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Moshfeghi S, Jan MT, Conniff J, Ghoreishi SGA, Jang J, Furht B, Yang K, Rosselli M, Newman D, Tappen R, Smith D. In-vehicle Sensing and Data Analysis for Older Drivers with Mild Cognitive Impairment. 2023 IEEE 20TH INTERNATIONAL CONFERENCE ON SMART COMMUNITIES: IMPROVING QUALITY OF LIFE USING AI, ROBOTICS AND IOT (HONET) 2023; 2023:140-145. [PMID: 38562260 PMCID: PMC10982740 DOI: 10.1109/honet59747.2023.10374639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Driving is a complex daily activity indicating age and disease-related cognitive declines. Therefore, deficits in driving performance compared with ones without mild cognitive impairment (MCI) can reflect changes in cognitive functioning. There is increasing evidence that unobtrusive monitoring of older adults' driving performance in a daily-life setting may allow us to detect subtle early changes in cognition. The objectives of this paper include designing low-cost in-vehicle sensing hardware capable of obtaining high-precision positioning and telematics data, identifying important indicators for early changes in cognition, and detecting early-warning signs of cognitive impairment in a truly normal, day-to-day driving condition with machine learning approaches. Our statistical analysis comparing drivers with MCI to those without reveals that those with MCI exhibit smoother and safer driving patterns. This suggests that drivers with MCI are cognizant of their condition and tend to avoid erratic driving behaviors. Furthermore, our Random Forest models identified the number of night trips, number of trips, and education as the most influential factors in our data evaluation.
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Affiliation(s)
- Sonia Moshfeghi
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Muhammad Tanveer Jan
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Joshua Conniff
- Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, USA
| | | | - Jinwoo Jang
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Borko Furht
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Kwangsoo Yang
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Monica Rosselli
- Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, USA
| | - David Newman
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, USA
| | - Ruth Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, USA
| | - Dana Smith
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
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Camilleri L, Whitehead D. Driving Assessment for Persons with Dementia: How and when? Aging Dis 2023; 14:621-651. [PMID: 37191415 DOI: 10.14336/ad.2022.1126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/26/2022] [Indexed: 05/17/2023] Open
Abstract
Dementia is a progressive neurodegenerative disease leading to deterioration in cognitive and physical skills. Driving is an important instrumental activity of daily living, essential for independence. However, this is a complex skill. A moving vehicle can be a dangerous tool in the hand of someone who cannot maneuver it properly. As a result, the assessment of driving capacity should be part of the management of dementia. Moreover, dementia comprises of different etiologies and stages consisting of different presentations. As a result, this study aims to identify driving behaviors common in dementia and compare different assessment methods. A literature search was conducted using the PRISMA checklist as a framework. A total of forty-four observational studies and four meta-analyses were identified. Study characteristics varied greatly with regards to methodology, population, assessments, and outcome measures used. Drivers with dementia performed generally worse than cognitively normal drivers. Poor speed maintenance, lane maintenance, difficulty managing intersections and poor response to traffic stimuli were the most common behaviors in drivers with dementia. Naturalistic driving, standardized road assessments, neuropsychological tests, participant self-rating and caregiver rating were the most common driving assessment methods used. Naturalistic driving and on-road assessments had the highest predictive accuracy. Results on other forms of assessments varied greatly. Both driving behaviors and assessments were influenced by different stages and etiologies of dementia at varying degrees. Methodology and results in available research are varied and inconsistent. As a result, better quality research is required in this field.
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Affiliation(s)
- Lara Camilleri
- Saint Vincent De Paul Long Term Care Facility, L-Ingiered Road, Luqa, Malta
| | - David Whitehead
- Department of Gerontology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom
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Stasiulis E, Naglie G, Sanford S, Belchior P, Crizzle A, Gélinas I, Mazer B, Moorhouse P, Myers A, Porter MM, Vrkljan B, Rapoport MJ. Developing the Driving and Dementia Roadmap: a knowledge-to-action process. Int Psychogeriatr 2023:1-14. [PMID: 36710624 DOI: 10.1017/s1041610222001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Despite three decades of research, gaps remain in meeting the needs of people with dementia and their family/friend carers as they navigate the often-tumultuous process of driving cessation. This paper describes the process of using a knowledge-to-action (KTA) approach to develop an educational web-based resource (i.e. toolkit), called the Driving and Dementia Roadmap (DDR), aimed at addressing some of these gaps. DESIGN Aligned with the KTA framework, knowledge creation and action cycle activities informed the development of the DDR. These activities included systematic reviews; meta-synthesis of qualitative studies; interviews and focus groups with key stakeholders; development of a Driving and Dementia Intervention Framework (DD-IF); and a review and curation of publicly available resources and tools. An Advisory Group comprised of people with dementia and family carers provided ongoing feedback on the DDR's content and design. RESULTS The DDR is a multi-component online toolkit that contains separate portals for current and former drivers with dementia and their family/friend carers. Based on the DD-IF, various topics of driving cessation are presented to accommodate users' diverse stages and needs in their experiences of decision-making and transitioning to non-driving. CONCLUSION Guided by the KTA framework that involved a systematic and iterative process of knowledge creation and translation, the resulting person-centered, individualized and flexible DDR can bring much-needed support to help people with dementia and their families maintain their mobility, community access, and social and emotional wellbeing during and post-driving cessation.
