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Bahrampouri S, Khankeh HR, Hosseini SA, Mehmandar M, Ebadi A. Components of driving competency measurement in the elderly: A scoping review. Med J Islam Repub Iran 2021; 35:2. [PMID: 33996653 PMCID: PMC8111623 DOI: 10.47176/mjiri.35.2] [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] [Received: 03/05/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Iran will face the "aging Tsunami" phenomenon by the 2040s. Therefore, paying attention to the elderly's driving to maintain and promote their independence and quality of life on the one hand and paying attention to the dangers of driving by the elderly for road safety will be important. The purpose of this research was to determine the components of driving competency in the elderly.
Methods: The research has employed a scoping review. To this end, searches of scientific databases were conducted using keywords between 1990 and 2019. The process of selecting the documentation was-based on the PRISMA chart.
Results: In the first phase, 2769 records were found, and finally, 37 records met the inclusion criteria set for this study. The results indicated that 18 components were extracted that were classified into seven main categories including cognitive, sensory, motor, mental functions, and medications, diseases, and driving history.
Conclusion: Sensory, motor, and cognitive abilities are the most important components of elderly safe driving. Therefore, as age increases, chronic disease, multiple drug use, and subsequent problems increase. This can affect the ability to drive safely and can cause traffic injuries. Therefore, it is recommended to use the results of this research to design a suitable tool and model for assessing driving competency in the elderly.
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Affiliation(s)
- Saiedeh Bahrampouri
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Reza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Betz ME, Haukoos JS, Schwartz R, DiGuiseppi C, Kandasamy D, Beaty B, Juarez-Colunga E, Carr DB. Prospective Validation of a Screening Tool to Identify Older Adults in Need of a Driving Evaluation. J Am Geriatr Soc 2018; 66:357-363. [PMID: 29231960 PMCID: PMC5809263 DOI: 10.1111/jgs.15222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To prospectively validate and refine the 5-item "CRASH" screening tool for identifying older drivers needing a behind-the-wheel (BTW) test. DESIGN Prospective observational study. SETTING Geriatric and internal medicine primary care clinics affiliated with a tertiary care hospital and a local BTW program. PARTICIPANTS Cognitively intact drivers aged 65 and older (N = 315). MEASUREMENTS Participants completed baseline questionnaire (including CRASH tool) and assessments and BTW test (evaluator blinded to questionnaire results) and participated in 1-month telephone follow-up. Analysis included descriptive statistics and examination of predictive ability of the CRASH tool to discriminate normal (pass) from abnormal (conditional pass or fail) on the BTW test, with logistic regression and CART techniques for tool refinement. RESULTS Two hundred sixty-six participants (84%) had a BTW test; of these, 17% had a normal rating and 83% an abnormal rating. Forty-five percent of those with an abnormal score were advised to limit driving under particular conditions. Neither the CRASH tool nor its individual component variables were significantly associated with the summary BTW score; in refined models with other variables, the best-performing tool had approximately 67% sensitivity and specificity for an abnormal BTW score. Most participants found the BTW test useful and were willing to pay a median of $50. At 1-month follow-up, no participants had stopped driving. CONCLUSION The CRASH screening tool cannot be recommended for use in clinical practice. Findings on older adults' perceived utility of the BTW test and the stability of driving patterns at 1-month follow-up could be useful for future research studies and for design of older driver programs.
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Affiliation(s)
- Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jason S. Haukoos
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Denver Health Medical Center, Denver, Colorado, USA
| | - Robert Schwartz
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; Eastern Colorado VA Geriatric Research Education and Clinical Center
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Deepika Kandasamy
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brenda Beaty
- Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, Colorado, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Elizabeth Juarez-Colunga
- Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, Colorado, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - David B. Carr
- Division of Geriatrics and Nutritional Science, Department of Medicine and Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
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Richmond NL, Flannigan SA, Keil LG, Betz ME, Platts-Mills TF. Cessation of driving is rare in older drivers seen in the emergency department after a motor vehicle collision: a prospective cohort study. J Am Geriatr Soc 2015; 63:183-5. [PMID: 25597573 DOI: 10.1111/jgs.13223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pereira GF, McLean SA, Tkacik TJ, Swor RA, Jones JS, Lee DC, Peak DA, Domeier RM, Rathlev NK, Hendry PL, Platts-Mills TF. Pain, distress, and anticipated recovery for older versus younger emergency department patients after motor vehicle collision. BMC Emerg Med 2014; 14:25. [PMID: 25547869 PMCID: PMC4307167 DOI: 10.1186/s12873-014-0025-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/09/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Motor vehicle collisions (MVCs) are the second most common injury mechanism resulting in emergency department (ED) visits by older adults. MVCs result in substantial pain and psychological distress among younger individuals, but little is known about the occurrence of these symptoms in older individuals. We describe the frequency of and characteristics associated with pain, distress, and anticipated time for physical and emotional recovery for older adults presenting to the ED after MVC in comparison to younger adults. METHODS In-person interviews were conducted for adults presenting to one of eight EDs after MVC without an obvious fracture or injury requiring admission as part of two prospective studies. Pain severity was assessed using a 0-10 verbal scale. Distress was assessed using the Peritraumatic Distress Inventory (range 0-52). Patients were asked to estimate their expected time for physical and emotional recovery; these responses were dichotomized to <30 or ≥30 days. ED pain and distress and associations between patient and collision characteristics and ED pain and distress were examined for patients age 65 years and older and patients age 18 to 64. RESULTS Older (n = 96) and younger (n = 943) adults had the same mean pain scores (5.5, SD 2.5 vs. 5.5, SD 2.4). Distress scores were lower in older than in younger adults (15.5, SD 9 vs. 19.2, SD 10). A higher percentage of older adults than younger adults had an anticipated time to physical recovery ≥30 days (41%, 95% confidence interval [CI] 28%-55% vs. 11%, 95% CI 9%-13%). Similarly, older adults were more likely to have an anticipated time for emotional recovery ≥30 days (45%, 95% CI 35%-55% vs. 17%, 95% CI 15%-20%). Older adults were less likely than younger adults to have moderate or severe neck pain (score ≥4) (25%, 95% CI 23% to 41% vs. 54%, 95% CI 48% to 60%) or back pain (31%, 95% CI 23% to 46% vs. 56%, 95% CI 51 to 62%) but more likely to have moderate or severe chest pain (42%, 95% CI 32% to 50% vs. 20%, 95% CI 16 to 23%). Pre-MVC depressive symptoms and pain catastrophizing were positively associated with pain and distress in both older and younger adults. CONCLUSIONS In our cohort, older adults who presented to the ED after MVC experienced similar pain severity as younger patients and less distress but were more likely to estimate their times for physical and emotional recovery to be 30 days or more. Increased emergency provider awareness of acute pain and distress symptoms among older patients experiencing MVC may improve outcomes for these patients.
