The influence of cognitive impairment with no dementia on driving restriction and cessation in older adults

Personality Is Associated with Driving Avoidance in the Canadian Longitudinal Study on Aging (CLSA)

As individuals age and become aware of changes in their driving capabilities, they are more likely to self-regulate their driving by avoiding certain driving situations (i.e., night driving, rush hour traffic, etc.). In this paper, we sought to examine the correlates of situational driving avoidance with a particular emphasis on the roles of personality traits, gender, and cognition within a large sample of mid-life and older adults from the Canadian Longitudinal Study on Aging (CLSA). Our findings show that women of older ages tend to report more driving avoidance and that personality traits, specifically extraversion, emotional stability, and openness to experience, may reduce driving avoidance. A negative association was also found between cognition and driving avoidance, such that individuals with higher cognition reported less driving avoidance.

The Impact of Cognition and Gender on Speeding Behaviour in Older Drivers with and without Suspected Mild Cognitive Impairment

Purpose

Mild cognitive impairment and gender can impact different aspects of driving performance and behaviour in older drivers. However, there is little evidence on how these may affect naturalistic speeding behaviour. Therefore, the aim of this study was to examine the relationship between speeding events and cognitive status for older male and female drivers.

Participants and Methods

A naturalistic driving study collected objective driving information over a two-week period using an in-vehicle monitoring device from 36 older drivers with suspected mild cognitive impairment and 35 older drivers without cognitive impairment. The outcome of interest examined was the number of speeding events, defined as travelling 5+ km/h over the posted speed limit for at least a minute.

Results

The majority of participants (n=58, 81.69%) did not have a speeding event during the two-week monitoring period. Twenty-three speeding events were recorded among seven drivers with suspected mild cognitive impairment and six drivers without cognitive impairment. The majority of speeding events (82.61%) were by older male drivers and occurred in 60km/h and 70km/h speed zones. The results of the two negative binomial regression models found that in older male drivers, suspected mild cognitive impairment (IRR=7.45, 95% CI=1.53–36.15, p=0.01) was associated with a significantly higher rate of speeding events, while increasing age was associated with a lower rate of speeding events (IRR=0.80, 95% CI=0.64–1.00, p=0.04). For older female drivers, there were no factors significantly associated with the rate of speeding events.

Conclusion

While the overall number of speeding events were infrequent, suspected mild cognitive impairment was associated with a significant increase in the rate of speeding events for older male drivers, but not for older female drivers. Speeding interventions and injury prevention policy strategies may need to be targeted differently for male and female drivers with mild cognitive impairment.

Driving Status and Transportation Disadvantage Among Medicare Beneficiaries

Transportation disadvantage may have important implications for the health, well-being, and quality of life of older adults. This study used the 2015 National Health Aging Trends Study, a nationally representative study of Medicare beneficiaries aged 65 and over (N = 7,498), to generate national estimates of transportation modalities and transportation disadvantage among community-dwelling older adults in the United States. An estimated 10.8 million community-dwelling older adults in the United States rarely or never drive. Among nondrivers, 25% were classified as transportation disadvantaged, representing 2.3 million individuals. Individuals with more chronic medical conditions and those reliant on assistive devices were more likely to report having a transportation disadvantage (p < .05). Being married resulted in a 50% decreased odds of having a transportation disadvantage (p < .01). Some individuals may be at higher risk for transportation-related barriers to engaging in valued activities and accessing care, calling for tailored interventions such as ride-share services combined with care coordination strategies.

Subjective Experiences of Driving Cessation and Dementia: A Meta-Synthesis of Qualitative Literature

Objectives: To review qualitative research on the specific challenges and strategies that relate to driving cessation for older adults with dementia, from the perspectives of key informant groups.Method: A meta-synthesis of qualitative studies was conducted. Structured inclusion criteria were applied to screen 616 titles and abstracts, and 9 qualitative studies were included, published from 2002 to 2016. Descriptive themes were identified using content analysis and synthesized to generate analytic themes.Results: The study samples and methodologies represented a diverse range. Cross-cutting themes on experiences of driving cessation for people with dementia are the: importance of open communication and autonomy in decision-making, and advanced planning to connect people with resources; significance of relationships; importance of providing support for the impact of cessation on identity and emotional wellbeing; and benefit of individualizing supportive approaches.Conclusion: This review identifies some important areas for consideration when designing supportive programs to address driving.Clinical Implications: Interventions to support driving cessation for people with dementia should prioritize support for communication, advanced planning, and emotional effects of stopping driving.

