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Elderly Drivers with Cognitive Impairment


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61. Benign Paroxysmal Positional Vertigo (BPPV)

of falls, depression, and impairments of their daily activities. Persistent untreated or undiagnosed vertigo in the elderly leads to increased caregiver burden with resultant societal costs including decreased family productivity and increased risk of nursing home placement. Among an estimated 7.0 million elderly individuals reporting dizziness in the prior 12 months, 2.0 million (30.1%) reported vertigo, and there were 230,000 office visits among the elderly with a diagnosis of BPPV (...) canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling; (4) reassess patients within 1 month after an initial

2017 American Academy of Otolaryngology - Head and Neck Surgery

62. Obstructive Sleep Apnea in Adults: Screening

OSA include cardiovascular disease and cerebrovascular events, diabetes, cognitive impairment, decreased quality of life, and motor vehicle crashes. Detection Evidence on the use of validated screening questionnaires in asymptomatic adults (or adults with unrecognized symptoms) to accurately identify who will benefit from further testing for OSA is inadequate. The USPSTF identified this as a critical gap in the evidence. Benefits of Early Detection and Intervention or Treatment The USPSTF found (...) , but the applicability of this evidence to screen-detected populations is unknown. The USPSTF found inadequate evidence on whether treatment with CPAP or MADs improves other health outcomes (mortality, cognitive impairment, motor vehicle crashes, and cardiovascular or cerebrovascular events). The USPSTF also found inadequate evidence on the effect of treatment with various surgical procedures in improving intermediate or health outcomes. Harms of Early Detection and Intervention or Treatment The USPSTF found

2017 U.S. Preventive Services Task Force

63. Rehabilitation of Lower Limb Amputation

with LLA is influenced by a variety of factors that include, but are not limited to, level of amputation, cognitive impairment, physical conditioning, social support, comorbidities, and psychological factors.[20] Amputations caused by vascular disease generally occur in aging populations with numerous other comorbidities such as cardiovascular disease, hypertension, renal 3 See Veterans Health Administration Directive 1410, Prevention of Amputation in Veterans Everywhere. Available at: https (...) Care 23 VII. Discussion of Recommendations 24 A. All Phases of Amputation Rehabilitation 24 B. Perioperative Phase 31 C. Pre-Prosthetic Phase 39 D. Prosthetic Training Phase 40 VIII. Knowledge Gaps and Recommended Research 46 A. Training programs 46 B. Rehabilitation dosing 47 C. Patient factors and considerations 47 D. Cognitive assessment 47 E. Perioperative LLA interventions 47 VA/DoD Clinical Practice Guideline for Rehabilitation of Individuals with Lower Limb Amputation September 2017 Page 4

2017 VA/DoD Clinical Practice Guidelines

64. Diagnosis and Treatment of Low Back Pain

to remain active, and providing information about self-care options. Strong for Reviewed, Amended 7. For patients with chronic low back pain, we suggest adding a structured education component, including pain neurophysiology, as part of a multicomponent self-management intervention. Weak for Reviewed, New-added C. Non-pharmacologic and Non-invasive Therapy 8. For patients with chronic low back pain, we recommend cognitive behavioral therapy. Strong for Reviewed, New-replaced 9. For patients with chronic

2017 VA/DoD Clinical Practice Guidelines

65. Management of Opioid Therapy (OT) for Chronic Pain

beliefs and expectations about chronic pain and its treatment.[36] Patients with chronic pain may also experience worsened quality of life, mental health, immune system function, physical function, sleep, employment status, and impaired personal relationships.[3,42-44] Worsening of some of these factors (e.g., quality of life, change in employment status) seems to also be associated with pain severity and the presence of psychiatric comorbidities.[45,46] Patients with chronic pain report psychological (...) of controlled substances ? Intolerance, serious adverse effects, or a history of inadequate beneficial response to opioids ? Impaired bowel motility unresponsive to therapy ? Traumatic brain injury ? Pain conditions worsened by opioids (e.g., fibromyalgia, headache) ? True allergy to opioid agents (that cannot be resolved by switching agents) a. Significant Risk Factors • Duration and dose of OT: See Recommendation 2 for more guidance on duration of OT and Recommendations 10-12 for more guidance on dosing

