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BackgroundOutdoor mobility is an important aspect of older adults’ functional status. GPS has been used to create indicators reflecting the spatiotemporal dimensions of outdoor mobility for applications in health and aging. However, outdoor mobility is a multidimensional construct. There is, as of yet, no classification algorithm that groups and characterizes older adults’ outdoor mobility based on its semantic aspects (ie, mobility intentions and motivations) by integrating geographic and domain knowledge. ObjectiveThis study assesses the feasibility of using GPS to determine semantic dimensions of older adults’ outdoor mobility, including destinations and activity types. MethodsA total of 5 healthy individuals, aged 65 years or older, carried a GPS device when traveling outside their homes for 4 weeks. The participants were also given a travel diary to record details of all excursions from their homes, including date, time, and destination information. We first designed and implemented an algorithm to extract destinations and infer activity types (eg, food, shopping, and sport) from the GPS data. We then evaluated the performance of the GPS-derived destination and activity information against the traditional diary method. ResultsOur results detected the stop locations of older adults from their GPS data with an F1 score of 87%. On average, the extracted home locations were within a 40.18-meter (SD 1.18) distance of the actual home locations. For the activity-inference algorithm, our results reached an F1 score of 86% for all participants, suggesting a reasonable accuracy against the travel diary recordings. Our results also suggest that the activity inference’s accuracy measure differed by neighborhood characteristics (ie, Walk Score). ConclusionsWe conclude that GPS technology is accurate for determining semantic dimensions of outdoor mobility. However, further improvements may be needed to develop a robust application of this system that can be adopted in clinical practice.

Older adults can experience declines in their cognitive abilities, which could affect their ability to engage in daily activities such as driving. Here, we compare the driving habits of older adults across different cognitive groups: cognitively healthy older adults (control), Subjective Cognitive Decline (SCD), Mild Cognitive Impairment (MCI), and Alzheimer’s Disease (AD). We analyzed data from the large-scale Comprehensive Assessment of Neurodegeneration and Dementia study (COMPASS-ND, Chertkow et al., 2019). Results revealed that the AD group drove the least often and shortest distances. Interestingly, on several measures, the SCD group was more like the MCI group than the control group (driving frequency, restrictions), suggesting that even subjective declines were associated with differences in driving habits. We will further discuss how these results are influenced by sensory and demographic factors. Driving-related limitations could reduce older adults’ participation and access to essential resources, in turn, negatively affecting their physical and mental health.

This randomized clinical trial assesses the efficacy of cognitive remediation plus transcranial direct current stimulation targeting the prefrontal cortex in slowing cognitive decline, acutely improving cognition, and reducing progression to dementia in older adults with remitted major depressive disorder, mild cognitive impairment, or both. Key Points: Question: Does cognitive remediation (CR) plus transcranial direct current stimulation (tDCS) slow cognitive decline in older adults with remitted major depressive disorder (rMDD) or mild cognitive impairment (MCI)? Findings: In this randomized clinical trial including 375 participants with rMDD or MCI, those randomized to receive active CR plus active tDCS experienced a slower cognitive decline over a median follow-up of 4 years than those randomized to receive sham-plus-sham treatments. The effects were more prominent in the rMDD (with or without MCI) than in the MCI without rMDD group. Meaning: The treatment of CR plus tDCS is effective in slowing cognitive decline in older adults with rMDD. Importance: Older adults with major depressive disorder (MDD) or mild cognitive impairment (MCI) are at high risk for cognitive decline. Objective: To assess the efficacy of cognitive remediation (CR) plus transcranial direct current stimulation (tDCS) targeting the prefrontal cortex in slowing cognitive decline, acutely improving cognition, and reducing progression to MCI or dementia in older adults with remitted MDD (rMDD), MCI, or both. Design, Setting, and Participants: This randomized clinical trial was conducted at 5 academic hospitals in Toronto, Ontario, Canada. Participants were older adults who had rMDD (with or without MCI, age ≥65 y) or MCI without rMDD (age ≥60 y). Assessments were made at baseline, month 2, and yearly from baseline for 3 to 7 years. Interventions: CR plus tDCS (hereafter, active) or sham plus sham 5 days a week for 8 weeks followed by twice-a-year 5-day boosters and daily at-home CR or sham CR. Main Outcomes and Measures: The primary outcome was change in global composite cognitive score. Secondary outcomes included changes in 6 cognitive domains, moderating effect of the diagnosis, moderating effect of APOE ε4 status, change in composite score at month 2, and progression to MCI or dementia over time. Results: Of 486 older adults who provided consent, 375 (with rMDD, MCI, or both) received at least 1 intervention session (mean [SD] age, 72.2 [6.4] years; 232 women [62%] and 143 men [38%]). Over a median follow-up of 48.3 months (range, 2.1-85.9), CR and tDCS slowed cognitive decline in older adults with rMDD or MCI (adjusted z score difference [active − sham] at month 60, 0.21; 95% CI, 0.07 to 0.35; likelihood ratio test [LRT] P =.006). In the preplanned primary analysis, CR and tDCS did not improve cognition acutely (adjusted z score difference [active − sham] at month 2, 0.06, 95% CI, −0.006 to 0.12). Similarly, the effect of CR and tDCS on delaying progression from normal cognition to MCI or MCI to dementia was weak and not significant (hazard ratio, 0.66; 95% CI, 0.40 to 1.08; P =.10). Preplanned analyses showed treatment effects for executive function (LRT P =.04) and verbal memory (LRT P =.02) and interactions with diagnosis (P =.01) and APOE ε4 (P <.001) demonstrating a larger effect among those with rMDD and in noncarriers of APOE ε4. Conclusions and Relevance: The study showed that CR and tDCS, both targeting the prefrontal cortex, is efficacious in slowing cognitive decline in older adults at risk of cognitive decline, particularly those with rMDD (with or without MCI) and in those at low genetic risk for Alzheimer disease. Trial Registration: ClinicalTrials.gov Identifier: NCT02386670 [ABSTRACT FROM AUTHOR]

