1
|
Joyce NR, Lombardi LR, Pfeiffer MR, Curry AE, Margolis SA, Ott BR, Zullo AR. Implications of using administrative healthcare data to identify risk of motor vehicle crash-related injury: the importance of distinguishing crash from crash-related injury. Inj Epidemiol 2024; 11:38. [PMID: 39135173 PMCID: PMC11318118 DOI: 10.1186/s40621-024-00523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Administrative healthcare databases, such as Medicare, are increasingly used to identify groups at risk of a crash. However, they only contain information on crash-related injuries, not all crashes. If the driver characteristics associated with crash and crash-related injury differ, conflating the two may result in ineffective or imprecise policy interventions. METHODS We linked 10 years (2008-2017) of Medicare claims to New Jersey police crash reports to compare the demographics, clinical diagnoses, and prescription drug dispensings for crash-involved drivers ≥ 68 years with a police-reported crash to those with a claim for a crash-related injury. We calculated standardized mean differences to compare characteristics between groups. RESULTS Crash-involved drivers with a Medicare claim for an injury were more likely than those with a police-reported crash to be female (62.4% vs. 51.8%, standardized mean difference [SMD] = 0.30), had more clinical diagnoses including Alzheimer's disease and related dementias (13.0% vs. 9.2%, SMD = 0.20) and rheumatoid arthritis/osteoarthritis (69.5% vs 61.4%, SMD = 0.20), and a higher rate of dispensing for opioids (33.8% vs 27.6%, SMD = 0.18) and antiepileptics (12.9% vs 9.6%, SMD = 0.14) prior to the crash. Despite documented inconsistencies in coding practices, findings were robust when restricted to claims indicating the injured party was the driver or was left unspecified. CONCLUSIONS To identify effective mechanisms for reducing morbidity and mortality from crashes, researchers should consider augmenting administrative datasets with information from police crash reports, and vice versa. When those data are not available, we caution researchers and policymakers against the tendency to conflate crash and crash-related injury when interpreting their findings.
Collapse
Affiliation(s)
- Nina R Joyce
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Box G-121-S2, Providence, RI, 02192, USA.
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI, USA.
| | - Leah R Lombardi
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melissa R Pfeiffer
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allison E Curry
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of General Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Seth A Margolis
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian R Ott
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Andrew R Zullo
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Box G-121-S2, Providence, RI, 02192, USA
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
2
|
Mukherjee S, McDonald AD, Kesler SR, Cuevas H, Swank C, Stevens A, Ferris TK, Danesh V. Driving among individuals with chronic conditions: A systematic review of applied research using kinematic driving sensors. J Am Geriatr Soc 2024; 72:1242-1251. [PMID: 38243756 PMCID: PMC11018482 DOI: 10.1111/jgs.18738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Kinematic driving data studies are a novel methodology relevant to health care, but prior studies have considerable variance in their methods, populations, and findings suggesting a need for critical analysis and appraisal for feasibility and methodological guidelines. METHODS We assessed kinematic driving studies of adults with chronic conditions for study feasibility, characteristics, and key findings, to generate recommendations for future study designs, and to identify promising directions for applications of kinematic driving data. PRISMA was used to guide the review and searches included PubMed, CINAHL, and Compendex. Of 379 abstract/titles screened, 49 full-text articles were reviewed, and 29 articles met inclusion criteria of analyzing trip-level kinematic driving data from adult drivers with chronic conditions. RESULTS The predominant chronic conditions studied were Alzheimer's disease and related Dementias, obstructive sleep apnea, and diabetes mellitus. Study objectives included feasibility testing of kinematic driving data collection in the context of chronic conditions, comparisons of simulation with real-world kinematic driving behavior, assessments of driving behavior effects associated with chronic conditions, and prognostication or disease classification drawn from kinematic driving data. Across the studies, there was no consensus on devices, measures, or sampling parameters; however, studies showed evidence that driving behavior could reliably differentiate between adults with chronic conditions and healthy controls. CONCLUSIONS Vehicle sensors can provide driver-specific measures relevant to clinical assessment and interventions. Using kinematic driving data to assess and address driving measures of individuals with multiple chronic conditions is positioned to amplify a functional outcome measure that matters to patients.
