Maureen Mohyde

Gender Differences in Self-Regulation Patterns and Attitudes Toward Driving Among Older Adults

ABSTRACT The automobile is essential for many older adults to fulfill their daily needs, especially since many live where they lack access to public transit or other acceptable modes of transportation. Increased self-regulation is one way older drivers continue to drive safely and maintain mobility. This research considers whether self-regulation attitudes and patterns differ by gender. Results indicate that women and men report distinct patterns of self-regulation behaviors. Age, health status, and household status also interact with gender, influencing the extent of self-regulation. The results also show that women report lower levels of confidence in their driving skills than men, although the difference varies based on whether or not a woman lives alone. Implications of these results are considered for an aging population—particularly women—that over the coming decades will be more reliant on the automobile for transportation than ever before.

To drive or not to drive, that isn't the question-the meaning of self-regulation among older drivers

PROBLEM This research examines older drivers and how they rationalize and cope with their own changing psychological and physical functioning vis-à-vis self-regulation and driving. METHOD A national survey was mailed to a sample of drivers over the age of 50. An overall response rate of 53.11% was achieved, with 3,824 valid responses returned. This paper discusses the qualitative findings of the open-ended questions in this survey. RESULTS A rich, multidimensional description of self-regulation emerged from the data. Driving self-regulation was not simply a checklist of behaviors performed but a combination of attitudes and behaviors, including important social and psychological processes and automobile attributes. Household composition played an important role in determining what ones options were for getting around and how serious they were in enforcing self-regulation behaviors. DISCUSSION & SUMMARY As a society, we must realize the importance of driving in maintaining independence, feelings of self-worth, and being connected to life and society. This research presents the qualitative findings of a nationwide survey of drivers over the age of 50. The results revealed that older drivers define self-regulation as much more than the changes in behaviors due to declining health and ability. The older adults in our research strongly emphasized the psychological processes surrounding independence, self-worth, remaining connected to life and society, and what role the automobile plays. Household composition impacted decisions related to self-regulation. For instance, those from a two-person household were more willing to let their partner drive or share in the driving, while those who lived alone were less likely to self-regulate their driving. IMPACT ON INDUSTRY Education programs targeting older adults need to be expanded to include not only the behavioral components of self-regulation, but also the psychological factors that play an equally meaningful role. Legislators devising policy programs need to reconsider what are viable transportation options for the older adult.

A qualitative exploration of self-regulation behaviors among older drivers

ABSTRACT While much of the research on aging and driving has focused on sensory and motor changes, little is known about older drivers and the actual self-regulation adjustments they employ to continue driving safely. This research looks at how older drivers have made changes to driving patterns and behaviors that have allowed them to continue to drive without compromising their perceived safety, independence, and quality of life. Nine focus groups were held with older men and women aged 58 to 89 years. Some of the major themes that emerged were the following: older adults are very aware of age-related changes to driving; they perceive that self-regulation behaviors change with age; and they view transportation alternatives as limited or nonexistent. Policy implications include developing functional transit programs for older adults and car manufacturer training workshops to educate older adults on the safety features of newly purchased automobiles.

At the Crossroads: Development and evaluation of a dementia caregiver group intervention to assist in driving cessation

ABSTRACT Deciding when an individual with dementia must reduce or stop driving can be a stressful issue for family caregivers. The purpose of this study was to develop a group intervention to assist these caregivers with driving issues and to provide a preliminary evaluation of the comparative effectiveness of this At the Crossroads intervention. Participants were randomized to one of three arms: (1) active intervention (four 2-hour manualized educational/support group meetings; n = 31); (2) written materials only (participants received written materials after a pretest; n = 23); and (3) control (participants received written materials after a posttest; n = 12). Participants were administered a battery of self-report and interview-based questionnaires at baseline and again 2 months later. At follow-up, the active intervention group scored significantly better than both other groups on key outcome variables, including self-efficacy, communication, and preparedness. The At the Crossroads caregiver intervention appears to effectively provide education and support needed for caregivers to address driving-related issues with their loved ones.

Family Matter: Older Drivers and the Driving Decision

Decisions about limiting or stopping driving are among the most difficult that older adults face. There is little research related to this decision making of older drivers, family members, and other trusted individuals who contribute to the decision. To report on the preferences that older drivers have for conversations with others with concerns about their driving, this paper draws on a series of focus groups and a U.S. survey of drivers age 50 and older. A majority of survey respondents indicated that they engaged in some degree of voluntary self-regulation of their driving. People generally preferred to be approached by individual family members as opposed to those outside the family for conversations about their driving. In terms of preferences for who should speak with the older driver, differences emerged on the basis of household status. Most older adults who were married preferred to hear first from a spouse, although the choice was not universal. Doctors and adult children were also preferred choices for conversations. The paper concludes with a discussion of pragmatic implications of the research for conducting conversations with older adults about concerns with their driving.

