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Background: The elderly are at risk for traumatic brain injury (TBI), but their outcome following these injuries remains unclear. Objective: This paper critically reviews research done to date on cognitive and functional outcome following TBI in the elderly. Methods: MEDLINE and PSYCHLIT databases going back to 1965 were searched. Results: Studies suggest that TBI results in adverse cognitive and functional outcomes in the elderly. There is uncertainty as to whether TBI is a significant risk factor for Alzheimer's disease (AD). Methodological problems in these studies include selection bias, small samples, retrospective analyses, and, particularly, the failure to address the role of pre-morbid functioning. These problems limit the strength of the outcome studies, and may account for the equivocal findings on AD risk. Conclusions: It is premature to conclude from the published research to date that the elderly have a uniformly poor outcome following TBI. Directions for further research are suggested. [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]

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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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, χ² = 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, χ² = 85.28, df = 1, p <0.0001) or a strong anticholinergic medication (adjusted HR: 1.63, 95% CI: 1.57-1.69, χ² = 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.

Objectives: To examine temporal trends in electroconvulsive therapy (ECT) use among all 12 million Ontario residents between January 1992 and December 2004 and to examine the differential trends in older adults, compared with younger ones., Methods: We undertook a time-series analysis to examine annual trends in the use and prevalence of ECT, using linked provincial datasets. Descriptive data were presented for the population as a whole, and then trends were described separately by age groups (younger and older). As a comparator, we similarly examined antidepressant prevalence for older adults over the same time period., Results: Overall rates of ECT prevalence were stable. Annual population rates of individuals receiving ECT increased by about 27%, from 12.3 per 100 000 population in 1992 to 15.6 per 100 000 in 1997, and then decreased to 12.5 per 100 000 by 2004. The population rates of ECT were about threefold higher among older adults, relative to the younger population. Antidepressant prevalence increased by 90.1% among older adults over the same time period. The female-to-male ratio was relatively stable over time., Conclusions: The rate of ECT has been relatively stable since the early 1990s. Older adults were much more likely to be prescribed a course of ECT than younger adults. ECT remains a commonly prescribed treatment, particularly in old age.

Objective: Authors assessed temporal changes in mental health-related drug utilization and costs in an older population., Methods: This was a population-based, cross-sectional time-series analysis of more than 1.4 million residents of Ontario, Canada, age 65 years or older. The study examined mental health-related drug utilization and costs, as derived from administrative databases from 1993 through 2002. They assessed use of antidepressants, antipsychotics, mood stabilizers, benzodiazepines, and acetylcholinesterase inhibitors (AChEIs), assessing trends over time., Results: The prevalence of mental health-related drug use increased from 21.3% of the older population in the beginning of 1993 to 23.8% by the end of 2002. The proportion of benzodiazepine prescriptions was the highest of all such drugs, but declined from approximately 67% of prescriptions, in 1993, to 38%, in 2002. Significant temporal increases were observed for use of antidepressants (5.6%, in 1993, to 10.9%, in 2002), antipsychotics (1.9% in 1993; 2.9% in 2002), and AChEIs (0.1% in 1999; 1.5% in 2002). These increases were associated with a 210% increase in total standardized expenditures on mental health-related drugs, from approximately $32 per older resident ($40 million total) in 1993 to $99 per older resident ($149 million total) in 2002. AChEIs accounted for fewer than 6% of prescriptions, but 25% of the costs., Conclusions: Significant shifts in prescription of mental health-related drugs and their costs have occurred over the past decade among older individuals with the introduction of newer, more expensive agents. Future research should address the appropriate balancing of increased costs versus their benefits in this population.