Collapse
Affiliation(s)
- Srijani Mukherjee
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, Texas, USA
| | - Anthony D. McDonald
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Shelli R. Kesler
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Chad Swank
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Alan Stevens
- Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Thomas K. Ferris
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, Texas, USA
| | - Valerie Danesh
- Baylor Scott & White Research Institute, Dallas, TX, USA
| |
Collapse
|
3
|
Gårdinger MB, Johansson R, Lidestam B, Selander H. Validation of a computerized driving simulator test of cognitive abilities for fitness-to-drive assessments. Front Psychol 2024; 14:1294965. [PMID: 38259535 PMCID: PMC10800903 DOI: 10.3389/fpsyg.2023.1294965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Background Driving requires a series of cognitive abilities, many of which are affected by age and medical conditions. The psychosocial importance of continued driving ushers the need for valid measurements in fitness-to-drive assessments. A driving simulator test could prove useful in these assessments, having greater face validity than other off-road tests and being more cost-effective and safer than ordinary on-road testing. The aim of this study was to validate a driving simulator test for assessment of cognitive ability in fitness-to-drive assessments. Methods The study included 67 healthy participants. Internal consistency of the simulator subtests was estimated. A correlation analysis between results on the simulator and the cognitive tests Trail Making Test (TMT) A and B and the Useful field of View test (UFOV) and multiple regression analysis were conducted. Finally, a comparison of results between age groups (>65 years) and (<65 years) was done. Results Results showed good internal consistency. Significant and moderate correlations were found for all reaction time in the simulator's subtests and UFOV 3, and all but two with TMT A. Lane positioning in the simulator showed significant and low to moderate correlations with UFOV 3 in all subtests. Reaction time and Double reaction time on subtest 3 were significantly correlated with UFOV 2 and UFOV 3 and TMT A, respectively. Test on Centerline (position) in subtest 3 as dependent variable was significantly correlated with UFOV 3. Significant means differences and large effect sizes between the age groups were found for all reaction time and lane positioning tests. Conclusion The findings of concurrent validity, especially with TMT A and UFOV 3 and its sensitivity for age-related differences, indicate potential for the simulator to be used as a complement in fitness-to-drive assessments. However, a clinical study is necessary to further examine its usefulness for patients with cognitive deficits.
Collapse
Affiliation(s)
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Björn Lidestam
- Swedish National Transport Research Institute, Linköping, Sweden
| | - Helena Selander
- Swedish National Transport Research Institute, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
Park K, Putra HA, Yoshida S, Yamashita F, Kawaguchi A. Uniformly positive or negative correlation of cerebral gray matter regions with driving safety behaviors of healthy older drivers. Sci Rep 2024; 14:206. [PMID: 38167857 PMCID: PMC10762062 DOI: 10.1038/s41598-023-50895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024] Open
Abstract
This study investigated the relationship between cerebral gray matter (GM) regions and driving safety behaviors (DSBs) of 98 older drivers without dementia (mean age, 77.72 ± 3.677 years). Their DSBs were evaluated on actual vehicles running on a closed-circuit course. The DSB was scored in six categories: DSB1, visual search behavior; DSB2, speeding; DSB3, signaling of the indicator; DSB4, vehicle stability; DSB5, positioning; and DSB6, steering. The scores were calculated by a single driving instructor; larger scores indicated safer driving performances. Regional GM volumes were measured with voxel-based morphometry by magnetic resonance imaging (MRI). Out of 56 GM regions, 18 were correlated with DSB categories except for DSB4. When a single GM region was correlated with multiple DSB categories, a positive or negative response was uniformly determined for the respective region despite clear differences in the DSB categories. This result suggests the possible existence of two contradictory mechanisms in the brain for DSB. The left postcentral gyrus may largely function in regulating DSBs because it was negatively correlated with five of six DSB categories. Thus, MRI's measurement of regional GM volumes may help deepen the understanding of the diversity and complexity inherent in brain functions for DSBs.
Collapse
Affiliation(s)
- Kaechang Park
- Traffic Medicine Laboratory, Research Organization for Regional Alliance, Kochi University of Technology, 185 Miyanokuchi Tosayamada, Kami-Shi, Kochi, 782-0003, Japan.
| | - Handityo Aulia Putra
- School of Information, Kochi University of Technology, 185 Miyanokuchi Tosayamada, Kami-Shi, Kochi, 782-0003, Japan
| | - Shinichi Yoshida
- School of Information, Kochi University of Technology, 185 Miyanokuchi Tosayamada, Kami-Shi, Kochi, 782-0003, Japan
| | - Fumio Yamashita
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Idaidori, Yahaba-Cho, Shiwa-Gun, Iwate, 028-3694, Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| |
Collapse
|
5
|
Erickson CM, Wexler A, Largent EA. Alzheimer's in the modern age: Ethical challenges in the use of digital monitoring to identify cognitive changes. Inform Health Soc Care 2024; 49:1-13. [PMID: 38116960 PMCID: PMC11001527 DOI: 10.1080/17538157.2023.2294203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Pushes toward earlier detection of Alzheimer's disease (AD)-related cognitive changes are creating interest in leveraging technologies, like cellphones, that are already widespread and well-equipped for data collection to facilitate digital monitoring for AD. Studies are ongoing to identify and validate potential "digital biomarkers" that might indicate someone has or is at risk of developing AD dementia. Digital biomarkers for AD have potential as a tool in aiding more timely diagnosis, though more robust research is needed to support their validity and utility. While there are grounds for optimism, leveraging digital monitoring and informatics for cognitive changes also poses ethical challenges, related to topics such as algorithmic bias, consent, and data privacy and security. As we confront the modern era of Alzheimer's disease, individuals, companies, regulators and policymakers alike must prepare for a future in which our day-to-day interactions with technology in our daily life may identify AD-related cognitive changes.