2017 VA/DoD Clinical Practice Guidelines

66. Dyslipidaemias

subtilisin/kexin type 9 PPAR-α peroxisome proliferator-activated receptor-α PROCAM Prospective Cardiovascular Munster Study PROSPER Prospective Study of Pravastatin in the Elderly at Risk PUFA polyunsaturated fatty acid RAAS renin–angiotensin–aldosterone system RCT randomized controlled trial REACH Reduction of Atherothrombosis for Continued Health REDUCE-IT Reduction of Cardiovascular Events with EPA-Intervention Trial REVEAL Randomized Evaluation of the Effects of Anacetrapib Through Lipid modification (...) RR relative risk RYR red yeast rice 4S Scandinavian Simvastatin Survival Study SALTIRE Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression SAGE Studies Assessing Goals in the Elderly SCORE Systemic Coronary Risk Estimation SEAS Simvastatin and Ezetimibe in Aortic Stenosis SFA saturated fatty acid SHARP Study of Heart and Renal Protection SLE systemic lupus erythematosus SPARCL Stroke Prevention by Aggressive Reduction in Cholesterol Levels STEMI ST elevation myocardial

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2016 European Society of Cardiology

67. Atrial Fibrillation

. , , Contemporary studies show that 20–30% of patients with an ischaemic stroke have AF diagnosed before, during, or after the initial event. , , White matter lesions in the brain, cognitive impairment, – decreased quality of life, , and depressed mood are common in AF patients, and between 10–40% of AF patients are hospitalized each year. , , Table 3 Cardiovascular morbidity and mortality associated with atrial fibrillation AF = atrial fibrillation; LV = left ventricular. Table 3 Cardiovascular morbidity (...) Concomitant atrial fibrillation surgery 69 11.4.2 Stand-alone rhythm control surgery 71 11.5 Choice of rhythm control following treatment failure 72 11.6 The atrial fibrillation Heart Team 72 12 Hybrid rhythm control therapy 74 12.1 Combining antiarrhythmic drugs and catheter ablation 74 12.2 Combining antiarrhythmic drugs and pacemakers 74 13 Specific situations 74 13.1 Frail and ‘elderly’ patients 74 13.2 Inherited cardiomyopathies, channelopathies, and accessory pathways 75 13.2.1 Wolff–Parkinson–White

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2016 European Society of Cardiology

68. An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years ? Technical report

. The quality of nutrition may influence the timing of puberty by several months even in the absence of obesity. A review of observational studies shows a delay of puberty onset in young girls with higher intakes of vegetable protein and lower intakes of animal protein. Nutrition and anemia In Canada, an estimated 3% of primary school-aged children are anemic. More are iron deficient. Iron deficiency has been associated with impaired cognitive and physical development. The supplementary pages in the Greig (...) dysfunctional long-term relationships later in life. Parenting initiatives such as cognitive stimulation and emotional support are effective measures for primary prevention of bullying. Cognitive stimulation and attending to early cognitive deficits such as language problems, imperfect causal understanding and poor inhibitory control are helpful strategies, possibly because children with these deficits also have decreased competence with peers (which can, in time, lead to them to exhibit bullying behaviours

2016 Canadian Paediatric Society

69. CVD Prevention in Clinical Practice

-reactive protein HYVET Hypertension in the Very Elderly Trial ICD International Classification of Diseases IMT intima–media thickness INVEST International Verapamil-Trandolapril Study LDL-C low-density lipoprotein cholesterol Lp(a) lipoprotein(a) LV left ventricle/left ventricular LVH left ventricular hypertrophy MET metabolic equivalent MHO metabolically healthy overweight/obesity MI myocardial infarction MUFA monounsaturated fatty acids NGO non-governmental organization NHS National Health Service (...) . bus drivers and pilots, may be reasonable,as is screening for CV risk factors in women before prescribing combined oralcontraception, although there are no data to support the beneficial effects.Beyond this, systematic CV risk assessment in adults <40 years of age with noknown CV risk factors is not recommended as a main strategy due to the lowcost-effectiveness. Systematic CV assessment may be considered in adult men>40 years of age and in women >50 years of age or post-menopausal with noknown CV

2016 European Society of Cardiology

70. Dementia, disability and frailty in later life - mid-life approaches to delay or prevent onset

, arthritis and cardiovascular disease, as well as obesity, are all associated with forms of disability. Frailty can be either physical or psychological frailty, or a combination of the two, and can occur as a result of a range of diseases and medical conditions. This guidance uses the deficit model of frailty that adds up a person's impairments and conditions to create a measure of risk and severity (Morley et al. 2013). This model includes comorbidity and disability as well as cognitive, psychological (...) and dementia, disability and frailty. Show how a wide range of domestic, leisure and work activities can help people to be physically active and explain how even modest increases in physical activity, at any age, can be beneficial. Include information on how physical activity: reduces the risk of illness in both the short and long term, preserves memory and cognitive ability, reduces risk of falls and leads to a healthier old age, improving wellbeing and quality of life is enjoyable and can have social

