Dr Ranmalee Eramudugolla

Making sense of hearing-related neurocognitive impairment: The Auditory Ageing and Cognitive Impairm

Dr Kim Kiely (Lead Investigator), Professor Kaarin Anstey (Associate Investigator) and Dr Ranmalee Eramudugolla (Associate Investigator)

With increasing age, nearly all adults experience progressive, irreversible, and bilateral declines in hearing ability. As a result, hearing loss is one of the most common chronic health conditions affecting older adults and if unmanaged its impacts are wide ranging and long lasting.

There is good evidence indicating that older adults with significant hearing difficulties are more likely to experience cognitive decline and dementia, but reasons for this association are unknown.

This project will investigate how hearing loss is related to cognitive impairment. Firstly, it will compare levels of hearing function and use of hearing services by cognitive status. Second, it will examine if the relationship between poor hearing and impaired cognitive functioning is explained by lower levels of participation in activities that are good for brain health. Third, it will investigate if hearing rehabilitation services and hearing aids protect against poorer levels of cognitive function.

Contact: audacious@neura.edu.au

The project is funded by a Dementia Australia Research Foundation (DARF) Project Grant

The Personality and Total Health (PATH) Through Life Project 

The Personality and Total Health (PATH) Through Life Project is co-hosted by the Australian National University and the University of New South Wales and has been led by Professor Anstey since 2006. It is a large on-going population-based longitudinal cohort study comprising approximately 7500 participants. The study includes three cohorts including a younger (aged 20–24 at baseline), midlife (aged 40–44 at baseline) and older (aged 60–64 at baseline) adults randomly sampled from the electoral roll of the ACT and the nearby city of Queanbeyan. Additional waves of data collection have occurred in 4-year increments, with the 5^th wave of data collection underway. The study involves many national and international collaborations.

The broad aims of the PATH study relate to clinical outcomes that constitute the major burden of disease within the Australian community.

Primary PATH Objectives:

• To delineate the course of depression, anxiety, substance use and cognitive ability with increasing age across the adult life span
• To identify environmental risk, genetic risk and protective factors influencing individual differences in the course of these characteristics
• To investigate interrelationships over time between the three domains of: depression and anxiety, substance use, and cognitive ability and dementia
• To examine the mental health related impact of various personal, social and lifestyle transitions and events experienced by the different age cohorts, including infertility, fertility and pregnancy, changes in family structure, relationship formation and separation, menopause, and retirement.

Several design features of the PATH project contribute to its unique standing among population-based longitudinal cohort studies.

• Obtaining measures of genetic, biological (including MRI), psychosocial and lifestyle risk and protective factors for mental health and wellbeing
• Use of a narrow age cohort design with longitudinal follow ups as an optimal means of separating age and cohort effects
• Assessment of participants across the full adult lifespan, permitting investigation of developmentally significant, though under-studied periods such as midlife
• Recruitment and follow up of a young-old population, providing important pre-clinical data for studying the development of age-related changes in memory and cognition.

This project has been funded primarily by the National Health and Medical Research Council. Wave 5 40s and 60s follow-ups (led by Professor Kaarin Anstey) are funded by the ARC Centre of Excellence in Population Ageing Research. 

For more information, please visit the study website at www.pathstudy.org.au. PATH participants can also contact the research team by phone on 1300 917 295.

The Driving, Ageing, Safety and Health (DASH) project

Older adults represent a growing sector of the driving population in Australia, and while driving can be important for maintaining social engagement in late life, age-related changes such as cognitive and visual impairment can impact on driving safety.

The Driving, Ageing, Safety and Health (DASH) project is designed to develop and validate screening measures for older drivers to support determinations of driving safety. The DASH project is a collaboration with Joanne Wood and the Queensland University of Technology.

Over 550 older drivers, across three groups, were followed for two years to evaluate how well laboratory assessments and an on-road test predict driving outcomes. The three groups included a) older drivers referred for assessment by GPs and Road Safety Authorities, b) older drivers with eye disease and c) older drivers drawn from the community.

Primary Aims:

• To validate a short screening battery for older drivers called the Multi-D based on the Multifactorial Model of Driving Safety, a theoretical model of the abilities involved in safe driving and knowledge of age-related changes in cognitive, visual and sensorimotor function
• To compare the Multi-D and existing screening approaches including Hazard Perception, Road Rules Knowledge, the Useful Field of View, and the Drivesafe tests to determine whether combining measures improves the accuracy of classification of safe and unsafe drivers.

Secondary Aims:

• To compare the efficacy of the Multi-D and other screening instruments in predicting prospective self-reported crash rates (derived from standardized monthly diaries) between three groups of older drivers
• To evaluate the screening instruments and assessments in relation to mobility outcomes (driving cessation, driving frequency, driving distance) over two years and longer pending further funding
• To collaborate with practitioners to develop clinical practice guidelines for using the Multi-D battery in the context of older driver assessment
• To inform the development and design of interventions to prevent injuries among older drivers.

Findings from this research project will enable health professionals and licensing authorities to assist in their decision-making regarding the fitness to drive of older adults.

DASH is funded by the National Health and Medical Research Council.

Better Drive Program

Current road safety policy for at-risk older drivers involves ‘fitness to drive’ assessment and either license restriction or revocation. However, research indicates that there is no clear evidence that mandatory testing lowers crash rates amongst older drivers, and that driving cessation in older adults is associated with increased rates of depression, social isolation, and general health decline.

The Better Drive program includes a series of studies evaluating interventions to improve driver skill. Two trials have been completed to date.

Trial 1 used a two-arm randomised controlled trial (RCT) approach to investigate the efficacy of individually tailored driving refresher lessons against a group-based refresher course on on-road driving performance, safety and crash risk in older adults. Findings indicate that although classroom based road rules workshops for seniors can lead to improvements in on-road driving skill, the inclusion of tailored driving instruction can significantly enhance safety and reduce crash-causing on-road errors relative to classroom based workshops alone.

Trial 2 used a two group (training, no-contact control) non-randomised design to examine the transfer of computerised speed of processing (SOP) training gains to cognitive measures that are known predictors of driving safety in older adults. Findings indicate that SOP training effects can be achieved with self-administered, online training at home, with some transfer to other known cognitive predictors of driving safety. However, differential effects of training may be observed for tasks requiring goal-directed search strategies rather than diffuse attention.

A third trial is currently underway. This trial uses a three-arm randomised controlled trial approach to assess the effectiveness of computerised cognitive training and tailored on-road skills training on driver safety in older adults. Data collection for this trial will be completed in 2019.

The Better Drive program has been funded by the NRMA Road Safety Trust.