Objectives: Despite three decades of research, gaps remain in meeting the needs of people with dementia and their family/friend carers as they navigate the often-tumultuous process of driving cessation. This paper describes the process of using a knowledge-to-action (KTA) approach to develop an educational web-based resource (i.e. toolkit), called the Driving and Dementia Roadmap (DDR), aimed at addressing some of these gaps. Design: Aligned with the KTA framework, knowledge creation and action cycle activities informed the development of the DDR. These activities included systematic reviews; meta-synthesis of qualitative studies; interviews and focus groups with key stakeholders; development of a Driving and Dementia Intervention Framework (DD-IF); and a review and curation of publicly available resources and tools. An Advisory Group comprised of people with dementia and family carers provided ongoing feedback on the DDR's content and design. Results: The DDR is a multi-component online toolkit that contains separate portals for current and former drivers with dementia and their family/friend carers. Based on the DD-IF, various topics of driving cessation are presented to accommodate users' diverse stages and needs in their experiences of decision-making and transitioning to non-driving. Conclusion: Guided by the KTA framework that involved a systematic and iterative process of knowledge creation and translation, the resulting person-centered, individualized and flexible DDR can bring much-needed support to help people with dementia and their families maintain their mobility, community access, and social and emotional wellbeing during and post-driving cessation. [ABSTRACT FROM AUTHOR]

Objectives Baltes and Baltes' "selective optimization with compensation" model is pertinent to driving but evidence about the use of compensation using longitudinal designs is scarce. Therefore, we sought to determine if older drivers reduced their engagement in distracting behaviors while driving, over a 6-year period. Methods We used data captured over several annual assessments from a cohort of 583 drivers aged 70 and older to determine if their engagement in 12 distracting behaviors (e.g. listening to the radio, talking with passengers) declined over time. We adjusted our multivariable model for several potential confounders of the association between our outcome variable and time. Results Overall, and after adjustment for potential confounders, the participants reduced their engagement in distracting behaviors over the study period (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.95–0.97). Baseline age was negatively associated with engagement in distracting behaviors (OR = 0.95, 95% CI = 0.94–0.96). Men engaged in more distracting behaviors than women (OR = 1.15, 95% CI = 1.03–1.27), as did participants living in the largest urban centers compared to participants living in the smallest areas (OR = 1.21, 95% CI = 1.04–1.41). The number of kilometers driven per year (for every 10,000 km) was positively associated with the proportion of distracting behaviors drivers engaged in (OR = 1.13, 95% CI = 1.08–1.19). Discussion Drivers in our cohort reduced their engagement in distracting behaviors over the study period. This suggests that older drivers adjust their driving over time, which aligns with age-related theories and models about compensation. [ABSTRACT FROM AUTHOR]

Background Assessing an older adult's fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults. Methods Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures. Results A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [ SD ] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD  = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81–9.84) compared to the lowest risk group. Conclusions For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation. [ABSTRACT FROM AUTHOR]

With a growing population of older adults living with dementia in the community, nurse practitioners (NPs) are increasingly expected to address issues of medical fitness to drive (MFTD) and driving cessation within their clinical practice. With their expertise in clinical assessment and communication skills, NPs are well suited to this area of practice. Studies that examined MFTD and/or driving cessation suggest that NPs want and need further knowledge and training with this population. As part of our aim to develop an online educational program on driving and dementia for health care providers, including NPs, this mixed-methods study explored NPs' preferences regarding the format and content for the proposed online program. Results from an online survey completed by 90 NPs and interviews with six NPs highlighted key areas of focus for virtual modules, where communication strategies, tools to assess MFTD, and the reporting process for medically unfit drivers were emphasized. Reflecting on their team approach to care, participants in this study preferred a hybrid approach of asynchronous and synchronous learning delivery for this educational program. The next step will be to evaluate this program and its impact on both NP knowledge and skills in terms of its real-world application. [ABSTRACT FROM AUTHOR]