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Objectives: Despite three decades of research, gaps remain in meeting the needs of people with dementia and their family/friend carers as they navigate the often-tumultuous process of driving cessation. This paper describes the process of using a knowledge-to-action (KTA) approach to develop an educational web-based resource (i.e. toolkit), called the Driving and Dementia Roadmap (DDR), aimed at addressing some of these gaps. Design: Aligned with the KTA framework, knowledge creation and action cycle activities informed the development of the DDR. These activities included systematic reviews; meta-synthesis of qualitative studies; interviews and focus groups with key stakeholders; development of a Driving and Dementia Intervention Framework (DD-IF); and a review and curation of publicly available resources and tools. An Advisory Group comprised of people with dementia and family carers provided ongoing feedback on the DDR’s content and design. Results: The DDR is a multi-component online toolkit that contains separate portals for current and former drivers with dementia and their family/friend carers. Based on the DD-IF, various topics of driving cessation are presented to accommodate users’ diverse stages and needs in their experiences of decision-making and transitioning to non-driving. Conclusion: Guided by the KTA framework that involved a systematic and iterative process of knowledge creation and translation, the resulting person-centered, individualized and flexible DDR can bring much-needed support to help people with dementia and their families maintain their mobility, community access, and social and emotional wellbeing during and post-driving cessation.

Background Assessing an older adult’s fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults. Methods Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures. Results A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [SD] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81–9.84) compared to the lowest risk group. Conclusions For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation.

Community mobility using private and public transportation is important for maintaining health, social participation and living well in later life. This international cross-sectional cohort study (N = 246) reported on the health and driving status of older adults from seven countries where the mobility patterns of drivers and non-drivers were compared in terms of city and rural areas, weather, as well as their respective differences in the number of out-of-home places accessed and quality of life. Older adults participated in a semi-structured interview and completed four standardised instruments: the EQ-5D-5L, modified PULSES health profile, modified Transportation Questionnaire, and the Transport – Participation in Activities and Places Outside the Home. Results suggested inclement weather and place of residence negatively impacted out-of-home activities but did not increase use of public transportation. Drivers accessed more out-of-home activities than non-drivers, suggesting higher community participation among this group, and quality of life was generally high among all participants, but slightly higher for drivers. Findings indicate that a complex myriad of factors can influence community mobility in older adults and further investigations are needed to understand patterns of transport in later life, particularly with regard to those factors that promote and maintain transport mobility, and relationships between transport mobility, community participation and quality of life.

Objectives The main objective was to determine the trajectory of instrumental activities of daily living (iADL) decline in persons with mild cognitive impairment (MCI) who progressed towards dementia relative to persons with MCI who remained stable. Methods/Design At study entry, 121 participants met criteria for MCI. Based on the follow‐up, 47 participants later converted to dementia and were identified as progressors. Sixteen participants, identified as decliners, presented a significant cognitive decline but did not reach the criteria for dementia within the study timeframe. Stable MCI remained cognitively stable during the 5‐year follow‐up; n = 58. Participants completed a yearly assessment using clinical tests/questionnaires, neuropsychological measures, and functional autonomy assessment until they met criteria for dementia. The average number of months for the follow‐up was 34. Results Many years of stable performance followed by an accelerated decline just prior to diagnosis, was observed for complex activities for progressors. No change was found for stable MCI and a gradual linear decline characterized decliners. The housekeeping‐related activities component showed a linear decline in progressors and did not change in stable and decliner MCI. We found a predictive model that includes significant predictors of dementia conversion with a high diagnostic accuracy the following year (area under the curve = 0.94 [95% confidence level; lower bound: 0.87, upper bound: 1]). Conclusions It is critical to assess iADL that reflect complex activities in the evaluation of MCI individuals as their impairment, combined with change on cognitive markers, indicates a higher risk of dementia progression 1 or 2 years later.

The nature of relationships between service providers and parents of children with disabilities influences the health and wellbeing of parents and ultimately the quality of life of their children. The aim of this study was to explore parents’ perceptions of their partnerships with service providers. We explored what was and was not working within these service relationships and solicited ideas for improved partnerships and services. We employed a qualitative, participatory research approach and adapted the Reflexive Methodology of Analysis in Partnership developed by Boudreault and Kalubi (2006). Thematic analysis and critical interpretation of the statements created in two focus groups by eight parents of nine children with disabilities generated eight themes: system complexity; funding; communication; navigation and advocacy; education; segregation; emotional support; and connecting with parents. Parents described difficulties in mediating partnerships in an ineffective disability service system and proposed practical solutions to these problems. We suggest that the structure of the disability service system is the root of these problems and must be radically changed to realize true partnership and client-centered services. Implications from this study for policy and practice include transforming the structure of the system, streamlining the organization and location of service information and delivery, including parents on decision-making bodies, and creating spaces for mutual peer support for parents of children with disabilities.

