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Veerhuis N, Merizzi A, Papoulias S, Bradbury C, Sheret K, Traynor V. 'It is empowering and gives people dignity in a very difficult process': A multistage, multimethod qualitative study to understand the views of end users in the cultural adaptation of a dementia and driving decision aid. Health Expect 2024; 27:e14006. [PMID: 38497286 PMCID: PMC10945392 DOI: 10.1111/hex.14006] [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: 05/31/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Decisions about driving for individuals living with dementia (ILWD) can be challenging. There are limited evidence-based person-centred interventions in the United Kingdom that support decisions about transitioning to not driving or guidelines for developing decision aids for ILWD. This study aimed to understand the important features of a decision aid through the cultural adaptation of Australian dementia and driving decision aid (DDDA) for ILWD residing in the United Kingdom. METHODS This qualitative study was theoretically underpinned by a person-centred framework and conducted over three stages: (1) Development of a draft UK-specific DDDA; (2) semistructured interviews with ILWD and an online survey with stakeholders to obtain their views on a draft UK DDDA and (3) content analysis and synthesis of qualitative data to inform the final version of the decision aid. RESULTS Eleven ILWD and six of their spouses participated in interviews, and 102 stakeholders responded to an online survey. The four broad features identified as important to include in a decision aid for drivers living with dementia were: a structured and interactive format; positive and supportive messaging and presentation; relevant and concise content and choice-centred. The perceived benefits of the decision aid were identified as supporting conversations, enhancing collaborative decision making and enabling agency with decisions about driving and future mobility options. CONCLUSIONS Decision aids that are underpinned by interactive choice-driven questions enhance a person-centred approach to decisions about driving. Positively framing decision aids through the presentation and content can facilitate engagement with the decision-making process about driving. The findings have implications for the development of decision aids designed for ILWD on other important health and social topics. PATIENT AND PUBLIC INVOLVEMENT Advocating for the development of a UK DDDA were ILWD. Healthcare professionals contributed to the development of a draft UK DDDA. Former and current drivers living with dementia, family members, healthcare professionals and other support networks of ILWD participated in interviews or an online survey which informed the final version of the UK DDDA.
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Affiliation(s)
- Nadine Veerhuis
- Aged, Dementia, Health Education and Research Centre, Faculty of Science Medicine and Health, School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Alessandra Merizzi
- Memory Assessment and Treatment Service, Pennine Care National Health Service Foundation Trust, Oldham, UK
| | - Stephanie Papoulias
- Memory Assessment and Treatment Service, Pennine Care National Health Service Foundation Trust, Oldham, UK
| | - Claire Bradbury
- Memory Assessment Service, Dorset Healthcare University Foundation Trust, Alderney Hospital, Poole, UK
| | - Kathy Sheret
- Memory Assessment Service, Dorset Healthcare University Foundation Trust, Alderney Hospital, Poole, UK
| | - Victoria Traynor
- Aged, Dementia, Health Education and Research Centre, Faculty of Science Medicine and Health, School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
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Veerhuis N, Traynor V. Evaluation of an education intervention for Australian health practitioners to support people with dementia with driving decisions: A pretest-posttest survey. TRAFFIC INJURY PREVENTION 2022; 23:327-332. [PMID: 35708996 DOI: 10.1080/15389588.2022.2079121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Drivers with dementia will at some stage need to stop driving. The timing of driving retirement is informed by the advice of health practitioners, however many find this task complex and challenging as they feel unprepared or lack confidence, having limited training and education on dementia and driving. Few opportunities exist for Australian health practitioners to advance learning about dementia and driving. This study evaluated the impact of a Dementia and Driving Education Module on practitioner self-perceived knowledge, confidence, and competence in supporting people living with dementia with decisions about driving. METHODS A single group, pretest-posttest survey was conducted for this study. Health practitioners were recruited over 19 months via email and invited to attend a face-to-face dementia and driving workshop. The workshop comprised of a two-hour Dementia and Driving Education Module including seven learning activities incorporating six vignettes, five self-reflections, one case study and a paper copy of a dementia and driving decision aid. Participants completed a survey prior to, immediately after and six weeks post completion of the education module. RESULTS A total of 240 health practitioners, from over six disciplines, took part in one of eleven workshops delivered via face-to-face and online across five states of Australia. Significant increases occurred in all outcome measures of perceived knowledge, confidence and competence between baseline and immediately post-education module survey responses and between baseline and six weeks post-survey responses. CONCLUSIONS The Dementia and Driving Education Module and accompanying decision aid demonstrate an efficacious solution for a diverse range of health practitioners to enhance their knowledge, confidence, and competence in supporting people living with dementia with driving retirement decisions.