Self-awareness of Driving Ability in the Healthy Elderly and Patients With Mild Cognitive Impairment (MCI)

INTRODUCTION

According to latest research, a percentage of cognitively impaired drivers fail to recognize their areas of weakness and overestimate their driving abilities.

METHODS

Twenty-seven individuals with amnestic mild cognitive impairment (MCI) and 26 healthy elderly drivers participated in a driving simulator study. After the driving assessment, participants were asked to self-evaluate their performance in comparison with what they considered as average for people of similar age and educational level.

RESULTS

According to the applied mixed analysis of variance model, the MCI patients presented increased difficulties in estimating their driving performance to a greater extent in the rural environment in comparison with the urban condition.

DISCUSSION

Our findings suggest that the ability of MCI patients to evaluate their driving performance accurately seems to be enhanced or compromised, depending on the number of cues available in their environment, suggesting that providing feedback may improve their metacognitive abilities.

To reduce or to cease: A systematic review and meta-analysis of quantitative studies on self-regulation of driving

INTRODUCTION

The ability to remain safe behind the wheels can become arduous with aging, yet important for sustaining local travel needs. This review aimed to explore safe mobility issues involving older adults and gain a broad understanding of older drivers' self-regulatory driving practices and motivators behind such behavioral changes, including strategies adopted to reduce or cease driving while maintaining safe mobility.

METHODS

A systematic literature search was performed on 11 online databases for quantitative studies describing self-regulation of driving amongst older adults aged 60 years and above from database inception until December 2018. Data were described narratively and, where possible, data were pooled using random-effects meta-analysis.

RESULTS

Of the 1556 studies identified, 54 studies met the inclusion criteria and 46 studies were included in the meta-analyses. All included studies examined car drivers only. Older adults who were single or female were found to be at higher odds of driving cessation. Physical fitness, mental health, social influence, and support systems received by older adults were important driving forces influencing mobility and adjustments made in their travel patterns.

CONCLUSIONS

Driving self-regulation amongst older adults is a multifaceted decision, impacting mobility and mental health. Therefore, future interventions and support systems should not only create opportunities for retaining mobility for those who have ceased driving, but also promote better psychological and social well-being for regulators and for those who are transitioning from driving to non-driving status. Practical applications: (a) Engage and educate older adults about self-regulation, including strategies that can be adopted and non-car mobility options available. (b) Expand the research focus to explore potential interactions of factors facilitating or hindering the transition process to develop a more comprehensive framework of self-regulation. (c) Encourage ongoing research to formulate, monitor, and evaluate the effectiveness of policies and interventions implemented. (d) Expand the research horizon to explore and understand the perspectives of older adults from developing countries.

Driving difficulties as reported by older drivers with mild cognitive impairment and without neurological impairment

Objective: Considerable evidence indicates that medical conditions prevalent among older individuals lead to impairments in visual, cognitive, or psychomotor functions needed to drive safely. The purpose of this study was to explore the factors determining driving difficulties as seen from the viewpoint of 30 older drivers with mild cognitive impairment (MCI) and 30 age-matched controls without cognitive impairment. Methods: Perceptions of driving difficulties from both groups were examined using data from an extensive questionnaire. Samples of drivers diagnosed with MCI and age-matched controls were asked to report the frequency with which they experienced driving difficulties due to functional deficits and knowledge of new traffic rules and traffic signs. Results: The analysis revealed that 2 factors underlie MCI perceptions of driving difficulties, representing (1) difficulties associated with late detection combined with slowed response to relevant targets in the peripheral field of view and (2) difficulties associated with divided attention between tasks requiring switching from automatic to conscious processing particularly of long duration. The analysis for healthy controls revealed 3 factors representing (1) difficulties in estimating speed and distance of approaching vehicles in complex (attention-dividing) high-information-load conditions; (2) difficulties in moving head, neck, and feet; and (3) difficulties in switching from automatic responses to needing to use cognitive processing in new or unexpected situations. Conclusions: Though both group analyses show difficulties with switching from automatic to decision making, the difficulties are different. For the control group, the difficulty in switching involves switching in new or unexpected situations associated with high-information-load conditions, whereas this switching difficulty for the MCI group is associated with divided attention between easier tasks requiring switching. These findings underline the ability of older drivers (with MCI and without cognitive impairment) to indicate probable impairments in various driving skills. The patterns of difficulties perceived by the MCI group and the age-matched healthy control group are indicative of demanding driving situations that may merit special attention for road designers and road safety engineers. They may also be considered in the design of older drivers' fitness to drive evaluations, training programs, and/or vehicle technologies that provide for older driver assistance.

