title: Longitudinal predictors of driving cessation among older adults from the ACTIVE clinical trial. Reliability and sensitivity to change assessed for a summary measure of lower body function: results from the Women's Health and Aging Study. Predictive value of the Short Physical Performance Battery following hospitalization in older patients. Ten years down the road: predictors of driving cessation. Using a driving simulator to identify older drivers at inflated risk of motor vehicle crashes. Characteristics of frail older adult drivers. What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study) Aerobic exercise training increases brain volume in aging humans. The role of perceived control in explaining depressive symptoms associated with driving cessation in a longitudinal study. Meaningful change and responsiveness in common physical performance measures in older adults. Examination of cognitive and instrumental functional performance as indicators for driving cessation risk across 3 years. Stability of physical assessment of older drivers over 1 year. Predicting driving cessation over 5 years in older adults: psychological well-being and cognitive competence are stronger predictors than physical health. Exercise can improve speed of behavior in older drivers. A Randomized Trial of a Physical Conditioning Program to Enhance the Driving Performance of Older Persons Consequences of driving cessation: decreased out-of-home activity levels. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. The effects of an exercise program on several abilities associated with driving performance in older adults. Determining the validity of the AMA guide: A historical cohort analysis of the assessment of driving related skills and crash rate among older drivers. Physical performance measures in the clinical setting. Lower extremity performance in nondisabled older persons as a predictor of subsequent hospitalization. Physical Performance Measures as Predictors of Mortality in a Cohort of Community-dwelling Older French Women Predicting road test performance in drivers with dementia. Exercise training and nutritional supplementation for physical frailty in very elderly people. Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting? Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults: The LIFE Randomized Trial. Risk Factors and Precipitants of Long-Term Disability in Community Mobility
abstract: We examined the physical , visual , health , and cognitive abilities of 1,656 older adults as prospect i ve predictors of self-reported driving cessation over a 5-year period . We examined the time to driving cessation across 5 years after we controlled for days driven per week at baseline and any cognitive intervention participation . Older age , congestive heart failure , and poorer physical performance ( according to the Turn 360 Test ) were statistically significant risk factors for driving cessation . Slower speed of processing ( according to the Digit Symbol Substitution and Useful Field of View tests ) was a significant risk factor even after we took baseline driving , age , health , vision , and physical performance into consideration . Implication s are that assessment s of cognitive speed of processing can provide valuable information about the subsequent risk of driving cessation A summary performance measure comprised of a hierarchical balance task , a 4-meter walk , and five repetitive chair st and s is increasingly being used as a predictor of independent living for older persons . The reliability and sensitivity to change of this summary performance measure have not been investigated , however . Because a measure can be reliable while being unresponsive to change , this study presents information on both the reliability and sensitivity to change for the summary performance measure . This is a 3-year prospect i ve cohort study of 1,002 moderately to severely disabled older women . Short- and long-term reliability was assessed by intraclass correlation coefficients ( ICC ) . Sensitivity to change was assessed by slope differences for three age categories ( 65 - 74 , 75 - 84 , and > or=85 ) over six 6-month follow-up periods . Sensitivity to change was also assessed by summary performance change scores for those who did and did not suffer from one of four medical events [ myocardial infa rct ion ( MI ) , stroke , hip fracture , or congestive heart failure ( CHF ) ] at follow-up . The summary performance measure showed excellent reliability . Intraclass correlation coefficients ranged from 0.88 to 0.92 for measures made 1 week apart . The 6-month average intraclass correlation coefficient was 0.77 ( range 0.72 - 0.79 ) . The summary performance measure was also highly responsive to change . Subjects who suffered an incident MI , stroke , hip fracture , or CHF at follow-up were significantly more likely to have poorer summary performance change scores ( -2.25 ) compared with those who did not have one of these medical events ( -0.24 ) . Additionally , subjects who suffered one of these events improved their summary performance scores in the following assessment period by 0.72 . With increasing utilization of the summary performance measure by research ers and clinicians it is important that the measurement properties of this instrument are known . Our results show that the summary performance measure has excellent reliability and is highly sensitive to change BACKGROUND Hospitalization represents a stressful and potentially hazardous event for older persons . We evaluated the value of the Short Physical Performance Battery ( SPPB ) in predicting rates of functional decline , rehospitalization , and death in older acutely ill patients in the year after discharge from the hospital . METHODS Prospect i ve cohort study of 87 patients aged 65 years and older who were able to walk and with a Mini-Mental State Examination score ≥ 18 and admitted to the hospital with a clinical diagnosis of congestive heart failure , pneumonia , chronic obstructive pulmonary disease , or minor stroke . Patients were evaluated with the SPPB at hospital admission , were reevaluated the day of hospital discharge , and 1 month later . Subsequently , they were followed every 3 months by telephone interviews to ascertain