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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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2
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Savoie C, Lavallière M, Voyer P, Bouchard S. Road safety of older drivers and the nursing profession: A scoping review. Int J Older People Nurs 2022; 17:e12452. [DOI: 10.1111/opn.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/05/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Camille Savoie
- Faculté des Sciences Infirmières Université Laval Quebec City Quebec Canada
| | - Martin Lavallière
- Département des Sciences de la Santé Université du Québec à Chicoutimi Chicoutimi Quebec Canada
| | - Philippe Voyer
- Faculté des Sciences Infirmières Université Laval Quebec City Quebec Canada
| | - Suzanne Bouchard
- Faculté des Sciences Infirmières Université Laval Quebec City Quebec Canada
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Vasques AM, Borelli WV, Pinho MS, Portuguez MW. Verbal Learning as a predictor of risks of accidents in elderly drivers. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 80:30-36. [PMID: 34932652 PMCID: PMC9651506 DOI: 10.1590/0004-282x-anp-2021-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Age-related cognitive decline impacts cognitive abilities essential for driving. OBJECTIVE We aimed to measure main cognitive functions associated with a high number of traffic violations in different driving settings. METHODS Thirty-four elderly individuals, aged between 65 and 90 years, were evaluated with a driving simulator in four different settings (Intersection, Overtaking, Rain, and Malfunction tasks) and underwent a battery of cognitive tests, including memory, attention, visuospatial, and cognitive screening tests. Individuals were divided into two groups: High-risk driving (HR, top 20% of penalty points) and normal-risk driving (NR). Non-parametric group comparison and regression analysis were performed. RESULTS The HR group showed higher total driving penalty score compared to the NR group (median=29, range= 9-44 vs. median=61, range= 47-97, p<0.001). The HR group showed higher penalty scores in the Intersection task (p<0.001) and the Overtaking and Rain tasks (p<0.05 both). The verbal learning score was significantly lower in the HR group (median=33, range=12-57) compared with the NR group (median=38, range=23-57, p<0.05), and it was observed that this score had the best predictive value for worse driving performance in the regression model. General cognitive screening tests (Mini-Mental State Examination and Addenbrooke's Cognitive Evaluation) were similar between the groups (p>0.05), with a small effect size (Cohen's d=0.3 both). CONCLUSION The verbal learning score may be a better predictor of driving risk than cognitive screening tests. High-risk drivers also showed significantly higher traffic driving penalty scores in the Intersection, Overtaking, and Rain tests.
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Affiliation(s)
- Adriana Machado Vasques
- Brain Institute of Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil.,Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Wyllians Vendramini Borelli
- Brain Institute of Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil.,Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Márcio Sarroglia Pinho
- Escola Politécnica, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Mirna Wetters Portuguez
- Brain Institute of Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil.,Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil
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Unsworth CA, Russell K, Lovell R, Woodward M, Browne M. Effect of Navigation Problems, Assessment Location, and a Practice Test on Driving Assessment Performance for People with Alzheimer's Disease. J Alzheimers Dis 2019; 67:1035-1043. [PMID: 30776013 DOI: 10.3233/jad-181069] [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: 11/15/2022]
Abstract
BACKGROUND People with Alzheimer's disease may be required to undertake clinical and on-road assessments to determine fitness to drive. The manner in which on-road assessments are conducted with drivers who do and do not have navigational problems may affect the outcome. OBJECTIVES Investigate the effect of 1) navigational difficulties, 2) location of assessment (un/familiar area) and assessment order, and 3) undertaking a second assessment (practice), on passing an on-road driving assessment. METHODS Forty-three drivers undertook an Occupational Therapy-Driver Assessment Off Road Assessment (OT-DORA) Battery which included the Drive Home Maze Test (DHMT). Participants with/without a history of navigational problems were randomly allocated into three groups: 1) Unfamiliar/then familiar area assessment; 2) Unfamiliar/unfamiliar; 3) familiar/unfamiliar. An on-road assessment protocol was used including over 100 expected behaviors at nominated points along the directed route. For familiar area assessments, the driver self-navigated from their home to shops and services. A pass/fail decision was made for each assessment. RESULTS A generalized linear mixed effects model showed neither location, nor practice affected passing the on-road assessment. Participants with navigational problems were six times less likely to pass regardless of route familiarity and direction method, and the DHMT was a significant negative predictor of passing. CONCLUSION Drivers with Alzheimer's disease who have navigational problems and are slow to complete the DHMT are unlikely to pass an on-road assessment. However, navigation and maze completion skills may be a proxy for an underlying cognitive skill underpinning driving performance.
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Affiliation(s)
- Carolyn A Unsworth
- School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, VIC, Australia
| | - Kay Russell
- Austin Health, Heidelberg West, VIC, Australia
| | - Robin Lovell
- Swinburne University of Technology, Melbourne, Australia
| | | | - Matthew Browne
- School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, VIC, Australia
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5
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Piersma D, Fuermaier ABM, de Waard D, De Deyn PP, Davidse RJ, de Groot J, Doumen MJA, Bredewoud RA, Claesen R, Lemstra AW, Vermeeren A, Ponds R, Verhey F, Brouwer WH, Tucha O. The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer's dementia. Acta Neurol Belg 2018; 118:637-642. [PMID: 30390211 PMCID: PMC6244746 DOI: 10.1007/s13760-018-1036-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022]
Abstract
Since Alzheimer’s disease may affect driving performance, patients with Alzheimer’s disease are assessed on fitness to drive. On-road driving assessments are widely used, and attempts have also been made to develop strategies to assess fitness to drive in a clinical setting. Preferably, a first indication of fitness to drive is obtained quickly after diagnosis using a single test such as the Mini-Mental State Examination (MMSE). The aim of this study is to investigate whether the MMSE can be used to predict whether patients with Alzheimer’s disease will pass or fail an on-road driving assessment. Patients with Alzheimer’s disease (n = 81) participated in a comprehensive fitness-to-drive assessment which included the MMSE as well as an on-road driving assessment [PLoS One 11(2):e0149566, 2016]. MMSE cutoffs were applied as suggested by Versijpt and colleagues [Acta Neurol Belg 117(4):811–819, 2017]. All patients with Alzheimer’s disease who scored below the lower cutoff (MMSE ≤ 19) failed the on-road driving assessment. However, a third of the patients with Alzheimer’s disease who scored above the upper cutoff (MMSE ≥ 25) failed the on-road driving assessment as well. We conclude that the MMSE alone has insufficient predictive value to correctly identify fitness to drive in patients with very mild-to-mild Alzheimer’s disease implicating the need for comprehensive assessments to determine fitness to drive in a clinical setting.
