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Elderly Drivers with Cognitive Impairment

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221. Epilepsy in Adults

of further seizures similar to the general recurrence risk after two unprovoked seizures (at least 60% over the next 10 years); or Diagnosis of an epilepsy syndrome. International classification of epileptic seizures l. Focal seizures (focal is now preferred to partial): originate within networks limited to one hemisphere, discretely localised or more widely distributed. They may be divided into simple focal (motor or sensory) with retained awareness or focal dyscognitive seizures (impaired awareness (...) ). Focal seizures may progress into generalised seizures. See also the separate article: A. Simple focal seizures (no loss of consciousness). B. Focal dyscognitive seizures: With impairment of consciousness at onset. Simple focal onset followed by impairment of consciousness. C. Focal seizure evolving to generalised tonic-clonic (GTC) convulsions. II. Generalised seizures (convulsive or non-convulsive with bilateral discharges involving subcortical structures); associated with impairment

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2008 Mentor

222. Insomnia

benzodiazepines and, more recently, zopiclone have all been implicated in illicit drug use. [ ] Driving : hypnotics impair judgement and increase reaction times, so affecting the ability to drive or operate machinery, and increasing risk of road traffic accidents. Patients must be aware of this and the fact that hangover effects of a night dose may still manifest themselves the following day. The Driver and Vehicle Licensing Agency (DVLA) advises that any patient suffering from excessive awake-time sleepiness (...) other . In this article In This Article Insomnia In this article Normal sleep requirements vary widely, and there is no standard definition of what is normal. [ ] The amount of sleep required tends to decrease with age. Insomnia is a condition of unsatisfactory sleep, either in terms of sleep onset, sleep maintenance or early waking. Because it is a disorder that subsequently impairs daytime well-being and subjective abilities and functioning, it has been termed a "24-hour disorder

2008 Mentor

223. Improving outcomes in urological cancers

to clinical decision-making, which then becomes a collective process. Another common strand is the importance of defining the natural sequence of events in the organisation and delivery of care. The processes from first referral through to arrangements to manage recurrent and advanced disease have to reflect the needs of the patient at various stages. This is a major driver to shape the way services are organised and delivered. Such ideas are not by any means the sole province of this guidance. There has (...) vary widely because these cancers are very different in nature and characteristics. Prostate cancer is particularly common among elderly men; two thirds of those who die from prostate cancer are over the age of 75. 3 Autopsy studies reveal that the majority of men over 80 years old have areas of malignant tissue in their prostate glands; most die with it, not of it. 4 Prostate cancer may be identified as a result of investigations or intervention for symptoms related to benign prostate disease

2002 National Institute for Health and Clinical Excellence - Clinical Guidelines

224. Practice Parameters for the Use of Actigraphy in the Assessment of Sleep and Sleep Disorders: An Update for 2007

that “the sleep-wake schedule must have been standardized for at least seven days before the polysomnographic testing (and documented by sleep log or actigraphy)” in order to properly in- terpret an MSLT. However, some individuals, such as those with impaired cognition, literacy, or motivation may be unable to keep accurate sleep logs, and both over- and underreporting of total sleep time and pattern have been of concern. Therefore, the com- mittee used the Rand/UCLA Appropriateness Method (described above (...) . For the purposes of this review, we chose appropriate reference standards based on speci?c diagnostic categories. Reference standards for insomnia included PSG and/or sleep logs; for circadian rhythm sleep disorders, PSG, phase markers, and/or sleep logs; for sleep apnea, PSG; for restless legs syndrome and periodic limb move- ments during sleep, PSG; for infants, caregiver reported observa- tions; for elderly or demented persons, phase markers, sleep logs, and/or caregiver reports; and for healthy controls

2007 American Academy of Sleep Medicine

225. Woman Abuse: Screening, Identification and Initial Response

is spared. However, it is important to be mindful that “harm comes to the most vulnerable” (Graham, 2000, p. 33) including, but not limited to, lesbian women, lone mothers, women with mental health issues, women with disabilities, and elderly women (Butterworth 2004; Eckert, Sugar, & Fine, 2002; Graham, 2000; Larkin, Hyman, Mathias, D’Amico, & MacLeod,1999; McClennen, Summers, & Daley, 2002; McFarlane et al., 2001). In this guideline, the development panel recommends that screening be conducted with all

2005 Registered Nurses' Association of Ontario

226. Syringe Drivers

is experienced by most patients with advanced cancer. Severe pain is experienced by 66% of people with cancer at some point in their illness [ ] . Sublingual administration is not always easy if the mouth is dry, co-ordination is poor or cognitive function is impaired. Rectal administration can be a challenge for carers, both physically and emotionally. A syringe driver is only an alternative method of administering medication. It does not produce more effective analgesia than the oral route unless (...) Syringe Drivers Syringe Drivers. Subcutaneous (SC) drug infusion Syringe Driver | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Syringe Drivers Authored by , Reviewed by | Last edited 2 Dec 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European

