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Davis S, Betz ME, Hill LL, Eby DW, Jones VC, Mielenz TJ, Molnar LJ, Strogatz D, Clancy K, Li G, DiGuiseppi CG. Associations of cannabis use with motor vehicle crashes and traffic stops among older drivers: AAA LongROAD study. TRAFFIC INJURY PREVENTION 2023; 24:307-314. [PMID: 36939676 DOI: 10.1080/15389588.2023.2180736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Acute cannabis use is associated with a higher risk of motor vehicle crashes (MVC). This study aimed to determine if self-reported past-year cannabis use is associated with MVC or traffic stops among older drivers. METHODS This cross-sectional analysis used data from a multi-center study enrolling active drivers aged 65-79 years. Data regarding cannabis use, MVC, and traffic stops (i.e., being pulled over by police, whether ticketed or not) within the previous 12 months were collected through participant interviews. Log-binomial regression models examined associations of past-year cannabis use with MVC and traffic stops, adjusting for site and sociodemographic and mental health characteristics. RESULTS Of 2,095 participating older drivers, 186 (8.88%) used cannabis in the past year but only 10 (<0.5%) within an hour before driving in the last 30 days; 11.41% reported an MVC and 9.45% reported a traffic stop. Past-year cannabis users had a higher prevalence of MVC (adjusted prevalence ratio [aPR] = 1.38; 95%CI: 0.96, 2.00; p = 0.086) and traffic stops (aPR = 1.58; 1.06, 2.35; p = 0.024). CONCLUSIONS Past-year cannabis use was associated with increased traffic stops, which are correlated modestly with increased MVC in past studies and may indicate impaired driving performance. We did not find a statistically significant association of past-year cannabis use with MVC, which may indicate limited sustained effects on driving performance from periodic use among older adults, who report rarely driving immediately after use.
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Affiliation(s)
- Shelby Davis
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), Veterans Health Administration, Aurora, Colorado
| | - Linda L Hill
- School of Public Health, University of California San Diego, La Jolla, California
| | - David W Eby
- University of Michigan Transportation Research Institute, College of Engineering, University of Michigan, Ann Arbor, Michigan
| | - Vanya C Jones
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University Center for Injury Science and Prevention, Columbia University, New York, New York
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, College of Engineering, University of Michigan, Ann Arbor, Michigan
| | - David Strogatz
- Bassett Research Institute, Bassett Healthcare Network, Cooperstown, New York
| | - Kate Clancy
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University Center for Injury Science and Prevention, Columbia University, New York, New York
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Davis J, Hamann C, Butcher BD, Peek-Asa C. Medical referral and license disposition for drivers in Iowa. JOURNAL OF SAFETY RESEARCH 2021; 76:83-89. [PMID: 33653572 DOI: 10.1016/j.jsr.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/29/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Driver retirement and determination of fitness-to-drive are important aspects of reducing the risk of motor-vehicle collision for an older driver. A lack of information about the review process may lead to poor evaluation of drivers or an increased testing burden to referred drivers. METHODS This paper evaluates the license review process for the state of Iowa. We evaluated data from January 2014 to January 2018 and described the source of referral, testing process, and ultimate license disposition. Cox proportional hazards for competing risk were used to determine the risk of having a change in restrictions on the license and the risk of license denial. RESULTS 20,742 individuals were followed through the medical referral process. The most common source of referrals was licensing officials (39.7%). Drivers referred by licensing officials were less likely to be denied their license when compared to drivers from other sources (HR = 0.92 95%CI: 0.87-0.98); however, licensing official referrals were more likely to result in license restrictions compared to other sources (HR = 1.91, 95%CI: 1.82-2.00). Drivers referred by either law enforcement or a physician were more likely to ultimately have their license denied. CONCLUSIONS Physician and law enforcement referred the drivers most likely to have their license denied. A smaller proportion of drivers were referred by physicians and law enforcement compared to licensing officials. Practical Applications: Licensing agencies should work with physicians and law enforcement to identify drivers who may need a review of their license. Comprehensive tracking of all medical referrals for a driver's license review is important for individual states to understand the burden of their driver referral process and for identifying referral sources with a high proportion of referrals with no licensing change for targeted outreach and education.