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Affiliation(s)
- Nadine Veerhuis
- Aged Dementia Health Education and Research (ADHERe), School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Victoria Traynor
- Aged Dementia Health Education and Research (ADHERe), School of Nursing, University of Wollongong, Wollongong, NSW, Australia
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Stamatelos P, Economou A, Stefanis L, Yannis G, Papageorgiou SG. Driving and Alzheimer's dementia or mild cognitive impairment: a systematic review of the existing guidelines emphasizing on the neurologist's role. Neurol Sci 2021; 42:4953-4963. [PMID: 34581880 DOI: 10.1007/s10072-021-05610-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Driving is a complex task requiring the integrity and the cooperation of cognition, motor, and somatosensory skills, all of which are impacted by neurological diseases. OBJECTIVE Identification of neurologist's role when assessing fitness to drive of cognitively impaired individuals. METHODS We performed a systematic review of the guidelines/recommendations (G/Rs) regarding the evaluation of driving fitness of patients with mild cognitive impairment (MCI) and/or dementia. Emphasis was put on the neurological and neuropsychological aspects of the evaluation. RESULTS Eighteen G/Rs were included in the review (9 national guidelines, 5 recommendation papers, 3 consensus statements, and 1 position paper). All G/Rs referred to drivers with dementia and 9/18 referred to drivers with MCI. A common approach among G/Rs is the initial trichotomization of patients in safe to drive, unsafe to drive, and undetermined cases, which are referred to a second-line evaluator. First-line evaluators are general practitioners in 10/18 G/Rs; second-line evaluators are neurologists in 7/18 G/Rs. Specific neuropsychological tests are proposed in 11/18 G/Rs and relative cut-off values in 7/18. The most commonly used tests are the MMSE, TMT, and CDT. A thorough neurological examination is proposed in only 1/18 G/R. CONCLUSION Although extensive multi-disciplinary research has provided useful information for driving behavior of cognitively impaired individuals, we are still far from a widely accepted approach of driving ability evaluation in this increasing population. A comprehensive assessment from a multi-disciplinary team in which the neurologist plays a critical role seems to be required, although this has not yet been implemented in any G/Rs.
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Affiliation(s)
- Petros Stamatelos
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - Alexandra Economou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - George Yannis
- School of Civil Engineering, Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece.
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Peng Z, Nishimoto H, Kinoshita A. Driving Performance and Its Correlation with Neuropsychological Tests in Senior Drivers with Cognitive Impairment in Japan. J Alzheimers Dis 2021; 79:1575-1587. [PMID: 33459651 DOI: 10.3233/jad-201323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND With the rapid aging of the population, the issue of driving by dementia patients has been causing increasing concern worldwide. OBJECTIVE To investigate the driving difficulties faced by senior drivers with cognitive impairment and identify the specific neuropsychological tests that can reflect specific domains of driving maneuvers. METHODS Senior drivers with cognitive impairment were investigated. Neuropsychological tests and a questionnaire on demographic and driving characteristics were administered. Driving simulator tests were used to quantify participants' driving errors in various domains of driving. RESULTS Of the 47 participants, 23 current drivers, though they had better cognitive functions than 24 retired drivers, were found to have impaired driving performance in the domains of Reaction, Starting and stopping, Signaling, and Overall (wayfinding and accidents). The parameters of Reaction were significantly related to the diagnosis, and the scores of MMSE, TMT-A, and TMT-B. As regards details of the driving errors, "Sudden braking" was associated with the scores of MMSE (ρ= -0.707, p < 0.01), BDT (ρ= -0.560, p < 0.05), and ADAS (ρ= 0.758, p < 0.01), "Forgetting to use turn signals" with the TMT-B score (ρ= 0.608, p < 0.05), "Centerline crossings" with the scores of MMSE (ρ= -0.582, p < 0.05) and ADAS (ρ= 0.538, p < 0.05), and "Going the wrong way" was correlated with the score of CDT (ρ= -0.624, p < 0.01). CONCLUSION Different neuropsychological factors serve as predictors of different specific driving maneuvers segmented from driving performance.
