Melissa L. O'Connor

Ten Years Down the Road: Predictors of Driving Cessation

PURPOSE Recent prospective studies have found that cognition is a more salient predictor of driving cessation than physical performance or demographic factors among community-dwelling older adults. However, these studies have been limited to 5 years of follow-up. The current study used data from the Maryland Older Drivers Project to examine predictors of driving cessation in older adults over a 10-year period. DESIGN AND METHODS Participants (N = 1,248) completed baseline and 5-year assessments of physical and cognitive abilities. Driving status was ascertained at baseline and annually thereafter. RESULTS Cox proportional hazard models were used to examine the risk of driving cessation as a function of demographic, physical, and cognitive predictors. The final model indicated three significant predictors of driving cessation, older age at baseline (hazard ratio [HR] = 1.12, p < .001), days driven per week (HR = 0.83, p = .05), and slower speed of processing as measured by the Useful Field of View Test (HR = 1.76, p < .01). IMPLICATIONS These results underscore the importance of cognitive speed of processing to the maintenance of driving. Brief cognitive assessment can be conducted in the field to potentially identify older adults at increased risk for driving cessation. Further research is needed to determine the costs and potential benefits of such screening.

Changes in Mobility Among Older Adults with Psychometrically Defined Mild Cognitive Impairment

Studies have found that adults with possible mild cognitive impairment (MCI) exhibit decrements in everyday functioning (e.g., Wadley, V. G., Crowe, M., Marsiske, M., Cook, S. E., Unverzagt, F. W., Rosenberg, A. L., et al. (2007). Changes in everyday function among individuals with psychometrically defined mild cognitive impairment. Journal of the American Geriatrics Society, 55, 1192-1198). However, it is not known whether driving mobility and life space mobility are reduced in such individuals. The current study examined 5-year trajectories of mobility change in older adults (N = 2,355) with psychometrically defined MCI from the Advanced Cognitive Training for Independent and Vital Elderly trial. Mixed effect models evaluated group differences for the following mobility outcomes: driving space, life space, driving frequency, and driving difficulty. Relative to cognitively normal participants, participants with possible MCI showed reduced baseline mobility for all outcomes as well as faster rates of decline for driving frequency and difficulty. These results suggest that mobility declines could be features of MCI, and changes in mobility may be particularly important for researchers and clinicians to monitor in this population.

Randomized trial of cognitive speed of processing training in Parkinson disease

Objective: To examine the efficacy of cognitive speed of processing training (SOPT) among individuals with Parkinson disease (PD). Moderators of SOPT were also examined. Methods: Eighty-seven adults, 40 years of age or older, with a diagnosis of idiopathic PD in Hoehn & Yahr stages 1–3 and on a stable medication regimen were randomized to either 20 hours of self-administered SOPT (using InSight software) or a no-contact control condition. Participants were assessed at baseline and after 3 months of training (or an equivalent delay). The primary outcome measure was useful field of view test (UFOV) performance, and secondary outcomes included cognitive self-perceptions and depressive symptoms. Results: Results indicated that participants randomized to SOPT experienced significantly greater improvements on UFOV performance relative to controls, Wilks λ = 0.938, F 1,72 = 4.79, p = 0.032, partial η2 = 0.062. Findings indicated no significant effect of training on secondary outcomes, Wilks λ = 0.987, F2,70 < 1, p = 0.637, partial η2 = 0.013. Conclusions: Patients with mild to moderate stage PD can self-administer SOPT and improve their cognitive speed of processing, as indexed by UFOV (a robust predictor of driving performance in aging and PD). Further research should establish if persons with PD experience longitudinal benefits of such training and if improvements translate to benefits in functional activities such as driving. Classification of evidence: This study provides Class III evidence that SOPT improves UFOV performance among persons in the mild to moderate stages of PD.

Development and Psychometric Validation of the Dementia Attitudes Scale

This study employed qualitative construct mapping and factor analysis to construct a scale to measure attitudes toward dementia. Five family caregivers, five professionals, and five college students participated in structured interviews. Qualitative analysis of the interviews led to a 46-item scale, which was reduced to 20 items following principal axis factoring with two different samples: college students (N = 302) and certified nursing assistant students (N = 145). Confirmatory factor analysis was then conducted with another sample of college students (N = 157). The final scale, titled the Dementia Attitudes Scale (DAS), essentially had a two-factor structure; the factors were labeled “dementia knowledge” and “social comfort.” Total-scale Cronbachs alphas ranged 0.83–0.85. Evidence for convergent validity was promising, as the DAS correlated significantly with scales that measured ageism and attitudes toward disabilities (range of correlations = 0.44–0.55; mean correlation = 0.50). These findings demonstrate the reliability and validity of the DAS, supporting its use as a research tool.