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Affiliation(s)
- Jonathan Davis
- University of Iowa Injury Prevention Research Center, 2195 Westlawn, Iowa City, IA 52242, USA.
| | - Cara Hamann
- University of Iowa Injury Prevention Research Center, 2195 Westlawn, Iowa City, IA 52242, USA; Department of Epidemiology, College of Public Health, University of Iowa, 145 North Riverside Drive, Iowa City, IA 52242, USA.
| | - Brandon D Butcher
- University of Iowa Injury Prevention Research Center, 2195 Westlawn, Iowa City, IA 52242, USA; 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, 2195 Westlawn, Iowa City, IA 52242, USA; 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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Baines N, Au B, Rapoport MJ, Naglie G, Tierney MC. Meta-analysis of Driving Cessation and Dementia: Does Sex Matter? J Gerontol B Psychol Sci Soc Sci 2019; 73:1185-1189. [PMID: 28025281 DOI: 10.1093/geronb/gbw158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/14/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives The number of drivers with dementia is expected to increase over the coming decades. Because dementia is associated with a higher risk of crashes, driving cessation becomes inevitable as the disease progresses, but many people with dementia resist stopping to drive. This meta-analysis examines whether there are sex differences in the prevalence and incidence of driving cessation among drivers with dementia and compares the pattern of sex differences in drivers with dementia to those without dementia. Method MEDLINE, PsycINFO, Scopus, and CINAHL were searched in July 2015 for observational studies of sex differences in driving cessation. Meta-analyses were performed using a random-effects model. Results Twenty studies provided data on sex differences in driving cessation in older adults with or without dementia. Driving cessation was significantly more prevalent in women with dementia than men (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.50-2.98), and the same pattern was found in women without dementia (OR = 2.74, 95% CI = 1.85-4.06). Discussion Our findings suggest that the patterns of driving cessation differ between men and women with dementia, and this may have implications for sex-specific approaches designed to support drivers with dementia both before and after driving cessation.
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Affiliation(s)
| | - Bonnie Au
- Primary Care Research Unit, Toronto, Ontario, Canada
| | - Mark J Rapoport
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Gary Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Mary C Tierney
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Primary Care Research Unit, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Ontario, Canada
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Schmidt NE, Steffen AM. Neurocognitive Disorder Diagnoses Matter: A Brief Report on Caregiver Appraisal of Driving Ability. J Appl Gerontol 2018; 39:966-970. [PMID: 30280632 DOI: 10.1177/0733464818803006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Age-associated neurocognitive disorders (NCDs) are associated with progressive loss of abilities for instrumental activities of daily living, including driving. This study assesses the impact of NCD diagnosis, while controlling for reported level of cognitive impairment, on family caregiver judgment of driving safety. Method: An intervention sample of 152 intergenerational caregivers who assist an older adult with medical tasks was used. Caregiver's pre-intervention response to a single item of confidence in the older adult driving was used to determine judgment of driving ability. Cognitive impairment was assessed using caregivers' report for Clinical Dementia Rating (CDR) Sum of Boxes score. Results: Older adults with a diagnosis were rated as less capable of driving safely than those without a diagnosis, while controlling for reported level of cognitive impairment. Conclusion: Results of this study highlight the importance of NCD diagnosis on caregiver judgments. Results of this study have implications for health care and driving safety.
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Li G, Eby DW, Santos R, Mielenz TJ, Molnar LJ, Strogatz D, Betz ME, DiGuiseppi C, Ryan LH, Jones V, Pitts SI, Hill LL, DiMaggio CJ, LeBlanc D, Andrews HF. Longitudinal Research on Aging Drivers (LongROAD): study design and methods. Inj Epidemiol 2017; 4:22. [PMID: 28736796 PMCID: PMC5537138 DOI: 10.1186/s40621-017-0121-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/06/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As an important indicator of mobility, driving confers a host of social and health benefits to older adults. Despite the importance of safe mobility as the population ages, longitudinal data are lacking about the natural history and determinants of driving safety in older adults. METHODS The Longitudinal Research on Aging Drivers (LongROAD) project is a multisite prospective cohort study designed to generate empirical data for understanding the role of medical, behavioral, environmental and technological factors in driving safety during the process of aging. RESULTS A total of 2990 active drivers aged 65-79 years at baseline have been recruited through primary care clinics or health care systems in five study sites located in California, Colorado, Maryland, Michigan, and New York. Consented participants were assessed at baseline with standardized research protocols and instruments, including vehicle inspection, functional performance tests, and "brown-bag review" of medications. The primary vehicle of each participant was instrumented with a small data collection device that records detailed driving data whenever the vehicle is operating and detects when a participant is driving. Annual follow-up is being conducted for up to three years with a telephone questionnaire at 12 and 36 months and in-person assessment at 24 months. Medical records are reviewed annually to collect information on clinical diagnoses and healthcare utilization. Driving records, including crashes and violations, are collected annually from state motor vehicle departments. Pilot testing was conducted on 56 volunteers during March-May 2015. Recruitment and enrollment were completed between July 2015 and March 2017. CONCLUSIONS Results of the LongROAD project will generate much-needed evidence for formulating public policy and developing intervention programs to maintain safe mobility while ensuring well-being for older adults.
