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Jun H, Liu Y, Chen E, Becker A, Mattke S. State Department of Motor Vehicles Reporting Mandates of Dementia Diagnoses and Dementia Underdiagnosis. JAMA Netw Open 2024; 7:e248889. [PMID: 38662368 PMCID: PMC11046347 DOI: 10.1001/jamanetworkopen.2024.8889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/22/2024] [Indexed: 04/26/2024] Open
Abstract
Importance With older drivers representing the fastest growing segment of the driver population and dementia prevalence increasing with age, policymakers face the challenge of balancing road safety and mobility of older adults. In states that require reporting a dementia diagnosis to the Department of Motor Vehicles (DMV), individuals with dementia may be reluctant to disclose symptoms of cognitive decline, and clinicians may be reluctant to probe for those symptoms, which may be associated with missed or delayed diagnoses. Objective To assess whether DMV reporting policies for drivers with dementia are associated with primary care clinicians' underdiagnosing dementia. Design, Setting, and Participants This cross-sectional study used data from the 100% Medicare fee-for-service program and the Medicare Advantage plans from 2017 to 2019 on 223 036 primary care clinicians with at least 25 Medicare patients. Statistical analysis was performed from July to October 2023. Exposures State DMV reporting policies for drivers with dementia. Main Outcomes and Measures The main outcome was a binary variable indicating whether the clinician underdiagnosed dementia or not. Each clinician's expected number of dementia cases was estimated using a predictive model based on patient characteristics. Comparing the estimation with observed dementia diagnoses identified clinicians who underdiagnosed dementia vs those who did not, after accounting for sampling errors. Results Four states have clinician reporting mandates, 14 have mandates requiring drivers to self-report dementia diagnoses, and 32 states and the District of Columbia do not have explicit requirements. Among primary care clinicians in states with clinician reporting mandates (n = 35 620), 51.4% were female, 91.9% worked in a metropolitan area, and 19.9% of the patient panel were beneficiaries dually eligible for Medicare and Medicaid. Among primary care clinicians in states with patient self-reporting mandates (n = 57 548), 55.7% were female, 83.1% worked in a metropolitan area, and 15.4% of the patient panel were dually eligible for Medicare and Medicaid. Among clinicians in states without mandates, 55.7% were female, 83.0% worked in a metropolitan area, and 14.6% of the patient panel were dually eligible for Medicare and Medicaid. Clinicians in states with clinician reporting mandates had an adjusted 12.4% (95% CI, 10.5%-14.2%) probability of underdiagnosing dementia compared with 7.8% (95% CI, 6.9%-8.7%) in states with self-reporting and 7.7% (95% CI, 6.9%-8.4%) in states with no mandates, an approximately 4-percentage point difference (P < .001). Conclusions and Relevance Results of this cross-sectional study of primary care clinicians suggest that mandatory DMV policies for clinicians to report patients with dementia may be associated with a higher risk of missed or delayed dementia diagnoses. Future research is needed to better understand the unintended consequences and the risk-benefit tradeoffs of these policies.
