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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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2
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Bayat S, Roe CM. Driving assessment in preclinical Alzheimer’s disease: progress to date and the path forward. Alzheimers Res Ther 2022; 14:168. [DOI: 10.1186/s13195-022-01109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Changes in driving behaviour may start at the preclinical stage of Alzheimer’s disease (AD), where the underlying AD biological process has begun in the presence of cognitive normality. Here, we summarize the emerging evidence suggesting that preclinical AD may impact everyday driving behaviour.
Main
Increasing evidence links driving performance and behaviour with AD biomarkers in cognitively intact older adults. These studies have found subtle yet detectable differences in driving associated with AD biomarker status among cognitively intact older adults.
Conclusion
Recent studies suggest that changes in driving, a highly complex activity, are linked to, and can indicate the presence of, neuropathological AD. Future research must now examine the internal and external validity of driving for widespread use in identifying biological AD.
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3
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Driving Ability Evaluation and Rehabilitation for People With Alzheimer's Disease and Related Dementias. Alzheimer Dis Assoc Disord 2022; 36:374-381. [PMID: 35984740 DOI: 10.1097/wad.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/29/2022] [Indexed: 01/27/2023]
Abstract
Worldwide, it is estimated that around 50 million older adults have Alzheimer's disease and related dementias (ADRD). Cognitive deficits associated with ADRD may affect a driver's perception and decision-making and potentially cause safety concerns. Despite much research, there lacks a comprehensive cognitive evaluation to determine the driving capability of a person with ADRD and it is unclear what are the most effective training and interventions that help to enhance driving performance for these individuals. The purpose of this article is to conduct a comprehensive literature survey to review and summarize studies of driving performance evaluation and intervention for people with ADRD and discuss perspectives for future studies. Although many studies have investigated the correlations between driving behaviors and cognitive performances for people with ADRD, it remains unclear how driving behaviors and cognitive performances are associated with psychophysiological measures. We discussed the need to develop regular driving evaluation and rehabilitation protocol for people with ADRD. We also highlighted the potential benefit to combine driving tests with psychophysiological measures to assist in characterizing personalized cognitive evaluation in the behavioral evaluation process.
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4
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Toups R, Chirles TJ, Ehsani JP, Michael JP, Bernstein JPK, Calamia M, Parsons TD, Carr DB, Keller JN. Driving Performance in Older Adults: Current Measures, Findings, and Implications for Roadway Safety. Innov Aging 2022; 6:igab051. [PMID: 35028434 DOI: 10.1093/geroni/igab051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Over 10,000 people a day turn 65 in the United States. For many older adults, driving represents an essential component of independence and is one of the most important factors in overall mobility. Recent survey studies in older adults suggest that up to 60% of older adult drivers with mild cognitive impairment, and up to 30% with dementia, continue to drive. The purpose of this review is to provide a comprehensive and detailed resource on the topics of cognition and driving for clinicians, researchers, and policymakers working on efforts related to older adult drivers. Research Design and Methods Publications on PubMed and Medline and discussions with experts working in geriatrics, technology, driving policy, psychology, and diverse aspects of driving performance were utilized to inform the current review. Results Research indicates that there is a complex and inverse correlation between multiple cognitive measures, driving performance, and risky driving behaviors. The fragmented nature of available peer-reviewed literature, and a reliance on correlative data, do not currently allow for the identification of the temporal and reciprocal nature of the interplay between cognition and driving endpoints. Discussion and Implications There are currently no widely accepted definitions, conceptual models, or uniform set of analyses for conducting geriatric research that is focused on driving. Establishing conventions for conducting research that harmonizes the fields of geriatrics, cognition, and driving research is critical for the development of the evidence base that will inform clinical practice and road safety policy.
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Affiliation(s)
- Robert Toups
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Theresa J Chirles
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Johnathon P Ehsani
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeffrey P Michael
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Matthew Calamia
- Department of Clinical Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Thomas D Parsons
- Department of Psychology, University of North Texas, Denton, Texas, USA.,Computational Neuropsychology and Simulation Laboratory, University of North Texas, Denton, Texas, USA
| | - David B Carr
- Department of Medicine and Neurology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jeffrey N Keller
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
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5
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Using Video Replay of Simulated Driving to Estimate Driving Safety and Cognitive Status. SAFETY 2021. [DOI: 10.3390/safety7020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cognitive decline resulting from Dementia of Alzheimer’s Type (DAT) can lead to reduced ability to perform complex daily tasks required for independent living, including driving an automobile. This study explores the ability of untrained observers to classify driving safety using short video clips of simulated driving through intersections; it also examined whether untrained observers could predict whether the driver was cognitively healthy or cognitively impaired. Participants (n = 54) were shown a series of 30 video clips arranged in an online survey and asked to answer questions following each clip regarding the safety of the maneuver and the cognitive status of the driver. Results showed that participants’ subjectively rated DAT drivers as significantly less safe in comparison to control drivers, F (1, 52) = 228.44, p < 0.001. Participant’s classification of DAT drivers and controls was also significantly higher than chance (i.e., >50% correct). Findings provide preliminary support for the development of a clinical decision-making aid using video replay of driving simulator performance in fitness-to-drive assessments for individuals with cognitive impairment.
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6
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Crizzle AM, Mullen N, Mychael D, Meger N, Toxopeus R, Gibbons C, Ostap S, Dubois S, Bédard M. The SIMARD-MD is not an Effective Driver Screening Tool for Determining Fitness-To-Drive. Can Geriatr J 2021; 24:14-21. [PMID: 33680259 PMCID: PMC7904326 DOI: 10.5770/cgj.24.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Studies have reported poor sensitivity and specificity of the Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers, a modification of the DemTech (SIMARD-MD) to screen for drivers with cognitive impairment. The purpose of this study was to determine whether the SIMARD-MD can accurately predict pass/fail on a road test in drivers with cognitive impairment (CI) and healthy drivers. Methods Data from drivers with CI were collected from two comprehensive driving assessment centres (n=86) and compared with healthy drivers (n=30). All participants completed demographic measures, clinical measures, and a road rest (pass/fail). Analyses consisted of correlations between the SIMARD-MD and the other clinical measures, and a receiver-operating-characteristic (ROC) curve to determine the predictive ability of the SIMARD-MD. Results All healthy drivers passed the road test compared with 44.2% of the CI sample. On the SIMARD-MD, the CI sample scored significantly worse than healthy drivers (p < .001). The ROC curve showed the SIMARD-MD, regardless of any cut-point, misclassified a large number of CI individuals (AUC=.692; 95% CI = 0.578, 0.806). Conclusions Given the high level of misclassification, the SIMARD-MD should not be used with either healthy drivers or those with cognitive impairment for making decisions about driving.
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Affiliation(s)
- Alexander M Crizzle
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Nadia Mullen
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada
| | - Diane Mychael
- St. Joseph's Health Centre Guelph, Guelph, ON, Canada
| | - Natasha Meger
- Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Ryan Toxopeus
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Carrie Gibbons
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - Simeon Ostap
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada
| | - Sacha Dubois
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada.,Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada.,Human Sciences Division, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Michel Bédard
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada.,Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada.,Human Sciences Division, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
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7
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Economou A, Pavlou D, Beratis I, Andronas N, Papadimitriou E, Papageorgiou SG, Yannis G. Predictors of accidents in people with mild cognitive impairment, mild dementia due to Alzheimer's disease and healthy controls in simulated driving. Int J Geriatr Psychiatry 2020; 35:859-869. [PMID: 32249449 DOI: 10.1002/gps.5306] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/11/2020] [Accepted: 03/28/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the driving variables that predict accident probability in mild dementia due to Alzheimer's disease (AD), mild cognitive impairment (MCI) and healthy older control drivers in simulated driving. To compare the three groups in mean performance and in frequency of scores exceeding 1.5 SD from the mean. METHODS/DESIGN Participants were 37 drivers with MCI, 16 drivers with AD, and 21 control drivers over the age of 52. Driving measures were derived from four rural driving conditions: moderate traffic without and with distraction and high traffic without and with distraction. The measures were z-transformed based on the performance of 90 control drivers of different ages. Two unexpected incidents occurred per condition, requiring the sudden breaking to avoid an accident. RESULTS Drivers with AD showed significantly lower average speed, speed variability, greater headway distance, headway variability and average reaction time (RT) than control drivers. Drivers with MCI showed significantly lower average speed, greater headway distance and average RT than control drivers in the two conditions of distraction. No differences were found in accident probability. Drivers with AD had more deviant scores than both control drivers and drivers with MCI in most comparisons. Predictors of accident probability were average RT, speed variability and lateral position variability but MCI and AD status were not significant predictors in any of the regression models. CONCLUSIONS Despite significant differences in performance, drivers with MCI and AD did not differ in accident probability from control drivers. An individualized approach of examining individual driving performance is recommended.
