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Elderly Drivers with Cognitive Impairment


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141. EFNS?ENS Guidelines on the diagnosis and management of disorders associated with dementia

management guidelines in dementia and original scientific papers published in peer‐reviewed journals before June 2011. The search strategy sought only studies published in English. The principal search term was dementia. Other terms entered into the search included diagnosis, guideline, management, recommendation, review, treatment. For each topic, the evidence was sought in MEDLINE according to pre‐defined search protocols 1 *Searching terms used in the search strategy: vascular cognitive impairment (...) , fluctuating attention and cognition, and motor features of parkinsonism . Suggestive features include neuroleptic sensitivity, changes in dopamine transporter SPECT imaging and REM sleep behaviour disturbance . Most previous studies observed a more severe impairment in visual‐spatial abilities, attention and executive functions in persons with DLB compared with persons with AD (class IV evidence). The complex visual hallucinations with emotional responses to these experiences, which vary from intense fear

2012 European Academy of Neurology

142. The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease

in the elderly. ARF still occurs from time to time in affluent populations, and the persistently high rates of ARF in some middle-class regions of the USA 1 highlight the need to remain aware of this disease in all populations. To support this in Australia, an evidence-based review for the diagnosis and management of ARF and RHD was published by the Heart Foundation and the Cardiac Society of Australia and New Zealand (CSANZ) in 2006. 2 This second edition of the original evidence-based review has again (...) ? pericardial friction rub or effusion • Expanded discussion on cognitive dysfunction with chorea • Upper limits of normal (ULN) for serum streptococcal antibody titres expanded to include children and adults based on Fiji data (Table 3.6) Table 1.1 Levels of evidence for clinical interventions, and grades of recommendation Level of evidence Study design Grade of recommendation I Evidence obtained from a systematic review of all relevant RCT A Rich body of high quality RCT data II Evidence obtained from

2012 Clinical Practice Guidelines Portal

143. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

in symptomatic patients, diabetes, diagnosis, dobutamine stress echocardiography, echocardiography, elderly, electrocardiogram (ECG) and chronic stable angina, emergency department, ethnic, exercise, exercise stress testing, follow-up testing, gender, glycemic control, hypertension, intravascular ultrasound, fractional flow reserve (FFR), invasive coronary angiography, kidney disease, low-density lipoprotein (LDL) lowering, magnetic resonance imaging (MRI), medication adherence, minority groups, mortality

2011 American Heart Association

144. Supportive care in multiple myeloma

be observed and some will become less anaemic as the myeloma is controlled with chemotherapy. ESA treatment is recommended for anaemic patients with myeloma with associated renal impairment ( ). ESA doses of <20 000 iu/week may be adequate in patients where renal disease is the main cause of the anaemia. In the UK, it may be necessary to refer the patient to a renal physician to access NHS funding for ESAs. Data from randomized trials, which have included patients with myeloma, suggest that ESAs increase (...) If no risk factors (RF) or only 1 RF consider aspirin If 2 or more RF present consider either: LMWH (high risk prophylactic dose e.g. enoxaparin 40 mg od) or Warfarin (target INR 2·5) Obesity (Body Mass Index ≥ 30) Co‐morbidities: cardiac, diabetes, renal impairment, chronic inflammatory disease Immobility (acute or chronic) Thrombophilias, myeloproliferative disorders, haemoglobinopathies Recent surgery (within 6 weeks): neuro‐, trauma, orthopaedic, general, other Medications: erythropoiesis stimulating

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2011 British Committee for Standards in Haematology

145. General Palliative Care Guidelines for the Management of Pain at the End of Life in Adult Patients

benefit from co-codamol 8/500 in comparison to paracetamol alone 38 . Dihydrocodeine - one tenth the potency of oral morphine. Maximum dose: 60mg Qds is approximately equivalent to 24mg oral morphine daily. a void in renal impairment Tramadol - Centrally acting with both opioid and non-opioid properties. the dose used should be the lowest dose that provides pain relief in the elderly, adjustment in the dosage or dose interval may be required. Maximum dose of 400mg /24hrs, is approximately equivalent (...) , deteriorating renal and/or hepatic function , hypercalcaemia. Symptoms and signs: Include drowsiness, myoclonic jerks, pinpoint pupils (poor discriminating sign), confusion/ agitation, hallucinations, vivid dreams, cognitive impairment and respiratory depression. Management • Mild opioid toxicity: reduce the dose of opioid; ensure adequate hydration and treat any underlying cause. If agitation / confusion problematic haloperidol 1.5mg - 3 mg orally or subcutaneously can be given. • Moderate opioid toxicity