Driving Cessation and Cognitive Dysfunction in Patients with Mild Cognitive Impairment

Although driving by adults with cognitive impairment is an important public health concern, little is known about the indicators of driving cessation in patients with mild cognitive impairment (MCI). We aimed to investigate the prevalence of driving cessation in patients with MCI and the predictive value of cognitive performances for driving cessation. Patients with MCI were recruited in the Seoul National University Bundang Hospital; they met following inclusion criteria. Age range of 51–80 years, Clinical Dementia Rating scale score of 0.5, and ever car drivers including former and current drivers. All participants underwent comprehensive standardized cognitive assessments and information on driving status was obtained via an interview using a systematic questionnaire. The median age of the 135 participants was 72 years, and 54 participants (40%) were women; 93 patients (68.9%) were current drivers and 42 (31.1%) were former drivers. In univariate analysis, former drivers showed poorer performances in digit span backward and categorical fluency tests than current drivers. In multivariate logistic regression analysis, a poor digit span backward test score was significantly related with driving cessation (odds ratio: 0.493, 95% confidence interval: 0.258–0.939). In patients with MCI, poor performance in the digit span backward test, which represents impaired working memory capacity, was associated with a higher probability of driving cessation.

Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility

BACKGROUND

Driving is related to social participation; therefore older drivers may be reluctant to cease driving. Continuation of driving has also been reported in a large proportion of patients with cognitive impairment. The aim of this study is to investigate whether patients with cognitive impairment adhere to driving cessation advice after a fitness-to-drive assessment and what the consequences are with regard to mobility.

METHODS

Patients with cognitive impairment (n = 172) participated in a fitness-to-drive assessment study, including an on-road driving assessment. Afterwards, patients were advised to either continue driving, to follow driving lessons, or to cease driving. Approximately seven months thereafter, patients were asked in a follow-up interview about their adherence to the driving recommendation. Factors influencing driving cessation were identified using a binary logistic regression analysis. Use of alternative transportation was also evaluated.

RESULTS

Respectively 92 and 79% of the patients adhered to the recommendation to continue or cease driving. Female gender, a higher Clinical Dementia Rating-score, perceived health decline, and driving cessation advice facilitated driving cessation. Patients who ceased driving made use of less alternative modes of transportation than patients who still drove. Nonetheless, around 40% of the patients who ceased driving increased their frequency of cycling and/or public transport use.

CONCLUSIONS

Adherence to the recommendations given after the fitness-to-drive assessments was high. Female patients were in general more likely to cease driving. However, a minority of patients did not adhere to driving cessation advice. These drivers with dementia should be made aware of the progression of their cognitive impairment and general health decline to facilitate driving cessation. There are large differences in mobility between patients with cognitive impairment. Physicians should discuss options for alternative transportation in order to promote sustained safe mobility of patients with cognitive impairment.

Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study

BACKGROUND/AIMS

Driving cessation is associated with significant morbidity in older people. People with mild cognitive impairment (MCI) may be at particular risk of this. Very little research has examined driving in this population. Given this, we sought to identify predictors of driving cessation in people with MCI.

METHODS

One hundred and eighty-five people with MCI were recruited from 9 memory clinics around Australia. People with MCI and their carers reported their driving status and completed measures of cognition, function, neuropsychiatric symptoms, and medication use at regular intervals over a 3-year period.

RESULTS

Of the 144 people still driving at baseline, 50 (27.0%) stopped driving during the study. Older age, greater cognitive and functional impairment, and greater decline in cognition and function at 6 months predicted subsequent driving cessation. Twenty-nine of the 50 people (58%) who stopped driving were diagnosed with dementia during the study; all except one of whom ceased driving after their dementia diagnosis.

CONCLUSION

A significant proportion of people diagnosed with MCI stop driving over the following 3 years. This cannot be entirely attributed to developing dementia. Easily assessable characteristics - such as age, cognition, and function - and changes in these measures over 6 months predict driving cessation.

Association between Sleep Disordered Breathing and Nighttime Driving Performance in Mild Cognitive Impairment

OBJECTIVES

The effect of sleep disordered breathing (SDB) on driving performance in older adults has not been extensively investigated, especially in those with mild cognitive impairment (MCI). The aim of this study was to examine the relationship between severity measures of SDB and a simulated driving task in older adults with and without MCI.

