Cognitive Decline and Older Driver Crash Risk

Metacognitive Awareness of Older Adult Drivers with Mild Cognitive Impairment: Relationships with Demographics, Subjective Evaluation of Cognition, and Driving Self-Efficacy

(1) Self-regulation of driving is a means of maintaining one's driving identity. The purpose of this study was to investigate the extent to which older drivers with Mild Cognitive Impairment (MCI) are metacognitively aware of the requirements of specific demanding driving conditions and whether this awareness is linked to subjective assessments of cognition. (2) One hundred seventeen (117) older MCI drivers participated in a telephone survey in which they reported their metacognitive experiences in nine driving conditions, listed as an aim of self-regulation. The analyses included the participants' subjective cognitive assessments, both in terms of their cognitive state and their perceived driving self-efficacy. (3) The analyses pointed out a direct and negative effect of age on the formation of the metacognitive feeling of certainty. Furthermore, an indirect effect of sex through driving self-efficacy was established. This effect was negative in the case of the metacognitive feeling of difficulty and the estimation of effort and positive in the case of the metacognitive feeling of certainty. (4) This position points out the need to establish appropriate levels of the perceived self-efficacy of older drivers with MCI, and it raises issues when it moves to fictitious levels.

The Impact of Spatial Orientation Changes on Driving Behavior in Healthy Aging

OBJECTIVES

Global cognitive changes in older age affect driving behavior and road safety, but how spatial orientation differences affect driving behaviors is unknown on a population level, despite clear implications for driving policy and evaluation during aging. The present study aimed to establish how spatial navigation changes affect driving behavior and road safety within a large cohort of older adults.

METHODS

Eight hundred and four participants (mean age: 71.05) were recruited for a prospective cohort study. Participants self-reported driving behavior followed by spatial orientation (allocentric and egocentric) testing and a broader online cognitive battery (visuomotor speed, processing speed, executive functioning, spatial working memory, episodic memory, visuospatial functioning).

RESULTS

Spatial orientation performance significantly predicted driving difficulty and frequency. Experiencing more driving difficulty was associated with worse allocentric spatial orientation, processing speed, and source memory performance. Similarly, avoiding challenging driving situations was associated with worse spatial orientation and episodic memory. Allocentric spatial orientation was the only cognitive domain consistently affecting driving behavior in under 70 and over 70 age groups, a common age threshold for driving evaluation in older age.

DISCUSSION

We established for the first time that worse spatial orientation performance predicted increased driving difficulty and avoidance of challenging situations within an older adult cohort. Deficits in spatial orientation emerge as a robust indicator of driving performance in older age, which should be considered in future aging driving assessments, as it has clear relevance for road safety within the aging population.

Experiences of Older Adults with Mild Cognitive Impairment from Cognitive Self-Training Using Touchscreen Tablets

Background: "Tablet Enhancement of Cognition and Health" (TECH) is a cognitive intervention that includes two components: 5 weeks of daily self-training using puzzle-game apps on a touch screen tablet and weekly group sessions. This study aimed to (i) explore experiences of older adults with mild cognitive impairment (MCI) following their participation in TECH, (ii) identify hindering and enabling factors to self-training, and (iii) describe participants' perceived and objective cognitive changes and examine factors associated with their satisfaction from TECH. Materials and Methods: We used quantitative and qualitative measures; a phenomenological qualitative design using focus groups and interviews of 14 older adults with MCI and a focus group of the TECH facilitators. Satisfaction with TECH, self-training time, and perceived and objective cognitive changes (using the Montreal Cognitive Assessment) were evaluated. Results: Qualitative data were classified into three categories: Memory problems, Hindering and enabling factors to self-training, and Meaningful group sessions. The TECH facilitators reported positive changes, less cognitive complaints, and commitment and satisfaction of the participants. Participants reported overall satisfaction from TECH and performed a median interquartile range of 22.6 (19.9-42.8) self-training hours. Higher satisfaction was correlated with a higher objective cognitive change (r = 0.95, P < 0.01) and less training time (r = -0.91, P < 0.01). Discussion and Conclusions: Participants in the current study actively engaged in daily self-training using touch screen-tablet-puzzle-game and functional apps, driven by both internal and external motivators. Despite the lack of cognitive improvement, they expressed satisfaction with their participation in TECH. Therefore, encouraging older adults to engage in meaningful cognitive stimulating activities is recommended.

TECH preserves global cognition of older adults with MCI compared with a control group: a randomized controlled trial

BACKGROUND

Cognitive training using touchscreen tablet casual game applications (apps) has potential to be an effective treatment method for people with mild cognitive impairment (MCI).

AIMS

This study aimed to establish the effectiveness of 'Tablet Enhancement of Cognition and Health' (TECH), a novel cognitive intervention for improving/preserving cognition in older adults with MCI.

METHODS

A single-blind randomized controlled trial with assessments pre-, post-, and at 6-month follow-up was conducted. TECH entailed 5 weeks of daily self-training utilizing tablet apps, facilitated by weekly group sessions. Global cognition was assessed by the Montreal Cognitive Assessment (MoCA), and specific cognitive components were assessed using WebNeuro computerized battery. Short Form Health Survey (SF-12) assessed health-related quality of life (HRQoL). Intention-to-treat analysis was conducted and the %change was calculated between pre-post and between pre-follow-up. Cohen's d effect size was also calculated.

RESULTS

Sixty-one participants aged 65-89 years were randomly allocated to TECH (N = 31, 14 women) or to standard care (N = 30, 14 women). Pre-post and pre-follow-up MoCA %change scores were significantly higher in TECH than control (U = 329.5, p < .05; U = 294.5, p < .05) with intermediate effect size values (Cohen's d = .52, Cohen's d = .66). Forty percent of TECH participants versus 6.5% of control participants achieved a minimal clinical important difference in MoCA. Pre-post between-group differences for specific cognitive components were not found and HRQoL did not change.

DISCUSSION AND CONCLUSIONS

TECH encouraged daily self-training and showed to preserve global cognition of older adults with MCI. The implementation of TECH is recommended for older adults with MCI, who are at risk for further cognitive decline.

Study protocol for "In-vehicle sensors to detect changes in cognition of older drivers"

BACKGROUND

Driving is a complex behavior that may be affected by early changes in the cognition of older individuals. Early changes in driving behavior may include driving more slowly, making fewer and shorter trips, and errors related to inadequate anticipation of situations. Sensor systems installed in older drivers' vehicles may detect these changes and may generate early warnings of possible changes in cognition.