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Affiliation(s)
- Elaine Stasiulis
- Rotman Research Institute, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
- Department of Medicine, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
| | - Gary Naglie
- Rotman Research Institute, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
- Department of Medicine, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
- KITE Research Institute, University Health Network, Toronto, OntarioM5G 2A2, Canada
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
| | - Sarah Sanford
- Rotman Research Institute, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
- Department of Medicine, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
| | - Patricia Belchior
- Faculty of Medicine and Health Sciences, McGill University and Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QuebecH3G 2M1, Canada
| | - Alexander Crizzle
- School of Public Health, University of Saskatchewan, Saskatoon, SaskatchewanS7N 2Z4, Canada
| | - Isabelle Gélinas
- Faculty of Medicine and Health Sciences, McGill University and Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QuebecH3G 2M1, Canada
| | - Barbara Mazer
- Faculty of Medicine and Health Sciences, McGill University and Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QuebecH3G 2M1, Canada
| | - Paige Moorhouse
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova ScotiaB3H 2E1, Canada
| | - Anita Myers
- School of Public Health Sciences, University of Waterloo, Waterloo, OntarioN2L 3G1, Canada
| | - Michelle M Porter
- Faculty of Kinesiology and Recreation, University of Manitoba, Winnipeg, ManitobaR3T 2N2, Canada
| | - Brenda Vrkljan
- Faculty of Health Sciences, McMaster University, Hamilton, OntarioL8N 3Z5, Canada
| | - Mark J Rapoport
- Geriatric Psychiatry, Sunnybrook Health Sciences, Toronto, OntarioM4N 3M5, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
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Davis R, Owens M. Self-Regulation of Driving Behaviors in Persons With Early-Stage Alzheimer's Disease. J Gerontol Nurs 2021; 47:21-27. [PMID: 33377981 DOI: 10.3928/00989134-20201209-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to determine if persons with Alzheimer's disease (AD) or mild cognitive impairment (MCI) due to AD reported awareness of driving ability and made self-regulatory changes to the same degree as older adults without AD. Driving awareness and behaviors were collected using a self-report survey. Results of the AD/MCI group were compared to a similarly aged control group. Results showed that persons with AD/MCI reported less confidence in their driving ability and worried about getting lost more often than the control group. In addition, they were more likely to have stopped driving. The AD/MCI group reported that they avoided driving in unfamiliar situations, drove less often, and drove with another person significantly more than the control group. The results give evidence that persons within the early stage of AD may have self-awareness of their driving ability and self-regulate their driving to enhance safety. [Journal of Gerontological Nursing, 47(1), 21-27.].
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Ryvicker M, Bollens-Lund E, Ornstein KA. Driving Status and Transportation Disadvantage Among Medicare Beneficiaries. J Appl Gerontol 2020; 39:935-943. [PMID: 30362863 PMCID: PMC6486463 DOI: 10.1177/0733464818806834] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transportation disadvantage may have important implications for the health, well-being, and quality of life of older adults. This study used the 2015 National Health Aging Trends Study, a nationally representative study of Medicare beneficiaries aged 65 and over (N = 7,498), to generate national estimates of transportation modalities and transportation disadvantage among community-dwelling older adults in the United States. An estimated 10.8 million community-dwelling older adults in the United States rarely or never drive. Among nondrivers, 25% were classified as transportation disadvantaged, representing 2.3 million individuals. Individuals with more chronic medical conditions and those reliant on assistive devices were more likely to report having a transportation disadvantage (p < .05). Being married resulted in a 50% decreased odds of having a transportation disadvantage (p < .01). Some individuals may be at higher risk for transportation-related barriers to engaging in valued activities and accessing care, calling for tailored interventions such as ride-share services combined with care coordination strategies.
