Driving Simulators Help Older Adults Improve Their Road Skills

Older drivers could benefit from training programs that put them behind the wheel - in a driving simulator, with an observer who helps them develop their skills. That's the conclusion of a new article published in Current Directions in Psychological Science, a journal of the Association for Psychological Science.

Older people are at much higher risk of car crashes than younger drivers. Some states and provinces test older drivers, hoping to get the riskiest drivers off the road. But the tests they use are inadequate, says Normand Teasdale of Université Laval in Québec, who cowrote the study with Pierre-Luc Gamache, Carol Hudon, and Martin Simoneau. Some governments only test vision; others test cognition, too. In some cases, on-the-road tests also are required.

But none of these tests is enough - they lack accuracy, sensitivity and specificity. To drive effectively, you not only have to be able to see, hear, and think about what's going on - you also have to be able to turn this sensory input into the right action, like stepping on the brake when you see a red light ahead of you. (And not stepping on the gas instead, a common mistake.)

Teasdale and his colleagues think a better approach is to help older adults improve their skills through the use of proper training using a driving simulator and appropriate feedbacks. In experiments, they've found that coaching helps older drivers improve. For example, in one experiment, older adults were tested on the road, then coached in a driving simulator. "We actually walk them through their errors by showing them their own response," Teasdale says. Then the drivers were tested again on the road - without coaching - and their driving improved. "After the training, they really were aware of why they were making errors and what not to do."

Older people should be able to treat driving the way they do golf or tennis, Teasdale says. "Elderly people, if they want, can pick up the phone and they'll have a golf pro or a tennis pro that will gladly help them for as many hours as they want, on the same day." Driving is just another set of motor skills, but there's no such service for driving. The services that are available are mostly to test older people and tell them if they aren't fit to drive anymore. "So I fully understand why older individuals are reluctant to get into this," Teasdale says.

Teasdale and his colleagues hope that coaches and driving simulators can be made available to more older drivers who are worried about their safety on the road. These methods may help keep older drivers behind the wheel longer without compromising road safety.

Source:
Keri Chiodo
Association for Psychological Science

Driving Simulators Help Older Adults Improve Their Road Skills

Online Tool Can Help Seniors Quickly Determine Risk For Dementia

A quick online assessment tool developed by Johns Hopkins researchers can help worried seniors find out if they are at risk of developing dementia and determine whether they should seek a comprehensive, face-to-face diagnosis from a physician, according to a new study.

The tool, which is being refined and validated, is not meant to replace a full evaluation from a doctor that includes a physical exam, blood work, imaging studies and more. Instead, this assessment provides a scientific way to help a person educate herself about a disease that doctors now believe is best managed if caught early.

"As the population ages and dementia becomes more prevalent, it's important to get people diagnosed early," says Jason Brandt, Ph.D., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the leader of the study appearing online in the journal Alzheimer's & Dementia. "Alzheimer's disease and other types of dementia don't just creep up on you. They're incubating for decades in the brain. This tool is potentially very useful in determining who is at risk."

Among the questions asked on the Dementia Risk Assessment are about whether a person has a history of high blood pressure, depression, diabetes, high cholesterol or head injury, all of which are considered well-documented risk factors for dementia. The assessment also includes a simple memory test that could point to a subtle cognitive decline, Brandt says.

The study analyzed responses from 357 people over the age of 50 who took the assessment here. Those who scored lowest on the memory test were significantly older, and were more likely to be men, have hypertension and report severe memory problems. And while only 9 percent of respondents reported they had severe memory problems, more than one-third said they had a first-degree relative with dementia or severe memory loss - a major risk factor for the condition.

The assessment takes just five to 10 minutes to complete online, and the questions have been borrowed from other scientifically valid assessments.

Brandt says the assessment may be helpful in weeding out those who have signs of dementia from those who are simply experiencing the memory loss that comes with aging or a busy lifestyle. Not being able to find your keys or remembering where you parked is rarely a failsafe sign that a person is suffering from dementia.

"Our goal is really to educate people about what some of the risk factors are and, often, to put people's minds at ease," he says. "We somehow expect our memories to be as good at 50 as they were at 30. We can't run as fast as we could 20 years ago. Why should our memory be as good?"

Alzheimer's disease still has no cure, but early interventions are being used to slow cognitive decline, Brandt says. Brandt says he hopes this assessment will get patients with several risk factors or symptoms to consult a physician.

Some forms of dementia, he says, may not be permanent, and getting to a doctor could help to restore brain function.

Sometimes, Brandt says, seniors are afraid to mention they are having memory or other cognitive issues. The new tool, he says, lets them learn more about themselves and their individualized risk factors in the privacy of their homes.

The aging population means that many more people will be diagnosed with dementia in the coming decades.