Most older adults perceive themselves as good drivers; however, their perception may not be accurate, and could negatively affect their driving safety. This study examined the accuracy of older drivers’ self-awareness of driving ability in their everyday driving environment by determining the concordance between the perceived (assessed by the Perceived Driving Ability [PDA] questionnaire) and actual (assessed by electronic Driving Observation Schedule [eDOS]) driving performance. One hundred and eight older drivers (male: 67.6%; age: mean = 80.6 years, standard deviation [SD] = 4.9 years) who participated in the study were classified into three groups: underestimation (19%), accurate estimation (29%), and overestimation (53%). Using the demographic and clinical functioning information collected in the Candrive annual assessments, an ordinal regression showed that two factors were related to the accuracy of self-awareness: older drivers with better visuo-motor processing speed measured by the Trail Making Test (TMT)-A and fewer self-reported comorbid conditions tended to overestimate their driving ability, and vice versa.

Purpose. Health promotion (HP) programs represent a promising avenue to address the prevention or mitigation of adverse effects of childhood cancer. However, we do not know the most effective way to promote healthy behaviours in pediatric oncology or how families experience HP interventions during the very challenging time of going through childhood cancer. The purpose of this study was to analyse the perspectives of families affected by childhood cancer regarding their behaviour when participating in a HP program. Methods. We undertook a cross-sectional qualitative study using semi-structured interviews. Individual interviews were conducted with parents and adolescents sampled within a larger study. Data was analyzed using thematic analysis. Results. Participants reported many barriers to participation including organizational barriers, physical or mental health issues and lack of interest or need. Key facilitators included tailoring of the interventions to individuals’ needs and social support. Most participants reported that the program had a positive impact on their health behaviour practices during cancer treatment and about half mentioned having the intention to modify their health behaviour practices in the long-term. For future implementation, participants suggested adding more educational activities, increasing physical activity sessions and improving the coordination with clinical activities. Conclusion. Participants’ and families’ perspectives allow researchers and clinicians to gain greater insights into how to shape HP programs that will be engaging and effective in promoting healthy behaviours in this population.

The current study aimed to: 1. to confirm the 21-item, three-factor Driver Behaviour Questionnaire (DBQ) structure suggested by Koppel et al. (2018) within an independent sample of Canadian older drivers; 2. to examine whether the structure of the DBQ remained stable over a four-year period; 3. to conduct a latent growth analysis to determine whether older drivers’ DBQ scores changed across time. Five hundred and sixty Canadian older drivers (males = 61.3%) from the Candrive/Ozcandrive longitudinal study completed the DBQ yearly for four years across five time-points that were approximately 12 months apart. In Year 1, the average age of the older drivers was 76.0 years (SD = 4.5 years; Range = 70–92 years). Findings from the study support the 21-item, three-factor DBQ structure suggested by Koppel and colleagues for an Australian sample of older drivers as being acceptable in an independent sample of Canadian older drivers. In addition, Canadian older drivers’ responses to this version of the DBQ were stable across the five time-points. More specifically, there was very little change in older drivers’ self-reported violations, and no significant change for self-reported errors or lapses. The findings from the current study add further support for this version of the DBQ as being a suitable tool for examining self-reported aberrant driving behaviours in older drivers. Future research should investigate the relationship between older drivers’ self-reported aberrant driving behaviours and their performance on functional measures, their responses to other driving-related abilities and practice scales and/or questionnaires, as well their usual (or naturalistic) driving practices and/or performance on on-road driving tasks.

Highly valued by seniors, community integration has beneficial effects on their biopsychosocial health. However, not all of them have the same opportunities to engage in social participation activi...

As cancer and its treatment negatively impacts the long-term health and quality of life of survivors, there is a need to explore new avenues to prevent or minimize the impact of adverse effects in children with cancer and cancer survivors. Therefore, this scoping review aimed to report on the state of the evidence on the use and effects of complex behavioral interventions (CBI) targeting physical activity and/or dietary behaviors in pediatric oncology. Fourteen quantitative studies were included, evaluating interventions that used a combination of two or three different treatment modalities. Overall, studies demonstrated that it is feasible to implement CBI and that they can potentially improve physical activity and dietary behaviors as well as patient outcomes such as physical and psychological health. Unfortunately, due to a paucity of studies and the heterogeneity of the studies included in this review, no conclusive evidence favoring specific interventions were identified.

