Missing drivers with dementia: antecedents and recovery

The Prevalence of Missing Incidents and Their Antecedents Among Older Adult MedicAlert Subscribers: Retrospective Descriptive Study

BACKGROUND

With the population aging, the number of people living with dementia is expected to rise, which, in turn, is expected to lead to an increase in the prevalence of missing incidents due to critical wandering. However, the estimated prevalence of missing incidents due to dementia is inconclusive in some jurisdictions and overlooked in others.

OBJECTIVE

The aims of the study were to examine (1) the demographic, psychopathological, and environmental antecedents to missing incidents due to critical wandering among older adult MedicAlert Foundation Canada (hereinafter MedicAlert) subscribers; and (2) the characteristics and outcomes of the missing incidents.

METHODS

This study used a retrospective descriptive design. The sample included 434 older adult MedicAlert subscribers involved in 560 missing incidents between January 2015 and July 2021.

RESULTS

The sample was overrepresented by White older adults (329/425, 77.4%). MedicAlert subscribers reported missing were mostly female older adults (230/431, 53.4%), living in urban areas with at least 1 family member (277/433, 63.8%). Most of the MedicAlert subscribers (345/434, 79.5%) self-reported living with dementia. MedicAlert subscribers went missing most frequently from their private homes in the community (96/143, 67.1%), traveling on foot (248/270, 91.9%) and public transport (12/270, 4.4%), during the afternoon (262/560, 46.8%) and evening (174/560, 31.1%). Most were located by first responders (232/486, 47.7%) or Good Samaritans (224/486, 46.1%). Of the 560 missing incidents, 126 (22.5%) were repeated missing incidents. The mean time between missing incidents was 11 (SD 10.8) months. Finally, the majority of MedicAlert subscribers were returned home safely (453/500, 90.6%); and reports of harm, injuries (46/500, 9.2%), and death (1/500, 0.2%) were very low.

CONCLUSIONS

This study provides the prevalence of missing incidents from 1 database source. The low frequency of missing incidents may not represent populations that are not White. Despite the low number of missing incidents, the 0.2% (1/500) of cases resulting in injuries or death are devastating experiences that may be mitigated through prevention strategies.

Risk Factors Associated with Missing Incidents among Persons Living with Dementia: A Scoping Review

Worldwide, over 55-million people have dementia, and the number will triple by 2050. Persons living with dementia are exposed to risks secondary to cognitive challenges including getting lost. The adverse outcomes of going missing include injuries, death, and premature institutionalization. In this scoping review, we investigate risk factors associated with going missing among persons living with dementia. We searched and screened studies from four electronic databases (Medline, CINAHL, Embase, and Scopus), and extracted relevant data. We identified 3,376 articles, of which 73 met the inclusion criteria. Most studies used quantitative research methods. We identified 27 variables grouped into three risk factor domains: (a) demographics and personal characteristics, (b) health conditions and symptoms, and (c) environmental and contextual antecedents. Identification of risk factors associated with getting lost helps to anticipate missing incidents. Risk factors can be paired with proactive strategies to prevent incidents and inform policies to create safer communities.

Driving Assessment for Persons with Dementia: How and when?

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.

Analysis of Silver Alert Reporting System Activations for Missing Adults With Dementia in Texas, 2017 to 2022

This cross-sectional study analyzes data from Silver Alert activations in Texas from 2017 to 2022 to identify temporal, geographic, and wandering characteristics of missing adults with dementia.

Influence of perspectives on user adoption of wander-management strategies

Sixty-percent of Canadians with dementia will wander and become lost. Strategies, such as wall murals that camouflage doors, and locator devices, offer proactive options for keeping persons with dementia who wander safer. Information that describes available strategies to mitigate this issue is diverse and inconsistent, creating challenges for caregivers and persons living with dementia when choosing helpful strategies. This project aimed to describe the spectrum of risks and risk mitigation strategies associated with dementia-related wandering. Thirty-eight phone interviews from across Canada were conducted with stakeholders including persons with dementia, paid and family caregivers, health professionals, law enforcement, and Alzheimer societies. Interviewees were asked about strategies that they have used to manage dementia-related wandering, and how their perceptions of risk, culture, stigma and geographical location may influence strategy adoption. Overall, a wide range of high- and low-tech solutions were used or suggested by participants, and factors such as risk, culture, geography and stigma were considered essential elements to successful adoption of these strategies. Results from this study highlight the need for unique combinations of strategies based on the type of stakeholder and influencing factors involved.

What do we know about best police practices for lost persons with dementia? A scoping review

Aim: To examine the efficacy of strategies used by the police for missing persons with dementia. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we searched peer-reviewed and gray literature of existing police practices used for missing persons with dementia. Data from the studies were analyzed descriptively. Results: The literature described 16 articles and 18 websites. Strategies ranged from identification tools, successful field techniques, locating technologies and community engagement/education. Overall scientific evidence was low, with only three studies evaluating the usability and effectiveness of the suggested strategies. Conclusion: More rigorous research is required to demonstrate the efficacy of best police practices for missing persons with dementia, which in turn could assist in the development of a best practice guideline.