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Affiliation(s)
- Hankyung Jun
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ying Liu
- The USC Brain Health Observatory, University of Southern California, Los Angeles
| | - Emily Chen
- The USC Brain Health Observatory, University of Southern California, Los Angeles
| | - Andrew Becker
- The USC Brain Health Observatory, University of Southern California, Los Angeles
| | - Soeren Mattke
- The USC Brain Health Observatory, University of Southern California, Los Angeles
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de Almeida WM, Quintas JL, Trindade IOA, Pitta LSR, Louzada LL, Nóbrega OT, Camargos EF. Diagnosis of Alzheimer's dementia and vehicle driving restriction: a scoping review. Psychogeriatrics 2024; 24:138-144. [PMID: 37990411 DOI: 10.1111/psyg.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/22/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
There are doubts about vehicle driving restriction for patients with Alzheimer's disease. A scoping review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-ScR) methodology. Relevant databases were searched for articles published between 2000 and 2022 in English, Spanish, or Portuguese. Articles were included if they specifically addressed driving, risk of accidents, permission or licence to drive a motor vehicle in a context of important cognitive decline, or if addressed traffic legislation on driving and dementia. Twenty-three articles were selected for full reading, six of which were observational studies and only one with an interventionist method. All articles were carried out in high-income countries such as the UK, the US, and Australia. As a conclusion, there is no psychometric test in the literature sensitive enough to assess vehicle driving competence in older adults with cognitive deficits. Based on selected studies, there is no robust evidence to make recommendation for or against the cessation of vehicular driving for patients with mild cognitive decline or with mild dementia. In some situations, vehicle driving cessation can impact patients and their families. In addition, legal regulations regarding vehicle driving for older adults and people with dementia are scarce worldwide. Despite the scarcity of studies addressing the theme of vehicle driving in the context of dementia, there is some level of consensual reasoning that patients with moderate to severe dementia should halt driving activities, but the same does not apply for patients with mild levels of cognitive impairment, including mild dementia.
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Affiliation(s)
| | - Juliana Lima Quintas
- Hospital of the University of Brasilia (HUB), Medical Centre for the Aged, Brasília, Brazil
| | | | | | - Luciana Lilian Louzada
- Hospital of the University of Brasilia (HUB), Medical Centre for the Aged, Brasília, Brazil
| | - Otávio Toledo Nóbrega
- Hospital of the University of Brasilia (HUB), Medical Centre for the Aged, Brasília, Brazil
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CR-IUGM), Montreal, Quebec, Canada
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Camilleri L, Whitehead D. Driving Assessment for Persons with Dementia: How and when? Aging Dis 2023; 14:621-651. [PMID: 37191415 DOI: 10.14336/ad.2022.1126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/26/2022] [Indexed: 05/17/2023] Open
Abstract
Dementia is a progressive neurodegenerative disease leading to deterioration in cognitive and physical skills. Driving is an important instrumental activity of daily living, essential for independence. However, this is a complex skill. A moving vehicle can be a dangerous tool in the hand of someone who cannot maneuver it properly. As a result, the assessment of driving capacity should be part of the management of dementia. Moreover, dementia comprises of different etiologies and stages consisting of different presentations. As a result, this study aims to identify driving behaviors common in dementia and compare different assessment methods. A literature search was conducted using the PRISMA checklist as a framework. A total of forty-four observational studies and four meta-analyses were identified. Study characteristics varied greatly with regards to methodology, population, assessments, and outcome measures used. Drivers with dementia performed generally worse than cognitively normal drivers. Poor speed maintenance, lane maintenance, difficulty managing intersections and poor response to traffic stimuli were the most common behaviors in drivers with dementia. Naturalistic driving, standardized road assessments, neuropsychological tests, participant self-rating and caregiver rating were the most common driving assessment methods used. Naturalistic driving and on-road assessments had the highest predictive accuracy. Results on other forms of assessments varied greatly. Both driving behaviors and assessments were influenced by different stages and etiologies of dementia at varying degrees. Methodology and results in available research are varied and inconsistent. As a result, better quality research is required in this field.