Collapse
Affiliation(s)
- Claire M Erickson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Moshfeghi S, Jan MT, Conniff J, Ghoreishi SGA, Jang J, Furht B, Yang K, Rosselli M, Newman D, Tappen R, Smith D. In-vehicle Sensing and Data Analysis for Older Drivers with Mild Cognitive Impairment. 2023 IEEE 20TH INTERNATIONAL CONFERENCE ON SMART COMMUNITIES: IMPROVING QUALITY OF LIFE USING AI, ROBOTICS AND IOT (HONET) 2023; 2023:140-145. [PMID: 38562260 PMCID: PMC10982740 DOI: 10.1109/honet59747.2023.10374639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Driving is a complex daily activity indicating age and disease-related cognitive declines. Therefore, deficits in driving performance compared with ones without mild cognitive impairment (MCI) can reflect changes in cognitive functioning. There is increasing evidence that unobtrusive monitoring of older adults' driving performance in a daily-life setting may allow us to detect subtle early changes in cognition. The objectives of this paper include designing low-cost in-vehicle sensing hardware capable of obtaining high-precision positioning and telematics data, identifying important indicators for early changes in cognition, and detecting early-warning signs of cognitive impairment in a truly normal, day-to-day driving condition with machine learning approaches. Our statistical analysis comparing drivers with MCI to those without reveals that those with MCI exhibit smoother and safer driving patterns. This suggests that drivers with MCI are cognizant of their condition and tend to avoid erratic driving behaviors. Furthermore, our Random Forest models identified the number of night trips, number of trips, and education as the most influential factors in our data evaluation.
Collapse
Affiliation(s)
- Sonia Moshfeghi
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Muhammad Tanveer Jan
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Joshua Conniff
- Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, USA
| | | | - Jinwoo Jang
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Borko Furht
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Kwangsoo Yang
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Monica Rosselli
- Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, USA
| | - David Newman
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, USA
| | - Ruth Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, USA
| | - Dana Smith
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| |
Collapse
|
7
|
Abstract
Agency is talked about by many as something that people living with dementia lose, once they've lost much else-autonomy, identity, and privacy, among other things. While the language of loss may capture some of what transpires in dementia, it can obscure how people living with dementia and their loved ones share agency through sharing capacities for memory, language, and decision-making. We suggest that one consequence of adopting a framework of loss is that it makes the default response to changes in agency the substitution of a family member's agency for the purported lost agency of someone living with dementia. We argue for an alternative framework in which sharing agency is recognized as a central feature of living with dementia. Building on the work of relational theorists, we argue for the value of thinking about agency in dementia as fundamentally shared, and explore potential implications for treatment, caregiver support, and building dementia-friendly environments.
Collapse
|
8
|
Peterson CM, Birkeland RW, Louwagie KW, Ingvalson SN, Mitchell LL, Scott TL, Liddle J, Pachana NA, Gustafsson L, Gaugler JE. Refining a Driving Retirement Program for Persons With Dementia and Their Care Partners: A Mixed Methods Evaluation of CarFreeMe™-Dementia. J Gerontol B Psychol Sci Soc Sci 2023; 78:506-519. [PMID: 36149829 PMCID: PMC9985324 DOI: 10.1093/geronb/gbac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES We adapted the CarFreeMe™-Dementia program created by The University of Queensland for drivers in the United States. CarFreeMe™-Dementia aims to assist drivers living with dementia and their care partners as they plan for or adjust to driving retirement. This semistructured program focuses on driving retirement education and support. Topics include how dementia affects driving, lifestyle planning, stress management, and alternative transportation options. This study evaluated the feasibility, acceptability, and utility of the CarFreeMe™-Dementia intervention. METHODS This pilot phase of the study included 16 care partners and 11 drivers with memory loss who were preparing for or adjusting to driving retirement. Participants completed 4-8 CarFreeMe™-Dementia intervention telehealth sessions. Online surveys (baseline, 1- and 3-month) and postintervention semistructured interviews informed evaluation of the intervention program using a mixed methods approach. RESULTS This study established initial support for CarFreeMe™-Dementia in the United States. Participants indicated the program facilitated dialogue around driving retirement and provided guidance on community engagement without driving. Respondents appreciated the program's emphasis on overall well-being, promoted through lifestyle planning and stress management. They also reported the program offered practical preparation for transitioning to driving retirement. DISCUSSION The CarFreeMe™-Dementia intervention, tailored to an American audience, appears to be a feasible, acceptable, and useful support program for drivers with memory loss (and/or their care partners) who are preparing for or adjusting to driving retirement. Further investigations of the efficacy of the CarFreeMe™-Dementia intervention in the United States, as well as in other countries and cultural contexts, are warranted.