"Screening procedures that have demonstrated validity and predictive value and are noninvasive, brief and do not require any special expertise to administer may have the greatest potential to be accepted and actually used by the greatest number of people," Brandt says. "This tool, which this study preliminarily validates, is the first step toward developing such a procedure."

Brandt and colleagues are currently conducting research that compares a patient's results from the online Dementia Risk Assessment with an in-person, comprehensive evaluation by a physician at one of two Johns Hopkins clinics.

This research was supported by a grant from the Geoffrey Beene Foundation's GB Gives Back Alzheimer's Initiative. Mark Rogerson, Ph.D., of Johns Hopkins also worked on this study.

Source:
Johns Hopkins Medicine

Taking More Steps Every Day Can Help Ward Off Diabetes

ScienceDaily (2011-01-13) -- Simply taking more steps every day not only helps ward off obesity but also reduces the risk of diabetes, finds a new study.

Take Up Tai Chi And And Cut Back On Meds To Reduce Risk Of Falling, Elderly Advised

Image via Wikipedia
Written by: Catharine Paddock, PhD

Taking up Tai Chi and cutting back on medication could form part of a multiple intervention approach to helping elderly people reduce their risk of falling, according to recently updated guidelines from the American Geriatrics Society and the British Geriatric Society, summarized this month in the Journal of the American Geriatrics Society.

In their first update since 2001, the guidelines for preventing falls in the elderly now recommend that interventions be "multifactorial" and include an exercise component and assess feet, footwear, fear of falling, ability to go about daily living, and other factors.

The guidelines also say that fall screening and prevention should be a routine part of healthcare for the elderly.

The new panel that updated the guidelines included members from previous panels and new members with considerable expertise, both in practical and published work, in preventing falls and caring for older people.

Dr Mary Tinetti of Yale University School of Medicine in New Haven, Connecticut in the US, was one of the panel co-chairs. She told the press that:

"Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence."

"Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes," she added.

The panel searched and reviewed the literature published between May 2001 and April 2008 for systematic literature reviews, meta-analyses, randomized controlled trials of fall prevention interventions, controlled before-and-after studies, and cohort studies.

They also reviewed randomized controlled trials published between April 2008 and July 2009 and found no reason to change their conclusions and recommendations.

The new guidelines say that doctors should decide whether to assess risk of falling by first asking patients if they have fallen recently or are unsteady when walking.

If patients say they have not experienced a fall recently and are not unsteady when walking then they do not need a risk assessment.

But if they answer yes, then doctors should go ahead with a risk assessment and look for other known problem areas like muscle weakness, poor balance or blood pressure that drops too much on standing.

If this risk assessment shows these problems, patients should then receive interventions as advised in the guidelines.

Tinetti said that they found the most effective fall prevention trials were those involving multiple interventions instead of only one.

She said while previous studies had suggested it is more effective to focus on single interventions, they are confident a multiple intervention approach is better because they looked not only at what was recommended but also what was actually carried out.

"We're confident that multifactorial interventions is the best course of action," stressed Tinetti.

The new guidelines suggest not only that doctors should design "multifactorial" interventions, but these also:

• Include exercise for balance, gait and strength training. A good example is Tai chi or physical therapy.


• Include "environmental adaptation" to reduce factors that increase risk of falling in the home and when carrying out daily activities.


• Include cataract surgery where needed, but not as an individual approach.


• Aim to reduce medication regardless of number of drugs prescribed: this is a departure from the 2001 guideline which said this need only apply to patients on four or more drugs.


• Pay particular attention to drugs that affect the brain, for instance sleeping pills and antidepressants.


• Focus on raising low blood pressure and managing heart rate and rhythm abnormalities.

Tinetti said:

"There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice."

"By making fall prevention part of the clinical care of older adults this trend can continue," she added.

"Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons."
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society.
Journal of the American Geriatrics Society, Volume 59, Issue 1, pages 148-157, published online 13 January 2011.
DOI: 10.1111/j.1532-5415.2010.03234.x

Additional source: Wiley-Blackwell (press release, 13 Jan 2011).

Bone Turnover Markers May Predict Fracture Risk

By Rita Baron-Faust, Contributing Writer, MedPage Today

High levels of bone turnover markers (BTMs) may help predict which people are at greatest risk of suffering fragility fractures due to osteoporosis, according to a position paper by an international team of researchers.

A review of 22 studies conducted over a decade found that high levels of BTMs may predict fracture risk independently from bone mineral density (BMD) in postmenopausal women, Samuel D. Vasikaran, MBBS, MD, of the Royal Perth Hospital in Perth, Australia, and colleagues reported online in the journal Osteoporosis International.
Full Article

Sense of Purpose Staves Off Alzheimer's from MedPage Today

By Kristina Fiore, Staff Writer, MedPage Today

Patients who maintain a greater sense of purpose in life as they age may have greater protection against Alzheimer's disease, researchers have found.

