The modified card sorting test: Test-retest stability and relationships with demographic variables in a healthy older adult sample

Objectives. To investigate the test-retest stability of a standardized version of Nelson's (1976) Modified Card Sorting Test (MCST) and its relationships with demographic variables in a sample of healthy older adults. Design. A standard card order and administration were devised for the MCST and administered to participants at an initial assessment, and again at a second session conducted a minimum of six months later in order to examine its test-retest stability. Participants were also administered the WAIS-R at initial assessment in order to provide a measure of psychometric intelligence. Methods. Thirty-six (24 female, 12 male) healthy older adults aged 52 to 77 years with mean education 12.42 years (SD = 3.53) completed the MCST on two occasions approximately 7.5 months (SD = 1.61) apart. Stability coefficients and test-retest differences were calculated for the range of scores. The effect of gender on MCST performance was examined. Correlations between MCST scores and age, education and WAIS-R IQs were also determined. Results. Stability coefficients ranged from .26 for the percent perseverative errors measure to .49 for the failure to maintain set measure. Several measures were significantly correlated with age, education and WAIS-R IQs, although no effect of gender on MCST performance was found. Conclusions. None of the stability coefficients reached the level required for clinical decision making. The results indicate that participants' age, education, and intelligence need to be considered when interpreting MCST performance. Normative studies of MCST performance as well as further studies with patients with executive dysfunction are needed.

A comprehensive neuropsychiatric study of elderly twins: The Older Australian Twins Study

The Older Australian Twins Study (OATS) was recently initiated to investigate genetic and environmental factors and their associations and interactions in healthy brain ageing and ageing-related neurocognitive disorders. The study extends the classic MZ-DZ design to include one or two equivalently aged siblings for each twin pair and utilizes the rich resources of the Australian Twin Registry. The study has a number of distinguishing features including comprehensive psychiatric, neuropsychological, cardiovascular, metabolic, and neuroimaging assessments, a longitudinal design and links with a brain donor program. The study measures many behavioral and environmental factors, but in particular lifetime physical and mental activity, physical and psychological trauma, loss of parent early in life, later losses and life events, early-life socioeconomic environment, alcohol and drug use, occupational exposure, and nutrition. It also includes comprehensive cardiovascular assessment, blood biochemistry, genetics and proteomics. The socio-demographic and health data on the first 172 pairs of twins participating in this study are presented. Prevalence of mild cognitive impairment is 12.8% and of dementia 1.5% in the sample. The target sample size is 1000, with at least 400 pairs of twins aged 65-90 years. The cohort will be assessed every two years, with in-depth assessments being repeated. OATS offers an excellent opportunity for collaboration with other similar studies as well as researchers who share the same interests.

Cognitive functioning in older twins: The Older Australian Twins Study

Aim: To examine the concordance rates of common medical conditions and neurocognitive performance in monozygotic (MZ) and dizygotic (DZ) older twins. Methods: Twins aged ≥65 years and living in the three Eastern states of Australia were recruited through the Australian Twin Registry and underwent detailed neuropsychological and medical assessment. Results: Assessments were conducted on 113 MZ and 96 DZ twin pairs, with a mean age of 70.5 years. MZ twins were more concordant than DZ twins for hypertension and asthma. MZ twins had higher correlations than DZ twins on most neuropsychological tests, with the exception of some tests related to processing speed. The concordance rate for mild cognitive impairment or dementia was 76.2% in MZ twins and 42.9% in DZ twins, a non-significant difference. Conclusions: Except for some aspects of processing speed, most cognitive functions in older individuals show significant heritability. The heritability of neurocognitive disorders is, however, low.

An exploration into younger and older pedestrians' risky behaviours at train level crossings

Background: Younger and older pedestrians are both overrepresented in train-pedestrian injury and fatality collision databases. However, scant research has attempted to determine the factors that influence level crossing behaviours for these high risk groups. Method: Five focus groups were undertaken with a total of 27 younger and 17 older pedestrian level crossing users (N = 44). Due to the lack of research in the area, a focus group methodology was implemented to gain a deeper exploratory understanding into the sample’s decision making processes through a pilot study. The three main areas of enquiry were identifying the: (a) primary reasons for unsafe behaviour; (b) factors that deter this behaviour and (c) proposed interventions to improve pedestrian safety at level crossings in the future. Results: Common themes to emerge from both groups regarding the origins of unsafe behaviours were: running late and a fatalistic perspective that some accidents are inevitable. However, younger pedestrians were more likely to report motivators to be: (a) non-perception of danger; (b) impulsive risk taking; and (c) inattention. In contrast, older pedestrians reported their decisions to cross are influenced by mobility issues and sensory salience. Conclusion: The findings indicate that a range of factors influence pedestrian crossing behaviours. This paper will further outline the major findings of the research in regards to intervention development and future research direction.

Older entrepreneurs: Do they work smarter or harder?