BACKGROUND With the legalization of cannabis in Canada, young adults, who are already at risk of automobile crashes, may increase their use of cannabis, which may further increase the risk of crashes. We examined the effects of inhaled cannabis on driving-related performance in healthy 18- to 24-year-old recreational cannabis users. METHODS In this within-subject randomized study, participants completed tests in the no-cannabis state and at 1, 3 and 5 hours after inhalation of a standard 100-mg dose of cannabis. We then measured performance (in useful-field-of-view and driving-simulation tests) and self-reported perceptions (driving ability and safety, cannabis effects). Repeated-measures analysis of variance (for cannabis effects on continuous performance measures), Cochran Q tests (for performance-related crash risk and binary complex simulator task scores) and correlational analyses (for self-reported perceptions relative to performance) were employed. RESULTS Forty-five participants completed all 180 testing sessions. Significant effects of cannabis (relative to no cannabis) were noted on complex useful-field-of-view tasks at 3 hours (complex divided-attention task: 70 ± 24 ms v. 37 ± 12 ms, 95% confidence intervals [CIs] 28-114 ms v. 29-45 ms, t = -2.98, df = 41, p = 0.005; complex selective-attention task: 102 ± 66 ms v. 64 ± 18 ms, 95% CIs 60-144 ms v. 53-75 ms, t = -2.42, df = 41, p = 0.02) and 5 hours (complex selective-attention task: 82 ± 29 ms v. 61 ± 19 ms, 95% CIs 62-100 ms v. 48-75 ms, t = -2.32, df = 41, p = 0.03) after cannabis use when the tasks were novel (performed in a cannabis state at the first session). Participants were significantly more likely to be classified as having a high crash risk (on the basis of simulator tasks) after cannabis use (χ 2 = 13.23, df = 1, p < 0.001, odds ratio 4.31, 95% CI 0.41-45.2) and reported significantly lower perceived driving ability and safety after cannabis use relative to non-use. INTERPRETATION Among young recreational cannabis users, a 100-mg dose of cannabis by inhalation had no effect on simple driving-related tasks, but there was significant impairment on complex tasks, especially when these were novel. These effects, along with lower self-perceived driving ability and safety, lasted up to 5 hours after use. TRIAL REGISTRATION The trial was registered with Health Canada (NOL [No Objection Letter] no. 215101).

Examining environmental factors that influence older adults’ driving patterns has important implications for understanding factors that can lead to self-regulation and cessation. The current study explored the effect of fuel prices on older adults’ driving patterns using objective data from the nationwide Candrive longitudinal study ( N = 807). Fuel prices were negatively associated with driving distance and positively associated with speeding and acceleration pattern. Specifically, on occasions when fuel prices were high, older adults drove less often but were speeding and accelerating more. However, the magnitudes of the effects were small, suggesting that older adults continue to rely on their vehicles for community mobility, despite variations in fuel prices.

Past research with JACO has principally focused on the short-term impacts on new users. Therefore, this study aims to document the long-term impacts of this assistive device on users and their family caregivers following prolonged use.Users' characteristics, caregivers' characteristics and expenses related to JACO were documented with questionnaires designed for this study. Upper extremity performance was measured with an adaptation of an upper extremity performance test, the TEMPA, and accomplishment of life habits was documented in an interview based on the LIFE-H questionnaire. Satisfaction with JACO and psychosocial impacts of its use were measured with validated questionnaires, namely the QUEST and the PIADS-10. Impacts of JACO on family caregivers were documented with a validated questionnaire, the CATOM. Descriptive statistics were used to report the results.Seven users and five caregivers were recruited. One user had expenses related to JACO in the past two months. Users had a better upper extremity performance with JACO than without it and they used their robotic arm to accomplish certain life habits. Most users were satisfied with JACO and the psychosocial impacts were positive. Impacts on family caregivers were slight.JACO increased performance in manipulation and facilitated the accomplishment of certain life habits. Users' increased participation in their life habits may slightly decrease the amount of caregiver assistance required. Future studies are needed to clarify its economic potential, its impact on caregivers' burden, including paid caregivers, and the variability in the tasks performed using JACO. Implications for Rehabilitation The use of JACO may have positive impacts on its users in terms of upper extremity performance, accomplishment of life habits, satisfaction with the device and psychosocial impacts. More research is needed to quantify more accurately the economic potential of the long-term use of JACO, to explore the factors related to the variability in the tasks performed using JACO, and to clarify the impact of JACO on caregivers' burden, including paid caregivers.

Aims: An older adult's on-road driving performance could be assessed by two different approaches, namely, the standard on-road driving evaluation (SODE) and the naturalistic driving observation (NDO). This paper aims to compare the SODE and the NDO approaches using the person–occupation–environment model, to improve clinicians' reasoning when choosing an appropriate approach for older drivers. Methods: A reflective review of the literature was used to evaluate the features of these two approaches. Results: During the SODE, driving capacity is examined in a controlled condition using predetermined driving maneuvers, routes, and vehicles that may be unfamiliar. In contrast, during the NDO, an older adult's driving competence is evaluated in the driver's everyday driving environment and vehicle with minimum interference. The limitations of each approach are discussed. Conclusions: Clinicians should make insightful choices based on the purpose of the evaluation and the understanding of the specific qu...

There is a concern in the public domain about driving safety among older drivers due the increase in age-associated medical conditions. It is not known how these medical changes impact driving performance and choice of driving environment. This study aimed to compare older drivers’ (≥74 years) driving performance in a naturalistic setting to middle-aged drivers (35–64 years) on their chosen driving environment, and number, type and severity of errors. The effect of sex and perceived driving ability was also examined. Drivers’ performance was studied using the electronic Driving Observation Schedule [eDOS]), a naturalistic observation approach. Fifty-three older (mean age = 80.6 years, 72% male) and 60 middle-aged (mean age = 50.0 years, 50% male) healthy drivers were recruited. Both groups made few driving errors that were mostly low-risk. Driving performance of older adults differed from middle-aged drivers; they drove on simpler routes (fewer intersections and lane changes) and made fewer errors. Findings are likely indicative of older drivers’ use of adaptive strategies to maintain safe driving.