functional decline , new hospitalizations , and vital status . RESULTS After adjustment for potential confounders , including self-report activity of daily living and comorbidity , the SPPB score at discharge was inversely correlated with the rate of decline in activity of daily living performance over the follow-up ( p < .05 ) . In a multivariable discrete-time survival analysis , patients with poor SPPB scores at hospital discharge ( 0 - 4 ) had a greater risk of rehospitalization or death ( odds ratio : 5.38 , 95 % confidence interval : 1.82 - 15.9 ) compared with those with better SPPB scores ( 8 - 12 ) . Patients with early decline in SPPB score after discharge also had steeper increase in activity of daily living difficulty and higher risk of rehospitalization or death over the next year . CONCLUSIONS In older acutely ill patients who have been hospitalized , the SPPB provides important prognostic information . Lower extremity performance-based functional assessment might identify older patients at high risk of poor outcomes after hospital discharge PURPOSE Recent prospect i ve studies have found that cognition is a more salient predictor of driving cessation than physical performance or demographic factors among community-dwelling older adults . However , these studies have been limited to 5 years of follow-up . The current study used data from the Maryl and Older Drivers Project to examine predictors of  driving cessation in older adults over a 10-year period . DESIGN AND METHODS Participants ( N = 1,248 ) completed baseline and 5-year assessment s of physical and cognitive abilities .  Driving status was ascertained at baseline and annually thereafter . RESULTS Cox proportional hazard models were used to examine the risk of driving cessation as a function of demographic , physical , and cognitive predictors . The final model indicated three significant predictors of driving cessation , older age at baseline ( hazard ratio [ HR ] = 1.12 , p < .001 ) , days driven per week ( HR = 0.83 , p = .05 ) , and slower speed of processing as measured by the Useful Field of View Test ( HR = 1.76 , p < .01 ) . IMPLICATION S These results underscore the importance of cognitive speed of processing to the maintenance of driving . Brief cognitive assessment can be conducted in the field to potentially identify older adults at increased risk for driving cessation . Further research is needed to determine the costs and potential benefits of such screening PROBLEM To develop appropriate assessment criteria to measure the performance of older drivers using an interactive PC-based driving simulator , and to determine which measures were associated with the occurrence of motor-vehicle crash . METHOD One hundred and twenty-nine older drivers residing in a metropolitan city volunteered to participate in this retrospective cohort study . Using the driving simulator , appropriate driving tasks were devised to test the older drivers , whose performances were assessed by 10 reliable assessment criteria . Logistic regression analysis was then undertaken to determine those criteria that influence the self-reported crash outcome . RESULTS As expected , driving skill of older drivers was found to decline with age . Over 60 % of the sample participants reported having at least one motor-vehicle crash during the past year . Adjusting for age in a logistic regression analysis , the cognitive abilities associated with the crash occurrence were working memory , decision making under pressure of time , and confidence in driving at high speed . SUMMARY The findings of this retrospective study indicated those individuals at inflated risk of vehicle crashes could be identified using the PC-based interactive driving simulator . Prospect i ve studies need to be undertaken to determine whether the driving simulator can predict future crash events . IMPACT ON INDUSTRY This study demonstrated an economical driving simulator approach to screen out problematic or unsafe older drivers before a more detailed but expensive road test is considered OBJECTIVES To determine the prevalence of driving in older adults with mild to moderate physical frailty and to compare characteristics of current frail older adult drivers with those of former drivers in the sample . DESIGN Retrospective study of frail older adults enrolled in r and omized trials of exercise and hormone replacement therapy . SETTING Urban , academic medical center . PARTICIPANTS One hundred eighty-three sedentary community-dwelling men and women aged 75 and older with mild to moderate physical frailty , as defined by two of the following three criteria : modified Physical Performance Test ( PPT ) score between 18 and 32 , peak oxygen uptake ( VO2 ) between 10 and 18 mL/kg per minute , and self-report of difficulty or assistance with one activity of daily living  (  ADL ) or two instrumental ADLs . Participants were classified as current or former drivers . MEASUREMENTS Demographic characteristics , medical diagnoses , medication use , modified PPT score , and psychometric tests . RESULTS The majority ( 85 % ) of the participants were drivers . Former drivers were more likely to be older , be female , reside in congregate independent living for the elderly , have a higher incidence of arthritis and congestive heart failure , take sedating medications , have lower total ADL scores , have lower VO2 peak scores , and have more impairment on tests of cognition and physical strength , although only age , type of residence , and grip strength were independent predictors of driving cessation in the regression analysis . CONCLUSION Despite the presence of physical frailty , many older adults choose to continue to drive . Further studies are needed to better underst and the driving behaviors of frail older adults and explore opportunities for optimizing driving abilities Objective Performance measures provide important information , but the meaning of change in these measures is not well known . The purpose of this research is to 1 ) examine the effect of treatment assignment on the relationship between self-report and performance ; 2 ) to estimate the magnitude of meaningful change in 400- meter walk time ( 400MWT ) , 4-meter gait speed ( 4MGS ) , and Short Physical Performance Battery ( SPPB ) and 3 ) to evaluate the effect of direction of change on estimates of magnitude . Design This is a secondary analysis of data from the LIFE-P study , a single blinded r and omized clinical trial . Using change over one year , we applied distribution-based and anchor-based methods for self-reported mobility to estimate minimally important and substantial change in 400MWT , 4MGS and SPPB . Setting Four university-based clinical research sites . Participants Sedentary adults aged 70–89 whose SPPB scores were less than 10 and who were able to complete a 400MW at baseline ( n=424 ) . Interventions A structured exercise program versus health education . Measurements 400MWT , 4MGS , SPPB . Results Relationships between self-report and performance measures were consistent between treatment arms . Minimally significant change estimates were 400MWT : 20–30 seconds , 4MGS : 0.03–0.05 m/s and SPPB : 0.3–0.8 points . Substantial changes were 400MWT : 50–60 seconds , 4MGS : 0.08 m/s , SPPB : 0.4–1.5 points . Magnitudes of change for improvement and decline were not significantly different . Conclusions The magnitude of clinical ly important change in physical performance measures is reasonably consistent using several analytic techniques and appears to be achievable in clinical trials of exercise . Due to limited power , the effect of direction of change on estimates of magnitude remains uncertain BACKGROUND The present study examined whether aerobic fitness training of older humans can increase brain volume in regions associated with age-related decline in both brain structure and cognition . METHODS Fifty-nine healthy but sedentary community-dwelling volunteers , aged 60 - 79 years , participated in the 6-month r and omized clinical trial . Half of the older adults served in the aerobic training group , the other half of the older adults participated in the toning and stretching control group .  Twenty young adults served as controls for the magnetic resonance imaging ( MRI ) , and did not participate in the exercise intervention . High spatial resolution estimates of gray and white matter volume , derived from 3D spoiled gradient recalled acquisition MRI images , were collected before and after the 6-month fitness intervention . Estimates of maximal oxygen uptake ( VO2 ) were also obtained . RESULTS Significant increases in brain volume , in both gray and white matter regions , were found as a function of fitness training for the older adults who participated in the aerobic fitness training but not for the older adults who participated in the stretching and toning ( nonaerobic ) control group . As predicted , no significant changes in either gray or white matter volume were detected for our younger participants . CONCLUSIONS These results suggest that cardiovascular fitness is associated with the sparing of brain tissue in aging humans . Furthermore , these results suggest a strong biological basis for the role of aerobic fitness in maintaining and enhancing central nervous system health and cognitive functioning in older adults PURPOSE The purpose of this article was to investigate the role of control beliefs in mediating the relationship between driving cessation and change in depressive symptoms in a population -based sample of older adults . DESIGN AND METHODS We report results from a prospect i ve , community-based cohort study that included two waves of data collected in 1992 and 1994 . Participants consisted of 700 men and women aged 70 and older , including 647 drivers and 53 participants who ceased driving between baseline ( 1992 ) and follow-up ( 1994 ) . Participants took part in interviews that included assessment s of driving status , sociodemographic characteristics , self-rated health , sensory function , depressive symptoms ( through the Center for Epidemiologic Studies -Depression scale ) , and expectancy of control . Using multilevel general linear models , we examined the extent to which driving status , expectancy of control , and relevant covariates explained change in depressive-symptom scores between baseline and follow-up . RESULTS Driving cessation was associated with an increase in depressive symptoms from baseline to follow-up . The higher depressive-symptom scores of ceased drivers relative to those of individuals who remained drivers at both waves was partly explained by a corresponding decrease in the sense of control among ceased drivers , and increased control beliefs among drivers . IMPLICATION S Interventions aim ed at promoting the maintenance of personal agency and associated control beliefs could be protective against the negative psychological concomitants of driving cessation OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change PURPOSE The purpose of this study was to prospect ively 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 assessment s 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 prospect i ve 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 ) . IMPLICATION S 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 Older adults represent the fastest-growing population of drivers with a valid driver 's licence . Also common in this age group are multiple chronic medical conditions that may have an effect on physical function and driving ability . Determining the reliability of physical measures used to assess older drivers ' functional ability is important to identifying those who are safe to continue driving . Most previous reliability studies of clinical physical measures of health used test-retest intervals shorter than those between patient visits with a clinician . In the present study we examined a more clinical ly representative interval of 1 year to determine the stability of commonly used physical measures collected during the C and rive II prospect i ve cohort study of older drivers .  