METHOD

A naturalistic longitudinal design is employed to obtain continuous information on driving behavior that will be compared with the results of extensive cognitive testing conducted every 3 months for 3 years. A driver facing camera, forward facing camera, and telematics unit are installed in the vehicle and data downloaded every 3 months when the cognitive tests are administered.

RESULTS

Data processing and analysis will proceed through a series of steps including data normalization, adding information on external factors (weather, traffic conditions), and identifying critical features (variables). Traditional prediction modeling results will be compared with Recurring Neural Network (RNN) approach to produce Driver Behavior Indices (DBIs), and algorithms to classify drivers within age, gender, ethnic group membership, and other potential group characteristics.

CONCLUSION

It is well established that individuals with progressive dementias are eventually unable to drive safely, yet many remain unaware of their cognitive decrements. Current screening and evaluation services can test only a small number of individuals with cognitive concerns, missing many who need to know if they require treatment. Given the increasing number of sensors being installed in passenger vehicles and pick-up trucks and their increasing acceptability, reconfigured in-vehicle sensing systems could provide widespread, low-cost early warnings of cognitive decline to the large number of older drivers on the road in the U.S. The proposed testing and evaluation of a readily and rapidly available, unobtrusive in-vehicle sensing system could provide the first step toward future widespread, low-cost early warnings of cognitive change for this large number of older drivers in the U.S. and elsewhere.

Association between driving frequency and well-being among older adults

OBJECTIVES

Research on driving in older adulthood suggests that driving is a form of independence for older adults and is often associated with increased social capital and overall-being. However, few studies have examined whether the frequency of driving, and not driving alone, affects likelihood of having well-being among older adults. This study aimed to examine the association between frequency of driving and well-being among older adults, guided by the activity theory of aging.

METHODS

Data were drawn from the 2018 National Health and Aging Trends Study, a longitudinal panel survey of Medicare beneficiaries living in the United States. Bivariate analyses were conducted using Chi-square tests and the association between frequency of driving and well-being was tested with a multivariable logistic regression model. Well-being was determined by 11 items measuring positive and negative affect and asking participants if they agreed with certain statements about their lives.

RESULTS

After controlling for other factors that could influence well-being among older adults, results showed that those who drove every day were the most likely to have high well-being, followed by those who drove most days, those who drove some days, those who drove rarely, and those who never drove.

DISCUSSION

The study results indicate that as frequency of driving increases, the chance of having well-being increases among older adults. This supports the activity theory of aging and highlights the importance of productive aging.

Special Report from the CDC: Provider knowledge and practices around driving safety and fall prevention screening and recommendations for their older adult patients, DocStyles 2019

INTRODUCTION

Falls and motor-vehicle crashes (MVCs) are leading causes of unintentional injury deaths among older adults (65+) in the United States. Injury prevention resources exist to help healthcare providers reduce fall and MVC risk among older adult patients. However, awareness of these resources among healthcare providers is unclear.

METHODS

Questions were included in the 2019 DocStyles survey that assessed healthcare provider awareness of three injury prevention resources: (1) the American Geriatrics Society's (AGS's) Clinician's Guide to Assessing and Counseling Older Drivers, (2) the Clinical Assessment of Driving Related Skills (CADReS), and (3) the Centers for Disease Control and Prevention's (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. We also explored the circumstances and current practices for counseling older adult patients on fall prevention and driving safety.

RESULTS

Only 20% of providers reported awareness of any of the injury prevention resources. Providers were more likely to report either screening for fall risk or unsafe driving when an older adult presented with a fall concern (74.5%) or driving concern or recent crash (85.1%), compared to annual screening for fall risk (67.7%) or driving safety (47.7%). More providers reported discussing the increased fall or MVC risk associated with patient medications, referring patient for driving fitness evaluations, or discussing alternative transportation options with the patient after adverse events or patient-initiated concerns compared to routine annual discussions.

CONCLUSION

Healthcare gaps persist in the screening and assessment of older adult risk factors for falls and unsafe driving. Limited provider awareness of clinical resources related to preventing older adult falls and unsafe driving may be contributing to these healthcare gaps.

PRACTICAL APPLICATIONS

Improving healthcare provider awareness of these resources could help them identify older adults at risk of a fall or MVC and promote injury prevention efforts in their clinical practices.

Research on driving behavior characteristics of older drivers based on drivers' behavior graphs analysis

Considerable evidence suggests that the decline in physiological abilities prevalent in older drivers leads to a reduction in the visual and psychomotor functions required for safe driving. The purpose of this study is to further investigate the differences in driving behavior between older and younger drivers and to describe the change process of driving behavior. In this study, 19 younger and older drivers each were recruited for a driving simulation experiment that included five scenarios. Driving operation data, eye movement data, and physiological data of drivers in five conflict scenarios were collected. The differences in driving behaviors between the two groups were also compared and analyzed, on which the thresholds of different driving behavior nodes were determined and driving behavior graphs were established. The results show that the eye movement nodes of older drivers appear later in five scenarios, the operational nodes of older people appear later in two steering scenarios, and are closer to those of younger drivers in three straight ahead scenarios, indicating that older drivers were later in observing and collecting traffic information, and later in applying brakes and steering to avoid conflicts when steering. The study provides a reference for the analysis of driving behavior and driving safety of older people.

The relationship between aggressive driving and driver performance: A systematic review with meta-analysis

Traffic crashes remain a leading cause of accidental human death where aggressive driving is a significant contributing factor. To review the driver's performance presented in aggressive driving, this systematic review screens 2412 pieces of relevant literature, selects and synthesizes 31 reports with 34 primary studies that investigated the driver's control performance among the general driver population in four-wheeled passenger vehicles and published with full text in English. These 34 selected studies involved 1731 participants in total. By examining the selected 34 studies, the measures relating to vehicle speed (e.g., mean speed, n = 22), lateral control (e.g., lane deviation, n = 17) and driving errors (e.g., violation of traffic rules, n = 12) were reported most frequently with a significant difference observed between aggressive driving and driving in the control group. The result of the meta-analysis indicates that the aggressive driving behaviour would have 1) a significantly faster speed than the behaviour in the control group with an increase of 5.32 km/h (95% confidence interval, [3.27, 7.37] km/h) based on 8 studies with 639 participants in total; 2) 2.51 times more driving errors (95% confidence interval, [1.32, 3.71] times) than the behaviour in the control group, based on 5 studies with 136 participants in total. This finding can be used to support the identification and quantification of aggressive driving behaviour, which could form the basis of an in-vehicle aggressive driving monitoring system.