Poster 547 Conceptual Design and Content Validation of a Screening Tool to Detect Disabling Spasticity in Stroke Survivors

Disclosures: J. Blazuk, No Disclosures. Case Description: A 58-year-old man with history of coronary artery disease, hypertension, seizures and multiple strokes presented to the emergency room with confusion. Computed tomography (CT) of head revealed chronic infarcts in the right frontal lobe and left occipital area. Magnetic resonance imaging (MRI) of brain revealed acute bilateral occipital lobe infarcts. Echocardiogram showed an ejection fraction of 10-15% and an apical thrombus in the left ventricle that was managed with Coumadin. On physical examination, extraocular movements were intact and pupils accommodated to light symmetrically. Difficulty naming objects and finger agnosia was noted. He adamantly denied vision problems and was diagnosed with Anton Syndrome. Given poor safety, impulsivity, and impaired balance, the patient was referred to acute inpatient rehabilitation. Setting: Acute inpatient rehabilitation hospital. Results or Clinical Course: Initially, he incorrectly named shapes and colors and could not locate objects in the room. During the rehabilitation course, his ability to recognize shapes and shades of color improved; he could read time on a clock and avoid obstacles when ambulating. He became aware of his visual deficits on the third day of rehab. At discharge, he could negotiate a flight of stairs and perform all ADLs and transfers with supervision. Discussion: Cortical blindness is loss of vision caused by insults to the occipital visual cortex, bilaterally. Visual agnosognosia, Anton syndrome, is a rare complication of cortical blindness that results from injury to the visual association cortex. It is characterized by denial of blindness and preserved pupillary reaction. Patients commonly confabulate explanations for their vision problems, are impulsive and have decreased safety awareness. Conclusions: Anton’s Syndrome is a rare neurological disorder where patients benefit substantially from inpatient rehabilitation.

Poster 534 Conceptual Design and Content Validation of a Health Related Quality of Life Measure for Stroke Survivors with Spasticity

Disclosures: B. O. Adeyemo, No Disclosures. Objective: Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct stimulation (tDCS) are two powerful noninvasive neuromodulatory therapies that have the potential to alter and evaluate the integrity of the corticospinal tract. Recent evidence has shown that brain stimulation might be beneficial in stroke recovery. Given the multiple attempted models of noninvasive stimulation, this study aims to develop and assess the safety of comparative treatment protocol of various forms of noninvasive stimulation. Design: This paper presents a sham-controlled double-blinded investigation of the treatment effects of rTMS and tDCS on human motor function. Two subjects underwent 6 different combined protocols of non-invasive stimulation: high-frequency rTMS (HrTMS), low-frequency rTMS (L-rTMS), sham rTMS (S-rTMS), anodal tDCS (A-tDCS), cathodal tDCS (C-tDCS), and sham tDCS (S-tDCS). Safety outcomes were measured before and after noninvasive stimulation and at 1-week follow-up. Setting: Research laboratory. Participants: 2 healthy subjects. Interventions: H-rTMS, L-rTMS, s-rTMS, A-tDCS, C-tDCS, StDCS. Main Outcome Measures: Safety and side-effects questionnaires and visual analog scales (pain and anxiety). Secondary outcome measures included Jebson Taylor Hand Function, ROM, cortical excitability, Mini Mental State Examination (MMSE), cortical excitability, Beck Depression Scale (BDS). Results: Overall, the investigation of H-rTMS, L-rTMS, s-rTMS, A-tDCS, C-tDCS, and S-tDCS was tolerated well with mild side effects primarily comprising headache and fatigue. The side-effects were not definitely attributed to the technique. No serious adverse events occurred. BDS data and self-report visual analog scales for anxiety and pain did not worsen with stimulation. Cognitive assessment using MMSE did not show an adverse outcome. No significant worsening in psychiatric, cortical excitability, motor, symptom, or neuropsychological measures was detected. All measured dimensions showed mild improvement/absence of decline, with notable patient tolerance and safety. Conclusions: It appears that application of this designed comparative protocol of stimulation is safe and well-tolerated. Future sham-controlled studies are warranted to support the clinical efficacy of this model, in hopes of employing its use to further adjunct therapy in stroke rehabilitation.