Using Travel Diaries to Examine the Extent to Which Older Adult Centres Are a Focal Point for Recreation and Social Activities.

This study aimed to better understand the extent to which older adult centres are a focal point for recreation and social activities for their members. Travel diaries completed by 261 members of 12 older adult centres across Ontario provided comprehensive and real-time (24-hour) data over two consecutive weeks concerning time away from home, trip purposes, and modes of travel. The data showed that nearly one-third of their trips included a stop at their older adult centre. Three-quarters also went to other community venues over the study period, possibly to access amenities (e.g., pools) not available at their centre. Notwithstanding, their local older adult centre was still a focal point in out-of-home travel, particularly for potentially more vulnerable older adults, including those who were non-drivers, had less education, and felt lonelier. The diaries also substantiated the importance of time spent socializing with peers and staff at the centre, apart from formal program participation.

Speeding and Speed Modification of Older Drivers: Does Vehicle Type Make a Difference?

The purpose of this study was to examine whether vehicle type based on size (car vs. other = truck/van/SUV) had an impact on the speeding, acceleration, and braking patterns of older male and female drivers (70 years and older) from a Canadian longitudinal study. The primary hypothesis was that older adults driving larger vehicles (e.g., trucks, SUVs, or vans) would be more likely to speed than those driving cars. Participants (n = 493) had a device installed in their vehicles that recorded their everyday driving. The findings suggest that the type of vehicle driven had little or no impact on per cent of time speeding or on the braking and accelerating patterns of older drivers. Given that the propensity for exceeding the speed limit was high among these older drivers, regardless of vehicle type, future research should examine what effect this behaviour has on older-driver road safety.

Development and Evaluation of Let's Do Lunch: A Congregate Meal Program at an Urban Senior Center.

A mixed-methods needs assessment was conducted in an urban senior center serving lower-income seniors in Toronto, Ontario, to determine whether they should offer a congregate meal program. Methods included three focus groups with participants (n = 31), a focus group with staff (n = 8), a center-wide survey (n = 36), and a community scan of programs in the area. Interviews with five coordinators at other seniors' centers who offered meal programs were also used to gauge interest and assist with program development. The results of these activities supported offering a twice weekly lunch program with user fees. Over a 6-month pilot period, process evaluation was conducted, comprising observations, record review, and focus groups with participants (n = 9) and staff/volunteers (n = 7) to examine delivery, usage, and costs. Results indicated that the program was well-received and affordable, and that demands on staff were reasonable when a facilitator with culinary training was available. The lessons learned can be used to guide other senior centers in developing and evaluating congregate meal programs.

Seasonal and Weather Effects on Older Drivers' Trip Distances.

The purpose of this study was to determine if season or weather affected the objectively measured trip distances of older drivers (≥ 70 years; n = 279) at seven Canadian sites. During winter, for all trips taken, trip distance was 7 per cent shorter when controlling for site and whether the trip occurred during the day. In addition, for trips taken within city limits, trip distance was 1 per cent shorter during winter and 5 per cent longer during rain when compared to no precipitation when controlling for weather (or season respectively), time of day, and site. At night, trip distance was about 30 per cent longer when controlling for season and site (and weather), contrary to expectations. Together, these results suggest that older Canadian drivers alter their trip distances based on season, weather conditions, and time of day, although not always in the expected direction.

Older driver estimates of driving exposure compared to in-vehicle data in the Candrive II study.

