Nina M. Silverstein

Driving behaviors in early stage dementia: a study using in-vehicle technology

According to the Alzheimers Association (2011), (1) in 8 people age 65 and older, and about one-half of people age 85 and older, have Alzheimers disease in the United States (US). There is evidence that drivers with Alzheimers disease and related dementias are at an increased risk for unsafe driving. Recent advances in sensor, computer, and telecommunication technologies provide a method for automatically collecting detailed, objective information about the driving performance of drivers, including those with early stage dementia. The objective of this project was to use in-vehicle technology to describe a set of driving behaviors that may be common in individuals with early stage dementia (i.e., a diagnosis of memory loss) and compare these behaviors to a group of drivers without cognitive impairment. Seventeen drivers with a diagnosis of early stage dementia, who had completed a comprehensive driving assessment and were cleared to drive, participated in the study. Participants had their vehicles instrumented with a suite of sensors and a data acquisition system, and drove 1-2 months as they would under normal circumstances. Data from the in-vehicle instrumentation were reduced and analyzed, using a set of algorithms/heuristics developed by the research team. Data from the early stage dementia group were compared to similar data from an existing dataset of 26 older drivers without dementia. The early stage dementia group was found to have significantly restricted driving space relative to the comparison group. At the same time, the early stage dementia group (which had been previously cleared by an occupational therapist as safe to drive) drove as safely as the comparison group. Few safety-related behavioral errors were found for either group. Wayfinding problems were rare among both groups, but the early stage dementia group was significantly more likely to get lost.

Older Learners on Campus

Abstract Who are the older learners on campus? What are their motivations for pursuing higher education? What obstacles do they face? And what do they intend to do upon completion of their course of study? These are some of the questions explored by gerontology students in an action-research study of older learners enrolled at the University of Massachusetts Boston (UMB). The overall factors mentioned by respondents that influenced their enrollment decisions were: interest in subject, becoming a more informed person, gaining self-confidence, and the joy of learning. The major obstacles they encountered while attending classes were family obligations and the scheduling of course offerings. Gaining insight into the perceptions of older learners is a positive step toward making campuses more “older learner-friendly.”

At-Risk Drivers with Alzheimer's Disease: Recognition, Response, and Referral

Objective. This manuscript addresses the following questions for licensing authorities: 1) Are drivers with Alzheimers disease (AD) an issue that should concern licensing authorities? 2) What critical driving skills impacted by AD should authorities recognize? 3) What should their response be? 4) Do licensing authorities have a role in providing information about or referral to community agencies that offer alternative transportation options and other services? Methods. To address issues important to licensing authorities the authors reviewed pertinent driving and dementia literature. Results. Drivers with AD have unique impairments that should be recognized and responded to early on in the disease process, with sensitivity and respect for continued mobility. As the disease progresses and they must stop driving, former drivers and their families could benefit from resource referrals that provide information about transportation alternatives and support services in their communities. Conclusions. The authors believe that drivers with AD should be a concern for licensing authorities. Licensing decisions and policies to assess and regulate drivers are in the end made individually by each state. Policymakers will make their decisions based upon current research and concerns of their constituency and need to consider a seamless approach to addressing safe mobility. Licensing authorities are an important partner along with individuals, family members, health care professionals, social service providers, researchers, and policymakers in assuring public safety and individual mobility. All of the partners should confront the concern directly—none should “look the other way.” The goal is to keep people driving safely for as long as possible. The responsibility is to recognize, respond, and refer when driving safely is no longer assured.

When Life Exceeds Safe Driving Expectancy: Implications for Gerontology and Geriatrics Education

ABSTRACT Research findings suggest that life expectancy exceeds safe driving expectancy after age 70 by about 6 years for men and 10 years for women; yet few people plan for a time when driving is no longer possible. Transportation planning should be considered along with financial, legal, health care, and housing issues during preretirement in the range of advice gerontologists and geriatricians provide to older adults and their families. The message is that we all should be planning for our nondriving years. Myriad issues of potential concern exist for gerontologists and geriatricians from the screening and assessment of functional impairments that may affect critical driving skills, to licensing and renewal and the monitoring of driver safety, to driving restriction and cessation, and to the introduction of senior friendly community mobility options. Transportation, after all, is critical for connecting us to goods and services as well as to employment, volunteering, and civic engagement opportunities. This theme issue brings together representatives from the research community, licensing authority, allied health profession of occupational therapy, and community transit. All have important messages for gerontology and geriatrics education.

