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Guidelines that physicians use to assess fitness to drive for dementia are limited in their currency, applicability, and rigor of development. Therefore, we performed a systematic review to determine the risk of motor vehicle collisions (MVCs) or driving impairment caused by dementia, in order to update international guidelines on driving with dementia. Seven literature databases (MEDLINE, CINAHL, Embase, etc.) were searched for all research studies published after 2004 containing participants with mild, moderate, or severe dementia. From the retrieved 12,860 search results, we included nine studies in this analysis, involving 378 participants with dementia and 416 healthy controls. Two studies reported on self-/informant-reported MVC risk, one revealing a four-fold increase in MVCs per 1,000 miles driven per week in 3 years prior, and the other showing no statistically significant increase over the same time span. We found medium to large effects of dementia on driving abilities in six of the seven recent studies that examined driving impairment. We also found that persons with dementia were much more likely to fail a road test than healthy controls (RR: 10.77, 95% CI: 3.00-38.62, z = 3.65, p < 0.001), with no significant heterogeneity (χ2 = 1.50, p = 0.68, I2 = 0%) in a pooled analysis of four studies. Although the limited data regarding MVCs are equivocal, even mild stages of dementia place patients at a substantially higher risk of failing a performance-based road test and of demonstrating impaired driving abilities on the road. [ABSTRACT FROM AUTHOR]

The article looks at the decision of psychiatrists to specialize in geriatric psychiatry, reporting on the authors’ survey of psychiatry residents in Canada. It discusses the factors that were associated with interest in this specialty, including comfort in working with the elderly and completion of a rotation in geriatric psychiatry during the first two years of residency.

The article reports on research which was conducted to develop physician consensus on the reporting of patients with mild cognitive impairment and dementia to transportation authorities in an area with no mandatory reporting laws. Researchers conducted a literature search of predictors of driving safety in patients with dementia. They found that the strongest predictors of a decision to report were caregiver concern about driving ability and abnormal Clock Drawing Test results for the patient.

Driving often provides a sense of independence, quality of life and emotional wellbeing. For older adults living with dementia, driving cessation eventually becomes inevitable. Driving cessation has been shown to negatively impact older adults' mobility and, consequently, quality of life. Caregivers of persons with dementia (PWD) who have ceased driving are also impacted as they often become responsible for meeting the mobility needs of PWD and they provide emotional support in respect to this significant life transition. To date, there is little information on the role of gender in the transition to driving cessation in PWD. The purpose of this study was to examine the role that gender plays among drivers and ex-drivers with dementia from the perspectives of PWD, their caregivers, and healthcare practitioners. Secondary thematic analyses were conducted from a pre-existing sample of persons with dementia (N=10), family caregivers (N=13), and healthcare practitioners (N=6) who participated in interviews and focus groups about their experiences around driving cessation in the context of dementia. Data analyses involved an inductive thematic technique that allowed for generating themes. The main themes identified gender differences as a significant factor in: (1) difficulty accepting driving cessation (2) driving as it is tied to identity, (3) emotional responses to driving cessation, (4) driving as part of the caregiving role. The findings suggest that there is a need for tailored interventions for men and women who lose their ability to drive, in addressing their unique emotional responses and in supporting them through this important life transition. Canadian Consortium on Neurodegeneration in Aging [ABSTRACT FROM AUTHOR]

Maintaining an active lifestyle and participating in social activities are key components of healthy ageing. These components rely on the individuals' ability to remain mobile out of home. The global positioning system (GPS) is increasingly used to assess outdoor mobility of older adults. However, there is a gap in establishing a framework that recognizes the differences between mobility patterns of cognitively intact older adults and older adults with dementia (OAwD). We propose a set of GPS-derived metrics to identify these differences, which can be used to evaluate changes in mobility patterns of OAwD over time. We analyzed the mobility profiles of 15 older adults from the greater Toronto area using GPS technology. Participants were aged between 65 and 90 years (M=74.9, SD=7.05) and were either cognitively healthy (n = 8) or diagnosed with dementia (n = 7). First, we created GPS-based features representing different dimensions of outdoor mobility. These features include (1) the typical distance covered by individuals, (2) randomness of the travel patterns, (3) the spatial variation of the GPS locations, (4) the number of distinct stops visited per day, (5) the number of daily trips away from home, (6) the score of three levels of outdoor life-space, and (7) the maximum distance travelled from home. Then, we used Recursive Feature Elimination (RFE) with Random Forest (RF) to select the most important mobility features with respect to cognitive status. A total of 55,580 GPS points were collected by the 15 unique participants over a period of 4 to 8 weeks. The RFE method indicated that features (1), (2), (3), and (5) had the strongest association with cognitive status. Our results suggested that OAwD displayed more predictability (i.e. smaller randomness) in travel patterns compared to the controls (OAwD: M=4.82, SD=0.57 vs. CTL:M=5.62, SD=0.71). Furthermore, the OAwD made fewer daily out-of-home trips compared to the controls (OAwD: M=1.06, SD=0.79 vs. CTL: M=1.65, SD=0.45), and covered smaller distances compared to the controls (OAwD: M=12.27, SD=11.73 km vs. CTL: M=15.78, SD=24.31 km). The proposed set of GPS-based features identified the differences between mobility patterns of cognitively intact older adults and OAwD. Canadian Consortium on Neurodegeneration in Aging [ABSTRACT FROM AUTHOR]