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Affiliation(s)
- Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. .,Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. .,Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 722 West 168th Street, Room 524, New York, NY, 10032, USA.
| | - David W Eby
- University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | | | - Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | | | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lindsay H Ryan
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Vanya Jones
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Samantha I Pitts
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Linda L Hill
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
| | - Charles J DiMaggio
- Division of Trauma, Emergency Surgery and Surgical Critical Care, New York University School of Medicine, New York, NY, USA
| | - David LeBlanc
- University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | - Howard F Andrews
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
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Hill LL, Laughlin GA, Bettencourt R, Barrett-Connor E. Associations Between Health and Driving in an Older Adult Cohort in Rancho Bernardo. J Aging Health 2016; 29:1367-1387. [PMID: 27492614 DOI: 10.1177/0898264316661828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the associations between health and health care utilization with driving patterns in a cohort of older adults. METHOD In 2012, a total of 1,826 surviving participants in the Rancho Bernardo cohort were sent a health and driving pattern survey; 1,277 were returned. RESULTS The majority of the respondents (1,151, 91%) were still driving. Older age, female sex, hospitalizations, emergency department (ED) visits and physical therapy visits, neurological disease, depression, limited vision, and limited hearing were associated with non-driving status. A total of 809 (71%) of drivers reported no citations or crashes in the last 5 years. DISCUSSION The vast majority of older drivers in this cohort continued to drive, and did so safely. Health care utilization, medications, medical conditions, and self-assessment of health were associated with non-driving status. Prospective studies are needed to clarify the temporal relationships between these factors.
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Affiliation(s)
- Linda L Hill
- 1 University of California, San Diego, La Jolla, 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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Wheatley CJ, Carr DB, Marottoli RA. Consensus statements on driving for persons with dementia. Occup Ther Health Care 2015; 28:132-9. [PMID: 24754761 DOI: 10.3109/07380577.2014.903583] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The presence of dementia can have a profound effect on a person's capacity for driving, and will lead to eventual cessation of driving and reliance on alternative transportation options. This paper offers evidence and discussion that affirm eight consensus statements related to drivers with dementia and the impact of dementia on the driving task. These statements offer guidance for occupational therapy practitioners when addressing driving and community mobility, a valued instrumental task of daily living.
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Affiliation(s)
- Carol J Wheatley
- 1Department of Outpatient Rehabilitation, MedStar Good Samaritan Hospital, 5601 Loch Raven Blvd , Baltimore, Maryland , USA
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Watts A, Ferdous F, Moore KD, Burns JM. Neighborhood Integration and Connectivity Predict Cognitive Performance and Decline. Gerontol Geriatr Med 2015; 1. [PMID: 26504889 PMCID: PMC4618386 DOI: 10.1177/2333721415599141] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: Neighborhood characteristics may be important for promoting walking, but little research has focused on older adults, especially those with cognitive impairment. We evaluated the role of neighborhood characteristics on cognitive function and decline over a 2-year period adjusting for measures of walking. Method: In a study of 64 older adults with and without mild Alzheimer’s disease (AD), we evaluated neighborhood integration and connectivity using geographical information systems data and space syntax analysis. In multiple regression analyses, we used these characteristics to predict 2-year declines in factor analytically derived cognitive scores (attention, verbal memory, mental status) adjusting for age, sex, education, and self-reported walking. Results: Neighborhood integration and connectivity predicted cognitive performance at baseline, and changes in cognitive performance over 2 years. The relationships between neighborhood characteristics and cognitive performance were not fully explained by self-reported walking. Discussion: Clearer definitions of specific neighborhood characteristics associated with walkability are needed to better understand the mechanisms by which neighborhoods may impact cognitive outcomes. These results have implications for measuring neighborhood characteristics, design and maintenance of living spaces, and interventions to increase walking among older adults. We offer suggestions for future research measuring neighborhood characteristics and cognitive function.
