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Context: Compared to Europeans, Māori and Pacific peoples living with dementia in the Counties Manukau District Health Board region are three times less likely to use Aged Residential Care (ARC). Objectives: The aim of this study was to investigate whether reduced ARC utilisation by Māori and Pacific peoples living with dementia is equitably compensated by an increase in Home Based Support Service (HBSS). Methods: Routinely collected sociodemographic and clinical data for people diagnosed with dementia at an NZ memory service (2013–2019) were linked with administrative ARC and HBSS invoicing data. Two-part models were used to estimate adjusted costs of HBSS utilisation or ARC placement. Findings: six hundred fifty-seven people of European, Māori and Pacific ethnicity were included in the analysis. Compared to Europeans, both unadjusted and adjusted ARC costs per person-year were significantly lower for both Māori (–NZD$3580, 95%CI: –$6890, –$140) and Pacific peoples (–NZD$3110, 95%CI: –$5590, –$540) but HBSS cost per person-year was only higher for Pacific peoples (+NZD$640, 95%CI: $100, $1180) and not Māori (+NZD$180, 95%CI: –$470, $840). There was no significant difference in the combined HBSS and ARC cost per person-year for Māori (–NZD3460, 95%CI –7200, 280) or Pacific peoples (–NZD2490 95%CI –5090, 110). Conclusions: Lower ARC utilisation amongst Māori and Pacific peoples living with dementia does not translate to an equitable increase in HBSS spend. The difference is likely to be compensated by care provided by unpaid family carers. Addressing the wider determinants of long-term care use in these populations and providing alternative culturally appropriate services must be prioritised to address this inequity in allocation of public sector resources.

Context: Compared to Europeans, Māori and Pacific peoples living with dementia in the Counties Manukau District Health Board region are three times less likely to use Aged Residential Care (ARC).Objectives: The aim of this study was to investigate whether reduced ARC utilisation by Māori and Pacific peoples living with dementia is equitably compensated by an increase in Home Based Support Service (HBSS).Methods: Routinely collected sociodemographic and clinical data for people diagnosed with dementia at an NZ memory service (2013–2019) were linked with administrative ARC and HBSS invoicing data. Two-part models were used to estimate adjusted costs of HBSS utilisation or ARC placement.Findings: six hundred fifty-seven people of European, Māori and Pacific ethnicity were included in the analysis. Compared to Europeans, both unadjusted and adjusted ARC costs per person-year were significantly lower for both Māori (–NZD$3580, 95%CI: –$6890, –$140) and Pacific peoples (–NZD$3110, 95%CI: –$5590, –$540) but HBSS cost per person-year was only higher for Pacific peoples (+NZD$640, 95%CI: $100, $1180) and not Māori (+NZD$180, 95%CI: –$470, $840). There was no significant difference in the combined HBSS and ARC cost per person-year for Māori (–NZD3460, 95%CI –7200, 280) or Pacific peoples (–NZD2490 95%CI –5090, 110).Conclusions: Lower ARC utilisation amongst Māori and Pacific peoples living with dementia does not translate to an equitable increase in HBSS spend. The difference is likely to be compensated by care provided by unpaid family carers. Addressing the wider determinants of long-term care use in these populations and providing alternative culturally appropriate services must be prioritised to address this inequity in allocation of public sector resources.

Introduction Aotearoa/New Zealand (NZ) is officially recognised as a bicultural country composed of Māori and non-Māori. Recent estimations have projected a threefold increase in dementia prevalence in NZ by 2050, with the greatest increase in non-NZ–Europeans. The NZ government will need to develop policies and plan services to meet the demands of the rapid rise in dementia cases. However, to date, there are no national data on dementia prevalence and overseas data are used to estimate the NZ dementia statistics. The overall aim of the Living with Dementia in Aotearoa study was to prepare the groundwork for a large full-scale NZ dementia prevalence study.Methods and analysis The study has two phases. In phase I, we will adapt and translate the 10/66 dementia assessment protocol to be administered in Māori, Samoan, Tongan and Fijian–Indian elders. The diagnostic accuracy of the adapted 10/66 protocol will be tested in older people from these ethnic backgrounds who were assessed for dementia at a local memory service. In phase II, we will address the feasibility issues of conducting a population-based prevalence study by applying the adapted 10/66 protocol in South Auckland and will include NZ–European, Māori, Samoan, Tongan, Chinese and Fijian–Indian participants. The feasibility issues to be explored are as follows: (1) how do we sample to ensure we get accurate community representation? (2) how do we prepare a workforce to conduct the fieldwork and develop quality control? (3) how do we raise awareness of the study in the community to maximise recruitment? (4) how do we conduct door knocking to maximise recruitment? (5) how do we retain those we have recruited to remain in the study? (6) what is the acceptability of study recruitment and the 10/66 assessment process in different ethnic groups?Ethics and dissemination The validity and feasibility studies were approved by the New Zealand Northern A Health and Disability Ethics Committee (numbers 17NTA234 and 18NTA176, respectively). The findings will be disseminated through peer-reviewed academic journals, national and international conferences, and public events. Data will be available on reasonable request from the corresponding author.