Reliability statistics indicate that the  sequential finger-thumb opposition , rapid pace walk  and the  Pelli-Robson contrast sensitivity tests  have adequate stability over 1 year . Poor stability was observed for the one-legged stance and Snellen visual acuity test . Several assessment s with nominal data ( Marottoli method [ functional neck range of motion ] , whispered voice test , range of motion and strength testing ) lacked sufficient variability to conduct reliability analyses ; however , a lack of variability between test days suggests consistency over a 1-year time frame . Our results provide evidence that specific physical measures are stable in monitoring functional ability over the course of a year OBJECTIVES To examine psychological , medical , and sensorimotor risk factors that predict driving cessation in older adults . DESIGN Prospect i ve cohort study including five waves of data collected in 1992 , 1993 , 1994 , 1995 , and 1997 . SETTING The Australian Longitudinal Study of Aging . PARTICIPANTS One thous and four hundred sixty-six men and women aged 70 and older drawn from the electoral roll and including 753 drivers at baseline . MEASUREMENTS Interviews , including assessment s of self-rated health ( indicating general well-being ) ; medical conditions ; driving status ; and clinical assessment s of vision , hearing , cognitive function , and grip strength  , were conducted in 1992 ( baseline ) and 1994 . Information on current driving status was obtained at baseline and four subsequent waves ( 1993 , 1994 , 1995 , and 1997 ) . Drivers and nondrivers were compared at baseline . Risk factors for driving cessation were identified using logistic regression . RESULTS Drivers were younger and more likely to be male and had better self-rated health , vision , hearing , and cognitive performance than nondrivers at baseline . Seventeen percent of drivers in the study had vision of 6/18 or worse , and 7.3 % were classified as possibly cognitively impaired . In those identified as drivers at baseline , subsequent cessation was associated with increasing age , low grip strength , poorer cognitive performance , and poorer self-rated health . CONCLUSION Self-rated health and cognitive function were more important than medical conditions or sensory function for predicting driving cessation The main aim of this research was to study the effects of a specific exercise program on the speed of behavior of older adults during on-the-road driving . Twenty-six drivers ( 55 - 78 yr old ) were r and omly assigned to either an exercise group or a control group . The exercise program ( 3 sessions of 60 min/wk for 8 wk ) incorporated tasks that induced the participants to respond quickly to challenging situations . On-the-road driving tasks ( under single- and dual-task conditions ) included measures of simple and choice reaction time , movement time , and response time . Significant positive effects were found at follow-up result ing from participation in the exercise program : Improvements were found for several measures in all driving tasks , and a composite score reflected a better general drivers ' speed of behavior . These results show that exercise can enhance speed of behavior in older drivers and should therefore be promoted Background As the number of older drivers increases , concern has been raised about the potential safety implication s. Flexibility , coordination , and speed of movement have been associated with older drivers ’ on road performance . Objective To determine whether a multicomponent physical conditioning program targeted to axial and extremity flexibility , coordination , and speed of movement could improve driving performance among older drivers . Design R and omized controlled trial with blinded assignment and end point assessment . Participants r and omized to intervention underwent graduated exercises ; controls received home , environment safety modules . Participants Drivers , 178 , age ≥ 70 years with physical , but without substantial visual ( acuity 20/40 or better ) or cognitive ( Mini Mental State Examination score ≥24 ) impairments were recruited from clinics and community sources . Measurements On-road driving performance assessed by experienced evaluators in dual-brake equipped vehicle in urban , residential , and highway traffic . Performance rated three ways : ( 1 ) 36-item scale evaluating driving maneuvers and traffic situations ; ( 2 ) evaluator ’s overall rating ; and ( 3 ) critical errors committed . Driving performance reassessed at 3 months by evaluator blinded to treatment group . Results Least squares mean change in road test scores at 3 months compared to baseline was 2.43 points higher in intervention than control participants ( P = .03 ) . Intervention drivers committed 37 % fewer critical errors ( P = .08 ) ; there were no significant differences in evaluator ’s overall ratings ( P = .29 ) . No injuries were reported , and complaints of pain were rare . Conclusions This safe , well-tolerated intervention maintained driving performance , while controls declined during the study period . Having interventions that can maintain or enhance driving performance may allow clinician – patient discussion s about driving to adopt a more positive tone , rather than focusing on driving limitation or cessation OBJECTIVES Increasing age , socioeconomic factors , and declining function and health have been linked to driving cessation , but little is known about the consequences of stopping driving . This study was design ed to test the hypothesis that driving cessation leads to a decline in out-of-home activity levels . METHODS In 1989 a survey of driving practice s was administered to surviving noninstitutionalized members of the New Haven Established Population s for Epidemiologic Studies of the Elderly ( EPESE ) cohort . Of 1,316 respondents , 502 were active drivers as of 1988 , 92 had stopped driving between 1982 and 1987 , and 722 never drove or stopped before 1982 . Information on sociodemographic and health-related variables came from in-home EPESE interviews in 1982 , 1985 , and 1988 , and from yearly phone interviews . Activity was measured at all three in-home interviews , and an activity measure was created based on self-reported participation in nine out-of-home activities . A repeated measures r and om-effects model was used to test the effect of driving cessation on activity while controlling for potential confounders . RESULTS Driving cessation was strongly associated with decreased out-of-home activity levels ( coefficient-1.081 , st and ard error 0.264 , p < .001 ) after adjustment for sociodemographic and health-related factors . DISCUSSION The potential consequences of driving