Inequity in health: older rural driving and dementia

Introduction The number of drivers with dementia is expected to increase exponentially over the coming decades. Most individuals with moderate-to-severe dementia (table 1) are unfit to drive.1 Drivers with moderate-to-severe dementia have higher rates of MVCs than age-matched controls.2 Identifying and preventing these individuals from driving is crucial, particularly in urban areas. The density of cars and pedestrians, and the complexity of traffic typically place greater demands on drivers in urban areas, and, therefore, require greater reactivity and forward planning than in rural environments.3 ,4 The ability to drive is a critical means of maintaining one's social inclusion, and is commonly a practical necessity. Therefore, decisions about the entitlement to drive should not unfairly restrict mobility or unnecessarily compound the disadvantages experienced by older people with mild cognitive impairment and early dementia (table 1), particularly as diagnoses are now being made earlier.1 This paper describes the difficulties inherent in addressing the question of when and in what circumstances a diagnosis of dementia might render a person unfit to drive and focuses on those who live in rural areas. We examine the consequences of dementia diagnosis on driving, driver testing requirements and licensing procedures, and the impacts of driving cessation. We then discuss how living in rural areas may alter the level of risk of drivers with dementia and practical implications for licensing policies.

The value of work in younger and older adults' lives: an Australian perspective

In the present study we examined the perceived role of work in the lives of younger and older adults in three different occupations: teaching, nursing, and small business. On the basis of lifespan developmental theory of changes in work-related values across the lifespan we expected that (1) older adults would rate their job satisfaction and organisational commitment more highly than younger adults, and (2) younger adults would rate the importance of work more highly than older workers. Based on utility theory we expected that nurses and teachers would view early retirement more positively than small business employees because of early retirement incentives in these two careers. One-hundred-sixty-two participants completed a 118-item survey. Overall few age differences were found between older and younger workers. On average, all participants rated work as moderately important and their job satisfaction as moderately high. Nonetheless, older participants rated their job satisfaction higher than younger participants. On average, all groups believed they would retire before 65 years of age. The latter finding is important for workability theory and raises issues about how to change attitudes, perceptions and values about working past traditional retirement ages.

Using complemenatry therapies wisely in older people.

Key points
• Over 30%, of older people use complementary therapies.
• Nurses need to be able to use complementary therapies safely if indicated and provide objective. accurate information about them.
• Complementary therapies can be used with conventional medical treatment to improve diabetes balance and quality of life.
• Herb-drug and herb-herb interactions and other adverse events can occur when conventional and complementary therapies are combined inappropriately.
• Complementary therapy use and the reasons for their use should be ascertained when taking a routine history and assessment.

Differences in the neuromuscular capacity and lean muscle tissue in old and older community-dwelling adults

This study investigated whether there was a worsening of the neuromuscular capacity of older adults after the seventh decade of life. The results suggest that the age-related deterioration in maximal strength measures and rapid force production characteristics in older adults could be related to a reduction in the mass and neural activation of the thigh muscles.

Older women`s experiences with sternotomy

While incision and subsequent scarring is a feature of all surgery, in cardiac surgery the sternotomy incision is significant and central to the body, separating the chest in half between the breasts. Increasingly older women count for a larger proportion of patients undergoing cardiac surgery each year in Australia yet there has been limited exploration of their experiences with sternotomy. A phenomenological approach was used to elicit the experiences of older women who had undergone cardiac surgery. In-depth interviews with four older women revealed a range of ways in which these women were affected by their sternotomy and their whole experience of cardiac surgery. Findings from this project provide insight into practical issues affecting these women and may assist nurses in the assessment and planning of care and education for older women having cardiac surgery, particularly in the areas of preparation for cardiac surgery and body image.

Fit for life : older women`s commitment to exercise

The article explores the lived experiences of older women with a high commitment to exercise. The methods of investigation were in-depth interviews with 17 women fitness instructors for the over-50s and the author's observations as a participant in a variety of exercise programs. The subjective experience of embodiment of older women, the ways in which the body is constructed discursively, and the objective processes of aging are explored. The women's narratives are placed in the wider context of consumption, lifestyle, and identity construction. The study analyzes whether older women's commitment to exercise is a reflection of a climate of constraint, in which individuals seek to shape and manage the body to combat the effects of aging, or is one of empowerment and enablement. More important, the article explores the ways in which the women used fitness programs as a means of constructing intimacy, a sense of community, and satisfaction in interpersonal relations.