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Sinnott C, Foley T, Forsyth J, McLoughlin K, Horgan L, Bradley CP. Consultations on driving in people with cognitive impairment in primary care: A scoping review of the evidence. PLoS One 2018; 13:e0205580. [PMID: 30321219 PMCID: PMC6188864 DOI: 10.1371/journal.pone.0205580] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/27/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To review the empirical evidence on approaches used by Primary Care Physicians (PCPs) in fitness to drive (FtD) consultations with people living with cognitive impairment. DESIGN Scoping review of empirical literature focused on primary studies of any design. SETTING Primary care practice. PARTICIPANTS PCPs or their equivalent and/ or individuals with cognitive impairment across the spectrum of mild cognitive impairment to dementia. MEASUREMENTS Systematic search of Medline, Cinahl, PsychINFO, Academic Search Complete, Psychological and Behavioural Sciences Collection, SocIndex and Social Sciences FT were conducted. Records screened by two reviewers against agreed inclusion criteria. Mixed studies (qualitative and quantitative) were synthesized within overarching themes. RESULTS Eighteen studies met our inclusion criteria. Synthesized data showed PCPs have mixed feelings on the appropriateness of their role in FtD assessments, with many feeling particularly uncomfortable and lacking confidence in the context of possible cognitive impairment. Reasons include lack of familiarity with legal requirements and local resources; fear of damaging the doctor-patient relationship; and impact on the patient's quality of life. Patients voiced their desire to maintain agency in planning their driving cessation. Studies evaluating pragmatic educational programmes suggest these can improve physician confidence in FtD consultations. CONCLUSION The increasing number of older people affected by cognitive impairment, for whom driving may be a concern, has implications for primary care practice. Addressing the reasons for PCPs lack of comfort in dealing with this issue is essential in order for them to better engage in, collaborative discussion with patients on plans and preferences for driving cessation.
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Affiliation(s)
- Carol Sinnott
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, United Kingdom
- Department of General Practice, University College Cork, Cork, Ireland
- * E-mail:
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Justin Forsyth
- Department of General Practice, University College Cork, Cork, Ireland
| | | | - Linda Horgan
- Department of Occupational Science and Occupational Therapy, University College Cork, Cork, Ireland
| | - Colin P. Bradley
- Department of General Practice, University College Cork, Cork, Ireland
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7
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Rapoport MJ, Zucchero Sarracini C, Kiss A, Lee L, Byszewski A, Seitz DP, Vrkljan B, Molnar F, Herrmann N, Tang-Wai DF, Frank C, Henry B, Pimlott N, Masellis M, Naglie G. Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial. J Med Internet Res 2018; 20:e194. [PMID: 29802093 PMCID: PMC5993977 DOI: 10.2196/jmir.9126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/10/2018] [Accepted: 03/08/2018] [Indexed: 11/25/2022] Open
Abstract
Background Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. Objective The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. Methods The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. Results A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=−0.19, P=.85). Two variables predicted algorithm-based reporting—caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001). Conclusions On the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians. Trial Registration ClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8)
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Affiliation(s)
- Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna Byszewski
- Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Geriatric Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dallas P Seitz
- Seniors Mental Health Program, Providence Care, Kingston, ON, Canada.,Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Frank Molnar
- Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Geriatric Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David F Tang-Wai
- Memory Clinic, University Health Network, Toronto, ON, Canada.,Division of Neurology, Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Frank
- Specialized Geriatric Services, Providence Care, Kingston, ON, Canada.,Division of Geriatric Medicine, Queen's University, Kingston, ON, Canada
| | - Blair Henry
- Clinical Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicholas Pimlott
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Mario Masellis
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Gary Naglie
- Department of Medicine, Baycrest Health Sciences, Toronto, ON, Canada.,Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
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8
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Fraade-Blanar LA, Ebel BE, Larson EB, Sears JM, Thompson HJ, Chan KCG, Crane PK. Cognitive Decline and Older Driver Crash Risk. J Am Geriatr Soc 2018; 66:1075-1081. [PMID: 29667168 DOI: 10.1111/jgs.15378] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine automobile crash risk associated with cognition in older drivers without dementia. DESIGN Retrospective secondary analysis of longitudinal cohort study. SETTING Our study used data from the Adult Changes in Thought (ACT) Study merged with Washington State crash reports and licensure records. Data were available from 2002 to 2015. PARTICIPANTS Group Health enrollees from Washington State aged 65 and older with active driver's licenses (N=2,615). MEASUREMENTS Cognitive function was assessed using the Cognitive Abilities Screening Instrument scored using item response theory (CASI-IRT). The study outcome was police-reported motor vehicle crash. We used a negative binomial mixed-effects model with robust standard errors clustered on the individual and considered associations between crash risk, level of cognition, and amount of decline since the previous study visit. Covariates included age, sex, education, alcohol, depression, medical comorbidities, eyesight, hearing, and physical function. Individuals were censored at dementia diagnosis, death, or failure to renew their license. RESULTS Over an average of 7 years of follow-up, 350 (13%) people had at least one crash. A 1-unit lower CASI-IRT score was associated with a higher adjusted incidence rate ratio of crash of 1.26 (95% confidence interval=1.08-1.51). Beyond level of cognition, amount of cognitive decline between study visits was not associated with crash risk. CONCLUSION This study suggests that, in older drivers, poorer performance on the CASI-IRT may be a risk factor for motor vehicle crashes, even in individuals without diagnosed dementia. Further research is needed to understand driving behavior and inform driving decisions for older adults with poor cognitive function.
