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Elderly Drivers with Cognitive Impairment

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1. Elderly Drivers with Cognitive Impairment

Elderly Drivers with Cognitive Impairment Elderly Drivers with Cognitive Impairment Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Elderly Drivers with Cognitive Impairment Elderly Drivers with Cognitive Impairment Aka: Elderly Drivers with Cognitive Impairment , Dementia Evaluation in Older Adult Drivers II. Epidemiology doubles crash risk (esp. fatal crashes) Drivers license active in 30% with III. History suggestive of unsafe driving Crashes, near-crashes, or dents in the car body Disoriented in familiar neighborhoods Missed or misinterpreted street signs Lack of awareness of surrounding traffic Misjudging speed, distance

2018 FP Notebook

2. Elderly Drivers with Cognitive Impairment

Elderly Drivers with Cognitive Impairment Elderly Drivers with Cognitive Impairment Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Elderly Drivers with Cognitive Impairment Elderly Drivers with Cognitive Impairment Aka: Elderly Drivers with Cognitive Impairment , Dementia Evaluation in Older Adult Drivers II. Epidemiology doubles crash risk (esp. fatal crashes) Drivers license active in 30% with III. History suggestive of unsafe driving Crashes, near-crashes, or dents in the car body Disoriented in familiar neighborhoods Missed or misinterpreted street signs Lack of awareness of surrounding traffic Misjudging speed, distance

2015 FP Notebook

3. A Systematic Evidence Review of the Signs and Symptoms of Dementia and Brief Cognitive Tests Available in VA

that was highly specific for AD, however, was impaired sense of touch for perceiving the form of an object (stereognosis), or the form of a letter or number written on the skin (graphesthesia).3 A Systematic Evidence Review of the Signs and Symptoms of Dementia and Brief Cognitive Tests Available in VA Evidence-based Synthesis Program KEY QUESTION #2. Which measures of cognitive function provide the optimal sensitivity, specificity, and time to completion among the measures available to V A providers? All 6 (...) patients with mild cognitive impairment (MCI). The SLUMS test was studied in a V A population and found to have high sensitivity (98-100%) and specificity (98-100%) with adjustment for education. The SLUMS takes longer to administer than other tests. It was developed more recently than the other tests and has not been widely studied. The STMS has been studied in a primary care setting. The STMS had sensitivity ranging from 86% to 95%, and specificity was highest (93.5%) when cut-off score was adjusted

2010 Veterans Affairs Evidence-based Synthesis Program Reports

4. Interventions with the Older Driver

and older drivers acknowledge these deficits but still wish to continue driving, practitioners can offer treatment to help correct the deficits or impairments. Aside from treating medical conditions that impair driving ability, most practitioners are ill-equipped to formulate or execute a driving rehabilitation plan; referral to specialists is often helpful. If deficits and impairments cannot be corrected enough to allow safe driving, practitioners may need to be proactive in regards to driving (...) , and cognitive skills as well as on-road evaluations. During on-road evaluations, the specialist goes in a vehicle with the older driver to evaluate actual driving skills in varied traffic conditions. The vehicle used during the evaluation should be equipped with features that allow the specialist to maintain safe control (eg, passenger-side brake). At the conclusion of the comprehensive driving evaluation, the specialist provides recommendations regarding the individual’s driving ability. These specialists

2013 Merck Manual (19th Edition)

5. Functional Assessment of the Older Driver

attention and visual scanning. Part A is easier and should always be given prior to part B. Part B is more challenging and assesses alternating attention and executive function. Drivers with an abnormal score on Part B (eg, > 180 sec) may be candidates for more specialized testing by a driving rehabilitation specialist. The Mini-Mental State Examination: screens for cognitive impairments. However, this test has not been validated for use in determining driving privileges, and traffic safety experts do (...) knowledge Quality of Life in the Elderly Which of the following factors can influence health-related quality of life in an elderly patient but may not be obvious or known by the patient’s practitioner? Chronic pain Functional status Religion and personal values Social isolation NEWS & VIDEOS Few Seniors Receive Regular Brief Cognitive Assessments WEDNESDAY, March 6, 2019 (HealthDay News) -- Only 16 percent of seniors receive regular cognitive assessments, according to the Alzheimer's Disease Facts