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Connor J, Brookland R, Samaranayaka A. Older Drivers and Their Future Mobility: Views and Involvement of Their Adult Children. J Appl Gerontol 2019; 40:55-66. [PMID: 31847685 DOI: 10.1177/0733464819894545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In car-dependent societies like New Zealand, getting the right balance between mobility and safety could improve outcomes for older people but will require changes to policy and practice. Driving cessation is a major life transition with many impacts, and adult children are frequently involved in both the transition to non-driving and maintaining mobility afterward. This cross-sectional study (N = 675) sought perspectives of family members of drivers aged 65 or older enrolled in a longitudinal study. Most (94%) were adult children, two thirds were women, and 19% were moderately to extremely anxious about their parent's driving. Loss of independence, driving's role in identity, and reluctance to rely on family were recognized as important barriers to driving cessation. Most (80%) felt that families, as well as older drivers, would be adversely affected by driving cessation. Families identified accessible local information and services, alternative transport, and community-based programs for drivers and families as assistance most needed.
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Piersma D, Fuermaier ABM, De Waard D, Davidse RJ, De Groot J, Doumen MJA, Ponds RWHM, De Deyn PP, Brouwer WH, Tucha O. Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility. BMC Geriatr 2018; 18:216. [PMID: 30223796 PMCID: PMC6142418 DOI: 10.1186/s12877-018-0910-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/10/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Driving is related to social participation; therefore older drivers may be reluctant to cease driving. Continuation of driving has also been reported in a large proportion of patients with cognitive impairment. The aim of this study is to investigate whether patients with cognitive impairment adhere to driving cessation advice after a fitness-to-drive assessment and what the consequences are with regard to mobility. METHODS Patients with cognitive impairment (n = 172) participated in a fitness-to-drive assessment study, including an on-road driving assessment. Afterwards, patients were advised to either continue driving, to follow driving lessons, or to cease driving. Approximately seven months thereafter, patients were asked in a follow-up interview about their adherence to the driving recommendation. Factors influencing driving cessation were identified using a binary logistic regression analysis. Use of alternative transportation was also evaluated. RESULTS Respectively 92 and 79% of the patients adhered to the recommendation to continue or cease driving. Female gender, a higher Clinical Dementia Rating-score, perceived health decline, and driving cessation advice facilitated driving cessation. Patients who ceased driving made use of less alternative modes of transportation than patients who still drove. Nonetheless, around 40% of the patients who ceased driving increased their frequency of cycling and/or public transport use. CONCLUSIONS Adherence to the recommendations given after the fitness-to-drive assessments was high. Female patients were in general more likely to cease driving. However, a minority of patients did not adhere to driving cessation advice. These drivers with dementia should be made aware of the progression of their cognitive impairment and general health decline to facilitate driving cessation. There are large differences in mobility between patients with cognitive impairment. Physicians should discuss options for alternative transportation in order to promote sustained safe mobility of patients with cognitive impairment.
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Affiliation(s)
- Dafne Piersma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Anselm B. M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Dick De Waard
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | | | - Jolieke De Groot
- SWOV Institute for Road Safety Research, The Hague, The Netherlands
| | - Michelle J. A. Doumen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Rudolf W. H. M. Ponds
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Peter P. De Deyn
- Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Wiebo H. Brouwer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
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Dickerson AE, Molnar LJ, Bédard M, Eby DW, Berg-Weger M, Choi M, Grigg J, Horowitz A, Meuser T, Myers A, O’Connor M, Silverstein NM. Transportation and Aging: An Updated Research Agenda to Advance Safe Mobility among Older Adults Transitioning From Driving to Non-driving. THE GERONTOLOGIST 2017; 59:215-221. [DOI: 10.1093/geront/gnx120] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne E Dickerson
- Department of Occupational Therapy, East Carolina University, Greenville, North Carolina
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute and Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, Michigan
| | - Michel Bédard
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - David W Eby
- Department of Occupational Therapy, East Carolina University, Greenville, North Carolina
| | - Marla Berg-Weger
- Geriatric Education Center, Saint Louis University School of Social Work, Missouri
| | - Moon Choi
- Graduate School of Science and Technology Policy, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jenai Grigg
- Holy Family University, Philadelphia, Pennsylvania
| | - Amy Horowitz
- Graduate School of Social Service, Fordham University, New York
| | - Thomas Meuser
- Department of Sociology, Gerontology & Gender, University of Missouri—St. Louis
| | - Anita Myers
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - Melissa O’Connor
- Department of Human Development and Family Science, North Dakota State University, Fargo
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9
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Silverstein NM, Turk K. Students Explore Supportive Transportation Needs of Older Adults. GERONTOLOGY & GERIATRICS EDUCATION 2016; 37:381-401. [PMID: 25621827 DOI: 10.1080/02701960.2015.1005289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Students in an undergraduate applied research in aging class learned about qualitative research methods by analyzing previously collected narratives. The interviews were with 32 participants who were national experts in senior transportation in the United States. The purpose of the study was to explore the specialized supportive mobility needs of community-residing older adults. The policy goal of the study was to expand the discussion on levels of assistance needed in senior transportation. The educational goal of the study was to expose undergraduate students to qualitative research methods, having them analyze transcripts and audio recordings. In preparation for the research, students reviewed the current literature in transportation and aging and learned that the ability to get to where you want to go, when you want to go there, is a key factor for aging-in-place in our communities. When that ability is compromised, the informal network of family and friends may not be a sustainable transportation option. Students were divided into three analysis groups by the domains of challenges, strategies, and policies and coded themes and subthemes through an iterative process. An important subtheme that emerged was the connection of community mobility to health care outcomes.