Collapse
Affiliation(s)
- Colleen M Peterson
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Robyn W Birkeland
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katie W Louwagie
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Lauren L Mitchell
- Department of Psychology and Neuroscience, Emmanuel College, Boston, Massachusetts, USA
| | - Theresa L Scott
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Jacki Liddle
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Queensland, Australia and the Princess Alexandra Hospital in Woolloongabba, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
9
|
Bayat S, Roe CM, Schindler S, Murphy SA, Doherty JM, Johnson AM, Walker A, Ances BM, Morris JC, Babulal GM. Everyday Driving and Plasma Biomarkers in Alzheimer's Disease: Leveraging Artificial Intelligence to Expand Our Diagnostic Toolkit. J Alzheimers Dis 2023; 92:1487-1497. [PMID: 36938737 PMCID: PMC10133181 DOI: 10.3233/jad-221268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Driving behavior as a digital marker and recent developments in blood-based biomarkers show promise as a widespread solution for the early identification of Alzheimer's disease (AD). OBJECTIVE This study used artificial intelligence methods to evaluate the association between naturalistic driving behavior and blood-based biomarkers of AD. METHODS We employed an artificial neural network (ANN) to examine the relationship between everyday driving behavior and plasma biomarker of AD. The primary outcome was plasma Aβ42/Aβ40, where Aβ42/Aβ40 < 0.1013 was used to define amyloid positivity. Two ANN models were trained and tested for predicting the outcome. The first model architecture only includes driving variables as input, whereas the second architecture includes the combination of age, APOE ɛ4 status, and driving variables. RESULTS All 142 participants (mean [SD] age 73.9 [5.2] years; 76 [53.5%] men; 80 participants [56.3% ] with amyloid positivity based on plasma Aβ42/Aβ40) were cognitively normal. The six driving features, included in the ANN models, were the number of trips during rush hour, the median and standard deviation of jerk, the number of hard braking incidents and night trips, and the standard deviation of speed. The F1 score of the model with driving variables alone was 0.75 [0.023] for predicting plasma Aβ42/Aβ40. Incorporating age and APOE ɛ4 carrier status improved the diagnostic performance of the model to 0.80 [>0.051]. CONCLUSION Blood-based AD biomarkers offer a novel opportunity to establish the efficacy of naturalistic driving as an accessible digital marker for AD pathology in driving research.
Collapse
Affiliation(s)
- Sayeh Bayat
- Department of Biomedical Engineering, University of Calgary, Calgary, Canada
- Department of Geomatics Engineering, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | | | - Suzanne Schindler
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Samantha A. Murphy
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jason M. Doherty
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ann M. Johnson
- Center for Clinical Studies, Washington University School of Medicine, St. Louis, MO, USA
| | - Alexis Walker
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Beau M. Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - John C. Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ganesh M. Babulal
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Institute of Public Health, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
10
|
Sinha A, Bisoi S, Zodpey S. Dementia Friendly Community: Concept to Implementation. Indian J Community Med 2022; 47:1-3. [PMID: 35368497 PMCID: PMC8971872 DOI: 10.4103/ijcm.ijcm_60_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/14/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Abhik Sinha
- Department of Ageing Research, ICMR - Centre for Ageing and Mental Health, Kolkata, West Bengal, India
| | - Sukamal Bisoi
- Medical Superintendent Cum Vice Principal, Deben Mahata Government Medical College and Hospital, Purulia, West Bengal, India
| | - Sanjay Zodpey
- Vice President, Public Health Foundation of India, New Delhi, India
| |
Collapse
|
11
|
Abstract
INTRODUCTION The syndromes of mild cognitive impairment (MCI) or mild neurocognitive disorder (MiND), often prodromal to dementia (Major Neurocognitive Disorder), are characterized by acquired clinically significant changes in one or more cognitive domains despite preserved independence. Mild impairment has significant medicolegal consequences for an affected person and their care system. We review the more common etiologies of MiND and provide a systematic review of its medicolegal implications. METHODS We conducted a systematic review of the peer-reviewed English literature on medicolegal aspects of MCI or MiND using comprehensive search terms and expanding our review to include sources cited by these reports. RESULTS Impairment of memory, executive function, social cognition, judgment, insight or abstraction can alter an individual's abilities in a variety of areas that include decision making, informed consent, designation of a surrogate decision-maker such as a health care proxy, understanding and management of financial affairs, execution of a will, or safe driving. CONCLUSION Even mild cognitive impairment can have significant behavioral consequences. Clinicians can assist care partners and persons with MCI or MiND by alerting them to the medicolegal concerns that often accompany cognitive decline. Early recognition and discussion can help a care system manage medicolegal risk more effectively and promote thoughtful advance planning.