Associations of cannabis use with motor vehicle crashes and traffic stops among older drivers: AAA LongROAD study

BACKGROUND

Acute cannabis use is associated with a higher risk of motor vehicle crashes (MVC). This study aimed to determine if self-reported past-year cannabis use is associated with MVC or traffic stops among older drivers.

METHODS

This cross-sectional analysis used data from a multi-center study enrolling active drivers aged 65-79 years. Data regarding cannabis use, MVC, and traffic stops (i.e., being pulled over by police, whether ticketed or not) within the previous 12 months were collected through participant interviews. Log-binomial regression models examined associations of past-year cannabis use with MVC and traffic stops, adjusting for site and sociodemographic and mental health characteristics.

RESULTS

Of 2,095 participating older drivers, 186 (8.88%) used cannabis in the past year but only 10 (<0.5%) within an hour before driving in the last 30 days; 11.41% reported an MVC and 9.45% reported a traffic stop. Past-year cannabis users had a higher prevalence of MVC (adjusted prevalence ratio [aPR] = 1.38; 95%CI: 0.96, 2.00; p = 0.086) and traffic stops (aPR = 1.58; 1.06, 2.35; p = 0.024).

CONCLUSIONS

Past-year cannabis use was associated with increased traffic stops, which are correlated modestly with increased MVC in past studies and may indicate impaired driving performance. We did not find a statistically significant association of past-year cannabis use with MVC, which may indicate limited sustained effects on driving performance from periodic use among older adults, who report rarely driving immediately after use.

Leisure activities and cognitive impairment in old age: The role of life course socioeconomic status

In the current literature on cognitive function, life course socioeconomic status (SES) and engaging in leisure activities are often viewed as parallel measures of cognitive reserve that independently affect cognitive impairment in old age. Some studies also suggest that leisure activity mediates the effect of SES on cognitive impairment. What is less examined is the modification effect of SES on the association between engaging in leisure activities and cognitive impairment, especially from a life course perspective. In this study, we focus on the interaction effects of specific measures of SES and leisure activities on cognitive impairment. We use data from the Chinese Longitudinal Healthy Longevity Survey, which includes five waves of interviews with adults aged 65 and older between 2002 and 2014. Cognitive impairment is measured by the Chinese version of the Mini-Mental Status Examination. Childhood and adulthood SES and participation in seven leisure activities are included in this analysis. We adopt a lagged independent variable approach and the Generalized Linear Mixed Model to conduct the analysis. Findings confirm that higher SES in both childhood and adulthood are associated with low levels of cognitive impairment in the older Chinese population. Furthermore, there are significant interaction effects between specific life course SES and leisure activities with a consistent pattern: Those of higher life course SES enjoy extra benefits from engaging in leisure activities. The findings point to a modification mechanism that connects life course SES, leisure activities, and cognitive health inequality among older adults.

Olfactory discrimination and identification as prognostic markers of fitness-to-drive in older drivers

The necessity for reliable, standardized and validated fitness to drive assessment tools for older drivers have been highlighted and discussed for over three decades. Existing neuropsychological tests of driving performance are focusing mostly on visuo-spatial attention and executive functioning rather than other senses. Over the last decade, olfactory deterioration has been found to be associated with cognitive decline and predicting transition from mild cognitive impairment to dementia. The AGILE fitness to drive battery is standardized for older drivers. In this study it was adapted to include the olfactory Sniff' and Stick's test. The aim was to investigate the value of relevant deficits as predictive markers of driving ability in three driving groups (older drivers with: (a) no impairment (controls), (b) with Mild Cognitive Impairment (MCI) and (c) MCI and other chronic conditions, i.e., comorbidities). So far, no other study has investigated the predictive value of olfactory deficits in driving ability. The findings revealed that discrimination is important for the first year of the examination and as the decline progresses, identification becomes the better olfactory marker. The latter is also evident in the literature. Hence, the results showed that less indicators are required compared to the initial battery. The olfactory markers were dominant over the neuropsychological tests, apart from alertness, for predicting the older driver's fitness to drive regardless of the presence of cognitive impairment and other chronic conditions.

Driving Cessation: What Are Family Members' Experiences and What Do They Think about Driving Simulators?

BACKGROUND

Driving cessation is difficult for persons living with cognitive decline (PLWCD) and their caregivers (CG). Physicians are often required to notify authorities of driving risks, and typically base decisions on paper-based cognitive assessments and on-road tests. This study examines experiences surrounding cessation and CG's views regarding simulators in the process.

METHODS

Semi-structured virtual interviews were conducted with CGs of PLWCD from an academic memory clinic. Experiences around cessation were explored first, followed by discussions regarding the simulator. Framework analysis was applied to transcribed interviews.

RESULTS

Six females and two males, three children and five spouses participated. PLWCD viewed driving cessation negatively, often had difficulty understanding why, and believed cessation was temporary. CGs experienced relief and/or shock. Cessation negatively impacted the relationships between the PLWCD and both the physician and CG. Isolation, coping challenges and loss of independence were experienced by the PLWCD. The lives of caregivers were adversely affected, especially regarding driving burden and worsening mental health. CGs were generally supportive of simulators. Positives included: measurement of driving skills, method of testing, and providing an understanding regarding the driving suspension. Potential drawbacks included difficulty using the machine, testing anxiety and stress induced by a crash. Caregivers were concerned about: PLWCD's disappointment of failure, requesting to retest, and reluctance to accept the decision.

CONCLUSION

PLWCD and caregivers had negative experiences related to the driving cessation. Generally, caregivers viewed implementing driving simulators positively, in a context of a practice session and support for PLWCD's potential reactions to the decision.

Speedometer-reading performance of senior drivers with cognitive impairment: a comparison of analogue and digital speedometers

BACKGROUND

With the deterioration of cognitive functions, the capability to obtain information with speed, one of the essential elements needed to perform safe driving, may be impacted. We aimed to compare the legibility of analogue and digital speedometers for senior drivers with cognitive impairment, and examined the demographic, cognitive, and driving-related variables that predict their speedometer-reading performance.

METHODS

A total of 50 senior drivers with cognitive impairment were investigated and asked to complete an office-based speedometer-reading test using an iPad. Two general types of speedometers (analogue and digital) were tested in this study.

