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Elderly Drivers with Cognitive Impairment


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21. Primary Prevention of Cardiovascular Disease

cardiovascular health,” referred to as Life’s Simple 7 (S1-5). Clinicians will find the 2018 Journal of American College of Cardiology (JACC) Cardiovascular Health Promotion Series very helpful 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 (...) 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 setting have important complementary roles in promoting increased physical activity (S3.2-16

2019 American College of Cardiology

23. Guidance on the clinical management of anxiety disorders, specifically focusing on diagnosis and treatment strategies

- ety in these other contexts (Andrews et al., 2009; Goldberg et al., 2009). • • Separation anxiety. • • Other disorders (e.g. psychosis, cognitive impairment, substance use disorders or personality disorders), for which the approach to treatment will differ. Working group The RANZCP Clinical Practice Guidelines Team for Panic Disorder, Social Anxiety Disorder and Generalised Anxiety Disorder (working group) was appointed in 2014, com- posed of health care academics and clinicians from Australia (...) of the clinician. The clinician should develop a detailed biopsychosocial formulation based on comprehensive assessment, for example: • • The nature, severity and duration of symptoms; • • The underlying cognitions; • • Behavioural and cognitive responses to anxiety (e.g. avoidance, worry, reassurance-seeking, safety behaviours); • • Precipitants for anxiety; • • The degree of distress and functional impairment; • • The presence of any comorbid mood disorders or anxiety disorders, substance use disorders

2018 Royal Australian and New Zealand College of Psychiatrists

24. Management of Stroke Rehabilitation

/DoD Clinical Practice Guideline for the Management of Stroke Rehabilitation July 2019 Page 6 of 170 Disability from stroke can present in a myriad of ways depending on the affected area(s) of the central nervous system. The most common presentations include focal weakness and sensory disturbances, speech and swallowing impairments, vision loss or neglect, cognitive problems with inattention or memory loss, as well as emotional difficulties with mood or anxiety. The early management of stroke (...) in Patients with Stroke and Transient Ischemic Attack [23] Abbreviations: AHA: American Heart Association; ASA: American Stroke Association Sidebar 2: Assessment of Impairments and Disabilities ? Assessment of impairments • Auditory/hearing • Bowel and bladder function • Cognition • Communication • Emotion and behavior • Inattention/neglect • Motor/mobility • Swallowing and nutrition • Tactile/touch • Vision function and formal visual field ? Assessment of barriers to participation in therapy • Cognitive

2019 VA/DoD Clinical Practice Guidelines

25. Prevention and Control of Methecillin-Resistant Staphylcoccus Aureus (MRSA)

a relatively high risk of MRSA infection and consider pre-operative screening for those particular patient sub-sets. For example, it may be appropriate for hospitals to screen emergency orthopaedic admissions as many of these patients are elderly and have frequent contact with the healthcare system. Grade C • Patients admitted to critical care areas, e.g. intensive care unit (ICU) and special care baby unit (SCBU) with at least weekly screening thereafter. Grade D • Patients requiring renal dialysis. Grade (...) of elderly units) within the same institution should be isolated or cohorted with contact precautions (CP) until MRSA screens are negative. If this is not feasible a risk assessment should be carried out before the patient is moved into the high-risk unit. Grade B g) All known MRSA cases on admission and all new MRSA cases upon identification in high- risk areas (critical care units, orthopaedics, surgical wards and transplant units) should be isolated or cohorted with CP and screened accordingly

2019 National Clinical Guidelines (Ireland)

26. Community-Acquired Pneumonia (CAP) in Adults

from three pre–post intervention studies and one prospective controlled observational study support the effectiveness and safety of using the PSI to guide the initial site of treatment ( – ). Clinical severity is not the only consideration in determining the need for hospital admission ( , ). Some patients have medical and/or psychosocial contraindications to outpatient therapy, such as inability to maintain oral intake, history of substance abuse, cognitive impairment, severe comorbid illnesses (...) , and impaired functional status. The PSI may underestimate illness severity among younger patients and oversimplify how clinicians interpret continuous variables (e.g., all systolic blood pressures <90 mm Hg are considered abnormal, regardless of the patient’s baseline and actual measurement). Therefore, when used as a decision aid, the PSI should be used in conjunction with clinical judgment. In comparison to the PSI, there is less evidence that CURB-65 is effective as a decision aid in guiding the initial