Highlights: [•] In this large sample of healthy older drivers, there was a modest association between performance on tests of psychomotor speed, mental flexibility and executive functioning and self-reported driving comfort, abilities, and restrictions. [•] Specifically, worse performance on Trails A and B were generally associated with modestly reduced driving frequency and perceived driving abilities and comfort, as well as a tendency to avoid more difficult driving situations. [•] There was no relationship between a global cognitive test, the Montreal Cognitive Assessment (MoCA), and the self-reported driving measures. [•] The modest relationship with Trails A and B and the lack of relationship with the MoCA may be due to the largely cognitively intact sample, a reduced awareness of and compensation for cognitive problems, or both. [Copyright &y& Elsevier]

Objective: To assess whether antidepressant treatment is associated with a temporary increase in the risk of a motor vehicle crash among older adults. Design: Population-based case-only time-to-event analysis. Setting and Subjects: Data from transportation and healthcare databases for adults age 65 and older in Ontario, Canada, between January 1, 2000, and October 31, 2007. Consecutive adults who had a motor vehicle crash anytime following their 66th birthday. Measurements: The primary exposure variable was treatment with antidepressant medication, and the primary outcome measure was a motor vehicle crash. Results: A total of 159,678 individuals had a crash during the study, of whom 7,393 (5%) received an antidepressant in the month prior to the crash. The hazard ratio (HR) of crash associated with second-generation antidepressants was 1.10 (95% confidence interval [CI]: 1.07-1.13, X² = 41.77, df = 1, p <0.0001), adjusted for gender, license suspensions, and other medications, but the risk for first-generation antidepressants was not significant. The increased risk was restricted to those who were also concurrently prescribed a benzodiazepine (adjusted HR: 1.23, 95% CI: 1.17-1.28, X² = 85.28, df = 1, p <0.0001) or a strong anticholinergic medication (adjusted HR: 1.63, 95% CI: 1.57-1.69, X² = 627-31, df = 1, p <0.0001), and was confined to crashes where the patient was at fault. The increased risk was apparent for the first 3-4 months following initiation of an antidepressant and returned to baseline thereafter. Conclusions: Prescriptions for second-generation antidepressants in older adults are associated with a modest increased risk of motor vehicle crashes, when combined with other medications that can impair cognition. (Am J Geriatr Psychiatry 2011; 19:998-1006) [ABSTRACT FROM AUTHOR]

The author reflects on the benefits of antidepressants in improving recovery from neurologic illness. He notes the prevalence of major depression among patients in the first year following acute stroke and discusses the results of a 12-week randomized controlled trial investigating the effectiveness of the antidepressants fluoxetine and nortriptyline following acute stroke by researcher Mikami and colleagues published within the issue.

Current pharmacotherapies for Alzheimer's disease (AD) are only modestly effective. There remains a critical need for treatments focused on early stages of the disease, when quality of life is still potentially excellent. While transcranial direct current stimulation (tDCS) has been shown to improve memory in some people with Mild Cognitive Impairment (MCI) and mild AD with minimal side-effects, recent evidence suggests that tDCS works better when brain circuits are active. As exercise increases brain activity using mechanisms that may support tDCS response, it may be an effective primer given before tDCS. This study assesses whether exercise priming with tDCS can help improve memory in MCI and mild AD, and whether this combination improves memory better than exercise or tDCS alone. In this 5-week, randomized, blinded, sham-controlled clinical trial, eligible patients receive either 1) combined exercise and tDCS, 2) exercise and sham tDCS, or 3) exercise education only and tDCS. Repeated measures analyses of covariance will be conducted to evaluate between-group differences on cognitive outcomes over time. Blinded preliminary findings are presented (N=10, mean age=74±6?years, 50% female, mean years of education=16.2±2.5?years, mean Montreal Cognitive Assessment (MoCA) score= 21.5±2.9). There was a significant effect of treatment over time on Word Recall scores (F(2,7)=5.5, p=0.036). There were no statistically significant differences between groups over times on MoCA (F(2,7)=3.6, p=0.085) or Word Recognition scores (F(2,7)=4.5, p=0.054). Participants randomized to exercise education only with tDCS did not increase their exercise frequency or intensity according to the Leisure Time Exercise Questionnaire. Participants randomized to exercise priming were able to exercise at a moderate-intensity level for the last two weeks of the study when receiving combined tDCS or sham tDCS treatment. Overall adherence to study interventions was 98%. Recruitment is ongoing (N=10/30). Updated results will be presented. This study may identify a new, feasible, non-invasive combination therapy that improves cognitive function in MCI and early stages of AD, therefore having major health implications. This research was funded by: Canadian Institutes of Health Research [ABSTRACT FROM AUTHOR]

