What predicts changes in useful field of view test performance?

The Useful Field of View Test (UFOV) has been used as an examination of age-related changes in visual processing and cognition and as an indicator of everyday performance outcomes, particularly driving, for over 20 years. How UFOV performance changes with age and what may impact such changes have not previously been investigated longitudinally. Predictors of change in UFOV performance over a 5-year period among control group participants (N=690) from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study were examined. Random effects models were estimated with 4-subtest-total UFOV as the outcome and with baseline age, education, gender, race, visual acuity, depressive symptoms, mental status, and self-rated health, as well as attrition, as predictors. UFOV performance generally followed a curvilinear pattern, improving and then declining over time. Only increased age was consistently related to greater declines in UFOV performance over time. UFOV and Digit Symbol Substitution subtest, a standard measure of cognitive speed, had similar trajectories of change. The implications of these results are discussed.

Acceptability and validity of older driver screening with the DrivingHealth Inventory.

Research has indicated that technology can be effectively used to identify high-risk older drivers. However, adaptation of such technology has been limited. Researchers debate whether older drivers represent a safety problem as well as whether they should be screened for driving fitness. The present study examined how drivers feel regarding technological screening and mandatory state testing. The validity and acceptability of a new technological screening battery for identifying high-risk drivers, the DrivingHealth Inventory (DHI), was also evaluated. In a sample of 258 Alabama drivers aged 18-87, older drivers performed significantly worse than younger drivers on sensory, cognitive, and physical subtests of the DHI, and older drivers with a crash history performed worse than older drivers without crashes. Regardless of age, 90% of participants supported states requiring screening for older drivers' license renewal. The majority of the participants (72%) supported use of technological screening batteries such as the DHI as a driver screening tool. Considering the acceptability and potential efficacy of the DHI, it may be a useful tool in evaluating driving fitness among older adults.

Continuity in the midst of change: behaviors of residents relocated from a nursing home environment to small households.

A time-sampling procedure was used to observe behaviors of 22 long-term-care residents with dementia (Mini-Mental State Exam median, 11.94; range 0-23) in public areas before and after relocation from a traditional nursing home environment to 2 small household units. Two trained observers noted the occurrence of 19 social behaviors (14 verbal, 5 nonverbal) in which the resident intentionally interacted with another person. Another 19 nonsocial behaviors (16 active, 3 passive) were also coded. Analysis by t tests of 6 groupings of behaviors showed no significant differences before and after relocation, with the exception of nonverbal social interactions. Overall, residents showed consistency in both social and nonsocial behaviors. Results are interpreted in light of personal, social, and environmental continuity despite the many changes associated with the relocation.

Driving cessation and health trajectories in older adults.

BACKGROUND: Older adults who cease driving have poorer health than those who continue to drive. However, it is unclear whether the transition to driving cessation itself results in health declines or whether driving cessation subsequently exacerbates health declines over time. METHODS: The current study addresses these questions using multilevel modeling among 690 older adults from the Advanced Cognitive Training for Independent and Vital Elderly study. Driving status and health, as indicated by the SF-36 questionnaire, self-rated health, physical performance (Turn 360 degrees Test), and depressive symptoms were assessed at baseline and at 1-, 2-, 3-, and 5-year follow-up visits. RESULTS: The transition to driving cessation was accompanied by significant declines in physical and social functioning, physical performance, and physical role (ps < .05). Health declines after driving cessation were steeper for general health. CONCLUSIONS: The transition to driving cessation is associated with health declines for older adults as measured by several indicators. Additionally, general health declines more sharply following driving cessation. These findings highlight the importance of interventions to sustain driving mobility among older adults.

Examination of cognitive and instrumental functional performance as indicators for driving cessation risk across 3 years.

PURPOSE: The purpose of this study was to prospectively examine the role of cognitive and instrumental functional performance in driving cessation while simultaneously accounting for any contributions of demographics, vision, physical performance, and health among a sample of older adults without dementia. DESIGN AND METHODS: Included in the analyses were 1,838 participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were drivers at baseline and completed the third-year assessment. Participants completed baseline assessments of sociodemographic characteristics, health, sensory function, physical function, cognitive abilities, instrumental functional performance, and depressive symptoms. Driving status was again ascertained 3 years later. RESULTS: We used Cox proportional hazard analyses to examine prospective predictors of driving cessation over a 3-year period. The final model indicated four significant risk factors for driving cessation: older age (hazard ratio [HR] = 1.06, p = .009), poorer balance as measured by the Turn 360 degrees test (HR = 1.17, p = .002), slower cognitive speed of processing as measured by the Useful Field of View test (HR = 1.37, p = .004), and poorer instrumental functional performance as assessed by the Everyday Problems Test (HR = 1.59, p < .001). IMPLICATIONS: Although vision, health, and physical abilities are commonly considered when determining driving capacity, cognitive speed of processing and instrumental functional performance may be better indicators of subsequent likelihood of driving cessation across 3 years among older adults. Poor health and vision may only impact driving cessation to the extent that cognitive speed of processing and instrumental functioning are affected.