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Elderly Drivers with Cognitive Impairment

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22. 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

23. 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

24. 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

26. 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

27. Driving and pain

accident. Benzodiazepines with long half lives may be particularly implicated in causing crashes. Opioids Opioids are associated with a number of side effects that may impair the ability to drive including: sedation, fatigue, cognitive and visual disturbance. Elderly drivers who are not habituated to opioids show signs of impairment even at relatively low doses of a weak opioid such as codeine. 8 It is of no surprise that stronger opioids when given to opioid naïve drivers also show evidence (...) and duloxetine are also associated with an increased risk of crashing, although objective tests of driving function often fail to demonstrate a deleterious effect. 7 Antiepileptic drugs Anticonvulsant medications such as carbamazepine and gabapentin can cause sedation, cognitive impairment and visual disturbance and are associated with a significantly increased risk of crashing. 7 Reducing the dose of anti- epileptic medication appears to reduce the risk of an accident. NSAIDS Although not commonly

2017 Faculty of Pain Medicine

29. Low back pain and radicular pain: evaluation and management

was proposed by physiotherapists and focused on non-invasive interventions (medication not included) in the treatment of chronic low back pain. It appeared indeed that several conservative multidisciplinary therapeutic programs based on physical reactivation (exercise) and cognitive-behavioral interventions existed without a definition of the precise composition of such programs and without consensual recommendations (see list of interventions in Appendix 2). However, the cost of surgery for low back pain (...) (suitable for primary care management according to guidelines), medium risk subgroup (high levels of physical prognostic indicators, appropriate for physiotherapy), and high risk subgroup (high levels of psychosocial prognostic indicators, appropriate for a combination of physical and cognitive-behavioural treatments). By contrast, the Örebro tool did not make any distinction between physical and psychosocial risk factors, making specific treatment allocation more difficult. ? The Belgian GDG

2017 Belgian Health Care Knowledge Centre

31. Active travel in Glasgow: what we?ve learned so far

of the research, data analysis and evidence reviews also have a wider focus on Scotland, the UK or internationally. Where appropriate, relevant research or data from other sources have also been cited. There are some important aspects of transport and active travel that relate to health that are not covered in detail in this report, including public transport, parking, traffic congestion, driver education and specific details of appropriate infrastructure developments. This is not because (...) health 16 and can contribute to improved mental wellbeing 17 and better cognitive function in older people 18 . 2.2 Healthy weight Physical activity helps maintain a healthy weight. Countries with higher levels of active travel have lower self-reported obesity rates and vice versa (see Figure 2). Figure 2: Relationship between adult obesity and active transport in Australia and 13 countries in Europe and North America: 2000–2006. Source: Pucher J, Buehler R, Bassett DR, Dannenberg AL. Walking

2017 Glasgow Centre for Population Health

32. ABCD position statement on standards of care for management of adults with type 1 diabetes

of ageing leads to progressive losses which affect physical and cognitive performance and impact on diabetes management. Activity levels fall, muscle bulk reduces and appetite may decrease, leading to weight loss and frailty, with increased insulin sensitivity The risks of hypoglycaemia (particularly neurological damage and falls) are increased in this age group. Cognitive decline and visual impairment may make self- management decisions more difficult. Many people with type 1 diabetes will have decades (...) of experience in managing their condition – such knowledge cannot be passed on to carers and the loss of independence and the control of their diabetes can be very distressing. Factors affecting diabetes management in older people ? Comorbidities and geriatric syndromes including depression ? Impaired cognition leading to insulin errors, missed meals and reduced ability to identify and manage hypoglycaemia ? Visual, hearing and functional impairment ? Polypharmacy ? Falls and fractures ? Vulnerability

2017 Association of British Clinical Diabetologists

33. CRACKCast E102 – Seizures

damage Rhabdomyolysis Autonomic discharge & bulbar muscle involvement may result in Urinary or fecal incontinence Vomiting Tongue biting Potential airway impairment. Posterior shoulder dislocations or fractures [9] Describe the legal implications of diagnosis of new seizure According to the Government of British Columbia New onset seizure has a private driving restriction: With a seizure free period up to 6 months; Or Medical clearance to drive by a Neurologist Professional Drivers must be: Seizure (...) will see seizures! Bimodal age distribution with vast majority being in infants (febrile seizures) and the elderly over age 75 (structural brain abnormalities). For neurons to work properly, we need a balance milieu inside and out of the cell membrane. This includes the balance between excitatory neurotransmitters (think glutamate and acetylcholine) and inhibitory neurotransmitters (think GABA). So things like infection, infection, toxins, electrolyte imbalances, and other pathologic processes come