• 7.2% of drivers reported increased speeding during COVID-19. • Significantly higher odds of increased speeding during COVID-19 for those with higher scores on Competitive Attitudes Towards Driving Scale. • Significantly higher odds of increased speeding during COVID-19 for those with higher kilometers traveled. • Significantly higher odds of increased speeding during COVID-19 for those who reported more alcohol consumption during the pandemic. Introduction: During COVID-19, increased speeding was observed in many jurisdictions. Yet, evidence is limited on what factors predicted increased speeding during the pandemic. This study's purpose was to examine speeding, and person and situation factors associated with increased speeding since the start of the pandemic. Methods: An online panel survey sampled 1,595 drivers using sex, age, and region quota sampling and weighting to approximate the Ontario, Canada adult population. Measures included: (1) person factors: socio-demographics (age, sex, region); psychological trait of risk propensity (Competitive Attitudes Toward Driving Scale (CATDS)); psychological states (distress - general and COVID-19-related); and behaviors (kilometers driven, alcohol use, police stops and collisions); and (2) COVID-19-related situation factors: perceived changes in (traffic volume, police enforcement). Results: 67.2% of respondents reported speeding; 7.2% reported increased speeding since the start of the pandemic. Bivariate analyses indicated that person factors of younger age, male sex, higher CATDS, higher distress, more alcohol use, more kilometers traveled, police stops, and collisions since the start of the pandemic were associated with increased speeding. Situation factor of perceived less traffic volume since the start of the pandemic was associated with increased speeding. Logistic regression analysis identified odds of reported increased speeding during the pandemic was significantly higher for drivers with higher scores on the CATDS, higher kilometers traveled, and more alcohol use during the pandemic. Conclusions: These findings suggest that higher risk propensity as well as the more kilometers driven and increased alcohol consumption were risk factors for increased speeding. Practical Applications: COVID-19-related factors of lower traffic volume and enforcement are less predictive of increased speeding than driver personality and pandemic-related behaviors of more driving and drinking. Interventions to reduce speeding still need to focus on these person factors through education, enforcement, and strong sanctions for speeding. [ABSTRACT FROM AUTHOR]

Introduction Decision-making about driving cessation and transitioning to non-driving is a challenging and complex issue faced by drivers diagnosed with dementia and their families. Driving cessation is associated with adverse psychosocial and health-related impacts for persons with dementia including a reduction in quality of life. To address the gap in evidence-based interventions that support individuals in the driving cessation process, we developed the Driving Cessation in Dementia Intervention Toolkit (DCD-IT). Our objective in this study was to further develop and refine the DCD-IT (content, design and mode of delivery) to facilitate its effective implementation in settings that support older adults with dementia. Methods Representatives (n=15) from Alzheimer Society organizations in British Columbia, Manitoba, Ontario and Nova Scotia reviewed the DCD-IT and provided feedback via a webinar, questionnaire and in-depth interviews. Data analysis techniques included thematic coding and inductive analysis. Results Participants emphasized the lack of accessible and trusted driving cessation resources specific to meeting the needs of persons with dementia (PWD) and their family caregivers. They identified gaps and corresponding areas of focus to inform the continued development and design of the DCD-IT, which included: materials directed separately to PWD encompassing appropriate content, language and design; resources geared to helping healthcare providers engage in discussions with PWD and family caregivers; information for PWD, family caregivers and healthcare providers about region-specific driving regulations and alternative transportation options. Conclusions Obtaining the perspectives of Alzheimer Society representatives have informed improvements to the content and design of the DCD-IT. Next steps include evaluating the implementation process of the intervention framework and toolkit in Alzheimer Society chapters in community settings in Ontario with the aim of informing widespread implementation and adaption across Canada. This research was funded by Canadian Institute of Health Research/Canadian Consortium on Neurodegeneration in Aging. [ABSTRACT FROM AUTHOR]