2013 Merck Manual (19th Edition)

6. Medical Assessment of the Older Driver

) monitoring of hospitalized patients, according... SOCIAL MEDIA Add to Any Platform Loading , OTD, OTR/L, BSW, SCDCM, CDRS, FAOTA, Washington University Medical School; , MD, Washington University School of Medicine Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Medical assessment of the older driver includes a thorough review of medical conditions and/or drugs that can impair driving ability. Such medical conditions can be chronic disorders that impair (...) important functional abilities needed for driving (eg, macular degeneration that decreases vision) or acute events that impair consciousness (eg, seizure, syncope). (See also .) The following are a few of the more common medical illnesses or syndromes that are associated with increased driving risk (eg, motor vehicle crashes [MVCs], poor performance on road tests). Falls Falls and MVCs share common causative factors (eg, impaired vision, muscle strength, cognition). A history of falls in the past 1 to 2

2013 Merck Manual (19th Edition)

7. Overview of the Older Driver

and can have negative outcomes (eg, social isolation, depression, fewer driving destinations). Age-related and disease-related changes in physical, motor, sensory, and cognitive function can impair driving ability and account for some of the increase in MVC rates per miles driven in older drivers. Many older drivers self-regulate their behavior. Older adults are more vulnerable to injury and death in a MVC than other age groups. The role of practitioners is to do functional and medical assessments (...) (MVC) or driving cessation. Safe driving requires the integration of complex visual, motor, and cognitive processes, and some older drivers may have mild to moderate deficits in one or more of these domains. Many older drivers successfully self-regulate their behavior and compensate for deficits by avoiding rush hour, driving fewer miles per year, limiting trips to shorter distances, and avoiding driving during twilight, nighttime, or inclement weather. Also, older drivers tend to be more cautious

2013 Merck Manual (19th Edition)

8. Suspected neurological conditions: recognition and referral

of 73Contents Contents Overview 6 Who is it for? 6 Recommendations for adults aged over 16 7 1.1 Blackouts in adults 7 1.2 Dizziness and vertigo in adults 7 1.3 Facial pain, atraumatic 9 1.4 Gait unsteadiness 10 1.5 Handwriting difficulties 11 1.6 Headaches in adults 12 1.7 Limb or facial weakness in adults 12 1.8 Memory failure and cognitive deterioration 14 1.9 Posture distortion in adults 16 1.10 Sensory symptoms including tingling or numbness in adults 16 1.11 Sleep disorders in adults 19 1.12 Smell (...) 1.31 Tics and involuntary movements in children 38 1.32 Tremor in children 39 T erms used in this guideline 40 Refer immediately 40 Refer urgently 40 Refer 40 Consider referring 40 Dizziness 40 Functional neurological disorder 40 Radiculopathy 40 Rationale: recommendations for adults aged over 16 41 Blackouts in adults 41 Dizziness and vertigo in adults 41 Facial pain, atraumatic 43 Gait unsteadiness 44 Handwriting difficulties 45 Limb or facial weakness in adults 45 Memory failure and cognitive

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

9. Dementia: assessment, management and support for people living with dementia and their carers

1.3 Care coordination 19 1.4 Interventions to promote cognition, independence and wellbeing 20 1.5 Pharmacological interventions for dementia 21 1.6 Medicines that may cause cognitive impairment 25 1.7 Managing non-cognitive symptoms 25 1.8 Assessing and managing other long-term conditions in people living with dementia 27 1.9 Risks during hospital admission 29 1.10 Palliative care 30 1.11 Supporting carers 31 1.12 Moving to different care settings 32 1.13 Staff training and education 32 T erms (...) care This guideline offers best-practice advice on care and support for people living with dementia and their families and carers. The principles of person-centred care underpin good practice in dementia care, and they are reflected in the recommendations. These principles assert: the human value of people living with dementia (regardless of age or cognitive impairment) and their families and carers the individuality of people living with dementia, and how their personality and life experiences

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

10. Risk factors for in hospital falls

/Loss of functional status Mental status Altered mental status Cognitive problems Impaired judgement Sedated mental status Agitation Amnesia Delirium Disorientation or Confusion Urinary issues Urge Incontinence Requires help to toilet at night Frequency Night-time frequency Mobility issues Mobility: decreased, impaired, change in activity Problems with gait Balance issues Muscle weakness – lower limbs Need for mobility assistance Needs a wheelchair Postural hypotension/sway Dizziness Co-morbidities (...) , mental health patients and obstetric patients. Existing risk factors for a fall maybe exacerbated by a variety of new factors faced on admission to hospital. Individuals who were not initially at risk of a fall may develop a falls risk. Patients who were identified at increased risk of falling during their admission may continue to be at increased risk of falling after discharge [2]. While in hospital, cognitive functioning can become impaired and pre-existing cognitive problems may worsen. This can