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Affiliation(s)
- Alexandra Economou
- Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimosthenis Pavlou
- School of Civil Engineering, Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Ion Beratis
- 1st University Department of Neurology, Eginiteion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Andronas
- Cognitive Disorders/Dementia Unit, 2nd University Department of Neurology, ATTIKON University General Hospital at Haidari, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleonora Papadimitriou
- Delft University of Technology, Faculty of Technology, Policy and Management, Delft, The Netherlands
| | - Sokratis G Papageorgiou
- 1st University Department of Neurology, Eginiteion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Yannis
- School of Civil Engineering, Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
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8
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Caffò AO, Tinella L, Lopez A, Spano G, Massaro Y, Lisi A, Stasolla F, Catanesi R, Nardulli F, Grattagliano I, Bosco A. The Drives for Driving Simulation: A Scientometric Analysis and a Selective Review of Reviews on Simulated Driving Research. Front Psychol 2020; 11:917. [PMID: 32528360 PMCID: PMC7266970 DOI: 10.3389/fpsyg.2020.00917] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/14/2020] [Indexed: 12/17/2022] Open
Abstract
Driving behaviors and fitness to drive have been assessed over time using different tools: standardized neuropsychological, on-road and driving simulation testing. Nowadays, the great variability of topics related to driving simulation has elicited a high number of reviews. The present work aims to perform a scientometric analysis on driving simulation reviews and to propose a selective review of reviews focusing on relevant aspects related to validity and fidelity. A scientometric analysis of driving simulation reviews published from 1988 to 2019 was conducted. Bibliographic data from 298 reviews were extracted from Scopus and WoS. Performance analysis was conducted to investigate most prolific Countries, Journals, Institutes and Authors. A cluster analysis on authors' keywords was performed to identify relevant associations between different research topics. Based on the reviews extracted from cluster analysis, a selective review of reviews was conducted to answer questions regarding validity, fidelity and critical issues. United States and Germany are the first two Countries for number of driving simulation reviews. United States is the leading Country with 5 Institutes in the top-ten. Top Authors wrote from 3 to 7 reviews each and belong to Institutes located in North America and Europe. Cluster analysis identified three clusters and eight keywords. The selective review of reviews showed a substantial agreement for supporting validity of driving simulation with respect to neuropsychological and on-road testing, while for fidelity with respect to real-world driving experience a blurred representation emerged. The most relevant critical issues were the a) lack of a common set of standards, b) phenomenon of simulation sickness, c) need for psychometric properties, lack of studies investigating d) predictive validity with respect to collision rates and e) ecological validity. Driving simulation represents a cross-cutting topic in scientific literature on driving, and there are several evidences for considering it as a valid alternative to neuropsychological and on-road testing. Further research efforts could be aimed at establishing a consensus statement for protocols assessing fitness to drive, in order to (a) use standardized systems, (b) compare systematically driving simulators with regard to their validity and fidelity, and (c) employ shared criteria for conducting studies in a given sub-topic.
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Affiliation(s)
- Alessandro Oronzo Caffò
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Luigi Tinella
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Antonella Lopez
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giuseppina Spano
- Department of Agricultural and Environmental Science, Faculty of Agricultural Science, University of Bari Aldo Moro, Bari, Italy
| | - Ylenia Massaro
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Andrea Lisi
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | | | - Roberto Catanesi
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Nardulli
- Commissione Medica Locale Patenti Speciali, Azienda Sanitaria Locale, Bari, Italy
| | - Ignazio Grattagliano
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Andrea Bosco
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
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9
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Sanford S, Naglie G, Cameron DH, Rapoport MJ. Subjective Experiences of Driving Cessation and Dementia: A Meta-Synthesis of Qualitative Literature. Clin Gerontol 2020; 43:135-154. [PMID: 29863962 DOI: 10.1080/07317115.2018.1483992] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objectives: To review qualitative research on the specific challenges and strategies that relate to driving cessation for older adults with dementia, from the perspectives of key informant groups.Method: A meta-synthesis of qualitative studies was conducted. Structured inclusion criteria were applied to screen 616 titles and abstracts, and 9 qualitative studies were included, published from 2002 to 2016. Descriptive themes were identified using content analysis and synthesized to generate analytic themes.Results: The study samples and methodologies represented a diverse range. Cross-cutting themes on experiences of driving cessation for people with dementia are the: importance of open communication and autonomy in decision-making, and advanced planning to connect people with resources; significance of relationships; importance of providing support for the impact of cessation on identity and emotional wellbeing; and benefit of individualizing supportive approaches.Conclusion: This review identifies some important areas for consideration when designing supportive programs to address driving.Clinical Implications: Interventions to support driving cessation for people with dementia should prioritize support for communication, advanced planning, and emotional effects of stopping driving.
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Affiliation(s)
| | - Gary Naglie
- Rotman Research Institute, Toronto, Canada.,Department of Medicine, Baycrest Health Sciences, Toronto, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Research Department, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Duncan H Cameron
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada
| | - Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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10
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Neilson D, Chacko E, Cheung G. Assessing driving fitness in dementia: a challenge for old age psychiatrists. Australas Psychiatry 2019; 27:501-505. [PMID: 31433198 DOI: 10.1177/1039856219867020] [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: 11/15/2022]
Abstract
OBJECTIVE To investigate how old age psychiatrists consider the fitness of dementia patients to drive safely and the challenges they face. METHOD Participants were interviewed using a semi-structured approach that explored topics including their approach to driving fitness and cessation, challenges experienced and previous training. Thematic analysis was used to generate main themes. RESULTS Thirteen participants were recruited. Most felt they were not experts in driving fitness. Many found these assessments challenging for both themselves and their patients, with a negative impact on therapeutic alliance. There was a lack of formal training and variability both in the approach when considering fitness to drive as well as raising the issue of driving with patients. CONCLUSIONS These results highlight the need to increase the availability of training for driving fitness, and to develop a standardised approach to help improve consistency amongst clinicians.
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Affiliation(s)
- Duncan Neilson
- Psychogeriatrician, Mental Health Services for Older People, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Emme Chacko
- Consultant Psychiatrist, Mental Health Services for Older People, Auckland District Health Board, Auckland.,Honorary Senior Lecturer, Department of Psychological Medicine, University of Auckland, New Zealand
| | - Gary Cheung
- Old Age Psychiatrist, Mental Health Services for Older People, Auckland District Health Board, Auckland.,Senior Lecturer in Psychiatry, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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11
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Baines N, Au B, Rapoport MJ, Naglie G, Tierney MC. Meta-analysis of Driving Cessation and Dementia: Does Sex Matter? J Gerontol B Psychol Sci Soc Sci 2019; 73:1185-1189. [PMID: 28025281 DOI: 10.1093/geronb/gbw158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/14/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives The number of drivers with dementia is expected to increase over the coming decades. Because dementia is associated with a higher risk of crashes, driving cessation becomes inevitable as the disease progresses, but many people with dementia resist stopping to drive. This meta-analysis examines whether there are sex differences in the prevalence and incidence of driving cessation among drivers with dementia and compares the pattern of sex differences in drivers with dementia to those without dementia. Method MEDLINE, PsycINFO, Scopus, and CINAHL were searched in July 2015 for observational studies of sex differences in driving cessation. Meta-analyses were performed using a random-effects model. Results Twenty studies provided data on sex differences in driving cessation in older adults with or without dementia. Driving cessation was significantly more prevalent in women with dementia than men (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.50-2.98), and the same pattern was found in women without dementia (OR = 2.74, 95% CI = 1.85-4.06). Discussion Our findings suggest that the patterns of driving cessation differ between men and women with dementia, and this may have implications for sex-specific approaches designed to support drivers with dementia both before and after driving cessation.
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Affiliation(s)
| | - Bonnie Au
- Primary Care Research Unit, Toronto, Ontario, Canada
| | - Mark J Rapoport
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Gary Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Mary C Tierney
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Primary Care Research Unit, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Ontario, Canada
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12
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Yao Y, Zhao X, Du H, Zhang Y, Zhang G, Rong J. Classification of Fatigued and Drunk Driving Based on Decision Tree Methods: A Simulator Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111935. [PMID: 31159221 PMCID: PMC6604013 DOI: 10.3390/ijerph16111935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/27/2019] [Accepted: 05/27/2019] [Indexed: 11/16/2022]
Abstract
It is a commonly known fact that both alcohol and fatigue impair driving performance. Therefore, the identification of fatigue and drinking status is very important. In this study, each of the 22 participants finished five driving tests in total. The control condition, serving as the benchmark in the five driving tests, refers to alert driving. The other four test conditions include driving with three blood alcohol content (BAC) levels (0.02%, 0.05%, and 0.08%) and driving in a fatigued state. The driving scenario included straight and curved roads. The straight roads connected the curved ones with radii of 200 m, 500 m, and 800 m with two turning directions (left and right). Driving performance indicators such as the average and standard deviation of longitudinal speed and lane position were selected to identify drunk driving and fatigued driving. In the process of identification, road geometry (straight segments, radius, and direction of curves) was also taken into account. Alert vs. abnormal and fatigued vs. drunk driving with various BAC levels were analyzed separately using the Classification and Regression Tree (CART) model, and the significance of the variables on the binary response variable was determined. The results showed that the decision tree could be used to distinguish normal driving from abnormal driving, fatigued driving, and drunk driving based on the indexes of vehicle speed and lane position at curves with different radii. The overall accuracy of classification of "alert" and "abnormal" driving was 90.9%, and that of "fatigued" and "drunk" driving was 94.4%. The accuracy was relatively low in identifying different BAC degrees. This experiment is designed to provide a reference for detecting dangerous driving states.
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Affiliation(s)
- Ying Yao
- Beijing Key Laboratory of Traffic Engineering, College of Metropolitan Transportation, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China.
| | - Xiaohua Zhao
- Beijing Key Laboratory of Traffic Engineering, College of Metropolitan Transportation, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China.
| | - Hongji Du
- Autonomous Driving unit, Baidu.com, Inc, No. 10 Xibeiwang East Road, Haidian District, Beijing 100193, China.
| | - Yunlong Zhang
- Zachry Department of Civil Engineering, Texas A&M University, 3136 TAMU, College Station, TX 77843, USA.
| | - Guohui Zhang
- Department of Civil and Environmental Engineering, University of Hawaii at Manoa, 2540 Dole Street, Holmes 338, Honolulu, HI 96822, USA.
| | - Jian Rong
- Beijing Key Laboratory of Traffic Engineering, College of Metropolitan Transportation, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China.