OBJECTIVE: Most studies on older adults' driving practices have relied on self-reported information. With technological advances it is now possible to objectively measure the everyday driving of older adults in their own vehicles over time. The purpose of this study was to examine the ability of older drivers to accurately estimate their kilometers driven over one year relative to objectively measured driving exposure. METHODS: A subsample (n = 159 of 928; 50.9% male) of Candrive II participants (age ≥ 70 years of age) was used in these analyses based on strict criteria for data collected from questionnaires as well as an OttoView-CD Autonomous Data Logging Device installed in their vehicle, over the first year of the prospective cohort study. RESULTS: Although there was no significant difference overall between the self-reported and objectively measured distance categories, only moderate agreement was found (weighted kappa = 0.57; 95% confidence interval, 0.47-0.67). Almost half (45.3%) chose the wrong distance category, and some people misestimated their distance driven by up to 20,000 km. Those who misjudged in the low mileage group (≤5000 km) consistently underestimated, whereas the reverse was found for those in the high distance categories (≥ 20,000); that is, they always overestimated their driving distance. CONCLUSIONS: Although self-reported driving distance categories may be adequate for studies entailing broad group comparisons, caution should be used in interpreting results. Use of self-reported estimates for individual assessments should be discouraged.

Drivers with Parkinson's disease: are the symptoms of PD associated with restricted driving practices?

This study examined whether symptoms (motor, cognitive, vision, sleepiness, depression) of Parkinson's disease (PD) were associated with restricted driving practices. To quantify driving practices, electronic devices were installed in the vehicles of 27 drivers with PD (78 % men; M = 71.6, SD = 6.6; Unified Parkinson's Disease Rating Scale (UPDRS) motor score M = 30.1, SD = 8.6; disease duration M = 3.9, SD = 2.8 years) and 20 controls (80 % men; M = 70.6, SD = 7.9) for 2 weeks. Participants completed measures of sleepiness, depression, quality of life, and assessments of motor, cognitive and visual functions. The PD group had significantly slower brake response times (p < 0.05), poorer cognitive and quality of life scores (p < 0.01) and greater depression (p < 0.05) compared to controls. Slower reaction time was significantly related to reduced driving; specifically, fewer trips (r = -0.46; p < 0.05), distance (r = -0.54, p < 0.01) and duration at night (r = -0.58, p < 0.01). Better cognitive scores were associated with driving less often in difficult situations such as bad weather and rush hour (p < 0.05), as well as reduced speed on city streets, but only for the control group. While most drivers with PD rated their overall health as good or excellent, the five PD drivers who rated their health more poorly had significantly worse clinical symptoms (UPDRS motor scores, contrast sensitivity, depression, brake response time) and more restricted driving patterns. These findings show that drivers with PD who perceive their health poorly have greater symptomatology and were more likely to restrict their driving, possibly due to noticeable declines in multiple driving-related abilities.

Examination of naturalistic driving practices in drivers with Parkinson's disease compared to age and gender-matched controls.

A few studies suggest that drivers with Parkinson's disease (PD) may self-regulate or modify their driving behavior more than drivers without neurological disorders; however findings are limited to self-report. The purpose of this study was to objectively examine whether drivers with PD show more restrictive driving practices (exposure and patterns). Electronic devices were installed in the vehicles of 27 drivers with PD (71.6±6.6; 78% men) and 20 matched controls (70.6±7.9; 80% men) for two weeks and driving data were matched with aerial maps, weather and daylight archives and trip logs to examine driving context. Compared to controls, the PD group drove significantly less overall (number of trips, kilometres, duration), and proportionately less at night and on days with bad weather suggesting more restricted driving practices, congruent with lower ratings of driving comfort and abilities. However, they may not necessarily drive more cautiously or safely as they drove significantly faster (and over the speed limit) on highways and freeways and 19% reported driving problems over the two weeks. These preliminary findings need to be replicated and longitudinal studies using objective indicators are needed to examine changes in driving practices, as well as crash outcomes, as disease severity progresses.

Self-regulatory practices of drivers with Parkinson's disease: accuracy of patient reports.