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Affiliation(s)
- Lara Camilleri
- Saint Vincent De Paul Long Term Care Facility, L-Ingiered Road, Luqa, Malta
| | - David Whitehead
- Department of Gerontology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom
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Peterson CM, Birkeland RW, Louwagie KW, Ingvalson SN, Mitchell LL, Scott TL, Liddle J, Pachana NA, Gustafsson L, Gaugler JE. Refining a Driving Retirement Program for Persons With Dementia and Their Care Partners: A Mixed Methods Evaluation of CarFreeMe™-Dementia. J Gerontol B Psychol Sci Soc Sci 2023; 78:506-519. [PMID: 36149829 PMCID: PMC9985324 DOI: 10.1093/geronb/gbac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES We adapted the CarFreeMe™-Dementia program created by The University of Queensland for drivers in the United States. CarFreeMe™-Dementia aims to assist drivers living with dementia and their care partners as they plan for or adjust to driving retirement. This semistructured program focuses on driving retirement education and support. Topics include how dementia affects driving, lifestyle planning, stress management, and alternative transportation options. This study evaluated the feasibility, acceptability, and utility of the CarFreeMe™-Dementia intervention. METHODS This pilot phase of the study included 16 care partners and 11 drivers with memory loss who were preparing for or adjusting to driving retirement. Participants completed 4-8 CarFreeMe™-Dementia intervention telehealth sessions. Online surveys (baseline, 1- and 3-month) and postintervention semistructured interviews informed evaluation of the intervention program using a mixed methods approach. RESULTS This study established initial support for CarFreeMe™-Dementia in the United States. Participants indicated the program facilitated dialogue around driving retirement and provided guidance on community engagement without driving. Respondents appreciated the program's emphasis on overall well-being, promoted through lifestyle planning and stress management. They also reported the program offered practical preparation for transitioning to driving retirement. DISCUSSION The CarFreeMe™-Dementia intervention, tailored to an American audience, appears to be a feasible, acceptable, and useful support program for drivers with memory loss (and/or their care partners) who are preparing for or adjusting to driving retirement. Further investigations of the efficacy of the CarFreeMe™-Dementia intervention in the United States, as well as in other countries and cultural contexts, are warranted.
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Affiliation(s)
- Colleen M Peterson
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Robyn W Birkeland
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katie W Louwagie
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Lauren L Mitchell
- Department of Psychology and Neuroscience, Emmanuel College, Boston, Massachusetts, USA
| | - Theresa L Scott
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Jacki Liddle
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Queensland, Australia and the Princess Alexandra Hospital in Woolloongabba, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Liu CC, Liu CH, Chang KC, Ko MC, Lee PC, Wang JY. Association Between Young-Onset Dementia and Risk of Hospitalization for Motor Vehicle Crash Injury in Taiwan. JAMA Netw Open 2022; 5:e2210474. [PMID: 35511178 PMCID: PMC9073564 DOI: 10.1001/jamanetworkopen.2022.10474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Several studies have suggested that older-onset dementia is associated with an increased risk of motor vehicle crash injury (MVCI). However, evidence of an association between young-onset dementia and the risk of MVCI is insufficient, particularly in Asia. OBJECTIVE To investigate the association between young-onset dementia and MVCI-related hospitalization in Taiwan. DESIGN, SETTING, AND PARTICIPANTS In this nationwide, population-based cohort study in Taiwan, a cohort of 39 344 patients aged 40 to 64 years with incident dementia diagnosed between 2006 and 2012 was matched 1:1 with a cohort of participants without dementia by age, sex, and index year (initial diagnosis of dementia). Participants were identified from Taiwan's National Health Insurance Research Database (NHIRD). Data were analyzed between March 25 and October 22, 2021. EXPOSURES Dementia, defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. MAIN OUTCOMES AND MEASURES Hospitalization for MVCI, determined using linked data from Taiwan's Police-Reported Traffic Accident Registry and the NHIRD from January 1, 2003, to December 31, 2015. Hazard ratios (HRs) for MVCI-related hospitalization were estimated using Cox proportional hazards regression models adjusted for sex, age, salary-based insurance premium, urbanization level, and comorbidities. RESULTS Of the 78 688 participants, 47 034 (59.8%) were male; the mean (SD) age was 54.5 (7.4) years. During the 10-year follow-up period, the incidence density of MVCI-related hospitalization was 45.58 per 10 000 person-years (95% CI, 42.77-48.39 per 10 000 person-years) among participants with dementia and 24.10 per 10 000 person-years (95% CI, 22.22-25.99 per 10 000 person-years) among participants without dementia. Compared with participants without dementia, patients with young-onset dementia were at higher risk of MVCI-related hospitalization (adjusted HR [aHR], 1.83; 95% CI, 1.63-2.06), especially those in younger age groups (aged 40-44 years: aHR, 3.54; 95% CI, 2.48-5.07) and within a shorter period (within 1 year of follow-up: aHR, 3.53; 95% CI, 2.50-4.98) after dementia was diagnosed. Patients with young-onset dementia also had a higher risk of being a pedestrian when the crash occurred (aHR, 2.89; 95% CI, 2.04-4.11), having an intracranial or internal injury (aHR, 2.44; 95% CI, 2.02-2.94), and having a severe injury (aHR, 2.90; 95% CI, 2.16-3.89). CONCLUSIONS AND RELEVANCE In this retrospective cohort study, patients in Taiwan with a diagnosis of young-onset dementia had a higher risk of MVCI-related hospitalization than did individuals without dementia and the risk varied by age, disease duration, transport mode, injury type, and injury severity. These findings suggest a need for the planning of strategies to prevent transportation crashes among patients with young-onset dementia.
