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Geriatrics, Volume 1, Issue 1 (March 2016)

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Open AccessCase Report
Advice for Elderly Drivers in a German Memory Clinic: A Case Report on Medical, Ethical and Legal Consequences
Received: 21 December 2015 / Revised: 10 March 2016 / Accepted: 14 March 2016 / Published: 19 March 2016
Cited by 2 | Viewed by 3404 | PDF Full-text (226 KB) | HTML Full-text | XML Full-text
Abstract
We report on a 75-year-old female who consulted our Memory Clinic because of subjective memory complaints that she first recognized three months previously. Next to the standard detailed patient history, neuropsychological assessment, psychopathological status, the patient’s driving history played an important role in [...] Read more.
We report on a 75-year-old female who consulted our Memory Clinic because of subjective memory complaints that she first recognized three months previously. Next to the standard detailed patient history, neuropsychological assessment, psychopathological status, the patient’s driving history played an important role in the diagnostic process. In this case report, we illustrate the diagnostic process starting with the first consultation, including a short neuropsychological examination and communicating its results, reporting on further work-up (detailed neuropsychological assessment, MRI scan and cerebrospinal fluid (CSF) analysis) up to the final consultation, including advice for the patient. We will focus on several medical, ethical and legal difficulties that may occur when consulting elderly drivers with initial cognitive decline. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
Open AccessArticle
Correspondence between Simulator and On-Road Drive Performance: Implications for Assessment of Driving Safety
Received: 14 January 2016 / Revised: 7 March 2016 / Accepted: 9 March 2016 / Published: 10 March 2016
Cited by 6 | Viewed by 3452 | PDF Full-text (1034 KB) | HTML Full-text | XML Full-text
Abstract
Forty-two younger (Mean age = 35) and 37 older drivers (Mean age = 77) completed four similar simulated drives. In addition, 32 younger and 30 older drivers completed a standard on-road drive in an instrumented vehicle. Performance in the simulated drives was evaluated [...] Read more.
Forty-two younger (Mean age = 35) and 37 older drivers (Mean age = 77) completed four similar simulated drives. In addition, 32 younger and 30 older drivers completed a standard on-road drive in an instrumented vehicle. Performance in the simulated drives was evaluated using both electronic drive data and video-review of errors. Safety errors during the on-road drive were evaluated by a certified driving instructor blind to simulator performance, using state Department of Transportation criteria. We examined the degree of convergence in performance across the two platforms on various driving tasks including lane change, lane keeping, speed control, stopping, turns, and overall performance. Differences based on age group indicated a pattern of strong relative validity for simulator measures. However, relative rank-order in specific metrics of performance suggested a pattern of moderate relative validity. The findings have implications for the use of simulators in assessments of driving safety as well as its use in training and/or rehabilitation settings. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
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Open AccessReview
Current and Future Perspectives of Liaison Psychiatry Services: Relevance for Older People’s Care
Received: 3 November 2015 / Revised: 16 February 2016 / Accepted: 26 February 2016 / Published: 3 March 2016
Cited by 1 | Viewed by 3181 | PDF Full-text (191 KB) | HTML Full-text | XML Full-text
Abstract
A large number of people admitted to medical wards have co-morbid mental health problems, and these predominantly include depression, dementia and delirium. An additional one third of medically ill patients remain in hospitals with undetected and, therefore, undiagnosed mental health problems. The comorbidity [...] Read more.