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Affiliation(s)
- Nina M Silverstein
- a Gerontology Institute, University of Massachusetts Boston , Boston , Massachusetts , USA
| | - Kristina Turk
- a Gerontology Institute, University of Massachusetts Boston , Boston , Massachusetts , USA
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Davis RL, Ohman JM. Driving in Early-Stage Alzheimer's Disease: An Integrative Review of the Literature. Res Gerontol Nurs 2016; 10:86-100. [PMID: 27665752 DOI: 10.3928/19404921-20160920-02] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/30/2016] [Indexed: 01/30/2023]
Abstract
One of the most difficult decisions for individuals with Alzheimer's disease (AD) is when to stop driving. Because driving is a fundamental activity linked to socialization, independent functioning, and well-being, making the decision to stop driving is not easy. Cognitive decline in older adults can lead to getting lost while driving, difficulty detecting and avoiding hazards, as well as increased errors while driving due to compromised judgment and difficulty in making decisions. The purpose of the current literature review was to synthesize evidence regarding how individuals with early-stage AD, their families, and providers make determinations about driving safety, interventions to increase driving safety, and methods to assist cessation and coping for individuals with early-stage AD. The evidence shows that changes in driving ability start early and progress throughout the trajectory of AD. Some individuals with mild cognitive impairment or early-stage AD may be safe to drive for a period of time. Support groups aimed at helping with the transition have been shown to be helpful for individuals who stop driving. Research and practice must support interventions to help individuals maintain safety while driving, as well as cope with driving cessation. [Res Gerontol Nurs. 2017; 10(2):86-100.].
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"The biggest problem we've ever had to face": how families manage driving cessation with people with dementia. Int Psychogeriatr 2016; 28:109-22. [PMID: 26365085 DOI: 10.1017/s1041610215001441] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is recognized that people with dementia are likely to need to stop driving at some point following diagnosis. Driving cessation can lead to negative outcomes for people with dementia and their family caregivers (FC), who often experience family conflict and tension throughout the process. Family experiences surrounding driving cessation have begun to be explored but warrant further examination. METHODS Using a descriptive phenomenological approach, semi-structured interviews were undertaken with key stakeholders, including 5 retired drivers with dementia, 12 FC, and 15 health professionals (HP). Data were analyzed inductively to explore the needs and experiences of people with dementia and FC. RESULTS The data revealed a range of possible interactions between people with dementia and FC. These were organized into a continuum of family dynamics according to levels of collaboration and conflict: in it together, behind the scenes, active negotiations, and at odds. At the in it together end of the continuum, people with dementia and FC demonstrated collaborative approaches and minimal conflict in managing driving cessation. At the at odds end, they experienced open conflict and significant tension in their interactions. Contextual factors influencing family dynamics were identified, along with the need for individualized approaches to support. CONCLUSIONS The continuum of family dynamics experienced during driving cessation may help clinicians better understand and respond to complex family needs. Interventions should be tailored to families' distinctive needs with consideration of their unique contextual factors influencing dynamics, to provide sensitive and responsive support for families managing driving cessation.
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Abstract
Capacity to make one's own decisions is fundamental to the autonomy of the individual. Capacity is a functional assessment made by a clinician to determine if a patient is capable of making a specific decision. Competency is a global assessment and legal determination made by a judge in court. Capacity evaluation for a patient with dementia is used to determine whether the patient is capable of giving informed consent, participate in research, manage their finances, live independently, make a will, and have ability to drive. Patients with dementia cannot be assumed to have impaired capacity. Even a patient with moderate or severe dementia, with obviously impaired capacity may still be able to indicate a choice and show some understanding. Four key components of decision-making in a capacity evaluation include understanding, communicating a choice, appreciation, and reasoning. Assessment of capacity requires a direct interview with the patient using open-ended questions and may include both informal and formal approaches depending on the situation and the context. A baseline cognitive evaluation with a simple test to assess executive function is often useful in capacity evaluation. All capacity evaluations are situation specific, relating to the particular decision under consideration, and are not global in scope. The clinician needs to spend adequate time with the patient and the family allaying their anxieties and also consider the sociocultural context. The area of capacity has considerable overlap with law and the clinician treating patients with dementia should understand the complexities of assessment and the implications of impaired capacity. It is also essential that the clinician be well informed and keep meticulous records. It is crucial to strike a balance between respecting the patient autonomy and acting in his/her best interest.