BACKGROUND: Studies suggest that drivers with Parkinson's disease (PD) are more likely than controls to restrict their exposure and avoid challenging situations possibly to compensate for declining abilities; however it is questionable whether patient reports should be taken at face value. To address this issue, this study examined agreement between self-reported and actual driving practices in drivers with and without PD. METHODS: Two electronic devices (one with GPS) were installed in the vehicles of 26 drivers with PD (mean age 71.5 ± 6.8, 77% men) and 20 controls (mean age 70.6 ± 7.9, 80% men) for two weeks. Participants completed a questionnaire on usual driving patterns, scales on Situational Driving Frequency (SDF) and Avoidance (SDA), the MoCA and an interview. RESULTS: Self-estimates of distance driven (km) over the two weeks were inaccurate in both groups; however the tendency to under-estimate was more pronounced in PD drivers. Drivers with PD reported more self-restrictions (higher SDA scores, p < .01; lower SDF scores, p < .05), yet drove more at night, in bad weather, in rush hour and on highways than they reported. Drivers with PD had significantly lower MoCA scores overall (p < .01) and on the memory subtest (p < .05), however, MoCA scores were not correlated with self-reported restrictions, or actual driving distance in either group. CONCLUSIONS: These findings indicate that patient reports of driving behavior should not be taken at face value by researchers or clinicians. Patients with PD may be more likely than drivers in general to have problems with recall and possibly less awareness of their driving practices.

Evaluating medically at-risk drivers: a survey of assessment practices in Canada.

BACKGROUND: Assessing medical fitness to drive (FTD) can include both off- and on-road testing, although consistency of practice is unclear. PURPOSE: To examine actual practices being used to assess FTD at driver assessment centres (DACs) across Canada. METHOD: Surveys e-mailed to 90 DACs were returned by 47 assessors. FINDINGS: The majority of respondents (89%) were occupational therapists. Assessors reported doing an average of eight FTD assessments per month (range = I to 40) at an average cost of $366 (SD = $225; range = $40 to $985). Referrals came from physicians (96%), other health professionals (70%), and licensing authorities (66%). Clients with stroke, dementia, traumatic brain injury, mild cognitive impairment, and multiple sclerosis composed 62% of estimated caseloads. Assessments took 3 hr on average (range = 1.24 to 4.5 hr); 64% reported they always took clients on road regardless of clinic results. IMPLICATIONS: Evidence-based guidelines for training and assessment are clearly needed given the inconsistency in practice.

Drivers with Parkinson's disease: who participates in research studies?

BACKGROUND: Concern about the effects of Parkinson's disease (PD) on driving competence has precipitated many studies, although most have consisted of small samples. Findings are difficult to interpret and compare as researchers have employed different inclusion/exclusion criteria and rarely provide information on the number of PD patients who are no longer driving, fail to meet other criteria, or refuse to participate. METHODS: The present study examined barriers to participation and representativeness of research participants by screening PD patients at a movement disorder research center to develop a profile of patients who were currently driving versus those who had stopped driving, and to ascertain eligibility and willingness to participate in driving research. RESULTS: Over 13 months, 128 PD patients were screened (mean age 69.2 ± 10.1; range 39-90); 62% men; with UPDRS motor scores ranging from 8.5 to 68 (mean 30.3 ± 11.3). Only 66% were still driving, and compared to those who had stopped driving, current drivers were more likely to be men (p < .05), younger (p < .05), experienced less severe motor dysfunction (p < .001) and were less likely to report freezing symptoms (p < .05). Less than half (48%) who were eligible for the study agreed to participate. The primary reasons for refusal was having their driving assessed and fear of being reported to licensing authorities. CONCLUSIONS: Recruitment of women and participants from various ethnic, educational and socioeconomic backgrounds are important when considering the generalizability of study findings and are needed to develop fitness to drive guidelines in persons with PD.

Naturalistic study of winter driving practices by older men and women: examination of weather, road conditions, trip purposes, and comfort.