Those with a purpose had more than a 50% reduced risk of the disease (HR 0.48, 95% CI 0.33 to 0.69, P<0.001), Patricia A. Boyle, PhD, of Rush University Medical Center in Chicago, and colleagues reported in the March Archives of General Psychiatry.

"The tendency to derive meaning from life's experiences and to possess a sense of intentionality and goal directedness are associated with a substantially reduced risk of Alzheimer's disease and a less rapid rate of cognitive decline in older age," the researchers wrote.

Some data have suggested that psychological factors such as extraversion and neuroticism, as well as experiential factors including social networks, are associated with risk of Alzheimer's disease.
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High Fat Intake Ups Stroke Risk in Older Women - in Meeting Coverage, ASA from MedPage Today

By Todd Neale, Staff Writer, MedPage Today

Postmenopausal women who eat the most fat have an elevated risk of ischemic stroke, researchers found.

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ICU Stay Hikes Mortality Risk

Interruptions in Medicaid Coverage and Risk for Hospitalization for Ambulatory Care-Sensitive Conditions

Andrew B. Bindman, MD; Arpita Chattopadhyay, PhD; and Glenna M. Auerback, MPH Annals of Internal Medicine 16 December 2008 Volume 149 Issue 12 Pages 854-860 A review of hospital discharge data in California revealed that interruptions in Medicaid coverage increased the risk of hospitalization for ambulatory care–sensitive conditions such as heart failure, diabetes, and chronic obstructive pulmonary disease, which can often be managed in an outpatient setting. Hospital admissions for these conditions may signal a decline in health status among patients who no longer have access to preventive and primary care services because of an interruption in their health care coverage.

Blacks with Breathing Conditions Have Higher Risk for Lung Cancer

from the Kaiser Health Disparities Report: A Weekly Look At Race, Ethnicity And Health Blacks with chronic obstructive pulmonary disease -- including chronic bronchitis and some types of serious chronic asthma -- have a risk for developing lung cancer about twice as high as that of whites with the condition, according to a study published in the journal Cancer Prevention Research, Reuters reports. For the study, lead researcher Carol Etzel of the University of Texas M.D. Anderson Cancer Center and colleagues developed a risk assessment model to help predict blacks' risk for lung cancer. Researchers analyzed data on 491 blacks with lung cancer and 497 blacks without the disease to develop the tool and then compared it with the existing risk models for whites. Researchers said that blacks' high risk for COPD prompted them to develop the risk assessment model to help doctors better predict lung cancer risk. The new model found that black men with a history of COPD had a more than sixfold increased risk of developing lung cancer, which is about the same risk for those who smoke. According to Reuters, both black and white smokers have a risk of lung cancer six times higher than that of non-smokers. Smoking is the leading cause of COPD, but pollution, and other environmental factors also play a role, Reuters reports. Etzel said, "What we hope is that a doctor can use these models to encourage their patients to take steps to prevent lung cancer. Even if they are never smokers, they can be at risk." The researchers now are working on a risk model for Hispanics (Reuters, 9/4). Study Report is available online: Development and Validation of a Lung Cancer Risk Prediction Model for African-Americans

Nonmelanoma Skin Cancer Increases Risk for Subsequent Cancers

Individuals with a history of nonmelanoma skin cancer (NMSC) are at increased risk for subsequent noncutaneous cancers. The results of a study published in the August 26 Advance Access issue of the Journal of the National Cancer Institute showed that even after adjusting for other risk factors, a history of confirmed NMSC was associated with a statistically significantly increased risk for future noncutaneous malignant tumors and may be a marker of a general high-cancer risk phenotype.

The Odds It Will Kill You? See New Charts

By NICHOLAS BAKALAR Published: September 2, 2008, New York Times New risk charts provide a broader perspective on the risks associated with 10 different causes of death. Charts

WHO Fracture Risk Assessment Tool

The FRAX tool has been developed by the World Health Organization to evaluate fracture risk of patients. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. The FRAX models have been developed from studying population-based cohorts from Europe, North America, Asia and Australia. In their most sophisticated form, the FRAX tool is computer-driven and is available on this site. Several simplified paper versions, based on the number of risk factors are also available, and can be downloaded for office use. The FRAX algorithms give the 10-year probability of fracture. The output is a 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture). This is a beta version

Risk, From a Broader Perspective

By NICHOLAS BAKALAR Published: July 8, 2008, New York Times New risk charts published last month provide a broader perspective than most of the risk calculators available on the Internet. Related Link http://jnci.oxfordjournals.org/cgi/content/abstract/djn124