2008 Mentor

228. APA Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change for Psychologists

/Hispanic/Latinx, Asian/Asian American/Pacific Islander, Black/African American/Black American, and White/White American (Trimble & Dickson, 2005). Psychologists strive to understand the need to become acquainted with aspects of identity, as well as which aspects of identity are especially relevant to the presenting problem or issue. Identity is a construct that has been central to theories of psychological development. Identity reflects both individual and collective features of emotional and cognitive

2002 American Psychological Association

229. Maze Test Performance and Reported Driving Ability in Early Dementia (PubMed)

driving impairment among cognitively impaired elderly and demented drivers. (...) to moderately demented drivers. Comparison was made to the same caregiver rating scale as well as to crash frequency. In the first study of neuropsychological tests, errors on Porteus Mazes emerged as the only significant predictor of driving ability in a stepwise regression analysis. In the follow-up study employing the computerized mazes, all 10 mazes were significantly related to driving ability ratings. Computerized tests of maze performance offer promise as a screening tool to identify potential

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2003 Journal of Geriatric Psychiatry and Neurology

230. Predictors of driving cessation in mild-to-moderate dementia. (PubMed)

Predictors of driving cessation in mild-to-moderate dementia. Although physicians in most provinces are mandated to report patients whose driving ability is impaired by illness, little is known about dementia-related factors associated with driving cessation. The purpose of our study was to explore factors that may affect the likelihood of driving cessation in a sample of elderly, community-dwelling patients with dementia.A 3-year prospective study, the Canadian Outcomes Study in Dementia (...) (COSID) has enrolled 883 patients with mild-to-moderate dementia at 32 centres across Canada. Assessment tools included the Mini-Mental State Examination (MMSE) for cognition, the Global Deterioration Scale (GDS) for staging (severity), the Functional Autonomy Measurement System (SMAF) for function, and the Neuropsychiatric Inventory (NPI) for behaviour. Factors associated with the decision to quit driving after the baseline assessment were tested with Cox survival analysis.Of 719 subjects who were

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2006 Canadian Medical Association Journal

231. Adult day care for the frail elderly: outcomes, satisfaction, and cost

in the community. Economic study type Cost-effectiveness analysis. Study population The study population consisted of patients older than 60 years of age, referred to any day centre. Patients were excluded if they did not speak French or English, as were those too cognitively impaired to be interviewed or without a caregiver. Patients referred to the centre for specialised treatments, those with urgent needs and those with a paid caregiver, were also excluded. Some inclusion criteria for the day centres were (...) of potential confounders and bias. Excluding the 39 clients lost to follow-up, the study groups were shown to have been comparable at baseline in terms of basic demographic characteristics,. However, at baseline, the controls were slightly less cognitively impaired while caregivers in the intervention group had a lower level of education and were more likely to live with the client. Effectiveness results The CES-D scores changed from 16.9 (baseline) to 16.5 (3 months) in the intervention group, and from

2002 NHS Economic Evaluation Database.

232. Characteristics of frail older adult drivers. (PubMed)

%) of the participants were drivers. Former drivers were more likely to be older, be female, reside in congregate independent living for the elderly, have a higher incidence of arthritis and congestive heart failure, take sedating medications, have lower total ADL scores, have lower VO2 peak scores, and have more impairment on tests of cognition and physical strength, although only age, type of residence, and grip strength were independent predictors of driving cessation in the regression analysis.Despite (...) Characteristics of frail older adult drivers. To determine the prevalence of driving in older adults with mild to moderate physical frailty and to compare characteristics of current frail older adult drivers with those of former drivers in the sample.Retrospective study of frail older adults enrolled in randomized trials of exercise and hormone replacement therapy.Urban, academic medical center.One hundred eighty-three sedentary community-dwelling men and women aged 75 and older with mild

2006 Journal of the American Geriatrics Society

233. Impaired navigation in drivers with Parkinson's disease. (PubMed)

Impaired navigation in drivers with Parkinson's disease. Navigating a new route during automobile driving uses the driver's cognitive resources and has the potential to impair driving ability in people with Parkinson's disease (PD). Our aim was to assess navigation and safety errors during a route following task (RFT) in drivers with the illness. Seventy-seven subjects with mild-moderate PD (median Hoehn-Yahr stage = 2.0) and 152 neurologically normal elderly adults, all active and licensed (...) dysfunction. Drivers with PD made more navigation and safety errors than neurologically normal drivers on a RFT that placed demands on driver memory, attention, executive functions and visual perception. The PD group driver safety was degraded possibly due to an increase in the cognitive load in patients with limited reserves. Navigational errors and lower driver safety were associated more with impairments in cognitive and visual function than the motor severity of their disease in drivers with PD.

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2007 Brain

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