Family medicine residents' risk of adverse motor vehicle events: comparison between rural and urban placements.

Background: Sleep deprivation and fatigue are associated with long and irregular work hours. These work patterns are common to medical residents. Motor vehicle crashes (MVCs) are a leading cause of injury related deaths in Canada, with MVC fatality rates in rural areas up to three times higher than in urban areas. Objectives: To: 1) examine the number of adverse motor vehicle events (AMVEs) in family medicine residents in Canada; 2) assess whether residents with rural placements are at greater risk of experiencing AMVEs than urban residents; and 3) determine if family medicine residency programs across Canada have travel policies in place. Methodology: A prospective, cross-sectional study, using a national survey of second-year family medicine residents. Results: A higher percentage of rural residents reported AMVEs than urban residents. The trend was for rural residents to be involved in more MVCs during residency, while urban residents were more likely to be involved in close calls. The majority of Canadian medical schools do not have resident travel policies in place. Conclusion: AMVEs are common in family medicine residents, with a trend for the number of MVCs to be greater for rural residents. These data support the need for development and incorporation of travel policies by medical schools

Will Ride-Hailing Enhance Mobility for Older Adults? A California Survey

Ride-hailing services such as Lyft and Uber offer a potential mobility option for the growing numbers of aging Californians who risk social and economic isolation if they cannot drive for health or financial reasons. They could also serve older adults who currently have mobility options but would prefer a ride-hailing alternative for at least some trips. This study addressed whether and how older Californians use ride-hailing, as well as the potential of this travel mode to meet the needs of older adults now and in the coming decade. An online survey was completed by 2,917 California adults aged 55 and older. This age range was chosen to include both current seniors (age 65 and older) and individuals who will soon be entering that age group (age 55 to 64). The survey explored whether older Californians who have access to the internet used ride-hailing, how comfortable they were with ride-hailing service features that might present barriers to usage, whether they would value potential new ride-hailing service features designed to improve safety, accessibility, and payment options, and what reasons (if any) they saw to use ride-hailing. We also collected data on various factors hypothesized to influence ride-hailing use and behaviors, such as use of the internet and online banking. Key survey findings indicated that 44% of respondents 65 years old and older had experienced ride-hailing and 27% had booked a ride themselves via phone or using the app. Also, the potential new ride-hailing service features that appealed to large numbers of today’s and tomorrow’s seniors include having a driver trained to help older passengers and the option to pay with a ride-hailing card that is not linked to a bank account or credit card. Results also indicated that there were fewer large variations by personal characteristics than we anticipated would influence ride- hailing behavior and attitudes, such as gender, age, and regular use of technology. However, there were some clear differences by population subgroups, most noticeably by income, education, community type (e.g., urban vs. rural), and use of public transit

Differences in ride-hailing adoption by older californians among types of locations

Ride-hailing services such as Lyft and Uber can complement rides offered by family, friends, paid providers, and public transit. To learn why older adults might wish to use ride-hail, we conducted an online survey of 2,917 California respondents age 55 and older. Participants were asked whether they would value four features hypothesized to be benefits of ride-hailing. We specified binary logit models and used market segmentation to investigate whether there were location-based differences in the use of ride-hailing. Our analysis showed that women, city dwellers, persons with disabilities, and those who rely on others for rides were more open to ride-hailing. Women in suburbs or small town/ rural settings were more likely to ride-hail than their male counterparts for reasons of independence, fear of being lost while driving, or getting help with carrying bags. Urban women, in contrast, were less likely than their male counterparts to ride-hail for these reasons. High-income individuals in suburbs or small town/rural locations were more likely to ride-hail than low-income respondents, while high-income urban residents were less likely to ride-hail. Adoption of ride-hailing services and the reasons for doing so showed strong variability by location even among respondents with similar socio-demographic attributes

The Introduction of a New Screening Tool for the Identification of Cognitively Impaired Medically At-Risk Drivers