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Affiliation(s)
- Laura A Fraade-Blanar
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Beth E Ebel
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.,Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jeanne M Sears
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.,Harborview Injury Prevention and Research Center, Seattle, Washington.,Institute for Work and Health, Seattle, Washington
| | - Hilaire J Thompson
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington
| | - Kwun Chuen G Chan
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.,Department of Biostatistics, University of Washington, Seattle, Washington
| | - Paul K Crane
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.,Department of Medicine, University of Washington, Seattle, Washington
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Naidu A, McKeith IG. Driving, dementia and the Driver and Vehicle Licensing Agency: a survey of old age psychiatrists. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.30.7.265] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodWe surveyed old age psychiatrists in the north-east of England to determine what they considered relevant indicators of driving ability. The survey asked about their satisfaction with the current Driver and Vehicle Licensing Agency (DVLA) procedure of assessing competence to drive in patients with dementia and how they thought this could be improved.ResultsFifty-seven out of 76 psychiatrists (75%) responded; 26 (45%) respondents thought the forms issued by the DVLA were unsatisfactory but 32 (57%) were satisfied with the eventual decisions made about individual patients. Factors thought to be relevant indicators of driving ability were occupational therapy (n=46, 81%), neuropsychological assessments (n=43, 75%) and carer's report of driving (n=48, 84%). Factors thought not to be relevant were patient's report of driving ability (n=13, 23%) and the Mini Mental State Examination (n=21, 38%).Clinical ImplicationsThe current system for determining driving ability in people with cognitive impairment and dementia was felt to be unsatisfactory. A multidisciplinary approach and use of on-road driving assessments may improve decision-making.
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10
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Kim YJ, An H, Kim B, Park YS, Kim KW. An International Comparative Study on Driving Regulations on People with Dementia. J Alzheimers Dis 2017; 56:1007-1014. [DOI: 10.3233/jad-160762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- You Joung Kim
- National Institute of Dementia, Seongnam, South Korea
| | - Hoyoung An
- National Institute of Dementia, Seongnam, South Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Binna Kim
- National Institute of Dementia, Seongnam, South Korea
| | - Young Shin Park
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Ki Woong Kim
- National Institute of Dementia, Seongnam, South Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
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11
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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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12
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Unsworth C, Chan SP. Determining fitness to drive among drivers with Alzheimer’s disease or cognitive decline. Br J Occup Ther 2015. [DOI: 10.1177/0308022615604645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Fitness to drive skills progressively deteriorate following a diagnosis of Alzheimer’s disease/cognitive decline. Occupational therapists require standardised assessments to help them make recommendations to clients and licensing authorities regarding client fitness to drive. This research aimed to determine whether drivers in the early stages of Alzheimer’s disease/cognitive decline can drive safely, and if this could be predicted using the occupational therapy – driver off-road assessment battery (OT-DORA Battery). Method Drivers with Alzheimer’s disease/cognitive decline were assessed by one of nine driver assessors over 18 months. Client data were collected on the OT-DORA Battery and following on-road assessment; the outcome was recorded as pass, pass with conditions, or fail. Results A total of 63 clients were assessed, and n = 40 (63.5%) were passed as fit to drive, of whom 33(83%) had at least one condition placed on their licence. Client age and scores on four subtests of the OT-DORA Battery were predictive of outcome. Conclusion A diagnosis of Alzheimer’s disease/cognitive decline should not automatically preclude driving. Scores on four of the subtests from the OT-DORA Battery may be used to help determine whether a client is fit to drive or not fit to drive, or whether a client should be referred for specialist occupational therapy driver assessment.
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Affiliation(s)
- Carolyn Unsworth
- Professor of Occupational Therapy, School of Human, Health and Social Sciences, CQ University, Melbourne, Australia
- Adjunct Professor, Jönköping University, Sweden
- Adjunct Professor of Occupational Therapy, Curtin University, Perth, Australia
- Adjunct Professor of Occupational Therapy, La Trobe University Melbourne, Australia
| | - Siew-Pang Chan
- Assistant Director, Yong Loo Lin School of Medicine, National University of Singapore
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Piersma D, de Waard D, Davidse R, Tucha O, Brouwer W. Car drivers with dementia: Different complications due to different etiologies? TRAFFIC INJURY PREVENTION 2015; 17:9-23. [PMID: 25874501 DOI: 10.1080/15389588.2015.1038786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Older drivers with dementia are an at-risk group for unsafe driving. However, dementia refers to various etiologies and the question is whether dementias of different etiology have similar effects on driving ability. METHODS The literature on the effects of dementia of various etiologies on driving ability is reviewed. Studies addressing dementia etiologies and driving were identified through PubMed, PsychINFO, and Google Scholar. RESULTS AND CONCLUSIONS Early symptoms and prognoses differ between dementias of different etiology. Therefore, different etiologies may represent different likelihoods with regard to fitness to drive. Moreover, dementia etiologies could indicate the type of driving problems that can be expected to occur. However, there is a great lack of data and knowledge about the effects of almost all etiologies of dementia on driving. One could hypothesize that patients with Alzheimer's disease may well suffer from strategic difficulties such as finding a route, whereas patients with frontotemporal dementia are more inclined to make tactical-level errors because of impaired hazard perception. Patients with other dementia etiologies involving motor symptoms may suffer from problems on the operational level. Still, the effects of various etiologies of dementias on driving have thus far not been studied thoroughly. For the detection of driving difficulties in patients with dementia, structured interviews with patients but also their family members appear crucial. Neuropsychological assessment could support the identification of cognitive impairments. The impact of such impairments on driving could also be investigated in a driving simulator. In a driving simulator, strengths and weaknesses in driving behavior can be observed. With this knowledge, patients can be advised appropriately about their fitness to drive and options for support in driving (e.g., compensation techniques, car adaptations). However, as long as no valid, reliable, and widely accepted test battery is available for the assessment of fitness to drive, costly on-road test rides are inevitable. The development of a fitness-to-drive test battery for patients with dementia could provide an alternative for these on-road test rides, on condition that differences between dementia etiologies are taken into consideration.