2011 Regulation and Quality Improvement Authority

146. Summary of General Palliative Care Guidelines for the Management of Pain at the End of Life for Adults

modified and immediate release morphine. • Stop regular weak opioid and consult opioid conversion charts for appropriate starting dose • Commence modified-release morphine e.g. 12 hourly morphine 10-20 mg Bd. lower doses (5mg Bd) should be used in patients who are opioid-naïve, elderly or have renal impairment. • Prescribe approximately 1/6 of this total daily dose as immediate release morphine for breakthrough pain. • if pain control is inadequate after 24-36hrs, and there is no evidence of opioid (...) Summary of General Palliative Care Guidelines for the Management of Pain at the End of Life for Adults Summary of General Palliative Care GuidelineS for the manaGement of Pain at the end of life for adultS Opioid for moderate to severe pain ± Non-opioid ± Adjuvant Opioid for mild to moderate pain ± Non-opioid ± Adjuvant Non-opioid ± Adjuvant WHO Pain Relief Ladder Step 3 Step 2 Step 1 Pain For patients with hepatic impairment or renal impairment consult full text version of Pain Guidelines Step

2011 Regulation and Quality Improvement Authority

147. Preventing and Mitigating Nurse Fatigue in Health Care

and patient safety 1 defines nurse fatigue as: “A subjective feeling of tiredness (experienced by nurses) that is physically and mentally penetrative. It ranges from tired- ness to exhaustion, creating an unrelenting overall condition that interferes with individuals’ physical and cognitive ability to function to their normal capacity. It is multidimensional in both its causes and manifestations; it is influenced by many factors: physiological (e.g. circadian rhythm), psychological (e.g. stress, alertness (...) , organi- zational performance and societal outcomes. External Socio-Cultural Factors Physical/Structural Policy Components Cognitive/Psycho/ Socio/Cultural Components Professional/ Occupational Components Cognitive/Psycho/Social Work Demand Factors Organizational Social Factors External Professional/Occupational Factors Individual Nurse Factors Organizational Professional/Occupational Factors External Policy Factors Physical Work Demand Factors Organizational Physical Factors Individual Work Context

2011 Registered Nurses' Association of Ontario

148. CPG on sleep disorders in childhood and adolescence in primary care

practices and behavioral interventions that at least include stimulus control is recommended for treating insomnia. Another intervention that could be recommended is cognitive restructuring. B For adolescents, sleep education and management programmes are recommended, including guidelines on sleep hygiene practices, instructions on stimulus control and information about consuming substances and the impact that sleep problems can have on mood and academic performance. B To reduce cognitive activation (...) receive supervision when they perform potentially dangerous activities (such as swimming). Adolescents who are diagnosed with narcolepsy and who have driver’s licenses will be advised not to drive and to notify their status to the Department of Motor Vehicles. They will also be informed about legislation in force, which states that persons with narcolepsy may not obtain or extend a driver’s license, unless a favourable medical report is issued, in which case the validity period of the license can

2011 GuiaSalud

149. Effects of Age and Task Load on Drivers’ Response Accuracy and Reaction Time When Responding to Traffic Lights (PubMed)

information and respond accurately. Both prolonged RT and increased no-response rate, especially for difficult tasks, might attest an impairment of cognitive abilities in relation to aging. Accordingly, casual driving conditions for young drivers may be particularly complex and stressful for elderly people who should thus be informed about the effects of normal aging upon driving. (...) Effects of Age and Task Load on Drivers’ Response Accuracy and Reaction Time When Responding to Traffic Lights Due to population aging, elderly drivers represent an increasing proportion of car drivers. Yet, how aging alters sensorimotor functions and impacts driving safety remains poorly understood. This paper aimed at assessing to which extent elderly drivers are sensitive to various task loads and how this affects the reaction time (RT) in a driving context. Old and middle-aged people

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2016 Frontiers in aging neuroscience

150. Anticipating and Tracking: Pack of Gerontological Assessment Embedded

aging" theme one of its priorities. This image of driver of innovation in this area can only be enhanced by a program like ARPEGE. Beyond the scientific and technological results expected, one can imagine the potential socio-economic benefits if this tracking solution is deployed on a large scale. Condition or disease Intervention/treatment Phase Elderly Other: evaluation of frailty Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial (...) or 6 Consenting to participate in the study Exclusion Criteria: Severe cognitive impairment ( MMSE < 10) Major neurosensory disorders Full hospitalization or not (acute care and rehabilitation..) Non- affiliation to a social security scheme Major protected by law (guardianship, trusteeship) Informed consent not provide Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using

