ABSTRACT
Cognitive function is an important indicator of healthy aging as it is central to maintaining functional independence, performing job-related tasks, decision-making, and improving quality of life. Therefore, researchers seek to identify biopsychosocial factors that can help preserve cognitive function in aging individuals. One such factor is the maintenance of good quality marital relationships. Research has consistently shown that married individuals fare better in terms of both physical and psychological health compared to their unmarried counterparts. However, being married is not universally beneficial - the quality of a marriage is also important to consider. To explore the issue further, we conducted a systematic review to examine the association between marital quality and cognitive function. PubMed, PsycINFO, and Scopus were searched for eligible articles examining any measure of marital quality and any cognitive outcome from the inception of each database to January 9th, 2024. Following two levels of citation screening by two independent reviewers, we included 15 articles representing 11 unique studies. Data were synthesized narratively following the Synthesis without Meta-Analysis guidelines and a risk of bias assessment was conducted using the Joanna Briggs Institute checklist. Most articles had a low risk of bias. Although some findings suggested more positive marital quality was associated with improved cognitive function, the results were not uniformly positive; some results were inverse or null, depending upon factors such as differences in study designs and measures of marital quality or cognition. This review is the first attempt to synthesize the literature on this topic. Our findings highlight that any examination of marital status and cognition should also consider contextual factors such as marital quality.
Subject(s)
Cognition , Marriage , Humans , Marriage/psychology , Quality of Life/psychology , Female , MaleABSTRACT
BACKGROUND: Visual perceptual learning (PL) shows promise for enhancing visual functions in individuals with visual impairment. OBJECTIVE: This systematic review aimed to evaluate the effectiveness of PL in improving visual function. STUDY ELIGIBILITY: Eligible studies were those examining the efficacy of PL in individuals with low vision. STUDY APPRAISAL AND SYNTHESIS METHODS: The review protocol was registered with the international Prospective Register of Systematic Reviews (ID CRD42022327545) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Screened studies were synthesized using random-effects meta-analysis and narrative synthesis following Synthesis Without Meta-analysis guidelines. The quality of the evidence was assessed using the Cochrane risk-of-bias tool and the JBI Critical Appraisal Tool for Quasi-Experimental studies. RESULTS: Fifty studies were included, covering various visual impairments and employing different PL interventions. Most studies had low risk of bias. Meta-analysis showed significant improvement in visual search for individuals with cortical blindness (Hedges' g = 0.71; 95% confidence interval, 0.48 to 0.93; p=0.002); all other analyses did not show significant improvements-reading in central vision loss and cortical blindness, and visual field in peripheral vision loss and cortical blindness. However, the narrative synthesis provided evidence showing effectiveness, particularly in individuals with central vision loss and cortical blindness, demonstrating positive effects on reading, contrast sensitivity, visual field, and motion perception. LIMITATIONS: Variations in study design, PL protocols, outcome measures, and measurement methods introduced heterogeneity, limiting the analysis. CONCLUSIONS: The efficacy of PL in vision rehabilitation remains uncertain. Although meta-analysis results were mostly inconclusive, the narrative synthesis indicated improved visual functions following PL, consistent with individual study findings. IMPLICATIONS OF KEY FINDINGS: Future research should optimize intervention parameters, explore long-term effects, and assess generalizability across diverse populations and visual impairment etiologies. Larger randomized controlled trials using standardized outcome measures are needed to advance the field.
Subject(s)
Vision, Low , Visual Perception , Humans , Vision, Low/rehabilitation , Vision, Low/physiopathology , Visual Perception/physiology , Learning/physiology , Visual Acuity/physiologyABSTRACT
Memory plays a crucial role in cognitive health. Social isolation (SI) and loneliness (LON) are recognized risk factors for global cognition, although their combined effects on memory have been understudied in the literature. This study used three waves of data over six years from the Canadian Longitudinal Study on Aging to examine whether SI and LON are individually and jointly associated with memory in community-dwelling middle-aged and older adults (n = 14,208). LON was assessed with the question: "In the last week, how often did you feel lonely?". SI was measured using an index based on marital/cohabiting status, retirement status, social activity participation, and social network contacts. Memory was evaluated with combined z-scores from two administrations of the Rey Auditory Verbal Learning Test (immediate-recall, delayed-recall). We conducted our analyses using all available data across the three timepoints and retained participants with missing covariate data. Linear mixed models were used to regress combined memory scores onto SI and LON, adjusting for sociodemographic, health, functional ability, and lifestyle variables. Experiencing both SI and LON had the greatest inverse effect on memory (least-squares mean: -0.80 [95 % confidence-interval: -1.22, -0.39]), followed by LON alone (-0.73 [-1.13, -0.34]), then SI alone (-0.69 [-1.09, -0.29]), and lastly by being neither lonely nor isolated (-0.65 [-1.05, -0.25]). Sensitivity analyses confirmed this hierarchy of effects. Policies developed to enhance memory in middle-aged and older adults might achieve greater benefits when targeting the alleviation of both SI and LON rather than one or the other individually.