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13
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Rashid R, Standen P, Carpenter H, Radford K. Systematic review and meta-analysis of association between cognitive tests and on-road driving ability in people with dementia. Neuropsychol Rehabil 2019; 30:1720-1761. [DOI: 10.1080/09602011.2019.1603112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Roshe Rashid
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Penny Standen
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Hannah Carpenter
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Radford
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
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14
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Rupp G, Berka C, Meghdadi AH, Karić MS, Casillas M, Smith S, Rosenthal T, McShea K, Sones E, Marcotte TD. EEG-Based Neurocognitive Metrics May Predict Simulated and On-Road Driving Performance in Older Drivers. Front Hum Neurosci 2019; 12:532. [PMID: 30697156 PMCID: PMC6341028 DOI: 10.3389/fnhum.2018.00532] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/17/2018] [Indexed: 01/12/2023] Open
Abstract
The number of older drivers is steadily increasing, and advancing age is associated with a high rate of automobile crashes and fatalities. This can be attributed to a combination of factors including decline in sensory, motor, and cognitive functions due to natural aging or neurodegenerative diseases such as HIV-Associated Neurocognitive Disorder (HAND). Current clinical assessment methods only modestly predict impaired driving. Thus, there is a need for inexpensive and scalable tools to predict on-road driving performance. In this study EEG was acquired from 39 HIV+ patients and 63 healthy participants (HP) during: 3-Choice-Vigilance Task (3CVT), a 30-min driving simulator session, and a 12-mile on-road driving evaluation. Based on driving performance, a designation of Good/Poor (simulator) and Safe/Unsafe (on-road drive) was assigned to each participant. Event-related potentials (ERPs) obtained during 3CVT showed increased amplitude of the P200 component was associated with bad driving performance both during the on-road and simulated drive. This P200 effect was consistent across the HP and HIV+ groups, particularly over the left frontal-central region. Decreased amplitude of the late positive potential (LPP) during 3CVT, particularly over the left frontal regions, was associated with bad driving performance in the simulator. These EEG ERP metrics were shown to be associated with driving performance across participants independent of HIV status. During the on-road evaluation, Unsafe drivers exhibited higher EEG alpha power compared to Safe drivers. The results of this study are 2-fold. First, they demonstrate that high-quality EEG can be inexpensively and easily acquired during simulated and on-road driving assessments. Secondly, EEG metrics acquired during a sustained attention task (3CVT) are associated with driving performance, and these metrics could potentially be used to assess whether an individual has the cognitive skills necessary for safe driving.
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Affiliation(s)
- Greg Rupp
- Advanced Brain Monitoring Inc., Carlsbad, CA, United States
| | - Chris Berka
- Advanced Brain Monitoring Inc., Carlsbad, CA, United States
| | | | | | - Marc Casillas
- Advanced Brain Monitoring Inc., Carlsbad, CA, United States
| | | | | | - Kevin McShea
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Emily Sones
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Thomas D. Marcotte
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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15
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Abstract
Driving is a complex, multifaceted instrumental activity of daily living that has an independent influence on multiple health and well-being outcomes among older adults. Therefore, the benefits of driving to the individual must be balanced, through careful assessment and diagnosis, with the potential risk to self and others posed by a medically impaired driver. The influence of dementia changes substantially during the disease progression from very mild to mild, and driving is not advised for those who have progressed to the moderate stage of Alzheimer disease. Fortunately, validated high-quality screening instruments, including modern simulators and other technology aids, can help clinicians trichotomize risk (i.e., high, moderate, or low) and determine which patients need further evaluation by a driving specialist (e.g., those in the moderate range). Moreover, a body of evidence is building regarding the efficacy of certain intervention pathways to maintain current levels of driving performance among individuals with dementia, or at least slow its decline. Even with the progression of advanced driving technologies, understanding driving ability of patients with dementia will remain a critical challenge to clinicians for the foreseeable future.
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Affiliation(s)
- David B Carr
- Departments of Medicine and Neurology, Washington University School of Medicine, St Louis, MO, United States
| | - James D Stowe
- Aging and Adult Services, Mid-America Regional Council, Kansas City, MO, United States
| | - John C Morris
- Department of Neurology and Director, Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO, United States.
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16
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Jang M, Hong CH, Kim HC, Choi SH, Seo SW, Kim SY, Na DL, Lee Y, Chang KJ, Roh HW, Son SJ. Subcortical Ischemic Change as a Predictor of Driving Cessation in the Elderly. Psychiatry Investig 2018; 15:1162-1167. [PMID: 30466207 PMCID: PMC6318496 DOI: 10.30773/pi.2018.10.10.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Motor, perceptual, and cognitive functions are known to affect driving competence. Subcortical ischemic changes on brain magnetic resonance imaging (MRI) can reflect reduction in cognitive and motor performance. However, few studies have reported the relationship between subcortical ischemic changes and driving competence of the elderly. Thus, the objective of this study was to investigate the association between subcortical ischemic changes on MRI and driving abilities of the elderly. METHODS Participants (n=540) were drawn from a nationwide, multicenter, hospital-based, longitudinal cohort. Each participant underwent MRI scan and interview for driving capacity categorized into 'now driving' and 'driving cessation (driven before, not driving now)'. Participants were divided into three groups (mild, n=389; moderate, n=116; and severe, n=35) depending on the degree of white matter hyperintensity (WMH) on MRI at baseline. Driving status was evaluated at follow-up. Statistical analyses were conducted using χ2 test, analysis of variance (ANOVA), structured equation model (SEM), and generalized estimating equation (GEE). RESULTS In SEM, greater baseline degree of WMH was directly associated with driving cessation regardless of cognitive or motor dysfunction (β=-0.110, p<0.001). In GEE models after controlling for age, sex, education, cognitive, and motor dysfunction, more severe change in the degree of WMH was associated with faster change from 'now driving' state to 'driving cessation' state over time in the elderly (β=-0.508, p<0.001). CONCLUSION In both cross-sectional and longitudinal results, the degree of subcortical ischemic change on MRI might predict driving cessation in the elderly.
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Affiliation(s)
- Mi Jang
- Department of General Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun-Chung Kim
- Department of Psychiatry, National Medical Center of Korea, Seoul, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ki Jung Chang
- Department of Psychiatry, Ajou Good Hospital, Suwon, Republic of Korea
| | - Hyun Woong Roh
- Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
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17
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Chen R, Chien WC, Kao CC, Chung CH, Liu D, Chiu HL, Chou KR. Analysis of the risk and risk factors for injury in people with and without dementia: a 14-year, retrospective, matched cohort study. Alzheimers Res Ther 2018; 10:111. [PMID: 30376887 PMCID: PMC6208020 DOI: 10.1186/s13195-018-0437-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most previous studies on dementia and injuries have focused on a particular type of injury, and few studies have investigated overall injury in people with dementia. In this study, we investigated the risk factors and risk of overall injury, including the diagnosis, cause, and intentionality of injury, in people with and without dementia in Taiwan. METHODS We collected relevant data between 2000 and 2013 from the National Health Insurance Research Database (NHIRD). Overall, 455,630 cases, consisting of 91,126 people with dementia and 364,504 people without dementia, were included in this study and we performed subgroup analysis. A multivariate Cox proportional hazards regression analysis was used to determine the risk of injuries. RESULTS The 14-year follow-up data showed that people with dementia had a higher risk of injury-related hospitalization than did people without dementia (19.92% vs 18.86%, hazard ratio (HR) = 1.070, p < 0.001). Regarding the cause of injury, people with dementia were more likely to be hospitalized due to suffocation (HR = 2.301, p < 0.001), accidental drug poisoning (HR = 1.485, p < 0.001), or falls (HR = 1.076, p < 0.001), and were less likely to be hospitalized due to suicide or self-inflicted injury (HR = 0.670, p < 0.001) or a traffic accident (HR = 0.510, p < 0.001) than were people without dementia. Subgroup analysis showed that people with dementia with any of the three subtypes of dementia were at a higher risk of homicide or abuse than were people without dementia (vascular dementia, HR = 2.079, p < 0.001; Alzheimer's disease, HR = 1.156, p < 0.001; other dementia, HR = 1.421, p < 0.001). The risk factors for overall injury included dementia diagnosis, female gender, age 65-74 years, and seeking medical attention for an injury within the past year. CONCLUSION People with dementia are at a higher risk of injury-related hospitalization than people without dementia. The results of this study provide a reference for preventing suffocation, drug poisoning, and falls in people with dementia. In addition, government agencies should pay attention to and intervene in cases of abuse suffered by people with dementia.
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Affiliation(s)
- Ruey Chen
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, Taipei, 23561 Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490 Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
- School of Public Health, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
| | - Ching-Chiu Kao
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Taipei, 11696 Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
| | - Doresses Liu
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Taipei, 11696 Taiwan
| | - Huei-Ling Chiu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Kuei-Ru Chou
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, Taipei, 23561 Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, No.252, Wuxing St, Xinyi District, Taipei, 110 Taiwan
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18
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Petersen JD, Siersma VD, Depont Christensen R, Storsveen MM, Nielsen CT, Vass M, Waldorff FB. Dementia and road traffic accidents among non-institutionalized older people in Denmark: A Danish register-based nested case-control study. Scand J Public Health 2018; 47:221-228. [PMID: 29914317 DOI: 10.1177/1403494818782094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM We used register-based data to estimate the effect of all-type dementia on road traffic accidents (RTAs) risk, combined with comorbidities or sedative medicines, among non-institutionalized older people in Denmark. METHODS The source population was all residents in Denmark aged 65 years and older, alive as of January 1, 2008 ( n = 853,228). Cases were those who had any type of RTA in 2009-2014. Each case was matched for age, sex and geographic location to 4-6 controls. All-type dementia was ascertained using the International Classification of Diseases version 10 (ICD-10) diagnosis supplemented with prescribed medicine records. Eight chronic diseases were selected to assess comorbidities. Four types of medicines were categorized as sedative medicines for analysis. Conditional logistic regression with adjustment for education and marital status as well as either the number of comorbidities or sedative medications use was performed using STATA software. RESULTS Older people with dementia had lower RTAs risk compared to their controls (odds ratio = 0.43, 95% confidence interval (0.32-0.60), p < 0.001). Significant interaction was observed between dementia and the number of comorbidities for RTAs estimation. CONCLUSIONS The significantly lower RTAs risk for older individuals with dementia observed in our study may be due to people with dementia living at home having a lower frequency of outdoor activities; that is, less exposure to traffic. However, this, together with the interaction between dementia and comorbidities as well as sedative medications, should be investigated further.