A large number of people admitted to medical wards have co-morbid mental health problems, and these predominantly include depression, dementia and delirium. An additional one third of medically ill patients remain in hospitals with undetected and, therefore, undiagnosed mental health problems. The comorbidity of mental and physical illnesses leads to poor health outcomes, prolonged inpatient stays and use of inpatient resources, involvement of various affiliated health services, introduction of medications and discharge to long-term facilities, including residential and nursing 24-h care, increased both readmission rates and mortality. The establishment of Liaison psychiatry services to meet the needs for people with mental health problems admitted to medical wards is a priority for many acute health Trusts. This has an economical background in terms of cost-savings, especially in relation to the older adults, with decreasing readmission rates and quicker hospital discharges. In the current review, we address the latest policies regarding Liaison psychiatry services; especially those for older people with dementia and delirium, and discuss their future shaping. Full article
(This article belongs to the Special Issue Medical Disorders and Cognition in the Elderly)
Open AccessArticle
The Older Driver with Cognitive Impairment: Perceptions of Driving Ability and Results of a Behind the Wheel Test
Received: 13 November 2015 / Revised: 14 December 2015 / Accepted: 29 January 2016 / Published: 4 February 2016
Cited by 4 | Viewed by 3444 | PDF Full-text (181 KB) | HTML Full-text | XML Full-text
Abstract
Older adult drivers with cognitive impairment pose a potential safety risk to themselves and others. Providers are often uncertain about when to request a formal evaluation of driving ability, leaving subjective reports of concerns by the patient or family as common initiators of [...] Read more.
Older adult drivers with cognitive impairment pose a potential safety risk to themselves and others. Providers are often uncertain about when to request a formal evaluation of driving ability, leaving subjective reports of concerns by the patient or family as common initiators of objective driving evaluation referral. This observational study evaluated the correspondence of patient and caregiver report of driving concerns relative to objective behind-the-wheel (BTW) testing. Data were analyzed from occupational therapy driving evaluations of older adult U.S. Veterans referred from cognitive disorder specialty clinics between 2005 and 2015 (n = 151). Driving ability was evaluated with a pre-testing interview of the patient and a knowledgeable caregiver, followed by objective BTW testing. Patients referred had a mean age of 77.6 (SD = 8.1) years, were 97% male, and 98% white. Results demonstrated that most patients are evaluated for driving concerns far too late, with only 3% of the sample being evaluated as independent to drive without restrictions, and 38% recommended to retire from driving. Although both patients and caregivers denied specific driving concerns (obey signs and lights) relative to objective testing, caregiver concerns were greater than their respective patient’s concerns (p < 0.001) and were associated with road test outcome (p = 0.001). Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
Open AccessArticle
Preliminary Validation of a Questionnaire Covering Risk Factors for Impaired Driving Skills in Elderly Patients
Received: 30 October 2015 / Revised: 7 December 2015 / Accepted: 16 December 2015 / Published: 8 January 2016
Cited by 2 | Viewed by 3684 | PDF Full-text (397 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Due to rather unspecific statutory regulations in Germany, particularly for patients with neurodegenerative disorders, many seniors still drive despite severe driving-related cognitive deficits. An accurate assessment of driving fitness requires immense financial, personnel and temporal resources which go beyond daily clinical routines. In [...] Read more.
Due to rather unspecific statutory regulations in Germany, particularly for patients with neurodegenerative disorders, many seniors still drive despite severe driving-related cognitive deficits. An accurate assessment of driving fitness requires immense financial, personnel and temporal resources which go beyond daily clinical routines. In cooperation with a working group from Switzerland, we therefore developed the questionnaire Safety Advice For Elderly drivers (SAFE), an economic instrument covering different risk factors for driving safety. The main aim of the current work was a first validation of the SAFE. Twenty-two driving seniors performed the Corporal A, a test battery permitted by law to assess driving-related cognitive functions. Based upon the Corporal results and the percentile rank 16 criterion, participants were divided into cognitively impaired and unimpaired drivers. Moreover, participants were assessed using the SAFE and an extensive neuropsychological test battery. The results revealed high sensitivity and specifity scores for the SAFE suggesting that the SAFE may be a valuable and economical instrument to quantify and document individual risk factors for driving safety and to differentiate between impaired and unimpaired drivers. Notably, the results must be replicated in future studies including a larger sample, different clinical subgroups, and a practical driving lesson. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
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Open AccessReview
Cognitive Impairment in Hospitalized Seniors
Received: 19 October 2015 / Revised: 17 December 2015 / Accepted: 29 December 2015 / Published: 5 January 2016
Cited by 1 | Viewed by 3208 | PDF Full-text (208 KB) | HTML Full-text | XML Full-text
Abstract
Cognitive disorders are highly prevalent in hospitalized seniors, and can be due to delirium, dementia, as well as other disorders. Hospitalization can have adverse cognitive effects, and cognitive dysfunction adversely affects hospital outcomes. In this article, the literature is reviewed on how hospitalization [...] Read more.