Entrepreneurs starting their first businesses between the ages of 55 and 64 years represent the fastest growing entrepreneurship segment in America and Australia. There is sparse research on older entrepreneurs with conflicting results, particularly with respect to generational differences. Previous literature on generational differences focuses on family businesses, but characteristics of founders of family businesses are quite different than those of founders of non-family businesses. Consequently, we compare characteristics of older entrepreneurs to younger entrepreneurs as they start new ventures. Are there differences in their work styles and venture performance? This study makes a contribution to entrepreneurship literature by studying the growing phenomenon of older entrepreneurs. We make a contribution to practice by helping older entrepreneurs identify their strengths, which could lead to more successful older entrepreneurs and provide satisfying and rewarding careers to those leaving wage and salary employment to pursue self employment.

Triaging older major trauma patients in the emergency department: An observational study

Background The objective of this study was to compare the triage category assigned to older trauma patients with younger trauma patients upon arrival to the emergency department. The focus was to examine whether older major trauma patients were less likely to be assigned an emergency triage category on arrival to the emergency department after controlling for relevant demographics, injury characteristics and injury severity. Methods This was an observational study using data from the Queensland Trauma Registry. All trauma patients aged 15 years and older who presented to contributing hospitals between 1 January 2005 and 31 December 2009 with an Injury Severity Score (ISS)>15 were included. Logistic regression analysis examined the odds of assignment to emergency (Australasian Triage Scale (ATS) 1 or 2) versus urgent (ATS 3–5) treatment for patients across various age categories after adjustment for relevant demographics, injury characteristics and injury severity. Results The study used data on 6923 patients with a median (IQR) age of 43 (26–62) years and a mortality of 11.4% (95% CI 10.7% to 12.2%). Compared with individuals aged 15–34, the adjusted odds of being assigned an ATS category 1 or 2 were 30% lower (OR=0.68, 95% CI 0.57 to 0.81) for individuals aged 55–75 years and were 50% lower (OR=0.46, 95% CI 0.37 to 0.56) for individuals aged 75 years or older. Conclusions Among patients with an ISS>15, older major trauma patients were less likely to be assigned an emergency triage category compared with younger patients. This suggests that the elderly may be undertriaged and provides a potential area of study for reducing mortality and morbidity in older

Sleepy driving and drink driving: attitudes, behaviours, and perceived legitimacy of enforcement of younger and older drivers

Sleepy driving and drink driving are two risky driving behaviours that substantially contribute to road crashes. Several studies demonstrate equivalent levels of impairment from both sleepy and drink driving. Yet, drivers perceive sleepy and drink driving distinctly different, with younger and older drivers engaging in these two risky driving behaviours at different rates. The current study sought to examine the sleepy and drink driving behaviours and perceptions in a sample of 114 younger (17-29 years) and 177 older (30+ years) drivers. Compared to older drivers, younger drivers reported more positive attitudes toward sleepy and drink driving behaviours, as well as more negative views regarding perceived legitimacy of sleepy driving enforcement. Younger drivers were also more likely to report performing sleepy driving behaviours than older drivers. Younger drivers reported greater likelihood to drive while sleepy, lower perceptions of legitimacy for sleepy driving, and more positive attitudes towards sleepy driving when compared to drink driving and the same pattern was found for older drivers as well. Subsequently, the self-reported likelihood of driving while sleepy was greater than drink driving in both age groups. Overall, the results suggest that sleepy driving is not viewed as equally dangerous as drink driving with younger drivers’ perceptions being more lenient than older drivers’ perceptions. It is likely that change is needed regarding the perceptions of dangerousness of sleepy driving with a particular focus on younger drivers seemingly needed.

Characteristics of on-road driving by persons with central vision loss: Learning to drive with a bioptic telescope

There is limited research on the driving performance and safety of bioptic drivers and even less regarding the driving skills that are most challenging for those learning to drive with bioptic telescopes. This research consisted of case studies of five trainee bioptic drivers whose driving skills were compared with those of a group of licensed bioptic drivers (n = 23) while they drove along city, suburban, and controlled-access highways in an instrumented dual-brake vehicle. A certified driver rehabilitation specialist was positioned in the front passenger seat to monitor safety and two backseat evaluators independently rated driving using a standardized scoring system. Other aspects of performance were assessed through vehicle instrumentation and video recordings. Results demonstrate that while sign recognition, lane keeping, steering steadiness, gap judgments and speed choices were significantly worse in trainees, some driving behaviors and skills, including pedestrian detection and traffic light recognition were not significantly different to those of the licensed drivers. These data provide useful insights into the skill challenges encountered by a small sample of trainee bioptic drivers which, while not generalizable because of the small sample size, provide valuable insights beyond that of previous studies and can be used as a basis to guide training strategies.