Physician outpatient contacts and hospitalizations among cognitively impaired elderly

This study examined how physician contacts and hospitalizations vary in relation to cognitive function level among community‐residing older adults.

Adult day health care for participants with Alzheimer's disease.

The purpose of this study was to explore existing practices and services provided by adult day health care (ADHC) in Massachusetts and to document how providers are addressing the specific needs of participants with Alzheimer’s disease and related disorders. Specific focus related to the early, late, and end stages of the disease process, and to early-onset dementia. Both quantitative and qualitative methods were used. A total of 93 (60%) providers responded to an electronic survey in 2008. In-person interviews were conducted with eight sites purposively chosen for their delivery of Alzheimer’s specific services. Results demonstrate that ADHC providers are adapting to the cognitive and physical abilities of their participants; however, there is need for enhancing stage-specific services, especially for participants at later stages and for early-onset dementia. This analysis provides preliminary insights into understanding the criteria that define ‘‘dementia-capable’’ programs and services.

Taking Control of Alzheimer's Disease: A Training Evaluation.

The purpose of the current study was to evaluate a training program for persons with early-stage Alzheimers disease and their care partners. Care partners were mailed two surveys, one for themselves and one for the person with dementia. Domains covered in the training included an overview of cognitive disorders, treatment of symptoms including medications, research updates and opportunities, memory and safety enhancement techniques, legal and financial planning, driving, ways to stay active, becoming an advocate, and communication. The results indicate a high level of participant satisfaction and impact on current lifestyles. Lifestyle changes such as diet, physical and mental exercises were likely to be made in tandem, by the person with dementia and the care partner together. Further, the results provide insights into the perceptions of the care partners and the persons with dementia as they learn about the disease and live through its progression. The program had positive impacts for the person with dementia and for the care partner in increasing knowledge of Alzheimers disease, providing comfort with sharing the diagnosis, personal planning, and in decision making. Although many had taken important decision-making actions prior to the training, an additional twenty percent prepared or revised their wills, health care proxies, durable powers of attorney, or medical directives and looked into asset protection after participating in the training.

The Two-Way Video Classroom

Abstract The authors describe an intercampus venture employing video-based, distance education technology to address gaps in their respective gerontology curricula. They discuss their efforts to increase participation of faculty in the exchange of gerontology resources by providing them with training in the pedagogy and technology of the two-way video classroom. The rationale for and nature of this training and the advantages and limitations of video-based distance education are explored. The authors consider several common concerns related to distance education, note innovations that have enhanced the delivery course content and student-active learning, and comment on bridges built between their respective institutions as a consequence of this project.

Assisted living residences in Massachusetts: How ready and willing are they to serve people with Alzheimer' s disease or a related disorder?

Assisted living is a growing residential option for persons with cognitive impairments and their families. Massachusetts recently passed legislation (January 1995) establishing assisted living residences into law. While many elder advocates applauded this legislation as a step forward in recognizing both the housing and supportive needs of older residents, others voiced concern that the legislation did not contain specific wording regarding the need Jbr 24-hour “awake” staff which many consider to be a crucial element in the care of dementia residents.

Do memory-impaired drivers and their family members agree on driving ability and behaviors?

It is estimated that approximately one-third of people with dementia continue to drive. Compared with the general driving population, drivers with dementia are at an increased risk of unsafe motor vehicle operation. Self-screening is often the basis for self-regulation of driving. It is not known how well self-screening as a predominant strategy works for drivers with memory impairment. This descriptive study explored the perceptions of 22 dyads of drivers with memory impairment and their family members through 44 structured telephone interviews within 4 months after specialized driving assessment to gain insights into their level of agreement on the drivers health, functioning, and critical driving behaviors. Drivers and family members were in fair agreement about current driving patterns and driver self-regulation (such as avoiding driving at night, in bad weather, or in unfamiliar areas). However, when reports of functional ability (such as vision, strength, and flexibility) were compared, drivers rated their fitness more highly than those abilities were rated by their family members on most measures. Moreover, there was poor agreement between drivers and family members on reported occurrence of driving behaviors suggestive of impairment in critical driving skills. These results have implications for health care and other professionals engaged in determining driver fitness. The findings suggest limited value in self-screening or in family reports when assessing fitness to drive in persons with memory impairment. Professionals should exercise caution in relying on reports from family members or drivers, especially with respect to reported driving fitness and driving behaviors.