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Andrew C, Traynor V, Iverson D. An integrative review: understanding driving retirement decisions for individuals living with a dementia. J Adv Nurs 2015. [PMID: 26224421 DOI: 10.1111/jan.12727] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To synthesise primary research exploring decision making practices used to determine the time to retire from driving for individuals living with a dementia. BACKGROUND Driving requires complex cognitive and physical skills potentially compromised due to the progressive nature of dementia. Whilst on-road assessments are considered reliable indicators of driving capacity by clinicians, drivers with dementia disagree. DESIGN Integrative literature review informed by Whittemore & Knafl (2005). DATA SOURCES Electronic database search of Medline, CINAHL, Web of Science, Google Scholar 1997-2012; and incremental hand search. REVIEW METHODS Primary studies published in peer reviewed journals were appraised against quality assessment criteria using CASP methodological assessment tools. RESULTS A total of 43 studies were retained for synthesis. Key findings were abstracted and a themes matrix was generated to identify patterns of meaning. Six themes emerged: (i) dementia may compromise the complex task of driving; (ii) defining onset and severity of dementia is problematic; (iii) symptom progression impacts on driving skills; (iv) assessment of fitness to drive remains subjective; (v) some drivers are reluctant to accept negative assessment outcomes; and (vi) the search for effective strategies to enhance acceptance of driver retirement continues. CONCLUSION This integrative literature review identified a large body of knowledge exploring the issues of driving cessation for drivers with dementia. However a challenge remains for practitioners, drivers and their family carers regarding how best to address this highly emotive issue. Findings could inform a structured approach to address this sensitive topic in a timely manner.
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Affiliation(s)
- Catherine Andrew
- University of Wollongong, New South Wales, Australia.,CPE, HFESA, Sydney, NSW, Australia
| | | | - Don Iverson
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Carmody J, Potter J, Lewis K, Bhargava S, Traynor V, Iverson D. Development and pilot testing of a decision aid for drivers with dementia. BMC Med Inform Decis Mak 2014; 14:19. [PMID: 24642051 PMCID: PMC3999924 DOI: 10.1186/1472-6947-14-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 03/11/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An increasing number of older adults drive automobiles. Given that the prevalence of dementia is rising, it is necessary to address the issue of driving retirement. The purpose of this study is to evaluate how a self-administered decision aid contributed to decision making about driving retirement by individuals living with dementia. The primary outcome measure in this study was decisional conflict. Knowledge, decision, satisfaction with decision, booklet use and booklet acceptability were the secondary outcome measures. METHODS A mixed methods approach was adopted. Drivers with dementia were recruited from an Aged Care clinic and a Primary Care center in NSW, Australia. Telephone surveys were conducted before and after participants read the decision aid. RESULTS Twelve participants were recruited (mean age 75, SD 6.7). The primary outcome measure, decisional conflict, improved following use of the decision aid. Most participants felt that the decision aid: (i) was balanced; (ii) presented information well; and (iii) helped them decide about driving. In addition, mean knowledge scores improved after booklet use. CONCLUSIONS This decision aid shows promise as an acceptable, useful and low-cost tool for drivers with dementia. A self-administered decision aid can be used to assist individuals with dementia decide about driving retirement. A randomized controlled trial is underway to evaluate the effectiveness of the tool.
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Affiliation(s)
- John Carmody
- Department of Neurology, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2522, Australia
| | - Jan Potter
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2522, Australia
- Department of Aged Care, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Kate Lewis
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2522, Australia
| | - Sanjay Bhargava
- Department of Aged Care, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Victoria Traynor
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2522, Australia
| | - Don Iverson
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2522, Australia
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Abstract
BACKGROUND The impact of dementia on safe driving is well recognized and is generally accepted that all people with dementia are likely to need to cease driving at some stage in the disease process. Both driving and driving cessation can have poor outcomes for people with dementia and their caregivers in terms of health, safety, community access, and well-being. Although approaches to facilitate better outcomes from driving cessation are being developed, the processes of driving cessation for people with dementia are still not fully understood. METHODS Within a descriptive phenomenological framework, semi-structured interviews were undertaken with key stakeholders, including retired drivers with dementia, family members, and health professionals. RESULTS Findings from four retired drivers with dementia, 11 caregivers, and 15 health professionals characterized driving cessation for people with dementia as a process with three stages and associated challenges and needs. The early stage involved worried waiting, balancing safety with impending losses, and the challenge of knowing when to stop. The crisis stage involved risky driving or difficult transportation, acute adjustment to cessation and life without driving, and relationship conflict. The post-cessation stage was described as a long journey with ongoing battles and adjustments as well as decreased life space, and was affected by the disease progression and the exhaustion of caregiver. CONCLUSIONS The concept of stages of driving cessation for people with dementia could be used to develop new approaches or adapt existing approaches to driving cessation. Interventions would need to be individualized, optimally timed, and address grief, explore realistic alternative community access, and simultaneously maintain key relationships and provide caregiver support.