• We explored whether older adults were less likely to have road injuries and fatalities in the first month of shelter-in-place lockdown of the COVID pandemic. • We found a 64.7 % reduction in the proportion of injuries and fatalities. • The excess COVID-19- associated mortality in oldest adults may be indirectly partially mitigated by a reduction in mortality from motor vehicle collisions. Older adults constitute the group most vulnerable to COVID-19 mortality. As a result, in North America and elsewhere, older adults have been strongly advised to shelter in place. Older adults also represent the fastest growing segment of licensed drivers. We examined the change in injuries and fatalities sustained by younger and older drivers and pedestrians during the first month of the COVID-19 pandemic. We hypothesized that adults ages 80 years and over would have a proportionally larger reduction than the other drivers and pedestrians. Using a cohort design, we compared the proportion of drivers and pedestrians involved in injuries and fatalities attributable to individuals aged 80 years and over, as recorded in the Ministry of Transportation of Ontario (Canada) database, between the 30 days prior to shelter-in-place related to the COVID-19 pandemic and the subsequent 30 days. By way of comparison, we conducted a similar comparison for younger age cohorts (16−24 years, 25−34 years, 35−54 years, 55−64 years, and 65−79 years). Drivers aged 80 years and over represented 21 per 1000 injuries and fatalities in the 30 days prior to March 17, 2020 (95 % CI: 15−29), and 8 per 1000 injuries and fatalities in the 30 days beginning on that date (95 % CI: 2−20), a 64.7 % reduction (exp (β) post 0.353, 95 % CI 0.105−0.892). Drivers in the 35−54 year age range underwent a significant but smaller reduction of 22.9 %; no significant changes were seen for drivers in other age groups, or for pedestrians of any age. The physical distancing measures that aimed to reduce the spread of COVID-19 resulted in a marked reduction in driver injuries and fatalities in the oldest old, illustrating the impact of physical distancing recommendations in this population. The excess mortality burden faced by the oldest adults during the COVID-19 pandemic, by direct exposure to the virus, may be indirectly mitigated by the reduction in road-related deaths in this cohort. [ABSTRACT FROM AUTHOR]

• Readiness for change in mobility may be an important element in promoting smooth transitions to non-driving for older people. • Participants who reported positive attitudes towards driving relative to themselves and others were less ready for mobility transition. • Participants who reported lower agreeableness were less ready for mobility transition. For many older adults, driving is an important means of community mobility. With changes in health, aging increases the likelihood of ceasing to drive. Driving cessation is associated with a host of negative physical and mental health outcomes. Increased readiness to transition to non-driving status may mitigate some of the adverse consequences of driving cessation, making the transition to non-driving a pivotal period for intervention. We examined the relationship between attitudes towards driving (positive and negative) and readiness for mobility transition. Participants (n = 253, mean age = 79.13) completed measures of health, cognition, personality, attitudes towards driving, and readiness for mobility change. The results from the multiple hierarchical regression analysis showed that individuals who reported more positive attitudes towards driving relative to themselves (i.e., pro-self scale) and others (i.e., pro-other scale), as well as scored lower on the personality trait agreeableness, were less ready for mobility transition. The results emphasize the importance of taking into account driver attitudes, in addition to health considerations, when supporting the transition to non-driving. [ABSTRACT FROM AUTHOR]

The article discusses care of older women who are at increased risk for personal and medical neglect and financial exploitation and mentions topics including employing protective services agencies for the care of older women, and neuropsychological testing of older of women.

The article focuses on the systematic intervention required for cessation of driving ability in older adults, and talks of self assessment of driving ability, social and emotional support for cessation of driving, and benefits of intervention program on the quality of life.

The article focuses on the challenges of geriatric psychiatrists to practice psychotropic medications due to uncertainty about the validity and limitations of medications, and talks of pharmacoepidemiology and administrative health data.

The article talks about contemporary Geriatric Psychiatry and how it parallels the story of "King Lear", a play written by playwright William Shakespeare.

Abstract: Emphysematous pyelonephritis is a rare, but potentially lethal, possible sequela of nephrolithiasis, occurring most commonly in diabetic patients. The diagnosis of emphysematous pyelonephritis relies on the radiologic finding of gas in the renal parenchyma. We present the case of a patient with sarcoidosis, diabetes, and obstructing, gas-containing ureteral stones. Gas-containing renal stones are exceedingly rare, but have been linked to serious renal infections. The case management and a brief review of the published reports follow. We propose that gas-containing stones be considered evidence of emphysematous pyelonephritis in certain clinical settings. [Copyright &y& Elsevier]

