Fit2Drive: Screening Older Drivers with Cognitive Concerns.

OBJECTIVES: The purpose of this study was to identify the most parsimonious combination of cognitive tests that accurately predicts the likelihood of passing an on-road driving evaluation in order to develop a screening measure that can be administered as an in-office test. DESIGN: This was a psychometric study of the new test's diagnostic accuracy. SETTINGS AND PARTICIPANTS: The study was conducted at the Florida Atlantic University's Memory Center and Clinical Research Unit, both easily accessible to older drivers. Participants were older drivers who received a driving evaluation at the Memory Center and agreed to have their results included in the Driving Repository and community-based older drivers who volunteered to participate. METHODS: Mini-Mental State Exam (MMSE), Trail Making Tests A and B, Clock Test, Hopkins Verbal Learning Test, and Driving Health Inventory results were compared with an on-road driving evaluation to identify those tests that best predict the ability to pass the on-road evaluation. RESULTS: Altogether, 412 older drivers, 179 men and 233 women, were included in the analysis. Fifty-four percent of Driving Repository participants failed the on-road evaluation compared with 8% of the community sample. The highest correlation to the on-road evaluation was Trails B time in seconds r = -0.713 (P < .001). Variables with high multicollinearity and/or low correlation with the on-road evaluation were eliminated and sets of receiver operating characteristics curves were generated to assess the predictive accuracy of the remaining tests. A linear combination of Trails B in seconds and MMSE using the highest of the Serial 7s or WORLD spelled backward scores accounted for the highest area under the curve of 0.915. Finally, an algorithm was created to rapidly generate the prediction for an individual patient. CONCLUSIONS AND IMPLICATIONS: The Fit2Drive algorithm demonstrated a strong 91.5% predictive accuracy. Usefulness in office-based patient consultations is promising but remains to be rigorously tested.

Study protocol for "In-vehicle sensors to detect changes in cognition of older drivers".

BACKGROUND: Driving is a complex behavior that may be affected by early changes in the cognition of older individuals. Early changes in driving behavior may include driving more slowly, making fewer and shorter trips, and errors related to inadequate anticipation of situations. Sensor systems installed in older drivers' vehicles may detect these changes and may generate early warnings of possible changes in cognition. METHOD: A naturalistic longitudinal design is employed to obtain continuous information on driving behavior that will be compared with the results of extensive cognitive testing conducted every 3 months for 3 years. A driver facing camera, forward facing camera, and telematics unit are installed in the vehicle and data downloaded every 3 months when the cognitive tests are administered. RESULTS: Data processing and analysis will proceed through a series of steps including data normalization, adding information on external factors (weather, traffic conditions), and identifying critical features (variables). Traditional prediction modeling results will be compared with Recurring Neural Network (RNN) approach to produce Driver Behavior Indices (DBIs), and algorithms to classify drivers within age, gender, ethnic group membership, and other potential group characteristics. CONCLUSION: It is well established that individuals with progressive dementias are eventually unable to drive safely, yet many remain unaware of their cognitive decrements. Current screening and evaluation services can test only a small number of individuals with cognitive concerns, missing many who need to know if they require treatment. Given the increasing number of sensors being installed in passenger vehicles and pick-up trucks and their increasing acceptability, reconfigured in-vehicle sensing systems could provide widespread, low-cost early warnings of cognitive decline to the large number of older drivers on the road in the U.S. The proposed testing and evaluation of a readily and rapidly available, unobtrusive in-vehicle sensing system could provide the first step toward future widespread, low-cost early warnings of cognitive change for this large number of older drivers in the U.S. and elsewhere.

Use of Sensors for Fall Prediction in Older Persons: A Scoping Review.