Most studies on seniors' driving practices are based on self-reports; none have objectively examined winter driving patterns. We used electronic devices, together with trip logs, digital maps, and weather archives, to examine the driving patterns of seniors aged 65 to 91 over two consecutive weeks between November 2008 and March 2009. Night driving differed by month showing the importance of seasonal factors, particularly the amount of daylight. Although 69 per cent of the sample drove on days with adverse conditions, seniors were significantly more likely to make trips for social/entertainment purposes on days with good weather, and out-of-town trips on days with good road conditions. Driving comfort scores, particularly for night driving, were significantly related to multiple indicators of exposure and patterns, including radius from home. Compared to men, women had significantly lower driving comfort scores and were less likely to drive on days with adverse weather and road conditions.

Examination of driving comfort and self-regulatory practices in older adults using in-vehicle devices to assess natural driving patterns.

Several studies have shown that age, gender, visual problems and confidence are associated with self-regulatory practices such as reduced exposure and avoidance of night and highway driving. To date, however, self-regulation has only been examined through self-report. The purpose of this study was to further our understanding of the association between driver characteristics, perceptions and self-regulation by monitoring the patterns of 61 drivers (mean age 80.4+/-5.5; 59% women) for one week using in-vehicle devices. Usual self-regulatory practices were assessed using the Situational Driving Frequency (SDF) and Avoidance (SDA) Scales, while perceptions were measured using the Driving Comfort and Perceived Driving Abilities Scales. Additional evidence for test-retest reliability was obtained with a separate sample of 39 older drivers. Lower comfort and poorer perceived abilities were significantly related to actual behavior: reduced exposure (km, duration) in general and at night, average and maximum radii from home and driving in challenging situations (such as on highways). Neither sex nor age was associated with any of the driving indicators. While longitudinal studies are required to determine temporality (when drivers change their behavior) and directionality (does lower comfort lead to driving restrictions or vice versa), this is the first study to demonstrate that driver perceptions are associated with actual self-regulatory practices.

Correspondence between self-reported and objective measures of driving exposure and patterns in older drivers.

The driving behavior of older adults has been traditionally examined using questionnaires and diaries. The accuracy of self-reports has been questioned, and in-vehicle recording devices touted as more objective measures of real-world driving. The purposes of this study were to replicate and extend prior research comparing self-report and actual measures of driving exposure and patterns. Two electronic devices were installed in the vehicles of 61 drivers (67-92 years, 59% women) who were instructed to drive as usual over 1-week. Participants completed trip logs, daily diaries, a questionnaire on usual driving habits, ratings of situational driving frequency and avoidance and a follow-up interview. Only 53% of the sample attempted to estimate how far they had driven over the week and self-estimates were inaccurate (ME=77.5 km; CV=44.5%). Drivers tended to miss a significant number of trips and stops in their diaries. Driving behavior over the week was fairly consistent with usual practices regarding time of day, driving in certain areas, and night driving. However, subjects drove in challenging situations more than usual. Triangulating multiple sources of electronic and self-reported data provided a better understanding about the behavior of older drivers.

Effectiveness of the First step Program delivered by professionals versus peers.

BACKGROUND: To compare the effectiveness of a theory-based lifestyle physical activity (PA) program delivered to individuals with type 2 diabetes in diabetes education centers by professionals and peers. METHODS: Changes over 16 weeks in PA (steps/day) and related variables (weight, waist girth, resting heart rate, systolic and diastolic blood pressures) were compared (RMANOVA) for two groups: 157 participants led by 13 different professionals versus 63 participants led by 5 peer leaders. RESULTS: Overall, the 81 male and 139 female participants (age = 55.7 +/- 7.3 years, BMI = 35.2 +/- 6.6) showed an incremental change of 4,059 +/- 3,563 steps/day, which translates into an extra 37 minutes of daily walking (P < .001). Statistically significant improvements were also seen in weight, waist girth, and blood pressure (all P < .001) and resting heart rate (P < .05). There were no significant differences in outcomes between professional and peer-led groups. CONCLUSIONS: A theory-based behavior modification program featuring simple feedback and monitoring tools, and with a proven element of flexibility in delivery, can be effective under real-world conditions while addressing inevitable concerns about resource allocation. Program delivery by peer leaders, in particular, could address a potential obstacle to dissemination by helping to alleviate existing high caseload demands on diabetes educators.