A Terror Management Perspective on Young Adults' Ageism and Attitudes toward Dementia.

According to Terror Management Theory as applied to ageism, older adults may be associated with mortality, thereby generating death-thought accessibility, stereotypes, and mixed emotions among younger adults. However, it is unclear how older adults’ health conditions, such as dementia, affect ageist attitudes and mortality salience. In the current study, college student participants (N = 240) read descriptions of hypothetical target persons. Target age (29 or 71) and health status (normal, unknown, arthritis, or dementia) were manipulated. Participants then rated targets on stereotype content dimensions of competence and warmth; rated their emotions toward the targets; and completed a measure of death-thought accessibility. Results (p < .05 for all) indicated that, relative to younger targets, older targets triggered lower competence ratings, higher warmth ratings, greater death-thought accessibility, and more empathy and pity. Targets with dementia generated lower competence ratings, higher warmth ratings, greater death-thought accessibility, and more fear, empathy, and pity than targets with normal and/or unknown health. Older targets with dementia (i.e., Alzheimers disease) received higher pity ratings than all other targets, and participants reported more death-related thoughts for older vs. younger targets with dementia. The current study supports Terror Management Theory as an explanation for ageism, and illustrates how ageism among young adults is affected by health conditions like dementia.

Cognitive speed of processing training in older adults with visual impairments.

To examine whether older adults with vision impairment differentially benefit from cognitive speed of processing training (SPT) relative to healthy older adults.

Use, maintenance and dose effects of cognitive speed of processing training in Parkinson's disease

ABSTRACT Introduction: Recent research indicated that cognitive speed of processing training (SPT) improved Useful Field of View (UFOV) among individuals with Parkinsons disease (PD). The effects of SPT in PD have not been further examined. The objectives of the current study were to investigate use, maintenance and dose effects of SPT among individuals with PD. Methods: Participants who were randomized to SPT or a delayed control group completed the UFOV at a six-month follow-up visit. Use of SPT was monitored across the six-month study period. Regression explored factors affecting SPT use. Mixed effect models were conducted to examine the durability of training gains among those randomized to SPT (n = 44), and training dose effects among the entire sample (n = 87). Results: The majority of participants chose to continue to use SPT (52%). Those randomized to SPT maintained improvements in UFOV performance. A significant dose effect of SPT was evident such that more hours of training were associated with greater UFOV performance improvements. The cognitive benefits derived from SPT in PD may be maintained for up to three months. Conclusion: Future research should determine how long gains endure and explore if such training gains transfer.

Predictors of health care provider anticipatory guidance provision for older drivers

ABSTRACT Objective: The objective of this study was to determine the frequency of health care provider (HCP) driving safety/cessation-related anticipatory guidance provision and predictors of driving safety-related anticipatory guidance provision by HCPs. Methods: HCPs in several central/upper Midwest states were surveyed about frequency of anticipatory guidance provision (n = 265). Results: More than half of HCPs stated that they frequently or always provide driving safety/cessation-related anticipatory guidance to patients aged 85 or older, 38.7% provided this guidance to patients aged 75 to 84, and 13.7% to patients aged 65 to 74. Predictors of driving safety/cessation-related anticipatory guidance provision differed by patient age. For patients aged 65–74, HCP personal experience with a motor vehicle crash (either the HCP themselves or a friend/family member) was significant in predicting anticipatory guidance provision. However, for patients aged 75 and older, significant predictors included HCP rural practice, HCP age, and percentage of HCP patients who were older adults. Conclusion: HCP counseling provision related to driving issues differs by patient age and several HCP characteristics, including HCP rurality, age, and personal experience with motor vehicle crashes. Because aging results in physical and mental changes that affect driving and can be identified by HCPs, HCPs are in a position to counsel patients on the potential impacts of aging on the act of driving. Future research should examine the reasons for the differences in anticipatory guidance provision found in this study.