2017 CandiEM

35. Key policies for addressing the social determinants of health and health inequities

for improving population health, and especially important for more vulnerable children. Evidence indicates that actions to improve early child development have the most cost-effective impact on health equity (9,10,12,20). Children’s social, educational and health care needs are closely intertwined. Thus, inadequate socioeconomic conditions, care, health, nutrition and physical and emotional nurturing can reduce educational attainment by impairing cognitive and behavioural capacities, delaying motor (...) programmes should be considered (Case study 3). The most successful programmes place a strong focus on cognitive outcomes, which are more malleable earlier in life. More information on the importance of these approaches for SROI is provided in the linked report on investment for health and well-being (12). Such programmes provide disadvantaged children with an enriched out-of-family environment while also working to raise the quality of the home environment (22). Home visiting improves service uptake

2017 WHO Health Evidence Network

36. Care at the Scene: Research for ambulance services

and injuries. But the majority of 999 calls are not traffic accidents and heart attacks. More typical- ly, calls involve people with complex and ongoing health problems experiencing a crisis. This could be an elderly person with heart failure and diabetes having had a fall, someone with lung disease experiencing breathlessness or a person at risk of suicide ringing in distress. Patient needs have become more complex, there is an ageing population and the number of 999 calls has risen. At the same time (...) arrangements. It is sometimes difficult to know which option is best. And we need to understand what encourages people to choose one service over another. The question of where patients go is addressed in part of an NIHR review looking at published research on drivers for increased demand for emergency care (Turner 2015, NIHR published study one). The reasons were complex and difficult to synthesise from the 38 relevant papers, but included issues such as access to, and confidence in, primary care

2016 NIHR Dissemination Centre - Themed Reviews

37. Influencing the trajectories of ageing

, declines are markedly faster in the overweight and obese. 14 By comparing otherwise similar individuals with contrasting muscle quality, Dr Ferrucci and colleagues identified 8 Katsimpardi L, et al. (2014). Vascular and neurogenic rejuvenation of the aging mouse brain by young systemic factors. Science 344(6184), 630–634. 9 Smith LK, et al. (2015). ß2-microglobulin is a systemic pro-aging factor that impairs cognitive function and neurogenesis. Nat Med. 21(8), 932–937. 10 Bjedov I, et al. (2010 (...) ). Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing. Age Ageing. 44(1), 162–165. The Academy of Medical Sciences 12 Two complementary approaches are most commonly used to identify and quantify frailty. The frailty index approach identifies generalised frailty and involves determining the proportion of deficits experienced by an individual, which include the following: the presence of long-term conditions; physical, cognitive or sensory impairments

2016 Academy of Medical Sciences

38. Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association

PVD Active substance abuse Impaired cognitive function Unmanaged psychiatric disorder Lack of social support CRT indicates cardiac resynchronization therapy; DT, destination therapy; NYHA, New York Heart Association; Vo 2 , oxygen consumption; and PVD, peripheral vascular disease. As of July 2014, 158 centers in the United States offer long-term MCS. Patients often live a substantial distance from the implanting center, necessitating active involvement of local first responders (emergency medical (...) to assist patients with MCS with device-related care on a daily basis. A multidisciplinary plan involving medical and psychosocial care, including psychopharmacology and counseling, may contribute to positive outcomes for both patients and caregivers. Cardiac-related cognitive dysfunction often resolves after MCS, which may significantly improve the quality of life for the patient and family. In elderly destination therapy patients, dementia can become an issue, and follow-up cognitive assessment

2017 American Heart Association

39. The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

not consistently occur. For example, different providers may have different methods of coding encounters, which can limit interprovider comparability. In addition, consistent biases in coding such as “up-coding” can significantly impair the veracity of claims data insights. Nonetheless, International Classification of Diseases codes have demonstrated accuracy in characterizing CVD conditions and care. Second, aspects of care that are important clinically (such as patient preferences) but not relevant from (...) Environmental Protection Agency air quality monitoring network to assess the relationship between coarse particular matter levels and cardiovascular hospitalizations among 110 large urban US counties. Researchers found that increased air pollution levels were associated with higher rates of hospitalizations in elderly patients, suggesting that actions such as counseling patients to remain indoors during high-pollution days may have an impact on overall cardiac health. Other environmental data sources

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2017 American Heart Association

40. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society

tone, with rapid and spontaneous recovery. The presumed mechanism is cerebral hypoperfusion. , There should not be clinical features of other nonsyncope causes of loss of consciousness, such as seizure, antecedent head trauma, or apparent loss of consciousness (ie, pseudosyncope). , Loss of consciousness A cognitive state in which one lacks awareness of oneself and one’s situation, with an inability to respond to stimuli. Transient loss of consciousness Self-limited loss of consciousness can (...) %. Females reported a higher prevalence of syncope (22% versus 15%, P <0.001). The incidence follows a trimodal distribution in both sexes, with the first episode common around 20, 60, or 80 years of age and the third peak occurring 5 to 7 years earlier in males. Predictors of recurrent syncope in older adults are aortic stenosis, impaired renal function, atrioventricular or left bundle-branch block, male sex, chronic obstructive pulmonary disorder, heart failure, atrial fibrillation, advancing age

2017 American Heart Association

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