Collapse
Affiliation(s)
- Anca Bejenaru
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA
| | - James M Ellison
- Department of Psychiatry and Behavioral Health, Christiana Care, Wilmington, DE, USA.,Department of Family and Community Medicine, Christiana Care, Wilmington, DE, USA.,Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
12
|
Bernstein JPK, Rich T, McKnight S, Mehr J, Ferguson J, Hughes A. On-road driving test performance in veterans: Effects of age, clinical diagnosis and cognitive measures. JOURNAL OF SAFETY RESEARCH 2021; 77:40-45. [PMID: 34092326 DOI: 10.1016/j.jsr.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/27/2020] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Veterans are at heightened risk of being in a motor-vehicle crash and many fail on-road driving evaluations, particularly as they age. This may be due in part to the high prevalence of age-associated conditions impacting cognition in this population, including neurodegenerative diseases (e.g., Alzheimer's Disease) and acquired neurological conditions (e.g., cerebrovascular accident). However, understanding of the impact of referral diagnosis, age and cognition on Veterans' on-road driving performance is limited. METHODS 109 Veterans were referred for a driving evaluation (mean age = 72.0, SD = 11.5) at a driving assessment clinic at the Minneapolis Veterans Affairs Healthcare System. Of the 109 Veterans enrolled, 44 were referred due to a neurodegenerative disease, 37 due to an acquired neurological condition, and 28 due to a non-neurological condition (e.g., vision loss). Veterans completed collection of health history information and administration of cognitive tests assessing visual attention, processing speed, and executive functioning, as well as a standardized, on-road driving evaluation. RESULTS A total of 17.9% of Veterans failed the on-road evaluation. Clinical diagnostic group was not associated with failure rate. Age was not associated with failure rates in the full sample or within diagnostic groups. After controlling for age, poorer processing speed and selective/divided attention were associated with higher failure rates in the full sample. No cognitive tests were associated with failure rates within diagnostic groups. CONCLUSION Referral diagnosis and age alone are not reliable predictors of Veterans' driving performance. Cognitive performance, specifically speed of processing and attention, may be helpful in screening Veterans' driving safety. Practical Applications: Clinicians tasked with assessing Veterans' driving safety should take into account cognitive performance, particularly processing speed and attention, when making decisions regarding driving safety. Age and referral diagnosis, while helpful information, are insufficient to predict outcomes on driving evaluations.
Collapse
Affiliation(s)
- John P K Bernstein
- Department of Clinical Psychology, Louisiana State University, Baton Rouge, LA, United States; Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States.
| | - Tonya Rich
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Stefanie McKnight
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Julie Mehr
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - John Ferguson
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States; Department of Rehabilitation Medicine, University of Minnesota, MN, United States
| | - Adriana Hughes
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States; Oregon Center for Aging & Technology, Portland, OR, United States; Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|
13
|
'We're not doing it to be nasty': Caregivers' ethical dilemmas in negotiating driving safety with older adults. Can J Aging 2021; 41:7-14. [PMID: 33397532 DOI: 10.1017/s0714980820000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of this research was to investigate how informal caregivers of older adults cope with and negotiate driving safety when their loved one is no longer safe to drive. Fifteen informal caregivers of an older adult living at home took part in the present study. Participants cared for individuals with a range of health conditions that significantly impaired driving safety, including dementia, Parkinson's disease, macular degeneration, and stroke. A thematic analysis of participants' accounts identified the complex interpersonal, social, and organisational context they encountered when their loved one did not recognise or acknowledge limitations in their ability to drive. This analysis highlights the ethical dilemma at the heart of caregivers' experiences and identifies stake and blame as key considerations in the development of sensitive and effective policies and practices.
Collapse
|
14
|
Ryvicker M, Bollens-Lund E, Ornstein KA. Driving Status and Transportation Disadvantage Among Medicare Beneficiaries. J Appl Gerontol 2020; 39:935-943. [PMID: 30362863 PMCID: PMC6486463 DOI: 10.1177/0733464818806834] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transportation disadvantage may have important implications for the health, well-being, and quality of life of older adults. This study used the 2015 National Health Aging Trends Study, a nationally representative study of Medicare beneficiaries aged 65 and over (N = 7,498), to generate national estimates of transportation modalities and transportation disadvantage among community-dwelling older adults in the United States. An estimated 10.8 million community-dwelling older adults in the United States rarely or never drive. Among nondrivers, 25% were classified as transportation disadvantaged, representing 2.3 million individuals. Individuals with more chronic medical conditions and those reliant on assistive devices were more likely to report having a transportation disadvantage (p < .05). Being married resulted in a 50% decreased odds of having a transportation disadvantage (p < .01). Some individuals may be at higher risk for transportation-related barriers to engaging in valued activities and accessing care, calling for tailored interventions such as ride-share services combined with care coordination strategies.