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Affiliation(s)
- Jindong Ding Petersen
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Volkert Dirk Siersma
- 3 Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - René Depont Christensen
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maria Munch Storsveen
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Connie Thurøe Nielsen
- 2 Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Mikkel Vass
- 3 Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- 1 Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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19
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Hamdy RC, Kinser A, Kendall-Wilson T, Depelteau A, Whalen K, Culp J. Driving and Patients With Dementia. Gerontol Geriatr Med 2018; 4:2333721418777085. [PMID: 29900187 PMCID: PMC5985540 DOI: 10.1177/2333721418777085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/09/2018] [Accepted: 04/09/2018] [Indexed: 11/23/2022] Open
Abstract
Driving is a symbol of autonomy and independence, eagerly awaited during adolescence, cherished during adulthood and reluctantly rescinded during old age. It is nevertheless an individual’s privilege, not right, especially as driving may affect other drivers and pedestrians on the road. It is therefore not only the individual patient who is at stake but essentially the entire community. In this case scenario, we describe the situation that arose when a patient with multi-infarct dementia wanted to go for a drive and his son and grandson tried to convince him that he could no longer drive. What went wrong in the caregivers/patient interaction is presented. The futility of arguing with patients who have dementia is highlighted as well as the suspiciousness it may generate. Alternate actions that can be useful to avoid/avert the situation from escalating and having a catastrophic ending are discussed. Testing/evaluating patients with dementia for fitness to drive is also reviewed and a list of select resources is included.
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Affiliation(s)
- R C Hamdy
- East Tennessee State University, Johnson City, TN, USA
| | - A Kinser
- East Tennessee State University, Johnson City, TN, USA
| | - T Kendall-Wilson
- East Tennessee State University, Johnson City, TN, USA.,Alzheimer's Tennessee, Knoxville, TN, USA
| | - A Depelteau
- East Tennessee State University, Johnson City, TN, USA
| | - K Whalen
- East Tennessee State University, Johnson City, TN, USA
| | - J Culp
- East Tennessee State University, Johnson City, TN, USA
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20
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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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21
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Duncanson H, Hollis AM, O'Connor MG. Errors versus speed on the trail making test: Relevance to driving performance. ACCIDENT; ANALYSIS AND PREVENTION 2018; 113:125-130. [PMID: 29407659 DOI: 10.1016/j.aap.2018.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/14/2017] [Accepted: 01/06/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND/OBJECTIVES Many studies have demonstrated that speed to complete items on the Trail Making Tests (TMT A and TMT B) is useful in the prediction of driving safety. However, there is no consensus regarding optimal "cut scores" to discriminate between safe and unsafe drivers. In this study, we examine TMT speed and errors in drivers referred for a road test. DESIGN Retrospective analysis. SETTING Patients referred for a DriveWise® evaluation at Beth Israel Deaconess Medical Center in Boston, Massachusetts. PARTICIPANTS Drivers age 65 or older were included (total n = 373). Forty-five percent of the sample had been diagnosed with Cognitive Impairment (CI) whereas the remaining participants were in the No Cognitive Impairment (NCI) group. MEASUREMENTS TMT Parts A & B, Folstein Mini Mental Status Examination, Washington University Road Test. RESULTS CI drivers with TMT A speed exceeding 46 s were more likely to fail the road test whereas TMT B speed was not a sensitive metric in this group. In the No Cognitive Impairment (NCI) group, TMT B speed exceeding 131 s predicted driving impairment whereas TMT A speed was not sensitive. Error scores were not useful in the determination of driving fitness for either group. CONCLUSIONS This study provides useful criteria for health providers working with older people in the determination of driving fitness. Results suggest that TMT speed, but not error rate, is associated with road test performance. Based on our work, we advocate that pre-existing dementia should be taken into consideration when using TMT performance as a screen for driving.
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Affiliation(s)
- Haley Duncanson
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, United States; Harvard Medical School, United States.
| | - Ann M Hollis
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, United States
| | - Margaret G O'Connor
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center, United States; Harvard Medical School, United States
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22
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Knoefel F, Wallace B, Goubran R, Marshall S. Naturalistic Driving: A Framework and Advances in Using Big Data. Geriatrics (Basel) 2018; 3:geriatrics3020016. [PMID: 31011060 PMCID: PMC6319207 DOI: 10.3390/geriatrics3020016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/22/2018] [Accepted: 03/24/2018] [Indexed: 11/16/2022] Open
Abstract
Driving is an activity that facilitates physical, cognitive, and social stimulation in older adults, ultimately leading to better physical and cognitive health. However, aging is associated with declines in vision, physical health, and cognitive health, all of which can affect driving ability. One way of assessing driving ability is with the use of sensors in the older adult’s own vehicle. This paper provides a framework for driving assessment and addresses how naturalistic driving studies can assist in such assessments. The framework includes driving characteristics (how much driving, speed, position, type of road), actions and reactions (lane changes, intersections, passing, merging, traffic lights, pedestrians, other vehicles), destinations (variety and distance, sequencing and route planning), and driving conditions (time of day and season). Data from a subset of Ottawa drivers from the Candrive study is used to illustrate the use of naturalistic driving data. Challenges in using naturalistic driving big data and the changing technology in vehicles are discussed.
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Affiliation(s)
- Frank Knoefel
- Bruyère Continuing Care, Ottawa, ON K1N 5C8, Canada.
- Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada.
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada.
- Department of Systems and Computer Engineering, Faculty of Engineering and Design, Carleton University, Ottawa, ON K1S 5B6, Canada.
- AGE-WELL NIH-SAM3, Ottawa, ON K1N 5C8, Canada.
| | - Bruce Wallace
- Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada.
- Department of Systems and Computer Engineering, Faculty of Engineering and Design, Carleton University, Ottawa, ON K1S 5B6, Canada.
- AGE-WELL NIH-SAM3, Ottawa, ON K1N 5C8, Canada.
| | - Rafik Goubran
- Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada.
- Department of Systems and Computer Engineering, Faculty of Engineering and Design, Carleton University, Ottawa, ON K1S 5B6, Canada.
- AGE-WELL NIH-SAM3, Ottawa, ON K1N 5C8, Canada.
| | - Shawn Marshall
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada.
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada.
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23
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Taylor BJ, Stevenson M, McDowell M. Communicating risk in dementia care: Survey of health and social care professionals. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e291-e303. [PMID: 29226458 DOI: 10.1111/hsc.12519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
Supporting people to live at home in line with community care policies requires increasing attention to assessing, communicating and managing risks. There is a challenge in supporting client choices that include risk-taking while demonstrating professional accountability. Risk communication becomes increasingly important with the need to engage clients and families in meaningful shared decision-making. This presents particular challenges in dementia services. This survey of risk communication in dementia care was administered to all health and social care professionals in community dementia services in Northern Ireland: June-September 2016. Of 270 professionals, 70 questionnaires were fully completed, with 55 partial completions. Scores on the Berlin Numeracy Test plus Schwartz items was low-moderate (mean 2.79 out of 7). This study did not find a significant association between numeracy and accurate perceptions of risk likelihoods in practice-based scenarios. Although 86% reported using numeric information in practice (mostly from assessment tools), respondents rarely communicated themselves using numbers. As in other domains, participants' responses were widely variable on numeric estimates of verbal terms for likelihood. In relation to medication side effects, few participants provided responses that were concordant with those in the guidance of the European Union. The risks most commonly encountered in practice were (in rank order): falls, depression, poor personal hygiene, medicines mismanagement, leaving home unsupervised, financial mismanagement, malnutrition, swallowing difficulties, abuse from others, risks to others, home appliance accidents and refusing equipment. Respondents generally overestimated the likelihood of serious harmful events by approximately 10-fold (having a missing person's report filed with the police; having a fall resulting in hospitalisation) and by approximately double (being involved in a car accident; causing a home fire), and with wide variation between respondents. There is potential in icon arrays for communicating risks. Risk literacy among dementia care practitioners needs to be developed.