RESULTS

The age of the participants ranged from 61 to 92 years (mean (SD), 79.10 (6.973)), and 29 were male. The mean (SD) score of the Mini-Mental State Examination was 22.48 (6.089). The median (Q_L , Q_U ) scores of the analogue and digital speedometer-reading tests were 4 (4, 5.25) and 6 (6), respectively. Based on the result of the Wilcoxon signed-rank test, the score of the digital speedometer-reading test was significantly higher than that of the analogue one (Z = 4.399, P < 0.001). The results of multiple linear regression analyses show that the scores of the Mini-Mental State Examination (β = 0.358, P = 0.025), and the trail-making test-A (β = -0.443, P = 0.006) predicted the digital speedometer-reading performance, and they together explain 54.7% of the total variance.

CONCLUSIONS

A digital speedometer was found to be easier for absolute value reading for senior drivers with cognitive impairment, compared to an analogue speedometer. Senior drivers with subjective cognitive decline may also have impairments in obtaining the speed information through an analogue speedometer. General cognitive function and attention may influence the speed-reading performance on the digital speedometer.

An innovative therapeutic educational program to support older drivers with cognitive disorders: Description of a randomized controlled trial study protocol

Older drivers face the prospect of having to adjust their driving habits because of health problems, which can include neurocognitive disorders. Self-awareness of driving difficulties and the interaction between individual with neurocognitive disorders and natural caregiver seem to be important levers for the implementation of adaptation strategies and for the subsequent voluntary cessation of driving when the cognitive disorders become too severe. This study aims to evaluate an educational program for patient/natural caregiver dyads who wish to implement self-regulation strategies in driving activity, and to improve self-awareness of driving ability. The ACCOMPAGNE program is based on seven group workshops, which target the dyad. The workshops deal with the impact of cognitive, sensory and iatrogenic disorders on driving. They tackle questions about responsibility, and about autonomy and social life. They also provide alternative solutions aimed at maintaining outward-looking activities even if driving is reduced or stopped. A randomized controlled trial is planned to evaluate the effectiveness of the program 2 months and 6 months after inclusion, and to compare this to the effectiveness of conventional approaches. The main outcome of this trial (i.e., the implementation of self-regulated driving strategies), will be measured based on scores on the “Current Self-Regulatory Practices” subscale of the Driver Perception and Practices Questionnaire. The Driving Habits Questionnaire will be used to measure secondary outcomes (indicators of driving changes; indicators of changes in mood, quality of life and caregiver burden; and self-awareness of driving abilities). Indicators will be collected for both patients and natural caregivers. This cognitive, social and psychological program should allow older individuals with cognitive disorders to drive more safely, and help to maintain the quality of life and mood of both patient and natural caregiver despite driving limitations. The patient's care path would be optimized, as he/she would become an actor in the process of giving up driving, which will, most certainly, be needed at some point in the progress of neurocognitive disorders. This process ranges from becoming aware of driving difficulties, to implementing self-regulation strategies, through to complete cessation of driving when necessary.

Clinical trial registration number

NCT04493957.

Cognitive, psychological and social factors associated with older adults' mobility: a scoping review of self-report and performance-based measures

Although many factors have been associated with mobility among older adults, there is paucity of research that explores the complexity of factors that influence mobility. This review aims to synthesise the available evidence for factors comprising the cognitive, psychological, and social mobility determinants and their associations with mobility self-reported and performance-based outcomes in older adults (60 years). We followed Arksey and O'Malley's five stages of a scoping review and searched PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature and Sociological Abstract databases. Reviewers in pairs independently conducted title, abstract, full-text screening and data extraction. We reported associations by analyses rather than articles because articles reported multiple associations for factors and several mobility outcomes. Associations were categorised as significantly positive, negative, or not significant. We included 183 peer-reviewed articles published in 27 countries, most of which were cross-sectional studies and conducted among community-dwelling older adults. The 183 articles reported 630 analyses, of which 381 (60.5%) were significantly associated with mobility outcomes in the expected direction. For example, older adults with higher cognitive functioning such as better executive functioning had better mobility outcomes (e.g., faster gait speed), and those with poor psychological outcomes, such as depressive symptoms, or social outcomes such as reduced social network, had poorer mobility outcomes (e.g., slower gait speed) compared to their counterparts. Studies exploring the association between cognitive factors, personality (a psychological factor) and self-reported mobility outcomes (e.g., walking for transportation or driving), and social factors and performance-based mobility outcomes in older adults are limited. Understanding the additive relationships between cognitive, psychological, and social factors highlights the complexity of older adults' mobility across different forms of mobility, including independence, use of assistive devices, transportation, and driving.

Examining Patterns of Driving Avoidance Behaviors Among Older People Using Latent Class Analysis

Objectives: Some older drivers choose to avoid certain situations where they do not feel confident driving. Little is known about the process by which older drivers may use avoidance in transitioning to non-driving. Methods: We analyzed 2015 ConsumerStyles data for 1198 drivers aged 60+. Driving patterns were examined by sociodemographic and driving characteristics. Avoidance classes were characterized by latent class analysis. Results: Among drivers 60+, 79% reported driving 3+ days/week and 84% reported good to excellent health. We identified four driving avoidance classes (low, mild, moderate, and high). High- (versus low-) avoidance drivers were more likely female, 75+, not White/non-Hispanic, and to have income <$25,000/year. Discussion: Avoidance of selected driving behaviors may be one component of a multi-step process supporting the transition to non-driving. Drivers displaying avoidance behaviors may be receptive to resources to prepare for this transition and minimize negative health and quality of life outcomes that accompany driving cessation.

Association between on-road driving performance test and usual walking speed or sustainable attention in the elderly; Preliminary survey

OBJECTIVE

An increase in older drivers has been widely recognized in Japan; accordingly, screening to prevent traffic accidents is a crucial issue for safe driving. As a preliminary study, we examined the association between on-road driving performance and cognition or physical performance in older individuals.

METHODS

The survey was conducted in 2020, and the participants were recruited in Katagami City, Akita, Japan. The Road Test was used to assess on-road driving performance. The physical assessment comprised the usual walking speed (UWS) and grip strength (GS), and the cognitive evaluation consisted of the National Center for Geriatrics and Gerontology Functional Assessment Tool (NCGG-FAT) and the Japanese version of Stroke Drivers' Screening Assessment (J-SDSA). A multiple regression model was also applied to examine the association between on-road driving performance and the physical items or cognitive domains of the NCGG-FAT and the J-SDSA in older individuals.

RESULTS

Twenty-one participants (mean age ± standard deviation [SD], 77.0 ± 5.5 years) were included in this study. A correlation analysis showed that the on-road test score was correlated with performances on the UWS (r = 0.53, p = .002), the word list memory (WM) test (r = 0.44, p = .046), the trail-making test-A (TMT-A) (r = -0.44, p = .048), the SDSA dot cancelation (DC) test (r = -0.63, p = .002), and the SDSA squares matrix compass test (SM) (r = 0.54, p = .048). According to a stepwise linear regression, the on-road test score was associated with the UWS (β = -0.01, p = .003) and the SDSA DC (β = 4.89, p = .01), with an adjusted R² = 0.54.