Cognitive disorders are highly prevalent in hospitalized seniors, and can be due to delirium, dementia, as well as other disorders. Hospitalization can have adverse cognitive effects, and cognitive dysfunction adversely affects hospital outcomes. In this article, the literature is reviewed on how hospitalization affects cognitive function and how cognitive impairment affects hospital outcomes. Possible interventions in cognitively impaired hospitalized seniors are reviewed. Full article
(This article belongs to the Special Issue Medical Disorders and Cognition in the Elderly)
Open AccessReview
Tackling Societal Challenges Related to Ageing and Transport Transition: An Introduction to Philosophical Principles of Causation Adapted to the Biopsychosocial Model
Received: 11 August 2015 / Revised: 14 December 2015 / Accepted: 17 December 2015 / Published: 23 December 2015
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Abstract
In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be [...] Read more.
In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be addressed at different levels by adapting medication, improving physical health, modifying behaviour, adapting lifestyle, or bringing changes to the environment. This transdisciplinary approach requires an understanding of how different disciplines are linked to each other. This article reviews the philosophical principles of causality between fields and provides a framework for understanding causality within the biopsychosocial model. Understanding interlevel constraints should help practitioners overcome their differences, and favor transversal approaches to driving cessation. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
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Open AccessArticle
Preliminary Investigation on the Association between Depressive Symptoms and Driving Performance in Heart Failure
Received: 18 August 2015 / Revised: 3 December 2015 / Accepted: 7 December 2015 / Published: 23 December 2015
Viewed by 2960 | PDF Full-text (189 KB) | HTML Full-text | XML Full-text
Abstract
Heart failure (HF) patients commit many errors on driving simulation tasks and cognitive dysfunction appears to be one important contributor to impaired driving in HF. Clinical modifiers of cognition may also play a key role. In particular, depression is common in HF patients, [...] Read more.
Heart failure (HF) patients commit many errors on driving simulation tasks and cognitive dysfunction appears to be one important contributor to impaired driving in HF. Clinical modifiers of cognition may also play a key role. In particular, depression is common in HF patients, linked with cognitive dysfunction, and contributes to reduced driving fitness in non-HF samples. However, the associations among depressive symptoms, cognition, and driving in HF are unclear. Eighteen HF patients completed a validated simulated driving scenario, the Beck Depression Inventory-II (BDI-II), and a cognitive test battery. Partial correlations controlling for demographic and medical confounds showed higher BDI-II score correlated with greater number of collisions, centerline crossings, and % time out of lane. Increased depressive symptoms correlated with lower attention/executive function, and reduced performance in this domain was associated with a greater number of collisions, centerline crossing, and % time out of lane. Depressive symptoms may be related to poorer driving performance in HF, perhaps through association with cognitive dysfunction. However, larger studies with on-road testing are needed to replicate our preliminary findings before recommendations for clinical practice can be made. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
Open AccessEditorial
Geriatrics in Practice and Research—Worldwide
Received: 7 December 2015 / Revised: 7 December 2015 / Accepted: 8 December 2015 / Published: 22 December 2015
Viewed by 2955 | PDF Full-text (123 KB) | HTML Full-text | XML Full-text
Abstract
This edition marks the launch of the new “Geriatrics” open access journal. Clinical geriatrics and the associated scientific activities required in the field constitute one of the major scientific challenges in medicine in the future. [...] Full article
Geriatrics EISSN 2308-3417 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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