limitations or cessation should be taken into account when advising older drivers and developing alternative transportation strategies to help maintain their mobility OBJECTIVE To determine how multiple risk factors for osteoporotic fractures could be modified by high-intensity strength training exercises in postmenopausal women . DESIGN R and omized controlled trial of 1-year duration . SETTING Exercise laboratory at Tufts University , Boston , Mass. POPULATION Forty postmenopausal white women , 50 to 70 years of age , participated in the study ; 39 women completed the study . The subjects were sedentary and estrogen-deplete . INTERVENTIONS High-intensity strength training exercises 2 days per week using five different exercises ( n = 20 ) vs untreated controls ( n = 19 ) . MAIN OUTCOME MEASURES Dual energy x-ray absorptiometry for bone status , one repetition maximum for muscle strength , 24-hour urinary creatinine for muscle mass , and backward t and em walk for dynamic balance . RESULTS Femoral neck bone mineral density and lumbar spine bone mineral density increased by 0.005 + /- 0.039 g/cm2 ( 0.9 % + /- 4.5 % ) ( mean + /- SD ) and 0.009 + /- 0.033 g/cm2 ( 1.0 % + /- 3.6 % ) , respectively , in the strength-trained women and decreased by -0.022 + /- 0.035 g/cm2 ( -2.5 % + /- 3.8 % ) and -0.019 + /- 0.035 g/cm2 ( -1.8 % + /- 3.5 % ) , respectively , in the controls ( P = .02 and .04 ) . Total body bone mineral content was preserved in the strength-trained women ( + 2.0 + /- 68 g ; 0.0 % + /- 3.0 % ) and tended to decrease in the controls ( -33 + 77 g ; -1.2 % + /- 3.4 % , P = .12 ) . Muscle mass , muscle strength , and dynamic balance increased in the strength-trained women and decreased in the controls ( P = .03 to < .001 ) . CONCLUSIONS High-intensity strength training exercises are an effective and feasible means to preserve bone density while improving muscle mass , strength , and balance in postmenopausal women The purpose of this study was to investigate the effects of participation in an exercise program on several abilities associated with driving performance in older adults . Thirty-two subjects were r and omly assigned to either an  exercise group ( 60 - 81 years , n=16 ) or a control group ( 60 - 82 years , n=16 ) . The exercise program was planned to stress perceptive , cognitive , and physical abilities . It lasted 12 weeks with a periodicity of three sessions of 60 min per week . Assessment s were conducted before and after the intervention on behavioral speed ( in single- and dual-task conditions ) , visual attention , psychomotor performance , speed perception ( time-to-contact ) , and executive functioning . Significant positive effects were found at 12-week follow-up result ing from participation in the exercise program .  Behavioral speed improvements were found in reaction time , movement time , and response time ( both in single- and dual-task conditions ) ; visual attention improvements took place in speed processing and divided attention ; psychomotor performance improvements occurred in lower limb mobility . These results showed that exercise is capable of enhancing several abilities relevant for driving performance and safety in older adults and , therefore , should be promoted BACKGROUND Chronic health conditions associated with ageing can lead to changes in driving ability . The Canadian Driving Research Initiative for Vehicular Safety in the Elderly ( C and rive II ) is a 5-year prospect i ve study funded by the Canadian Institutes of Health Research aim ing to develop an in-office screening tool that will help clinicians identify potentially at-risk older drivers . Currently , no tools exist to directly predict the risk of motor vehicle collision ( MVC ) in this population . The American Medical Association ( AMA ) , in collaboration with the National Highway Traffic Safety Association , has design ed an opinion-based guide for assessing medical fitness to drive in older adults and recommends that physicians use the Assessment of Driving Related Skills ( ADReS ) as a test battery to measure vision , cognition and motor/somatosensory functions related to driving . The ADReS consists of the  Snellen visual acuity test , visual fields by confrontation test , Trail Making Test part B , clock drawing test , Rapid Pace Walk  , and  manual tests of range of motion and motor strength .  We used baseline data from the C and rive/Ozc and rive common cohort of older drivers to evaluate the validity of the ADReS subtests . We hypothesized that participants who crashed in the 2 years before the baseline assessment would have poorer scores on the ADReS subtests than participants who had not crashed . METHODS In the C and rive/Ozc and rive study , 1230 participants aged 70 years or older were recruited from 7 Canadian cities , 1 Australian city and 1 New Zeal and city , all of whom completed a comprehensive clinical assessment at study entry . The assessment included all tests selected as part of the ADReS. For this historical cohort study , data on all crashes ( at-fault and non-at-fault ) that occurred within 2 years preceding the baseline assessment were obtained from the respective licensing jurisdictions . Those who crashed were compared to those who had not crashed on their ADReS subtest scores using Pearson 's chi-squared test and Student 's t-test . RESULTS Sixty-three of the 1230 participants ( 5.1 % ) were involved in an MVC within the 2 years preceding the baseline assessment . Contrary to our hypothesis , there were no statistically significant associations between abnormal performance on the tests constituting the  ADReS  and history of crash in the previous 2 years ( p>0.01 ) . DISCUSSION We found that a history of crash in the previous 2 years was not associated with abnormalities on the subtests comprising the ADReS. This suggests the need for prospect i ve analyses of risk factors over time to establish sensitive , valid predictors of crash that can be incorporated in clinical practice guidelines OBJECTIVES To assess the ability of gait speed alone and a three-item lower extremity performance battery to predict 12-month rates of hospitalization , decline in health , and decline in function in primary care setting s serving older adults . DESIGN Prospect i ve