METHODS

Nineteen older adults (age ≥50) meeting criteria for MCI and 23 age-matched cognitively intact controls underwent neuropsychological assessment and a driving simulator task in the evening before a diagnostic sleep study.

RESULTS

There were no differences in driving simulator performance or SDB severity between the two groups. In patients with MCI, a higher oxygen desaturation index (ODI) was associated with an increased number of crashes on the simulator task, as well as other driving parameters such as steering and speed deviation. Poorer driving performance was also associated with poorer executive functioning (set-shifting) but the relationship between ODI and crashes was independent of executive ability.

CONCLUSIONS

While driving ability did not differ between older adults with and without MCI, oxygen saturation dips in MCI were related to worse driving performance. These results suggest that decreased brain integrity may render those with SDB particularly vulnerable to driving accidents. In older adults, both cognition and SDB need to be considered concurrently in relation to driving ability. (JINS, 2017, 23, 502-510).

The influence of age-related health difficulties and attitudes toward driving on driving self-regulation in the baby boomer and older adult generations

Our study aimed to determine how age- and disease-related difficulties were associated with attitudes and beliefs about driving self-regulation in men and women in the baby boomer and older generations. Three hundred and ninety-nine men (n=204) and women (n=195) aged between 48 and 91 years participated in a cross-sectional study of Australian drivers. Demographic characteristics and measures of driving confidence, driving difficulty and driving self-regulation; perceptions of visual, physical and cognitive capacity; and attitudes and beliefs about driving were obtained. Driving self-regulation in men and women was explained by different mechanisms. For men, self-report of visual and cognitive difficulties and poor driving confidence predicted driving self-regulation. For women, negative attitudes toward driving mediated the associations found between health-related difficulties and driving self-regulation. Barriers to driving self-regulation were not associated with the driving self-regulatory practices of men or women. Regardless of generation, women reported poorer driving confidence, greater driving difficulty and more driving self-regulation than men. We concluded that age- and disease-related difficulties are related to increasing driving self-regulation in mature men and women. These results indicate that different pathways are needed in models of driving self-regulation for men and women regardless of generational cohort.

Sensitivity and specificity of the safe driving behavior measure and the driving habits questionnaire for older self-drivers

[Purpose] To evaluate the sensitivity and specificity of the Safe Driving Behavior Measure and the Driving Habits Questionnaire in community-dwelling older self-drivers. [Subjects and Methods] Forty-five older participated in this study, to measure the Safe Driving Behavior Measure and the Driving Habits Questionnaire. Sensitivity and specificity were calculated along with cut-off values and overall accuracy of each measure as determined by the participants operating characteristic curve and the area under the curve. Multivariate logistic regression analysis was employed to identify predictors of driving abilities. [Results] The sensitivities were 0.538 for Safe Driving Behavior Measure, and 0.577, 0.423, and 0.615 for the difficulty, crash and citations, and driving space on domains of the Driving Habits Questionnaire, respectively. The specificities of the person-vehicle domain, person-environment domain, and person-vehicle-environment domain of the Safe Driving Behavior Measure were 0.474, 0.526, and 0.421, respectively, while the Driving Habits Questionnaire domains, the specificities of difficulty, crash and citations, and driving space were 0.526, 0.211, and 0.421, respectively. [Conclusion] The results of this study suggest that factors related to the accident history of older self-drivers were not well-explained, although the Safe Driving Behavior Measure and Driving Habits Questionnaire domains have the potential to determine driving-related accident history.

Self-rated confidence and on-road driving performance among older adults: Autoévaluation de la confiance et de la performance au volant chez les personnes âgées

BACKGROUND.

Driver confidence can be measured through concepts such as driving frequency, situational avoidance, and self-perceptions. However, it is not clear how well confidence aligns with actual driving performance.

PURPOSE.

We examined the relationship between subjective measures of confidence in driving ability and on-road performance.

METHOD.

We report findings from two studies. The first compared scores from the Older and Wiser Driver Questionnaire to an on-road driving evaluation. The second looked at the Day and Night Driving Comfort Scales and Driving Habits and Intentions Questionnaire in relation to an on-road driving evaluation.

FINDINGS.

No measures of confidence in driving ability were related to on-road driving performance.

IMPLICATIONS.

Confidence in driving ability bears little relationship to on-road performance. Future research should examine approaches to foster a better match between self-assessments and actual abilities among drivers.