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Affiliation(s)
- Dafne Piersma
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Dick de Waard
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Ragnhild Davidse
- b SWOV Institute for Road Safety Research , The Hague , The Netherlands
| | - Oliver Tucha
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Wiebo Brouwer
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
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Bryden KJ, Charlton J, Oxley J, Lowndes G. Older driver and passenger collaboration for wayfinding in unfamiliar areas. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2014. [DOI: 10.1177/0165025414531466] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Passenger collaboration offers a potential compensatory strategy to assist older drivers who have difficulty driving in unfamiliar areas (wayfinding). This article describes a survey of 194 healthy, community-dwelling older drivers and their regular passengers to investigate how passengers assist drivers, and to identify the characteristics of drivers and passengers who regularly collaborate to assist with wayfinding. Three aspects of passenger assistance were investigated: Pre-trip planning, directional guidance and searching for visual cues. Results revealed a high incidence of collaboration amongst drivers and passengers who regularly drive together. Collaboration was dependent on the perceived wayfinding abilities of the driver by both passenger and driver, suggesting that passengers are more likely to help if they think they will be of assistance. This information provides baseline information on which future research can examine the safety benefits of passenger assistance in wayfinding.
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Abstract
Driving is a highly valued instrumental activity of daily living, especially for the older adults who consider it part of their definition of independence and mobility. This paper discusses the issues associated with driving and older adults, including the difficulty of identifying when it is time to give up the keys. With a review of the latest research and need for specialized services for those with diminished capacity, the paper highlights how general practice occupational therapists must work in conjunction with driver rehabilitations specialists to meet the need of this growing population. A framework for referral and judgment is described and resources offered to practitioners to use.
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Affiliation(s)
- Anne E Dickerson
- Professor, Department of Occupational Therapy, East Carolina University , Greenville, NC. USA
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Ott BR, Davis JD, Papandonatos GD, Hewitt S, Festa EK, Heindel WC, Snellgrove CA, Carr DB. Assessment of driving-related skills prediction of unsafe driving in older adults in the office setting. J Am Geriatr Soc 2013; 61:1164-9. [PMID: 23730836 DOI: 10.1111/jgs.12306] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the sensitivity and specificity of the Assessment of Driving-Related Skills (ADReS), a clinical tool recommended by the American Medical Association for identifying potentially unsafe older drivers that includes tests of vision, motor function, and cognition. DESIGN Cross-sectional observation study. SETTING Memory assessment outpatient clinic of a university hospital. PARTICIPANTS Drivers with normal cognition (n = 47) and cognitive impairment (n = 75). MEASUREMENTS A neurologist completed the ADReS during an office visit. Additional cognitive tests of executive, visuospatial, and visuomotor function were also performed. On a separate day, participants completed a standardized on-road test, assessed by a professional driving instructor using a global safety rating and a quantitative driving score. RESULTS In this sample of currently active older drivers with and without cognitive impairment, measures of cognition-particularly the Trail-Making Test Part B-were more highly correlated with driving scores than other measures of function. Using recommended scoring procedures, the ADReS had a sensitivity of 0.81 for detecting impaired driving on the road test, with a specificity of 0.32 and an area under the receiver operating characteristic curve (AUC) of 0.57. A logistic regression model that incorporated computerized maze task and Mini-Mental State Examination scores improved overall classification accuracy, yielding a sensitivity of 0.61, a specificity of 0.84, and an AUC of 0.80. CONCLUSION In its present form, the ADReS has limited utility as an office screen for individuals who should undergo formal driving assessment. Improved scoring methods and screening tests with greater diagnostic accuracy than the ADReS are needed for general office practice.
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Affiliation(s)
- Brian R Ott
- Department of Neurology, Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, Rhode Island 02903, USA.
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Anderson SW, Aksan N, Dawson JD, Uc EY, Johnson AM, Rizzo M. Neuropsychological assessment of driving safety risk in older adults with and without neurologic disease. J Clin Exp Neuropsychol 2012; 34:895-905. [PMID: 22943767 PMCID: PMC3910382 DOI: 10.1080/13803395.2011.630654] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Decline in cognitive abilities can be an important contributor to the driving problems encountered by older adults, and neuropsychological assessment may provide a practical approach to evaluating this aspect of driving safety risk. The purpose of the present study was to evaluate several commonly used neuropsychological tests in the assessment of driving safety risk in older adults with and without neurological disease. A further goal of this study was to identify brief combinations of neuropsychological tests that sample performances in key functional domains and thus could be used to efficiently assess driving safety risk. A total of 345 legally licensed and active drivers over the age of 50, with no neurologic disease (N = 185), probable Alzheimer's disease (N = 40), Parkinson's disease (N = 91), or stroke (N = 29), completed vision testing, a battery of 10 neuropsychological tests, and an 18-mile drive on urban and rural roads in an instrumented vehicle. Performances on all neuropsychological tests were significantly correlated with driving safety errors. Confirmatory factor analysis was used to identify 3 key cognitive domains assessed by the tests (speed of processing, visuospatial abilities, and memory), and several brief batteries consisting of one test from each domain showed moderate corrected correlations with driving performance. These findings are consistent with the notion that driving places demands on multiple cognitive abilities that can be affected by aging and age-related neurological disease, and that neuropsychological assessment may provide a practical off-road window into the functional status of these cognitive systems.
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Affiliation(s)
- Steven W Anderson
- Division of Neuroergonomics, Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
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Relationship of Physical and Functional Independence and Perceived Quality of Life of Veteran Patients With Alzheimer Disease. Am J Hosp Palliat Care 2012; 30:462-6. [DOI: 10.1177/1049909112453868] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Alzheimer disease not only affects the cognitive function but also impacts one’s abilities to perform daily tasks. This study evaluated for correlation between the quality of life of patients with Alzheimer disease (QoL-AD) and the level of independence and to evaluate the statistical difference between patients’ quality of life and proxy perception of quality of life by utilizing the Katz activities of daily living and QoL-AD on patients and QoL-AD on caregivers. There was a small positive correlation ( r = .13) between the levels of physical and functional independence and the perceived QoL. Also, patient consistently had higher QoL-AD than their caregiver counterparts. These findings provide some insight into our need to acknowledge factors that may influence QoL and illustrate the importance of monitoring for executive dysfunction and the safety risk.