Background: Aged residential care (ARC) is a significant cost of dementia care. However, little is known about the predictors of ARC placement in New Zealand (NZ), which is important for service planning and funding. The aim of this study was to investigate the sociodemographic and clinical characteristics that predict future ARC placement among people who received a new diagnosis of dementia at a NZ memory service. Methods: Routinely collected baseline sociodemographic and clinical data in a memory service from 14/06/13 and 14/12/19 were linked with administrative LTC admission data up to 24/1/2020. Survival analysis was carried out using multivariate Cox regression models to determine significant risk factors and their association with ARC placement. Results: A total of 657 NZ European, Māori and Pacific Islander patients were included in the analyses. There were significant differences by ethnicity including age, living situation, comorbidity and ARC placement. Adjusted analyses showed that risk of ARC placement was increased by older age (HR 1.02 per year, 95%CI:1.00–1.05), moderate dementia (HR 1.45, 95%CI:1.05–1.99), severe dementia (HR 2.25, 95%CI:1.33–3.81), and antipsychotics (HR 1.55, 95%CI:1.04–2.32); while risk was reduced in Māori (HR 0.35, 95%CI:0.18–0.68) and Pacific Islanders (HR 0.32, 95%CI:0.20–0.51). Conclusions: Despite having more severe dementia and higher comorbidity, Māori and Pacific Islanders had reduced risks of ARC placement. There is an urgent need to better understand dementia care issues and to ensure culturally safe and responsive dementia services are accessible by Māori and Pacific Islanders living in the community.

Background: Aged residential care (ARC) is a significant cost of dementia care. However, little is known about the predictors of ARC placement in New Zealand (NZ), which is important for service planning and funding. The aim of this study was to investigate the sociodemographic and clinical characteristics that predict future ARC placement among people who received a new diagnosis of dementia at a NZ memory service.Methods: Routinely collected baseline sociodemographic and clinical data in a memory service from 14/06/13 and 14/12/19 were linked with administrative LTC admission data up to 24/1/2020. Survival analysis was carried out using multivariate Cox regression models to determine significant risk factors and their association with ARC placement.Results: A total of 657 NZ European, Māori and Pacific Islander patients were included in the analyses. There were significant differences by ethnicity including age, living situation, comorbidity and ARC placement. Adjusted analyses showed that risk of ARC placement was increased by older age (HR 1.02 per year, 95%CI:1.00–1.05), moderate dementia (HR 1.45, 95%CI:1.05–1.99), severe dementia (HR 2.25, 95%CI:1.33–3.81), and antipsychotics (HR 1.55, 95%CI:1.04–2.32); while risk was reduced in Māori (HR 0.35, 95%CI:0.18–0.68) and Pacific Islanders (HR 0.32, 95%CI:0.20–0.51).Conclusions: Despite having more severe dementia and higher comorbidity, Māori and Pacific Islanders had reduced risks of ARC placement. There is an urgent need to better understand dementia care issues and to ensure culturally safe and responsive dementia services are accessible by Māori and Pacific Islanders living in the community.

Working with Indigenous students who are in jail is a specialised area of student services that has attracted little attention, but is immensely worthwhile. The author of the following short story is one of many Indigenous young men incarcerated in a men's jail somewhere in Queensland. He was thrilled when it was suggested that his story be published and has given permission for his real name to be used, as has the prison where he is held. The story was written last year for a creative writing course which Gavin was taking in the bridging program run by the local university’s Indigenous centre through in distance education. Tutoring to support his learning was provided by the Federal Government under the Indigenous Tertiary Assistance Scheme (ITAS). In this short story, written as an assignment for his creative writing course, Gavin tells the tale of his life in a heartbreakingly simple way that unfortunately typifies the experience of many Indigenous youth who end up in jail. However, there is hope for young people such as Gavin, because by enrolling in bridging programs which lead straight into TAFE or university study, prisoners are making a decision to turn their lives around. Gavin learned a huge amount from the two writing courses he took last year and was immensely proud when it was suggested his story be published.