The application of technological advances and clear articulation of how they improve patient outcomes are not always well described in the literature. Our research team investigated the numerous ways to measure conditions and behaviors that precede patient events and could signal an important change in health through a scoping review. We searched for evidence of technology use in fall prediction in the population of older adults in any setting. The research question was described in the population-concept-context format: "What types of sensors are being used in the prediction of falls in older persons?" The purpose was to examine the numerous ways to obtain continuous measurement of conditions and behaviors that precede falls. This area of interest may be termed emerging knowledge . Implications for research include increased attention to human-centered design, need for robust research trials that clearly articulate study design and outcomes, larger sample sizes and randomization of subjects, consistent oversight of institutional review board processes, and elucidation of the human costs and benefits to health and science.

Nursing Home Resident, Family, and Staff Perspectives on Achieving Comfort at End of Life: A Qualitative Study.

Increasing numbers of US older adults die in long-term care facilities. This qualitative study explored nursing home resident, family member, and staff perspectives and preferences regarding end-of-life care for the resident. From 67 potential participants referred by staff, 47 were found eligible and consented, including 16 residents, 10 family members, and 20 staff. A semistructured questionnaire guided the interview process and included questions such as what matters most at the end of life and whether participants would opt for any of the 8 aggressive treatments proposed for a resident at the end of life. Data were analyzed using descriptive and pattern coding for thematic interpretation. The 3 themes that emerged were centrality of comfort, what matters most at the end of life, and promoting comfort. All participant groups overwhelmingly endorsed comfort as a priority. Some participants would accept aggressive treatment to alleviate suffering and promote comfort. Residents were concerned about the well-being of their families, whereas family members emphasized the importance of their presence and that their dying relatives were not suffering. Staff sometimes filled this role on their behalf. Ancillary staff emphasized bathing, dressing, and grooming the resident to preserve the resident's dignity. The results support comfort as a priority for care at the end of life and the need for more discussion to increase mutual agreement on goals of care and what promotes comfort for the resident and family.

Regional Workshops to Disseminate Decision Guide to Reduce Potentially Preventable Hospital Transfers: Application of the Diffusion of Innovation Model.

INTRODUCTION: Medically unnecessary, potentially preventable transfers of nursing home (NH) residents to acute care poses multiple risks for residents. Family and resident insistence on these preventable transfers has not been thoroughly addressed in transfer reduction programs. METHODS: The Diffusion of Innovation model guided dissemination of an evidence-based patient decision guide that addressed resident and family insistence on hospital transfer. Twenty workshops were held across eight states of Centers for Medicare and Medicaid Services Region IV. All Medicare-certified NHs in Region IV received emailed invitations to the workshops in their states. Quantitative and qualitative data were collected on workshop attendees, the facilities they represented, and response to the workshop including adoption of the Guide and its effect on hospital readmissions. RESULTS: Altogether, 1124 facility representatives and affiliated professionals attended the workshops. NH administrators rated the program 4.4 out of 5. Of those who responded, 71% said that they were using the Guide as a result of the workshop; 89% of these said that it was helpful, especially to initiate difficult conversations about end-of-life care and to discuss the care a contemporary NH can provide. Readmission rates dropped 30% in the NHs that reported their results. CONCLUSIONS: The use of the Diffusion of Innovation model was effective in delivering information to a large number of facilities in sufficient detail to implement the Decision Guide. However, the workshop format provided little opportunity to respond to concerns that arose after the workshops, to diffuse the innovation further, or to build sustainability.

NON-INTRUSIVE DROWSINESS DETECTION TECHNIQUES AND THEIR APPLICATION IN DETECTING EARLY DEMENTIA IN OLDER DRIVERS.

Drowsy drivers cause the most car accidents thus, adopting an efficient drowsiness detection system can alert the driver promptly and precisely which will reduce the numbers of accidents and also save a lot of money. This paper discusses many tactics and methods for drowsy driving warning. The non-intrusive nature of most of the strategies mentioned and contrasted means both vehicular and behavioural techniques are examined here. Thus, the latest strategies are studied and discussed for both groups, together with their benefits and drawbacks. The goal of this review was to identify a practical and low-cost approach for analysing elder drivers' behaviour.