Subject(s)
Aging , Loneliness , Social Isolation , Humans , Loneliness/psychology , Male , Longitudinal Studies , Aged , Female , Social Isolation/psychology , Middle Aged , Aging/psychology , Canada , Memory , Risk Factors , Independent Living/psychology , Aged, 80 and overABSTRACT
We investigated the association between pre-COVID-19 memory function and (a) receipt of a COVID-19 test and (b) incidence of COVID-19 using the COVID-19 Questionnaire Study (CQS) of the Canadian Longitudinal Study on Aging (CLSA). The CQS included 28,565 middle-aged and older adults. We regressed receipt of a COVID-19 test on participants' immediate and delayed recall memory scores and re-ran the regression models with COVID-19 incidence as the outcome. All regression models were adjusted for sociodemographic, lifestyle, and health covariates. In the analytical sample (n = 21,930), higher delayed recall memory (better memory) was significantly associated with lower COVID-19 incidence. However, this association was not significant for immediate recall memory. Immediate and delayed recall memory were not associated with receipt of a COVID-19 test. Health policymakers and practitioners may viewmemory status as a potential risk for COVID-19. Memory status may not be a barrier to COVID-19 testing.
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We explored longitudinal associations between religion/spirituality (R/S) Salience and R/S Attendance, and colorectal cancer screening, among adults aged ≥ 50 years in Alberta, Canada. R/S Salience was not statistically significantly associated with colorectal cancer screening (adjusted odds ratio [aOR]: 1.06, 95% confidence interval [CI] 0.88-1.28). Conversely, R/S Attendance was statistically significantly associated with higher odds of colorectal cancer screening: the aOR was 1.28 (95% CI 1.02-1.59) for participants attending services at least once a month and 1.31 (95% CI 1.01-1.69) for participants attending between one and four times yearly, compared to participants who never attended. Researchers should explore the possibility of delivering colorectal cancer screening programs in R/S settings.
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OBJECTIVE: The purpose of this review was to examine the reporting in chiropractic mixed methods research using Good Reporting of A Mixed Methods Study (GRAMMS) criteria. METHODS: In this methodological review, we searched MEDLINE, Embase, CINAHL, and the Index to Chiropractic Literature from the inception of each database to December 31, 2020, for chiropractic studies reporting the use of both qualitative and quantitative methods or mixed qualitative methods. Pairs of reviewers independently screened titles, abstracts, and full-text studies, extracted data, and appraised reporting using the GRAMMS criteria and risk of bias with the Mixed Methods Appraisal Tool (MMAT). Generalized estimating equations were used to explore factors associated with reporting using GRAMMS criteria. RESULTS: Of 1040 citations, 55 studies were eligible for review. Thirty-seven of these 55 articles employed either a multistage or convergent mixed methods design, and, on average, 3 of 6 GRAMMS items were reported among included studies. We found a strong positive correlation in scores between the GRAMMS and MMAT instruments (r = 0.78; 95% CI, 0.66-0.87). In our adjusted analysis, publications in journals indexed in Web of Science (adjusted odds ratio = 2.71; 95% CI, 1.48-4.95) were associated with higher reporting using GRAMMS criteria. Three of the 55 studies fully adhered to all 6 GRAMMS criteria, 4 studies adhered to 5 criteria, 10 studies adhered to 4 criteria, and the remaining 38 adhered to 3 criteria or fewer. CONCLUSION: Our findings suggest that reporting in chiropractic mixed methods research using GRAMMS criteria was poor, particularly among studies with a higher risk of bias.