Expressive assessments facilitate sharing, and the therapeutic understanding of youth. The experiences of nine young adults seeking help for psychosis were explored with an arts-based, occupational therapy expressive evaluation. The study used participant-observation methods. Data analysis drew on hermeneutic phenomenology. The findings illustrate the challenges these participants have in feeling connected to a shared world of doing, and in locating themselves within the temporal flow of time. Of significance was the potential to read the unfolding of creation in clay media as an acted narrative to tap into “constellations of meaning.” Implications for clinical practice and professional reasoning are highlighted.

Background: The multiple sequelae caused by traumatic brain injuries (TBIs) can considerably reduce the ability of seniors to resume their activities of daily living and their leisure activities, and to return to meaningful relationships so they can participate in the life of their community.

Introduction En 2018 et 2019, la Societe de transport de Montreal (STM) a cree une formation visant a faciliter l’utilisation des transports en commun par des personnes ayant des limitations fonctionnelles motrices et a fait appel a une equipe interdisciplinaire de chercheurs afin d’en faire la bonification et l’evaluation. Au printemps 2019, la formation a ete offerte a douze personnes ayant des limitations fonctionnelles motrices. Materiel et methode Afin de mieux preparer la formation, elle a premierement ete offerte a deux groupes tests puis presentee a un groupe focalise d’experts provenant des milieux communautaires, du milieu de la readaptation ainsi que gouvernemental (OPHQ). Par la suite, la formation a ete bonifiee et offerte a deux groupes de participants. Avant la formation, les participants ont premierement ete evalues sur leurs connaissances du reseau de transport ainsi que sur leurs objectifs et capacites de deplacements. Suite a la formation de sept heures comprenant des activites theoriques et pratiques puis d’un bref entrainement individuel, les personnes devaient documenter douze trajets faits de maniere autonome a l’aide d’un carnet de voyage afin de connaitre les effets de la formation/entrainement dans leur utilisation du transport regulier. Finalement, apres avoir effectue leurs deplacements, leurs points de vue ont ete recueillis a l’aide d’entrevues individuelles. Resultats Les resultats de la recherche indiquent que la mise en place d’un programme de formation et d’entrainement a l’utilisation des reseaux de bus et de metro accessibles vient augmenter l’utilisation du transport regulier et facilite la participation sociale. La presentation permettra d’aborder ces elements afin de faire connaitre les portees et limites de la formation.

PURPOSE To compare the advantages of training on a driving simulator versus on the road, when learning to drive with new assistive technologies (AT) in individuals with motor impairments. METHOD An experimental group (EXP = 16) that trained on a driving simulator was compared to a comparison group (CMP = 16) that received training only on the road. A post-training road test assessed driving performance. Analysis included proportion of participants who successfully completed the on-road driving test, number of training sessions, level of satisfaction, simulator sickness, advantages and discomforts. RESULTS EXP and CMP were comparable for age (48 ± 17 years), sex (13 M, 3 F), and AT (3 steering wheel knobs with integrated switches, 4 left accelerators, 9 hand controls and steering wheel knobs). No significant difference was observed between groups in the proportion of participants who were found to be fit to drive (EXP: 9/16; CMP: 13/16; p = 0.126) or in the number of sessions completed (EXP: 4.3; CMP: 3.2; p = 0.061). For 6 of the 9 satisfaction variables, participants reported being satisfied/very satisfied with training on a simulator with driving assistive technologies 76% to 100% of the time. EXP was satisfied to have been able to use simulator sessions before going on the road (100%). Participants determined to be fit to drive on an on-road test following simulator training showed no significant difficulty continuing with the training. EXP reported temporary discomfort on the simulator during the initial session (88%). CONCLUSION Simulators provide some advantages for training drivers with adaptive aids in a safe context.IMPLICATIONS FOR REHABILITATIONAmong individuals with motor impairments who used to drive: All participants reported a high level of satisfaction training on the simulator with assistive technologies.The simulator proved to be an interesting tool for initiating training with new driving AT in a safe environment at no cost to individuals.The few discomforts reported during the first session resolved over time when participants continued with the driving simulator protocol.Occupational therapists noticed that the difficulties observed on the simulator were the same as those observed during on-road testing.The simulator allowed participants to begin to learn how to operate a vehicle with new assistive technology in a safe context.

Older drivers' self-awareness of driving ability can prompt self-regulatory behaviors and modifications of their everyday driving performance. To date, studies have yet to examine how older drivers' self-awareness of changes in driving ability over time or identify the characteristics of those who can accurately monitor such changes. 64 older drivers (Age: Mean = 80.0 years, SD = 5.4; male: 70 %) were recruited and categorized into four groups based on the correspondence of changes in their perceived and actual driving ability over one year: 40 % of the participants were accurate in their stable or better driving ability over time, 30 % did not detect their driving performance had worsened and over-estimated their driving ability, and the remainder either accurately detected their performance had worsened or under-estimated their driving performance. No demographic or clinical factors were associated with older drivers' self-awareness of changes in driving ability over time, except the mental processing and executive functioning measured using the Trail Making Tests Part B, showed a marginal effect. Implications for clinical importance are discussed.