The number of drivers with a cognitive impairment due to dementia or other age-associated pathologies will increase significantly over the next 3 decades. Physicians are well placed to identify medically at-risk drivers, but are hampered by the lack of a valid, easy to administer screening tool. This research develops and validates a brief screening tool for use in the primary care setting to identify drivers with cognitive impairment with or without dementia. Initial Study Participants: A cohort of 146 consecutive referrals from community-based family physicians, diagnosed with an undifferentiated cognitive impairment or dementia, as well as 35 community dwelling healthy controls. Validation Study: A cohort of 192 consecutive referrals carrying the same diagnosis as above and 52 community dwelling healthy controls. Criterion Measure: Pass/fail on an On-Road evaluation. Predictor Measures: Subtests of the DemTect, a screening test for cognitive impairment or dementia developed by Kalbe and colleagues. 1 Initial Study: Three of the DemTect measures predicted On-Road outcomes (R 2 = .262). Regression results were used to develop a simple scoring algorithm, with cut-points then derived by identifying those most at risk for failing and passing the On-Road assessment, and those needing a driving assessment for determination of driving competency. 89 individuals scored in the indeterminate range, with 49 and 43 predicted to fail and pass, respectively—86% and 84% of those predicted to fail and pass did subsequently fail and pass. Validation Study: 123 individuals scored in the indeterminate range, with 66 and 55 predicted to fail and pass, respectively—80% and 87% of those predicted to fail and pass did subsequently fail and pass. Conclusions: The SIMARD A Modification of the DemTect ( S creen for the I dentification of cognitively impaired M edically A t- R isk D rivers) is a brief paper and pencil screening tool with a high degree of accuracy that can be used for immediate decisions in the clinical setting

A Tale of Two Solitudes: Loneliness and Anxiety of Family Caregivers Caring in Community Homes and Congregate Care

We surveyed 604 family caregivers residing in the province of Alberta to better understand the impact of the COVID-19 pandemic on anxiety, loneliness, and care work. We assessed anxiety with the Six-Item State Anxiety Scale and loneliness with the DeJong-Gierveld Loneliness Scale. The COVID-19 pandemic created two contexts giving rise to feelings of solitude for family caregivers. Family caregivers of Albertans living in private community homes were overwhelmed with caregiving needs while those caring for Albertans living in congregate settings were restricted from caregiving. The results indicated that before the COVID-19 pandemic, 31.7% of family caregivers were anxious and 53.5% were lonely. The proportions of those who were anxious rose to 78.8% and lonely to 85.9% during the pandemic. The qualitative responses of family caregivers connected being overwhelmed with care work either in community homes or as the designated essential caregiver in congregate living settings, as well as being unable to care in congregate care settings, with anxiety and loneliness. The caregivers reporting improvements in their health and relationships with care-receivers credited spending time with the receiver doing pleasant activities together, rather than purely performing onerous care tasks. Policymakers need to consider organizing health and community services to ensure family caregivers are not overwhelmed with care tasks or excluded from caring in congregate care

Neglected Needs of Family Caregivers during the COVID-19 Pandemic and What They Need Now: A Qualitative Study

COVID-19 has had a negative impact on family caregivers, whether the care receivers lived with the caregiver, in a separate community home, in supportive living, or in long-term care. This qualitative study examines the points of view of family caregivers who care in diverse settings. Family caregivers were asked to describe what could have been done to support them during the COVID-19 pandemic and to suggest supports they need in the future as the pandemic wanes. Thorne’s interpretive qualitative methodology was employed to examine current caregiver concerns. Thirty-two family caregivers participated. Family caregivers thought the under-resourced, continuing care system delayed pandemic planning, and that silos in health and community systems made caregiving more difficult. Family caregivers want their roles to be recognized in policy, and they cite the need for improvements in communication and navigation. The growth in demand for family caregivers and their contributions to the healthcare system make it critical that the family caregiver role be recognized in policy, funding, and practice