Māori: living and dying with cardiovascular disease in Aotearoa New Zealand

Abstract

Purpose of reviewThis article provides an informed perspective on cardiovascular disease (CVD) and palliative care need among Ma ¯ori New Zealanders. High Ma ¯ori CVD risk factors will contribute to a sharp increase in older Ma ¯ori deaths which has implications for health and palliative care service provision. Recent findingsCVD is New Zealand's leading cause of premature deaths and disability among Ma ¯ori. A projected rise in older Ma ¯ori deaths within the next 30 years will require increased palliative care. However, accessing palliative care and obtaining and understanding information can be challenging for families who are already often overburdened with high social and economic disadvantages. Meeting the high financial costs associated with end-of-life care make living with CVD challenging. Engaging with the health system's biomedical approach when holistic care is preferable can be a major barrier. SummaryMa ¯ori families provide the bulk of care at end-of-life, but they can become fatigued with the challenges that accompany long-term progressive illnesses, such as CVD. They are also burdened by the financial costs associated with end-of-life. It is often difficult for Ma ¯ori to access palliative care and to obtain and understand information about the illness and treatment. Navigating an unfamiliar and complex health system, low health literacy among Ma ¯ori and poor relationship building and communication skills of health professionals are significant barriers. Cultural safety training would help to increase health and cardiovascular professionals' cultural understanding of Ma ¯ori and their holistic end-of-life preferences; this could go some way to strengthen rapport building and communication skills necessary for effective engagement and informational exchanges. Increasing the Ma ¯ori palliative care workforce and introducing cultural safety training among health professionals could help to bridge the gap. A current study to gather traditional care customs and present these to wha ¯nau and the health and palliative care sectors in the form of an online resource could contribute to this decolonizing objective.

Predictors of health‐related quality of life in older New Zealanders with cardiovascular health problems

“…Similar to the global ageing trend, older New Zealanders experience complex conditions affecting their cardiovascular health. 8,9 While the causes of cardiovascular problems are mostly multifactorial and usually have a cumulative genetic and environmental predisposition, 18 there is limited understanding of how these health issues impact older adults in consideration of their health history and common risk factors such as physical inactivity. Our findings provided evidence on specific demographic characteristics of older adults and their HRQOL in relation to cardiovascular health problems.…”

“…Cardiovascular disease (CVD) among New Zealanders continues to rise and is the leading cause of death in New Zealand. 4,8 With longer life expectancies, CVD is increasingly common among older adults and adds to the burden on the health system. 4 It has been reported that older New Zealanders who have cardiovascular health issues have an increased likelihood of hospital readmissions.…”

“…Moreover, symptoms such as shortness of breath and fatigue in CVD restrict older adults' functional abilities required to remain active and mobile. 8,11 With the New Zealand population contributing to the global ageing phenomenon, national health organisations have taken part in the international campaign of keeping older adults active, healthy and living with good quality of life. 5,7 Factors related to chronic conditions have compounding health effects on older people given the already known decreasing participation in leisure and physical activities in advanced age.…”

Frailty of Māori, Pasifika, and Non-Māori/Non-Pasifika Older People in New Zealand: A National Population Study of Older People Referred for Home Care Services

“…Frailty is also driven by poverty (5,(30)(31)(32). Māori and Pasifika are more likely to have been born into poverty than non-Māori and non-Pasifika (33).…”

“…Low health literacy makes navigating an unfamiliar and complex health system a significant barrier for Māori (30). While equity in health care for Māori and Pasifika is embedded in policy in New Zealand, there is a struggle to put it into practice because cultural and diversity training is not a condition of employment (31).…”