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Affiliation(s)
- Zhouyuan Peng
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Nishimoto
- Integrated Center for Advanced Medical Technologies, Kochi University Hospital, Kochi, Japan
| | - Ayae Kinoshita
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Using Video Replay of Simulated Driving to Estimate Driving Safety and Cognitive Status. SAFETY 2021. [DOI: 10.3390/safety7020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cognitive decline resulting from Dementia of Alzheimer’s Type (DAT) can lead to reduced ability to perform complex daily tasks required for independent living, including driving an automobile. This study explores the ability of untrained observers to classify driving safety using short video clips of simulated driving through intersections; it also examined whether untrained observers could predict whether the driver was cognitively healthy or cognitively impaired. Participants (n = 54) were shown a series of 30 video clips arranged in an online survey and asked to answer questions following each clip regarding the safety of the maneuver and the cognitive status of the driver. Results showed that participants’ subjectively rated DAT drivers as significantly less safe in comparison to control drivers, F (1, 52) = 228.44, p < 0.001. Participant’s classification of DAT drivers and controls was also significantly higher than chance (i.e., >50% correct). Findings provide preliminary support for the development of a clinical decision-making aid using video replay of driving simulator performance in fitness-to-drive assessments for individuals with cognitive impairment.
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Caffò AO, Tinella L, Lopez A, Spano G, Massaro Y, Lisi A, Stasolla F, Catanesi R, Nardulli F, Grattagliano I, Bosco A. The Drives for Driving Simulation: A Scientometric Analysis and a Selective Review of Reviews on Simulated Driving Research. Front Psychol 2020; 11:917. [PMID: 32528360 PMCID: PMC7266970 DOI: 10.3389/fpsyg.2020.00917] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/14/2020] [Indexed: 12/17/2022] Open
Abstract
Driving behaviors and fitness to drive have been assessed over time using different tools: standardized neuropsychological, on-road and driving simulation testing. Nowadays, the great variability of topics related to driving simulation has elicited a high number of reviews. The present work aims to perform a scientometric analysis on driving simulation reviews and to propose a selective review of reviews focusing on relevant aspects related to validity and fidelity. A scientometric analysis of driving simulation reviews published from 1988 to 2019 was conducted. Bibliographic data from 298 reviews were extracted from Scopus and WoS. Performance analysis was conducted to investigate most prolific Countries, Journals, Institutes and Authors. A cluster analysis on authors' keywords was performed to identify relevant associations between different research topics. Based on the reviews extracted from cluster analysis, a selective review of reviews was conducted to answer questions regarding validity, fidelity and critical issues. United States and Germany are the first two Countries for number of driving simulation reviews. United States is the leading Country with 5 Institutes in the top-ten. Top Authors wrote from 3 to 7 reviews each and belong to Institutes located in North America and Europe. Cluster analysis identified three clusters and eight keywords. The selective review of reviews showed a substantial agreement for supporting validity of driving simulation with respect to neuropsychological and on-road testing, while for fidelity with respect to real-world driving experience a blurred representation emerged. The most relevant critical issues were the a) lack of a common set of standards, b) phenomenon of simulation sickness, c) need for psychometric properties, lack of studies investigating d) predictive validity with respect to collision rates and e) ecological validity. Driving simulation represents a cross-cutting topic in scientific literature on driving, and there are several evidences for considering it as a valid alternative to neuropsychological and on-road testing. Further research efforts could be aimed at establishing a consensus statement for protocols assessing fitness to drive, in order to (a) use standardized systems, (b) compare systematically driving simulators with regard to their validity and fidelity, and (c) employ shared criteria for conducting studies in a given sub-topic.