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Affiliation(s)
- Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chien-Hui Liu
- School of Nursing, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Natural Biotechnology, NanHua University, Chiayi, Taiwan
| | - Ming-Chung Ko
- Department of Surgery, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Pei-Chen Lee
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Abdulwahid SN, Mahmoud MA, Zaidan BB, Alamoodi AH, Garfan S, Talal M, Zaidan AA. A Comprehensive Review on the Behaviour of Motorcyclists: Motivations, Issues, Challenges, Substantial Analysis and Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063552. [PMID: 35329238 PMCID: PMC8950571 DOI: 10.3390/ijerph19063552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/17/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
With the continuous emergence of new technologies and the adaptation of smart systems in transportation, motorcyclist driving behaviour plays an important role in the transition towards intelligent transportation systems (ITS). Studying motorcyclist driving behaviour requires accurate models with accurate and complete datasets for better road safety and traffic management. As accuracy is needed in modelling, motorcyclist driving behaviour analyses can be performed using sensors that collect driving behaviour characteristics during real-time experiments. This review article systematically investigates the literature on motorcyclist driving behaviour to present many findings related to the issues, problems, challenges, and research gaps that have existed over the last 10 years (2011–2021). A number of digital databases (i.e., IEEE Xplore®, ScienceDirect, Scopus, and Web of Science) were searched and explored to collect reliable peer-reviewed articles. Out of the 2214 collected articles, only 174 articles formed the final set of articles used in the analysis of the motorcyclist research area. The filtration process consisted of two stages that were implemented on the collected articles. Inclusion criteria were the core of the first stage of the filtration process keeping articles only if they were a study or review written in English or were articles that mainly incorporated the driving style of motorcyclists. The second phase of the filtration process is based on more rules for article inclusion. The criteria of inclusion for the second phase of filtration examined the deployment of motorcyclist driver behaviour characterisation procedures using a real-time-based data acquisition system (DAS) or a questionnaire. The final number of articles was divided into three main groups: reviews (7/174), experimental studies (41/174), and social studies-based articles (126/174). This taxonomy of the literature was developed to group the literature into articles with similar types of experimental conditions. Recommendation topics are also presented to enable and enhance the pace of the development in this research area. Research gaps are presented by implementing a substantial analysis of the previously proposed methodologies. The analysis mainly identified the gaps in the development of data acquisition systems, model accuracy, and data types incorporated in the proposed models. Finally, research directions towards ITS are provided by exploring key topics necessary in the advancement of this research area.
