Feasibility and Validity of a Low-Cost Racing Simulator in Driving Assessment after Stroke.

There is a myriad of methodologies to assess driving performance after a stroke. These include psychometric tests, driving simulation, questionnaires, and/or road tests. Research-based driving simulators have emerged as a safe, convenient way to assess driving performance after a stroke. Such traditional research simulators are useful in recreating street traffic scenarios, but are often expensive, with limited physics models and graphics rendering. In contrast, racing simulators developed for motorsport professionals and enthusiasts offer high levels of realism, run on consumer-grade hardware, and can provide rich telemetric data. However, most offer limited simulation of traffic scenarios. This pilot study compares the feasibility of research simulation and racing simulation in a sample with minor stroke. We determine that the racing simulator is tolerated well in subjects with a minor stroke. There were correlations between research and racing simulator outcomes with psychometric tests associated with driving performance, such as the Trails Making Test Part A, Snellgrove Maze Task, and the Motricity Index. We found correlations between measures of driving speed on a complex research simulator scenario and racing simulator lap time and maximum tires off track. Finally, we present two models, using outcomes from either the research or racing simulator, predicting road test failure as linked to a previously published fitness-to-drive calculator that uses psychometric screening.

Driving in the elderly in health and disease.

Driving is a complex, multifaceted instrumental activity of daily living that has an independent influence on multiple health and well-being outcomes among older adults. Therefore, the benefits of driving to the individual must be balanced, through careful assessment and diagnosis, with the potential risk to self and others posed by a medically impaired driver. The influence of dementia changes substantially during the disease progression from very mild to mild, and driving is not advised for those who have progressed to the moderate stage of Alzheimer disease. Fortunately, validated high-quality screening instruments, including modern simulators and other technology aids, can help clinicians trichotomize risk (i.e., high, moderate, or low) and determine which patients need further evaluation by a driving specialist (e.g., those in the moderate range). Moreover, a body of evidence is building regarding the efficacy of certain intervention pathways to maintain current levels of driving performance among individuals with dementia, or at least slow its decline. Even with the progression of advanced driving technologies, understanding driving ability of patients with dementia will remain a critical challenge to clinicians for the foreseeable future.

A randomized crash injury prevention trial of transitioning high-risk elders from driving.

UNLABELLED: Supplemental digital content is available in the text. BACKGROUND: Older adults with medical conditions that impair function are at risk for experiencing a motor vehicle crash. This randomized controlled trial tested an intervention to reduce crash-related risk among older patients. METHODS: A 2-to-1 allocation ratio resulted in comparisons between 26 intervention and 13 attention control (n = 39) group members who were recruited from inpatient and outpatient settings. The intervention consisted of two sessions of facilitated planning in which participants' health, transportation alternatives, attitudes/emotions regarding a change in mobility, and actions to ensure continued safe mobility were discussed. Moreover, all participants received supportive telephone calls during the 6-month intervention period. RESULTS: Results showed that when compared with the control group, the intervention group had significantly better subjective health, had fewer high-risk driving behaviors, and drove less distance on excursions from home at follow-up. Yet, simple repeated-measures analyses were not significant. CONCLUSION: Results suggest that facilitated planning may help ease the transition to driving retirement among some high-risk older patients. Larger samples and longer study duration are needed to confirm these effects and to measure direct crash and injury outcomes. A significant proportion of high-risk patients do not plan for driving retirement and remain a crash risk. LEVEL OF EVIDENCE: Therapeutic/care management study, level III.

Productive and social engagement following driving cessation: a couple-based analysis.

Drawing on interdependence theory, this study examined the cross-spouse impact of driving cessation on productive (work, formal volunteering, and informal volunteering) and social engagement of older couples aged 65+ using longitudinal data from the Health and Retirement Study (1998-2010; N = 1,457 couples). Multilevel modeling results indicate that driving cessation reduced husbands' productive and social engagement, and wives' productive engagement. Spousal driving cessation reduced husbands' likelihood of working or formal volunteering, and wives' likelihood of working or informal volunteering. The more time since spousal driving cessation, the less likely husbands were to work and the less likely wives were to formally volunteer. Results suggest the need for greater recognition of the impact of driving cessation on couples, rather than just individuals, as well as the need for enhanced services or rehabilitation efforts to maintain driving even among couples with one remaining driver.