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Affiliation(s)
- Soumya Hegde
- Nightingales Centre for Ageing and Alzheimer's, Bengaluru, Karnataka, India
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13
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Vaughan L, Hogan PE, Rapp SR, Dugan E, Marottoli RA, Snively BM, Shumaker SA, Sink KM. Driving with Mild Cognitive Impairment or Dementia: Cognitive Test Performance and Proxy Report of Daily Life Function in Older Women. J Am Geriatr Soc 2015; 63:1774-82. [PMID: 26338449 DOI: 10.1111/jgs.13634] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate associations between proxy report of cognitive and functional limitations and cognitive performance and current or former driving status in older women with mild cognitive impairment (MCI) and all-cause dementia. DESIGN Cross-sectional data analysis of retrospectively identified older women with adjudicated MCI and all-cause dementia in the Women's Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes (WHIMS-ECHO). SETTING Academic medical center. PARTICIPANTS Women (mean age ± standard deviation 83.7 ± 3.5) adjudicated with MCI or dementia during Year 1, 2, 3, or 4 of the WHIMS-ECHO follow-up period (N = 385). MEASUREMENTS The telephone-administered cognitive battery included tests of attention, verbal learning and memory, verbal fluency, executive function, working memory, and global cognitive function plus self-report measures of depressive symptomatology. The Dementia Questionnaire (DQ) was administered to a knowledgeable proxy (family member, friend). RESULTS Sixty percent of women with MCI and 40% of those with dementia are current drivers. Proxy reports of functional limitations in instrumental activities of daily living (IADLs) are associated with current driving status in women with MCI, whereas performance-based cognitive tests are not. In women with dementia, proxy reports of functional limitations in IADLs and performance-based cognitive tests are associated with current driving status, as expected. CONCLUSION These findings have clinical implications for the importance of evaluating driving concurrently with other instrumental functional abilities in MCI and dementia. Additional work is needed to determine whether proxy report of cognitive and functional impairments should help guide referrals for driving assessment and rehabilitation or counseling for driving transition.
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Affiliation(s)
- Leslie Vaughan
- Department of Social Sciences and Health Policy, Wake Forest University, Winston-Salem, North Carolina
| | - Patricia E Hogan
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Stephen R Rapp
- Department of Social Sciences and Health Policy, Wake Forest University, Winston-Salem, North Carolina.,Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Elizabeth Dugan
- Department of Gerontology, McCormack Graduate School for Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts
| | - Richard A Marottoli
- School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Beverly M Snively
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Sally A Shumaker
- Department of Social Sciences and Health Policy, Wake Forest University, Winston-Salem, North Carolina
| | - Kaycee M Sink
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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14
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Barco PP, Baum CM, Ott BR, Ice S, Johnson A, Wallendorf M, Carr DB. Driving Errors in Persons with Dementia. J Am Geriatr Soc 2015; 63:1373-80. [PMID: 26140521 DOI: 10.1111/jgs.13508] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To differentiate driving errors in persons with dementia who fail a performance- based road test from errors in persons who pass. DESIGN Cross-sectional. SETTING Community. PARTICIPANTS Active drivers diagnosed with dementia (n = 60) and older adult controls (n = 32). MEASUREMENT All participants completed a standardized clinical and on-road driving assessment. The outcome variable was the number and types of driving errors according to the Record of Driving Errors (RODE), a standardized tool to record driving errors. RESULTS Sixty-two percent (n = 37) of individuals with dementia and 3% (n = 1) of controls failed the road test. Based on the RODE, individuals with dementia made twice as many driving errors as healthy controls. Within the dementia sample, individuals who failed the road test had more difficulties driving straight and making left and right turns than during lane changes. Dangerous actions occurred most often while driving straight and making left turns. Specific driving behaviors associated with road test failure in the sample with dementia included difficulties in lane positioning and usage, stopping the vehicle appropriately, attention, decision-making, and following rules of the road. Informants of participants with dementia who failed the road test reported more impairment with cognitive functioning on the Assessing Dementia 8 Screening Interview (AD8). CONCLUSION This report highlights the driving errors most common in people with dementia who fail a road test. The finding that most of the dangerous actions in the sample with dementia occurred while driving straight condition is novel. Driving on straight roads has not been considered a condition of "high challenge" in prior driving studies in individuals with dementia. This finding has potential implications for future interventions related to vehicle instrumentation and driving recommendations for people with dementia.