• Systematic review conducted to establish the crash risk for drivers with sleep disorders. • 39 studies met the inclusion criteria, with 14 published in the last decade. • 18 of the 27 studies investigating MVC risk associated with sleep apnoea reported an increased risk, 7 reported no difference, and 2 two provided inconclusive findings. • All 5 studies investigating MVC risk associated with disorders of hypersomnolence and narcolepsy reported an increased risk. • Only two studies investigated MVC risk associated with insomnia, with inconsistent findings. • Weight of evidence suggests a moderately elevated MVC risk for drivers with sleep disorders (sleep apnoea; hypersomnia and narcolepsy), and lower risk with treatment. In many parts of the world, drivers with serious sleep disorders have restrictions on their licence – with the fitness-to-drive criteria varying across licensing jurisdictions. This study aimed to systematically review the literature that evaluated the available scientific evidence for the relationship between sleep disorders and two driving safety outcome measures: (i) motor vehicle crashes (MVC) and (ii) on-road driving test outcome. This review was registered with PROSPERO in July 2019 (see CRD42019144643). A systematic search of public health, psychology and transport databases was conducted on November 8th, 2019. The quality of evidence for each study was rated using the National Heart, Lung and Blood Institute Quality Assessment tools. Thirty-nine studies published between 1976 and 2015 met the inclusion criteria (n = 9 case-control; n = 24 cohort/cross-sectional; n = 6 before-after). Overall, the quality of evidence for 22 studies was rated as 'good', nine as 'fair' and eight as 'poor'. Included studies addressed: sleep apnoea and sleep-related breathing disorders (n = 35); central disorders of hypersomnolence and narcolepsy (n = 5), and insomnia (n = 2), with some studies covering multiple sleep disorders. Of the thirty-five studies specifically investigating MVC risk associated with sleep apnoea, eighteen studies reported an increased risk (n = 11 'good', n = 4 'fair', n = 3 'poor' quality), seven reported no difference in risk (n = 3 'good', n = 4 'fair' quality), and two provided inconclusive findings (n = 1 'good', n = 1 'fair' quality). Most studies suggested that increased sleep apnoea severity was associated with an increased MVC risk. Furthermore, untreated sleep apnoea was predominantly associated with increased risk, whilst decreased risk was associated with Continuous Positive Airway Pressure (CPAP) and uvulopalatopharyngoplasty (UPPP) treatments. Five studies (n = 3 'good', n = 2 'fair' quality) investigated MVC risk associated with disorders of hypersomnolence and narcolepsy, and all reported increased risk. Only two studies investigated MVC risk associated with insomnia, with inconsistent findings: one reporting increased MVC risk ('good') and one reporting no difference ('fair'). Regarding impacts on on-road driving test outcome, our comprehensive search found no studies investigating the association between sleep disorders and this driving safety outcome measure. Notwithstanding the limitations of the included studies, the weight of evidence suggests a moderately elevated MVC risk for drivers with sleep disorders (sleep apnoea; hypersomnia and narcolepsy), with the majority reporting around two and a half times higher risk, and lower risk with treatment. This evidence is consistent with current fitness-to-drive guidelines, most of which specify licence restrictions conditional upon severity, treatment compliance and effective response to treatment. The generalisability of the findings is limited as many identified studies had methodological limitations, were conducted across a wide time period, in numerous licensing jurisdictions with different requirements, and across a diverse range of participant populations. A large-scale, population-based controlled study, in multiple licensing jurisdictions with equivalent licensing and fitness-to-drive requirements, is warranted to rigorously investigate MVC risk and sleep disorders, including evaluating the possible benefit of therapies. [ABSTRACT FROM AUTHOR]

This study examined serum cytochrome P450-soluble epoxide hydrolase (CYP450-sEH) oxylipins and depressive symptoms together in relation to cognitive performance in individuals with type 2 diabetes mellitus (T2DM). Clinically cognitively normal T2DM individuals were recruited (NCT04455867). Depressive symptom severity was assessed using the Beck Depression Inventory-II (BDI-II; total scores ≤13 indicated minimal depressive symptoms and ≥ 14 indicated significant depressive symptoms). Executive function and verbal memory were assessed. Fasting serum oxylipins were quantified by ultra-high-performance liquid chromatography tandem mass-spectrometry. The study included 85 participants with minimal depressive symptoms and 27 with significant symptoms (mean age: 63.3 ± 9.8 years, 49 % women). In all participants, higher concentrations of linoleic acid derived sEH (12,13-dihydroxyoctadecamonoenoic acid; DiHOME) and CYP450 (12(13)-epoxyoctadecamonoenoic acid; EpOME) metabolites were associated with poorer executive function (F 1,101 = 6.094, p = 0.015 and F 1,101 = 5.598, p = 0.020, respectively). Concentrations of multiple sEH substrates interacted with depressive symptoms to predict 1) poorer executive function, including 9(10)-EpOME (F 1,100 = 12.137, p < 0.001), 5(6)-epoxyeicosatrienoic acid (5(6)-EpETrE; F 1,100 = 6.481, p = 0.012) and 11(12)-EpETrE (F 1,100 = 4.409, p = 0.038), and 2) verbal memory, including 9(10)-EpOME (F 1,100 = 4.286, p = 0.041), 5(6)-EpETrE (F 1,100 = 6.845, p = 0.010), 11(12)-EpETrE (F 1,100 = 3.981, p = 0.049) and 14(15)-EpETrE (F 1,100 = 5.019, p = 0.027). Associations of CYP450-sEH metabolites and depressive symptoms with cognition highlight the biomarker and therapeutic potential of the CYP450-sEH pathway in T2DM. • Pro-resolving fatty acid epoxides are generated by cytochrome p450s. • Epoxide hydrolases (e.g. sEH) produce inert or toxic diols from fatty acid epoxides. • Higher diols in serum were associated with poor cognitive performance in diabetes. • Serum epoxides were associated with poorer cognition only in those with depression. • Depression in diabetes may involve sEH, which produces markers of poor cognition. [ABSTRACT FROM AUTHOR]