2019 Monash Health Evidence Reviews

11. Guidelines on Chronic Coronary Syndromes

8.1.2 Valvular heart disease (including planned transcatheter aortic valve implantation) 44 8.1.3 After heart transplantation 44 8.2 Non-cardiovascular comorbidities 45 8.2.1 Cancer 45 8.2.2 Diabetes mellitus 45 8.2.3 Chronic kidney disease 46 8.2.4 Elderly 46 8.3 Sex 46 8.4 Patients with refractory angina 47 9. Key messages 48 10. Gaps in the evidence 49 10.1 Diagnosis and assessment 49 10.2 Assessment of risk 49 10.3 Lifestyle management 49 10.4 Pharmacological management 49 10.5 Revascularization (...) coronary syndromes 46 Recommendations for elderly patients with chronic coronary syndromes 46 Recommendation for sex issues and chronic coronary syndromes 47 Recommendations for treatment options for refractory angina 48 Recommendations: ’what to do’ and ’what not to do’ 50 List of tables Table 1 Classes of recommendations 6 Table 2 Levels of evidence 6 Table 3 Traditional clinical classification of suspected anginal symptoms 12 Table 4 Grading of effort angina severity according to the Canadian

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2019 European Society of Cardiology

12. Empowering Caregivers to Deliver Home-based Restorative Care

-cognitive impairments, and found this practice improved mood and decreased depressive symptoms of caregivers, while another recent medium-quality review found that teaching mindfulness to informal palliative caregivers reduced depression, anxiety and caregiver burden, as well as increased quality of life, hope and overall mental health of the caregiver.(24) The outcomes associated with specific educational and training strategies could not be determined given the multi-component nature (...) the impact of calendars and note-taking among caregivers of those with mild-cognitive impairments and found this practice improved mood and decreased depressive symptoms of caregivers.(23) • One recent high-quality review found that education interventions to improve coping, knowledge and social support (included as a behaviour below) reduced caregiver burden of those with dementia. o However, the specifics of what was included in each of the interventions was not provided in the review.(45) • Similarly

2019 McMaster Health Forum

13. Management of Dyslipidaemias

Trialists CV Cardiovascular CVD Cardiovascular disease CYP Cytochrome P450 4D Die Deutsche Diabetes Dialyse Studie dal-OUTCOMES Effects of Dalcetrapib in Patients with a Recent Acute Coronary Syndrome DASH Dietary Approaches to Stop Hypertension DGAT-2 Diacylglycerol acyltransferase-2 DHA Docosahexaenoic acid DM Diabetes mellitus EAPC European Association of Preventive Cardiology EAS European Atherosclerosis Society EBBINGHAUS Evaluating PCSK9 Binding Antibody Influence on Cognitive Health in High (...) SFA Saturated fatty acid SHARP Study of Heart and Renal Protection siRNA Small interfering RNA SMI Severe mental illness SPARCL Stroke Prevention by Aggressive Reduction in Cholesterol Levels STAREE STAtin Therapy for Reducing Events in the Elderly STEMI ST-elevation myocardial infarction STRENGTH Outcomes Study to Assess STatin Residual Risk Reduction with EpaNova in HiGh CV Risk PatienTs with Hypertriglyceridemia TC Total cholesterol T1DM Type 1 diabetes mellitus T2DM Type 2 diabetes mellitus

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2019 European Society of Cardiology

14. Canadian stroke best practice recommendations: secondary prevention of stroke, sixth edition practice guidelines

A]. ii. Echocardiography should be considered in cases where a stroke mechanism has not been identified [Evidence Level C]. 1.3 Functional assessment i. Selected patients with transient ischemic attack or ischemic stroke should be assessed for neurological impairments and functional limitations when appropriate (e.g. cognitive evaluation, screening for depression, screening of fitness to drive, need for potential rehabilitation therapy, and assistance with activities of daily living), especially (...) balanced with undesirable effects or undesirable effects outweigh or are closely balanced with desirable effects. C Writing group consensus and/or supported by limited research evidence. Desirable effects outweigh or are closely balanced with undesirable effects or undesirable effects outweigh or are closely balanced with desirable effects, as determined by writing group consensus. Recommendations assigned a Level-C evidence may be key system drivers supporting other recommendations, and some may