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Abstract
Objective: This study aims to identify social, psychological, and biomedical risk factors for current and future driving cessation in older adults. Method: Data from six waves (1998-2008) of the Health and Retirement Study (HRS) were pooled. Participants aged 65 and above were included in the study ( N = 17,349). Results: Multivariate logistic regression models to identify risk factors for current and future driving cessation were consistent (age, gender, education, race, marital status, income, cognitive function, limits in activities of daily living and instrumental activities of daily living, vision, health, diabetes, stroke, arthritis, and hip fracture). Only one variable, falls, was associated with future driving cessation (odds ratio [OR] = 0.92; confidence interval [CI] = [0.85, 1.0]), but not current driving cessation. Discussion: Older age, female gender, and minority race were risk factors for current and future cessation. Adults with arthritis were more likely to keep driving compared with those without arthritis.
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Affiliation(s)
| | - Chae Man Lee
- The University of Massachusetts Boston, Boston USA
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Kowalski K, Love J, Tuokko H, MacDonald S, Hultsch D, Strauss E. The influence of cognitive impairment with no dementia on driving restriction and cessation in older adults. ACCIDENT; ANALYSIS AND PREVENTION 2012; 49:308-315. [PMID: 23036411 DOI: 10.1016/j.aap.2011.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 11/13/2011] [Accepted: 11/19/2011] [Indexed: 06/01/2023]
Abstract
Cognitively impaired older adults may be at increased risk of unsafe driving. Individuals with insight into their own impairments may minimize their risk by restricting or stopping driving. The purpose of this study was to examine the influence of cognitive impairment on driving status and driving habits and intentions. Participants were classified as cognitively impaired, no dementia single (CIND-single), CIND-multiple, or not cognitively impaired (NCI) and compared on their self-reported driving status, habits, and intentions to restrict or quit driving in the future. The groups differed significantly in driving status, but not in whether they restricted their driving or reduced their driving frequency. CIND-multiple group also had significantly higher intention to restrict/stop driving than the NCI group. Reasons for restricting and quitting driving were varied and many individuals reported multiple reasons, both external and internal, for their driving habits and intentions. Regardless of cognitive status, none of the current drivers were seriously thinking of restricting or quitting driving in the next 6 months. It will be important to determine, in future research, how driving practices change over time and what factors influence decisions to restrict or stop driving for people with cognitive impairment.
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Affiliation(s)
- Kristina Kowalski
- University of Victoria, Department of Psychology, Centre on Aging, Canada.
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15
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Choi M, Adams KB, Mezuk B. Examining the aging process through the stress-coping framework: application to driving cessation in later life. Aging Ment Health 2011; 16:75-83. [PMID: 21702704 PMCID: PMC5704988 DOI: 10.1080/13607863.2011.583633] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aging process is marked by a series of transitions that influence multiple domains of well-being. One important transition for older adults is the process of driving cessation. Numerous studies have examined risk factors for driving cessation among older adults to identify at-risk older drivers for road safety. Recent research has focused on the consequences of driving cessation in later life for health and well-being. However, these reports have been largely empirical and are not drawn from a defined conceptual framework. Establishing a theoretical model of 'how driving cessation interacts with other processes and domains of aging' will promote synthesis of seemingly disparate findings and also link the empirical research on cessation to the broader field of gerontology. This article describes a conceptual model for articulating and examining the components of the driving cessation process based on the stress-coping paradigm. This model situates driving cessation within the context of exogenous stressors, individual vulnerabilities and coping strategies, and environmental hazards and buffers over the lifespan. This model could assist in guiding intervention strategies aimed at reducing premature driving cessation in older drivers with ameliorable impairments while assisting at-risk older drivers to reduce or stop driving in a less stressful way.