Highlights • A 21-item, three-factor version of the DBQ was confirmed in a sample of Canadian older drivers. • Older drivers' responses to this version of the DBQ were stable across four years. • Older drivers' errors, violations and lapses remained similar across four years. Abstract The current study aimed to: 1. to confirm the 21-item, three-factor Driver Behaviour Questionnaire (DBQ) structure suggested by Koppel et al. (2018) within an independent sample of Canadian older drivers; 2. to examine whether the structure of the DBQ remained stable over a four-year period; 3. to conduct a latent growth analysis to determine whether older drivers' DBQ scores changed across time. Five hundred and sixty Canadian older drivers (males = 61.3%) from the Candrive/Ozcandrive longitudinal study completed the DBQ yearly for four years across five time-points that were approximately 12 months apart. In Year 1, the average age of the older drivers was 76.0 years (SD = 4.5 years; Range = 70–92 years). Findings from the study support the 21-item, three-factor DBQ structure suggested by Koppel and colleagues for an Australian sample of older drivers as being acceptable in an independent sample of Canadian older drivers. In addition, Canadian older drivers' responses to this version of the DBQ were stable across the five time-points. More specifically, there was very little change in older drivers' self-reported violations, and no significant change for self-reported errors or lapses. The findings from the current study add further support for this version of the DBQ as being a suitable tool for examining self-reported aberrant driving behaviours in older drivers. Future research should investigate the relationship between older drivers' self-reported aberrant driving behaviours and their performance on functional measures, their responses to other driving-related abilities and practice scales and/or questionnaires, as well their usual (or naturalistic) driving practices and/or performance on on-road driving tasks. [ABSTRACT FROM AUTHOR]

Examining environmental factors that influence older adults’ driving patterns has important implications for understanding factors that can lead to self-regulation and cessation. The current study explored the effect of fuel prices on older adults’ driving patterns using objective data from the nationwide Candrive longitudinal study ( N  = 807). Fuel prices were negatively associated with driving distance and positively associated with speeding and acceleration pattern. Specifically, on occasions when fuel prices were high, older adults drove less often but were speeding and accelerating more. However, the magnitudes of the effects were small, suggesting that older adults continue to rely on their vehicles for community mobility, despite variations in fuel prices. [ABSTRACT FROM AUTHOR]

We investigated whether traits from the five-factor model of personality traits (Extraversion, Neuroticism, Agreeableness, Conscientiousness, and Openness-to-Experience) were associated with driving self-regulation – specifically, situational driving frequency (SDF) and situational driving avoidance (SDA). Using data from 324 participants (185 men, 139 women, aged 72–92 years), collected as part of the Canadian Driving Research Initiative for Vehicular Safety in the Elderly study, we examined associations between each personality trait and driving self-regulation (SDF and SDA). Crude associations between personality factors and self-restriction highlighted the relevance of Extraversion, Conscientiousness, Neuroticism, and Openness-to-Experience. However, after controlling for common predictors of driving behaviour (including demographic variables, driving-related psychosocial measures, cognitive measures, and a measure of depression), only Extraversion was positively associated with SDF ( p = 0.012), accounting for a small amount of additional variance (i.e., 1.3%). Future research is required to further elucidate the relationship between personality and objective measures of self-regulation among older drivers. [ABSTRACT FROM AUTHOR]

