Cultural factors key to health of older Māori

Wednesday, June 13, 2018

New research from Massey University and the University of Auckland suggests more focus in the health sector is needed to foster culturally appropriate food practices for older Māori that may lead to less hospitalisations and lower mortality rates.

The study, carried out over five years, investigated the association between nutrition risk with hospitalisations and mortality and was part of the Life and Living in Advanced Age Cohort Study in New Zealand (LiLACS NZ) - a longitudinal study of Māori and non-Māori in advanced age.

New Zealanders aged over 80 years are the fastest growing population group and are predicted to increase six-fold by 2050. Māori comprise 14 per cent of the total population – two per cent of those are aged over 80 years and the age group is increasing faster than the non-Māori octogenarian population.

Associate Professor Carol Wham, from Massey University’s School of Sport, Exercise and Nutrition, says older people are known to be at a disproportionate risk of malnutrition and have an increased risk of developing health problems as result of compromised food and nutrition intake.

“Malnutrition risk among older Māori is identifiable and treatable. Effort is needed to engage relevant community and whānau support to ensure older Māori have food security and better access to traditional foods,” Dr Wham says.

A validated nutrition screening tool (SCREEN II) is specifically developed for community-living older adults and determines malnutrition risk according to three specific risk factor domains: ‘Weight Change’, ‘Dietary Intake’ and, ‘Factors Affecting Intake (adaptive and functional)’.

“Identifying nutritional problems from these domains creates the opportunity to plan appropriate

interventions across the multiple pathways leading to poor nutritional health. The aim of this paper was to examine the consequences of high malnutrition risk, using the SCREEN II nutrition risk domain scores among Māori aged over 80 years and non-Māori aged over 85 years.”

This study examined the specific domains of nutrition risk within the SCREEN II tool in relation to hospitalisations and mortality for 256 Māori and 399 non-Māori octogenarians.

“Overall, 49 per cent of Māori and 38 per cent of non-Māori participants were at high nutrition risk.

Lower nutrition risk in the ‘Dietary Intake’ domain was associated with reduced hospitalisations and mortality for Māori but not non-Māori.”

Overcoming barriers to healthy food consumption is key to improving the health of this vulnerable group, Dr Wham says. “Older single Māori, mostly women, have the least material wellbeing, which may lead to low food security. Food has special cultural significance for Māori. The impact of colonisation has affected access to traditional foods with limited availability of food species and time to go out on the land, the sea and the forest to harvest and may compromise dietary quality.”

Community-based interventions oriented towards improving the nutritional health for older Māori need to consider the role of companionship and community integral to Māori culture and the concept of manaakitanga (hospitality) to ensure food is available to all, Dr Wham says.

“There is potential for Māori-led strategies and community group support to build on existing programmes that aim to enhance the quality of life and wellbeing of Kaumātua [older Māori].”

Dr Wham says further work is needed to raise awareness among primary health professionals and foster partnerships with local Māori community organisations.

“Interventions to improve the nutrition status of older Māori need to be based on a holistic Māori worldview. Indeed, the importance of language and culture and being able to access traditional foods are associated with lower nutrition risk in older Māori. A multifaceted approach, including education of the health workforce, may be needed to ensure culturally appropriate food practices are met.”

Key findings:

- The prevalence of nutrition risk among Māori women compared to men - 54 percent of women compared to 42 per cent of men versus 27 per cent in non-Māori men and 49 per cent in non-Māori women
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- Nearly 2/3 Māori and 1/5 non-Māori reported fewer than five servings of fruit and vegetables per day
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- Limiting or avoiding certain foods was a common risk factor item for both Māori and non-Māori
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- Eating alone was a key risk factor for more than half of the Māori and non-Māori women and one third of Māori and non-Māori men
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High nutrition risk related to dietary intake is associated with an increased risk of hospitalization and mortality for older Māori: LiLACS NZ was published in the Australian and New Zealand Journal of Public Health on Monday June 11.

The paper was written by Sylvia North, dietitian and Massey University masters student (Dietetics), Associate Professor Carol Wham, School of Sport, Exercise and Nutrition, Massey University, Dr Ruth Teh, Simon Moyes, Dr Anna Rolleston and Professor Ngaire Kerse, School of Population Health, University of Auckland.

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