human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 
    Output:
    
agent
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 .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 
    Output:
    