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Affiliation(s)
- Peggy P Barco
- Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, Missouri
| | - Carolyn M Baum
- Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, Missouri
| | - Brian R Ott
- Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Steven Ice
- Independent Drivers, LLC, St. Louis, Missouri
| | - Ann Johnson
- Center for Clinical Studies, School of Medicine, Washington University, St. Louis, Missouri
| | - Michael Wallendorf
- Division of Biostatistics, School of Medicine, Washington University, St. Louis, Missouri
| | - David B Carr
- Department of Medicine, School of Medicine, Washington University, St. Louis, Missouri.,Department of Neurology, School of Medicine, Washington University, St. Louis, Missouri
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Choi NG, DiNitto DM. Depressive Symptoms Among Older Adults Who Do Not Drive: Association With Mobility Resources and Perceived Transportation Barriers. THE GERONTOLOGIST 2015; 56:432-43. [PMID: 25601389 DOI: 10.1093/geront/gnu116] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/22/2014] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY To examine alternative means of mobility that nondriving older adults rely on and their impact on well-being. DESIGN AND METHODS Data from the 2011 (T1, N = 6,680) and 2012 (T2, N = 5,413) interview waves of the National Health and Aging Trends Study were used to examine sample characteristics by driving status, use of alternative mobility resources, and perceived transportation-related barriers among ex-drivers and nondrivers, and their association with depressive symptoms. RESULTS A majority of nondrivers relied on their informal support system and/or paid assistance to drive them to places. About half reported walking/using a wheelchair or scooter. A significant proportion of never drivers also used public transportation and van/shuttle services, whereas a smaller proportion of ex-drivers used them. Nondrivers who walked for transport had lower depressive symptoms than those who did not walk at either T1 or T2, and perception of transportation barriers to visiting friends/family was associated with higher depressive symptoms at T1 only. IMPLICATIONS Older adults' mobility needs should be met through increasing walkability, public and paratransit transportation, supplemental senior transportation, and increasing informal caregivers-transportation providers' ability to aid older adults.
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Affiliation(s)
- Namkee G Choi
- School of Social Work, The University of Texas at Austin.
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Moorhouse P, Hamilton LM. Not if, but when: impact of a driving and dementia awareness and education campaign for primary care physicians. Can Geriatr J 2014; 17:70-5. [PMID: 24883165 PMCID: PMC4038538 DOI: 10.5770/cgj.17.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Canadian physicians are responsible for assessing medical fitness to drive; however, national data indicate that physicians lack confidence in performing such assessments and face numerous barriers to addressing driving in patients with dementia. We report on the impact of a provincial Web-based resource (www.notifbutwhen.ca) regarding driving cessation in dementia aimed towards primary care physicians (PCPs). Methods A pre/post cross-sectional survey (n = 134 baseline and n = 113 follow-up) of English-speaking, Nova Scotian PCPs. Descriptive statistics, chi-square, Pearson correlation, and multivariable logistic regression (controlling for sex, years of practice, and practice type) are reported. Results Most PCPs consider discussions regarding driving cessation to be routine part of dementia care; however, report multiple barriers to such discussions. Although the Web-based resource and awareness campaign were not associated with improvement in physician comfort in assessing driving risk in dementia, after completion of the campaign, fewer PCPs reported avoiding the topic of driving. Additionally, family resistance and lack of resources were less often reported as barriers. Conclusions Despite a lack of confidence, Nova Scotian PCPs routinely discuss driving cessation, and perform driving assessments for individuals with dementia. The Web-based resource and awareness campaign have shown moderate effectiveness in addressing specific barriers to assessment (e.g., caregiver resistance, lack of resources). Future efforts will address additional barriers, such as lack of comfort in decision-making.
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Affiliation(s)
- Paige Moorhouse
- Geriatric Medicine Research, Capital District Health Authority & Dalhousie University, Halifax, NS; ; Division of Geriatric Medicine, Capital District Health Authority & Dalhousie University, Halifax, NS, Canada
| | - Laura M Hamilton
- Geriatric Medicine Research, Capital District Health Authority & Dalhousie University, Halifax, NS
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O'Connor ML, Edwards JD, Bannon Y. Self-rated driving habits among older adults with clinically-defined mild cognitive impairment, clinically-defined dementia, and normal cognition. ACCIDENT; ANALYSIS AND PREVENTION 2013; 61:197-202. [PMID: 23769114 DOI: 10.1016/j.aap.2013.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 02/28/2013] [Accepted: 05/15/2013] [Indexed: 06/02/2023]
Abstract
Older adults with clinically-defined dementia may report reducing their driving more than cognitively normal controls. However, it is unclear how these groups compare to individuals with clinically-defined mild cognitive impairment (MCI) in terms of driving behaviors. The current study investigated self-reported driving habits among adults age 60 and older with clinical MCI (n=41), clinical mild dementia (n=40), and normal cognition (n=43). Participants reported their driving status, driving frequency (days per week), and how often they avoided accessing the community, making left turns, driving at night, driving in unfamiliar areas, driving on high-traffic roads, and driving in bad weather. After adjusting for education, a MANCOVA revealed that participants with MCI and dementia avoided unfamiliar areas and high-traffic roads significantly more than normal participants. Participants with dementia also avoided left turns and accessing the community more than those with normal cognition and MCI (p<0.05 for all). The other driving variables did not significantly differ between groups. Thus, older adults with clinically-defined MCI, as well as those with dementia, avoided some complex driving situations more than cognitively intact adults. However, all diagnostic groups had similar rates of driving cessation and frequency. Future research should examine the safety implications of such findings.