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Affiliation(s)
- Brian J Taylor
- Institute for Social Sciences, Ulster University, Northern Ireland, UK
| | - Mabel Stevenson
- School of Sociology & Applied Social Studies, Ulster University, Northern Ireland, UK
| | - Michelle McDowell
- Harding Centre for Risk Literacy, Max Planck Institute, Berlin, Germany
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Agimi Y, Albert SM, Youk AO, Documet PI, Steiner CA. Dementia and motor vehicle crash hospitalizations: Role of physician reporting laws. Neurology 2018; 90:e808-e813. [PMID: 29386271 PMCID: PMC10681054 DOI: 10.1212/wnl.0000000000005022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 12/01/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the effect of physician reporting laws and state licensing requirements on crash hospitalizations among drivers with dementia. METHODS A study of drivers hospitalized because of vehicle crashes, identified from the State Inpatient Databases of the Agency for Healthcare Research and Quality. Multivariable logistic regression was used to examine the effect of mandatory physician reporting of at-risk drivers and state licensing requirement on the prevalence of dementia among hospitalized drivers. RESULTS Physician reporting laws, mandated or legally protected, were not associated with a lower likelihood of dementia among crash hospitalized drivers. Hospitalized drivers aged 60 to 69 years in states with in-person renewal laws were 37% to 38% less likely to have dementia than drivers in other states and 23% to 28% less likely in states with vision testing at in-person renewal. Road testing was associated with lower dementia prevalence among hospitalized drivers aged 80 years and older. CONCLUSION Vision testing at in-person renewal and in-person renewal requirements were significantly related with a lower prevalence of dementia in hospitalized older adults among drivers aged 60 to 69 years. Road testing was significantly associated with a lower proportion of dementia among hospitalized drivers aged 80 years and older. Mandatory physician driver reporting laws lacked any independent association with prevalence of dementia among hospitalized drivers.
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Affiliation(s)
- Yll Agimi
- From Salient CRGT Inc. (Y.A.), Health Services, Silver Spring, MD; Departments of Behavioral and Community Health Sciences (S.M.A., P.I.D.) and Biostatistics (A.O.Y.), University of Pittsburgh, PA; Kaiser Permanente-Denver (C.A.S.), Institute for Health Research, CO; Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (C.A.S.), DHHS, Rockville, MD.
| | - Steven M Albert
- From Salient CRGT Inc. (Y.A.), Health Services, Silver Spring, MD; Departments of Behavioral and Community Health Sciences (S.M.A., P.I.D.) and Biostatistics (A.O.Y.), University of Pittsburgh, PA; Kaiser Permanente-Denver (C.A.S.), Institute for Health Research, CO; Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (C.A.S.), DHHS, Rockville, MD
| | - Ada O Youk
- From Salient CRGT Inc. (Y.A.), Health Services, Silver Spring, MD; Departments of Behavioral and Community Health Sciences (S.M.A., P.I.D.) and Biostatistics (A.O.Y.), University of Pittsburgh, PA; Kaiser Permanente-Denver (C.A.S.), Institute for Health Research, CO; Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (C.A.S.), DHHS, Rockville, MD
| | - Patricia I Documet
- From Salient CRGT Inc. (Y.A.), Health Services, Silver Spring, MD; Departments of Behavioral and Community Health Sciences (S.M.A., P.I.D.) and Biostatistics (A.O.Y.), University of Pittsburgh, PA; Kaiser Permanente-Denver (C.A.S.), Institute for Health Research, CO; Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (C.A.S.), DHHS, Rockville, MD
| | - Claudia A Steiner
- From Salient CRGT Inc. (Y.A.), Health Services, Silver Spring, MD; Departments of Behavioral and Community Health Sciences (S.M.A., P.I.D.) and Biostatistics (A.O.Y.), University of Pittsburgh, PA; Kaiser Permanente-Denver (C.A.S.), Institute for Health Research, CO; Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (C.A.S.), DHHS, Rockville, MD
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Spreng L, Favrat B, Borruat FX, Vaucher P. Cross-sectional study assessing the addition of contrast sensitivity to visual acuity when testing for fitness to drive. BMJ Open 2018; 8:e018546. [PMID: 29374663 PMCID: PMC5829587 DOI: 10.1136/bmjopen-2017-018546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study is to quantify the importance of loss of contrast sensitivity (CS) and its relationship to loss of visual acuity (VA), driving restrictions and daytime, on-road driving evaluations in drivers aged 70+. DESIGN A predictive cross-sectional study. SETTING Volunteer participants to a drivers' refresher course for adults aged 70+ delivered by the Swiss Automobile Club in western Switzerland from 2011 to 2013. PARTICIPANTS 162 drivers, male and female, aged 70 years or older. CLINICAL PREDICTORS We used a vision screener to estimate VA and the The Mars Letter Contrast Sensitivity Test to test CS. OUTCOMES We asked drivers to report whether they found five driving restrictions useful for their condition; restrict driving to known roads, avoid driving on highways, avoid driving in the dark, avoid driving in dense traffic and avoid driving in fog. All participants also underwent a standardised on-road evaluation carried out by a driving instructor. RESULTS Moderate to severe loss of CS for at least one eye was frequent (21.0% (95% CI 15.0% to 28.1%)) and often isolated from a loss of VA (11/162 cases had a VA ≥0.8 decimal and a CS of ≤1.5 log(CS); 6.8% (95% CI 3.4% to 11.8%)). Drivers were more likely (R2=0.116, P=0.004) to report a belief that self-imposed driving restrictions would be useful if they had reduced CS in at least one eye. Daytime evaluation of driving performance seems limited in its ability to correctly identify difficulties related to CS loss (VA: R2=0.004, P=0.454; CS: R2=0.006, P=0.332). CONCLUSION CS loss is common for older drivers. Screening CS and referring for cataract surgery even in the absence of VA loss could help maintain mobility. Reduced CS and moderate reduction of VA were both poor predictors of daytime on-road driving performances in this research study.
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Affiliation(s)
- Lucie Spreng
- Doctoral School of Medicine, Faculty of Medicine and Biology, University of Lausanne, Lausanne, Switzerland
| | - Bernard Favrat
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
- Unit of Psychology and Traffic Medicine, University Centre of Legal Medicine Lausanne-Geneva, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - François-Xavier Borruat
- Ophthalmology Department, Jules-Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
| | - Paul Vaucher
- Unit of Psychology and Traffic Medicine, University Centre of Legal Medicine Lausanne-Geneva, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- aR&D, School of Health Sciences Fribourg, University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland
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Vair CL, King PR, Gass J, Eaker A, Kusche A, Wray LO. Electronic Medical Record Documentation of Driving Safety for Veterans with Diagnosed Dementia. Clin Gerontol 2018; 41:66-76. [PMID: 28459309 DOI: 10.1080/07317115.2017.1312654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Many older adults continue to drive following dementia diagnosis, with medical providers increasingly likely to be involved in addressing such safety concerns. This study examined electronic medical record (EMR) documentation of driving safety for veterans with dementia (N = 118) seen in Veterans Affairs primary care and interdisciplinary geriatrics clinics in one geographic region over a 10-year period. METHODS Qualitative directed content analysis of retrospective EMR data. RESULTS Assessment of known risk factors or subjective concerns for unsafe driving were documented in fewer than half of observed cases; specific recommendations for driving safety were evident for a minority of patients, with formal driving evaluation the most frequently documented recommendation by providers. CONCLUSION Utilizing data from actual clinical encounters provides a unique snapshot of how driving risk and safety concerns are addressed for veterans with dementia. This information provides a meaningful frame of reference for understanding potential strengths and possible gaps in how this important topic area is being addressed in the course of clinical care. CLINICAL IMPLICATIONS The EMR is an important forum for interprofessional communication, with documentation of driving risk and safety concerns an essential element for continuity of care and ensuring consistency of information delivered to patients and caregivers.
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Affiliation(s)
- Christina L Vair
- a W. G. "Bill" Heffner VA Medical Center , Salisbury , North Carolina , USA.,b VA Western New York Healthcare System, Buffalo , New York , USA
| | - Paul R King
- b VA Western New York Healthcare System, Buffalo , New York , USA
| | - Julie Gass
- b VA Western New York Healthcare System, Buffalo , New York , USA.,c The University at Buffalo, State University of New York, Buffalo , New York , USA
| | - April Eaker
- b VA Western New York Healthcare System, Buffalo , New York , USA
| | - Anna Kusche
- b VA Western New York Healthcare System, Buffalo , New York , USA
| | - Laura O Wray
- b VA Western New York Healthcare System, Buffalo , New York , USA.,c The University at Buffalo, State University of New York, Buffalo , New York , USA
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Agnihotri K, Pothineni N, Charilaou P, Vaidya VR, Thakkar B, Goyal V, Kadavath S, Patel N, Badheka A, Noseworthy P, Kapa S, Friedman P, Gersh B, Paydak H, Deshmukh A. Impact of atrial fibrillation on outcomes with motor vehicle accidents. Int J Cardiol 2018; 250:128-132. [DOI: 10.1016/j.ijcard.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/07/2017] [Accepted: 10/02/2017] [Indexed: 11/30/2022]
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Versijpt J, Tant M, Beyer I, Bier JC, Cras P, De Deyn PP, De Wit P, Deryck O, Hanseeuw B, Lambert M, Lemper JC, Mormont E, Petrovic M, Picard G, Salmon E, Segers K, Sieben A, Thiery E, Tournoy J, Vandewoude M, Ventura M, Verschraegen J, Engelborghs S, Goffin T, Deneyer M, Ivanoiu A. Alzheimer's disease and driving: review of the literature and consensus guideline from Belgian dementia experts and the Belgian road safety institute endorsed by the Belgian Medical Association. Acta Neurol Belg 2017; 117:811-819. [PMID: 28983881 DOI: 10.1007/s13760-017-0840-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022]
Abstract
Alzheimer's disease (AD) is a highly prevalent condition and its prevalence is expected to further increase due to the aging of the general population. It is obvious that the diagnosis of AD has implications for driving. Finally, driving discussions are also emotionally charged because driving is associated with independence and personal identity. However, it is not clear how to implement this in clinical practice and the Belgian law on driving is rather vague in its referral to neurodegenerative brain diseases in general nor does it provide clear-cut instructions for dementia or AD compared to for example driving for patients with epilepsy and as such does not prove to be very helpful. The present article reviews what is known from both literature and existing guidelines and proposes a consensus recommendation tailored to the Belgian situation agreed by both AD experts and the Belgian Road Safety Institute endorsed by the Belgian Medical Association. It is concluded that the decision about driving fitness should be considered as a dynamic process where the driving fitness is assessed and discussed early after diagnosis and closely monitored by the treating physician. The diagnosis of AD on itself definitely does not imply the immediate and full revocation of a driving license nor does it implicate a necessary referral for a formal on-road driving assessment. There is no evidence to recommend a reduced exposure or a mandatory co-pilot. A MMSE-based framework to trichotomise AD patients as safe, indeterminate or unsafe is presented. The final decision on driving fitness can only be made after careful history taking and clinical examination, neuropsychological, functional and behavioral evaluation and, only for selected cases, a formal assessment of driving performance.