2019 Infectious Diseases Society of America

27. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

medical and/or psychosocial contraindications to outpatient therapy, such as inability to maintain oral intake, history of substance abuse, cognitive impairment, severe comorbid illnesses, and impaired functional status. The PSI may underestimate illness severity among younger patients and oversimplify how clinicians interpret continuous variables (e.g., all systolic blood pressures <90 mm Hg are considered abnormal, regardless of the patient’s baseline and actual measurement). Therefore, when used

2019 American Thoracic Society

28. Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association

of limited data, treatment goals are similar to those of other pulmonary arterial hypertension subgroups. Finally, given the confluence of sleep disorders, particularly obstructive sleep apnea, with CVD, it is also worth noting that HIV is associated with sleep impairment in general and that obstructive sleep apnea may be underdiagnosed among PLWH. , Pathophysiology and Presentation of Atherosclerotic CVD and HF in HIV After 2 decades of progress in studying the elevated risks for CVD among PLWH (...) cause of cardiomyopathy and HF in general and is common in HIV (particularly alcohol, methamphetamine, and cocaine). However, this is unlikely to be the primary driver of HF in HIV, particularly in light of the aforementioned VACS analysis demonstrating greater HF risks in HIV after the analyses were restricted to people without substance use. Cardiac arrhythmias contribute to myocardial dysfunction and may be particularly common in HIV. PLWH appear to have a several-fold greater risk of sudden

2019 American Heart Association

29. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures

clearly envisioned within the nexus of ABCD and a newly proposed model of dysglycemia- based chronic disease (DBCD) (45). In this model, abnormal adiposity intersects with stage-I DBCD as a driver for insulin resistance, T2D, and CVD (45). The recent findings of a large, multicenter, retrospective matched cohort study by Fisher et al. (46) corroborate this concept. They found a lower risk of macrovascular outcomes associated with bariatric surgery in patients with T2D and severe obesity (46). From (...) ). Patients with the following comorbidities and BMI =35 kg/m 2 may also be considered for a bariatric procedure though the strength of evidence is more variable: obesity- hypoventilation syndrome and Pickwickian syndrome after a careful evaluation of DOI:10.4158/GL-2019-0406 © 2019 AACE. 25 operative risk; idiopathic intracranial hypertension; gastroesophageal reflux disease; severe venous stasis disease; impaired mobility due to obesity; and considerably impaired quality of life (Grade C; BEL 3). R3

2019 American Association of Clinical Endocrinologists

30. Child Abuse, Elder Abuse, and Intimate Partner Violence

z Ongoing cognitive and physical development, z Thin skin (a temperature of 65 degrees Celsius causes a burn in a child in 0.5 seconds), z Propensity to “freeze” when in contact with a heat source (resulting in deeper burns), and z Curiosity leading them to investigate their environment and risk burn exposure. Burn injury is both a source and a marker of abuse-related injury in children. Small children are susceptible to abuse- related burn injuries due to their small size, reliance on adults

2019 American College of Surgeons

31. Improving the health of the public by 2040

health, health-related quality of life and health equity, and in which the UK contributes to the global endeavour for similar improvements. Through public engagement activities we found widespread support for our assumption that this aspiration is of inherent societal value. To realise this, we must take a much broader view of the drivers of health and the types of evidence we need to intervene – now and in the future – for the promotion of health and the prevention of disease. ‘Health of the public (...) and genetic determinants of health and health inequalities. Yet there remains much we do not know about the complex array of interlinking factors that influence the health of the public, and about how to prevent and solve the many health challenges we face as a population, including obesity, diabetes, dementia, depression, cancer and persisting and emerging infections. We do not yet have a robust understanding of the long-term impacts of many of the wider drivers of health that cut across local, national

