Occupational Therapy and Older Drivers: Research,Education, and Practice

ABSTRACT

Occupational therapists facilitate independence and support participation in occupations that are personally meaningful to clients to enhance well-being and quality of life. Among the occupations addressed by occupational therapists is the instrumental activity of daily living (IADL) of driving. Occupational therapists are particularly concerned with older adult engagement in driving because of the vital contributions driving and community mobility make to engagement in other activities and subsequently quality of life. This article includes the current status of occupational therapy research, education, and practice and presents the role of the occupational therapist as a member of the team with regard to older drivers.     

Clinical impact of infections caused by ESBL-producing E. coli and K. pneumoniae

The outcome of infections occurring at different anatomic sites caused by ESBL-producing E. coli or K. pneumoniae was retrospectively analysed for a 3-y period. 23 cases were compared to 46 controls with infections caused by third-generation cephalosporin-susceptible strains matched by age, severity of illness and duration of hospitalization before onset of infection. Only 27.8% of cases received appropriate empirical antimicrobial therapy compared with 79.6% of controls (OR(paired)=0.053, p=0.001). This did not result in higher costs of antibiotic therapy, a longer median post-infection hospital stay or higher mortality in cases of patients with urinary tract or wound infections. In cases of patients with respiratory tract and bloodstream infections (RTI/BSI), median costs of definitive antibiotic treatment were significantly higher than in controls (325 vs 58.9 Euros, p=0.002). Moreover, more case patients with RTI/BSI had a post-infection stay exceeding the 75th percentile of 15 d on ICU and of 18 d in hospital, respectively (50% vs 6.67%, p=0.034). There was no difference in in-hospital mortality between case and control patients with RTI/BSI (25% vs 20%, p=1.0).     

Well-Being,Self-Efficacy and Independence in older adults: A Randomized Trial of Occupational Therapy

ObjectiveThe main objective of the research was to analyze whether there were differences in the effects of individual and group occupational therapy (OT) treatment on psychological well-being, self-efficacy and personal independence.MethodA randomized clinical trial (N = 70; age = 85 years, SD = 4) comparing individual versus group occupational therapy treatment for 6 months was conducted. The evaluation was performed with the Barthel Index (Personal Independence), the Ryff Wellness Index (Well-being), the Global Self-Efficacy Scale (Self-efficacy) and the Geriatric Depression Scale (Affective state Scale).ResultsResults showed a decrease in individual treatment scores in the variables autonomy, environmental mastery, personal growth and purpose in life, reflecting worse self-acceptance and negative well-being as well as a lower ability to maintain stable relationships. By contrast, group treatment users maintained more stable social relationships and exhibited a greater ability to resist social pressure, to develop their potential skills and to define their goals in life. There were statistically significant differences in overall self-efficacy (p < 0.001), emotional well-being (p < 0.001) and personal independence (p = 0.013), with better scores in group versus individual treatment.ConclusionsGroup occupational therapy interventions in older adults could be the treatment of choice in people with depressed state, improving their emotional well-being, sense of self-efficacy and level of personal independence in basic activities of daily living.     

Mutagenicity of beta-oxidized N,N,-di-n-propylnitrosamine derivatives in S. typhimurium mediated by rat and hamster tissues.

The relative abilities of liver, kidney and lung fractions from untreated or phenobarbitone-pretreated rats and hamsters to convert N,N-di-n-propylnitrosamine and several beta-oxidized synthetic putative intermediates into mutagens was quantitatively compared in a tissue-mediated mutagenicity assay with S. typhimurium TA 1530 in vitro. With one exception, namely, N,N-di(2-acetoxy-n-propyl)nitrosamine, liver was the most active tissue from hamsters; in rats also, only liver fractions were able to activate some nitroso-compounds to mutagens. The highest enzyme-mediated mutagenicities were observed with N-2-hydroxy-n-propyl-N-n-propylnitrosamine, N,N-di-n-propylnitrosamine and N,N-di(2-acetoxy-n-propyl)nitrosamine. Hamster lung tissue converted N,N-di-n-propylnitrosamine, N-2-hydroxy-n-propyl-N-n-propylnitrosamine and N,N-di(2-acetoxy-n-propyl)nitrosamine into mutagens; activity with the latter compound was greater with lung tissue than with liver tissue when untreated animals were used. N-methyl-N-n-propylnitrosamine was mutagenic in the presence of hamster liver fraction but less so than N,N-di-n-propylnitrosamine. The results of the mutagenicity assays using various tissues are qualitatively compared to sites of tumour formation in rats and hamsters by these N-nitrosamines.