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Chee JN, Rapoport MJ, Molnar F, Herrmann N, O'Neill D, Marottoli R, Mitchell S, Tant M, Dow J, Ayotte D, Lanctôt KL, McFadden R, Taylor JP, Donaghy PC, Olsen K, Classen S, Elzohairy Y, Carr DB. Update on the Risk of Motor Vehicle Collision or Driving Impairment with Dementia: A Collaborative International Systematic Review and Meta-Analysis. Am J Geriatr Psychiatry 2017; 25:1376-1390. [PMID: 28917504 DOI: 10.1016/j.jagp.2017.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/28/2017] [Accepted: 05/11/2017] [Indexed: 11/25/2022]
Abstract
Guidelines that physicians use to assess fitness to drive for dementia are limited in their currency, applicability, and rigor of development. Therefore, we performed a systematic review to determine the risk of motor vehicle collisions (MVCs) or driving impairment caused by dementia, in order to update international guidelines on driving with dementia. Seven literature databases (MEDLINE, CINAHL, Embase, etc.) were searched for all research studies published after 2004 containing participants with mild, moderate, or severe dementia. From the retrieved 12,860 search results, we included nine studies in this analysis, involving 378 participants with dementia and 416 healthy controls. Two studies reported on self-/informant-reported MVC risk, one revealing a four-fold increase in MVCs per 1,000 miles driven per week in 3 years prior, and the other showing no statistically significant increase over the same time span. We found medium to large effects of dementia on driving abilities in six of the seven recent studies that examined driving impairment. We also found that persons with dementia were much more likely to fail a road test than healthy controls (RR: 10.77, 95% CI: 3.00-38.62, z = 3.65, p < 0.001), with no significant heterogeneity (χ2 = 1.50, p = 0.68, I2 = 0%) in a pooled analysis of four studies. Although the limited data regarding MVCs are equivocal, even mild stages of dementia place patients at a substantially higher risk of failing a performance-based road test and of demonstrating impaired driving abilities on the road.
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Affiliation(s)
- Justin N Chee
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frank Molnar
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Sara Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Tant
- Belgian Road Safety Institute, Brussels, Belgium
| | - Jamie Dow
- Société de l'assurance automobile du Québec, Québec City, Québec, Canada
| | - Debbie Ayotte
- Canadian Medical Association, Ottawa, Ontario, Canada
| | - Krista L Lanctôt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Paul C Donaghy
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Kirsty Olsen
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Sherrilene Classen
- School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Yoassry Elzohairy
- Road User Safety Division, Ontario Ministry of Transportation, Toronto, Ontario, Canada
| | - David B Carr
- School of Medicine, Washington University St. Louis, St. Louis, MO, USA
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Dickerson AE, Molnar L, Bedard M, Eby DW, Classen S, Polgar J. Transportation and Aging: An Updated Research Agenda for Advancing Safe Mobility. J Appl Gerontol 2017; 38:1643-1660. [PMID: 29165017 DOI: 10.1177/0733464817739154] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This article discusses what is currently known about three important topics related to older driver safety and mobility: screening and evaluation, education and training interventions, and in-vehicle technology. Progress is being made to improve the safe mobility of older adults in these key areas; however, significant research gaps remain. This article advances the state of knowledge by identifying these gaps, and proposing further research topics will improve the lives of older adults. In addition, we discuss several themes that emerged from the review, including the need for multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education/training for both older adults themselves and the variety of stakeholders involved in older adult transportation; and programs and interventions that are flexible and responsive to individual needs and differences.
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Affiliation(s)
| | - Lisa Molnar
- UMTRI, University of Michigan, Ann Arbor, MI, USA
| | | | - David W Eby
- UMTRI, University of Michigan, Ann Arbor, MI, USA
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31
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Davis R, Ohman JM, Weisbeck C. Salient Cues and Wayfinding in Alzheimer's Disease within a Virtual Senior Residence. ENVIRONMENT AND BEHAVIOR 2017; 49:1038-1065. [PMID: 29230067 PMCID: PMC5722469 DOI: 10.1177/0013916516677341] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Wayfinding is a problem for persons with Alzheimer's disease (AD), especially in complex environments such as senior residential communities. In this study, persons with AD or mild cognitive impairment (MCI) and a control group of older adults were asked to navigate a virtual reality simulation of a senior residential community. Subjects had to find their way repeatedly over multiple trials for two consecutive days in standard (no extra cues) and salient (colorful, memorable cues placed at key decision points) cue conditions. The results showed that all subjects found their way faster and more effectively in the salient cue condition than in the standard cue condition. Those in the AD/MCI group were significantly more impaired in wayfinding ability compared with those in the control group. Persons with impaired wayfinding ability due to AD and MCI can find their way more effectively in virtual environments enhanced with salient environmental cues.
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Affiliation(s)
- Rebecca Davis
- Professor, Kirkhof College of Nursing, Grand Valley State University
| | | | - Catherine Weisbeck
- Former Project Director, Wayfinding Study, Kirkhof College of Nursing, Grand Valley State, University
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Marie Dit Asse L, Fabrigoule C, Helmer C, Laumon B, Berr C, Rouaud O, Auriacombe S, Lafont S. Gender effect on driving cessation in pre-dementia and dementia phases: results of the 3C population-based study. Int J Geriatr Psychiatry 2017; 32:1049-1058. [PMID: 27550076 DOI: 10.1002/gps.4565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/24/2016] [Accepted: 07/14/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Aging entails deterioration in sensory, physical, and cognitive functions, raising doubt in the driving capacity of older drivers, especially when the deficits are severe, as in dementia. Many older drivers, especially women, adapt their driving habits in order to compensate for these deficits and eventually stop driving. The present prospective study assessed driving cessation in men and women throughout the dementia process, including a 2-year pre-dementia phase. METHODS The study was based on a three-city cohort of subjects who were aged 65 years and older in 2000 and followed for more than 10 years. Active dementia detection was conducted at each follow-up. The probability of driving cessation was assessed in men and women during the 2-year pre-dementia phase and until 5 years after diagnosis. RESULTS In the 2-year pre-dementia phase, both men and women ceased driving earlier than drivers with no central nervous system pathology (p < 0,001), and women ceased driving earlier than men. A total of 45% of men and 74% of women had already ceased driving at dementia diagnosis. In contrast, the probability of cessation within 3 years after diagnosis was similar between men and women. CONCLUSION The study showed that, in this French urban population, few demented drivers, especially women, were still driving after diagnosis. Those who continued to drive 3 years after the diagnosis all had Alzheimer-type dementia. There is certainly a need for physicians to help these drivers to adapt their driving activity to their deficits and to prepare them to stop driving. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Catherine Helmer
- Centre INSERM U897-Epidemiologie-Biostatistique, ISPED, Bordeaux, France
| | - Bernard Laumon
- Univ Lyon, Université Claude Bernard Lyon1, Ifsttar, UMRESTTE, Bron, France
| | - Claudine Berr
- INSERM U1061 - Hôpital La Colombière, Montpellier Cedex 5, France
| | - Olivier Rouaud
- Centre Mémoire de Ressources et de Recherche, Bocage Central, Dijon, France
| | - Sophie Auriacombe
- Centre Mémoire de Ressources et de Recherche, Bordeaux Cedex, France
| | - Sylviane Lafont
- Univ Lyon, Université Claude Bernard Lyon1, Ifsttar, UMRESTTE, Bron, France
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Payyanadan RP, Maus A, Sanchez FA, Lee JD, Miossi L, Abera A, Melvin J, Wang X. Using trip diaries to mitigate route risk and risky driving behavior among older drivers. ACCIDENT; ANALYSIS AND PREVENTION 2017; 106:480-491. [PMID: 27720427 DOI: 10.1016/j.aap.2016.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/29/2016] [Accepted: 09/22/2016] [Indexed: 06/06/2023]
Abstract
To reduce exposure to risky and challenging driving situations and prolong mobility and independence, older drivers self-regulate their driving behavior. But self-regulation can be challenging because it depends on drivers' ability to assess their limitations. Studies using self-reports, survey data, and hazard and risk perception tests have shown that driving behavior feedback can help older drivers assess their limitations and adjust their driving behavior. But only limited work has been conducted in developing feedback technology interventions tailored to meet the information needs of older drivers, and the impact these interventions have in helping older drivers self-monitor their driving behavior and risk outcomes. The vehicles of 33 drivers 65 years and older were instrumented with OBD2 devices. Older drivers were provided access to customized web-based Trip Diaries that delivered post-trip feedback of the routes driven, low-risk route alternatives, and frequency of their risky driving behaviors. Data were recorded over four months, with baseline driving behavior collected for one month. Generalized linear mixed effects regression models assessed the effects of post-trip feedback on the route risk and driving behaviors of older drivers. Results showed that post-trip feedback reduced the estimated route risk of older drivers by 2.9% per week, and reduced their speeding frequency on average by 0.9% per week. Overall, the Trip Diary feedback reduced the expected crash rate from 1 in 6172 trips to 1 in 7173 trips, and the expected speeding frequency from 46% to 39%. Thus providing older drivers with tailored feedback of their driving behavior and crash risk could help them appropriately self-regulate their driving behavior, and improve their crash risk outcomes.
