What Factors Influence Older People in the Decision to Relinquish Their Driver’s Licence? a Discrete Choice Experiment.

What factors influence older people in the decision to relinquish their driver’s licence? A discrete choice experiment.

Accid Anal Prev. 2013 Mar 5; 55C: 178-184
McNamara A, Chen G, George S, Walker R, Ratcliffe J

PURPOSE: To investigate the relative importance of a number of key factors that influence older people in the decision to relinquish their driver’s licence. METHOD: A discrete choice experiment (DCE) was administered as an online survey to Australian adults, 65 years plus (N=114) who drive, recruited from an online panel. The survey was composed of three main sections. (A) The Adelaide Driving Self Efficacy Scale to assess confidence in driving. The scale is generated from individual’s responses about confidence in their driving ability in various situations. (B) The DCE in which respondents were presented with a series of hypothetical binary choice situations and asked to indicate in which situation they would be more likely to relinquish their driving licence. (C) Socio-demographic and health status questions. A conditional logit regression model was adopted to analyse the DCE data. RESULTS: Older people would be more likely to relinquish their driver’s licence due to advanced age, low confidence in driving ability and in situations where their local doctor advises them to cease driving. Other transport options availability and the cost of public transport were not found to be influential to this decision. CONCLUSIONS: Factors pertaining to the individual themselves including advanced old age and low confidence in driving ability may be more influential than environmental factors such as availability of other transport options and the cost of public transport in an older person’s decision to relinquish their driving licence. HubMed – rehab


Water-Swallowing Test: Screening for Aspiration in Stroke Patients.

Cerebrovasc Dis. 2013 Mar 26; 35(3): 276-281
Osawa A, Maeshima S, Tanahashi N

Background and Purpose: The water-swallowing test (WST) is frequently used in clinical practice as a functional assessment to detect aspiration and prevent pneumonia. It is a standardized test used all over the world, but the amount of water given varies depending on the examiner. Furthermore, there are very few reports on the simultaneous performance of the WST and videofluorography (VF). This study compared the amount of swallowed water to investigate the reliability of WST to exclude aspiration following acute stroke. Methods: We assessed 111 stroke patients (65 men and 46 women) with suspected dysphagia/difficulty in swallowing and performed VF upon obtaining consent from the patients and their families. Patients were aged between 20 and 98 years (65.6 ± 13.4 years); 64 had cerebral infarction, 26 cerebral hemorrhage, 13 subarachnoid hemorrhage, and 8 had other cerebrovascular disease. The time from stroke onset to VF was 16.6 ± 10.3 days (range, 2-55). WSTs using 5, 10, 30, and 60 ml and the modified WST (MWST) were performed during VF. Results: We found that the number of instances of choking, cough, wet voice, and aspiration increased with higher amounts of water. The sensitivity and specificity of WST for aspiration ranged from 34.8 to 55.7% and from 78.9 to 93.2%, respectively. The MWST, which used only 3 ml of water, yielded a sensitivity of 55.3% and a specificity of 80.8% for aspiration. There was a positive correlation between the time for one swallow and age, but there was no difference between genders. There was also no connection between clinical findings during WST or the presence of aspiration with the number of swallows, swallowing speed, or time for one swallow. Conclusions: WSTs are not as powerful as VF as a screening instrument in acute stroke. WSTs with more water detected aspiration with greater sensitivity, but there is no justification for overconfidence when investigating aspiration. We recommend using WST as well as VF to investigate swallowing in stroke patients. HubMed – rehab