Cognitive Performance, Driving Behavior, and Attitudes over Time in Older Adults

Nous 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 <0,05). Selon cette analyse exploratoire, le ralentissement cognitif et le dysfonctionnement exécutif semblent être associés aux capacités à conduire perçues d'être modestement inférieurs et à l’évitement accru des situations de conduite au fil du temps.

Driving Task: How Older Drivers’ On-Road Driving Performance Relates to Abilities, Perceptions, and Restrictions

Cette étude a examiné une cohorte de 227 conducteurs âgés et a étudié la relation entre leur performance sur la grille d’observation e-DOS pour manœuvres de conduite et (1) les caractéristiques des conducteurs; (2) les capacités fonctionnelles; (3) les perceptions des capacités et le confort pendant la conduite, ainsi que (4) les restrictions auto-déclarées de la conduite. Les participants (hommes: 70%; âge: M = 81.53 ans, É-T = 3,37 ans) a achevé une série de mesures de la capacité fonctionnelle et d’écailles sur le confort, les capacités et les restrictions aperçut du Candrive / Ozcandrive protocole d’évaluation Année 2, avec une tâche de conduite e-DOS. Les observations des comportements de conduite des participants au cours de la tâche de conduite ont été enregistrées pour : la négociation au carrefour, le changement de voie, la fusion, les manœuvres à basse vitesse, et la conduite sans manoeuvres. Les scores de conduite e-DOS étaient élevés (M = 94,74; É-T = 5,70) et étaient liés d’une façon significative aux capacité de conduite perçu des participants, la fréquence rapporté de la conduite dans des situations difficiles, et le nombre de restrictions de la conduite. Les analyses futures exploreront les changements potentiels dans les scores de tâches de conduite au fil du temps.

Effects of chewing gum on driving performance as evaluated by the STISIM driving simulator

[Purpose] The purpose of this study was to determine the effects of chewing gum on driving performance in a driving simulator. [Subjects] In total, 26 young licensed drivers participated. [Methods] The driving scenario was typical of an urban environment: a single-carriageway, two-way road consisting of a mix of curved and straight sections, with considerable levels of traffic, pedestrians, and parked cars. Mean distance driven above the speed limit, lane position, mean distance driven across the center line, and mean distance driven off the road were used as estimates of brake, accelerator, and steering control. The results were compared with those of a non-chewing gum control condition. [Results] The driving performance while chewing gum was significantly better: the mean distance driven above the speed limit was 26.61% shorter, and the mean distance driven off the road was 31.99% shorter. Lane position and mean distance driven across the center line did not differ significantly between the two conditions. [Conclusion] Chewing gum appears to enhance driving performance during a sustained attention driving task.

Self-regulation of older drivers with cognitive impairment: a systematic review

BACKGROUND

Cognitive decline contributes significantly to the safety risk of older drivers. Some drivers may be able to compensate for the increased crash risk by avoiding complex driving situations or restricting their driving.

OBJECTIVE AND METHOD

A comprehensive English-language systematic review was conducted to determine the level of evidence for older adult drivers with cognitive impairment engaging in self-regulation.

RESULTS

Twelve studies were included in the review. The majority of studies investigated driver avoidance, followed by driver restriction. Few studies ascertained the reasons for changing driving behaviour.

CONCLUSIONS

The evidence supports the view that drivers with cognitive impairment do restrict their driving and avoid complex driving situations. However, it remains to be determined whether the drivers who engage in self-regulation have insight into their own driving abilities or whether external factors result in self-regulation of driving behaviour.

The Canadian Safe Driving Study-Phase I pilot: Examining potential logistical barriers to the full cohort study

Multiple organizations and task forces have called for a reliable and valid method to identify older drivers who are medically unfit to drive. The development of a clinical decision rule for this type of screening requires data from a longitudinal prospective cohort of older drivers. The aim of this article is to identify potential design, sampling and data collection barriers to such studies based on an analysis of the Canadian Safe Driving Study-phase I pilot (Candrive I). A convenience sample of 100 active older drivers aged 70 years or more was recruited through the aid of a seniors' organization, 94 of whom completed the full study (retention rate 94%). Data were collected over the course of 1 year on various driving behaviours, as well as on cognitive, physical and mental functioning. Driving patterns were recorded using driving diaries, logs and electronic devices. Driving records from the Ministry of Transportation of Ontario (MTO) were obtained for the 3-year period preceding the study initiation and up to 1 year following study completion. An increased burden of illness was observed as the number of medical diagnoses and medication use increased over the study period. Study participants were involved in a total of five motor vehicle collisions identified through MTO records, which was comparable to the Ontario annual collision rate of 4.1% for drivers aged 75 years or older. In sum, many of the relevant logistical and practical barriers to studying a large sample of older drivers longitudinally have been shown to be addressable, supporting the feasibility of completing a large prospective cohort study of older drivers.