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Affiliation(s)
- Rashmi P Payyanadan
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA.
| | - Adam Maus
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Fabrizzio A Sanchez
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - John D Lee
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Lillian Miossi
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Amsale Abera
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Jacob Melvin
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Xufan Wang
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, 53706, USA
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Fields SM, Unsworth CA. Revision of the Competency Standards for Occupational Therapy Driver Assessors: An overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations. Aust Occup Ther J 2017; 64:328-339. [DOI: 10.1111/1440-1630.12379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Sally M. Fields
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast Queensland Australia
| | - Carolyn A. Unsworth
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Department of Rehabilitation; School of Health Sciences; Jönköping University; Jönköping Sweden
- Faculty of Health Sciences; Curtin University; Bentley Western Australia Australia
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Rapoport MJ, Cameron DH, Sanford S, Naglie G. A systematic review of intervention approaches for driving cessation in older adults. Int J Geriatr Psychiatry 2017; 32:484-491. [PMID: 28181711 DOI: 10.1002/gps.4681] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/13/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this project was to review the literature on interventions aimed at facilitating driving cessation in older adults, with and without dementia. METHODS A literature search was performed using the databases MEDLINE, CINAHL, Cochrane Central, Embase, and PsycINFO, from 1994 to September 2014. Two independent raters screened articles for inclusion and extracted study data. We only included articles if they directly addressed the topic of intervention approaches to facilitate the process of driving cessation in older adults or to support the adaptation of older adults who have had to stop driving and included a control group. RESULTS Of an initial 477 unique records identified, 111 pertained to driving cessation in older adults, and only three articles were controlled trials of intervention approaches related to driving cessation. One article described an intervention for retired drivers with dementia, while another was aimed at caregivers of drivers with dementia, and the third included retired and retiring drivers without dementia. Outcomes such as reduced depressive symptoms, increased trips out of home, and efficacy in dealing with the driving cessation process were positive, but the specific outcome measures and magnitude of effects varied across studies. CONCLUSIONS Although the results summarized in this review point toward potentially promising effects of interventions for facilitating driving cessation in older adults, these findings must be interpreted with caution given the significant methodological limitations of the studies, including small samples, participant attrition, lack of blinding, and non-validated outcome measures. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Duncan H Cameron
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Sarah Sanford
- Department of Medicine, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Gary Naglie
- Department of Medicine, Baycrest Health Sciences, Toronto, Ontario, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Research Department, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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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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Meuleners LB, Hobday MB. A Population-Based Study Examining Injury in Older Adults with and without Dementia. J Am Geriatr Soc 2017; 65:520-525. [DOI: 10.1111/jgs.14523] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lynn B. Meuleners
- Curtin-Monash Accident Research Centre; Faculty of Health Sciences; Curtin University; Perth Western Australia Australia
| | - Michelle B. Hobday
- Curtin-Monash Accident Research Centre; Faculty of Health Sciences; Curtin University; Perth Western Australia Australia
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Allan CL, Behrman S, Baruch N, Ebmeier KP. Driving and dementia: a clinical update for mental health professionals. EVIDENCE-BASED MENTAL HEALTH 2016; 19:110-113. [PMID: 27765792 PMCID: PMC10699514 DOI: 10.1136/eb-2016-102485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 11/04/2022]
Abstract
Most people with mild dementia can continue to drive, but dementia is progressive and many patients and clinicians will be faced with questions about driving safety in the course of their illness. Determining when this happens is a complex decision, with risks of personal and public safety needing to be weighed against individual patient benefits of driving in terms of autonomy, independence and well-being. Decisions need to make reference to cognitive abilities, as well as other factors including physical comorbidity, vision, mobility, insight and history of driving errors and accidents. Deciding to stop driving, or being required to stop driving is often difficult for patients to accept and can be a particularly problematic consequence of a dementia diagnosis. Legal frameworks help in decision-making but may not provide sufficient detail to advise individual patients. We review the current guidelines and evidence relating to driving and dementia to help clinicians answer questions about driving safety and to consider the full range of assessment tools available.
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Affiliation(s)
- Charlotte L Allan
- Centre for the Health of the Elderly, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Sophie Behrman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Nina Baruch
- Older People's Services, Oxford Health NHS Foundation Trust, Oxford, UK
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Petersen JD, Siersma V, Nielsen CT, Vass M, Waldorff FB. Dementia and Traffic Accidents: A Danish Register-Based Cohort Study. JMIR Res Protoc 2016; 5:e191. [PMID: 27678553 PMCID: PMC5059484 DOI: 10.2196/resprot.6466] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 11/16/2022] Open
Abstract
Background As a consequence of a rapid growth of an ageing population, more people with dementia are expected on the roads. Little is known about whether these people are at increased risk of road traffic-related accidents. Objective Our study aims to investigate the risk of road traffic-related accidents for people aged 65 years or older with a diagnosis of dementia in Denmark. Methods We will conduct a nationwide population-based cohort study consisting of Danish people aged 65 or older living in Denmark as of January 1, 2008. The cohort is followed for 7 years (2008-2014). Individual’s personal data are available in Danish registers and can be linked using a unique personal identification number. A person is identified with dementia if the person meets at least one of the following criteria: (1) a diagnosis of the disease in the Danish National Patient Register or in the Danish Psychiatric Central Research Register, and/or (2) at least one dementia diagnosis-related drug prescription registration in the Danish National Prescription Registry. Police-, hospital-, and emergency room-reported road traffic-related accidents occurred within the study follow-up are defined as the study outcome. Cox proportional hazard regression models are used for the main analysis. Results Our study protocol has 3 phases including data collection, data analysis, and reporting. The first phase of register-based data collection of 853,228 individual’s personal information was completed in August, 2016. The next phase is data analysis, which is expected to be finished before December 2016, and thereafter writing publications based on the findings. The study started in January 2016 and will end in December 2018. Discussion This study covers the entire elderly population of Denmark, and thereby will avoid selection bias due to nonparticipation and loss to follow-up. Furthermore, this ensures that the study results are reliable and generalizable. However, underreporting of traffic-related accidents may occur, which will limit estimation of absolute risks.
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Affiliation(s)
- Jindong Ding Petersen
- The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
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Older Driver Safety: A Survey of Psychologists' Attitudes, Knowledge, and Practices. Can J Aging 2016; 35:393-404. [PMID: 27476964 DOI: 10.1017/s0714980816000386] [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: 11/06/2022] Open
Abstract
Using an online survey, we examined the knowledge, attitudes, and practices with respect to older driver safety concerns of clinical psychologists from across Canada who self-identified as working with at least some drivers over 60 years of age. Eighty-four psychologists completed the survey, and many were aware of the issues relevant to older driver safety, although only about half reported that assessing fitness to drive was an important issue in their practice. The majority (75%) reported that they would benefit from education concerning evaluation of fitness to drive. The primary recommendation emerging from this investigation is to increase efforts to inform and educate psychologists about driving-related assessment and regulatory issues in general, and specifically with respect to older adults. As the population ages, it is of growing importance for all health care providers to understand the influence of mental health conditions-including cognitive impairment and dementia-on driving skills.
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Bennett JM, Chekaluk E, Batchelor J. Cognitive Tests and Determining Fitness to Drive in Dementia: A Systematic Review. J Am Geriatr Soc 2016; 64:1904-17. [DOI: 10.1111/jgs.14180] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meuleners LB, Ng J, Chow K, Stevenson M. Motor Vehicle Crashes and Dementia: A Population-Based Study. J Am Geriatr Soc 2016; 64:1039-45. [DOI: 10.1111/jgs.14109] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lynn B. Meuleners
- Curtin-Monash Accident Research Centre; Curtin University; Perth Western Australia Australia
- Eye and Vision Epidemiology Research Group; Perth Western Australia Australia
| | - Jonathon Ng
- Eye and Vision Epidemiology Research Group; Perth Western Australia Australia
- Centre for Health Services Research; School of Population Health; University of Western Australia; Crawley Western Australia Australia
| | - Kyle Chow
- Curtin-Monash Accident Research Centre; Curtin University; Perth Western Australia Australia
| | - Mark Stevenson
- Melbourne School of Population and Global Health and Melbourne School of Design; University of Melbourne; Melbourne Victoria Australia
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Lovas J, Fereshtehnejad SM, Cermakova P, Lundberg C, Johansson B, Johansson K, Winblad B, Eriksdotter M, Religa D. Assessment and Reporting of Driving Fitness in Patients with Dementia in Clinical Practice: Data from SveDem, the Swedish Dementia Registry. J Alzheimers Dis 2016; 53:631-8. [PMID: 27163829 PMCID: PMC4969696 DOI: 10.3233/jad-160254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Driving constitutes a very important aspect of daily life and is dependent on cognitive functions such as attention, visuo-spatial skills and memory, which are often compromised in dementia. Therefore, the driving fitness of patients with dementia needs to be addressed by physicians and those that are deemed unfit should not be allowed to continue driving. OBJECTIVE We aimed at investigating to what extent physicians assess driving fitness in dementia patients and determinant factors for revoking of their licenses. METHODS This study includes 15113 patients with newly diagnosed dementia and driver's license registered in the Swedish Dementia Registry (SveDem). The main outcomes were reporting to the licensing authority and making an agreement about driving eligibility with the patients. RESULTS Physicians had not taken any action in 16% of dementia patients, whereas 9% were reported to the authority to have their licenses revoked. Males (OR = 3.04), those with an MMSE score between 20-24 (OR = 1.35) and 10-19 (OR = 1.50), patients with frontotemporal (OR = 3.09) and vascular dementia (OR = 1.26) were more likely to be reported to the authority. CONCLUSION For the majority of patients with dementia, driving fitness was assessed. Nevertheless, physicians did not address the issue in a sizeable proportion of dementia patients. Type of dementia, cognitive status, age, sex and burden of comorbidities are independent factors associated with the assessment of driving fitness in patients with dementia. Increased knowledge on how these factors relate to road safety may pave the way for more specific guidelines addressing the issue of driving in patients with dementia.