In occupational therapy practice, client assessments are essential for establishing treatment priorities and determining the effectiveness of interventions. However, occupational therapists' assessment practices are not well documented.This work aimed to provide an overview of the assessment practices of Quebec occupational therapists based on the person-environment-occupation components and clienteles.A cross-sectional survey was conducted using an online survey that was sent to occupational therapists in Quebec.In paediatrics, occupational therapists tend to use standardized tools to assess physical and neurological abilities. Adult assessment focuses mainly on physical abilities and productivity. For seniors, assessment focuses mainly on functional aspects (physical abilities, personal care, and home safety) and screening for cognitive difficulties.Occupational therapy assessment mostly focuses on physicial abilities. To ensure a holistic approach, more occupational and environmental components should be included in the assessment practices.L’évaluation du client est primordiale dans la pratique de l’ergothérapie, notamment pour établir les priorités de traitement et pour vérifier l’efficacité des interventions. Les pratiques évaluatives des ergothérapeutes sont cependant peu documentées.Dresser un portrait des pratiques évaluatives des ergothérapeutes du Québec selon les dimensions personne-environnement-occupation et les clientèles.Une enquête transversale a été réalisée à l’aide d’un sondage en ligne envoyé aux ergothérapeutes du Québec.En pédiatrie, les ergothérapeutes utilisent majoritairement des outils standardisés des aptitudes physiques et neurologiques. L’évaluation d’adultes cible principalement les aptitudes physiques et la productivité. Auprès des aînés, l’évaluation repose surtout sur les aspects fonctionnels, particulièrement les aptitudes physiques, les soins personnels et la sécurité à domicile, et sur le dépistage des difficultés cognitives.L’évaluation ergothérapique serait généralement axée sur les aptitudes physiques. Pour assurer une approche holistique, l’occupation et l’environnement devraient être davantage considérés dans l’évaluation.

Background. Robotic arms may help users perform various activities. Even though robotic arms are commercially available, their impacts are still poorly understood. Purpose. This scoping review aimed to identify the potential impacts of using robotic arms for individuals with upper-extremity disabilities and appraise the scientific quality of the selected studies. Method. A search for studies published between 1970 and 2016 was conducted in PubMed, Embase, Compendex, and Scopus. The Canadian Model of Occupational Performance and Engagement was used to classify activities in which impacts were evaluated. The quality of each study was rated using McMaster University’s critical review form for quantitative studies. Findings. Thirty-six studies were reviewed, which evaluated self-care (21), productivity (33), and leisure (8). The short-term impacts were more commonly documented than long-term impacts. The impacts identified were mostly positive. The studies’ mean quality score was 8.8/15. Implications. Additional studies with more rigorous conditions are needed to produce higher-quality scientific evidence of the long-term impacts of robotic arm use.

Community mobility in older adults is important for maintaining health, quality of life and social participation. Globally, older adults who are non-drivers, access their community through various modes of transport to maintain community mobility. This international cross-sectional cohort study (n=246) explored the mobility patterns of older adults and examined their access to out-of-home activities and health related quality of life in seven countries. Quality of life was determined using EQ-5D-5L and was generally high among all participants. Findings from the study indicate that a complex myriad of factors influence safe transport mobility in older adults. Results suggested that inclement weather and place of residence negatively impacted access to out-of-home activities, yet these factors but did not increase use of public transport. Given the complexity of transportation use and mobility patterns in older adults, an individualised approach may be necessary to keep older adults connected to their out-of-home activities.

This international symposium brings together leading occupational therapy researchers from around the world with a shared focus is on evaluating and improving the driving performance of older adults to decrease their crash risk and facilitate their community participation. In this session, five groups of international scholars will share their collective and individual research outcomes for driving as a means of community mobility. The first presentation will outline their collective international, cross-sectional study of 247 older adults from seven countries where the impact of driving on out-of-home mobility was compared. Each presentation that follows will then present results from innovative studies of ways in which to assess and address fitness to drive in older adulthood. Our discussant will summarize the potential expansion of the current work and engage the audience through interactive questions. Transportation and Aging Interest Group Sponsored Symposium.

A bias inherent to prospective studies is focusing only on individuals who remain in the study; these individuals may differ from those who leave early. To examine this issue, we analyzed SF-36 scores by completion status for individuals enrolled in the seven-year Candrive cohort. The SF-36 provides a self-reported evaluation of health and well-being along two subscales, the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Of 928 participants in the cohort, 887 had at least two consecutive years of data starting at baseline (age=76.17, SD=4.81; 61.9% male). A total of 142 participants had 7 years of data. Study discontinuation (due to withdrawal, driving cessation, or death) happened least in early years, and peaked after 6 years (n=235). When analyzed according to completion status, patterns of change in SF-36 scores varied. For example, participants with 7 years of data had mean PCS scores ranging from 51.41 (SD=7.92) at baseline to 46.93 (SD=9.46) at year 7, a change of 0.75 points per year. For those with only two years of data, scores were lower and dropped from 45.82 (SD=9.98) to 43.59 (SD=10.90), a change of 2.23 points over a single year (p