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Watanabe T, Konagaya Y, Yanagi T, Miyao M, Mukai M, Shibayama H. Study of Daily Driving Characteristics of Individuals with Dementia Using Video-Recording Driving Recorders. J Am Geriatr Soc 2012; 60:1381-3. [DOI: 10.1111/j.1532-5415.2012.04011.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Yoko Konagaya
- Obu Dementia Care Research and Training Center; Obu City; Japan
| | - Tsutomu Yanagi
- Obu Dementia Care Research and Training Center; Obu City; Japan
| | - Masaru Miyao
- Graduate School of Information Science; Nagoya University; Nagoya City; Japan
| | - Marehiro Mukai
- School of Psychology; Chukyo University; Nagoya City; Japan
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Adler G, Rottunda SJ. The driver with dementia: a survey of physician attitudes, knowledge, and practice. Am J Alzheimers Dis Other Demen 2011; 26:58-64. [PMID: 21282279 PMCID: PMC10845376 DOI: 10.1177/1533317510390350] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND One of the most difficult issues physicians must address when caring for persons with dementia is fitness to drive. The purpose of this project was to investigate the attitudes, knowledge, and practices of physicians toward drivers with dementia. METHODS A questionnaire that obtained perspectives about and experiences with drivers' with dementia was mailed to physicians from North Carolina and South Carolina. RESULTS The sample was comprised of 239 physicians who worked with persons with dementia. Respondents who were aware of the Physician's Guide to Assessing and Counseling Older Drivers, had a strong perceived role regarding driving, were older, and believed it was important to address driving were more likely to engage in driving discussions. CONCLUSIONS Concerns associated with the driver with dementia have implications for not only patient care but also public safety. We recommend that all physicians be encouraged to address the issue and utilize existing educational materials.
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Affiliation(s)
- Geri Adler
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.
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Dickerson AE, Reistetter T, Davis ES, Monahan M. Evaluating Driving as a Valued Instrumental Activity of Daily Living. Am J Occup Ther 2011; 65:64-75. [DOI: 10.5014/ajot.2011.09052] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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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Segal-Gidan F, Varma R, Salazar X, Mack WJ. Factors influencing driving status in an older Latino population. J Aging Health 2010; 22:332-47. [PMID: 20142628 DOI: 10.1177/0898264309358763] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study aims at examining factors associated with driving status and self-reported driving difficulty, with particular attention to vision and cognitive impairment. METHOD This study uses cross-sectional data from 421 elderly Latino participants in the Los Angeles Latino Eye Study (LALES) along with cognitive screening, and comparison is by driving status (currently driving, used to drive, never drove) and self-reported difficulty driving among current drivers. RESULTS Current drivers were more educated and reported better health.Those who never drove were less acculturated.Those who gave up driving had more visual impairment and lower scores on mental status testing. Self-reported difficulties among current drivers were associated with more health problems but not cognitive difficulties. DISCUSSION Elderly Latinos have a lower driving rate than the general older population. There are significant differences between older Latinos who continue to drive versus those who never drove or have stopped driving. Poorer cognitive performance and poorer vision are associated with driving cessation.
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Affiliation(s)
- Freddi Segal-Gidan
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Kreutzer JS, Livingston LA, Everley RS, Gary KW, Arango-Lasprilla JC, Powell VD, Marwitz JH. Caregivers' Concerns about Judgment and Safety of Patients with Brain Injury: A Preliminary Investigation. PM R 2009; 1:723-8. [DOI: 10.1016/j.pmrj.2009.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 07/09/2009] [Accepted: 07/10/2009] [Indexed: 10/20/2022]
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Lukas A, Nikolaus T. Fahreignung bei Demenz. Z Gerontol Geriatr 2009; 42:205-11. [PMID: 19562428 DOI: 10.1007/s00391-009-0036-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 03/25/2009] [Accepted: 03/30/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Albert Lukas
- Bethesda Geriatrische Klinik Ulm, Akademisches Krankenhaus Universität Ulm, Ulm, Deutschland.
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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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Caregiver Communications and the Transition From Driver to Passenger Among People With Dementia. TOPICS IN GERIATRIC REHABILITATION 2009. [DOI: 10.1097/tgr.0b013e31819149ee] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Leproust S, Lagarde E, Salmi LR. Risks and advantages of detecting individuals unfit to drive: a Markov decision analysis. J Gen Intern Med 2008; 23:1796-803. [PMID: 18780128 PMCID: PMC2585670 DOI: 10.1007/s11606-008-0777-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Revised: 07/03/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many countries have initiated legislation to detect individuals who are unfit to drive, without any evidence that positive effects of these screening procedures outweigh negative effects. OBJECTIVE To measure the potential effectiveness of a screening program to detect individuals unfit to drive. DESIGN Markov decision analysis was used to compare no screening to two potential screening strategies. PARTICIPANTS Hypothetical cohorts of 10,000 45-year-old, 65-year-old, 75-year-old and 85-year-old individuals seen in primary care practices. INTERVENTIONS Within the screening strategies: a clinical test without on-road confirmatory testing; a clinical test with on-road confirmatory testing, and an imposed driving cessation for patients with a positive test. MEASUREMENTS For each strategy, we compared for two conditions (sleep disorders and dementia) the numbers of crash-related consequences prevented and of adverse events induced (primary objective) and measured the gain in quality-adjusted life years (secondary objective). RESULTS For sleep disorders, on-road confirmatory annual testing was the preferred strategy. Whatever the medical condition and age when screening starts, no screening was always better than single-test screening without an on-road confirmatory testing. In sensitivity analyses, these baseline conclusions were only affected by extreme values of test specificity. CONCLUSION Because of the expected difficult application and cost of road tests and annual screening by clinicians, the most acceptable strategy from public health, clinical, and individual points of view is likely to be no screening.