Implementation, process, and preliminary outcome evaluation of two community programs for persons with stroke and their care partners.

PURPOSE: This evaluation compared a new self-management program with land and water exercise (Moving On after STroke or MOST) to a standard education program (Living with Stroke or LWS). PARTICIPANTS: Of 30 persons with stroke (average age 68 and 2 years post stroke), 18 selected MOST and 12 chose LWS. Sixteen care partners participated. METHOD: Assessments at baseline, program completion, and 3-month follow-up included the Reintegration to Normal Living (RNL) Index, Activity-specific Balance Confidence (ABC) scale, exercise participation, and goal attainment (for the MOST group). Program delivery costs were calculated and focus groups conducted to examine participant expectations and experiences. RESULTS: Social support was an important benefit of both programs, but only MOST participants improved significantly on the RNL (p < .05) and ABC (p < .001). Seventy-eight percent of all short-term personal goals in MOST were achieved, and overall goal attainment was above the expected level. At follow-up, a higher percentage of MOST participants were enrolled in exercise programs (p < .05). CONCLUSION: Although self-management programs with exercise are more costly to deliver than standard educational programs, these preliminary results indicate that such programs may be more effective in helping persons with stroke and care partners deal with the challenges of living with stroke.

Participant experiences in a workplace pedometer-based physical activity program.

BACKGROUND: Limited process evaluation of pedometer-based interventions has been reported. METHODS: Feedback via focus groups (n=38) and exit questionnaires (n=68) was used to examine participants' experiences in a group-based, pedometer-based physical activity (PA) program delivered in the workplace. RESULTS: The pedometer was described as a useful tool for increasing awareness of PA, providing motivation and visual feedback, and encouraging conversation and support among participants and others such as family and friends. Group meetings provided motivation and social support, as did participation by coworkers. Self-selected goals, self-selected PA strategies, and recording of steps/d were also important. CONCLUSIONS: Given the importance of social support as a mediating variable in changing PA behavior, future pedometer-based programs might benefit from including a group-based component.

Conceptualizing and measuring confidence in older drivers: development of the day and night driving comfort scales.

OBJECTIVE: To examine and measure driving confidence from the perspective of older adults. DESIGN: Used focus groups for construct examination, item generation, and ratings; conducted psychometric testing using Rasch analysis for scale refinement; examined test-retest reliability and associations with driver characteristics and driving habits. SETTING: Retirement complexes and seniors' housing and centers in Ontario, Canada. PARTICIPANTS: Convenience samples of current drivers (n=143) (range, 66-92y) and 7 counselors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Day (DCS-D) and Night (DCS-N) Driving Comfort Scales developed inductively with older drivers. RESULTS: Older drivers believed that it was important to consider confidence in their own abilities and discomfort caused by other drivers, to separate day and night driving, and to specify the driving context (eg, traffic flow, speed). Rasch analysis showed that the final 13-item DCS-D and 16-item DCS-N were both hierarchic and unidimensional, with good person (.89, .96) and item (.98, .97) reliabilities, respectively. Test-retest reliability was adequate for the DCS-D (intraclass correlation coefficient [ICC]=.7) and good for the DCS-N (ICC=.88). Scores were significantly associated with reported driving frequency, situational avoidance, and perceived abilities (P<.001). CONCLUSIONS: The Driving Comfort Scales are promising new tools for research and practice.

Assessing subjective fall concerns in residential living seniors: development of the activities-specific fall caution scale.