Subject(s)
Chiropractic , HumansABSTRACT
OBJECTIVES: Mounting evidence suggests religion plays an important role in maintaining cognition. No prior systematic review has focused on the specific association between religion and the memory domain of cognition in middle-aged and older adults. We carried out a systematic review to explore this association in depth. METHODS: We searched the PsycINFO, Scopus, and PubMed databases to identify articles assessing any means of measuring religion as the exposure and memory as the outcome. Articles had to report on studies with comparison groups to be eligible for inclusion in the review. We followed the PRISMA checklist to conduct the review (PROSPERO registration # CRD42022330389). RESULTS: Nine out of the 1648 citations retrieved in the literature search were included in the review. The majority of included articles had a moderate risk of bias. Most results showed positive associations between religion and memory. DISCUSSION: Despite consistency in the direction of association between religion and memory, the literature contained some important research gaps: the studies were cross-sectional; a lack of information existed regarding whether different faiths, sex/gender and depression affected the association; and underpowered studies prevented us from drawing firm conclusions about the direction or magnitude of effect. Longitudinal studies avoiding these issues are needed in this field.
Subject(s)
Checklist , Cognition , Middle Aged , Humans , Aged , Databases, Factual , Evidence Gaps , PubMedABSTRACT
Depression and social isolation increase risk for executive function declines and are among the top five modifiable risk factors for dementia. However, the interrelationships between depression, social isolation and executive function are not well established. Further evidence is needed to inform strategies to promote executive function and independence in older age. We examined whether social isolation mediated the association between depression and executive function in community-dwelling middle-aged and older adults and whether this association was modified by age and sex. Adults aged 45 to 85 years from the Canadian Longitudinal Study on Aging (CLSA) Comprehensive cohort were followed over three years (complete case analysis, n = 14,133). Baseline depressive symptoms, a history of clinical depression, and functional social isolation (perceived lack of social support) were self-reported. Executive function at follow-up was a composite measure of five cognitive tests. Conditional process analysis assessed the mediating effects of functional social isolation across age group and sex, adjusted for sociodemographic and health covariates. Functional social isolation significantly mediated the association of depressive symptoms (proportion mediated [PM] = 8.0%) or clinical depression (PM = 17.5%) with executive function only among women aged 75+ years. Functional social isolation explains a proportion of the total effect of depressive symptoms or clinical depression on executive function in women aged 75 and older. Although reverse causation cannot be ruled out, our findings suggest that interventions that reduce functional social isolation or depression in older women may promote executive function.
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BACKGROUND: Functional social support (FSS) impacts memory function through biological and psychological pathways. In a national sample of middle-aged and older adults in Canada, we explored the association between FSS and changes in memory over three years and investigated effect modification by age group and sex. METHODS: We analyzed data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging (CLSA). FSS was measured with the Medical Outcomes Study - Social Support Survey; memory was measured with combined z-scores from immediate and delayed recall administrations of a modified version of the Rey Auditory Verbal Learning Test. We regressed memory change scores over three years on baseline overall FSS and four FSS subtypes in separate multiple linear regression models, controlling for sociodemographic, health, and lifestyle covariates. We also stratified our models by age group and sex. RESULT: We found positive associations between higher FSS and improvement in memory score, although only the tangible FSS subtype (availability of practical assistance) was significantly associated with changes in memory (ß^ = 0.07; 95% confidence interval = 0.01, 0.14). After stratification by age group and sex, this association remained significant for males, although we found no evidence of effect modification. CONCLUSION: In a cognitively healthy sample of middle-aged and older adults, we found a statistically significant and positive association between tangible FSS and memory change over three years of follow-up. We did not find adults with low FSS to be at increased risk of memory decline compared to adults with higher FSS.
Subject(s)
Aging , Mental Recall , Male , Humans , Middle Aged , Aged , Longitudinal Studies , Canada/epidemiology , Aging/psychology , Social SupportABSTRACT
BACKGROUND: Functional social support (FSS) has been shown to be positively associated with better cognitive function, especially memory, in cross-sectional and longitudinal studies. To better understand this complex association, researchers should consider the impact of additional factors that affect both FSS and memory. Therefore, we conducted a systematic review to examine whether one such factor, marital status or related variables (e.g., FSS from spouses compared to FSS from relatives or friends), affects (e.g., confounds or modifies) the association between FSS and memory in middle-aged and older adults. METHODS: We searched PubMed, PsycINFO, and Scopus from database inception to June 2022. Eligible articles examined the association between FSS and memory, and included marital status or related variables in the analysis. Data were synthesized narratively and reported in accordance with the Synthesis without meta-analysis (SWiM) guidelines; risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Four articles were included in the narrative synthesis. All four articles had a low risk of bias. Overall findings suggested some positive associations between FSS from a spouse/partner and memory; however, effect sizes were small and similar to other sources of support, including children, relatives, and friends. CONCLUSIONS: Our review is the first attempt to synthesize the literature on this topic. Despite theoretical support for examining the impact of marital status or related variables on the association between FSS and memory, published studies explored this issue secondarily to other research questions.