cohort study . SETTING Primary care programs of a Medicare health maintenance organization ( HMO ) and Veterans Affairs ( VA ) system . PARTICIPANTS Four hundred eighty-seven persons aged 65 and older . MEASUREMENTS  Lower extremity performance Established Population for Epidemiologic Studies of the Elderly ( EPESE ) battery including  gait speed , chair st and s , and t and em balance tests ; demographics ; health care use ; health status ; functional status ; probability of repeated admission scale ( Pra ) ; and primary physician 's hospitalization risk estimate . RESULTS Veterans had poorer health and higher use than HMO members . Gait speed alone and the EPESE battery predicted hospitalization ; 41 % ( 21/51 ) of slow walkers ( gait speed < 0.6 m/s ) were hospitalized at least once , compared with 26 % ( 70/266 ) of intermediate walkers ( 0.6 - 1.0 m/s ) and 11 % ( 15/136 ) of fast walkers ( > 1.0 m/s ) ( P < .0001 ) . The relationship was stronger in the HMO than in the VA . Both performance measures remained independent predictors after accounting for Pra . The EPESE battery was superior to gait speed when both Pra and primary physician 's risk estimate were included . Both performance measures predicted decline in function and health status in both health systems . Performance measures , alone or in combination with self-report measures , were more able to predict outcomes than self-report alone . CONCLUSION Gait speed and a physical performance battery are brief , quantitative estimates of future risk for hospitalization and decline in health and function in clinical population s of older adults . Physical performance measures might serve as easily accessible " vital signs " to screen older adults in clinical setting BACKGROUND This study examines , in initially nondisabled older persons , the impact of reduced lower extremity performance on subsequent hospitalizations . METHODS A 4-year prospect i ve cohort study was conducted among 3381 persons , aged 71 years and older , who initially reported no disability . At baseline , lower extremity performance was measured by an assessment of st and ing balance , a timed 2.4-m walk , and a timed test of rising from a chair five times .  Data on subsequent hospital admissions and discharge diagnoses over 4 years were obtained from the Medicare data base . RESULTS During the follow-up period , nondisabled persons with poor lower extremity performance spent significantly more days in the hospital ( 17.7 days ) than those with intermediate and high performance ( 11.6 and 9.7 days , respectively ) . Poor lower extremity performance in nondisabled persons significantly predicted subsequent hospitalization over 4 years ( relative risk for hospitalization in those with poor vs high performance : 1.78 ; 95 % confidence interval , 1.45 - 2.17 ) . This increased hospitalization risk could not be explained by several indicators of baseline health status . Increased hospitalization risks were especially found for geriatric conditions , such as dementia , decubitus ulcer , hip fractures , other fractures , pneumonia , dehydration , and acute infections . CONCLUSIONS Even in persons who are currently nondisabled , a simple measure of lower extremity performance is predictive of subsequent hospitalization , especially for geriatric conditions This prospect i ve cohort study evaluate the predictive value of physical performance measures for mortality in older French women , in particular those with a high health status . The subjects were 7,250 community-dwelling non-disabled French women aged 75 years or older , enrolled in the Epidémiologie de l’ostéoporose ( EPIDOS ) study .  The short physical performance battery ( SPPB ) , including walking speed , repeated chair st and s , and balance tests , was administered and h and grip strength was measured . Anthropometric measurements , physical function , cognitive performance , sensory status , smoking , medical history , medication use , subjective self- assessment of health status , and physical activity level were assessed at the baseline visit . During a mean follow-up of 3.8 years , 754 ( 10.4 % ) participants died . Complementary analysis was performed on the 2,157 non-disabled healthiest participants ( no disease at baseline ) . The SPPB and h and grip strength distinguished a gradient of risk for mortality from a low to high functional spectrum . Risk of death was 2.04-fold higher in poor ( SPPB 0–6 ) than in good ( SPPB 10–12 ) performers and 1.56-fold higher in participants with lower tertile grip strength . Walking speed alone also distinguished a gradient of mortality risk . After adjustment for confounders , low SPPB , grip strength score and slow walking speed remained significantly associated with death . In the non-disabled healthiest women , no physical performance measure predicted death . In community-dwelling elderly French women , physical performance measures significantly and independently predicted mortality . Increased risk of death was partly explained by baseline health status and was absent in the healthiest elderly OBJECTIVES To develop a cognitive and functional screening battery for the on-road performance of older drivers with dementia . DESIGN Prospect i ve observational study . SETTING On-road driving evaluation clinic at an academic rehabilitation center . PARTICIPANTS Ninety-nine older people with dementia ( 63 % male , mean age 74.2 ± 9 ) , referred by community physicians to an occupational therapy driving clinic . MEASUREMENTS The outcome variable was pass or fail on the modified Washington University Road Test . Predictor measures were tests of visual , motor , and cognitive functioning , selected for their empirical or conceptual relationship to the complex task of driving safely . RESULTS Sixty-five ( 65 % ) participants failed the on-road driving test . The best predictive model , with an overall accuracy of up to 85 % when participants were blinded , included the Eight-item Informant Interview to Differentiate Aging and Dementia , Clock Drawing Test score , and time to complete the Snellgrove Maze Test or Trail Making Test Part A. Visual and motor functioning were not associated with road test failure . CONCLUSION A screening battery that could be performed in less than 