OBJECTIVES: To examine subjective fall concerns of seniors in residential care and to develop a tool applicable to both nursing home and assisted living settings. DESIGN: Used focus groups with residents and staff for construct examination and item generation; surveyed staff and interviewed residents for item verification; and conducted psychometric testing using Rasch analysis for scale refinement. SETTING: Seventeen residential care facilities in Ontario, Canada. PARTICIPANTS: Convenience samples totaling 57 staff and 234 residents. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Activities-specific Fall Caution (AFC) Scale, developed inductively with residents and staff, with items pertaining to residential living (eg, moving around a room full of people, furniture, or walkers). RESULTS: Resident terms (being cautious or careful) and qualifications (whether alone and proximity of gait aids) guided tool development. Rasch analysis showed that the final 13-item AFC Scale was hierarchic and unidimensional, with good person (.86) and item (.95) reliability. CONCLUSIONS: The AFC scale is a promising new tool for assessing subjective fall concerns in residential care residents. This tool can be administered via interview in about 10 minutes to most residents with Mini-Mental State Examination scores of 12 or greater, using practice questions to determine understanding and a 4-point color response card similar to a traffic light to facilitate responding.

Reliability, construct validity, and clinical feasibility of the activities-specific fall caution scale for residential living seniors.

OBJECTIVE: To examine the reliability, validity, and feasibility of the Activities-specific Fall Caution (AFC) Scale. DESIGN: Cross-sectional studies with test-retest and interrater reliability. SETTING: Residential care facilities in Ontario, Canada: 10 in study 1 and 6 in study 2. PARTICIPANTS: Convenience samples of 101 and 31 residents. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: In study 1, the AFC Scale was readministered to 44 residents, 64 were assessed using the Berg Balance Scale, Timed Up & Go, and Self-Paced Walk Test, and the Nursing Home Life-Space Diameter was completed for 80 residents. In study 2, staff administered the AFC Scale to 31 residents on 2 occasions. RESULTS: In study 1, test-retest reliability (intraclass correlation coefficient [ICC]) was .87 (95% confidence interval, .78-.93). AFC scores were associated with physical performance and mobility patterns (P<.001) and able to discriminate on the basis of gait aid use (P<.001), balance disorders (P<.05), and transfer assistance and walk speed (P<.01). Comparatively, general fear of falling showed weaker associations and a sex bias. In study 2, staff administration was fairly consistent (ICC=.71) and similar associations emerged for AFC scores. CONCLUSIONS: The AFC Scale shows good reproducibility, convergent and discriminative validity, and is feasible for clinical as well as research use.

Pedometer accuracy in nursing home and community-dwelling older adults.

PURPOSE: The accuracy of pedometers has not been thoroughly tested with older adult populations. The purpose of the present study was to examine the effects of walking speed and gait disorders on the accuracy of Yamax pedometers with nursing home residents (NH) relative to older adults living in the community. METHODS: Pedometer accuracy was evaluated against observed steps taken during a self-paced walking test (slow, normal, and fast speeds) in 26 NH residents and 28 seniors' recreation center members (SC). Devices were attached to clothing at the waist. Walking speed was ascertained from the timed walk and a gait assessment was conducted. Percent error was calculated as ([pedometer steps - observed steps]/observed steps) x 100. RESULTS: The walking speeds of both samples increased across self-selected paces (P < 0.0001). The community-dwelling older adults walked significantly faster (P < 0.0001) in all trials and had significantly higher (P < 0.0001) gait assessment scores (indicating fewer gait problems). Gait scores were positively associated with walking speed and pedometer percent error. Pedometers significantly underestimated NH residents' observed steps taken by 74% (slow), 55% (normal), and 46% (fast) paces (P < 0.0001). In the SC sample, the instruments failed to detect 25%, 13%, and 7% of actual steps taken, respectively (P < 0.0001). The magnitude of the error was greater for NH versus SC older adults (P < 0.0001) across all trials. CONCLUSIONS: Slow walking speed and gait disorders hamper the utility of pedometers for physical activity measurement in frail seniors, such as NH residents, when worn at the usual attachment site. Pedometers, however, can be confidently used with ostensibly healthy older adult populations for both assessment and motivation purposes.