Philip D. St. John

Should meta-analysts search Embase in addition to Medline?

It is widely accepted that meta-analysts should search multiple databases. The selection of databases is ideally based on the potential contribution of each database to the project or on the potential for bias if a database is excluded, as supported by research evidence. We explore whether searching Embase yields additional trials that influence a meta-analysis. We identified meta-analyses that searched Medline and Embase. A random-effects weighted mean method was used to estimate the intervention effect in articles indexed only in Embase compared with those indexed elsewhere. On average, Embase-unique trials yielded significantly smaller estimates by 29% (ratio of odds ratio [ROR] 0.71, 95% confidence interval [CI] 0.56-0.90) but influenced the pooled estimate by an average of only 6% (ROR 0.94, 95% CI 0.88-0.99). Searching Medline but not Embase risks biasing a meta-analysis by finding studies that show larger estimates, but their prevalence seems low enough that the risk may be slight, provided the rest of the search is comprehensive.

Cognitive impairment and life satisfaction in older adults

Quality of life in dementia has been studied in clinical settings. There is less population‐based research on life satisfaction and cognition.

Marital status, partner satisfaction, and depressive symptoms in older men and women.

Objectives: To determine if marital status is associated with depressive symptoms in men and women, and to determine if partner satisfaction is associated with depressive symptoms. Methods: Community-dwelling adults (n = 1751) aged 65 years and older were sampled from a representative population-based registry. Age, sex, education, and marital status were self-reported. Satisfaction with living partner was assessed with an item from the terrible-delightful scale. The Center for Epidemiologic Studies—Depression was used to assess depressive symptoms, with a score of 15 or more indicating depressive symptoms. Results: Only 3% of the sample were dissatisfied with their living partner, and those who were dissatisfied with their living partner had higher levels of depressive symptoms. Proportions of men with depressive symptoms were: 20.6% for never married; 19.2% for separated or divorced; 17.3% for widowed; 7.3% for married (satisfied); and 38.1% for married (dissatisfied) (χ2 = 32.98, df = 4, P < 0.001). In women, the results were different: 11.8% for never married; 23.1% for separated or divorced; 15.4% for widowed; 14.4% for married (satisfied); and 41.9% for married (dissatisfied) (χ2 = 18.33, df = 4, P < 0.001). In logistic regression models, a significant interaction term was seen for Marital status x Sex. In stratified models, adjusting for age and education, an effect of marital status was seen in men, but not in women. Conclusions: The effects of marriage on depressive symptoms in men and women may be different, with lower levels of depressive symptoms in married men, compared with unmarried men, but similar rates in married women, compared with unmarried women. Dissatisfaction with their partner was uncommon, but highly associated with depressive symptoms.

Is bilingualism associated with a lower risk of dementia in community-living older adults? Cross-sectional and prospective analyses.

Objective:The aim of this study was to determine whether bilingualism is associated with dementia in cross-sectional or prospective analyses of older adults. Methods:In 1991, 1616 community-living older adults were assessed and were followed 5 years later. Measures included age, sex, education, subjective memory loss (SML), and the modified Mini-mental State Examination (3MS). Dementia was determined by clinical examination in those who scored below the cut point on the 3MS. Language status was categorized based upon self-report into 3 groups: English as a first language (monolingual English, bilingual English) and English as a Second Language (ESL). Results:The ESL category had lower education, lower 3MS scores, more SML, and were more likely to be diagnosed with cognitive impairment, no dementia at both time 1 and time 2 compared with those speaking English as a first language. There was no association between being bilingual (ESL and bilingual English vs. monolingual) and having dementia at time 1 in bivariate or multivariate analyses. In those who were cognitively intact at time 1, there was no association between being bilingual and having dementia at time 2 in bivariate or multivariate analyses. Conclusions:We did not find any association between speaking >1 language and dementia.

Depressive symptoms and frailty

Frailty and depressive symptoms are common issues facing older adults and may be associated.

Alcohol misuse, gender and depressive symptoms in community-dwelling seniors.

Alcohol misuse in seniors has been studied in clinical samples and in small communities, but relatively few studies are population‐based. Objectives are: (1) to describe the characteristics of seniors who score 1 or more on the CAGE (Cut down; Annoyed; Guilty; Eye‐opener) questionnaire of alcohol problems; (2) to determine if depressive symptoms are associated with alcohol misuse after accounting for other factors.