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Affiliation(s)
- Alessandro Oronzo Caffò
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Luigi Tinella
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Antonella Lopez
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giuseppina Spano
- Department of Agricultural and Environmental Science, Faculty of Agricultural Science, University of Bari Aldo Moro, Bari, Italy
| | - Ylenia Massaro
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Andrea Lisi
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | | | - Roberto Catanesi
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Nardulli
- Commissione Medica Locale Patenti Speciali, Azienda Sanitaria Locale, Bari, Italy
| | - Ignazio Grattagliano
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Andrea Bosco
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
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Abstract
Dementia is a risk factor for unsafe driving. Therefore, an assessment strategy has recently been developed for the prediction of fitness to drive in patients with the Alzheimer disease (AD). The aim of this study was to investigate whether this strategy is also predictive of fitness to drive in patients with non-AD dementia, that is, vascular dementia, frontotemporal dementia, and dementia with Lewy bodies. Predictors were derived from 3 types of assessment: clinical interviews, neuropsychological tests, and driving simulator rides. The criterion was the pass-fail outcome of an official on-road driving assessment. About half of the patients with non-AD dementia (n=34) failed the on-road driving assessment. Neuropsychological assessment [area under the curve (AUC)=0.786] was significantly predictive of fitness to drive in patients with non-AD dementia, however, clinical interviews (AUC=0.559) and driving simulator rides (AUC=0.404) were not. The fitness-to-drive assessment strategy with the 3 types of assessment combined (AUC=0.635) was not found to significantly predict fitness to drive in non-AD dementia. Different types of dementia require different measures and assessment strategies.
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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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Fuermaier AB, Piersma D, de Waard D, Davidse RJ, de Groot J, Doumen MJ, Bredewoud RA, Claesen R, Lemstra AW, Scheltens P, Vermeeren A, Ponds R, Verhey F, De Deyn PP, Brouwer WH, Tucha O. Driving Difficulties Among Patients with Alzheimer’s Disease and Other Neurodegenerative Disorders. J Alzheimers Dis 2019; 69:1019-1030. [DOI: 10.3233/jad-181095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anselm B.M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Dafne Piersma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Dick de Waard
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | | | - Jolieke de Groot
- SWOV Institute for Road Safety Research, The Hague, The Netherlands
| | - Michelle J.A. Doumen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- SWOV Institute for Road Safety Research, The Hague, The Netherlands
| | | | - René Claesen
- CBR Dutch driving license authority, Rijswijk, The Netherlands
| | - Afina W. Lemstra
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemiek Vermeeren
- Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Rudolf Ponds
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Peter Paul De Deyn
- Department of Neurology and Alzheimer Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Wiebo H. Brouwer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Department of Neurology and Alzheimer Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
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Rashid R, Standen P, Carpenter H, Radford K. Systematic review and meta-analysis of association between cognitive tests and on-road driving ability in people with dementia. Neuropsychol Rehabil 2019; 30:1720-1761. [DOI: 10.1080/09602011.2019.1603112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Roshe Rashid
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Penny Standen
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Hannah Carpenter
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Radford
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
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Piersma D, Fuermaier ABM, De Waard D, Davidse RJ, De Groot J, Doumen MJA, Ponds RWHM, De Deyn PP, Brouwer WH, Tucha O. Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility. BMC Geriatr 2018; 18:216. [PMID: 30223796 PMCID: PMC6142418 DOI: 10.1186/s12877-018-0910-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/10/2018] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Dafne Piersma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Anselm B. M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Dick De Waard
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | | | - Jolieke De Groot
- SWOV Institute for Road Safety Research, The Hague, The Netherlands
| | - Michelle J. A. Doumen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Rudolf W. H. M. Ponds
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Peter P. De Deyn
- Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Wiebo H. Brouwer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
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Petersen JD, Siersma VD, Depont Christensen R, Storsveen MM, Nielsen CT, Vass M, Waldorff FB. Dementia and road traffic accidents among non-institutionalized older people in Denmark: A Danish register-based nested case-control study. Scand J Public Health 2018; 47:221-228. [PMID: 29914317 DOI: 10.1177/1403494818782094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM We used register-based data to estimate the effect of all-type dementia on road traffic accidents (RTAs) risk, combined with comorbidities or sedative medicines, among non-institutionalized older people in Denmark. METHODS The source population was all residents in Denmark aged 65 years and older, alive as of January 1, 2008 ( n = 853,228). Cases were those who had any type of RTA in 2009-2014. Each case was matched for age, sex and geographic location to 4-6 controls. All-type dementia was ascertained using the International Classification of Diseases version 10 (ICD-10) diagnosis supplemented with prescribed medicine records. Eight chronic diseases were selected to assess comorbidities. Four types of medicines were categorized as sedative medicines for analysis. Conditional logistic regression with adjustment for education and marital status as well as either the number of comorbidities or sedative medications use was performed using STATA software. RESULTS Older people with dementia had lower RTAs risk compared to their controls (odds ratio = 0.43, 95% confidence interval (0.32-0.60), p < 0.001). Significant interaction was observed between dementia and the number of comorbidities for RTAs estimation. CONCLUSIONS The significantly lower RTAs risk for older individuals with dementia observed in our study may be due to people with dementia living at home having a lower frequency of outdoor activities; that is, less exposure to traffic. However, this, together with the interaction between dementia and comorbidities as well as sedative medications, should be investigated further.