Developing tools that accurately detect at-risk driving behaviors is a public-health priority. There is a need for a measure that accurately assesses older drivers’ level of competence on familiar roadways. The objective of this presentation is to describe the development of the procedures and scoring of a new approach, the Electronic Driving Observation Schedule (eDOS), to observe everyday driving in the community. The eDOS was used to record and compare the driving environment and performance of older drivers and low-risk younger drivers during their everyday driving. Older (n=160, >74y) and younger (n=60, 35-64y) drivers completed a 20-30-minute drive from their home to destinations of their choice. Older drivers drove on simpler routes with fewer intersections and lane changes. Both groups made few driving errors, which were mostly low-risk. Younger drivers tended to demonstrate poor driving habits (not signaling, speeding, poor lane position) and compliance with road rules. Part of a symposium sponsored by Transportation and Aging Interest Group.

Introduction Occupational therapists are amongst the certified driving rehabilitation specialists providing driving rehabilitation and training. This study aimed at gathering information on driving readiness in adolescents and young adults with physical and/or cognitive impairments related to cerebral palsy and spina bifida to guide the development of a driving readiness program for this clientele. Method A review of the scientific literature was performed. Seventy-four driving rehabilitation specialists across North America were surveyed, of whom eight were subsequently interviewed. Results Learner drivers with cerebral palsy and spina bifida lack the basic skills (such as information processing, visual memory, attention span) for and familiarity with community mobility and self-efficacy, often resulting in a lengthy and difficult learning process for automobile driving. The literature findings were corroborated by a survey and interview of specialized driving rehabilitation therapists. There is a therapist-driven desire to improve pre-requisite skills for driving through a driving readiness program tailored to this population’s specific needs. An outline of such a program was developed based on the person–environment–occupation model. Conclusion A driving readiness program may act as an important clinical tool intended to optimize pre-driving skills in adolescents with cerebral palsy or spina bifida in order to facilitate the driving training process and ensure greater community independence in this population.

Early psychosis intervention aims to accurately detect adolescents and young adults at risk for major mental disorders, particularly schizophrenia, yet early biomedical diagnostic accuracy remains poor. However, phenomenological approaches focusing on eliciting and understanding the subjective experience of help-seeking youth better detect incipient schizophrenia. The Azima Battery is an occupational therapy projective assessment that uses expressive media in a standard setup, in order to phenomenologically elicit and describe the activity performance and narratives of individuals at risk of, or on, the psychotic-spectrum. The purpose of this study was to estimate the predictive validity of the Azima Battery with youth seeking help for a first episode of psychosis, and identify patterns of performance distinctive of a diagnosis of schizophrenia 1-year later. A mixed methods phenomenological approach was used to calculate the predictive validity of the Azima Battery in detecting incipient schizophrenia, and to qualitatively identify patterns of performance. Study results demonstrate that the diagnostic accuracy of the Azima Battery is greater than psychiatric interviewing for a future diagnosis of schizophrenia (N = 62: 88.7 % vs 42 %). Performance elements and patterns statistically distinctive of schizophrenia are described, and relate to the structure of the created objects. Therefore, the Azima Battery is a valid measure for clinical use by occupational therapists working in early intervention for psychosis as a complement to traditional psychiatric interviewing.

Description. Les partenariats en ergothérapie entre les praticiens et les chercheurs sont importants pour produire des connaissances pertinentes pour la pratique clinique et pour favoriser la pratique fondée sur les données probantes au sein de la profession. But. Dans ce discours Muriel Driver, l’auteure discute des raisons pour lesquelles nous devons favoriser la participation des praticiens à la recherche et elle examine les conditions essentielles à la réussite des partenariats de recherche en collaboration. Questions clés. Les partenariats de collaboration peuvent réduire les obstacles empêchant les praticiens de participer à la recherche et permettre de veiller à ce que les initiatives de recherche soient plus pertinentes pour la pratique clinique. Les facteurs clés pour établir et maintenir des partenariats significatifs sont la présence de conditions préalables et favorables au partenariat en lien avec le contexte, de même que l’utilisation de principes directeurs axés sur la vision, les valeurs, la confiance, la communication, le partage du pouvoir et les interactions. Conséquences. Plusieurs des facteurs identifiés comme étant favorables à la réussite d’un partenariat de collaboration correspondent aux rôles fondamentaux des ergothérapeutes et témoignent de nos valeurs professionnelles. La prise en compte de ces facteurs lors de l’établissement de collaborations de recherche permettrait d’accroître les probabilités de réussite.