Specialist Physicians in Geriatrics— Report of the Canadian Geriatrics Society Physician Resource Work Group

Background At the 2011 Annual Business Meeting of the Canadian Geriatrics Society (CGS), an ad hoc Work Group was struck to submit a report providing an estimate of the number of physicians and full-time equivalents (FTEs) currently working in the field of geriatrics, an estimate of the number required (if possible), and a clearer understanding of what has to be done to move physician resource planning in geriatrics forward in Canada. Methods It was decided to focus on specialist physicians in geriatrics (defined as those who have completed advanced clinical training or have equivalent work experience in geriatrics and who limit a significant portion of their work-related activities to the duties of a consultant). Results In 2012, there are 230–242 certified specialists in geriatric medicine and approximately 326.15 FTE functional specialists in geriatrics. While this is less than the number required, no precise estimate of present and future need could be provided, as no attempts at a national physician resource plan in geriatrics based on utilization and demand forecasting, needs-based planning, and/or benchmarking have taken place. Conclusions This would be an opportune time for the CGS to become more involved in physician resource planning. In addition to this being critical for the future health of our field of practice, there is increasing interest in aligning specialty training with societal needs (n = 216).

Is Subjective Memory Loss Correlated with MMSE Scores or Dementia

Objectives: (1) to determine if subjective memory loss (SML) is associated with Mini-Mental State Examination (MMSE) scores, (2) to determine if this association persists after adjustment for other factors, and (3) to determine the sensitivity and specificity of SML for dementia. Population: 1751 seniors sampled from a population registry. Measures: age, sex, education, SML, the MMSE, and the Center for Epidemiologic Studies-Depression (CES-D) scale. Dementia was diagnosed by clinical examination. Analysis: linear regression models were constructed. The sensitivity and specificity of SML were determined with a diagnosis of dementia being the gold standard. Results: SML was correlated with MMSE scores, even after adjusting for age, sex, education, and depressive symptoms. The sensitivity of SML was 0.58 (95% confidence interval [CI]: 0.45, 0.71), and the specificity was 0.76 (95% CI: 0.74, 0.78) for dementia. Conclusions: SML is correlated with MMSE score. However, SML is neither sensitive nor specific for dementia. (J Geriatr Psychiatry Neurol 2003; 16:80-83)

Does life satisfaction predict five-year mortality in community-living older adults?

Objectives: Depression and depressive symptoms predict death, but it is less clear if more general measures of life satisfaction (LS) predict death. Our objectives were to determine: (1) if LS predicts mortality over a five-year period in community-living older adults; and (2) which aspects of LS predict death. Method: 1751 adults over the age of 65 who were living in the community were sampled from a representative population sampling frame in 1991/1992 and followed five years later. Age, gender, and education were self-reported. An index of multimorbidity and the Older American Resource Survey measured health and functional status, and the Terrible–Delightful Scale assessed overall LS as well as satisfaction with: health, finances, family, friends, housing, recreation, self-esteem, religion, and transportation. Cox proportional hazards models examined the influence of LS on time to death. Results: 417 participants died during the five-year study period. Overall LS and all aspects of LS except finances, religion, and self-esteem predicted death in unadjusted analyses. In fully adjusted analyses, LS with health, housing, and recreation predicted death. Other aspects of LS did not predict death after accounting for functional status and multimorbidity. Conclusion: LS predicted death, but certain aspects of LS are more strongly associated with death. The effect of LS is complex and may be mediated or confounded by health and functional status. It is important to consider different domains of LS when considering the impact of this important emotional indicator on mortality among older adults.

Life satisfaction and frailty in community-based older adults: cross-sectional and prospective analyses

BACKGROUND Frailty may be associated with reduced life satisfaction (LS). The objectives of this paper are to determine if (1) frailty is associated with LS in community-dwelling older adults in cross-sectional analyses; (2) frailty predicts LS five years later; and (3) specific domains of LS are preferentially associated with frailty. METHODS This paper presents analysis of an existing population-based cohort study of 1,751 persons aged 65+ who were assessed in 1991, with follow-up five years later. LS was measured using the terrible-delightful scale, which measures overall LS and LS in specific domains. Frailty was measured using the Brief Frailty Instrument. Analyses were adjusted for age, gender, education, and marital status. RESULTS Frailty was associated with overall LS at time 1 and predicted overall LS at time 2. This was seen in unadjusted analyses and after adjusting for confounding factors. Frailty was associated with all domains of LS at time 1, and predicted LS at time 2 in all domains except housing and self-esteem. However, the effect was stronger for LS with health than with other domains for both times 1 and 2. CONCLUSIONS Frailty is associated with LS, and the effect is strongest for LS with health.