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Affiliation(s)
- Sandy Leproust
- INSERM, U897, Équipe Avenir “Prévention et prise en charge des traumatismes”, Bordeaux, France
- IFR99, Université Victor Segalen Bordeaux 2, Bordeaux, France
- ISPED, Université Victor Segalen Bordeaux 2, Bordeaux, France
| | - Emmanuel Lagarde
- INSERM, U897, Équipe Avenir “Prévention et prise en charge des traumatismes”, Bordeaux, France
- IFR99, Université Victor Segalen Bordeaux 2, Bordeaux, France
- ISPED, Université Victor Segalen Bordeaux 2, Bordeaux, France
| | - Louis-Rachid Salmi
- INSERM, U897, Équipe Avenir “Prévention et prise en charge des traumatismes”, Bordeaux, France
- IFR99, Université Victor Segalen Bordeaux 2, Bordeaux, France
- ISPED, Université Victor Segalen Bordeaux 2, Bordeaux, France
- Centre Hospitalier Universitaire de Bordeaux, Service d’information médicale, Bordeaux, France
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Adler G, Silverstein NM. At-risk drivers with Alzheimer's disease: recognition, response, and referral. TRAFFIC INJURY PREVENTION 2008; 9:299-303. [PMID: 18696385 DOI: 10.1080/15389580801895186] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This manuscript addresses the following questions for licensing authorities: 1) Are drivers with Alzheimer's disease (AD) an issue that should concern licensing authorities? 2) What critical driving skills impacted by AD should authorities recognize? 3) What should their response be? 4) Do licensing authorities have a role in providing information about or referral to community agencies that offer alternative transportation options and other services? METHODS To address issues important to licensing authorities the authors reviewed pertinent driving and dementia literature. RESULTS Drivers with AD have unique impairments that should be recognized and responded to early on in the disease process, with sensitivity and respect for continued mobility. As the disease progresses and they must stop driving, former drivers and their families could benefit from resource referrals that provide information about transportation alternatives and support services in their communities. CONCLUSIONS The authors believe that drivers with AD should be a concern for licensing authorities. Licensing decisions and policies to assess and regulate drivers are in the end made individually by each state. Policymakers will make their decisions based upon current research and concerns of their constituency and need to consider a seamless approach to addressing safe mobility. Licensing authorities are an important partner along with individuals, family members, health care professionals, social service providers, researchers, and policymakers in assuring public safety and individual mobility. All of the partners should confront the concern directly-none should "look the other way." The goal is to keep people driving safely for as long as possible. The responsibility is to recognize, respond, and refer when driving safely is no longer assured.
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Affiliation(s)
- Geri Adler
- Graduate College of Social Work, University of Houston, Houston, Texas 77204-4013, USA.
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Leproust S, Lagarde E, Suissa S, Salmi LR. Association between road vehicle collisions and recent medical contact in older drivers: a case-crossover study. Inj Prev 2008; 13:382-7. [PMID: 18056314 DOI: 10.1136/ip.2007.016477] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the association between past medical contacts and the risk of vehicle collision in a population of older drivers from the province of Quebec, Canada. DESIGN Case-crossover study. SETTING Quebec. PARTICIPANTS 111 699 older drivers involved in at least one vehicle collision between January 1988 and December 2000. MAIN OUTCOME MEASURES For each driver, the risk of having a vehicle collision while exposed and not exposed to a medical contact was compared. Separate conditional logistic regression analyses were conducted for all drivers and in four diagnostic-specific subgroups. RESULTS The study found a weak but statistically significant increased risk of all collisions being associated with a medical contact within 1 month before the collision, for all drivers (OR=1.10, 95% CI 1.08 to 1.11) and for drivers with diabetes (OR=1.07, 95% CI 1.03 to 1.11). CONCLUSION Older drivers who have a collision are more likely to have been in contact with a physician shortly before the collision. These findings suggest that there might be an opportunity to detect medical conditions that put older drivers at higher risk of collision; however, further research is needed to assess the potential effectiveness and practical modalities of screening.
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Affiliation(s)
- Sandy Leproust
- INSERM, U593, Equipe Avenir Santé et Insécurité Routière, ISPED, Université Victor Segalen Bordeaux 2, Bordeaux, F-33000, France
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Ott BR, Festa EK, Amick MM, Grace J, Davis JD, Heindel WC. Computerized maze navigation and on-road performance by drivers with dementia. J Geriatr Psychiatry Neurol 2008; 21:18-25. [PMID: 18287166 PMCID: PMC3292182 DOI: 10.1177/0891988707311031] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the ability of computerized maze test performance to predict the road test performance of cognitively impaired and normal older drivers. The authors examined 133 older drivers, including 65 with probable Alzheimer disease, 23 with possible Alzheimer disease, and 45 control subjects without cognitive impairment. Subjects completed 5 computerized maze tasks employing a touch screen and pointer as well as a battery of standard neuropsychological tests. Parameters measured for mazes included errors, planning time, drawing time, and total time. Within 2 weeks, subjects were examined by a professional driving instructor on a standardized road test modeled after the Washington University Road Test. Road test total score was significantly correlated with total time across the 5 mazes. This maze score was significant for both Alzheimer disease subjects and control subjects. One maze in particular, requiring less than 2 minutes to complete, was highly correlated with driving performance. For the standard neuropsychological tests, highest correlations were seen with Trail Making A (TrailsA) and the Hopkins Verbal Learning Tests Trial 1 (HVLT1). Multiple regression models for road test score using stepwise subtraction of maze and neuropsychological test variables revealed significant independent contributions for total maze time, HVLT1, and TrailsA for the entire group; total maze time and HVLT1 for Alzheimer disease subjects; and TrailsA for normal subjects. As a visual analog of driving, a brief computerized test of maze navigation time compares well to standard neuropsychological tests of psychomotor speed, scanning, attention, and working memory as a predictor of driving performance by persons with early Alzheimer disease and normal elders. Measurement of maze task performance appears to be useful in the assessment of older drivers at risk for hazardous driving.