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

71. The role of biomarkers in ruling out cerebral lesions in mild cranial trauma

. Its main causes include falls, motor vehicle accidents, assaults, alcohol consumption and sports injuries. Cranial trauma may lead to a temporary or permanent impairment of cognitive, physical, or psychosocial functions. They represent one of the most critical public health problems around the world with an estimated annual incidence rate in Europe of 262 per 100 000 population. 1 Populations more at risk of cranial trauma include children below 4 years of age, young adults (aged below 25 (...) ) and the elderly (aged over 75). 1 There is a distinction between mild (or light), moderate and severe cranial trauma. Such distinction is most often based on the Glasgow Coma Scale (GCS): a 3 to 15-point scale used to assess patients’ level of consciousness and neurologic functioning after a head injury (see Table 1). Mild cranial trauma (mCT) often defined as GCS 13-15 is by far, the most frequent, accounting for as many as 71% to 98% of cases and is the subject of interest of this review. 5 Biomarkers

2016 Belgian Health Care Knowledge Centre

72. ABCD position statement on standards of care for management of adults with type 1 diabetes - this has been superseded by the 2017 version - see above

and appetite may decrease, leading to weight loss and frailty, with increased insulin sensitivity. Cognitive decline and visual impairment may make self-management decisions more difficult. The risks of hypoglycaemia (particularly neurological damage and falls) are increased in this age group. 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 ? Co-morbidities 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 ? Poly-pharmacy ? Falls and fractures ? Vulnerability to hypoglycaemia There is no evidence on which to base guidance for management of type 1 diabetes in older people. The emphasis should be on individualising

2016 Association of British Clinical Diabetologists

73. An Official ATS Statement: Impact of Mild Obstructive Sleep Apnea in Adults

drivers, including 56 with mild OSA, found the mean ESS was 7.4 in those with mild OSA versus 6.8 in those with no OSA, but there was no statistical comparison of mild versus no OSA (65). In a Swedish study of middle-aged women, including 128 with mildOSA,theprevalenceof EDSde?nedas ESS greater than or equal to 10 was similar in those with mild OSA (36%) and no OSA (37%) (49). Although the prevalence rates of EDS and involuntarily falling asleep during the daytime on the basis of speci?c questions (...) ). In summary, a limited number of population-based and clinic-based studies providecon?ictingdataregardingtheriskof MVAs associated with mild OSA. Quality of life. Three large population- based cross-sectional studies evaluating the impact of mild OSA on quality of life were identi?ed. One study in elderly men (1,009 with mild OSA) and another in elderly women (178 with mild OSA) failed to show any association between mild OSA and the Functional Outcomes of Sleep Questionnaire (FOSQ) score (32, 33

2016 American Thoracic Society

74. Acute Myocardial Infarction in Women

-Hispanic white women, black and Hispanic women have more comorbidities (eg, DM, hypertension, HF, and obesity) at the time of presentation with AMI. , , , At the time of presentation, 60% of older black women and 54% of younger black women have a clustering of ≥3 risk factors. The high prevalence of comorbidities is the hypothesized driver of higher rates of MI and a significant contributor to poorer long-term outcomes in black women. , , In the Corpus Christi Heart Project, rates of hospitalization (...) with atherosclerosis regression. CAS plays a significant role in the development of an AMI via thrombin generation resulting in thrombus formation and impaired fibrinolytic activity resulting in thrombus preservation. In patients with ACS from the Coronary Artery Spasm in Patients With Acute Coronary Syndrome (CASPAR) study, ≈25% had no obstructive culprit lesion on coronary angiography. CAS was present in almost 50% of the patients who underwent acetylcholine provocative testing. Provoked CAS is an independent

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2016 American Heart Association

75. Guidelines for adult stroke rehabilitation and recovery

are well established in clinical practice and constitute a standard of care that is unlikely to be directly tested in a randomized, clinical trial, for example, the provision of physical therapy (PT) to early stroke survi- vors with impaired walking ability. Thus, practice guidelines such as this one will likely rely on a mixture of evidence and consensus. It is hoped that the relative proportion of recom- mendations based on rigorous evidence will grow over time. This guideline uses the framework (...) of the International Classification of Functioning, Disability, and Health (ICF) 3 ; (4) Sensorimotor Impairments and Activities (treatment/interventions), focused on the activity level of the ICF; and (5) Transitions in Care and Community Rehabilitation, focused primarily on the participation level of the ICF. Published guidelines are, by their very nature, a reflection of clinical practice at a particular point in time and the evidence base available. As new information becomes available, best practice can