Background. Partnerships in occupational therapy between practitioners and researchers are important to advance knowledge relevant to clinical practice and support evidence-based practice in the profession. Purpose. This Muriel Driver lecture discusses why we should support practitioners’ engagement in research and examines essential conditions required for successful collaborative partnerships in research. Key Issues. Collaborative partnerships can alleviate the challenges preventing practitioners from participating in research and ensure that research initiatives are more relevant to clinical practice. Key factors for building and sustaining meaningful partnerships include the presence of favourable pre-partnership conditions related to the context and the use of guiding principles focusing on vision, values, trust, communication, power sharing, and interactions. Implications. Several of the factors found to foster a good collaborative partnership are consistent with our core competency roles and reflect our professional values. Being mindful of these factors when initiating research collaborations would increase the likelihood of success.

This pilot project aims to test and see the relevance of the direct observation method to collect data on the barriers and facilitators to attending public places by seniors with TBI. The study is based on the conceptual framework VADA WHO which focuses on the development of friendly built and technological environments for seniors. Three elderly people participated in the study, recruited from an ongoing project, The Citizen Intervention in Community Living (APIC), in the presence of their personalized attendant. The study shows the feasibility of the method in terms of its acceptability and resources mobilized. It shows its relevance to access additional data that would have been difficult to obtain using others methods (e.g., semi-structured interview), such as the identification of the strategies used by the participants to address the obstacles encountered (avoidance, travel planning, use of physical and preventative support of the personalized attendant).

Background:Mild deficits in instrumental activities of daily living (IADLs) have consistently been reported in the individuals with mild cognitive impairment (MCI). A variety of functional assessment tools, including self-and informant report questionnaires and performance-based measures, have been employed in MCI. Previously, a limited focus has been directed at appraising the quality of questionnaires. The goal of this study was to identify the questionnaires that have been validated in the MCI population. Additionally, the quality of validation studies and psychometric attributes of these questionnaires were appraised.Methods:Relevant articles were systematically searched in PsychINFO, Ovid MEDLINE, and CINAHL against specific eligibility criteria. To evaluate the methodology of the psychometric studies, the COSMIN checklist was employed. Also, the psychometric properties of the assessment tools were evaluated based upon Terwee's criteria.Results:A total of five psychometric studies and questionnaires were critically evaluated. Varying psychometric properties were available for the chosen tools. None of the studies received the best possible rating for their methodological quality. It was found that questionnaires with high discriminative ability to distinguish MCI from other diagnostic groups were: Disability Assessment in Dementia-6 (DAD-6), Functional Activity Questionnaire (FAQ), and Alzheimer's Disease Cooperative Study/Activities of Daily Living scale adapted for MCI patients (ADCS-MCI-ADL-24).Conclusion:Psychometric studies with strong methodological rigor are required in the future. Considering the fact that IADL decline has been associated with dementia, early detection of functional difficulties in MCI needs to be encouraged as it will allow suitable and timely interventions to prolong functional independence of affected individuals.

RÉSUMÉNous avons théorisé que les changements au fil du temps dans les performances cognitives sont associés à des changements dans les perceptions, les attitudes et les comportements d’auto-régulation des personnes âgées qui conduisent. Les adultes âgés en bonne santé (n = 928) ont subi les évaluations cognitives au début avec deux suivis annuels subséquents, et ils ont rempli des formulaires avec des échelles qui mesurent leurs perceptions, les attitudes et les comportements de conduite. L’analyse multivariée montre des petites relations, mais statistiquement significatives, entre les tests cognitifs et les mesures qui ont été auto-déclarée, les plus grandes amplitudes entre les scores étant sur les sentiers B tâche cognitive (secondes), la perception de la capacité de conduire (β = 0,32), et l’évasion des situations de conduite (β = 0,55) (p

RÉSUMÉLes associations entre les variables psychosociaux et les comportements de conduite ont été examinés seulement en coupe transversale à ce jour. Dans cette étude, nous avons utilisé trois vagues de données recueillies chaque année de 928 conducteurs âgés (âge moyen = 76.21 ans; 62% d'hommes) s'inscrits pour la cohorte Candrive II, afin de déterminer si des changements dans les attitudes et les perceptions à l'égard de conduire (l'équilibre décisionnel et le confort à la conduite de jour comme de nuit) ont été associés à des limitations à la conduite rapportées chez les aînés et de leurs capacités perçues à conduire. Des modèles à plusieurs niveaux ont révélé que plus de personnes âgées qui ont montré une augmentation des attitudes négatives à l'égard de conduite étaient plus susceptibles de déclarer la pratique de plus en plus restreinte (on évite souvent des situations difficiles de conduite) et des baisses perçues dans la capacité de conduire, par rapport aux individus dont les attitudes envers la conduite restaient stable au cours de deux années. Ce travail confirme les résultats précédents et offre une nouvelle compréhension de la façon dont les attitudes ont trait aux perceptions de conduite (c'est-à-dire, le confort), et l'auto-régulation chez les personnes âgées au fil du temps.