Association between glaucoma and at–fault motor vehicle collision involvement among older drivers

Objective To examine the association between glaucoma and motor vehicle collision (MVC) involvement among older drivers, including the role of visual field impairment that may underlie any association found. Design A retrospective population-based study Participants A sample of 2,000 licensed drivers aged 70 years and older who reside in north central Alabama. Methods At-fault MVC involvement for five years prior to enrollment was obtained from state records. Three aspects of visual function were measured: habitual binocular distance visual acuity, binocular contrast sensitivity and the binocular driving visual field constructed from combining the monocular visual fields of each eye. Poisson regression was used to calculate crude and adjusted rate ratios (RR) and 95% confidence intervals (CI). Main Outcomes Measures At-fault MVC involvement for five years prior to enrollment. Results Drivers with glaucoma (n = 206) had a 1.65 (95% confidence interval [CI] 1.20-2.28, p = 0.002) times higher MVC rate compared to those without glaucoma after adjusting for age, gender and mental status. Among those with glaucoma, drivers with severe visual field loss had higher MVC rates (RR = 2.11, 95% CI 1.09-4.09, p = 0.027), whereas no significant association was found among those with impaired visual acuity and contrast sensitivity. When the visual field was sub-divided into six regions (upper, lower, left, and right visual fields; horizontal and vertical meridians), we found that impairment in the left, upper or lower visual field was associated with higher MVC rates, and an impaired left visual field showed the highest RR (RR = 3.16, p = 0.001) compared to other regions. However, no significant association was found in deficits in the right side or along the horizontal or vertical meridian. Conclusions A population-based study suggests that older drivers with glaucoma are more likely to have a history of at-fault MVC involvement than those without glaucoma. Impairment in the driving visual field in drivers with glaucoma appears to have an independent association with at-fault MVC involvement, whereas visual acuity and contrast sensitivity impairments do not.

Assistance arrangements and use of services among persons with multiple sclerosis and their caregivers

A large population-based survey of persons with multiple sclerosis (MS) and their caregivers was conducted in Ontario using self-completed mailed questionnaires. The objectives included describing assistance arrangements, needs, and use of and satisfaction with services, and comparing perceptions of persons with MS and their caregivers. Response rates were 83% and 72% for those with MS and caregivers, respectively. Based on 697 respondents with MS whose mean age is 48 years, 70% are female, and 75% are married. While 24% experience no mobility restrictions, the majority require some type of aid or a wheelchair for getting around. Among 345 caregivers, who have been providing care for 9 years on average, the majority are spouses. Caregivers report providing more frequent care than do persons with MS report receiving it, particularly for the following activities of daily living: eating, meal preparation, and help with personal finances. Caregivers also report assistance of longer duration per day than do care recipients with MS. Frequency and duration of assistance are positively associated with increased MS symptom severity and reduced mobility. Generally there is no rural-urban disparity in service provision, utilization or satisfaction, and although there is a wide range of service utilization, satisfaction is consistently high. Respite care is rarely used by caregivers. Use of several services is positively associated with increased severity of MS symptoms and reduced mobility. Assistance arrangements and use of services, each from the point of view of persons with MS and their caregivers, must be taken into account in efforts to prolong home care and to postpone early institutionalization of persons with MS.

Examining the profile and experiences of older sub-acute patients who present to public hospital emergency departments in South East Queensland: A mixed methods approach

There is a scarcity of research that informs Interface Health Service (IHS) development. This research applied a mixed methods approach to profile older emergency department patients and patterns of health service use and to explore their ED experiences in public hospital EDs in South-East Queensland. IHS was under-utilised by older people with complex co-morbidities. Lack of communication and need identification were factors that undermined the effectiveness of IHS in reaching this cohort which highlighted a need for change.

Older adults and driving reduction: Is the gender gap narrowing?

This study investigated driving reduction in a diverse sample of 229 male and female older drivers aged 70 years and above in Queensland, Australia. The study sought to determine whether differences existed between male and female older drivers in regard to driving patterns, and to identify factors that were predictive of driving reduction in female versus male older drivers. Participants provided information on their health, self-reported driving patterns, driving perceptions, alternative transport options, and feedback. Overall, females were more likely to avoid challenging situations but less likely to reduce their driving when compared to males. Self-rated health and driving confidence were significant predictors for driving reduction among females. For males, driving importance was the only significant predictor for driving reduction in this sample. This study indicates the need for longitudinal research on the process of driving reduction and whether the planning process for driving cessation differ between females and males.

Predictors of mental health in midlife and older Australian women: A multilevel investigation

The purpose of this article is to examine the factors associated with women's mental health. A random sample of 340 Australian women aged 40–55 completed surveys on menopausal and lifestyle factors and mental health at three time points. We used hierarchical models to show that decrements in mental health were associated with a corresponding increase in some midlife symptoms (p < .01), time (p < .01), and poor physical health (p < .01), but the effect was not permanent. In older women, mental health was associated with physical functioning, climacteric symptoms, and time, while individual variations in mental health score were largely explained by lifestyle factors.