2017 Academy of Medical Sciences

32. How to improve the Organisation of Mental healthcare for older adults in Belgium?

because of their involvement in the topic of “Mental health care elderly”. Therefore, by definition, each of them might have a certain degree of conflict of interest to the main topic of this report’ Membership of a stakeholder group on which the results of this report could have an impact: Gérald Deschietere (Target population in consultation), An Haekens (VVP), Christophe Lafosse (Belgische Vereniging van Geriatrie en Gerontologie), Chantal Mathy (Nomenclature change - financial impact (INAMI (...) – RIZIV)), Mary Quentin (SSMG, FAMGB – GGNO), Véronique Tellier (Mental health care services), Petra Thewes (Specific initiatives for the elderly of SSM), Rik Thys (Board member centre GGZ, about law Flanders), Robert Van Buggenhout (Vlaamse Vereniging voor psychiatrie, sector elderly psychiatrie), Patrick Vanneste (AVIQ), Sylvie Veyt (Influence on the SSM study) Fees or other compensation for writing a publication or participating in its development: Frederic Limosin (Publication of a clinical trial

2018 Belgian Health Care Knowledge Centre

33. Wellbeing indicators across the life cycle

, covering economic, home, health, education and skills, and social and community. They are household income, educational attainment, employment, unemployment, financial hardship, overcrowding, housing affordability, homelessness, life expectancy, self-reported health status, disability, smoking behaviour, mental health, cognitive skills, social network/support and volunteering. 8 WELLBEING INDICATORS ACROSS THE LIFE CYCLE | SAX INSTITUTE Table 1. High useability indicators Economic 1. Household income 2 (...) . Employment 3. Unemployment 4. Financial hardship Home 1. Overcrowding 2. Housing affordability 3. Homelessness Health 1. Life expectancy 2. Self-reported health status 3. Disability 4. Smoking behaviour 5. Mental health Education and Skills 1. Educational attainment 2. Cognitive skills Social and Community 1. Social network/support 2. Volunteering Empowerment (0) Safety (0) While we assessed these indicators as having high useability for the NSW framework, FACS may wish to use other indicators. We have

2017 Sax Institute Evidence Check

35. Developing a National Pain Strategy for Canada

, as in is the case of [neuropathic or nociplastic pain].”(9) Biopsychosocial model for managing chronic pain An interdisciplinary approach that addresses the dynamic interaction among physiological, psychological and social factors, and embraces the assessment and management of all dimensions of pain (e.g., emotional disorders, maladaptive cognitions, functional deficits, and physical deconditioning).(10) McMaster Health Forum 9 Evidence >> Insight >> Action While the brief strives to address all Canadians (...) of pain (to address the dynamic interaction among physiological, psychological and social factors) and beyond the assessment and management of that pain (to embrace the assessment and management of all dimensions of pain, including for example, emotional disorders, maladaptive cognitions, functional deficits, and physical deconditioning). Related to this, appropriate goal-setting moves beyond ‘treating the pain’ (to making measurable improvements in functioning and quality of life) for the many

2017 McMaster Health Forum

36. Cognitive reserve

. These terms, albeit often used interchangeably in the literature, provide a useful way of discussing the models. Using a computer analogy brain reserve can be seen as hardware and cognitive reserve as software. All these factors are currently believed to contribute to global reserve. Cognitive reserve is commonly used to refer to both brain and cognitive reserves in the literature. In 1988 a study published in Annals of Neurology reporting findings from post-mortem examinations on 137 elderly persons (...) onset dementia. This might indicate a vulnerability to the manifestation of clinical cognitive impairment, although there may be other explanations. Structures like the cerebellum contribute to brain reserve. The cerebellum contains the majority of neurons in the brain and participates to both cognitive and motor operations. Genetic component of cognitive reserve [ ] Evidence from a indicates a genetic contribution to cognitive functions. Heritability estimates have been found to be high for general