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Affiliation(s)
- Gregory F Pereira
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
- Departments of Emergency Medicine and Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
| | - Thomas J Tkacik
- Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
| | - Robert A Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
| | - Jeffrey S Jones
- Department of Emergency Medicine, Spectrum Health - Butterworth Campus, Grand Rapids, MI, USA.
| | - David C Lee
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA.
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Robert M Domeier
- Department of Emergency Medicine, St. Joseph Mercy Hospital, Ann Arbor, MI, USA.
| | - Niels K Rathlev
- Department of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA.
| | - Phyllis L Hendry
- Department of Emergency Medicine and Pediatrics, University of Florida-Jacksonville, Jacksonville, FL, USA.
| | - Timothy F Platts-Mills
- Department of Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
- Departments of Emergency Medicine and Anesthesiology, University of North Carolina, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
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Betz ME, Carpenter CR, Genco E, Carr DB. Driving Self-Restriction and Age: A Study of Emergency Department Patients. Inj Epidemiol 2014; 1:18. [PMID: 26413455 PMCID: PMC4580257 DOI: 10.1186/s40621-014-0018-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 06/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Driving self-restriction is a well-documented among older drivers but might also occur among younger drivers. Little is known about the driving patterns of emergency department (ED) patients, who may be a high-risk population for motor vehicle crashes (MVCs). We sought to compare the driving patterns and MVCs of younger and older adult ED patients in order to inform development of injury prevention interventions in EDs. METHODS We surveyed English-speaking younger adult (age 25-64) and older adult (age ≥65) ED patients, excluding non-drivers and those who were cognitively-impaired or too sick to participate. We compared drivers by age group and used logistic regression with adjustment for driving frequency to examine factors associated with driving self-restriction. RESULTS Of those eligible, 82% (n=178) of younger adult and 91% (n=134) of older adult patients participated; approximately half were women. Similar proportions of younger and older adult patients reported driving everyday/almost everyday (80%) but also self-restricting driving in inclimate weather (48%), heavy traffic (27%), in unfamiliar places (21%), when travelling with passengers (1.6%) or when alone (1.3%). Fewer younger adult than older adult patients avoided driving at night (22% versus 49%) or on highways (6.7% versus 26%). In multivariable logistic regression, factors significantly associated self-imposed driving restriction in ≥1 driving situation were female gender (Odds Ratio [OR] 2.40; 95%CI 1.42-4.05) and ever feeling "confused, nervous or uncomfortable" while driving (OR 1.87; 95% CI 1.03-3.39). There was a non-significant trend for differences in proportions between younger adult (11%) and older adult (6.8%) drivers reporting ≥1 MVC as a driver in the past 12 months. CONCLUSIONS Similar proportions of younger and older adult ED patients self-restrict driving, albeit in different situations, which has implications for behavioral interventions for injury prevention and for education of patients and medical providers.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Ave B-215, Aurora, 80045 Colorado USA
| | - Christopher R Carpenter
- Division of Emergency Medicine, Washington University School of Medicine, Campus Box 8072, 660 S. Euclid Avenue, St. Louis, 63110 MO USA
| | - Emma Genco
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Ave B-215, Aurora, 80045 Colorado USA
- VISN 19 Mental Illness Research, Education and Clinical Center, Denver, 80220 CO USA
| | - David B Carr
- Department of Medicine and Neurology, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, 4488 Forest Park Ave, St. Louis, 63108 MO USA
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Betz ME, Carr DB, DiGuiseppi C, Haukoos JS, Lowenstein SR, Schwartz R. Recruitment of older drivers from primary care clinics for on-road fitness-to-drive testing: results of a pilot study. J Am Geriatr Soc 2014; 62:1388-90. [PMID: 25039512 DOI: 10.1111/jgs.12913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado, Aurora, Colorado
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