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Affiliation(s)
- Brian R. Ott
- Department of Clinical Neurosciences, Brown University
| | | | - Melissa M. Amick
- Department of Psychiatry and Human Behavior Brown University, Providence, Rhode Island
| | - Janet Grace
- Department of Psychiatry and Human Behavior Brown University, Providence, Rhode Island
| | - Jennifer D. Davis
- Department of Psychiatry and Human Behavior Brown University, Providence, Rhode Island
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Leproust S, Lagarde E, Salmi LR. Systematic screening for unsafe driving due to medical conditions: still debatable. BMC Public Health 2008; 8:27. [PMID: 18215269 PMCID: PMC2259338 DOI: 10.1186/1471-2458-8-27] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 01/23/2008] [Indexed: 11/16/2022] Open
Abstract
Background Assessing people's ability to drive has become a public health concern in most industrialized countries. Although age itself is not a predictive factor of an increased risk for dangerous driving, the prevalence of medical conditions that may impair driving increases with age. Because the implementation of a screening for unsafe driving due to medical conditions is a public health issue, its usefulness should be judged using standardised criteria already proposed for screening for chronic disease. The aim of this paper is to propose standardised criteria suitable to assess the scientific validity of screening for unsafe driving due to medical conditions, and identify potential issues to be clarified before screening can be implemented and effective. Discussion Using criteria developed for screening for chronic diseases and published studies on driving with medical conditions, we specify six criteria to judge the opportunity of screening for unsafe driving due to medical conditions. This adaptation was needed because of the complexity of the natural history of medical conditions and their potential consequences on driving and road safety. We then illustrate that published studies pleading for or against screening for unsafe driving due to medical conditions fail to provide the needed documentation. Individual criteria were mentioned in 3 to 72% of 36 papers pleading for or against screening. Quantitative estimates of relevant indicators were provided in at most 42% of papers, and some data, such as the definition of an appropriate unsafe driving period were never provided. Summary The standardised framework described in this paper provides a template for assessing the effectiveness (or lack of effectiveness) of proposed measures for screening for unsafe driving due to medical conditions. Even if most criteria were mentioned in the published literature pleading for or against such a screening, the failure to find quantitative and evidence-based estimates of relevant indicators provides useful insight for further research.
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Affiliation(s)
- Sandy Leproust
- INSERM, U593, Equipe Avenir Santé et Insécurité Routière, 146, rue Léo Saignat, Bordeaux, F-33076, France.
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Dickerson AE, Molnar LJ, Eby DW, Adler G, Bédard M, Berg-Weger M, Classen S, Foley D, Horowitz A, Kerschner H, Page O, Silverstein NM, Staplin L, Trujillo L. Transportation and aging: a research agenda for advancing safe mobility. THE GERONTOLOGIST 2008; 47:578-90. [PMID: 17989400 DOI: 10.1093/geront/47.5.578] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE We review what we currently know about older driver safety and mobility, and we highlight important research needs in a number of key areas that hold promise for achieving the safety and mobility goals for the aging baby boomers and future generations of older drivers. DESIGN AND METHODS Through the use of a framework for transportation and safe mobility, we describe key areas of screening and assessment, remediation and rehabilitation, vehicle design and modification, technological advancements, roadway design, transitioning to nondriving, and alternative transportation to meet the goals of crash prevention and mobility maintenance for older adults. RESULTS Four cross-cutting themes emerged from this review: safe transportation for older adults is important; older adults have a variety of needs, abilities, and resources; research to help meet the transportation needs of older adults may be of benefit to persons with disabilities; and transportation issues concerning older adults are multifaceted. IMPLICATIONS Safe mobility is essential to continued engagement in civic, social, and community life, and to the human interactions necessary for health, well-being, and quality of life. When safe driving is no longer possible for older adults, safe and practicable alternative transportation must be available. Furthermore, older adults are individuals; they have specific needs, abilities, and resources. Not all older adults will have difficulty meeting their transportation needs and no single transportation solution will work for all people. Research and countermeasures intended to help meet the transportation needs of older adults will likely also benefit younger users of the transportation system, particularly those with disabilities. The issues surrounding the maintenance of safe transportation for older adults will require an interdisciplinary research approach if we are to make significant progress in the next decade as the baby boomers begin to reach age 70.
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Affiliation(s)
- Anne E Dickerson
- Department of Occupational Therapy, East Carolina University, Health Sciences Building Room 3305, Greenville NC, 27858, USA.
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Stern RA, D'Ambrosio LA, Mohyde M, Carruth A, Tracton-Bishop B, Hunter JC, Daneshvar DH, Coughlin JF. At the crossroads: development and evaluation of a dementia caregiver group intervention to assist in driving cessation. GERONTOLOGY & GERIATRICS EDUCATION 2008; 29:363-382. [PMID: 19064472 PMCID: PMC2679525 DOI: 10.1080/02701960802497936] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Deciding when an individual with dementia must reduce or stop driving can be a stressful issue for family caregivers. The purpose of this study was to develop a group intervention to assist these caregivers with driving issues and to provide a preliminary evaluation of the comparative effectiveness of this At the Crossroads intervention. Participants were randomized to one of three arms: (1) active intervention (four 2-hour manualized educational/support group meetings; n = 31); (2) written materials only (participants received written materials after a pretest; n = 23); and (3)control (participants received written materials after a posttest; n = 12).Participants were administered a battery of self-report and interview-based questionnaires at baseline and again 2 months later. At follow-up, the active intervention group scored significantly better than both other groups on key outcome variables, including self-efficacy, communication, and preparedness. The At the Crossroads caregiver intervention appears to effectively provide education and support needed for caregivers to address driving-related issues with their loved ones.
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Affiliation(s)
- Robert A Stern
- Department of Neurology, Alzheimer's Disease Clinical and Research Program, Boston University School of Medicine, Boston, MA 02118-2526, USA.
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Meuser TM, Carr DB, Berg-Weger M, Niewoehner P, Morris JC. Driving and dementia in older adults: Implementation and evaluation of a continuing education project. THE GERONTOLOGIST 2007; 46:680-7. [PMID: 17050760 DOI: 10.1093/geront/46.5.680] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We aimed to develop and evaluate a multimedia workshop curriculum to educate physicians and other health professionals about (a) driving-related assessment in older adults with dementia, and (b) strategies to encourage driving retirement for impaired individuals. DESIGN AND METHODS A curriculum developed by the Older Drivers Project of the American Medical Association was expanded for presentation by a multidisciplinary team. One pilot and seven test workshops were offered. A program evaluation method-testing knowledge, confidence, attitudes, and practice behaviors-was employed at four points in time: T1 (Time 1; pretest focusing on the previous 12 months), T2 (Time 2; same-day post-test), T3 (Time 3; post-test at 3 months), and T4 (Time 4; post-test at 12 months). RESULTS At T1, participants (N = 147) expressed high agreement that an assessment of driving ability is an important issue in clinical dementia care, but they reported low knowledge of assessment strategies, resources, and state reporting requirements. Modest gains in knowledge and confidence were demonstrated at both T3 (n = 93) and T4 (n = 63). In addition, the frequency of driving-related practice behaviors (i.e., incorporation of driving-related questions into clinical evaluation, chart documentation, reporting of impaired drivers) had increased significantly by T3 and T4. IMPLICATIONS The results indicate that a focused workshop curriculum, with practical and immediate applications to care, can motivate measurable changes in clinical practice. Once they are informed, health professionals can address issues of driving ability in older patients with dementia and, with the support of available resources, encourage impaired individuals to retire from driving for the safety of everyone on the road.