Subject(s)
Social Support , Spouses , Humans , Middle Aged , Aged , Cross-Sectional Studies , Spouses/psychology , Marital Status , CognitionABSTRACT
BACKGROUND: Intact cognitive function is crucial for healthy aging. Functional social support is thought to protect against cognitive decline. We conducted a systematic review to investigate the association between functional social support and cognitive function in middle- and older-aged adults. METHODS: Articles were obtained from PubMed, PsycINFO, Sociological Abstracts, CINAHL, and Scopus. Eligible articles considered any form of functional social support and cognitive outcome. We narratively synthesized extracted data by following the Synthesis Without Meta-Analysis (SWiM) guidelines and assessed risk of bias using the Newcastle-Ottawa Scale (NOS). RESULTS: Eighty-five articles with mostly low risk-of-bias were included in the review. In general, functional social support-particularly overall and emotional support-was associated with higher cognitive function in middle- and older-aged adults. However, these associations were not all statistically significant. Substantial heterogeneity existed in the types of exposures and outcomes evaluated in the articles, as well as in the specific tools used to measure exposures and outcomes. CONCLUSIONS: Our review highlights the role of functional social support in the preservation of healthy cognition in aging populations. This finding underscores the importance of maintaining substantive social connections in middle and later life. SYSTEMATIC REVIEW REGISTRATION: Rutter EC, Tyas SL, Maxwell CJ, Law J, O'Connell ME, Konnert CA, Oremus M. Association between functional social support and cognitive function in middle-aged and older adults: a protocol for a systematic review. BMJ Open;10(4):e037301. https://doi.org/10.1136/bmjopen-2020-037301.
Subject(s)
Cognition , Cognitive Dysfunction , Middle Aged , Humans , Aged , Adult , Cross-Sectional Studies , Cohort Studies , Social SupportABSTRACT
BACKGROUND AND OBJECTIVES: Adverse childhood experiences (ACEs) are a recognized risk factor for unfavorable health outcomes. No prior systematic review has explored the association between ACEs and cognition in late life, a critical period for cognitive fluctuation. The objective of this review is to address the following research question: What is the association between ACEs and late-life cognition? RESEARCH DESIGN AND METHODS: Articles were obtained from PubMed, PsycINFO, and Scopus. The last search was performed in May 2021. Eligible articles examined the association between exposure to at least 1 ACE and the outcome of late-life cognition, measured either by cognitive testing or the presence/absence of a neurocognitive disorder. Data were synthesized narratively using the synthesis without meta-analysis guidelines, and the risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Adapted NOS. RESULTS: Twenty articles representing 18 unique studies were included in the narrative synthesis. Associations with lower late-life cognition were reported for: childhood maternal death, parental divorce, physical neglect, emotional neglect, physical abuse, and combinations of ACEs. However, most results were statistically nonsignificant, and many were unlikely to be clinically important. DISCUSSION AND IMPLICATIONS: We found an association between ACEs and late-life cognition. However, the direction and magnitude of association varied between and within types of ACEs and measures of cognitive function. Most included articles had a moderate risk of bias. This review is the first attempt to synthesize the literature on this topic and it outlines the next steps to improve the evidence base in the area.
Subject(s)
Adverse Childhood Experiences , Humans , Cross-Sectional Studies , Risk Factors , Case-Control Studies , CognitionABSTRACT
BACKGROUND: Some research suggests social isolation and loneliness are important risk factors for reduced successful aging and cognitive health. However, findings are inconsistent and no prior systematic review has investigated whether social isolation and loneliness are associated with the memory domain of cognition. This review examined whether social isolation and loneliness individually and jointly affected the memory of middle- and older-aged adults. METHODS: We used PubMed, PsycInfo, and Scopus to search for comparative studies that examined the impact of both loneliness and social isolation (e.g., social activity, social networks) on memory (including all subtypes) in populations aged ≥ 45 years. Three raters performed data extraction and risk of bias assessment using the Joanna Briggs Institute checklist. Data were synthesized narratively following the Synthesis without Meta-Analysis guideline. RESULTS: In 12 included articles, higher levels of loneliness and social isolation (combining a range of different indicators) were associated with lower memory performance, where the interaction between loneliness and social isolation had the largest adverse effect on memory, followed by social isolation alone, and followed by loneliness alone. However, substantial heterogeneity was observed in the composition of the two most common indicators of social isolation (social network size, social activity participation), with the magnitude of most results being clinically non-important. Most articles had moderate risk of bias. CONCLUSION: This review found an inverse association between social isolation/loneliness and memory, and outlines future steps to systematically combine the two constructs and measure social isolation in a consistent, multi-modal format.