CONCLUSIONS

The results of the study suggested that the UWS and sustainable attention might be potential factors influencing on-road driving performance. Our preliminary findings warrant further investigation.

Driving Performance and Its Correlation with Neuropsychological Tests in Senior Drivers with Cognitive Impairment in Japan

BACKGROUND

With the rapid aging of the population, the issue of driving by dementia patients has been causing increasing concern worldwide.

OBJECTIVE

To investigate the driving difficulties faced by senior drivers with cognitive impairment and identify the specific neuropsychological tests that can reflect specific domains of driving maneuvers.

METHODS

Senior drivers with cognitive impairment were investigated. Neuropsychological tests and a questionnaire on demographic and driving characteristics were administered. Driving simulator tests were used to quantify participants' driving errors in various domains of driving.

RESULTS

Of the 47 participants, 23 current drivers, though they had better cognitive functions than 24 retired drivers, were found to have impaired driving performance in the domains of Reaction, Starting and stopping, Signaling, and Overall (wayfinding and accidents). The parameters of Reaction were significantly related to the diagnosis, and the scores of MMSE, TMT-A, and TMT-B. As regards details of the driving errors, "Sudden braking" was associated with the scores of MMSE (ρ= -0.707, p < 0.01), BDT (ρ= -0.560, p < 0.05), and ADAS (ρ= 0.758, p < 0.01), "Forgetting to use turn signals" with the TMT-B score (ρ= 0.608, p < 0.05), "Centerline crossings" with the scores of MMSE (ρ= -0.582, p < 0.05) and ADAS (ρ= 0.538, p < 0.05), and "Going the wrong way" was correlated with the score of CDT (ρ= -0.624, p < 0.01).

CONCLUSION

Different neuropsychological factors serve as predictors of different specific driving maneuvers segmented from driving performance.

Driving With Distraction: Measuring Brain Activity and Oculomotor Behavior Using fMRI and Eye-Tracking

Introduction

Driving motor vehicles is a complex task that depends heavily on how visual stimuli are received and subsequently processed by the brain. The potential impact of distraction on driving performance is well known and poses a safety concern - especially for individuals with cognitive impairments who may be clinically unfit to drive. The present study is the first to combine functional magnetic resonance imaging (fMRI) and eye-tracking during simulated driving with distraction, providing oculomotor metrics to enhance scientific understanding of the brain activity that supports driving performance.

Materials and Methods

As initial work, twelve healthy young, right-handed participants performed turns ranging in complexity, including simple right and left turns without oncoming traffic, and left turns with oncoming traffic. Distraction was introduced as an auditory task during straight driving, and during left turns with oncoming traffic. Eye-tracking data were recorded during fMRI to characterize fixations, saccades, pupil diameter and blink rate.

Results

Brain activation maps for right turns, left turns without oncoming traffic, left turns with oncoming traffic, and the distraction conditions were largely consistent with previous literature reporting the neural correlates of simulated driving. When the effects of distraction were evaluated for left turns with oncoming traffic, increased activation was observed in areas involved in executive function (e.g., middle and inferior frontal gyri) as well as decreased activation in the posterior brain (e.g., middle and superior occipital gyri). Whereas driving performance remained mostly unchanged (e.g., turn speed, time to turn, collisions), the oculomotor measures showed that distraction resulted in more consistent gaze at oncoming traffic in a small area of the visual scene; less time spent gazing at off-road targets (e.g., speedometer, rear-view mirror); more time spent performing saccadic eye movements; and decreased blink rate.

Conclusion

Oculomotor behavior modulated with driving task complexity and distraction in a manner consistent with the brain activation features revealed by fMRI. The results suggest that eye-tracking technology should be included in future fMRI studies of simulated driving behavior in targeted populations, such as the elderly and individuals with cognitive complaints - ultimately toward developing better technology to assess and enhance fitness to drive.

Obstructive Sleep Apnea: Cognitive Outcomes

There is a strong association between obstructive sleep apnea (OSA) and cognitive dysfunction. Executive function, attention, verbal/visual long-term memory, visuospatial/constructional ability, and information processing are more likely to be affected, whereas language, psychomotor function, and short-term memory are less likely to be affected. Increased accumulation of Aß₂-amyloid in the brain, episodic hypoxemia, oxidative stress, vascular inflammation, and systemic comorbidities may contribute to the pathogenesis. Patients with OSA should have cognitive screening or formal testing, and patients with cognitive decline should have testing for OSA. Treatment with continuous positive airway pressure may improve cognitive symptoms in the patient with OSA.

Cognitive Efficiency and Fitness-to-Drive along the Lifespan: The Mediation Effect of Visuospatial Transformations

The way people represent and transform visuospatial information affects everyday activities including driving behavior. Mental rotation and perspective taking have recently been found to predict cognitive prerequisites for fitness-to-drive (FtD). We argue that the relationship between general cognitive status and FtD is mediated by spatial transformation skills. Here, we investigated the performance in the Mental Rotation Test (MRT) and the Perspective-Taking Test (PT) of 175 male active drivers (aged from 18 to 91 years), by administering the Montreal Cognitive Assessment (MoCA) to measure their global cognitive functioning. All participants were submitted to a computerized driving assessment measuring resilience of attention (DT), reaction speed (RS), motor speed (MS), and perceptual speed (ATAVT). Significant results were found for the effect of global cognitive functioning on perceptual speed through the full mediation of both mental rotation and perspective-taking skills. The indirect effect of global cognitive functioning through mental rotation was only found to significantly predict resilience of attention whereas the indirect effect mediated by perspective taking only was found to significantly predict perceptual speed. Finally, the negative effect of age was found on each driving measure. Results presented here, which are limited to male drivers, suggest that general cognitive efficiency is linked to spatial mental transformation skills and, in turn, to driving-related cognitive tasks, contributing to fitness-to-drive in the lifespan.

