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The relevance of Marjory Warren’s writings today
- Authors:
- ST. JOHN Philip D., HOGAN David B.
- Journal article citation:
- Gerontologist, 54(1), 2014, pp.21-29.
- Publisher:
- Oxford University Press
Marjory Warren was one of the initial geriatricians in the United Kingdom. She established specialised geriatric units, held important administrative positions, and wrote influential papers where she argued for the need of the specialty of geriatric medicine and outlined principles for inpatient care of older adults with chronic illness. The authors compare and contrast Warren’s early papers describing these principles with contemporary models for improving inpatient care of older adults and the need for the specialty of geriatrics. Warren’s writings on the inpatient care of older adults presage the principles of both Hospital Elder Life Programs and Acute Care of the Elderly units. The importance of multidisciplinary teams, the physical environment, attention to diverse issues (medical, social, functional), early ambulation, and the active involvement of the older person in their daily routine are present in Warren’s writings and in contemporary approaches. Warren’s arguments for both the specialty of geriatric medicine and increased training of nonspecialist physicians and other health professionals are remarkably similar to those made in a recent Institute of Medicine report. Across time and place, there has been consistency in the general principles perceived as required for the effective cares of older persons, but challenges persist in implementing and sustaining them. (Publisher abstract)
Cognitive impairment and life satisfaction in older adults
- Authors:
- ST. JOHN Philip D., MONTGOMERY Patrick R.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(8), August 2010, pp.814-821.
- Publisher:
- Wiley
While quality of life in dementia patients has been studied in clinical settings, there is less population-based research on life satisfaction and cognition. This study aimed to compare the overall life satisfaction (LS), the effect of cognition on LS across a broad spectrum of cognition, and explore the effect of factors such as depressive symptoms, functional impairment, education, and social support. The authors interviewed 1,620 community-dwelling older people with a mini-mental state examination (MMSE) score greater than 10, sampled from a representative list from the Study of Health and Aging, a population based study conducted in the province of Manitoba, Canada. Age, gender, education, social networks, and social supports were all self-reported. Analysis identified two main factors: LS (material); and LS (social). A global item measuring overall LS was also used. Results showed that those with dementia and cognitive impairment but no dementia had lower LS than those with normal cognition, but the effect was relatively small. There was a gradient in LS which extended into the normal range of cognition. Depressive symptoms and functional status were strongly associated with LS. The study concluded that cognition is mildly associated with LS, and older adults are generally satisfied with life.
Does life satisfaction predict five-year mortality in community-living older adults?
- Authors:
- ST. JOHN Philip D., MACKENZIE Corey, MENEC Verena
- Journal article citation:
- Aging and Mental Health, 19(4), 2015, pp.363-370.
- Publisher:
- Taylor and Francis
Objectives: Depression and depressive symptoms predict death, but it is less clear if more general measures of life satisfaction (LS) predict death. This study aimed 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. (Edited publisher abstract)
Depressive symptoms among older adults in urban and rural areas
- Authors:
- ST. JOHN Philip D., BLANDFORD Audrey A., STRAIN Laurel A.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(12), December 2006, pp.1175-1180.
- Publisher:
- Wiley
The aim was to determine if there are differences in depressive symptoms between residents of urban areas, small town zones, and predominantly rural regions and to determine factors associated with depressive symptoms among these groups of residents. The study was set in the Canadian province of Manitoba amongst a community-dwelling population of older adults who were cognitively intact. The design of the study was a cross-sectional survey and measures included age, gender, education, living arrangements, number of persons providing companionship, perceived adequacy of income, functional impairment, self-rated health and the Center for Epidemiologic Studies - Depression (CES-D) scale. Urban/rural residence was measured by grouping Census sub-divisions according to 1991 Census population: urban (>19,999); small town (2500 to 19,999); or predominantly rural (<2500). In the total sample (n = 1382), 11.5% exhibited depressive symptoms: 11.6% in urban areas (n = 844); 14.0% in small town zones (n = 250); 9.0% in predominantly rural regions (n = 288) (p > 0.05, chi-square test). No rural-urban differences were seen in multivariate models. In predominantly rural regions, living alone, perceiving one's income as inadequate, and having functional impairment were associated with depressive symptoms. The only significant factor in small town zones was poorer self-rated health whereas in urban areas, poorer self-rated health, functional impairment, and fewer persons providing companionship were significantly related to depressive symptoms. The factors associated with depressive symptoms varied among older adults living in predominantly rural regions, in small towns, and in urban areas.