2018 CPG Infobase

15. Diagnosis and management of epilepsy in adults

but usually resolve with time. 126 Sedation may be less with AEDs licensed from, for example, 1990 onwards, particularly lamotrigine, oxcarbazepine and levetiracetam. 94 Many patients on long term AED therapy report cognitive adverse effects (see section 4.6.5) but studies to confirm this have been contradictory and confounded by the effects of chronic epilepsy. 142, 143 Polytherapy is probably associated with more cognitive adverse effects than monotherapy. 144 Impaired bone health is associated (...) to be universally adopted. A brief summary of these classifications systems is given below. Diagnosis and management of epilepsy in adults 2 + 4| 7 3.2.1 CLASSIFICATION OF EPILEPTIC SEIZURES (ILAE 1981) International classification of epileptic seizures: 11 I. Partial seizures A. simple partial seizures (no loss of consciousness) B. complex partial seizures 1. with impairment of consciousness at onset 2. simple partial onset followed by impairment of consciousnes C. partial seizures evolving to generalised

2018 SIGN

16. Multimorbidity: a priority for global health research

complexes such as frailty or chronic pain. • Sensory impairment such as sight or hearing loss. • Alcohol and substance misuse.2.2 Challenges arising from a lack of consensus regarding definition It was clear from our evidence gathering that the diversity of terminology, multiplicity of definitions, and the inconsistency in how these terms and definitions are used, makes the scientific literature about multimorbidity difficult to navigate and assimilate. Inconsistent approaches to the definition

2018 Academy of Medical Sciences

17. Heart Disease and Stroke Statistics

of death. “Any-mention” mortality means that the condition was nominally selected as the underlying cause or was otherwise mentioned on the death certificate. For many deaths classified as attributable to CVD, selection of the single most likely underlying cause can be difficult when several major comorbidities are present, as is often the case in the elderly population. It is useful, therefore, to know the extent of mortality attributable to a given cause regardless of whether it is the underlying

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2019 American Heart Association

18. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm

impairment, or ASCVD), comorbidities, other relevant laboratory data, concomitant drug administration, complications of diabetes, and psychosocial factors affecting patient care. With CGM, initial therapy adjustments can be made much more frequently until stable. Less frequent monitoring is acceptable once targets are achieved. The choice of therapy includes ease of use and affordability. The therapeutic regimen should be as simple as possible to optimize adherence. The initial acquisition cost (...) of reducing body weight by at least 5 to 10%. As shown in the Look AHEAD (Action for Health in Diabetes) and Diabetes Prevention Program studies, lowering caloric intake is the main driver for weight loss ( ). The clinician, a registered dietitian, or a nutritionist (i.e., a healthcare professional with formal training in the nutritional needs of individuals with diabetes) should discuss recommendations in plain language at the initial visit and periodically during follow-up office visits. Discussion

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2019 American Association of Clinical Endocrinologists

19. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

in approaching the various aspects of prevention with patients (S1-6). An increasing number of ideal cardiovascular health factors have been associated with a lower prevalence and incidence of ASCVD events, heart failure, atrial fibrillation, cancer, depression, and cognitive impairment (S1-7). Therefore, moving individuals toward ideal cardiovascular health is critically important for prevention of many important health conditions. The ACC/AHA Task Force on Clinical Practice Guidelines has commissioned (...) (S3.2-25). But, in discussions with patients, it should be mentioned that these very high levels of physical activity (i.e., >10 times the minimum recommended amount) pertain to only a small fraction of the population (S3.2-12). Individuals with significant functional impairments may need modifications to and more specific guidance on the type, duration, and intensity of physical activity. Recommendation-Specific Supportive Text 1. Physical activity assessment and counseling in the healthcare

2019 American Heart Association

20. Addressing Social Isolation To Improve the Health of Older Adults: A Rapid Review

, increasing access to and use of clinical preventive services and behavioral health care, and increasing access to healthy food to improve the health of older adults. 55 Physical activity in particular also been shown to have mild positive effects on cognition for adults both with and without cognitive impairment. 56 Health systems should target the interventions to the needs of their population and may want to consider piloting new efforts to address social isolation to improve health to inform future (...) health care utilization? Figure 1, below, is an analytic framework depicting the relationship between the questions and population, interventions, and outcomes of this rapid review. Figure 1. Analytic framework 3 Methods We conducted a rapid review of the last 5 years of research to inform health systems’ decisionmaking on a leading social determinant of health for the elderly—social isolation. This rapid review was guided by established rapid review methodology 26, 27 and took the following steps

2019 Effective Health Care Program (AHRQ)

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