Benefits of Higher Cardiovascular and Motor Coordinative Fitness on Driving Behavior Are Mediated by Cognitive Functioning: A Path Analysis

Driving is an important skill for older adults to maintain an independent lifestyle, and to preserve the quality of life. However, the ability to drive safely in older adults can be compromised by age-related cognitive decline. Performing an additional task during driving (e.g., adjusting the radio) increases cognitive demands and thus might additionally impair driving performance. Cognitive functioning has been shown to be positively related to physical activity/fitness such as cardiovascular and motor coordinative fitness. As such, a higher fitness level might be associated with higher cognitive resources and may therefore benefit driving performance under dual-task conditions. For the first time, the present study investigated whether this association of physical fitness and cognitive functioning causes an indirect relationship between physical fitness and dual-task driving performance through cognitive functions. Data from 120 healthy older adults (age: 69.56 ± 3.62, 53 female) were analyzed. Participants completed tests on cardiovascular fitness (cardiorespiratory capacity), motor coordinative fitness (composite score: static balance, psychomotor speed, bimanual dexterity), and cognitive functions (updating, inhibition, shifting, cognitive processing speed). Further, they performed a virtual car driving scenario where they additionally engaged in cognitively demanding tasks that were modeled after typical real-life activities during driving (typing or reasoning). Structural equation modeling (path analysis) was used to investigate whether cardiovascular and motor coordinative fitness were indirectly associated with lane keeping (i.e., variability in lateral position) and speed control (i.e., average velocity) while dual-task driving via cognitive functions. Both cardiovascular and motor coordinative fitness demonstrated the hypothesized indirect effects on dual-task driving. Motor coordinative fitness showed a significant indirect effect on lane keeping, while cardiovascular fitness demonstrated a trend-level indirect effect on speed control. Moreover, both fitness domains were positively related to different cognitive functions (processing speed and/or updating), and cognitive functions (updating or inhibition), in turn, were related to dual-task driving. These findings indicate that cognitive benefits associated with higher fitness may facilitate driving performance. Given that driving with lower cognitive capacity can result in serious consequences, this study emphasizes the importance for older adults to engage in a physically active lifestyle as it might serve as a preventive measure for driving safety.

Development of an Android-Based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) App: Mixed Methods Study

Background

Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, a paper-based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR through an Android app, which provides the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity.

Objective

This study tested the validity and reliability of a mobile app-based version of a self-report assessment for elderly persons contextualized to the South Korean culture and compared it with a paper-based test.

Methods

In this mixed methods study, we recruited and interviewed 567 elderly drivers (aged 65 years and older) between August 2018 and May 2019. For participants who provided consent, the app-based test was repeated after 2 weeks and an additional paper-based test (Driver 65 Plus test) was administered. Using the collected data, we analyzed the reliability and validity of the app-based SAFE-DR. The internal consistency of provisional items in each subdomain of the SAFE-DR and the test-retest stability were analyzed to examine reliability. Exploratory factor analysis was performed to examine the validity of the subdomain configuration. To verify the appropriateness of using an app-based test for older drivers possibly unfamiliar with mobile technology, the correlation between the results of the SAFE-DR app and the paper-based offline test was also analyzed.

Results

In the reliability analysis, Cronbach α for all items was 0.975 and the correlation of each item with the overall score ranged from r=0.520 to r=0.823; 4 items with low correlations were removed from each of the subdomains. In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing very high reliability. Exploratory factor analysis on 40 of the 44 items established 5 subdomains: on-road (8 items), coping (16 items), cognitive functions (5 items), general conditions (8 items), and medical health (3 items). A very strong negative correlation of –0.864 was observed between the total score for the app-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The app-based test was found to be reliable.

Conclusions

In this study, we developed an app-based self-report assessment tool for elderly drivers and tested its reliability and validity. This app can help elderly individuals easily assess their own driving skills. Therefore, this assessment can be used to educate drivers and for preventive screening for elderly drivers who want to renew their driver’s licenses in South Korea. In addition, the app can contribute to safe driving among elderly drivers.

Protein Intake and Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis

Introduction:

The present study investigated the association between protein intake and cognitive function in older adults.

Methods:

We performed a literature search with no restriction on publication year in MEDLINE, SCOPUS, CINAHL, AgeLine from inception up to October 2020. Observational studies that investigated as a primary or secondary outcome the association of protein intake and cognitive function in older adults aged ⩾60 years were included.

Results:

Nine cross-sectional studies that investigated a total of 4929 older adults were included in the qualitative analysis. Overall cognitive function was examined in 6 studies. Four investigations reported null associations and 2 studies found that older adults with a high protein intake had higher global cognitive function than their counterparts. Results from the meta-analysis suggested that there were no significant associations between protein consumption and global cognitive function in older adults, regardless of gender. Three studies investigated other cognitive domains. Memory and protein intake were significantly and positively correlated in all studies. In addition, visuospatial, verbal fluency, processing speed, and sustained attention were positively associated with protein consumption in 1 study each.

Conclusion:

No significant associations between protein intake and global cognitive function were observed in neither qualitative nor quantitative analyses. The association between protein consumption with multiple other cognitive domains were also tested. As a whole, 3 studies reported a positive and significant association between high protein intake and memory, while 1 study observed a significant and positive association with visuospatial, verbal fluency, processing speed, and sustained attention.

Cannabis and crash risk among older drivers

The purpose of this research was to reanalyze data collected from the National Highway Traffic Safety Administration's Drug and Alcohol Crash Risk Study to investigate whether driving under the influence of cannabis (THC-positive) was associated with elevated crash risk for younger and older drivers. The data came from a case-control relative risk study collected from Virginia Beach, VA, over a 20-month period. Data collectors gathered driver information from the scene of vehicle crashes and, in some cases, from hospitals. Non-crash controls were sampled from the same locations, days, and times as crashes. Key data items included driver demographics and oral fluid and blood samples, which were assayed for licit and illicit drugs. We found no overall association between cannabis use and risk of crash involvement. However, when age and age² were allowed to interact with THC, significant interaction effects emerged. THC was associated with increased risk of crash involvement for older drivers. Difference between THC-positive and sober drivers emerged as significant at age 64. The research underscores the value of examining drugged driving in the context of driver age. Age-related declines in neurocognitive and psychomotor functioning were not measured but might be important in explaining the results.

Mandarin version of dementia and driving decision aid (DDDA): Development and stakeholder evaluation in Taiwan

BACKGROUND

Dementia causes cognitive and memory difficulties which can reduce the driving safety of the individuals. The decision-making process for driving retirement is challenging, and yet limited guidance is available.

OBJECTIVES

This article reports the development of the Taiwanese version of dementia and driving decision aid (DDDA) and the evaluation from stakeholders through a dementia and driving education programme.

