Coming Out of Retirement -Predictors of Driving Resumption Among Older Drivers

Background and Objectives: Predictors and consequences of driving cessation in older adults have been studied extensively. This study sought to establish the extent to which former drivers resume driving and identify associated factors. Research Design and Methods: Descriptive analysis of the 2011-2015 National Health and Aging Trends Study data (Round 1: Results: Among drivers who stopped driving during the study, 17%-28% resumed driving. Age, vehicle ownership, stroke, hospitalization, memory, and perceived transportation barriers were associated with resumption in regression analysis. In multilevel analysis stratified by baseline driving status, poor word recall (OR = 0.62; 95% CI = 0.40, 0.95) and use of public transportation (OR = 9.74; 95% CI = 1.54, 61.77) were significantly associated with driving resumption for baseline drivers, while use of taxi (OR \u3c 0.001; 95% CI = Discussion and Implications: This study highlights several factors associated with driving resumption. Uncertainty about the underlying causes for resumption remains, so results should be interpreted with caution. However, predictive factors may help to identify individuals in need of additional mobility transition counseling. Ongoing transportation assessment may be warranted among former drivers

Online training and support programs designed to improve mental health and reduce burden among caregivers of people with dementia : a systematic review

Introduction -- Dementia poses a considerable socioeconomic burden to society. On a global scale, family and other unpaid care predominates. Supporting caregivers is crucial, but scalable interventions are currently lacking. Because a growing number of studies have suggested that online training and support programs hold considerable promise for scaling up, we reviewed existing literature. Methods -- We systematically searched 6 databases to identify studies of Internet-based interventions designed to train and support caregivers of people with dementia, and we formally assessed risk of bias. Our prespecified primary outcomes of interest included both mental health and caregiver burden/perceived stress. Our secondary outcomes of interest included knowledge, quality of life of caregivers, quality of care, caregiver response to challenging behaviors, coping, and self-efficacy. Results -- Eight randomized control trials met our inclusion criteria involving over 900 participants. The content and structure of Internet-based interventions, outcome measures, and duration differed markedly, and selection, performance, and reporting biases were varied and on occasion of concern. Six studies reported outcomes in caregivers' mental health outcomes, 3 studies reported burden outcomes. Three studies reported knowledge skills, quality of life and reaction to challenging behaviours, whereas 2 studies reported changes in coping outcomes and self-efficacy. No studies reported outcomes on quality of care. Discussion -- Although there is some evidence that Internet-based interventions can improve mental health outcomes for informal caregivers of people with dementia, marked methodological diversity across studies prevented the robust pooling of the results. A concerted and cohesive approach from all stakeholders is now required to help realize the full potential of this emerging field

Brain health: the importance of recognizing cognitive impairment: an IAGG consensus conference

Cognitive impairment creates significant challenges for patients, their families and friends, and clinicians who provide their health care. Early recognition allows for diagnosis and appropriate treatment, education, psychosocial support, and engagement in shared decision-making regarding life planning, health care, involvement in research, and financial matters. An IAGG-GARN consensus panel examined the importance of early recognition of impaired cognitive health. Their major conclusion was that case-finding by physicians and health professionals is an important step toward enhancing brain health for aging populations throughout the world. This conclusion is in keeping with the position of the United States' Centers for Medicare and Medicaid Services that reimburses for detection of cognitive impairment as part the of Medicare Annual Wellness Visit and with the international call for early detection of cognitive impairment as a patient's right. The panel agreed on the following specific findings: (1) validated screening tests are available that take 3 to 7 minutes to administer; (2) a combination of patient- and informant-based screens is the most appropriate approach for identifying early cognitive impairment; (3) early cognitive impairment may have treatable components; and (4) emerging data support a combination of medical and lifestyle interventions as a potential way to delay or reduce cognitive decline

SocialWelfare Policy Changes and SocialWork Practice

Managed care, welfare reform, changes in government-sponsored health insurance, privatization, for-profit commercial activity, and increasing competition for charitable funding are affecting nonprofit social service organizations. This study of 244 nonprofit social service agencies explores the influence of social policy changes on nonprofit organizations. The effects of such changes on social work practice and social work field education within nonprofit organizations are explicated. Guidance for social work field education departments is provided