10 minutes predicted with good accuracy failure rate for the on-road driving test in this sample of older drivers with dementia . A probability of failure calculator is provided from a logistic regression model that may be useful for clinicians in their decision to refer impaired older adults for further testing . More studies are needed in larger community-based sample s , along with discussion s with patients , families , and clinicians , with regard to acceptable levels of test uncertainty BACKGROUND Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people , the efficacy of interventions targeted specifically at these deficits has not been carefully studied . METHODS We conducted a r and omized , placebo-controlled trial comparing progressive resistance exercise training , multinutrient supplementation , both interventions , and neither in 100 frail nursing home residents over a 10-week period . RESULTS The mean ( + /- SE ) age of the 63 women and 37 men enrolled in the study was 87.1 + /- 0.6 years ( range , 72 to 98 ) ; 94 percent of the subjects completed the study .  Muscle strength increased by 113 + /- 8 percent in the subjects who underwent exercise training , as compared with 3 + /- 9 percent in the nonexercising subjects ( P < 0.001 ) . Gait velocity increased by 11.8 + /- 3.8 percent in the exercisers but declined by 1.0 + /- 3.8 percent in the nonexercisers ( P = 0.02 ) . Stair-climbing power also improved in the exercisers as compared with the nonexercisers ( by 28.4 + /- 6.6 percent vs. 3.6 + /- 6.7 percent , P = 0.01 ) , as did the level of spontaneous physical activity . Cross-sectional thigh-muscle area increased by 2.7 + /- 1.8 percent in the exercisers but declined by 1.8 + /- 2.0 percent in the nonexercisers ( P = 0.11 ) . The nutritional supplement had no effect on any primary outcome measure . Total energy intake was significantly increased only in the exercising subjects who also received nutritional supplementation . CONCLUSIONS High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people . In contrast , multi-nutrient supplementation without concomitant exercise does not reduce muscle weakness or physical frailty OBJECTIVES To evaluate the relationship between performance-based risk factors and subsequent at-fault motor vehicle collision ( MVC ) involvement in a cohort of older drivers . DESIGN Prospect i ve cohort study . SETTING Motor Vehicle Administration ( MVA ) field sites in Maryl and . PARTICIPANTS Of the 4,173 older drivers invited to participate in the study , 2,114 individuals aged 55 to 96 agreed to do so . These analyses focus on 1,910 individuals recruited through MVA field sites . MEASUREMENTS  Gross Impairment Screening Battery  , which included  Rapid Pace Walk , Head/Neck Rotation , Foot Tap , Arm Reach , Cued Recall , Symbol Scan , Visual Closure subtest of the Motor Free Visual Perception Test ( MVPT ) , Delayed Recall , and Trail Making Test with an Abbreviated Part A and  st  and ard Part B ; Useful Field of View ( UFOV ) subtest 2 ; a Mobility Question naire ; and MVC occurrence . RESULTS In drivers aged 55 and older with intact vision ( 20/70 far visual acuity and 140 degrees visual field ) , age , sex , history of falls , and poorer cognitive performance , as measured using Trails B , MVPT , and UFOV subtest 2 , were predictive of future at-fault MVC involvement . After adjusting for annual mileage , participants aged 78 and older were 2.11 as more likely to be involved in an at-fault MVC , those who made four or more errors on the MVPT were 2.10 times as likely to crash , those who took 147 seconds or longer to complete Trails B were 2.01 times as likely to crash , and those who took 353 ms or longer on subtest 2 of the UFOV were 2.02 times as likely to incur an at-fault MVC . Older adults , men , and individuals with a history of falls were more likely to be involved in subsequent at-fault MVCs . CONCLUSION Performance-based cognitive measures are predictive of future at-fault MVCs in older adults . Cognitive performance , in particular , is a salient predictor of subsequent crash involvement in older adults . High-risk older drivers can be identified through brief , performance-based measures administered in a MVA setting IMPORTANCE In older adults reduced mobility is common and is an independent risk factor for morbidity , hospitalization , disability , and mortality . Limited evidence suggests that physical activity may help prevent mobility disability ; however , there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability . OBJECTIVE To test the hypothesis that a long-term structured physical activity program is more effective than a health education program ( also referred to as a successful aging program ) in reducing the risk of major mobility disability . DESIGN , SETTING , AND PARTICIPANTS The Lifestyle Interventions and Independence for Elders ( LIFE ) study was a multicenter , r and omized trial that enrolled participants between February 2010 and December 2011 , who participated for an average of 2.6 years . Follow-up ended in December 2013 . Outcome assessors were blinded to the intervention assignment . Participants were recruited from urban , suburban , and rural communities at 8 centers throughout the United States . We r and omized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations , defined as a score on the Short Physical Performance Battery of 9 or below , but were able to walk 400 m. INTERVENTIONS Participants were r and omized to a structured , moderate-intensity physical activity program ( n = 818 ) conducted in a center ( twice/wk ) and at home ( 3 - 4 times/wk ) that included aerobic , resistance , and flexibility training activities or to a health education program ( n = 817 ) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises . MAIN OUTCOMES AND MEASURES The primary outcome was major mobility disability objective ly defined by loss of ability to walk 400 m. RESULTS Incident major mobility disability occurred in 30.1 % ( 246 participants ) of the physical activity group and 35.5 % ( 290 participants ) of the health education group ( hazard ratio [ HR ] , 0.82 [ 95 % CI , 0.69 - 0.98 ] , P = .03).Persistent mobility disability was experienced by 120 participants ( 14.7 % ) in the physical activity group and 162 participants ( 19.8 % ) in the health education group ( HR , 0.72 [ 95 % CI , 0.57 - 0.91 ] ; P = .006 ) . Serious adverse events were reported by 404 participants ( 49.4 % ) in the physical activity group and 373 participants ( 45.7 % ) in the health education group ( risk ratio , 1.08 [ 95 % CI , 0.98 - 1.20 ] ) . CONCLUSIONS AND RELEVANCE A structured , moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability . These findings suggest mobility benefit from such a program in vulnerable older adults . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01072500 IMPORTANCE Epidemiological evidence suggests that physical activity benefits cognition , but results from r and omized trials are limited and mixed . OBJECTIVE To determine whether a 24-month physical activity program results in better cognitive function , lower risk of mild cognitive impairment ( MCI )  or dementia , or both , compared with a health education program . DESIGN , SETTING , AND PARTICIPANTS A r and omized clinical trial , the Lifestyle Interventions and Independence for Elders ( LIFE ) study , enrolled 1635 community-living participants at 8 US centers from February 2010 until December 2011 . Participants were sedentary adults aged 70 to 89 years who were at risk for mobility disability but able to walk 400 m. INTERVENTIONS A structured , moderate-intensity physical activity program ( n = 818 ) that included walking , resistance training , and flexibility exercises or a health education program ( n = 817 ) of educational workshops and upper-extremity stretching . MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes of the LIFE study included cognitive function measured by the Digit Symbol Coding ( DSC ) task subtest of the Wechsler Adult Intelligence Scale ( score range : 0 - 133 ; higher scores indicate better function ) and the revised Hopkins Verbal Learning Test ( HVLT-R ; 12-item word list recall task ) assessed in 1476 participants ( 90.3 % ) . Tertiary outcomes included global and executive cognitive function and incident MCI or dementia at 24 months . RESULTS At 24 months , DSC task and HVLT-R scores ( adjusted for clinic site , sex , and baseline values ) were not different between groups . The mean DSC task scores were 46.26 points for the physical activity group vs 46.28 for the health education group ( mean difference , -0.01 points [ 95 % CI , -0.80 to 0.77 points ] , P = .97 ) . The mean HVLT-R delayed recall scores were 7.22 for the physical activity group vs 7.25 for the health education group ( mean difference , -0.03 words [ 95 % CI , -0.29 to 0.24 words ] , P = .84 ) . No differences for any other cognitive or composite measures were observed . Participants in the physical activity group who were 80 years or older ( n = 307 ) and those with poorer baseline physical performance ( n = 328 ) had better changes in executive function composite scores compared with the health education group ( P = .01 for interaction for both comparisons ) . Incident MCI or dementia occurred in 98 participants ( 13.2 % ) in the physical activity group and 91 participants ( 12.1 % ) in the health education group ( odds ratio , 1.08 [ 95 % CI , 0.80 to 1.46 ] ) . CONCLUSIONS AND RELEVANCE Among sedentary older adults , a 24-month moderate-intensity physical activity program compared with a health education program did not result in improvements in global or domain-specific cognitive function . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01072500 BACKGROUND Relatively little is known about why older persons develop long-term disability in community mobility .  OBJECTIVE To identify the risk factors and precipitants for long-term disability in walking a quarter mile and driving a car . DESIGN Prospect i ve cohort study from March 1998 to December 2009 . SETTING Greater New Haven , Connecticut . PARTICIPANTS 641 persons , aged 70 years or older , who were active drivers or nondisabled in walking a quarter mile . Persons who were physically frail were over sample d. MEASUREMENTS C and i date risk factors were assessed every 18 months .  Disability in community mobility and exposure to potential precipitants , including illnesses or injuries leading to hospitalization or restricted activity  , were assessed every month . Disability that lasted 6 or more consecutive months was considered long-term . RESULTS 318 ( 56.0 % ) and 269 ( 53.1 % ) participants developed long-term disability in walking and driving , respectively . Seven risk factors were independently associated with walking disability and 8 were associated with driving disability ; the strongest associations for each outcome were found for older age and lower score on the Short Physical Performance Battery . The precipitants had a large effect on long-term disability , with multivariate hazard ratios for each outcome greater than 6.2 for hospitalization and greater than 2.4 for restricted activity . The largest differences in absolute risk were generally observed in participants with a specific risk factor who were subsequently hospitalized . LIMITATIONS The observed associations may not be causal . The severity of precipitants was not assessed . The effect of the precipitants may have been underestimated because their exposure after the initial onset of disability was not evaluated . CONCLUSION Long-term disability in community mobility is common among older persons . Multiple risk factors , together with subsequent precipitants , greatly increase the likelihood of long-term mobility disability . PRIMARY FUNDING SOURCE National Institute on Aging , National Institutes of Health
target: Conclusions The Timed Up- and -Go test measure appears not to be a useful measure of physical functioning for the driving outcomes included here .
  The Rapid Pace Walk may be useful in studies of driving ability and exposure .
background: Background Improving physical functioning may be a future intervention to keep older adults driving safely longer as it can help maintain both physical and cognitive health longer .
  This systematic review assesses the evidence on the association between three physical functioning measures : the Short Physical Performance Battery , the Timed Up- and -Go test , and the Rapid Pace Walk with driving outcomes in older adults .