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Affiliation(s)
- Jindong Ding Petersen
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Volkert Dirk Siersma
- 3 Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - René Depont Christensen
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maria Munch Storsveen
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Connie Thurøe Nielsen
- 2 Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Mikkel Vass
- 3 Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Hamdy RC, Kinser A, Kendall-Wilson T, Depelteau A, Whalen K, Culp J. Driving and Patients With Dementia. Gerontol Geriatr Med 2018; 4:2333721418777085. [PMID: 29900187 PMCID: PMC5985540 DOI: 10.1177/2333721418777085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/09/2018] [Accepted: 04/09/2018] [Indexed: 11/23/2022] Open
Abstract
Driving is a symbol of autonomy and independence, eagerly awaited during adolescence, cherished during adulthood and reluctantly rescinded during old age. It is nevertheless an individual’s privilege, not right, especially as driving may affect other drivers and pedestrians on the road. It is therefore not only the individual patient who is at stake but essentially the entire community. In this case scenario, we describe the situation that arose when a patient with multi-infarct dementia wanted to go for a drive and his son and grandson tried to convince him that he could no longer drive. What went wrong in the caregivers/patient interaction is presented. The futility of arguing with patients who have dementia is highlighted as well as the suspiciousness it may generate. Alternate actions that can be useful to avoid/avert the situation from escalating and having a catastrophic ending are discussed. Testing/evaluating patients with dementia for fitness to drive is also reviewed and a list of select resources is included.
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Affiliation(s)
- R C Hamdy
- East Tennessee State University, Johnson City, TN, USA
| | - A Kinser
- East Tennessee State University, Johnson City, TN, USA
| | - T Kendall-Wilson
- East Tennessee State University, Johnson City, TN, USA.,Alzheimer's Tennessee, Knoxville, TN, USA
| | - A Depelteau
- East Tennessee State University, Johnson City, TN, USA
| | - K Whalen
- East Tennessee State University, Johnson City, TN, USA
| | - J Culp
- East Tennessee State University, Johnson City, TN, USA
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Versijpt J, Tant M, Beyer I, Bier JC, Cras P, De Deyn PP, De Wit P, Deryck O, Hanseeuw B, Lambert M, Lemper JC, Mormont E, Petrovic M, Picard G, Salmon E, Segers K, Sieben A, Thiery E, Tournoy J, Vandewoude M, Ventura M, Verschraegen J, Engelborghs S, Goffin T, Deneyer M, Ivanoiu A. Alzheimer's disease and driving: review of the literature and consensus guideline from Belgian dementia experts and the Belgian road safety institute endorsed by the Belgian Medical Association. Acta Neurol Belg 2017; 117:811-819. [PMID: 28983881 DOI: 10.1007/s13760-017-0840-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022]
Abstract
Alzheimer's disease (AD) is a highly prevalent condition and its prevalence is expected to further increase due to the aging of the general population. It is obvious that the diagnosis of AD has implications for driving. Finally, driving discussions are also emotionally charged because driving is associated with independence and personal identity. However, it is not clear how to implement this in clinical practice and the Belgian law on driving is rather vague in its referral to neurodegenerative brain diseases in general nor does it provide clear-cut instructions for dementia or AD compared to for example driving for patients with epilepsy and as such does not prove to be very helpful. The present article reviews what is known from both literature and existing guidelines and proposes a consensus recommendation tailored to the Belgian situation agreed by both AD experts and the Belgian Road Safety Institute endorsed by the Belgian Medical Association. It is concluded that the decision about driving fitness should be considered as a dynamic process where the driving fitness is assessed and discussed early after diagnosis and closely monitored by the treating physician. The diagnosis of AD on itself definitely does not imply the immediate and full revocation of a driving license nor does it implicate a necessary referral for a formal on-road driving assessment. There is no evidence to recommend a reduced exposure or a mandatory co-pilot. A MMSE-based framework to trichotomise AD patients as safe, indeterminate or unsafe is presented. The final decision on driving fitness can only be made after careful history taking and clinical examination, neuropsychological, functional and behavioral evaluation and, only for selected cases, a formal assessment of driving performance.