Nursing Home Resident, Family, and Staff Perspectives on Hospital Transfers for End-of-Life Care.

Residents who are terminally ill often experience transfers to the emergency department resulting in hospitalizations, which may be potentially avoidable with treatment in the nursing home. This qualitative study explored the perspectives of 15 residents, 10 family members, and 20 nursing home staff regarding end-of-life care and the circumstances prompting resident transfers. Data analysis of participant interviews conducted January to May 2019 in a South Florida nursing home identified four themes related to transfer to the hospital: time left to live, when aggressive treatments would be unavailing, not knowing what the nursing home can do, and transfer decisions are situation-dependent. Study findings underscore the importance of increasing resident and family awareness of treatments available in the nursing home and person-centered advance care planning discussions. Further research should explore the reasons for residents' and family members' choice of aggressive therapies and their goals for care at the end of life.

Cannabinoids and synthetic cannabinoids as a cause of death: Trends and their healthcare implications.

INTRODUCTION: Cannabis remains one of the most widely used illicit substances globally, with 188 million users in 2017. In the United States, nearly 50 million people are reported to have used cannabis in 2020. More research is needed because of the dramatic increase in cannabis use and the perception that its use has minimal risk. DESIGN: The researchers used a retrospective design for this study. METHODS: We used the Florida Department of Law Enforcement data from 2014 to 2020 for this study. We used descriptive statistics to report the characteristics of decedents whose cause of death (COD) was associated with cannabinoid (CB) and synthetic cannabinoid (SC) use. We used a general linear model with repeated measures to examine CB and SC death rate trends. RESULTS: A total of 386 decedents' COD in Florida was associated with CB and SC use. Nearly 28% of decedents were 45-54 years, male (87.8%), and non-Hispanic whites (65.3%). One hundred percent of CB-related decedents died in urban counties. In rural counties, SC decedents accounted for 28.3% of deaths. Of decedents in rural counties, 39.9% were African American. Most decedents (with CB and SC use) died from accidents (98.7%), with 12.6% of cases involving cardiovascular-related illnesses. CONCLUSION: CBs and SCs as a COD pose a legitimate health problem to society. More people ages 45-54 died from CBs and SCs. Drug intoxications (from CBs and SCs) and motor vehicle collisions accounted for most of the accidents reported while under the influence of CBs and SCs. While most decedents from both CBs and SCs were non-Hispanic whites, a substantial proportion of African Americans died from SCs as a COD in rural counties. It is important that the public become aware of the risks for adverse effects of CB and SC. The public needs to be aware that CB and SC use can exacerbate cardiac-related conditions. CLINICAL RELEVANCE: This study has clinical relevance to patient safety. CB and SC use contributes to motor vehicle accidents and can cause adverse effects including death.

Abnormal Driving Detection using GPS Data.

Given a GPS dataset comprising driving records captured at one-second intervals, this research addresses the challenge of Abnormal Driving Detection (ADD). The study introduces an integrated approach that leverages data preprocessing, dimensionality reduction, and clustering techniques. Speed Over Ground (SOG), Course Over Ground (COG), longitude (lon), and latitude (lat) data are aggregated into minute-level segments. We use Singular Value Decomposition (SVD) to reduce dimensionality, enabling K-means clustering to identify distinctive driving patterns. Results showcase the methodology's effectiveness in distinguishing normal from abnormal driving behaviors, offering promising insights for driver safety, insurance risk assessment, and personalized interventions.

Anomalous Behavior Detection in Trajectory Data of Older Drivers.

Given a road network and a set of trajectory data, the anomalous behavior detection (ABD) problem is to identify drivers that show significant directional deviations, hard-brakings, and accelerations in their trips. The ABD problem is important in many societal applications, including Mild Cognitive Impairment (MCI) detection and safe route recommendations for older drivers. The ABD problem is computationally challenging due to the large size of temporally-detailed trajectories dataset. In this paper, we propose an Edge-Attributed Matrix that can represent the key properties of temporally-detailed trajectory datasets and identify abnormal driving behaviors. Experiments using real-world datasets demonstrated that our approach identifies abnormal driving behaviors.