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Affiliation(s)
- Moon Choi
- Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
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Arai A, Mizuno Y, Arai Y. Differences in perceptions regarding driving between young and old drivers and non-drivers in Japan. Int J Geriatr Psychiatry 2010; 25:1239-45. [PMID: 21086536 DOI: 10.1002/gps.2457] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The issue of driving cessation for dementia patients is one of the urgent public health priorities in Japan and is often complicated, with family or social barriers yet to be sufficiently addressed. Because the possibility of dementia or family caregiving can befall anyone, we focused on the disparity in people's perceptions of driving as possible barriers. The present study aimed to assess perceptions of driving among the general public and examine differences in perceptions based on age and driving status. METHODS A survey was conducted in a sample of the general public aged 40 and over in Japan. Respondents were 1010 people who received a self-administered questionnaire that included questions regarding perceptions about driving and sociodemographic factors. RESULTS The drivers that participated in this study tended to highly agree that 'driving is a "right" which we all deserve', compared with the non-drivers. The most common reason for reluctance to stop driving among drivers was the possible loss of personal mobility. Apart from transportation, older drivers were more likely than younger drivers to value the qualitative aspects of driving, for example, driving was viewed as 'a motivating factor in my life'. CONCLUSIONS These disparities in the general public's perceptions about driving may be possible family or social barriers to driving cessation in the case of drivers with dementia. Our findings also suggest that when addressing the need for driving retirement, not only mobility but also the qualitative aspects of driving be paid more attention.
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Affiliation(s)
- Asuna Arai
- Department of Gerontological Policy, National Institute for Longevity Sciences, National Center for Geriatrics and Gerontology, Aichi, Japan
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Ackerman ML, Edwards JD, Ross LA, Ball KK, Lunsman M. Examination of cognitive and instrumental functional performance as indicators for driving cessation risk across 3 years. THE GERONTOLOGIST 2009; 48:802-10. [PMID: 19139253 DOI: 10.1093/geront/48.6.802] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to prospectively examine the role of cognitive and instrumental functional performance in driving cessation while simultaneously accounting for any contributions of demographics, vision, physical performance, and health among a sample of older adults without dementia. DESIGN AND METHODS Included in the analyses were 1,838 participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were drivers at baseline and completed the third-year assessment. Participants completed baseline assessments of sociodemographic characteristics, health, sensory function, physical function, cognitive abilities, instrumental functional performance, and depressive symptoms. Driving status was again ascertained 3 years later. RESULTS We used Cox proportional hazard analyses to examine prospective predictors of driving cessation over a 3-year period. The final model indicated four significant risk factors for driving cessation: older age (hazard ratio [HR] = 1.06, p = .009), poorer balance as measured by the Turn 360 degrees test (HR = 1.17, p = .002), slower cognitive speed of processing as measured by the Useful Field of View test (HR = 1.37, p = .004), and poorer instrumental functional performance as assessed by the Everyday Problems Test (HR = 1.59, p < .001). IMPLICATIONS Although vision, health, and physical abilities are commonly considered when determining driving capacity, cognitive speed of processing and instrumental functional performance may be better indicators of subsequent likelihood of driving cessation across 3 years among older adults. Poor health and vision may only impact driving cessation to the extent that cognitive speed of processing and instrumental functioning are affected.
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Abstract
In order to characterize the driving and mobility status of older adults with dementia, a questionnaire was mailed to 527 informants; 119 were returned. The majority of patients were diagnosed with Dementia of the Alzheimer's Type. Only 28% were actively driving at the time of survey. Informants rated 53% of current or recently retired drivers as potentially unsafe. Few informants reported using community/educational resources. Individuals with progressive dementia retire from driving for differing reasons, many subsequent to family recognition of impaired driving performance. Opportunities for education and supportive assistance exist but are underutilized.
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Literature Review on Older Adult Gender Differences for Driving Self-regulation and Cessation. TOPICS IN GERIATRIC REHABILITATION 2009. [DOI: 10.1097/tgr.0b013e3181a10305] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- David B Carr
- Division of Geriatrics, Department of Medicine, and the Alzheimer's Disease Research Center, Washington University in St. Louis School of Medicine, St. Louis, Mo 63108, USA
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