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Affiliation(s)
| | - Moamin A. Mahmoud
- Institute of Informatics and Computing in Energy, Universiti Tenaga Nasional, Kajang 43000, Malaysia
- Correspondence: (M.A.M.); (B.B.Z.)
| | - Bilal Bahaa Zaidan
- Future Technology Research Center, National Yunlin University of Science and Technology, Douliu 64002, Taiwan
- Correspondence: (M.A.M.); (B.B.Z.)
| | - Abdullah Hussein Alamoodi
- Department of Computing, Universiti Pendidikan Sultan Idris, Tanjong Malim 35900, Malaysia; (A.H.A.); (S.G.); (A.A.Z.)
| | - Salem Garfan
- Department of Computing, Universiti Pendidikan Sultan Idris, Tanjong Malim 35900, Malaysia; (A.H.A.); (S.G.); (A.A.Z.)
| | - Mohammed Talal
- Department of Electronic Engineering, Faculty of Electrical and Electronic Engineering, Universiti Tun Hussein Onn Malaysia (UTHM), Batu Pahat 86400, Malaysia;
| | - Aws Alaa Zaidan
- Department of Computing, Universiti Pendidikan Sultan Idris, Tanjong Malim 35900, Malaysia; (A.H.A.); (S.G.); (A.A.Z.)
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Holland PJ, Tappen RM, Newman DO, Freeman-Costin KC, Fisher LJ. Effect of Memantine on Prolonging Safe Driving in Early AD: a Pilot Study. Can Geriatr J 2021; 24:292-296. [PMID: 34912482 PMCID: PMC8629502 DOI: 10.5770/cgj.24.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background To determine the feasibility of conducting an RCT on the potential effectiveness of memantine hydrochloride in prolonging safe driving in mild AD. Methods A placebo-controlled, double blind randomized trial was conducted. Forty-three individuals ≥60 with mild AD met screening criteria and were randomized. Driving ability was measured by a standardized on-road driving test. Outcomes were driving capacity at 6 and 12 months and completion of the 12-month intervention. Results Of 43 participants randomized, 59% of the memantine group and 52% of the placebo group completed the on-road test at 12 months (p = .66). All 13 memantine group participants maintained their driving status at 12 months, whereas only 8 of the 11 placebo group participants did (p = .040, OR = 4.45). Conclusions Results provide the framework for designing a rigorous multisite clinical trial of memantine effect on maintaining driving capacity in mild AD.
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Affiliation(s)
- Peter J Holland
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Ruth M Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - David O Newman
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Lori J Fisher
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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Bahrampouri S, Khankeh HR, Hosseini SA, Mehmandar M, Ebadi A. Components of driving competency measurement in the elderly: A scoping review. Med J Islam Repub Iran 2021; 35:2. [PMID: 33996653 PMCID: PMC8111623 DOI: 10.47176/mjiri.35.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Iran will face the "aging Tsunami" phenomenon by the 2040s. Therefore, paying attention to the elderly's driving to maintain and promote their independence and quality of life on the one hand and paying attention to the dangers of driving by the elderly for road safety will be important. The purpose of this research was to determine the components of driving competency in the elderly.
Methods: The research has employed a scoping review. To this end, searches of scientific databases were conducted using keywords between 1990 and 2019. The process of selecting the documentation was-based on the PRISMA chart.
Results: In the first phase, 2769 records were found, and finally, 37 records met the inclusion criteria set for this study. The results indicated that 18 components were extracted that were classified into seven main categories including cognitive, sensory, motor, mental functions, and medications, diseases, and driving history.
Conclusion: Sensory, motor, and cognitive abilities are the most important components of elderly safe driving. Therefore, as age increases, chronic disease, multiple drug use, and subsequent problems increase. This can affect the ability to drive safely and can cause traffic injuries. Therefore, it is recommended to use the results of this research to design a suitable tool and model for assessing driving competency in the elderly.