2016 Clinical Trials

151. Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning

addressed in this guideline, eg fever is covered by SIGN 108. 7 Table 1: Common impairments, limitations and complications after stroke Common impairments after a first ever stroke include: ? Aphasia ? Apraxia of speech ? Arm/hand/leg weakness ? Cognitive impairment ? Dysarthria ? Dysphagia ? Facial weakness ? Gait, balance and coordination problems ? Perceptual impairments, including visuospatial dysfunction ? Sensory loss ? Upper limb impairment ? Visual problems Common activity limitations include (...) General rehabilitation principles 12 4.2 Gait, balance and mobility 15 4.3 Upper limb function 19 4.4 Cognition 22 4.5 Visual problems 23 4.6 Communication 25 4.7 Nutrition and swallowing 26 4.8 Continence 29 4.9 Post-stroke spasticity 31 4.10 Prevention and treatment of shoulder subluxation 34 4.11 Pain 35 4.12 Prevention of post-stroke shoulder pain 36 4.13 Treatment of post-stroke shoulder pain 39 4.14 Post-stroke fatigue 42 4.15 Disturbances of mood and emotional behaviour 43 4.16 Sexuality 46

2010 SIGN

152. Management of diabetes

Crescent Edinburgh EH12 9EB 1 Introduction 1 1.1 The need for a guideline 1 1.2 Remit of the guideline 1 1.3 Definitions 2 1.4 Statement of intent 3 2 Key recommendations 5 2.1 Lifestyle management 5 2.2 Psychosocial factors 5 2.3 Management of type 1 diabetes 6 2.4 Management of diabetes in pregnancy 7 2.5 Management of diabetic cardiovascular disease 7 2.6 Management of kidney disease in diabetes 7 2.7 Prevention of visual impairment 8 2.8 Management of diabetic foot disease 8 (...) and progression of kidney disease in diabetes 84 9.3 Screening for kidney disease in diabetes 85 9.4 Investigation of kidney disease in diabetes 87 9.5 Prevention and treatment of kidney disease in diabetes 87 9.6 Management of complications 93 9.7 Models of care 94 9.8 Checklist for provision of information 9510 Prevention of visual impairment 96 10.1 Risk identification and prevention 96 10.2 Screening 97 10.3 Treatment 100 10.4 Rehabilitation 102 10.5 Checklist for provision of information 102 11

2010 SIGN

153. Management of obesity

and associated lost productivity. Treatment for affected individuals with elevated health risks, provided within clinical settings, represents only one part of a broader societal solution. The need for a comprehensive and multisectoral approach to obesity prevention is clear. Effective action requires addressing the commercial, environmental and social policy drivers of obesity. These are beyond the scope of this clinical guideline and approaches to broader determinants are discussed in other documents. 2,3 (...) or death. 46 2 + Mortality Obesity is associated with excess mortality. 47,48,49 BMI (above 22.5-25 kg/m 2 ) is a strong predictor of overall mortality with most of the excess mortality likely to be causal and due to vascular disease. In the elderly (age =65), a BMI in the moderately obese range is associated with a modest increase in mortality risk regardless of sex, disease state and smoking status. 50 Physical inactivity and adiposity have both independent and dependent effects on all-cause

2010 SIGN

154. Chronic obstructive pulmonary disease

What are the complications? Disability and impaired quality of life — progressive breathlessness can lead to reduced mobility, and the person becoming increasingly housebound. Depression and anxiety — these common comorbidities of COPD and are often undiagnosed [ ]. Cor pulmonale (right heart failure secondary to lung disease) — caused by pulmonary hypertension as a consequence of hypoxia. Frequent chest infections. Secondary polycythaemia — overproduction of red blood cells due to hypoxia. Type 2 (...) respiratory failure — caused by increased airway resistance. Lung cancer — COPD may increase the risk of lung cancer. However, it is not clear whether this is due to common risk factors, such as smoking, involvement of susceptibility genes, or impaired clearance of carcinogens [ ]. [ ] Diagnosis Diagnosis of chronic obstructive pulmonary disease Diagnosis - COPD Diagnosis of chronic obstructive pulmonary disease There is no single diagnostic test for chronic obstructive pulmonary disease (COPD). Make

2015 NICE Clinical Knowledge Summaries

155. Bipolar disorder

additional symptoms, and which is severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization, or which includes psychotic features. A hypomanic episode is similar to a manic episode except that a diagnosis only requires that symptoms have lasted for 4 days, a hypomanic episode is not severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization, and there are no psychotic features. A depressive episode (...) into this topic. The 2011/2012 QOF indicators have also been added to this topic. Issued in June 2011. May 2011 — interaction between SSRIs and tamoxifen added as stated in the most recent SPCs. Issued in June 2011. February 2011 — topic structure revised to ensure consistency across CKS topics - no changes to clinical recommendations have been made. October 2010 — minor update. Information on fitness to drive from the Driver and Vehicle Licensing Agency's guidance for medical practitioners, At a glance guide