In-vehicle Sensing and Data Analysis for Older Drivers with Mild Cognitive Impairment.

Driving is a complex daily activity indicating age and disease-related cognitive declines. Therefore, deficits in driving performance compared with ones without mild cognitive impairment (MCI) can reflect changes in cognitive functioning. There is increasing evidence that unobtrusive monitoring of older adults' driving performance in a daily-life setting may allow us to detect subtle early changes in cognition. The objectives of this paper include designing low-cost in-vehicle sensing hardware capable of obtaining high-precision positioning and telematics data, identifying important indicators for early changes in cognition, and detecting early-warning signs of cognitive impairment in a truly normal, day-to-day driving condition with machine learning approaches. Our statistical analysis comparing drivers with MCI to those without reveals that those with MCI exhibit smoother and safer driving patterns. This suggests that drivers with MCI are cognizant of their condition and tend to avoid erratic driving behaviors. Furthermore, our Random Forest models identified the number of night trips, number of trips, and education as the most influential factors in our data evaluation.

Factors Associated with Physical Activity in a Diverse Older Population.

Physical activity is important for healthy aging, but few older adults achieve the goal of 150 min per week of moderate activity. The purpose of this study was to employ a robust statistical approach in the analysis of the factors related to physical activity in a diverse sample of older adults. A secondary analysis of factors associated with calculated MET-h/week was conducted in a sample of 601 African Americans, Afro-Caribbeans, European Americans, and Hispanic Americans age 59 to 96 living independently in the community. Age, education, social network, pain, and depression were the five variables that accounted for a statistically significant proportion of unique variance in the model. The strongest correlation to total MET-h/week was with depression. Directionality of the relationship between these variables and physical activity is complex: while pain and depression can reduce physical activity, activity may also help to reduce pain and depression. Additionally, of note is that many of these factors may be modified, calling for the design and testing of individual, group, and community level interventions to increase physical activity in the older population.

Digital Health Information Disparities in Older Adults: a Mixed Methods Study.

Important health information including disease prevention and chronic disease self-management is increasingly packaged for digital use. The purpose of this sequential explanatory mixed methods study was to describe the extent of computer ownership, Internet access, and digital health information use in an ethnically diverse sample of older adults, comparing ownership, access, and use of digital health information (DHI) across ethnic groups and identifying the factors associated with them quantitatively. Significant differences in computer ownership, Internet access, and DHI use were found across ethnic groups (African American, Afro-Caribbean, Hispanic American, and European American). Logistic regression identified older age, less education, lower income, and minority group membership as significant predictors of limited DHI use. Older African Americans were one-fifth as likely to own a computer than were European Americans; Hispanic Americans were one-half as likely to have access to the Internet. We then conducted a series of focus groups which highlighted differences across ethnic groups. Participants in the African American/Afro-Caribbean group expressed frustration with lack of access to DHI but appreciation for alternative sources of information. Hispanic Americans critiqued information received from providers and drug inserts, some suggesting that a positive attitude and trust in God also contributed to getting well. European American participants evaluated various DHI websites, looking to providers for help in applying information to their personal situation. As the development and use of DHI continue, parallel efforts to increase access to DHI among economically disadvantaged and minority older adults are critical to prevent further disfranchisement.

Communicating With Nursing Home Residents About End of Life.

