A Randomized Trial of a Physical Conditioning Program to Enhance the Driving Performance of Older Persons

BACKGROUND: As the number of older drivers increases, concern has been raised about the potential safety implications. Flexibility, coordination, and speed of movement have been associated with older drivers’ on road performance. OBJECTIVE: To determine whether a multicomponent physical conditioning program targeted to axial and extremity flexibility, coordination, and speed of movement could improve driving performance among older drivers. DESIGN: Randomized controlled trial with blinded assignment and end point assessment. Participants randomized to intervention underwent graduated exercises; controls received home, environment safety modules. PARTICIPANTS: Drivers, 178, age ≥ 70 years with physical, but without substantial visual (acuity 20/40 or better) or cognitive (Mini Mental State Examination score ≥24) impairments were recruited from clinics and community sources. MEASUREMENTS: On-road driving performance assessed by experienced evaluators in dual-brake equipped vehicle in urban, residential, and highway traffic. Performance rated three ways: (1) 36-item scale evaluating driving maneuvers and traffic situations; (2) evaluator’s overall rating; and (3) critical errors committed. Driving performance reassessed at 3 months by evaluator blinded to treatment group. RESULTS: Least squares mean change in road test scores at 3 months compared to baseline was 2.43 points higher in intervention than control participants (P = .03). Intervention drivers committed 37% fewer critical errors (P = .08); there were no significant differences in evaluator’s overall ratings (P = .29). No injuries were reported, and complaints of pain were rare. CONCLUSIONS: This safe, well-tolerated intervention maintained driving performance, while controls declined during the study period. Having interventions that can maintain or enhance driving performance may allow clinician–patient discussions about driving to adopt a more positive tone, rather than focusing on driving limitation or cessation

Algorithm for the use of biochemical markers of bone turnover in the diagnosis, assessment and follow-up of treatment for osteoporosis

Introduction Increased biochemical bone turnover markers (BTMs) measured in serum are associated with bone loss, increased fracture risk and poor treatment adherence, but their role in clinical practice is presently unclear. The aim of this consensus group report is to provide guidance to clinicians on how to use BTMs in patient evaluation in postmenopausal osteoporosis, in fracture risk prediction and in the monitoring of treatment efficacy and adherence to osteoporosis medication. Methods A working group with clinical scientists and osteoporosis specialists was invited by the Scientific Advisory Board of European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Results Serum bone formation marker PINP and resorption marker βCTX-I are the preferred markers for evaluating bone turnover in the clinical setting due to their specificity to bone, performance in clinical studies, wide use and relatively low analytical variability. BTMs cannot be used to diagnose osteoporosis because of low sensitivity and specificity, but can be of value in patient evaluation where high values may indicate the need to investigate some causes of secondary osteoporosis. Assessing serum levels of βCTX-I and PINP can improve fracture prediction slightly, with a gradient of risk of about 1.2 per SD increase in the bone marker in addition to clinical risk factors and bone mineral density. For an individual patient, BTMs are not useful in projecting bone loss or treatment efficacy, but it is recommended that serum PINP and βCTX-I be used to monitor adherence to oral bisphosphonate treatment. Suppression of the BTMs greater than the least significant change or to levels in the lower half of the reference interval in young and healthy premenopausal women is closely related to treatment adherence. Conclusion In conclusion, the currently available evidence indicates that the principal clinical utility of BTMs is for monitoring oral bisphosphonate therapy

Looking to the Future — Google / Navigating Tomorrow

About Ron Medford Ron Medford joined Google in January 2013 as its Safety Director for the Self-Driving Car Program. In this position Ron leads the program’s safety team that is working with other program development teams to ensure the safety of the self-driving car. Prior to taking on this role at Google, Mr. Medford served as the Deputy Administrator of the National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation from January 2010 until December 2012. Ron began his career at NHTSA in May 2003 as the Senior Associate Administrator for Vehicle Safety. In this position, he was responsible for overseeing all aspects of the U.S. auto safety programs. This included vehicle safety research, regulations, enforcement as well as the National Center for Statistics and Analysis. Before joining NHTSA, Mr. Medford was the Assistant Executive Director for Hazard Identification & Reduction at the U.S. Consumer Product Safety Commission (CPSC). He was responsible for the regulatory and technical work of the Agency, such as overseeing the Directorates for Engineering Sciences, Health Sciences, Epidemiology, Economic Analysis as well as the Agency’s Chemistry and Engineering Laboratories. Mr. Medford spent more than 25 years in a variety of technical management positions at the CPSC. Just prior to joining NHTSA, Mr. Medford spent 10 months on a government-sponsored sabbatical to work with Dean Kamen, an inventor from Manchester, New Hampshire. Mr. Kamen is president of Deka Research and Development Corporation and is known for his inventions of the IBOTTM wheel chair and the SegwayTM Human Transporter (HT). Mr. Medford holds a B.S. and M.S. from the University of Maryland

Health-care use and cost for multimorbid persons with dementia in the National Health and Aging Trends Study

Background: Most persons with dementia have multiple chronic conditions; however, it is unclear whether co-existing chronic conditions contribute to health-care use and cost. Methods: Persons with dementia and ≥2 chronic conditions using the National Health and Aging Trends Study and Medicare claims data, 2011 to 2014. Results: Chronic kidney disease and ischemic heart disease were significantly associated with increased adjusted risk ratios of annual hospitalizations, hospitalization costs, and direct medical costs. Depression, hypertension, and stroke or transient ischemic attack were associated with direct medical and societal costs, while atrial fibrillation was associated with increased hospital and direct medical costs. No chronic condition was associated with informal care costs. Conclusions: Among older adults with dementia, proactive and ambulatory care that includes informal caregivers along with primary and specialty providers, may offer promise to decrease use and costs for chronic kidney disease, ischemic heart disease, atrial fibrillation, depression, and hypertension

Mobility and Ageing: a review of interactions between transport and technology from the perspective of older people

This chapter is an overview of the issues for older people in relation to transport and technology. I demonstrate that mobility and technology are intertwined in complex ways, and that non-transport technologies may impact older people’s experience and achievement of mobility. Understanding the nexus between mobility, information and communication technologies and older people can help us design accessible and acceptable technologies to support well-being and health in older age. This matters because new ICT is increasingly relied on to support service delivery in both the public and private sectors. Older people are heterogeneous, with different attitudes, levels of income and education affecting technology uptake. Age-related cognitive and physical impairments can also impact on technology adoption. The chapter concludes with how age-friendly design principles can support active ageing