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1.
Traffic Inj Prev ; 19(sup2): S173-S175, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30841798

RESUMEN

OBJECTIVE: The current study investigated whether older drivers' driving patterns during a customized on-road driving task were representative of their real-world driving patterns. METHODS: Two hundred and eight participants (male: 68.80%; mean age = 81.52 years, SD = 3.37 years, range = 76.00-96.00 years) completed a customized on-road driving task that commenced from their home and was conducted in their own vehicle. Participants' real-world driving patterns for the preceding 4-month period were also collected via an in-car recording device (ICRD) that was installed in each participant's vehicle. RESULTS: During the 4-month period prior to completing the on-road driving task, participants' median real-world driving trip distance was 2.66 km (interquartile range [IQR] = 1.14-5.79 km) and their median on-road driving task trip distance was 4.41 km (IQR = 2.83-6.35 km). Most participants' on-road driving task trip distances were classified as representative of their real-world driving trip distances (95.2%, n = 198). CONCLUSIONS: These findings suggest that most older drivers were able to devise a driving route that was representative of their real-world driving trip distance. Future research will examine whether additional aspects of the on-road driving task (e.g., average speed, proportion of trips in different speed zones) are representative of participants' real-world driving patterns.


Asunto(s)
Conducción de Automóvil , Desempeño Psicomotor , Autocontrol , Accidentes de Tránsito , Anciano , Anciano de 80 o más Años , Recolección de Datos , Femenino , Humanos , Masculino
2.
J Geriatr Psychiatry Neurol ; 13(1): 9-16, 2000.
Artículo en Inglés | MEDLINE | ID: mdl-10753002

RESUMEN

The objective of this analysis was to evaluate comprehensively the efficacy of metrifonate, a long-acting acetylcholinesterase inhibitor, in improving the ability of mild-to-moderate Alzheimer's disease (AD) patients to perform activities of daily living (ADLs). Alzheimer's disease patients with Mini-Mental State Examination scores of 10 to 26 were enrolled in three 26-week trials to receive once-daily placebo (n = 430) or metrifonate 30 to 60 mg (by weight, n = 650) or 60/80 mg (by weight, n = 197). Metrifonate efficacy was assessed using the Disability Assessment for Dementia scale. Data from the three studies were pooled and analyzed retrospectively. The intent-to-treat analysis (last observation carried forward) at 26 weeks demonstrated that metrifonate significantly improved the ability of AD patients to perform ADLs when compared with placebo (30-60 mg dose, delta = 3.03; P = .002; 60/80 mg dose, delta = 5.25; P = .0002). Metrifonate significantly improved the ability of the AD patients to perform instrumental ADLs, those abilities typically lost first during the disease process (30-60 mg dose, delta = 3.88, P = .002; 60/80 mg dose, delta = 5.79, P = .003). Metrifonate also tended to improve, relative to placebo, the ability of AD patients to use three levels of executive skills when performing ADLs: initiation (30-60 mg dose, delta = 3.45, P = .001; 60/80 mg dose, delta = 5.44, P = .003), planning/organization (30-60 mg dose, delta = 4.50, P = .004; 60/80 mg dose, delta = 4.89, P = .014), and effective execution (30-60 mg dose, delta = 1.80, P = .076; 60/80 mg dose, delta = 4.06, P = .030). These results indicate that metrifonate has a beneficial effect on the ADLs in mild-to-moderate AD patients.


Asunto(s)
Actividades Cotidianas , Enfermedad de Alzheimer/tratamiento farmacológico , Inhibidores de la Colinesterasa/administración & dosificación , Triclorfón/administración & dosificación , Actividades Cotidianas/psicología , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/psicología , Inhibidores de la Colinesterasa/efectos adversos , Método Doble Ciego , Femenino , Humanos , Masculino , Escala del Estado Mental , Estudios Prospectivos , Resultado del Tratamiento , Triclorfón/efectos adversos
3.
Am J Occup Ther ; 53(5): 471-81, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10500855

RESUMEN

OBJECTIVES: This article describes the development of an assessment of functional disability for use with proxy-respondents of community-dwelling persons who have Alzheimer's disease as well as a study testing its reliability. METHOD: Panels composed of health care professionals and caregivers of persons with Alzheimer's disease were used to develop the Disability Assessment for Dementia (DAD). Fifty-nine caregivers participated in the refinement of the content and the testing of reliability. RESULTS: The DAD includes 40 items: 17 related to basic self-care and 23 to instrumental activities of daily living. It demonstrated a high degree of internal consistency (Cronbach's alpha = .96) and excellent interrater (N = 31, ICC = .95) and test-retest (N = 45, ICC = .96) reliability. In addition, it was found not to have gender bias. CONCLUSION: This instrument may help clinicians and caregivers of the population with Alzheimer's disease make decisions regarding the choice of suitable interventions.


