Healthcare utilization and costs among older adult female drivers and former drivers

PurposeThis study compared the healthcare utilization and costs for specific types of medical services among older adult women who currently drive and those who no longer drive.MethodsThis study included 347 women aged 65 or older who were either former (had stopped driving) or current drivers, randomly sampled from a large U.S. health plan to participate in a telephone survey, and who had automated health records with healthcare utilization and cost data. Bivariate analyses and generalized linear modeling were used to examine associations between driving status and healthcare utilization and costs.ResultsAdjusting for age, income, and marital status, former drivers were more likely than current drivers to use mental health care services (RR = 3.37; 95% CI: 1.03, 10.98). Former drivers also tended to use more inpatient (RR = 1.85; 95% CI: 0.88, 3.87) and emergency services (RR = 1.89; 95% CI: 0.96, 3.70), but results did not reach statistical significance. Total annual healthcare costs in 2005 were almost twice as high for former drivers compared with current drivers ($13,046 vs. $7,054; mean difference = $5,992; 95% CI: -$360, $12,344), although this relationship was not statistically significant (CR = 1.61; 95% CI: 0.88, 2.96).Impact on IndustryFormer drivers were more than three times as likely as current drivers to use mental health services, and tended to use more emergency and inpatient services. Further research on factors that potentially mediate the relationship between driving status and health service use is warranted.     

Preferred modes of travel among older adults: What factors affect the choice to walk instead of drive?

Introduction

There are many factors that influence older adults' travel choices. This paper explores the associations between mode of travel choice for a short trip and older adults' personal characteristics.

Methods

This study included 406 drivers over the age of 64 who were enrolled in a large integrated health plan in the United States between 1991 and 2001. Bivariate analyses and generalized linear modeling were used to examine associations between choosing to walk or drive and respondents' self-reported general health, physical and functional abilities, and confidence in walking and driving.

Results

Having more confidence in their ability to walk versus drive increased an older adult's likelihood of walking to make a short trip by about 20% (PR = 1.22; 95% CI: 1.06-1.40), and walking for exercise increased the likelihood by about 50% (PR = 1.53; 95% CI = 1.22-1.91). Reporting fair or poor health decreased the likelihood of walking, as did cutting down on the amount of driving due to a physical problem.

Discussion

Factors affecting a person's decision to walk for exercise may not be the same as those that influence their decision to walk as a mode of travel. It is important to understand the barriers to walking for exercise and walking for travel to develop strategies to help older adults meet both their exercise and mobility needs. Impact on Industry: Increasing walking over driving among older adults may require programs that increase confidence in walking and encourage walking for exercise.     

Characterizing In Situ Methane‐Enhanced Biostimulation Potential for 1,4‐Dioxane Biodegradation in Groundwater

This study characterizes the 1,4‐dioxane biodegradation potential for an in situ methane‐enhanced biostimulation field pilot study conducted at Air Force Plant 44, located south of the Tucson International Airport in Arizona. In this study, the use of methane as the primary substrate in aerobic cometabolic biodegradation of 1,4‐dioxane is evaluated using environmental molecular diagnostic tools. The findings are compared to an adjacent pilot study, wherein methane was generated via enhanced reductive dechlorination and where methane monooxygenase and methane‐oxidizing bacteria were also found to be abundant. This article also presents the use of ¹³C and ²H isotopic ratio enrichment, a more recent tool, to support the understanding of 1,4‐dioxane biodegradation in situ. This study is the first of its kind, although alkane gas‐enhanced biodegradation of 1,4‐dioxane has been evaluated extensively in microcosm studies and propane‐enhanced biodegradation of 1,4‐dioxane has been previously studied in the field. ©2016 Wiley Periodicals, Inc.     

Cost‐Effective Sediment Dredge Disposal Options for Small Craft Harbors in Canada

Sediment dredge disposal options were reviewed to improve cost‐effectiveness and environmental safety for dredging of coastal sediments at the Department of Fisheries and Oceans Small Craft Harbours (DFO‐SCH) program in Canada. Historically, contaminated dredge sediments exceeding federal guidelines were disposed of in nearby landfills. Recent federal regulatory changes in sediment quality guidelines adopted by provincial regulators in Canada has resulted in updates to guidelines for disposal of contaminated solids in landfills. Updates now require specific and general disposal options for contaminated dredge material destined for land‐based disposal, resulting in more expensive disposal in containment cells (if contaminated sediments exceed federal guidelines). However, as part of this study, a leachate testing method was applied to contaminated sediments to simulate migration of potential contaminants in groundwater. Using this approach, leachate quality was compared to federal freshwater criteria and drinking water quality guidelines for compliance with new regulations. Leachate testing performed on the highest sediment contaminant concentrations triggered less than 2 percent potable water exceedances, meaning that most dredge spoils could be disposed of in privately owned or provincially operated landfill sites, providing less expensive disposal options compared to containment cell disposal. Current dredge disposal practices were reviewed at 35 harbor sites across Nova Scotia and their limitations identified in a gap analysis. Improved site management was developed following this review and consultation with interested marine stakeholders. New disposal options and chemical analyses were proposed, along with improvements to cost efficiencies for management of dredged marine sediments in Atlantic Canada. © 2013 Wiley Periodicals, Inc.     

Community-Based Monitoring in support of local sustainability

Community-based monitoring (CBM) activities in Canada are increasing. A conceptual framework developed for and used to guide a pilot CBM project in 31 Canadian communities is evaluated. The framework provided the strategic direction necessary for successful implementation of the pilot and proved useful in the training of community coordinators hired for the project. Limitations of the framework include its inadequate attention to community diversity, its linearity, and insufficient expression of the adaptive and synergistic nature of its components. In order to support local sustainability, CBM appears to require an approach that is context-specific, iterative, and adaptive. Given these emergent characteristics, an enhanced conceptual framework for CBM in Canada is developed based on four dynamic themes: community mapping, participation assessment, capacity building, and information delivery.