2016 American Academy of Neurology

76. Management of Carpal Tunnel Syndrome

The principal impact of CTS on patients relates to the sensory disturbance which may disrupt sleep and, during non-sleeping hours, impair strength and the ability to carry out fine manipulation. CTS may also be associated with pain in the wrist and digits. These symptoms may have a substantial effect on an individual’s ability to accomplish activities of daily living and to perform work-related duties. Potential Benefits, Harms, and Contraindications The main benefit of a guideline focused on diagnosis

2016 American Academy of Orthopaedic Surgeons

77. AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery

) and balance/vestibular rehabilitation; and therapies for cognitive impairments and hemi-spatial neglect, the reader is directed to those subsections in The Rehabilitation Program section. Prevention and Medical Management of Comorbidities Prevention of Skin Breakdown and Contractures Hemiparesis, sensory changes, and altered levels of consciousness place the patient with stroke at risk for joint and muscle contractures and skin breakdown. Pressure ulcers are also associated with impaired circulation (...) ICH. Therefore, recommendations are consistent with those of ischemic stroke. Treatment of Bowel and Bladder Incontinence Urinary incontinence and fecal incontinence are common problems after stroke. Approximately 40% to 60% of stroke patients have urinary incontinence during their acute admission for stroke, falling to 25% by hospital discharge. At 1 year, 15% will remain incontinent of urine. Age, cognition, and motor impairments are risk factors for bladder incontinence. Fecal incontinence

2016 American Heart Association

78. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

achieve weight loss or should it be used chronically in the treatment of obesity? 103 Q7.4. Are there differences in weight-loss drug efficacy and safety? 104 Q7.5. Should combinations of weight-loss medications be used in a manner that is not approved by the U.S. Food and Drug Administration? 108 Q8. Are there hierarchies of drug preferences in patients with the following disorders or characteristics? 108 Q8.1. Chronic kidney disease 108 Q8.2. Nephrolithiasis 109 Q8.3. Hepatic impairment 110 Q8.4 (...) . Hypertension 111 Q8.5. Cardiovascular disease and arrhythmia 113 Q8.6. Depression with or without selective serotonin reuptake inhibitors 115 Q8.7. Anxiety 118 Q8.8. Psychotic disorders with or without medications (lithium, atypical antipsychotics, monoamine oxidase inhibitors) 119 Q8.9. Eating disorders including binge eating disorder 121 Q8.10. Glaucoma 123 Q8.11. Seizure disorder 124 Q8.12. Pancreatitis 124 Q8.13. Opioid use 125 Q8.14. Women of reproductive potential 126 Q8.15. The elderly, age =65

2016 American Association of Clinical Endocrinologists

79. Age and the anaesthetist

. Negotiations on a new English consultant contract are advanced, but a final offer has yet to be made. Pension changes have already been introduced, with the ageing population as one of the major drivers. More people living longer with more comorbidities will undoubtedly put more strain on the affordability of healthcare and healthcare workers are not immune to these pressures. The implications for anaesthetists of these demographic changes are not just theoretical. We will all face clinical, personal (...) . Anaesthesia News 2016; 349: 3-27. ‘Every generation Blames the one before And all of their frustrations Come beating on your door’ Mike and the Mechanics, 1988 One of the most important problems facing developed societies is how to manage and support the increase in the elderly, economically inactive population through taxation levied on the younger, economically active population. This financial burden has come into sharp focus over recent years as the retirement patterns of the 55-65 year old group have

2016 Association of Anaesthetists of GB and Ireland

80. Canadian stroke best practice recommendations: acute inpatient stroke care guidelines, update 2015

and strokerecoverygroupliaisons(EvidenceLevelB). iii. The interprofessional team should assess patients within48hofadmissiontohospitalandformulate a management plan (Evidence Level B). a. Clinicians should use standardized, valid assess- ment tools to evaluate the patient’s stroke- related impairments and functional status (Evidence Level B). b. Assessment components should include dyspha- gia, mood and cognition, mobility, functional assessment, temperature, nutrition, bowel and bladder function, skin breakdown, discharge (...) Level C). vi. Patients should undergo an initial screening for vascular cognitive impairment when indicated (Evidence Level C). 2.1. Cardiovascular investigations i. Incaseswheretheelectrocardiogramorinitialcar- diac rhythm monitoring (e.g. 24 or 48h ECG monitoring) does not show atrial ?brillation but a cardioembolic mechanism is suspected, International Journal of Stroke, 11(2) 244 International Journal of Stroke 11(2)prolonged ECG monitoring, up to 30 days dur- ation, is recommended in selected

2015 CPG Infobase

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