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Fuermaier ABM, Piersma D, de Waard D, Davidse RJ, de Groot J, Doumen MJA, Bredewoud RA, Claesen R, Lemstra AW, Scheltens P, Vermeeren A, Ponds R, Verhey F, Brouwer WH, Tucha O. Assessing fitness to drive-A validation study on patients with mild cognitive impairment. TRAFFIC INJURY PREVENTION 2017; 18:145-149. [PMID: 27623685 DOI: 10.1080/15389588.2016.1232809] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES There is no consensus yet on how to determine which patients with cognitive impairment are able to drive a car safely and which are not. Recently, a strategy was composed for the assessment of fitness to drive, consisting of clinical interviews, a neuropsychological assessment, and driving simulator rides, which was compared with the outcome of an expert evaluation of an on-road driving assessment. A selection of tests and parameters of the new approach revealed a predictive accuracy of 97.4% for the prediction of practical fitness to drive on an initial sample of patients with Alzheimer's dementia. The aim of the present study was to explore whether the selected variables would be equally predictive (i.e., valid) for a closely related group of patients; that is, patients with mild cognitive impairment (MCI). METHODS Eighteen patients with mild cognitive impairment completed the proposed approach to the measurement of fitness to drive, including clinical interviews, a neuropsychological assessment, and driving simulator rides. The criterion fitness to drive was again assessed by means of an on-road driving evaluation. The predictive validity of the fitness to drive assessment strategy was evaluated by receiver operating characteristic (ROC) analyses. RESULTS Twelve patients with MCI (66.7%) passed and 6 patients (33.3%) failed the on-road driving assessment. The previously proposed approach to the measurement of fitness to drive achieved an overall predictive accuracy of 94.4% in these patients. The application of an optimal cutoff resulted in a diagnostic accuracy of 100% sensitivity toward unfit to drive and 83.3% specificity toward fit to drive. Further analyses revealed that the neuropsychological assessment and the driving simulator rides produced rather stable prediction rates, whereas clinical interviews were not significantly predictive for practical fitness to drive in the MCI patient sample. CONCLUSIONS The selected measures of the previously proposed approach revealed adequate accuracy in identifying fitness to drive in patients with MCI. Furthermore, a combination of neuropsychological test performance and simulated driving behavior proved to be the most valid predictor of practical fitness to drive.
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Affiliation(s)
- Anselm B M Fuermaier
- a Department of Clinical and Developmental Neuropsychology , University of Groningen , Groningen , The Netherlands
| | - Dafne Piersma
- a Department of Clinical and Developmental Neuropsychology , University of Groningen , Groningen , The Netherlands
| | - Dick de Waard
- a Department of Clinical and Developmental Neuropsychology , University of Groningen , Groningen , The Netherlands
| | | | - Jolieke de Groot
- b SWOV Institute for Road Safety Research , The Hague , The Netherlands
| | - Michelle J A Doumen
- a Department of Clinical and Developmental Neuropsychology , University of Groningen , Groningen , The Netherlands
| | - Ruud A Bredewoud
- c CBR Dutch Driving Test Organisation , Rijswijk , The Netherlands
| | - René Claesen
- c CBR Dutch Driving Test Organisation , Rijswijk , The Netherlands
| | - Afina W Lemstra
- d Alzheimer Center, Department of Neurology , VU University Medical Center , Amsterdam , The Netherlands
| | - Philip Scheltens
- d Alzheimer Center, Department of Neurology , VU University Medical Center , Amsterdam , The Netherlands
| | - Annemiek Vermeeren
- e Department of Neuropsychology & Psychopharmacology , Maastricht University , Maastricht , The Netherlands
| | - Rudolf Ponds
- f Department of Psychiatry and Neuropsychology , School of Mental Health and Neurosciences (MHeNS), Maastricht University , Maastricht , The Netherlands
| | - Frans Verhey
- f Department of Psychiatry and Neuropsychology , School of Mental Health and Neurosciences (MHeNS), Maastricht University , Maastricht , The Netherlands
| | - Wiebo H Brouwer
- a Department of Clinical and Developmental Neuropsychology , University of Groningen , Groningen , The Netherlands
- g Department of Neurology , University Medical Center Groningen , Groningen , The Netherlands
| | - Oliver Tucha
- a Department of Clinical and Developmental Neuropsychology , University of Groningen , Groningen , The Netherlands
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Abstract
