Thomas M. Meuser

Motor-vehicle crash history and licensing outcomes for older drivers reported as medically impaired in Missouri

The identification and evaluation of medically impaired drivers is an important safety issue. Medical fitness to drive is applicable to all ages but is particularly salient for older adults. Voluntary procedures, whereby various professionals and family members may report medical fitness concerns to State driver license bureaus, are common in the United States. This paper examines traffic crashes of drivers reported during 2001-2005 under the State of Missouris voluntary reporting law (House Bill HB-1536) and the resulting licensing outcomes. Missouris law is non-specific as to age, but the mean age of reported drivers was 80. Reports were submitted by police officers (30%), license office staff (27%), physicians (20%), family members (16%), and others (7%). The most common medical condition was dementia/cognitive (45%). Crash history for reported drivers was higher than that of controls, dating back to 1993, reaching a peak in 2001 when the crash involvement of reported drivers was 9.3% vs. 2.2% for controls--a fourfold difference. The crash involvement of reported drivers decreased rapidly after, indicating the impact of HB-1536 reporting with subsequent license revocation and to a lesser degree, mortality. Of the 4,100 reported individuals, 144 (3.5%) retained a drivers license after the process.

Driving Retirement in Older Adults with Dementia.

To characterize the driving and mobility status of older adults with dementia, a questionnaire was mailed to 527 informants; 119 were returned. The majority of patients were diagnosed with dementia of the Alzheimer type. Only 28% were actively driving at the time of survey. Informants rated 53% of current or recently retired drivers as potentially unsafe. Few informants reported using community/educational resources. Individuals with progressive dementia retire from driving for differing reasons, many subsequent to family recognition of impaired driving performance. Opportunities for education and supportive assistance exist but are underutilized.

Clinician Beliefs and Practices in Dementia Care: Implications for Health Educators.

Research on assessment and treatment of Alzheimers disease (AD) is moving at a rapid pace. Continuing education (CE) providers must translate new findings for clinicians so as to enhance patient care. A two-page survey was distributed by mail to a sample of 5,000 licensed Missouri clinicians to gather data in support of this translation process. Clinicians were surveyed regarding their AD-related knowledge, their felt confidence and attitudes concerning dementia care, and their continuing education preferences. Respondents (n = 834) included primary care physicians (53%), advanced practice nurses (23%), specialist physicians (18%), and physician assistants (5%). Differences in knowledge and confidence levels were found across professional categories. Specialist physicians reported the highest scores. Rural providers largely did not differ from their urban counterparts. Respondents reported a greater preference for live, in-person programming than for technology-driven offerings (CD/DVD, satellite, Internet). CE providers can use such information to target programs to meet the learning needs and preferences of different clinician groups.

Decoding the Miss Daisy Syndrome: An Examination of Subjective Responses to Mobility Change

The subjective responses associated with personal life space and mobility status were explored. Thirty individuals participated in focus groups based on self-rated disability status, current places visited, and availability. Qualitative analyses revealed that most participants equated personal mobility with driving a vehicle. Attitudes concerning mobility status and preparedness for change varied based on disability level and personal experience. Fear of dependence from future mobility loss was prominent in all groups. Few participants acknowledged significant planning for future retirement from driving or other mobility challenges. An understanding of common attitudes, perceptions and meanings can inform professionals who intervene and support older adults experiencing mobility changes.

The American Medical Association older driver curriculum for health professionals: changes in trainee confidence, attitudes, and practice behavior

Few gerontology and geriatrics professionals receive training in driver fitness evaluation, state reporting of unfit drivers, or transportation mobility planning yet are often asked to address these concerns in the provision of care to older adults. The American Medical Association (AMA) developed an evidence-based, multi-media Curriculum to promote basic competences. This study evaluated reported changes in practice behaviors 3 months posttraining in 693 professionals trained via the AMA approach. Eight Teaching Teams, designated and trained by AMA staff, offered 22 training sessions across the United States in 2006 to 2007. Trainees (67% female; mean age 46) completed a pretest questionnaire and a posttest administered by mail. Physicians were the largest professional group (32%). Although many trainees acknowledged having conversations with patients about driving at pretest, few endorsed utilizing specific techniques recommended by the AMA prior to this training. The posttest response rate was 34% (n = 235). Significant improvements in reported attitudes, confidence, and practices were found across measured items. In particular, posttest data indicated new adoption of in-office screening techniques, chart documentation of driver safety concerns, and transportation alternative planning strategies. Findings suggest that a well-designed, one-time continuing education intervention can enhance health professional confidence and clinical practice concerning driver fitness evaluation and mobility planning. Targeted dissemination of this Curriculum (in-person and online) will allow more to benefit in the future.

