Findings on Advance Care Plans among Cognitively Impaired Older Adults.

Cognitively impaired and cognitively intact older adults seemingly differ regarding engagement in aspects of advance care plans (ACPs). Through informant reports in the Canadian Study on Health and Aging, we examined differences between deceased cognitively impaired and intact older adults in components of ACPs: (1) discussions/arrangements for end-of-life care; (2) creation of legal documents; and in ACP outcomes, (3) location of death; and (4) dying in accordance with wishes. Cognitively impaired older adults were more likely to have made arrangements for a substitute decision-maker (OR = 1.90) and to have created legal documents (OR = 2.64 for health care preferences, OR = 2.00 for naming a decision-maker). They were less likely to have discussed preferences for end-of-life care (OR = 0.62). These findings suggest that ACPs differ for cognitively impaired persons, indicating a need for further investigation. This is a step towards understanding this complex process in a particularly vulnerable population.

Stages of driving behavior change within the Transtheoretical Model (TM).

INTRODUCTION: Many older adults voluntarily restrict their driving or stop driving of their own accord. Driving behavior change may occur in stages, as predicted by the Transtheoretical Model of Behavior Change (TM). METHOD: This study explored the process of older driver behavior change within the TM framework using interviews/focus groups with drivers and former drivers aged 71-94 years. Within those groups of drivers, driving behavior was divided into two classes: those who changed their driving with age and those who did not. Those who changed their driving as they aged included people gradually imposing restrictions ("gradual restrictors") and those making plans in anticipation of stopping driving ("preparers"). Participants who did not change their driving included those who employed lifelong driving restrictions ("consistent") and those who made no changes ("non-changers"). RESULTS: Preliminary support for TM within the driving context was found; however, further exploration of driving behavior change within this framework is warranted. PRACTICAL APPLICATIONS: It is important to continue to investigate the factors that might influence driving behavior in older adults. By promoting self-regulation in individuals, it may be possible to help older adults continue to drive, thereby improving older adult's mobility and quality of life.