Asunto(s)
Actividades Cotidianas , Enfermedad de Alzheimer/psicología , Demencia/clasificación , Evaluación de la Discapacidad , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
4.
Am J Occup Ther ; 55(5): 552-7, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-14601816

RESUMEN

OBJECTIVE: The objective of this pilot study was to examine the use of a visual attention analyzer in the evaluation and retraining of useful field of view in clients with stroke. METHOD: Fifty-two clients with stroke referred to a driving evaluation service were evaluated with a visual attention analyzer referred to as the UFOV. The UFOV assesses three aspects of visual attention: processing speed, divided attention, and selective attention. Seven participants were retested to determine the test-retest reliability of the UFOV. Six participated in the development of a training protocol and in a 20-session visual attention retraining program. RESULTS: UFOV scores indicated substantial reduction in visual attention in clients after stroke, with older participants performing the most poorly. Test-retest reliability was moderate (ICC = .70). Mean UFOV scores improved significantly after retraining. CONCLUSION: Although UFOV scores indicated poor visual attention skills in clients with stroke, preliminary information suggests that UFOV scores significantly improve with training.


Asunto(s)
Atención , Pruebas Neuropsicológicas , Rehabilitación de Accidente Cerebrovascular , Percepción Visual , Adulto , Anciano , Diagnóstico por Computador , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Reproducibilidad de los Resultados
5.
Can J Occup Ther ; 61(3): 141-8, 1994 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-10136924

RESUMEN

Every day in Canada occupational therapists are asked to assess clients with neurological impairments and to provide recommendations to provincial licensing bureaus regarding the individual's fitness to drive. These decisions have great impact on the client and on society. In this paper we briefly review the findings that have been published regarding the assessment of individuals with neurological conditions who wish to resume driving. In addition, a description of the tools commonly used to assess individuals is provided, along with where available, the measurement properties of each. Finally, the Driving Evaluation Service of a physical rehabilitation centre is described.


Asunto(s)
Conducción de Automóvil/legislación & jurisprudencia , Trastornos Cerebrovasculares/rehabilitación , Evaluación de la Discapacidad , Terapia Ocupacional/normas , Recolección de Datos , Estudios de Evaluación como Asunto , Humanos , Examen Neurológico/métodos , Examen Neurológico/normas , Terapia Ocupacional/métodos , Quebec
6.
Accid Anal Prev ; 61: 253-60, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23639887

RESUMEN

This paper describes the development and evaluation of an on-road procedure, the Driving Observation Schedule (DOS), for monitoring individual driving behavior. DOS was developed for use in the Candrive/Ozcandrive five-year prospective study of older drivers. Key features included observations in drivers' own vehicles, in familiar environments chosen by the driver, with start/end points at their own homes. Participants were 33 drivers aged 75+ years, who drove their selected route with observations recorded during intersection negotiation, lane-changing, merging, low speed maneuvers and maneuver-free driving. Driving behaviors were scored by a specialist occupational therapy driving assessor and another trained observer. Drivers also completed a post-drive survey about the acceptability of DOS. Vehicle position, speed, distance and specific roadways traveled were recorded by an in-vehicle device installed in the participant's vehicle; this device was also used to monitor participants' driving over several months, allowing comparison of DOS trips with their everyday driving. Inter-rater reliability and DOS feasibility, acceptability and ecological validity are reported here. On average, drivers completed the DOS trip in 30.48min (SD=7.99). Inter-rater reliability measures indicated strong agreement between the trained and the expert observers: intra-class correlations (ICC)=0.905, CI 95% 0.747-0.965, p<0.0001; Pearson product correlation, r (18)=.83, p<0.05. Standard error of the measurement (SEM), method error (ME) and coefficient of variation (CV) measures were consistently small (3.0, 2.9 & 3.3%, respectively). Most participants reported being 'completely at ease' (82%) with the driving task and 'highly familiar with the route' (97%). Vehicle data showed that DOS trips were similar to participants' everyday driving trips in roads used, roadway speed limits, drivers' average speed and speed limit compliance. In summary, preliminary findings suggest that DOS can be scored reliably, is of feasible duration, is acceptable to drivers and representative of everyday driving. Pending further research with a larger sample and other observers, DOS holds promise as a means of quantifying and monitoring changes in older drivers' performance in environments typical of their everyday driving.