Approximately 33% of the 1.2 million older individuals residing in nursing homes have the capacity to discuss their preferences for end-of-life care, and 35% will die within their first year in the nursing home. These conversations necessary to promote care consistent with the resident's preferences are often limited and most often occur when the resident is actively dying. The purpose of this secondary analysis was to understand the resident's perspectives on end-of-life communication in the nursing home and suggest approaches to facilitate this communication. We interviewed 46 participants (16 residents, 10 family members, and 20 staff) in a Southeast Florida nursing home from January to May 2019. The data were analyzed using descriptive and pattern coding and matrices to decipher preliminary categories and thematic interpretation within and across each participant group. Two themes emerged from this secondary analysis that residents assume others know their end-of-life preferences, and past experiences may predict future end-of-life choices. Residents and family members were willing to discuss end-of-life care. Study findings also suggested that past experiences with the end-of-life and critical illness of another could impact residents' and family members' end-of-life care decisions, and that nurses' recognition of subtle signs of a resident's decline may trigger provider-initiated end-of-life conversations. Future research should focus on strategies to promote earlier end-of-life discussions to support independent decision-making about end-of-life care in this relatively dependent population of older adults.

Methods and Tools for Monitoring Driver's Behavior.

In-vehicle sensing technology has gained tremendous attention due to its ability to support major technological developments, such as connected vehicles and self-driving cars. In-vehicle sensing data are invaluable and important data sources for traffic management systems. In this paper we propose an innovative architecture of unobtrusive in-vehicle sensors and present methods and tools that are used to measure the behavior of drivers. The proposed architecture including methods and tools are used in our NIH project to monitor and identify older drivers with early dementia.

Effect of Memantine on Prolonging Safe Driving in Early AD: a Pilot Study.

BACKGROUND: To determine the feasibility of conducting an RCT on the potential effectiveness of memantine hydrochloride in prolonging safe driving in mild AD. METHODS: A placebo-controlled, double blind randomized trial was conducted. Forty-three individuals ≥60 with mild AD met screening criteria and were randomized. Driving ability was measured by a standardized on-road driving test. Outcomes were driving capacity at 6 and 12 months and completion of the 12-month intervention. RESULTS: Of 43 participants randomized, 59% of the memantine group and 52% of the placebo group completed the on-road test at 12 months (p = .66). All 13 memantine group participants maintained their driving status at 12 months, whereas only 8 of the 11 placebo group participants did (p = .040, OR = 4.45). CONCLUSIONS: Results provide the framework for designing a rigorous multisite clinical trial of memantine effect on maintaining driving capacity in mild AD.

Chief Nursing Officer Perspectives on Nursing Theory-Guided Practice.

OBJECTIVE: The purpose of this study was to identify what guides nursing practice. BACKGROUND: Change occurred when the Magnet Recognition Program® no longer required a nursing theory. METHODS: This was a mixed-methods study to identify the process used to implement nursing theory-guided practice and the relationship to professional practice recognition. Deidentified quantitative data were collected from 36 chief nursing officers (CNOs). Seventeen CNOs participated in the qualitative interview. RESULTS: Thirteen CNOs were from a Magnet®-designated facility. Ten CNOs were on the Magnet journey, and 2 had no intent to seek Magnet recognition. Two CNOs were from a Pathway to Excellence®-designated facility. One CNO was on the Pathway to Excellence journey. The majority of respondents who were Magnet® recognized who participated in the survey used Watson's Theory of Human Caring. Themes were identified that share the benefits and strategies to integrate nursing-guided theory into nursing processes, structures, and outcomes. CONCLUSION: Findings will benefit CNOs as they make decisions related to pursuing Magnet status recognition.

Sustaining or Declining Physical Activity: Reports from an Ethnically Diverse Sample of Older Adults.