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Affiliation(s)
- Joel Lovas
- Alzheimer’s Disease Research Center, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Department of Neurology and Neurosurgery, McGill University, Montreal General Hospital, Montreal, PQ, Canada
| | - Pavla Cermakova
- Alzheimer’s Disease Research Center, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- International Clinical Research Center and St.Anne‘s University Hospital, Brno, Czech Republic
| | - Catarina Lundberg
- Traffic Medicine Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Johansson
- Traffic Medicine Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Kurt Johansson
- Traffic Medicine Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Winblad
- Alzheimer’s Disease Research Center, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Dorota Religa
- Alzheimer’s Disease Research Center, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
- Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
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Abstract
OBJECTIVES Hazard perception, the ability to identify and react to hazards while driving, is of growing importance in driving research, given its strong relationship to real word driving variables. Furthermore, although poor hazard perception is associated with novice drivers, recent research suggests that it declines with advanced age. In the present study, we examined the neuropsychological correlates of hazard perception in a healthy older adult sample. METHODS A total of 68 adults age 60 and older who showed no signs of dementia and were active drivers completed a battery of neuropsychological tests as well as a hazard perception task. Tests included the Repeatable Battery for the Assessment of Neuropsychological Status, Wechsler Test of Adult Reading, Trail Making Test, Block Design, Useful Field of View, and the Delis-Kaplan Executive Function System Color Word Interference Test. RESULTS Hazard perception errors were related to visuospatial/constructional skills, processing speed, memory, and executive functioning skills, with a battery of tests across these domains accounting for 36.7% of the variance in hazard perception errors. Executive functioning, particularly Trail Making Test part B, emerged as a strong predictor of hazard perception ability. CONCLUSIONS Consistent with prior work showing the relationship of neuropsychological performance to other measures of driving ability, neuropsychological performance was associated with hazard perception skill. Future studies should examine the relationship of neuropsychological changes in adults who are showing driving impairment and/or cognitive changes associated with Mild Cognitive Impairment or dementia.
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Impact of Deep Brain Stimulation on Daily Routine Driving Practice in Patients with Parkinson's Disease. PARKINSONS DISEASE 2015; 2015:608961. [PMID: 26640738 PMCID: PMC4657404 DOI: 10.1155/2015/608961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 10/20/2015] [Indexed: 11/22/2022]
Abstract
Objective. To determine the influence of deep brain stimulation (DBS) on daily routine driving behavior in Parkinson's disease (PD) patients. Methods. A cross-sectional questionnaire survey was done in 121 DBS-PD patients. The influences of patient characteristics and DBS on current driving and driving at time of surgery and the predictive value of the preoperative levodopa-test on postoperative driving were evaluated. Results. 50% of 110 driving-license holders currently drove. 63.0% rated themselves as safe drivers, 39.4% reported improvement, and 10.9% noted deterioration in driving after DBS surgery. Inactive drivers had quit driving mainly due to disease burden (90.9%). Active drivers were younger, more often males, and less impaired according to H&Y and MMSE, had surgery more recently, and reported more often overall benefit from DBS. H&Y “on” and UPDRS III “off” scores at time of surgery were lower in pre- and postoperative active than in inactive drivers. Tremor and akinesia were less frequent reasons to quit driving after than before DBS surgery. Postoperatively, 22.7% (10/44) of patients restarted and 10.6% (7/66) of patients discontinued driving, independently of H&Y stage. The preoperative levodopa-test was not predictive for the postoperative driving outcome. Conclusion. 50% of PD patients with DBS drive. DBS surgery changes daily routine driving behavior.
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Fuermaier ABM, Tucha L, Evans BL, Koerts J, de Waard D, Brookhuis K, Aschenbrenner S, Thome J, Lange KW, Tucha O. Driving and attention deficit hyperactivity disorder. J Neural Transm (Vienna) 2015; 124:55-67. [PMID: 26419597 PMCID: PMC5281661 DOI: 10.1007/s00702-015-1465-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/18/2015] [Indexed: 12/01/2022]
Abstract
Adults with attention deficit hyperactivity disorder (ADHD) suffer from various impairments of cognitive, emotional and social functioning, which can have considerable consequences for many areas of daily living. One of those areas is driving a vehicle. Driving is an important activity of everyday life and requires an efficient interplay between multiple cognitive, perceptual, and motor skills. In the present study, a selective review of the literature on driving-related difficulties associated with ADHD is performed, seeking to answer whether individuals with ADHD show increased levels of unsafe driving behaviours, which cognitive (dys)functions of individuals with ADHD are related to driving difficulty, and whether pharmacological treatment significantly improves the driving behaviour of individuals with ADHD. The available research provides convincing evidence that individuals with ADHD have different and more adverse driving outcomes than individuals without the condition. However, it appears that not all individuals with ADHD are affected uniformly. Despite various cognitive functions being related with driving difficulties, these functions do not appear helpful in detecting high risk drivers with ADHD, nor in predicting driving outcomes in individuals with ADHD, since impairments in these functions are defining criteria for the diagnoses of ADHD (e.g., inattention and impulsivity). Pharmacological treatment of ADHD, in particular stimulant drug treatment, appears to be beneficial to the driving difficulties experienced by individuals with ADHD. However, additional research is needed, in particular further studies that address the numerous methodological weaknesses of many of the previous studies.
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Affiliation(s)
- Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - Lara Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Ben Lewis Evans
- Traffic and Environmental Psychology Group, University of Groningen, Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Dick de Waard
- Traffic and Environmental Psychology Group, University of Groningen, Groningen, The Netherlands
| | - Karel Brookhuis
- Traffic and Environmental Psychology Group, University of Groningen, Groningen, The Netherlands
| | - Steffen Aschenbrenner
- Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany
| | - Johannes Thome
- Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Klaus W Lange
- Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
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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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Abstract
PURPOSE To confirm that subjects with primary open-angle glaucoma (POAG) who avoid driving in high-risk situations are less likely to be involved in motor vehicle collisions (MVCs) than those who do not. METHODS This study evaluated 252 consecutive Japanese aged between 40 and 85 years with POAG. All participants were requested to answer a questionnaire on their driving habits, including self-restriction in driving at night, in rain, in fog, on freeways, and lane changing, and history of MVCs. Those who reported restricting their driving in one or more ways constituted the self-restriction group, and those who reported no self-restriction made up the no-restriction group. The prevalence of MVCs and the crash rate (number of MVCs/10,000 km driven) were compared between the two groups. The association between prevalence of MVCs and the number of driving self-restrictions was also evaluated. RESULTS The association between driving self-restriction and MVCs was observed among the male subjects, not among the female subjects. Among the male subjects, the prevalence of MVCs was significantly higher in the no-restriction group than in the self-restriction group (no-restriction group, 33/107 = 30.8%; self-restriction group, 9/66 = 13.6%, p = 0.01). The crash rate was also significantly higher in the no-restriction group (no-restriction group, 1.4 ± 0.8; self-restriction group, 0.4 ± 0.3, average ± SE, p = 0.01). No restriction was significantly associated with MVCs (multivariable-adjusted odds ratios, 2.43 [95% confidence interval, 1.03 to 5.73]). The number of driving self-restrictions was also associated with MVCs (multivariable-adjusted odds ratios, 0.41 [95% confidence interval, 0.18 to 0.99], per one increment of self-restriction). CONCLUSIONS Driving self-restriction may be associated with a reduced prevalence of MVCs in men with POAG.
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Kwok JCW, Gélinas I, Benoit D, Chilingaryan G. Predictive validity of the Montreal Cognitive Assessment (MoCA) as a screening tool for on-road driving performance. Br J Occup Ther 2015. [DOI: 10.1177/0308022614562399] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction The objectives of this study are to determine (1) the ability of the Montreal Cognitive Assessment to predict on-road driving performance in drivers with a neurological condition and elderly drivers with suspected cognitive decline, and (2) the association between the performance on the Useful Field of View and the performance on the Montreal Cognitive Assessment. Method This study used a retrospective design. Clients were included who had completed the Montreal Cognitive Assessment and the on-road driving evaluation from November 2006 to May 2009 ( n = 154) in a driving rehabilitation program in the Montreal Area. Total scores on the Montreal Cognitive Assessment, Useful Field of View risk categories, pass or fail outcomes from an on-road evaluation, as well as demographic and clinical characteristics were recorded from participants’ medical charts. Results The Montreal Cognitive Assessment was found to have a sensitivity of 84.5% and a specificity of 50% with a cut-off of ≤25. It was significantly associated with the Useful Field of View risk category. Conclusion The Montreal Cognitive Assessment could be a valuable screening tool. However, its predictive validity is not strong enough to recommend its use as the sole instrument for identifying unfit drivers.
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Affiliation(s)
- Jade Chiu Wai Kwok
- Occupational Therapist, CHUM Hopital Notre-Dame, Montreal, Quebec, Canada
| | - Isabelle Gélinas
- Associate Professor and Graduate Program Director, McGill University, Montreal, Quebec, Canada
| | - Dana Benoit
- Occupational Therapist, Constance-Lethbridge Rehabilitation Center, Montreal, Quebec, Canada
| | - Gevorg Chilingaryan
- Statistician, Jewish Rehabilitation Hospital, Feil & Oberfeld Research Centre, Montreal, Quebec, Canada
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