Subject(s)
Loneliness , Social Isolation , Humans , Adult , Middle Aged , Loneliness/psychology , Social Isolation/psychology , Risk Factors , Aging , CognitionABSTRACT
This study investigated the association between subtypes of social support availability (SSA) and memory in persons aged 45 to 85 years (n = 24,719). We examined two memory outcomes using a modified Rey Auditory Verbal Learning Test (RAVLT)-immediate recall (RAVLT I) and delayed recall (RAVLT II)-and five subtypes of SSA: affectionate, emotional/informational, positive interactions, tangible, overall. We found statistically significant and adjusted positive associations between all SSA subtypes and memory, except for positive interactions and delayed recall memory. For RAVLT I, the regression coefficients (ßËs) ranged from 0.03 to 0.07; the ßËs for RAVLT II ranged from 0.02 to 0.05. The differences in ßËs for each SSA subtype (ßË RAVLT I - ßË RAVLT II) ranged from 0.00 to 0.02 (mean difference = 0.01; 95% confidence interval = -0.01 to 0.03). All effect sizes, regardless of SSA subtype or memory outcome, were small and clinically unimportant.
Subject(s)
Aging , Verbal Learning , Humans , Cross-Sectional Studies , Longitudinal Studies , Neuropsychological Tests , Canada , Aging/psychology , Social SupportABSTRACT
To successfully create assistive technologies for persons with dementia, product developers must understand the capacity of people with dementia to use these technologies. Capacity assessment is typically done through user experience research. However, the published literature is bereft of guidelines to conduct optimal user experience research in samples of persons with dementia. We recruited persons with dementia from community-based organizations and private partners to participate in user experience research for an assistive technology platform. After a testing session, we used semi-structured interviews to ask participants about their involvement in the user experience process. We employed an inductive thematic approach to analyze the interview transcripts and draft guidelines to meaningfully engage persons with dementia in user experience research in the future. Ten participants with mild to moderate dementia (6 females, 4 males) participated in the study. Nine participants had previous experience with mobile devices. Thematic analysis yielded three overarching themes: 1) the techniques, approaches and attributes of the interviewer; 2) participants' views on being part of the user experience research process; and 3) specific items to optimize the research process. Resulting guidelines were divided into recommendations for the interviewer specifically, and for the broader research process.
Subject(s)
Dementia , Self-Help Devices , Male , Female , Humans , Computers, HandheldABSTRACT
To investigate the association between religious participation and memory in persons aged 45-85 years. Using the Canadian Longitudinal Study on Aging, frequency of religious participation was measured from "daily" to "never"; immediate and delayed recall memory were assessed with the Rey Auditory Verbal Learning Test. We regressed memory onto religious participation for persons aged < 65 years and persons aged ≥ 65 years. We found some evidence of effect modification: among persons < 65 years, monthly to yearly participation versus never attending was positively associated with immediate and delayed recall memory; among persons aged ≥ 65 years, weekly or more participation versus never attending was negatively associated with immediate and delayed recall memory. However, regression coefficients were small (-0.09 ≤ B ≤ 0.06) and most were not statistically significant (p < 0.05). Insufficient evidence existed to conclude that religious participation was associated with memory in our sample.