METHODS

A multi-method approach was adopted using a pre-test, post-test survey and focus group interviews. A total of 154 healthcare professionals, family caregivers and people with dementia participated education programme, and 12 experts attended the focus group discussion. The survey included demographics, knowledge, confidence, competence and awareness of using DDDA. Participants completed a survey prior and immediately after the education programme. We translated a 32-page interactive DDDA booklet from the original English version to Mandarin. The education programme consisted of three-hour dementia and driving education module delivered both face-to-face and online.

RESULTS

The majority of participants described the booklet as balanced (91.7%) with the information presented in a 'good' or 'excellent' manner (93.4%). Most participants (85.3%) felt that DDDA helps them in making decisions about driving. Five themes were extracted from the focus group interview: (1) approach targeted to people with dementia, (2) specific content and additional information, (3) culturally appropriate modification, (4) having the right to drive and (5) booklet dissemination. The knowledge, confidence, competence and awareness of using the DDDA increased significantly (p < 0.001) after the education programmes.

CONCLUSION

We anticipate that use of the DDDA booklet will raise awareness of this social and health issue among the general public and facilitate collaborations with clinicians, municipalities and related organisations in providing a decision-making resource material for those with people living with dementia and their families. This study was not a clinical trial and the focus of this study was development and evaluation of the DDDA booklet. As mentioned in the methods section, participants were invited to attend the education program and provided their thoughts on the DDDA booklet based on their satisfaction level. Moreover, the education program was a one-day, workshop type program. This study was neither "prospectively assigns human participants or groups of humans to one or more health-related interventions" nor "to evaluate the effects on health outcomes", according to the definition of clinical trial by WHO. Therefore, we did not consider this study was a clinical trial.

IMPLICATIONS FOR PRACTICE

There is an urgent need for supporting people with dementia and their families to negotiate the complex decision-making involved in deciding to change their approach to driving. The DDDA booklet can fill an important gap in service delivery to people with dementia who are adjusting to life without driving.

Factors influencing occupational truck driver safety in ageing society

In ageing societies, the effective employment of ageing occupational drivers is one of the most important managerial concerns to be addressed to compensate for the lack of younger workers. In this study, the key factors contributing to the safety outcome in trucking transportation were identified using empirical data, including driving accident information, individual attributes, and task-related attributes. For this purpose, 306 driver records from 26 trucking companies in Japan were analysed. The driver sample was dichotomised by age into elderly drivers (age ≥ 50 years, referred to as older; N = 131) and young drivers (age < 50 years, referred to as younger; N = 175). Based on the analysis results, no significant age difference was identified in the likelihood of involvement in accidents for truck drivers. While older drivers who have penalty point records were more likely to be involved in traffic accidents, they were less affected by hard work conditions compared with young drivers. In conclusion, elderly drivers can be effectively employed as occupational drivers. They do not necessarily have a higher risk of accidents than young drivers. In addition, employment policies are proposed from a safety viewpoint, particularly for elderly truck drivers.

Do healthcare providers assess for risk factors and talk to patients about return to driving after a mild traumatic brain injury (mTBI)? Findings from the 2020 DocStyles Survey

BACKGROUND

There is a dearth of information and guidance for healthcare providers on how to manage a patient's return to driving following a mild traumatic brain injury (mTBI).

METHODS

Using the 2020 DocStyles survey, 958 healthcare providers were surveyed about their diagnosis and management practices related to driving after an mTBI.

RESULTS

Approximately half (52.0%) of respondents reported routinely (more than 75% of the time) talking with patients with mTBI about how to safely return to driving after their injury. When asked about how many days they recommend their patients with mTBI wait before returning to driving after their injury: 1.0% recommended 1 day or less; 11.7% recommended 2-3 days; 24.5% recommended 4-7 days and 45.9% recommended more than 7 days. Many respondents did not consistently screen patients with mTBI for risk factors that may affect their driving ability or provide them with written instructions on how to safely return to driving (59.7% and 62.6%, respectively). Approximately 16.8% of respondents reported they do not usually make a recommendation regarding how long patients should wait after their injury to return to driving.

CONCLUSIONS

Many healthcare providers in this study reported that they do not consistently screen nor educate patients with mTBI about driving after their injury. In order to develop interventions, future studies are needed to assess factors that influence healthcare providers behaviours on this topic.

Spatial Mental Transformation Skills Discriminate Fitness to Drive in Young and Old Adults

Literature on driving research suggests a relationship between cognition and driving performance in older and younger drivers. There is little research on adults and driving, despite them being the largest age cohort behind the wheel. Among the cognitive domains, visuospatial abilities are expected to be highly predictive of driving skills and driving fitness. The relationship between specific spatial mental transformation skills (i.e., object and self-based ones) and driving performance has not yet been examined. The present study aimed to investigate the relationship between overall cognitive functioning, self and object-based spatial mental transformation skills, and driving performance in a sample of younger and older adult drivers. Participants were comprised of one hundred younger and 83 older adult Italian drivers. Participants completed a computerized driving test assessing traffic stress resilience, visual and motor reaction time, and the ability to obtain an overview of the traffic scenario (DT, vRT, mRT, and ATAV respectively in the Shufried®-Vienna Test System-DRIVESC). The Mental Rotation Test (MRT) and the Object Perspective Taking Test (OPT) were administered in order to assess object-based and self-based spatial mental transformation skills. The Montreal Cognitive Assessment Test (MoCA) was administered control for global cognitive functioning. The effects of education and gender were also controlled in the analysis. The results of the present study suggested that: (1) The effect of age, favoring younger participants, was found in DT, vRT, mRT, and ATAVT tests. (2) The effect of global cognitive functioning was found in DT and ATAV tests. (3) The effect of the spatial mental transformation tests was found in DT, vRT (MRT only), and ATAVT (OPT only) tests. Taken together, these results suggest the specific contribution of spatial mental transformation skills in the execution of complex behaviors connected to the fitness to drive. Prospectively, the results of the present study relating spatial mental transformation skills and driving processes may be a valuable source of knowledge for researchers dealing with the relationship between cognitive resources and navigation aids.

Using Serial Trichotomization with Neuropsychological Measures to Inform Clinical Decisions on Fitness-to-Drive among Older Adults with Cognitive Impairment

Decisions related to driving safety and when to cease driving are complex and costly. There is an interest in developing an off-road driving test utilizing neuropsychological tests that could help assess fitness-to-drive. Serial trichotomization has demonstrated potential as it yields 100% sensitivity and specificity in retrospective test samples. The purpose of this study was to test serial trichotomization using four common neuropsychological tests (Trail Making Test Part A and B, Clock Drawing Test, and Modified Mini-Mental State Examination). Test scores from 105 patients who were seen in a memory clinic were abstracted. After applying the model, participants were classified as unfit, fit, or requiring further testing, 38.1%, 25.8%, and 36.1%, respectively. This study provides further evidence that trichotomization can facilitate the assessment of fitness-to-drive.