Examining Rowe and Kahn's Concept of Successful Aging: Importance of Taking a Life Course Perspective.

PURPOSE OF THE STUDY: This article critiques Rowe and Kahn's conceptualization of successful aging using tenets of the life course perspective. DESIGN AND METHODS: A review and synthesis of the literature on successful aging and studies that use a life course perspective. RESULTS: We draw on life course principles that view development as a dynamic lifelong process, embedded in historical time and place, and influenced by the web of relationships individuals are linked to, as well as more distal social structural factors. This discussion questions the relatively static nature of Rowe and Kahn's successful aging model, its emphasis on personal control over one's later-life outcomes, and neglect of historical and cultural context, social relationships, and structural forces in influencing later-life functioning. IMPLICATIONS: Caution in using the model in its current formulation is needed, and we promote thinking about how successful aging can better align with micro- and macrolevel issues through utilization of a life course perspective.

Giving up the keys: how driving cessation affects engagement in later life.

PURPOSE: Many older adults consider driving vital to maintaining their preferred lifestyle and engagement with society, yet it is normative for individuals to eventually stop driving. This study examined the impact of driving cessation on older adults' productive and social engagement and whether their mental and physical health mediated this relationship. DESIGN AND METHODS: Multilevel modeling was used to analyze longitudinal data (N = 4,788 adults age 65 and over) from the Health and Retirement Study (1998-2010). RESULTS: Productive engagement (paid work, formal volunteering, and informal volunteering) was negatively affected when older adults stopped driving, but social engagement was not immediately compromised by their transition to nondriver status. The role of physical health and mental health as mediators in explaining this relationship was negligible. IMPLICATIONS: The results suggest that interventions aimed at maintaining nondrivers' participation in productive roles should focus on factors other than enhancement of health and well-being to spur greater engagement (e.g., availability of and barriers to use of public transportation). Also important in the intervention process is planning for mobility transitions. Future research should test for geographic (e.g., urban vs. rural) differences in the impact of driving cessation on productive and social engagement.

An intervention to help older adults maintain independence safely.

Older adults who live alone are at risk for problems (e.g., falling, sudden illness). To maintain themselves safely at home they may benefit from planning to prevent problems. The purpose of this study was to evaluate an intervention designed to train family members or friends as to how to help older adults who were living alone make plans to maintain independence safely in their homes and to make behavioral and household changes to enhance safety. Support network members of 19 older adults randomly assigned to the intervention group were taught to use multiple segment vignettes to assist the older adults in creating plans for living safely. Older adults in the control group (n = 21) were asked to engage in an unstructured discussion about home safety with their network members. Older adults in the intervention group developed safer plans and made more household and behavioral changes than did control group adults.

Assessment of Readiness for Mobility Transition (ARMT): a tool for mobility transition counseling with older adults.

Individualized assessment is important when counseling older adults concerning the transition from driving to nondriving mobility. This study validated a measure of emotional and attitudinal readiness in support of mobility transition counseling (MTC). Items derived from a mixed-methods approach were administered by mailed questionnaire to community-dwelling adults (n = 297; ages 57-95). Factor analysis was employed to form the 24-item Assessment of Readiness for Mobility Transition (ARMT). The ARMT-Total Score (ARMT-TS) demonstrated sound internal consistency and split-half reliability (.88 each). The ARMT-TS correlated as hypothesized with validity measures, including self-reported physical functioning, mental health, and openness to experience. High scorers, who evidenced strong self-reliance and an unwillingness to be a burden on others, are considered to be at risk when faced with a significant mobility transition. An appreciation for such differences can allow for personalized, tailored discussion and planning for when it is time to "hang up the keys."