Collapse
|
15
|
Caffò AO, Tinella L, Lopez A, Spano G, Massaro Y, Lisi A, Stasolla F, Catanesi R, Nardulli F, Grattagliano I, Bosco A. The Drives for Driving Simulation: A Scientometric Analysis and a Selective Review of Reviews on Simulated Driving Research. Front Psychol 2020; 11:917. [PMID: 32528360 PMCID: PMC7266970 DOI: 10.3389/fpsyg.2020.00917] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/14/2020] [Indexed: 12/17/2022] Open
Abstract
Driving behaviors and fitness to drive have been assessed over time using different tools: standardized neuropsychological, on-road and driving simulation testing. Nowadays, the great variability of topics related to driving simulation has elicited a high number of reviews. The present work aims to perform a scientometric analysis on driving simulation reviews and to propose a selective review of reviews focusing on relevant aspects related to validity and fidelity. A scientometric analysis of driving simulation reviews published from 1988 to 2019 was conducted. Bibliographic data from 298 reviews were extracted from Scopus and WoS. Performance analysis was conducted to investigate most prolific Countries, Journals, Institutes and Authors. A cluster analysis on authors' keywords was performed to identify relevant associations between different research topics. Based on the reviews extracted from cluster analysis, a selective review of reviews was conducted to answer questions regarding validity, fidelity and critical issues. United States and Germany are the first two Countries for number of driving simulation reviews. United States is the leading Country with 5 Institutes in the top-ten. Top Authors wrote from 3 to 7 reviews each and belong to Institutes located in North America and Europe. Cluster analysis identified three clusters and eight keywords. The selective review of reviews showed a substantial agreement for supporting validity of driving simulation with respect to neuropsychological and on-road testing, while for fidelity with respect to real-world driving experience a blurred representation emerged. The most relevant critical issues were the a) lack of a common set of standards, b) phenomenon of simulation sickness, c) need for psychometric properties, lack of studies investigating d) predictive validity with respect to collision rates and e) ecological validity. Driving simulation represents a cross-cutting topic in scientific literature on driving, and there are several evidences for considering it as a valid alternative to neuropsychological and on-road testing. Further research efforts could be aimed at establishing a consensus statement for protocols assessing fitness to drive, in order to (a) use standardized systems, (b) compare systematically driving simulators with regard to their validity and fidelity, and (c) employ shared criteria for conducting studies in a given sub-topic.
Collapse
Affiliation(s)
- Alessandro Oronzo Caffò
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Luigi Tinella
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Antonella Lopez
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giuseppina Spano
- Department of Agricultural and Environmental Science, Faculty of Agricultural Science, University of Bari Aldo Moro, Bari, Italy
| | - Ylenia Massaro
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Andrea Lisi
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | | | - Roberto Catanesi
- Department of Interdisciplinary Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Nardulli
- Commissione Medica Locale Patenti Speciali, Azienda Sanitaria Locale, Bari, Italy
| | - Ignazio Grattagliano
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Andrea Bosco
- Dipartimento di Scienze della Formazione, Psicologia, Comunicazione, Università degli Studi di Bari Aldo Moro, Bari, Italy
| |
Collapse
|
16
|
Jay M, Régnier A, Dasnon A, Brunet K, Pelé M. The light is red: Uncertainty behaviours displayed by pedestrians during illegal road crossing. ACCIDENT; ANALYSIS AND PREVENTION 2020; 135:105369. [PMID: 31783336 DOI: 10.1016/j.aap.2019.105369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
Road accidents involving pedestrians are a reality of urban life. Pedestrian risk is now well known and documented from the perspective of drivers. However, pedestrian behaviour plays a central role in road accidents, notably in terms of illegal road crossing at signalized intersections. This study focuses on pedestrians crossing illegally at a signal light, and specifically investigates uncertainty behaviour, also referred to as hesitation, which occurs when a pedestrian slows down or stops his/her crossing movement then (1) abandons the crossing by returning to the kerb or (2) accelerates to cross the road more quickly. We sought to understand the causes of this behaviour in France and Japan, two countries where interesting differences have already been demonstrated in the way pedestrians behave. The results show a longer period of uncertainty for pedestrians in Japan compared to France. Japanese pedestrians also hesitated longer when they were alone. This study demonstrates a tendency to speed up if there are a number of pedestrians already crossing the road, but abandoning behaviours were more frequently observed than acceleration. This study confirms that pedestrians may misevaluate the moment to cross and hesitate when they realise that they have made a mistake, thus increasing the risk of an accident. These results could help to find solutions that prevent illegal and dangerous road-crossing behaviours.
Collapse
Affiliation(s)
- Mathilde Jay
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000, Strasbourg, France
| | - Anne Régnier
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000, Strasbourg, France
| | - Anaïs Dasnon
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000, Strasbourg, France
| | - Killian Brunet
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000, Strasbourg, France
| | - Marie Pelé
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000, Strasbourg, France.