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Affiliation(s)
- Melissa L O'Connor
- Department of Human Development and Family Science, North Dakota State University, EML Hall 283D, 1310 Centennial Boulevard, Fargo, ND 58102, USA.
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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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Classen S, Wang Y, Winter SM, Velozo CA, Lanford DN, Bédard M. Concurrent criterion validity of the safe driving behavior measure: a predictor of on-road driving outcomes. Am J Occup Ther 2013; 67:108-16. [PMID: 23245789 DOI: 10.5014/ajot.2013.005116] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We determined the concurrent criterion validity of the Safe Driving Behavior Measure (SDBM) for on-road outcomes (passing or failing the on-road test as determined by a certified driving rehabilitation specialist) among older drivers and their family members-caregivers. On the basis of ratings from 168 older drivers and 168 family members-caregivers, we calculated receiver operating characteristic curves. The drivers' area under the curve (AUC) was .620 (95% confidence interval [CI] = .514-.725, p = .043). The family members-caregivers' AUC was .726 (95% CI = .622-.829, p ≤ .01). Older drivers' ratings showed statistically significant yet poor concurrent criterion validity, but family members-caregivers' ratings showed good concurrent criterion validity for the criterion on-road driving test. Continuing research with a more representative sample is being pursued to confirm the SDBM's concurrent criterion validity. This screening tool may be useful for generalist practitioners to use in making decisions regarding driving.
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Affiliation(s)
- Sherrilene Classen
- Institute for Mobility, Activity and Participation, and Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, PO Box 100164, Gainesville, FL 32610, USA.
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Curl AL, Stowe JD, Cooney TM, Proulx CM. Giving up the keys: how driving cessation affects engagement in later life. THE GERONTOLOGIST 2013; 54:423-33. [PMID: 23651920 DOI: 10.1093/geront/gnt037] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Many older adults consider driving vital to maintaining their preferred lifestyle and engagement with society, yet it is normative for individuals to eventually stop driving. This study examined the impact of driving cessation on older adults' productive and social engagement and whether their mental and physical health mediated this relationship. DESIGN AND METHODS Multilevel modeling was used to analyze longitudinal data (N = 4,788 adults age 65 and over) from the Health and Retirement Study (1998-2010). RESULTS Productive engagement (paid work, formal volunteering, and informal volunteering) was negatively affected when older adults stopped driving, but social engagement was not immediately compromised by their transition to nondriver status. The role of physical health and mental health as mediators in explaining this relationship was negligible. IMPLICATIONS The results suggest that interventions aimed at maintaining nondrivers' participation in productive roles should focus on factors other than enhancement of health and well-being to spur greater engagement (e.g., availability of and barriers to use of public transportation). Also important in the intervention process is planning for mobility transitions. Future research should test for geographic (e.g., urban vs. rural) differences in the impact of driving cessation on productive and social engagement.
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Affiliation(s)
- Angela L Curl
- *Address correspondence to Angela L. Curl, School of Social Work, University of Missouri, 709 Clark Hall, Columbia, MO 65211. E-mail:
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Berg-Weger M, Meuser TM, Stowe J. Addressing individual differences in mobility transition counseling with older adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2013; 56:201-218. [PMID: 23548142 DOI: 10.1080/01634372.2013.764374] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the final phase of a 3-phase project, the Assessment of Readiness for Mobility Transition (ARMT) was clinically validated, emphasizing assessment/intervention. ARMT and coping, health/vision status, and social support measures were administered to 133 community-dwelling older adults. Concurrent validity is supported. Higher readiness to cope with mobility transition and self-confidence related to fall risk, higher self-rated health/vision, and fewer maladaptive behaviors, but not social support/adaptive coping, suggesting that those at risk can benefit from person-centered intervention to mobilize strengths for transportation/mobility planning. Older drivers may harbor unrealistic expectations regarding nonfamily mobility support. Implications for practice, education, research, and policy are presented.
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Affiliation(s)
- Marla Berg-Weger
- School of Social Work, Saint Louis University, St. Louis, MO 63103, USA.