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Affiliation(s)
- Thomas M Meuser
- Director of Education, Alzheimer's Disease Research Center, Washington University School of Medicine, 4488 Forest Park Avenue, Suite 130, St. Louis, MO 63108, USA.
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Kass J. ETHICAL PERSPECTIVES IN NEUROLOGY. Continuum (Minneap Minn) 2007. [DOI: 10.1212/01.con.0000267242.37992.eb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kim H, Richardson VE. Driving Cessation and Consumption Expenses in the Later Years. J Gerontol B Psychol Sci Soc Sci 2006; 61:S347-53. [PMID: 17114315 DOI: 10.1093/geronb/61.6.s347] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study examined the association between consumption and driving status among older persons within the context of selected variables, including self-rated health and functional status. METHODS The data were from the 1998, 2000, and 2002 Health and Retirement Study and the 2003 Health and Retirement Study Consumption and Activities Mail Survey. We conducted Tobit regression analyses on five consumption categories of basic needs (such as food) and higher order needs (such as trips and dining out). RESULTS Consumption and driving status were significantly associated, showing that driving cessation was related to a 46% to 63% reduction in spending on trips, tickets, and dining out. Another significant relationship emerged between consumption and having never driven. Driving cessation was minimally related to consumption of basic needs (such as food and clothing) and was more strongly associated with higher order needs (such as trips). DISCUSSION The findings demonstrate the association between older people's driving status and consumption, specifically higher order activities. Older persons who drive and, presumably, have more opportunities to go to stores, restaurants, and other outside events, spend more on food, tickets, and dining out than those who cease driving or have never driven. Although the direction of causality remains unclear, these findings have implications for those concerned with alternative transportation resources for older adults.
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Affiliation(s)
- Hyungsoo Kim
- Department of Family Studies, University of Kentucky, 315 Funkhouser Building, Lexington, KY 40506, USA.
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Perkinson MA, Berg-Weger ML, Carr DB, Meuser TM, Palmer JL, Buckles VD, Powlishta KK, Foley DJ, Morris JC. Driving and dementia of the Alzheimer type: beliefs and cessation strategies among stakeholders. THE GERONTOLOGIST 2006; 45:676-85. [PMID: 16199403 DOI: 10.1093/geront/45.5.676] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Although driving by persons with Alzheimer's disease (AD) is an important public health concern, we know little about the attitudes and perceptions of key stakeholders regarding driving safety in these individuals or the factors that precipitate and influence driving assessment and cessation decisions. DESIGN AND METHODS We convened 10 focus groups composed of persons intimately involved in driving decisions for older adults to identify and compare beliefs and perceptions concerning AD and driving and to identify effective strategies to limit or cease unsafe driving. The 68 focus-group participants included health professionals, transportation and law-enforcement professionals, current and former drivers with AD, and family caregivers of current and former drivers with the disease. RESULTS With few exceptions, participants said that a diagnosis of very mild AD alone did not preclude driving. Most regarded family members as pivotal in monitoring and managing unsafe driving and recognized their need for institutional and medical support, especially support from physicians in counseling and evaluation of health-related fitness of older drivers. Members of each group acknowledged their own roles and responsibilities in driving decisions and described difficulties they experienced in making assessments and implementing decisions to limit or stop the driving of given individuals with AD. IMPLICATIONS Education of families, professionals, and transportation specialists is needed to understand the influence of AD severity on driving abilities, identify problem driving behaviors, make appropriate referrals of unsafe drivers, and access available resources for drivers with AD and those most responsible for their safety.
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Affiliation(s)
- Margaret A Perkinson
- Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, St. Louis, MO 63108, USA
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Abstract
PURPOSE This article reviews the effects of various types of dementia on driving skills, the available assessment measures, legal considerations, and the important role played by the nurse practitioner (NP) in the process of recommending driving cessation. It provides strategies and resources that may offer guidance to NPs who are attempting to balance the continued independence of patients with dementia, as represented by driving, with the safety not only of such patients but also of the public at large. DATA SOURCES A review of the biomedical literature, resources available on the World Wide Web, and illustrative case studies were used. CONCLUSIONS The diagnosis of dementia alone is often insufficient to determine driver competence because the topographic losses of dementia are complex. Recognizing when cessation should occur is made more difficult because objective assessment tools do not exist to predict impaired driving skills. Recommending driving cessation at the appropriate time can be a challenge for NPs, who must balance such a significant impact on the driver's autonomy with concerns about public safety if the patient continues to drive despite progressive impairment. IMPLICATIONS FOR PRACTICE The progressive loss of cognitive abilities in dementia presents a series of ongoing challenges for the patient throughout the disease continuum. Unfortunately, the recommendation to stop driving can present one of the more immediate issues confronting the patient, the family, and the healthcare provider. Failure to assess diminished driving skill can lead either to premature or to delayed driving cessation. Either outcome can have adverse effects on the patient, the patient's family, and public safety.
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Abstract
The purpose of this article is to review the literature on the ability of individuals with dementia to drive an automobile. Based on a review of the literature, several factors were identified that may be useful in differentiating between people with dementia who presently remain safe drivers from those who have progressed to impaired driving. These factors include disease duration and severity, sex, patient self-assessment, family assessment, neuropsychological measures, findings on road evaluations, and driving simulator testing. The approach of the physician to driving and dementia is addressed, including in-office screening, referral for on-road driving assessments, and the potential for physician reporting to state agencies.
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Affiliation(s)
- Laura B Brown
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Neuropsychology Program, 593 Eddy Street, Physician's Office Building, Providence, RI 02903, USA
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