This study compared older drivers’ driving patterns during a naturalistic on-road driving task (i.e., eDOS driving task) with their real-world driving from the preceding four-month period. Two hundred and eight participants (Male: 68.8%; Mean age = 81.5 years, SD = 3.3 years) completed the eDOS driving task in their own vehicle which commenced from their home and followed a self-selected route. Participants’ driving patterns were collected via an in-car recording device that was installed in their vehicle. This study examined the sub-trip from participants’ homes to their first destination during the eDOS driving task. The median sub-trip distance was 4.4 km (Q1 = 2.8, Q3 = 6.4). Across the four-month period of real-world driving, participants completed a median of 151 driving trips from their home (Q1 = 103.0, Q3 = 202.7), with a median trip distance of 2.7 km (Q1 = 1.1, Q3 = 5.8). Most participants’ eDOS driving task trip distance was classified as representative of their real-world driving trip distances (95.2%). By mapping GPS coordinates for driving pattern data with road types and roadways, most eDOS driving task trips included roadways that were actively used during their real-world driving (85.0%). During the preceding four-month period of real-world driving, most participants had visited the first nominated destination during the eDOS driving task at least once per month (77.4%). Given the increasing international interest and use of modified (local area) licences, these findings suggest that naturalistic on-road driving tasks could be used by licensing authorities to assess potentially at-risk older drivers within their own driving environments.

Introduction Driving is an important activity for the social participation of young people with physical and cognitive disabilities. Learning to drive, however, presents difficulties for this population. Innovative services have been developed in the province of Quebec, Canada, but the extent to which they are evidence-based is not known nor are optimal parameters for learning to drive. Objectives The aims of this study were to 1) explore users' views and preferences with respect to learning to drive; 2) create indicators based on science, experience, and users' views and preferences that can be used to evaluate driver education programs; and 3) use these indicators to measure the gaps between knowledge and practice in an existing adapted driver education program. Method Based on an integrated knowledge translation model, this study used a qualitative and quantitative design consisting of three steps: 1) focus group meeting and telephone interviews with users, 2) definition and validation of criteria and indicators, and 3) chart audit. Results 1) Users' needs and expectations were documented from the focus group meeting and three interviews. 2) Building on the results of step 1 and a review of the literature, including expert opinions on adapted driver's education, 34 quality indicators were created. These indicators were supported by information from the literature (42%), expert opinions (33%), and users' views (25%). 3) Forty charts from an existing program were audited and showed that the indicators are relevant to evaluate the quality of this type of program. Conclusion These preliminary indicators were created to facilitate the implementation of new evidence-based adapted driver education programs. This entire initiative will make it easier for young adults with disabilities to obtain a driver's licence, which will ultimately foster more satisfactory social participation.

Introduction Decision-making about driving cessation and transitioning to non-driving is a challenging and complex issue faced by drivers diagnosed with dementia and their families. Driving cessation is associated with adverse psychosocial and health-related impacts for persons with dementia including a reduction in quality of life. To address the gap in evidence-based interventions that support individuals in the driving cessation process, we developed the Driving Cessation in Dementia Intervention Toolkit (DCD-IT). Our objective in this study was to further develop and refine the DCD-IT (content, design and mode of delivery) to facilitate its effective implementation in settings that support older adults with dementia. Methods Representatives (n=15) from Alzheimer Society organizations in British Columbia, Manitoba, Ontario and Nova Scotia reviewed the DCD-IT and provided feedback via a webinar, questionnaire and in-depth interviews. Data analysis techniques included thematic coding and inductive analysis. Results Participants emphasized the lack of accessible and trusted driving cessation resources specific to meeting the needs of persons with dementia (PWD) and their family caregivers. They identified gaps and corresponding areas of focus to inform the continued development and design of the DCD-IT, which included: materials directed separately to PWD encompassing appropriate content, language and design; resources geared to helping healthcare providers engage in discussions with PWD and family caregivers; information for PWD, family caregivers and healthcare providers about region-specific driving regulations and alternative transportation options. Conclusions Obtaining the perspectives of Alzheimer Society representatives have informed improvements to the content and design of the DCD-IT. Next steps include evaluating the implementation process of the intervention framework and toolkit in Alzheimer Society chapters in community settings in Ontario with the aim of informing widespread implementation and adaption across Canada. This research was funded by Canadian Institute of Health Research/Canadian Consortium on Neurodegeneration in Aging.

Introduction Following a neurological event, returning to driving is an important activity contributing to improved participation within the community. The purpose of this study was to examine the effectiveness of driving simulator retraining on driving in clients with neurological impairment and to examine factors associated with treatment effectiveness. Method Individuals with non-degenerative brain injury were randomized to either a simulator training or control group. The simulator group received individualized training (16 sessions) using a driving simulator. The control group did not receive intervention. A blind evaluator assessed participants on the DriveAble On-Road Driving Evaluation. Results There was no significant difference between groups in the proportion of individuals who passed the driving evaluation (Chi2 = 0.65; p = 0.42; CI = −0.41 to +0.17). However, participants with moderate impairment who received simulator training were more likely to pass the driving test compared with those in the control group (86% versus 17%; Chi2 = 6.2; p = 0.03; CI = −1.00 to −0.30). There were no differences in pass rate according to diagnosis, gender, or for those with severe impairments. Conclusion Results provide clinicians with preliminary information on the potential clinical usefulness of driving simulator training. While the findings do not support simulator retraining for the group as a whole, they suggest that clients with moderate impairment have the potential to benefit.