Driving in the elderly in health and disease

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.

How can we better use Twitter to find a person who got lost due to dementia?

Twitter is a social media platform for online message sharing. The aim of this study is to evaluate the effectiveness of using Twitter to search for people who got lost due to dementia. The online messages on Twitter, i.e., tweets, were collected through an Application Programming Interface. Contents of the tweets were analysed. The personal characteristics, features of tweets and types of Twitter users were collected to investigate their associations with whether a person can be found within a month. Logistic regression was used to identify the features that were useful in finding the missing people. Results showed that the young age of the persons with dementia who got lost, having tweets posted by police departments, and having tweets with photos can increase the chance of being found. Social media is reshaping the human communication pathway, which may lead to future needs on a new patient-care model.

Twitter can help find people who get lost due to dementia—if the social media tool is used optimally. Kelvin Tsoi and colleagues from the Chinese University of Hong Kong analysed over 45,000 tweets about people with dementia or Alzheimer’s disease who went missing. The researchers identified 40 individuals who were found within a month of the first tweet, and 14 others who were not. Comparing the two groups, they found that people were more likely to be located if they were younger, if police departments were tweeting about the missing person, and if tweets contained photos of the lost individuals. The findings point toward better ways of using Twitter to track down those who get lost, a common and unpredictable phenomenon that occurs for at least half of all people living with dementia.

Silver Alerts: A Notification System for Communities with Missing Adults

As the U.S. population ages, the prevalence of dementia will grow and communities will face the problem of older adults wandering or becoming lost. Silver Alert systems are programs designed to locate missing older adults with dementia or other mental disabilities. Such programs have been initiated in all but five states. Data collection for these programs is often minimal or incomplete. Social workers should be involved in prevention, follow up and education with caregivers, community members and law enforcement officers. When reviewing Silver Alert policy, special attention must be given to ethical concerns and protection of older adults' civil rights.

Reporting Policy Regarding Drivers with Dementia

PURPOSE OF THE STUDY

States have various policies regarding physician reporting of drivers with dementia to the Department of Motor Vehicles (DMV) for testing. Some states have mandatory reporting policies, others have optional reporting policies, and some have no policy regarding this issue. Arkansas has no reporting policy. Physicians in Arkansas face the risk of liability if they report a patient against their will to the DMV.

DESIGN AND METHODS

Three research questions were developed to identify how the problem of drivers with dementia is defined among neurologists and geriatricians in Arkansas: (i) What knowledge do these specialists have of state policy regarding reporting of drivers with dementia to the DMV; (ii) What are their opinions regarding various policy options for reporting such drivers; and (iii) What are their reporting practices for drivers with dementia? A survey was distributed to Arkansas neurologists and geriatricians.

RESULTS

There was considerable uncertainty among respondents, regarding the process of assessing and reporting at-risk drivers with dementia. Support for optional reporting policy was strong. Mandatory reporting policy was less favored. Conversations with patients and caregivers regarding cessation of driving were described as being contentious and ongoing.

IMPLICATIONS

These findings lead to the recommendation that the Arkansas legislature adopt an optional reporting policy. There is also a need for physician education regarding state reporting policy, as well as training for assessment of fitness to drive for patients with dementia.

The Concept of Missing Incidents in Persons with Dementia

Behavioral symptoms of dementia often present the greatest challenge for informal caregivers. One behavior, that is a constant concern for caregivers, is the person with dementia leaving a designated area such that their whereabouts become unknown to the caregiver or a missing incident. Based on an extensive literature review and published findings of their own research, members of the International Consortium on Wandering and Missing Incidents constructed a preliminary missing incidents model. Examining the evidence base, specific factors within each category of the model were further described, reviewed and modified until consensus was reached regarding the final model. The model begins to explain in particular the variety of antecedents that are related to missing incidents. The model presented in this paper is designed to be heuristic and may be used to stimulate discussion and the development of effective preventative and response strategies for missing incidents among persons with dementia.

Family reports of medically impaired drivers in Missouri: cognitive concerns and licensing outcomes

This study investigated reasons why older adults (n=689) were reported to the Driver License Bureau, Missouri Department of Revenue, by family members as potentially unfit to drive with an emphasis on cognitive concerns and associated licensing outcomes. A total of 448 drivers were reported to have some cognitive issue; common symptoms included confusion, memory loss, and becoming lost while driving. Diagnostic labels (Alzheimer's disease (AD), cognitive impairment/dementia, brain injury/insult) were listed for 365 cases. A physician evaluation is required for license review. Of those with a diagnostic label, half (51%, n=187) failed to submit this evaluation and almost all were de-licensed immediately. Of those evaluated by a physician, diagnostic agreement between family members and physicians was high for specific conditions (100% for AD, 97% for acute brain injury), and less so for cognitive impairment/dementia (75%). This latter finding suggests that physicians and family members may understand cognitive symptoms differently. Whether cognitively impaired or not, few family reported drivers in this sample (∼2%) retained a valid license. Family members may be in the best position to recognize when medical-functional deficits impact on driving safety, and physicians and driver licensing authorities would do well to take their observations into account with respect to older driver fitness.