Abstract: Background: A new tool, the SIMARD-MD, has been proposed to help physicians identify cognitively impaired drivers who may be unfit to drive, but little empirical evidence is available to justify its use. We analyzed data from a cohort of older Canadian drivers who had undergone cognitive testing to: (1) correlate the SIMARD-MD with other tools that measure cognition (e.g., trail-making test), (2) identify how many drivers, using published cut-offs on the SIMARD-MD, would be recommended to lose their license, or be considered fit to drive, or be required to undergo further driving assessment, and (3) determine if the SIMARD-MD is biased by level of education as many cognitive tools are. Methods: Cross-sectional data from 841 drivers aged 70 and over from seven Canadian sites who are enrolled in a 5-year cohort study were used for the analyses. Scores on the SIMARD-MD were correlated with scores on the other cognitive measures. The recommendations that would be made based on the SIMARD-MD scores were based on published cut-off values suggested by the authors of the tool. The impact of education status was examined using linear regression controlling for age. Results: Correlations between the SIMARD-MD and other cognitive measures ranged from .15 to .86. Using published cut-off scores, 21 participants (2.5%) would have been recommended to relinquish their licenses, 428 (50.9%) would have been deemed fit to drive, and 392 (46.6%) would have been required to undergo further testing. We found a difference of 8.19 points (95% CI=4.99, 11.40, p <.001) in favor of drivers with post-secondary education versus those without, representing over 11% of the mean score. Discussion: The SIMARD-MD is unlikely to be valuable to clinicians because it lacks sufficient precision to provide clear recommendations about fitness-to-drive. Recommendations based solely on the SIMARD-MD may place many seniors at risk of losing their transportation mobility or incurring unnecessary stress and costs to prove they are safe to drive. Furthermore, the education bias may create an unwanted structural inequity. Hence, adoption of the SIMARD-MD as a tool to determine fitness-to-drive appears premature. [Copyright &y& Elsevier]

Highlights: [•] Based on a historical cohort analysis, the American Medical Association Assessment of Driving Related Skills (ADReS) for older drivers was not associated with collision in the 2 years preceding assessment. [•] Prospective derivation of valid predictors of crash risk for medically at-risk older drivers remains a research priority. [•] The Candrive/Ozcandrive study is positioned to further prospectively investigate predictors of driving fitness for older drivers. [Copyright &y& Elsevier]

Abstract: The present study sought to investigate the influence of subclinical sleep disturbances on driving practices and driver perceptions in a large cohort of healthy older drivers. Participants from the Candrive II prospective cohort study were investigated. Self-reported measures of sleep problems were used to determine the influence of sleep disturbance on self-reported driving practices and perceived driving abilities, as measured by the Situational Driving Frequency, Situational Driving Avoidance, and Perceived Driving Abilities scales. Hierarchical regression analyses were used to estimate whether mild self-reported sleep problems were predictive of driving restrictions and perceived abilities, while controlling for a variety of health-related factors and demographic variables known to mediate sleep problems or to impact driving. Cross-sectional analysis of baseline data from the Candrive II study suggests that subclinical sleep problems do not significantly influence self-reported driving patterns or perceived driving abilities in older drivers once control variables are considered. The relationship between sleep problems, driving frequency, avoidance and perceived abilities is better explained by mediating demographic, health, and cognitive factors. Further research examining sleep disturbances and driving should include objective measures of driving practices (exposure, patterns) and outcomes (crashes, violations) and should take in consideration the severity of sleep problems. [Copyright &y& Elsevier]

Abstract: The relations among driving-related psychosocial measures (e.g., driving comfort, attitudes toward driving) and measures of self-reported health were examined in the context of driver characteristics (i.e., age and gender) within the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive II) baseline data, available for the cohort of 928 drivers, 70 years of age and older. Older members of the cohort had lower comfort scores and poorer perceptions of their driving abilities. Men reported significantly higher levels of driving comfort than women. When analyses including health were controlled for age and gender, significant relations with health status were evident for most of the psychosocial measures. These findings extend previous research and suggest that attitudes, beliefs, and perceptions about driving may be influenced by health status and act as mediators in the self-regulation process. [Copyright &y& Elsevier]

Abstract: Older adults represent the fastest-growing population of drivers with a valid driver's licence. Also common in this age group are multiple chronic medical conditions that may have an effect on physical function and driving ability. Determining the reliability of physical measures used to assess older drivers’ functional ability is important to identifying those who are safe to continue driving. Most previous reliability studies of clinical physical measures of health used test–retest intervals shorter than those between patient visits with a clinician. In the present study we examined a more clinically representative interval of 1 year to determine the stability of commonly used physical measures collected during the Candrive II prospective cohort study of older drivers. Reliability statistics indicate that the sequential finger–thumb opposition, rapid pace walk and the Pelli–Robson contrast sensitivity tests have adequate stability over 1 year. Poor stability was observed for the one-legged stance and Snellen visual acuity test. Several assessments with nominal data (Marottoli method [functional neck range of motion], whispered voice test, range of motion and strength testing) lacked sufficient variability to conduct reliability analyses; however, a lack of variability between test days suggests consistency over a 1-year time frame. Our results provide evidence that specific physical measures are stable in monitoring functional ability over the course of a year. [Copyright &y& Elsevier]