The Medical Referral Process and Motor-Vehicle Crash Risk for Drivers with Dementia

Cognitive and physical impairment can occur with dementia and reduce driving ability. In the United States, individual states have procedures to refer and evaluate drivers who may no longer be fit to drive. The license review process is not well understood for drivers with dementia. This study uses comprehensive data from the Iowa Department of Transportation to compare the referral process for drivers with and without dementia from January 2014 through November 2019. The likelihood of failing an evaluation test was compared between drivers with and without dementia using logistic regression. The risk of motor-vehicle crash after referral for review of driving ability was compared using a Cox proportional hazard model. Analysis controlled for the age and sex of the referred driver. Drivers with dementia performed worse on all tests evaluated except the visual screening test. After the referral process, the risk of crash was similar between those with and without dementia. Drivers with dementia were denied their license more frequently than referred drivers without dementia. However, drivers with dementia who successfully kept their license as a result of the license review process were not at an increased risk of crash compared to other referred drivers.

Glucose control and cognitive and physical function in adults 80+ years of age with diabetes

INTRODUCTION

We modeled associations between glycated hemoglobin (HbA1c) levels (<7%, 7% to 8%, and >8%) and cognitive and physical function among adults 80+ years of age with diabetes and determined whether associations differ by frailty, multimorbidity, and disability.

METHODS

A total of 316, adults with diabetes, 80+ years of age, were from the Adult Changes in Thought Study. The Cognitive Abilities Screening Instrument Item Response Theory (CASI-IRT) measured cognition. Short performance-based physical function (sPPF) and gait speed measured physical function. Glycosylated hemoglobin (HbA1c) levels were from clinical measurements. Analyses estimated associations between average HbA1c levels (<7%, 7% to 8%, and >8%) and functional outcomes using linear regressions estimated with generalized estimating equations.

RESULTS

sPPF scores did not differ significantly by HbA1c levels. Gait speed did, but only for non-frail individuals; those with HbA1c >8% were slower (-0.10 m/s [95% CI, -0.16 to -0.04]) compared to those with HbA1c 7% to 8%. The association between HbA1c and CASI-IRT varied with age (interaction P = 0.04). At age 80, for example, relative to people with HbA1c levels of 7% to 8%, CASI-IRT scores were, on average, 0.18 points lower (95% CI, -0.35 to -0.02) for people with HbA1c <7% and 0.22 points lower (95% CI, -0.40 to -0.05) for people with HbA1c >8%. At older ages, these estimated differences were attenuated. Estimated associations were not modified by multimorbidity or disability.

DISCUSSION

Moderate HbA1c levels of 7% to 8% were associated with better cognition in early but not late octogenarians with diabetes. Furthermore, HbA1c >8% was associated with slower gait speed among those without frailty. These results add to an evidence base for determining glucose targets for very old adults with diabetes.

Driver Self-Regulation Practices in Older Drivers with and Without Mild Cognitive Impairment

Objective

To assess the impact of cognitive, socio-demographic and driving-related characteristics on self-regulation practices in older drivers with mild cognitive impairment (MCI) (determined by the Telephone Cognitive Screen (T-CogS) score), compared with drivers with no cognitive impairment.

Design, Setting, Participants

A cross-sectional study collected information from 362 drivers with MCI and 611 drivers with no cognitive impairment, who were aged 65+ years, and were living in Western Australia between November 2018 and February 2019.

Measurements

Self-reported self-regulation driving practices.

Results

The majority of drivers with MCI (62.4%) and those with no cognitive impairment (57.1%) reported self-regulating their driving in at least one situation, in the past three months. The most common situations that both groups of drivers self-regulated in were “driving at night in the rain”, “parallel parking”, and “driving when raining”. Drivers with MCI were only significantly more likely to self-regulate when “making turns across oncoming traffic” and “driving at night”. They also had 39% greater odds of self-regulating in at least one driving situation, compared with drivers with no cognitive impairment (OR: 1.39, 95% CI=1.04–1.85, p=0.02). Females also had 2.3 times greater odds of self-regulating (OR=2.34, 95% CI=1.76–3.12, p<0.001). Drivers aged 75+ years had 1.6 times greater odds of self-regulating, compared with drivers aged 65–69 years (OR=1.58, 95% CI=1.12–2.23, p=0.01).

Conclusion

Older drivers with MCI were more likely to self-regulate their driving, compared to drivers with no cognitive impairment, particularly in complex driving situations. This suggests that some drivers with MCI may be able to recognize their cognitive limitations and adjust their driving accordingly. However, several drivers with MCI, particularly males, did not self-regulate their driving. This highlights the importance of advising patients about the impact of MCI on driving ability, suitable self-regulation strategies, as well as monitoring their driving ability.

Shifting gears versus sudden stops: qualitative study of consultations about driving in patients with cognitive impairment

OBJECTIVE

General practitioners (GPs) report finding consultations on fitness to drive (FtD) in people with cognitive impairment difficult and potentially damaging to the physician-patient relationship. We aimed to explore GP and patient experiences to understand how the negative impacts associated with FtD consultations may be mitigated.

METHODS

Individual qualitative interviews were conducted with GPs (n=12) and patients/carers (n=6) in Ireland. We recruited a maximum variation sample of GPs using criteria of length of time qualified, practice location and practice size. Patients with cognitive impairment were recruited via driving assessment services and participating general practices. Interviews were audio-recorded, transcribed and analysed thematically by the multidisciplinary research team using an approach informed by the framework method.

RESULTS

The issue of FtD arose in consultations in two ways: introduced by GPs to proactively prepare patients for future driving cessation or by patients who urgently needed a medical report for an expiring driving license. The former strategy, implementable by GPs who had strong relational continuity with their patients, helped prevent crisis consultations from arising. The latter scenario became acrimonious if cognition had not been openly discussed with patients previously and was now potentially impacting on their right to drive. Patients called for greater clarity and empathy for the threat of driving cessation from their GPs.

CONCLUSION

GPs used their longitudinal relationship with cognitively impaired patients to reduce the potential for conflict in consultations on FtD. These efforts could be augmented by explicit discussion of cognitive impairment at an earlier stage for all affected patients. Patients would benefit from greater input into planning driving cessation and acknowledgement from their GPs of the impact this may have on their quality of life.