Over 80% of adults in the US fail to meet the ≥150 min weekly physical activity guideline; 40% age ≥ 75 are entirely inactive. The study purpose was to understand the reasons why community-dwelling older adults (age ≥ 60) from diverse backgrounds increase, sustain, or decline in their physical activity levels over time. Sixty-two older adults were interviewed. Two-thirds of the African Americans, 57% of the Afro-Caribbeans, and 50% of the European Americans reported being less active than 2-3 years ago. Reasons for activity decline included health issues (e.g., pain, shortness of breath), lack of time, interest, or motivation. Reasons for sustaining or increasing activity levels included meeting personal goals, having a purpose for remaining active, or feeling better when active (e.g., it is important to keep moving, good for the joints, going on a cruise). Themes identified were pride in maintaining activity, goal-driven activity, pushing oneself to get past pain or fatigue, and some confusion between social and physical activity in participant reports. The results indicate widespread acceptance that activity is beneficial, but that knowledge alone was insufficient to maintain activity levels over time unless individuals had a goal or purpose ("means to an end") and could overcome their physical and psychological barriers to physical activity.

Nursing home performance in a trial to reduce hospitalizations: Implications for future trials.

BACKGROUND: Experience in trials of implementing quality improvement (QI) programs in nursing homes (NHs) has been variable. Understanding the characteristics of NHs that demonstrate improvements during these trials is critical to improving NH care. DESIGN: Secondary analysis of a randomized controlled trial of implementation of a QI program to reduce hospital transfers. PARTICIPANTS: Seventy-one NHs that completed the 12-month trial INTERVENTION: Implementation included distance-learning strategies, involvement of a champion, regular submission of data on hospitalizations and root cause analyses of transfers, and training, feedback and support. MEASUREMENTS: Primary outcomes included all-cause and potentially avoidable hospitalizations and emergency department (ED) visits per 1000 NH resident days, and the percentage of residents readmitted in 30-days. We compared multiple other variables that could influence effective program implementation in NHs in the highest versus lowest quartile of changes in the primary outcomes. RESULTS: The 18 high-performing NHs had significant reductions in hospitalization and ED visits, whereas the 18 NHs in the low-performing group had increases. The difference in changes in each outcome varied between a reduction of 0.75 and 2.30 events relative to a NH with a census of 100; the absolute difference in 30-day readmissions was 19%. None of the variables we examined reached significance after adjustment for multiple comparisons between the groups. There was no consistent pattern of differences in nonprofit status, nursing staffing, and quality ratings. CONCLUSION: Our experience and reviews of other NH trials suggest that key factors contributing to successful implementation QI programs in NHs remain unclear. To improve NH care, implementation trials should account for intervention fidelity and factors that have not been examined in detail, such as degree and nature of leadership support, financial and regulatory incentives, quality measures, resident and family perspectives, and the availability of onsite high-quality medical care and support of the medical director.

Evaluation of a Novel Decision Guide "Go to the Hospital or Stay Here?" for Nursing Home Residents and Families: A Randomized Trial.

Initiatives to reduce potentially preventable hospitalizations of nursing home residents have focused on staff response to changes in condition and advance care planning. Yet, resident and family insistence on transfer has been one of the most intractable sources of these hospitalizations, although not the target of active intervention until now. Consented residents and family members in the intervention group received a newly developed decision aid entitled, "Go to the Hospital or Stay Here?," providing information on the risks and benefits of transfer versus remaining in the nursing home. This person-centered decision aid was developed from the results of 271 interviews of residents, families, and providers to identify what they wanted to know and any misunderstandings surrounding the transfer process. Engaging residents in the decision respects their right to participate and provides the information they need to make a deliberative decision. The intervention group showed a gain in knowledge and reduction in decisional conflict but reported decreased decisional preparation. There was no decrease in transfers compared to the control group. Evaluation of the decision guide by residents and families was positive. TARGETS: Nursing home residents and their family members. INTERVENTION: To provide information regarding the decision to stay in the nursing home or transfer to acute care due to a change in condition. MECHANISMS OF ACTION: Decision aid "Go the "Hospital or Stay Here?" to impart knowledge regarding the decision to remain in the nursing home or transfer to acute care. OUTCOMES: Use of the Guide was found to increase residents' and family members' knowledge and decrease decisional conflict, but it did not increase decisional preparation. No reduction in transfers was found. Residents and families rated the Guide as very helpful. [Research in Gerontological Nursing, 13(6), 309-319.].