2012 Wikipedia

37. The Wechsler Digit Symbol Substitution Test as the Best Indicator of the Risk of Impaired Driving in Alzheimer Disease and Normal Aging. (PubMed)

The Wechsler Digit Symbol Substitution Test as the Best Indicator of the Risk of Impaired Driving in Alzheimer Disease and Normal Aging. Our purpose was to identify cognitive tools associated with unsafe driving among elderly drivers of varying cognitive levels.Twenty drivers with early-stage dementia of the Alzheimer type and 56 nondemented drivers aged 65-85 were recruited. Various cognitive processes were measured and unsafe driving was evaluated during an in-traffic road test with 3 (...) different indicators and a composite indicator.The Wechsler Digit Symbol Substitution Test score was the best cognitive measure to detect unsafe drivers using the composite driving indicator.The Digit Symbol Substitution Test may be used by physicians for the evaluation and follow-up of older patients, with or without Alzheimer-type dementia, as a screening tool of unsafe driving.

2010 Dementia and Geriatric Cognitive Disorders

38. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm

mechanisms of action. 11. Comprehensive management includes lipid and BP therapies and treatment of related comorbidities. 12. Therapy must be evaluated frequently (e.g., every 3 months) until stable using multiple criteria, includ- ing A1C, SMBG records (fasting and postprandial) or continuous glucose monitoring tracings, documented and suspected hypoglycemia events, lipid and BP values, adverse events (weight gain, fluid retention, hepatic or renal impairment, or CVD), comorbidi- ties, other relevant (...) for Health in Diabetes) and Diabetes Prevention Program (DPP) stud- ies, lowering caloric intake is the main driver for weight loss (3-6). The clinician, a registered dietitian, or a nutri- tionist (i.e., a healthcare professional with formal train- ing 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 should focus on foods that promote health, including information

2018 American Association of Clinical Endocrinologists

39. Improving Quality of Life: Substance Use and Aging

services. This chapter provides an overview of some of the harmful consequences of substance use among the aging population, including hospitalization, falls, vehicular accidents, cognitive impairment, depression, substance withdrawal and death, including by suicide. Mortality rates are much higher among older adults who have substance use disorders. Because the use of alcohol and medication, whether prescribed or misused, causes greater harm in older adults than illicit drugs, this chapter focuses (...) of substance use in older adults has proven to be difficult for a number of reasons. Too often, the symptoms of impairment are dismissed by clinicians as the symptoms of old age. The social isolation experienced by many older adults results in fewer opportunities for monitoring by friends and family. As their social networks continue to grow smaller, many older adults are hesitant to even broach the topic of substance use with family or caregivers, not wanting to bring conflict into their few remaining

2018 Canadian Centre on Substance Abuse

40. Continuous glucose monitoring (CGM real-time) and flash glucose monitoring (FGM) as personal, standalone systems in patients with diabetes mellitus treated with insulin

and women. The prevalence of peripheral vascular dis- ease in patients with diabetes aged 30 years or older is 26% [102-104]. In addition to the traditional complications described above, diabetes has been associated with increased rates of specific cancers, and increased rates of physical and cognitive disability [16]. [A0006] – What are the consequences of diabetes mellitus for the society? Diabetes mellitus and related complications have significant impact on the population level, as a serious threat (...) on intensive insulin regimens: • with impaired or absent awareness of hypoglycaemia; • with symptomatic hypoglycaemic events despite optimal management using SMBG or alternatives • who have a significant fear of hypoglycaemia which prevents them from managing their diabetes optimally • whose HbA1c remains high despite optimal management using SMBG or alternative glucose monitoring • who have a need for particularly tight control of BG in order to continue in their occupation (such as driving cars

2018 EUnetHTA

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