Caregiver Grief in End-Stage Dementia: Using the Marwit and Meuser Caregiver Grief Inventory for Assessment and Intervention in Social Work Practice

Abstract Caregivers of individuals with end-stage dementia experience increased grief reactions; however, their grief is too often overlooked by health professionals. Regardless of their practice setting, social workers must assess and intervene with caregivers dealing with grief. This article provides information on the Marwit and Meuser Caregiver Grief Inventory (MM-CGI) that was designed to measure the grief of caregivers of individuals with progressive memory loss. Through the use of case examples, key areas of assessment are highlighted, as well as initial areas for helping caregivers cope and heal from their experiences of grief.

Addressing Individual Differences in Mobility Transition Counseling With Older Adults

In the final phase of a 3-phase project, the Assessment of Readiness for Mobility Transition (ARMT) was clinically validated, emphasizing assessment/intervention. ARMT and coping, health/vision status, and social support measures were administered to 133 community-dwelling older adults. Concurrent validity is supported. Higher readiness to cope with mobility transition and self-confidence related to fall risk, higher self-rated health/vision, and fewer maladaptive behaviors, but not social support/adaptive coping, suggesting that those at risk can benefit from person-centered intervention to mobilize strengths for transportation/mobility planning. Older drivers may harbor unrealistic expectations regarding nonfamily mobility support. Implications for practice, education, research, and policy are presented.

Improving physician awareness of Alzheimer disease and enhancing recruitment: the Clinician Partners Program.

BackgroundPrimary care providers routinely evaluate older adults and are thus in a position to first detect symptoms and signs of Alzheimer disease. In urban areas, diagnostic or management difficulties may be referred to specialists; however, in rural areas, specialists may not be available. The Clinician Partners Program (CPP) was initiated to enhance rural health providers’ ability in the diagnosis of dementia and care, and to increase research recruitment into dementia research studies of participants from rural communities. MethodsThe CPP is a 3-day “miniresidency” of didactic, observational, and skill-based teaching techniques. Participants completed pretests and posttests evaluating dementia knowledge, confidence in providing care, and practice behaviors. ResultsBetween 2000 and 2009, 146 health care professionals with a mean age of 45.7±10.8 years attended the CPP; 79.2% were white, 58.2% were women, and 58% of participants had been in practice for more than 10 years. Posttests showed an improvement in knowledge and confidence for diagnosis and treatment and increased the use of dementia screening tools. Rural research participation in an urban Alzheimer Disease Research Center increased 52% over the pre-CPP period. ConclusionsThe following primary goals were accomplished: increased knowledge and confidence, changed practice habits, and enhanced research recruitment. Educational programs such as the CPP may be beneficial for increasing access to accurate diagnoses and appropriate treatment for Alzheimer disease while also enhancing research participation.

Family reports of medically impaired drivers in Missouri: cognitive concerns and licensing outcomes.

This study investigated reasons why older adults (n=689) were reported to the Driver License Bureau, Missouri Department of Revenue, by family members as potentially unfit to drive with an emphasis on cognitive concerns and associated licensing outcomes. A total of 448 drivers were reported to have some cognitive issue; common symptoms included confusion, memory loss, and becoming lost while driving. Diagnostic labels (Alzheimers disease (AD), cognitive impairment/dementia, brain injury/insult) were listed for 365 cases. A physician evaluation is required for license review. Of those with a diagnostic label, half (51%, n=187) failed to submit this evaluation and almost all were de-licensed immediately. Of those evaluated by a physician, diagnostic agreement between family members and physicians was high for specific conditions (100% for AD, 97% for acute brain injury), and less so for cognitive impairment/dementia (75%). This latter finding suggests that physicians and family members may understand cognitive symptoms differently. Whether cognitively impaired or not, few family reported drivers in this sample (∼2%) retained a valid license. Family members may be in the best position to recognize when medical-functional deficits impact on driving safety, and physicians and driver licensing authorities would do well to take their observations into account with respect to older driver fitness.

Assessment of Readiness for Mobility Transition (ARMT): a tool for mobility transition counseling with older adults.

Individualized assessment is important when counseling older adults concerning the transition from driving to nondriving mobility. This study validated a measure of emotional and attitudinal readiness in support of mobility transition counseling (MTC). Items derived from a mixed-methods approach were administered by mailed questionnaire to community-dwelling adults (n = 297; ages 57-95). Factor analysis was employed to form the 24-item Assessment of Readiness for Mobility Transition (ARMT). The ARMT–Total Score (ARMT-TS) demonstrated sound internal consistency and split-half reliability (.88 each). The ARMT-TS correlated as hypothesized with validity measures, including self-reported physical functioning, mental health, and openness to experience. High scorers, who evidenced strong self-reliance and an unwillingness to be a burden on others, are considered to be at risk when faced with a significant mobility transition. An appreciation for such differences can allow for personalized, tailored discussion and planning for when it is time to “hang up the keys.”