Today, frontotemporal dementia (FTD) remains one of the most common forms of early-onset dementia, that is, before the age of 65, thus posing several diagnostic challenges to clinicians since symptoms are often mistaken for psychiatric or neurological diseases causing a delay in correct diagnosis, and the majority of patients with FTD present with symptoms at ages between 50 and 60. Genetic components are established risk factors for FTD, but the influence of lifestyle, comorbidity, and environmental factors on the risk of FTD is still unclear. Approximately 40% of individuals with FTD have a family history of dementia but less than 10% have a clear autosomal dominant pattern of inheritance. Lack of insight is often an early clue to FTD. A tailored treatment option at an early phase can mitigate suffering and improve patients' and caregivers' quality of life.
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Affiliation(s)
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
| | - Zeina Chemali
- Department of Neurology and Psychiatry, Neuropsychiatry Clinics, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, Neuropsychiatry Clinics, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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Ranchet M, Tant M, Akinwuntan AE, Morgan JC, Devos H. Fitness-to-drive Disagreements in Individuals With Dementia. THE GERONTOLOGIST 2016; 57:833-837. [DOI: 10.1093/geront/gnw119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/19/2016] [Indexed: 11/14/2022] Open
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Piersma D, Fuermaier ABM, de Waard D, Davidse RJ, de Groot J, Doumen MJA, Bredewoud RA, Claesen R, Lemstra AW, Vermeeren A, Ponds R, Verhey F, Brouwer WH, Tucha O. Prediction of Fitness to Drive in Patients with Alzheimer's Dementia. PLoS One 2016; 11:e0149566. [PMID: 26910535 PMCID: PMC4766198 DOI: 10.1371/journal.pone.0149566] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/02/2016] [Indexed: 12/02/2022] Open
Abstract
The number of patients with Alzheimer’s disease (AD) is increasing and so is the number of patients driving a car. To enable patients to retain their mobility while at the same time not endangering public safety, each patient should be assessed for fitness to drive. The aim of this study is to develop a method to assess fitness to drive in a clinical setting, using three types of assessments, i.e. clinical interviews, neuropsychological assessment and driving simulator rides. The goals are (1) to determine for each type of assessment which combination of measures is most predictive for on-road driving performance, (2) to compare the predictive value of clinical interviews, neuropsychological assessment and driving simulator evaluation and (3) to determine which combination of these assessments provides the best prediction of fitness to drive. Eighty-one patients with AD and 45 healthy individuals participated. All participated in a clinical interview, and were administered a neuropsychological test battery and a driving simulator ride (predictors). The criterion fitness to drive was determined in an on-road driving assessment by experts of the CBR Dutch driving test organisation according to their official protocol. The validity of the predictors to determine fitness to drive was explored by means of logistic regression analyses, discriminant function analyses, as well as receiver operating curve analyses. We found that all three types of assessments are predictive of on-road driving performance. Neuropsychological assessment had the highest classification accuracy followed by driving simulator rides and clinical interviews. However, combining all three types of assessments yielded the best prediction for fitness to drive in patients with AD with an overall accuracy of 92.7%, which makes this method highly valid for assessing fitness to drive in AD. This method may be used to advise patients with AD and their family members about fitness to drive.
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Affiliation(s)
- Dafne Piersma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | - Anselm B. M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - Dick de Waard
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | | | - Jolieke de Groot
- SWOV Institute for Road Safety Research, The Hague, the Netherlands
| | - Michelle J. A. Doumen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | | | - René Claesen
- CBR Dutch driving test organisation, Rijswijk, the Netherlands
| | - Afina W. Lemstra
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Annemiek Vermeeren
- Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, the Netherlands
| | - Rudolf Ponds
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Wiebo H. Brouwer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
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