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Affiliation(s)
- Saiedeh Bahrampouri
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Reza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Davis J, Hamann C, Butcher B, Peek-Asa C. The Medical Referral Process and Motor-Vehicle Crash Risk for Drivers with Dementia. Geriatrics (Basel) 2020; 5:geriatrics5040091. [PMID: 33202718 PMCID: PMC7709686 DOI: 10.3390/geriatrics5040091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/31/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
Cognitive and physical impairment can occur with dementia and reduce driving ability. In the United States, individual states have procedures to refer and evaluate drivers who may no longer be fit to drive. The license review process is not well understood for drivers with dementia. This study uses comprehensive data from the Iowa Department of Transportation to compare the referral process for drivers with and without dementia from January 2014 through November 2019. The likelihood of failing an evaluation test was compared between drivers with and without dementia using logistic regression. The risk of motor-vehicle crash after referral for review of driving ability was compared using a Cox proportional hazard model. Analysis controlled for the age and sex of the referred driver. Drivers with dementia performed worse on all tests evaluated except the visual screening test. After the referral process, the risk of crash was similar between those with and without dementia. Drivers with dementia were denied their license more frequently than referred drivers without dementia. However, drivers with dementia who successfully kept their license as a result of the license review process were not at an increased risk of crash compared to other referred drivers.
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Affiliation(s)
- Jonathan Davis
- University of Iowa Injury Prevention Research Center, 2190 Westlawn, Iowa City, IA 52242, USA; (C.H.); (B.B.); (C.P.-A.)
- Correspondence:
| | - Cara Hamann
- University of Iowa Injury Prevention Research Center, 2190 Westlawn, Iowa City, IA 52242, USA; (C.H.); (B.B.); (C.P.-A.)
- Department of Epidemiology, College of Public Health, University of Iowa, 145 North Riverside Drive, Iowa City, IA 52242, USA
| | - Brandon Butcher
- University of Iowa Injury Prevention Research Center, 2190 Westlawn, Iowa City, IA 52242, USA; (C.H.); (B.B.); (C.P.-A.)
- Department of Biostatistics, College of Public Health, University of Iowa, 145 North Riverside Drive, Iowa City, IA 52242, USA
| | - Corinne Peek-Asa
- University of Iowa Injury Prevention Research Center, 2190 Westlawn, Iowa City, IA 52242, USA; (C.H.); (B.B.); (C.P.-A.)
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, 145 North Riverside Drive, Iowa City, IA 52242, USA
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Toepper M, Falkenstein M. Driving Fitness in Different Forms of Dementia: An Update. J Am Geriatr Soc 2019; 67:2186-2192. [PMID: 31386780 DOI: 10.1111/jgs.16077] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Most forms of dementia are associated with progressive cognitive and noncognitive impairments that can severely affect fitness to drive. Whether safe driving is still possible in the single case, however, is often difficult to decide and may be dependent on both severity and type of the respective dementia syndrome. Particularly in early disease stages, Alzheimer disease dementia (ADD) and different types of non-Alzheimer dementias, such as vascular dementia (VaD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and Parkinson disease dementia (PDD), might differentially affect fitness to drive. DESIGN To examine the effects of severity and type of dementia on driving fitness, we conducted a systematic review with qualitative narrative synthesis, involving different driving outcomes in different forms and stages of dementia. SETTING Literature research included MEDLINE and PsycINFO databases with a focus on the most relevant and recent publications on the topic. PARTICIPANTS The population of interest included older drivers in different stages of ADD and different forms of non-Alzheimer dementias (VaD, FTD, DLB, and PDD). MEASUREMENTS Narrative description of driving outcomes in the population of interest. RESULTS Overall, previous studies suggest that driving fitness is severely impaired in moderate and severe dementia, irrespective of the type of dementia. In milder disease stages, fitness to drive appears to be more severely impaired in non-Alzheimer dementias than in ADD, since the non-Alzheimer syndromes are not only associated with driving-relevant cognitive but noncognitive risk factors, such as behavioral or motor symptoms. CONCLUSIONS Based on these findings, practical recommendations are presented, including a risk evaluation for driving safety, depending on severity and type of different dementia syndromes. J Am Geriatr Soc 67:2186-2192, 2019.
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Affiliation(s)
- Max Toepper
- Evangelisches Klinikum Bethel, Research Division, Department of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany.,Evangelisches Klinikum Bethel, Division of Geriatric Psychiatry, Department of Psychiatry and Psychotherapy Bethel, Bielefeld, Germany
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