Asunto(s)
Conducción de Automóvil/estadística & datos numéricos , Recolección de Datos/métodos , Accidentes de Tránsito/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Desempeño Psicomotor , Reproducibilidad de los Resultados
8.
Brain Inj ; 19(8): 585-97, 2005 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-16175812

RESUMEN

PRIMARY OBJECTIVE: To investigate the experiences of individuals who had sustained a traumatic brain injury, their families and the physicians and health professionals involved, from the critical care episodes and subsequent rehabilitation. RESEARCH DESIGN: Semi-structured interviews were conducted with individuals who had sustained a TBI (n =8) and their families (n = 8) as well as with the health professionals (or service providers) (n = 22) and physicians (n = 9) who provided them care. MAIN OUTCOMES AND RESULTS: Results revealed the difficulties encountered by the different people involved, from the standpoint of the readjustment of the individual with the TBI and their family, the relationships among the various actors and the continuity of care. CONCLUSIONS: This study brings to light the importance of including the family and the person with a TBI in the care process by calling for their participation and by setting up suitable structures that prioritize a meaningful partnership among the key individuals.


Asunto(s)
Actitud del Personal de Salud , Lesiones Encefálicas/rehabilitación , Continuidad de la Atención al Paciente/normas , Familia/psicología , Adaptación Psicológica , Adolescente , Adulto , Anciano , Atención a la Salud/normas , Femenino , Humanos , Comunicación Interdisciplinaria , Masculino , Persona de Mediana Edad , Médicos/psicología , Relaciones Profesional-Familia , Relaciones Profesional-Paciente
9.
Int Psychogeriatr ; 9 Suppl 1: 163-5, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9447439

RESUMEN

Functional impairment is a core symptom of Alzheimer's disease. The most accurate indicator of functional impairment is the decline in performance of Activities of Daily Living (ADL). Several scales have been used to measure ADL in geriatric and Alzheimer's disease (AD) populations including the Disability Assessment for Dementia (DAD). The key to making a correct differential diagnosis between benign cognitive impairment and dementia is the detection of a decline in functioning. The instrumental ADL (IADL) relevant items of the DAD could provide crucial guidance in the diagnosis of early stage AD for primary care physicians. It is anticipated that the role of primary care physicians, already essential for the management of the AD patient, will expand to include the diagnosis of earlier cases and the prescription of cholinergic drugs as treatment. ADL assessment tools such as the DAD may help their tasks.


Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Evaluación de la Discapacidad , Actividades Cotidianas , Anciano , Humanos
10.
Alzheimer Dis Assoc Disord ; 15(2): 89-95, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-11391090

RESUMEN

The Disability Assessment for Dementia (DAD) scale was developed and validated as a measure of functional ability in dementia. DAD results have been reported in Alzheimer disease (AD) randomized, controlled treatment trials of up to 6 months, but results beyond 6 months have yet to be described. SAB INT 12 was a randomized, double-blind, placebo-controlled, parallel-group study in mild to moderate AD that included DAD assessments at baseline, month 6, and month 12. One hundred forty-four patients with AD in the placebo arm of SAB INT 12 were followed up for 12 months. DAD scores were obtained at baseline (mean DAD = 70.1, SD = 22.2), 6 months (mean DAD = 63.7, SD = 25.2), and 12 months (mean DAD = 59.3, SD = 28.9). The rate of decline was consistent across the domains of basic activities of daily living (ADLs) and instrumental ADLs, as well as the scoring of initiation, planning, and organization. The decline in DAD total scores in mild to moderate AD averages about one point per month, which equates to the loss of one item on the DAD scale every 2 months.


Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Evaluación de la Discapacidad , Pruebas Neuropsicológicas/estadística & datos numéricos , Actividades Cotidianas/clasificación , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/tratamiento farmacológico , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Piperidinas/uso terapéutico , Psicometría , Tiazoles/uso terapéutico
11.
Alzheimer Dis Assoc Disord ; 13 Suppl 3: S143-7, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10609694

RESUMEN

Decline in functional abilities is a major component of the dementia syndrome. The definition of dementia in the International Classification of Diseases (10th rev.) requires a cognitive impairment sufficient to impair personal activities of daily living (ADL). The Diagnostic and Statistical Manual of Mental Disorders (4th ed.) also requires cognitive deficits sufficiently severe to cause impairment in occupational or social functioning and must represent a decline from a higher level of functioning. However, the term disability is more appropriate than impairment to describe a loss in activities, as opposed to a loss of elementary functions, and is consistent with World Health Organization definitions of impairment, disability, and handicap. There is no doubt that ADL outcomes are required in therapeutic drug studies on vascular dementia, and there is a good rationale and some evidence for the use of ADL scales developed for therapeutic research in Alzheimer disease, favoring scales devoid of items sensitive to physical disabilities. Similarly, ADL-related clinical milestones could be used for longer-term studies aiming predominantly at slowing progression of disease in both early and later stages of dementia. Slower decline in ADL and delay in reaching ADL-related clinical milestones should be considered as valid outcomes by regulatory bodies in the process of dementia drug approval.


Asunto(s)
Actividades Cotidianas , Demencia Vascular/fisiopatología , Demencia Vascular/psicología , Evaluación de Resultado en la Atención de Salud , Ensayos Clínicos como Asunto , Demencia Vascular/tratamiento farmacológico , Humanos
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