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Rowe MA, Greenblum CA, Boltz M, Galvin JE. Missing drivers with dementia: antecedents and recovery. J Am Geriatr Soc 2012; 60:2063-9. [PMID: 23134069 DOI: 10.1111/j.1532-5415.2012.04159.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the circumstances under which persons with dementia become lost while driving, how missing drivers are found, and how Silver Alert notifications are instrumental in those discoveries. DESIGN A retrospective, descriptive study. SETTING Retrospective record review. PARTICIPANTS Conducted using 156 records from the Florida Silver Alert program for October 2008 through May 2010. These alerts were issued in Florida for missing drivers with dementia. MEASUREMENTS Information derived from the reports on characteristics of the missing driver, antecedents to missing event, and discovery of a missing driver. RESULTS The majority of missing drivers were men aged 58 to 94 who were being cared for by a spouse. Most drivers became lost on routine, caregiver-sanctioned trips to usual locations. Only 15% were driving when found, with most being found in or near a parked car. Law enforcement officers found the large majority. Only 40% were found in the county where they went missing, and 10% were found in a different state. CONCLUSION Silver Alert notifications were most effective for law enforcement; citizen alerts resulted in a few discoveries. There was 5% mortality in the study population, with those living alone more likely to be found dead than alive. An additional 15% were found in dangerous situations such as stopped on railroad tracks. Thirty-two percent had documented driving or other dangerous errors, such as driving the wrong way or into secluded areas or walking in or near roadways.
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Affiliation(s)
- Meredeth A Rowe
- College of Nursing, University of South Florida, Tampa, Florida, USA.
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Betz ME, Lowenstein SR, Schwartz R. Older Adult Opinions of “Advance Driving Directives”. J Prim Care Community Health 2012; 4:14-27. [DOI: 10.1177/2150131912447082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Discussions about driving cessation are difficult. “Advance driving directives” (ADDs), like advance directives for end-of-life care, would allow drivers to designate someone to help make driving decisions for them in the future. It is not known if older drivers support the concept of ADDs. Design and methods: Cross-sectional study of a convenience sample of English-speaking drivers (55+ years) at 2 independent living facilities and 2 community centers who completed anonymous surveys. Results: Of 168 participants, 80% were female; the median age was 76.5 years (range = 56-93 years). Most (74%) drove daily or almost daily, and 7% reported a crash in the past year. Few had spoken with someone about driving safety (5%) or their wishes when driving skills decline (21%). Of the few who had discussed this topic, 83% had spoken with a family member; only 17% had spoken with a health care provider. However, participants were open to driving discussions, and 54% said they would be willing to complete an ADD if recommended. Of these, 79% said it was “likely” or “very likely” they would comply with the directive in the future. Most (73%) supported mandatory, age-based retesting; the median recommended testing age suggested was 80 years. More participants thought the driver (71%), a family member (61%), or a physician (59%) should determine license revocation for an unsafe driver, rather than the department of motor vehicles (32%). Conclusions: Many older drivers may be open to discussing their driving plans with physicians and family members. ADDs may facilitate these discussions in the present and help define driving-related wishes in the future.
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Affiliation(s)
- Marian E. Betz
- University of Colorado Denver School of Medicine, Aurora, CO, USA
- Colorado School of Public Health, Aurora, CO, USA
| | - Steven R. Lowenstein
- University of Colorado Denver School of Medicine, Aurora, CO, USA
- Colorado School of Public Health, Aurora, CO, USA
| | - Robert Schwartz
- University of Colorado Denver School of Medicine, Aurora, CO, USA
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Abstract
Although automobiles remain the transportation of choice for many older adults, late-life cognitive impairment and dementia often impair the ability to drive safely. However, there is no commonly used method of assessing dementia severity in relation to driving, no consensus on the assessment of older drivers with cognitive impairment, and no gold standard for determining driving fitness. Yet clinicians are called on by patients, their families, other health professionals, and often their state's Department of Motor Vehicles to assess their patients' fitness to drive and to make recommendations about driving privileges. This article describes the challenges of driving with cognitive impairment for both the patient and caregiver, summarizes the literature on dementia and driving, discusses evidence-based assessment of fitness to drive, and addresses important ethical and legal issues. It also describes the role of physician assessment, referral for neuropsychological testing, screening for functional ability, tools to assess dementia severity, driving evaluation clinics, and Department of Motor Vehicles referrals that may assist with evaluation. Lastly, it discusses mobility counseling (eg, exploration of transportation alternatives), because health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance patients' social connectedness and quality of life while meeting their psychological and medical needs and maintaining personal and public safety.
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Affiliation(s)
- David B. Carr
- Departments of Medicine and Neurology, Washington University at St. Louis
| | - Brian R. Ott
- Department of Neurology, Warren Alpert Medical School of Brown University
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