| |
Collapse
|
17
|
De Sousa A. Dementia and driving fitness: Critical clinical issues. JOURNAL OF GERIATRIC MENTAL HEALTH 2020. [DOI: 10.4103/jgmh.jgmh_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
18
|
Estevis E, Noll KR, Bradshaw ME, Wefel JS. Driver safety in patients with primary brain tumors. Neurooncol Pract 2019; 6:490-498. [PMID: 31832220 PMCID: PMC6899044 DOI: 10.1093/nop/npz014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Operating a motor vehicle involves multiple cognitive and sensorimotor faculties. Neurological conditions pose driving risk, but this has not been examined in patients with primary brain tumors. METHODS Sixty-four patients with primary brain tumors (32 left hemisphere; 69% glioblastoma) completed the Cognitive Behavioral Driver's Inventory (CBDI). A subset also completed broader cognitive testing. Patient characteristics, CBDI measures, and broader neuropsychological test scores were compared between Passing and Nonpassing groups. Follow-up logistic regression analyses identified patient characteristics and CBDI measures predictive of Pass/Nonpass outcome. Point-biserial correlations determined associations between neuropsychological tests and CBDI outcome. RESULTS Sixty-nine percent of patients were classified as passing the CBDI. Nonpassing patients were older and more likely to have WHO grade IV and temporal lobe tumors. Age was the most salient predictor of CBDI performance. CBDI measures of speeded visual search and set-shifting, speeded response inhibition, vigilance and freedom from distractibility, and basic visual scanning speed were predictive of Pass/Nonpass outcome. Neuropsychological tests of memory in particular, but also speeded visual scanning and discrimination, executive function, basic visual attention, visuoconstruction, and manual dexterity (dominant hand), were associated with CBDI outcome. CONCLUSIONS A sizeable proportion of patients with primary brain tumors appear at risk of driving difficulty, particularly those with higher-grade tumors and of older age. Memory, visual attention, and executive difficulties appear to contribute most to driving safety risk as determined by the CBDI. These results highlight the importance of driving safety screening in this population.
Collapse
Affiliation(s)
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mariana E Bradshaw
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
19
|
Walsh L, Chacko E, Cheung G. The process of determining driving safety in people with dementia: A review of the literature and guidelines from 5 English speaking countries. Australas Psychiatry 2019; 27:480-485. [PMID: 31084441 DOI: 10.1177/1039856219848828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To review literature and guidelines related to the process of determining driving safety in people with dementia. METHOD Four electronic databases were searched in December 2016/January 2017. We limited our search to literature and guidelines published in the UK, USA, Canada, New Zealand and Australia. RESULTS General practitioners are primarily responsible for driver licensing; however, they often feel ill-equipped and it can compromise the therapeutic relationship. Occupational therapist driving assessment is considered as the 'gold-standard' but is costly and often not available. Medical advisory boards assist the assessment process by providing independent licencing decisions. CONCLUSIONS General practitioner training, funding for occupational therapist driving assessment and the establishment of a medical advisory board could be considered to improve the current practice of driving assessment in dementia.
Collapse
Affiliation(s)
- Liam Walsh
- Senior House Officer, Auckland District Health Board, Auckland, New Zealand
| | - Emme Chacko
- Consultant Psychiatrist, Mental Health Services for Older People, Auckland District Health Board, Auckland, New Zealand; Honorary Senior Lecturer, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Consultant Psychiatrist, Mental Health Services for Older People, Auckland District Health Board, Auckland, New Zealand; Senior Lecturer, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
20
|
Baines N, Au B, Rapoport MJ, Naglie G, Tierney MC. Meta-analysis of Driving Cessation and Dementia: Does Sex Matter? J Gerontol B Psychol Sci Soc Sci 2019; 73:1185-1189. [PMID: 28025281 DOI: 10.1093/geronb/gbw158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/14/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives The number of drivers with dementia is expected to increase over the coming decades. Because dementia is associated with a higher risk of crashes, driving cessation becomes inevitable as the disease progresses, but many people with dementia resist stopping to drive. This meta-analysis examines whether there are sex differences in the prevalence and incidence of driving cessation among drivers with dementia and compares the pattern of sex differences in drivers with dementia to those without dementia. Method MEDLINE, PsycINFO, Scopus, and CINAHL were searched in July 2015 for observational studies of sex differences in driving cessation. Meta-analyses were performed using a random-effects model. Results Twenty studies provided data on sex differences in driving cessation in older adults with or without dementia. Driving cessation was significantly more prevalent in women with dementia than men (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.50-2.98), and the same pattern was found in women without dementia (OR = 2.74, 95% CI = 1.85-4.06). Discussion Our findings suggest that the patterns of driving cessation differ between men and women with dementia, and this may have implications for sex-specific approaches designed to support drivers with dementia both before and after driving cessation.