2015 NICE Clinical Knowledge Summaries

156. Atrial fibrillation

may result from the persistently elevated ventricular rate seen in uncontrolled AF [ ]. Reduced quality of life AF can result in reduced exercise tolerance and impaired cognitive function [ ; ]. A systematic review of 49 studies found that people with AF have significantly poorer quality of life than healthy controls, the general population, and people with coronary heart disease [ ]. Prognosis What is the prognosis? People with atrial fibrillation (AF) are nearly twice as likely to die (...) Atrial fibrillation Atrial fibrillation - NICE CKS Clinical Knowledge Summaries Share Atrial fibrillation: Summary Atrial fibrillation (AF) is an arrhythmia. It results from irregular, disorganized electrical activity in the atria, leading to an irregular ventricular rhythm. The ventricular rate of untreated AF often averages between 160–180 beats per minute (although this is typically slower in elderly people). The most common causes of AF are ischaemic heart disease, hypertension, valvular

2015 NICE Clinical Knowledge Summaries

157. Psychosis and schizophrenia

Psychosis and schizophrenia Psychosis and schizophrenia - NICE CKS Clinical Knowledge Summaries Share Psychosis and schizophrenia: Summary Psychosis is a disordered mental state characterized principally by positive symptoms such as hallucinations, delusions, and thought disorder. Psychotic symptoms are cardinal features of psychotic disorders such as schizophrenia, but may be caused by medicines and substance misuse, and by medical conditions such as sepsis in the elderly. Psychotic disorders (...) health service if not. An antipsychotic drug should not be given to the person while awaiting specialist assessment unless it is done under advice from a consultant psychiatrist. For people who are at risk of developing a psychotic disorder, specialist mental health services will usually offer treatment with individual cognitive behavioural therapy (CBT) with or without family intervention. For people with a diagnosed psychotic disorder, specialist mental health services will usually offer

2015 NICE Clinical Knowledge Summaries

158. Depression

of recurrence is: At least 50% after a first episode of depression, 70% after a second episode and 90% after a third episode. Increased in people under 20 years of age, and in elderly people. Depression is diagnosed according to the DSM-5 classification by the presence of at least five out of a possible nine defining symptoms, present for at least 2 weeks, of sufficient severity to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. People (...) activities and a range of associated emotional, cognitive, physical, and behavioural symptoms. It is defined in the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the presence of at least five out of a possible nine defining , present for at least 2 weeks, of sufficient severity to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning [ ]. Subthreshold depressive

2015 NICE Clinical Knowledge Summaries

159. Insomnia

for elderly people). Lormetazepam 500 micrograms at night. Benzodiazepines are contraindicated in people with [ ]: Respiratory depression, marked neuromuscular respiratory weakness such as unstable myasthenia gravis, acute pulmonary insufficiency, and sleep apnoea syndrome. Adverse effects of benzodiazepines include : Cognitive and psychomotor impairment, depression, emotional blunting, and, less commonly, paradoxical excitement with increased anxiety, irritability, or hyperactive or aggressive behaviour (...) that may exacerbate insomnia. The diary should be kept for at least 2 weeks. Good sleep hygiene should be established in all people with insomnia. This aims to make people more aware of behavioural, environmental, and temporal factors that may be detrimental or beneficial to sleep. For short-term insomnia, a short course (less than 2 weeks) of a hypnotic drug may be considered if daytime impairment is severe. For long-term insomnia, cognitive and behavioural interventions are recommended first line

2014 NICE Clinical Knowledge Summaries

160. MI - secondary prevention

of Direct Oral Anticoagulants in the Elderly for Stroke Prevention in Atrial Fibrillation andSecondary Prevention of Venous Thromboembolism: Systematic Review and Meta-Analysis. Circulation 132 (3), 194-204. [ ] Primary evidence No new randomized controlled trials published since 1 June 2014. New policies New policies No new national policies or guidelines since 1 June 2014. New safety alert New safety alert No new safety alerts since 1 June 2014. Changes in product availability Changes in product (...) on the person's physical and psychological status, the nature of the work, and the work environment. Driving The latest information from the Driver and Vehicle Licensing Agency (DVLA) regarding medical fitness to drive can be obtained at . In general: For a car or motorcycle licence holder, following an MI the person does not need to inform the DVLA. However, driving should stop for a time (the length depends on factors such as type of MI and treatments). The person should check with their insurer

2014 NICE Clinical Knowledge Summaries

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