Subjective quality of life, perceived control and dispositional optimism among older people

Objectives: To examine whether the subjective quality of life (QOL) of elderly people is held under homeostatic control, and to investigate the role of perceived control and dispositional optimism in the maintenance of subjective QOL.
Method: 100 older people (M=75.6 years) and a control group of 107 younger people (M=20.1 years) completed a self-report survey.
Results: Both groups had a level of subjective QOL within the normal range. The older group reported higher levels of secondary control and optimism, but similar levels of primary control, as the younger group. Primary control and optimism predicted subjective QOL for both groups. Secondary control was a significant predictor (or the younger group, however it was only marginally significant for the older group. Optimism accounted for the most subjective QOL variance for both groups.
Conclusions: The finding that the subjective QOL of the older group lay within the normative range supports the proposal that their subjective QOL is being successfully maintained under bomeostatic control. However, they appear to have an increased reliance on secondary control. The fact that dispositional optimism captures the predictive variance of perceived control, is an important finding adding to the understanding of subjective QOL maintenance.

The relationship between lower body strength and obstructed gait in community-dwelling older adults

OBJECTIVES: To determine the relationship between lower body strength of community-dwelling older adults and the time to negotiate obstructed gait tasks.

DESIGN: A correlational study.

SETTING: The Biomechanics Laboratory, Deakin University, Australia.

PARTICIPANTS: Twenty-nine women and 16 men aged 62 to 88 were recruited using advertisements placed in local newspapers. The participants were independent community dwellers, healthy and functionally mobile.

MEASUREMENTS: Maximal isometric strength of the knee extensors and dynamic strength of the hip extensors, hip flexors, hip adductors, hip abductors, knee extensors, knee flexors, and ankle plantar flexors were assessed. The times to negotiate four obstructed gait tasks at three progressively challenging levels on an obstacle course and to complete the course were recorded. The relationship between strength and the crossing times was explored using linear regression models.

RESULTS: Significant associations between the seven strength measures and the times to negotiate each gait task and to walk the entire course at each level were obtained (r = -0.38 to -0.55; P < .05). In addition, the percentage of the variance explained by strength (R2), consistently increased as a function of the progressively challenging level. This increase was particularly marked for the stepping over task (R2 = 19.3%,25.0%, and 27.2%, for levels 1, 2, and 3, respectively) and the raised surface condition (R2 = 17.1%,21.1%, and 30.8%, for levels 1,2, and 3, respectively) .

CONCLUSION: The findings of the study showed that strength is a critical requirement for obstructed locomotion. That the magnitude of the association increased as a function of the challenging levels suggests that intervention programs aimed at improving strength would potentially be effective in helping community-dwelling older adults negotiate environmental gait challenges.

Constipation and diet in a community sample of older Australians

Objective: To estimate the prevalence of constipation and laxative use in a sample of people 65 years and over and examine relationships between usual diet and constipation.
Design: A mailed survey using validated instruments to measure bowel habit and laxative use with follow-up interviews to collect dietary data.
Subjects and setting: Three hundred and thirty people aged 65 years and over living at home in Melbourne were randomly selected from the electoral roll of a federal electorate.
Statistical analysis: Descriptive statistics, frequencies and two sample t-tests were used.
Results: Seventy-nine people responded to the mailed bowel survey and 61 were interviewed to collect food intake data. The proportion of constipated people was approximately one quarter (n = 18). Laxative use in the previous 12 months was reported by a fifth of respondents and in these subjects one in four was not constipated. Analysis of the dietary data revealed that the average number of cereal and vegetable serves consumed per day was similar to the national average but less than recommended by nutrition bodies although fruit intake met these recommendations. Constipated subjects consumed fewer serves from the cereals food group than those who were not constipated (2.9 and 3.5 serves respectively, P = 0.03).
Conclusion: Constipation and laxative use appears to be as common in older Australians as in similar populations overseas. Low intake of cereal foods may be a contributing factor.