducted with Māori informal/whānau caregivers, this study identifies that the pandemic impacted the physical and mental health of Māori informal caregivers, facing challenges due to lockdown measures, limited access to support services and increased care responsibilities. However, the study predominantly highlights a range of positive aspects of informal caregiving during the pandemic, such as a sense of purpose and fulfilment in their role, enhanced appreciation for loved ones, and increased hononga and whanaungatanga. The study underscores the importance of cultural values and practices in maintaining the wellbeing of Māori informal caregivers and suggests the need for larger social changes to address structural injustices as well as inequalities. Overall, the study provides insights into the experiences of Māori informal caregivers and highlights the significance of recognising and addressing their health and wellbeing during times of crisis.
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    Understanding the use of Flexible Work Arrangements Among Older New Zealand Caregivers
    (SAGE Publications, 2023-05) Koreshi SY; Alpass F
    Flexibility in the workplace has been suggested to promote prolonged employment among older workers. This study focuses on the question of whether the use of flexible work arrangements (FWAs) differs between caregivers and non-caregivers and how potential differences can be explained. Participants were 296 carers and 1611 non-carers (aged 55–70 years) who completed the 2018 Health, Work and Retirement survey and were in paid employment. Hierarchical regression was used to investigate caregiving as an independent predictor of use of FWAs after controlling for demographic and work-related variables. Results show that caregivers on average used more FWAs than non-caregivers, including flexible work hours, flexible schedules and time off. Differences in FWAs use between caregivers and non-caregivers cannot be explained by differences in socio demographic and work characteristics. The use of FWAs warrants attention in discussions about prolonged employment and reconciliation of care and work among older adults.
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    Validation of Persian Version of the Telephone Interview for Cognitive Status-modified Questionnaire Among Iranian Adults
    (Mazandaran University of Medical Sciences and Health Services, 2022-06) Aminisani N; Shamshirgaran M; Laghousi D; Javadpour A; Gholamnezhad Z; Gilani N; Alpass F
    Background: Dementia is a growing public health problem worldwide, and its early detection can help to manage the disease more effectively. This study aimed to validate the Persian version of the Telephone Interview for Cognitive Status-modified (TICS-m) questionnaire in older adults in the northeast of Iran. Methods: This cross-sectional study was accomplished as part of the Neyshabur Longitudinal Study on Ageing (NeLSA) from January to May 2019. The translated Persian version of TICS-m was tested for content and face validity. The construct validity of the questionnaire was also assessed using exploratory factor analysis (EFA) with the extraction method of principal component analysis (PCA) and Oblimin rotation. Results: A total of 210 community-dwelling adults (aged ≥ 50; mean age: 59.6 ± 6.8 years) were registered in the NeLSA. The content validity ratio (CVR) of all items in the TICS-m questionnaire was higher than 0.62. The content validity index (CVI) of the three items was less than 0.78; so, these items were revised and replaced with alternative words. The face validity of the questionnaire was also confirmed. According to the results of EFA, the six extracted factors accounted for 68.8% of the total variance. Conclusions: Our results revealed that the construct validity of the Persian version of the TICS-m is satisfactory.