The relationship between cognitive performance, perceptions of driving comfort and abilities, and self-reported driving restrictions among healthy older drivers

The objective of the present study was to examine the relationship between cognitive performance, driver perceptions and self-reported driving restrictions. A cross-sectional analysis was conducted on baseline data from Candrive II, a five-year prospective cohort study of 928 older drivers aged 70-94 years from seven cities. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) as well as the Trail Making Test, parts A and B. Driver perceptions were assessed using the Day and Night Driving Comfort Scales and the Perceived Driving Abilities scale, while driving practices were captured by the Situational Driving Frequency and Avoidance scales, as well as the Driving Habits and Intentions Questionnaire. The baseline data indicates this cohort is largely a cognitively intact group. Univariate regression analysis showed that longer Trails A and B completion times were significantly, but only modestly associated with reduced driving frequency and perceived driving abilities and comfort, as well as a significant tendency to avoid more difficult driving situations (all p<.05). Most of these associations persisted after adjusting for age and sex, as well as indicators of health, vision, mood and physical functioning. Exceptions were Trails A and B completion times and situational driving frequency, as well as time to complete Trails B and current driving restrictions. After adjusting for the confounding factors, the total MoCA score was not associated with any of the driving measure scores while the number of errors on Trails A was significantly associated only with situational driving frequency and number of errors on Trails B was significantly associated only with situational driving avoidance. Prospective follow-up will permit examination of whether baseline cognition or changes in cognition are associated with changes in driver perceptions, actual driving restrictions and on-road driving outcomes (e.g., crashes, violations) over time.

The impact of subclinical sleep problems on self-reported driving patterns and perceived driving abilities in a cohort of active older drivers

The present study sought to investigate the influence of subclinical sleep disturbances on driving practices and driver perceptions in a large cohort of healthy older drivers. Participants from the Candrive II prospective cohort study were investigated. Self-reported measures of sleep problems were used to determine the influence of sleep disturbance on self-reported driving practices and perceived driving abilities, as measured by the Situational Driving Frequency, Situational Driving Avoidance, and Perceived Driving Abilities scales. Hierarchical regression analyses were used to estimate whether mild self-reported sleep problems were predictive of driving restrictions and perceived abilities, while controlling for a variety of health-related factors and demographic variables known to mediate sleep problems or to impact driving. Cross-sectional analysis of baseline data from the Candrive II study suggests that subclinical sleep problems do not significantly influence self-reported driving patterns or perceived driving abilities in older drivers once control variables are considered. The relationship between sleep problems, driving frequency, avoidance and perceived abilities is better explained by mediating demographic, health, and cognitive factors. Further research examining sleep disturbances and driving should include objective measures of driving practices (exposure, patterns) and outcomes (crashes, violations) and should take in consideration the severity of sleep problems.

Self-regulatory practices of drivers with Parkinson's disease: accuracy of patient reports

BACKGROUND

Studies suggest that drivers with Parkinson's disease (PD) are more likely than controls to restrict their exposure and avoid challenging situations possibly to compensate for declining abilities; however it is questionable whether patient reports should be taken at face value. To address this issue, this study examined agreement between self-reported and actual driving practices in drivers with and without PD.

METHODS

Two electronic devices (one with GPS) were installed in the vehicles of 26 drivers with PD (mean age 71.5 ± 6.8, 77% men) and 20 controls (mean age 70.6 ± 7.9, 80% men) for two weeks. Participants completed a questionnaire on usual driving patterns, scales on Situational Driving Frequency (SDF) and Avoidance (SDA), the MoCA and an interview.

RESULTS

Self-estimates of distance driven (km) over the two weeks were inaccurate in both groups; however the tendency to under-estimate was more pronounced in PD drivers. Drivers with PD reported more self-restrictions (higher SDA scores, p < .01; lower SDF scores, p < .05), yet drove more at night, in bad weather, in rush hour and on highways than they reported. Drivers with PD had significantly lower MoCA scores overall (p < .01) and on the memory subtest (p < .05), however, MoCA scores were not correlated with self-reported restrictions, or actual driving distance in either group.

CONCLUSIONS

These findings indicate that patient reports of driving behavior should not be taken at face value by researchers or clinicians. Patients with PD may be more likely than drivers in general to have problems with recall and possibly less awareness of their driving practices.