Abstract: The Candrive II/Ozcandrive study, a multicentre prospective cohort study examining the predictive validity of tools for assessing fitness to drive, aims to develop an in-office screening tool that will help clinicians identify older drivers who may be unsafe to drive. This paper describes the study protocol. We are following a cohort of drivers aged ≥70 years for up to 4 years. Starting in 2009, 928 participants have been recruited in seven cities in four Canadian provinces, as well as 302 participants in two sites in Melbourne, Australia and Wellington, New Zealand. Participants underwent a comprehensive assessment at baseline and repeat the assessment yearly thereafter, as well as a brief follow-up assessment at 4 and 8 months each year. A recording device is installed in participants’ vehicles to assess driving patterns, and driving records are obtained from licensing authorities to determine the outcomes: at-fault crashes per kilometre driven and violations. To date, the protocol has been generally well adhered to, with 1230 participants, and barriers and challenges are being addressed, as necessary. The Candrive II/Ozcandrive study is unique owing to its size, duration, partnerships with Canadian, Australian and New Zealand stakeholders, and international research collaboration. [Copyright &y& Elsevier]

Patients with various neurologic disorders exhibit exaggerated or inappropriate episodes of laughter, crying, or both without an apparent motivating stimulus or in response to stimuli that would not have elicited such an emotional response before the onset of the underlying disease. During these episodes, patients have difficulty controlling their emotional expression according to the contextual information, in contrast, patients with mood disorders have a pervasive and sustained change in their emotional experience and thus exhibit spells of laughter or crying because of an underlying mania or depression. This article focuses on the clinical presentation, diagnosis, prevalence, and proposed pathophysiological mechanisms of and available treatment options for this clinical phenomenon. [ABSTRACT FROM AUTHOR]

• Effects of COVID-19 pandemic on road safety is unknown. • Previous research indicates economic downturns lead to declines in collisions. • COVID-19 has led to an economic downturn of unprecedented proportions. • Differential person- and situation-factors effects should be examined. In March 2020, the World Health Organization declared COVID-19 a world-wide pandemic. Countries introduced public health measures to contain and reduce its spread. These measures included closures of educational institutions, non-essential businesses, events and activities, as well as working from and staying at home requirements. These measures have led to an economic downturn of unprecedented proportions. Generally, as economic activity declines, travel decreases and drivers are exposed to a lower risk of collisions. However, research on previous economic downturns suggests economic downturns differentially affect driver behaviours and situations. COVID-19 pandemic effects on road safety are currently unknown. However, preliminary information on factors such as the increased stress and anxiety brought about by the COVID-19 pandemic, more "free" (idle) time, increased consumption of alcohol and drugs, and greater opportunities for speeding and stunt driving, might well have the opposite effect on road safety. Using an interactionist model we identify research questions for researchers to consider on potential person and situation factors associated with COVID-19 that could affect road safety during and after the pandemic. Collaborative efforts by researchers, and public and private sectors will be needed to gather data and develop road safety strategies in relation to the new reality of COVID-19. [ABSTRACT FROM AUTHOR]

Abstract: Background: Nonpharmacological therapies are often recommended as a first-line treatment for neuropsychiatric symptoms (NPS) of dementia in long term care (LTC); however, little is known about which nonpharmacological interventions are most effective for NPS in LTC or the feasibility of interventions, given the availability of resources in typical LTC environments. Methods: We searched the electronic databases MEDLINE, EMBASE, PsychINFO (1980–2010), the Cochrane Library, and Google Scholar using keywords and medical subject headings for randomized, controlled trials evaluating nonpharmacological interventions for NPS conducted in LTC settings. Change in severity of NPS symptoms was evaluated through the NPS outcomes measures reported in studies. We assessed study quality and described the feasibility of interventions based on various aspects of study design. Results: A total of 40 studies met inclusion criteria. Sixteen (40%) of 40 included studies reported statistically significant results in favor of nonpharmacological interventions on at least one measure of NPS. These interventions included staff training in NPS management strategies, mental health consultation and treatment planning, exercise, recreational activities, and music therapy or other forms of sensory stimulation. Many of the studies had methodological limitations that placed them at potential risk of bias. Most interventions (n = 30, 75%) required significant resources from services outside of LTC or significant time commitments from LTC nursing staff for implementation. Conclusions: There are several nonpharmacological interventions that may be effective for NPS in LTC, although there are a limited number of large-scale, high-quality studies in this area. The feasibility of some interventions will be limited in many LTC settings and further research into practical and sustainable interventions for NPS in LTC is required to improve usage of these important treatments. [Copyright &y& Elsevier]