Subject(s)
Aging , Mental Recall , Humans , Adult , Middle Aged , Longitudinal Studies , Canada , Aging/psychology , Memory and Learning TestsABSTRACT
BACKGROUND: Emerging evidence suggests that access to chiropractic care may reduce the likelihood of initiating an opioid prescription for spinal pain; however, the impact of chiropractic care for patients already prescribed opioids is uncertain. We undertook a sequential explanatory mixed methods study to evaluate the association between initiating chiropractic care and continued opioid use among adult patients attending an Ontario community health centre (CHC) and receiving opioid therapy for chronic non-cancer spinal pain. METHODS: We conducted a retrospective cohort study of 210 patient records between January 1, 2014 and December 31, 2020. We used generalized estimating equations, adjusted for patient demographics, co-morbidities, visit frequency, and calendar year, to evaluate the association between receipt versus non-receipt of chiropractic services and continued opioid use (e.g., unique opioid fills, number of refills, and dosages) up to one year following the index chiropractic visit. We also completed follow-up interviews with 14 patients and nine general practitioners from the CHC and integrated these data with our quantitative findings. RESULTS: Over 12-month follow-up, there were lower rates of opioid fills (incidence rate ratio [IRR] = 0.66; 95% confidence interval [CI], 0.52-0.83) and refills (IRR = 0.27; 95% CI, 0.17-0.42) among chiropractic recipients (n = 49) versus non-recipients (n = 161). Although patients who did and did not receive chiropractic care began the study with the same dose of opioids, recipients were less likely to be prescribed higher-dose opioids (i.e., ≥ 50 mg morphine equivalents daily) compared to non-recipients at three months (odds ratio [OR] = 0.14; 95% CI, 0.04-0.47), six months (OR = 0.14; 95% CI, 0.05-0.40), nine months (OR = 0.19; 95% CI, 0.07-0.57), and 12 months (OR = 0.22; 95% CI, 0.08-0.62). Interviews suggested that patient self-efficacy, limited effectiveness of opioids for chronic pain, stigma regarding use of opioids, and access to chiropractic treatment were important influencing factors. CONCLUSION: We found that continued prescription opioid use among patients with chronic non-cancer spinal pain who received chiropractic care was lower than in patients who did not receive chiropractic care. Four themes emerged in our qualitative interviews to help provide a richer understanding of this association. Randomized controlled trials are needed to establish the effect of chiropractic care on opioid use for chronic spinal pain.
Subject(s)
Chiropractic , Chronic Pain , Opioid-Related Disorders , Adult , Humans , Chronic Pain/drug therapy , Analgesics, Opioid/adverse effects , Retrospective Studies , Ontario/epidemiology , Opioid-Related Disorders/drug therapy , Drug Prescriptions , Community Health CentersABSTRACT
OBJECTIVE: The purpose of this systematic review is to assess the impact of assistive devices on the life satisfaction of (Research Question 1), and informal caregiving hours received by (Research Question 2), community-dwelling older adults (≥ 65 years). METHODS: We searched CINAHL, MEDLINE, and Scopus from database inception to March 2022. For each question, two reviewers independently screened citations, extracted and narratively synthesized the data, and assessed article quality and strength of evidence. RESULTS: Of the 1391 citations screened, we found two articles pertaining to each question, for a total of four articles. In general, assistive device use was not associated with life satisfaction, while it was positively associated with informal caregiving hours. However, the risk of bias was serious across the two studies for Research Question 1, and the overall quality of evidence was "very low". The risk of bias was not serious across the two studies included in Research Question 2 and the overall quality of evidence was "low". CONCLUSION: Due to the scarcity of studies, the limitations of existing studies (i.e., risk of bias), and the evidence being low or very low quality, we could not draw firm conclusions about the associations of interest. Additional research will produce a better understanding of the two relationships and provide further evidence to inform policy decisions regarding the provision and funding of assistive devices for community-dwelling older adults. TRIAL REGISTRATION: This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database of systematic reviews (identification number: CRD42021248929 ).
Subject(s)
Independent Living , Self-Help Devices , Aged , Humans , CaregiversABSTRACT
Objectives: To estimate the proportion of the population infected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Canada through April 2021, 16 months into the coronavirus disease 2019 (COVID-19) pandemic and 4 months after COVID-19 vaccines became available. Methods: Publication databases, preprint servers, public health databases and the grey literature were searched for seroprevalence surveys conducted in Canada from 1 November 2019 to 10 July 2021. Studies were assessed for bias using the Joanna Briggs Checklist. Numbers of infections derived from seroprevalence estimates were compared with reported cases to estimate under-ascertainment ratios. Results: In total, 12 serosurveys with 210,321 participants were identified. Three (25%) serosurveys were conducted at national level, one (8.3%) was conducted at provincial level, and eight (66.7%) were conducted at local level. All 12 serosurveys had moderate or high risk of bias. The proportion of the population infected by April 2021 was low (2.6%). The proportion of the population infected was higher in surveys of residents of long-term care facilities (43.0-86%), workers at long-term care facilities (22.4-32.4%), and workers in healthcare institutions (1.4-14%). Conclusions: As of April 2021, the proportion of the population infected by SARS-CoV-2 was low in the overall population of Canada, but was high in healthcare facilities, particularly long-term care facilities, supporting the need for vaccines.