Collapse
Affiliation(s)
| | - Bonnie Au
- Primary Care Research Unit, Toronto, Ontario, Canada
| | - Mark J Rapoport
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Gary Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Mary C Tierney
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Primary Care Research Unit, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| |
Collapse
|
21
|
Yan MK, Kumar H, Kerr N, Medeiros FA, Sandhu SS, Crowston J, Kong YXG. Transnational review of visual standards for driving: How Australia compares with the rest of the world. Clin Exp Ophthalmol 2019; 47:847-863. [DOI: 10.1111/ceo.13572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/11/2019] [Accepted: 05/18/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Mabel K. Yan
- The Ophthalmology DepartmentAlfred Hospital Melbourne Victoria Australia
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
| | - Himeesh Kumar
- The Ophthalmology DepartmentAlfred Hospital Melbourne Victoria Australia
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
| | - Nathan Kerr
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
- Ophthalmology DepartmentRoyal Victorian Eye and Ear Hospital Victoria Australia
| | | | - Sukhpal S. Sandhu
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
- Ophthalmology DepartmentRoyal Victorian Eye and Ear Hospital Victoria Australia
| | - Jonathan Crowston
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
- Ophthalmology DepartmentRoyal Victorian Eye and Ear Hospital Victoria Australia
- Centre for Vision ResearchDuke‐NUS Medical School Singapore Singapore
| | - Yu X. G. Kong
- Clinical Research DepartmentCentre for Eye Research Australia Melbourne Victoria Australia
- Ophthalmology DepartmentRoyal Victorian Eye and Ear Hospital Victoria Australia
| |
Collapse
|
22
|
Rashid R, Standen P, Carpenter H, Radford K. Systematic review and meta-analysis of association between cognitive tests and on-road driving ability in people with dementia. Neuropsychol Rehabil 2019; 30:1720-1761. [DOI: 10.1080/09602011.2019.1603112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Roshe Rashid
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Penny Standen
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Hannah Carpenter
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Radford
- Department of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| |
Collapse
|
23
|
Jang M, Hong CH, Kim HC, Choi SH, Seo SW, Kim SY, Na DL, Lee Y, Chang KJ, Roh HW, Son SJ. Subcortical Ischemic Change as a Predictor of Driving Cessation in the Elderly. Psychiatry Investig 2018; 15:1162-1167. [PMID: 30466207 PMCID: PMC6318496 DOI: 10.30773/pi.2018.10.10.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Motor, perceptual, and cognitive functions are known to affect driving competence. Subcortical ischemic changes on brain magnetic resonance imaging (MRI) can reflect reduction in cognitive and motor performance. However, few studies have reported the relationship between subcortical ischemic changes and driving competence of the elderly. Thus, the objective of this study was to investigate the association between subcortical ischemic changes on MRI and driving abilities of the elderly. METHODS Participants (n=540) were drawn from a nationwide, multicenter, hospital-based, longitudinal cohort. Each participant underwent MRI scan and interview for driving capacity categorized into 'now driving' and 'driving cessation (driven before, not driving now)'. Participants were divided into three groups (mild, n=389; moderate, n=116; and severe, n=35) depending on the degree of white matter hyperintensity (WMH) on MRI at baseline. Driving status was evaluated at follow-up. Statistical analyses were conducted using χ2 test, analysis of variance (ANOVA), structured equation model (SEM), and generalized estimating equation (GEE). RESULTS In SEM, greater baseline degree of WMH was directly associated with driving cessation regardless of cognitive or motor dysfunction (β=-0.110, p<0.001). In GEE models after controlling for age, sex, education, cognitive, and motor dysfunction, more severe change in the degree of WMH was associated with faster change from 'now driving' state to 'driving cessation' state over time in the elderly (β=-0.508, p<0.001). CONCLUSION In both cross-sectional and longitudinal results, the degree of subcortical ischemic change on MRI might predict driving cessation in the elderly.
Collapse
Affiliation(s)
- Mi Jang
- Department of General Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun-Chung Kim
- Department of Psychiatry, National Medical Center of Korea, Seoul, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ki Jung Chang
- Department of Psychiatry, Ajou Good Hospital, Suwon, Republic of Korea
| | - Hyun Woong Roh
- Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| |
Collapse
|
24
|
Abstract
Patients with dementia have unique safety needs due to cognitive and behavioral changes associated with dementia. Because the prevalence of dementia is expected to greatly increase with an aging population, and because an estimated 70% of people with dementia live at home, it is essential that healthcare providers receive adequate training on the special needs of this population. This article will discuss home safety interventions with regard to: 1) risk of falling, 2) kitchen use and food safety, 3) medication safety, and 4) wandering and personal safety. A successful health program must include ongoing evaluation of the patient's risk profile with regard to health issues, physical and cognitive deficits, medications, and physical environment. Risks can be accepted, addressed, or actively remediated as appropriate. Good interventions should promote acceptable patient behavior and engage assistive personnel to achieve the desired outcome. To promote safety, the home environment can be modified to encourage positive behaviors and to discourage potentially harmful behaviors. Communication between the patient, trained healthcare providers, and family caregivers is essential.
Collapse
|
25
|
Velayudhan L, Baillon S, Urbaskova G, McCulloch L, Tromans S, Storey M, Lindesay J, Bhattacharyya S. Driving Cessation in Patients Attending a Young-Onset Dementia Clinic: A Retrospective Cohort Study. Dement Geriatr Cogn Dis Extra 2018; 8:190-198. [PMID: 29805385 PMCID: PMC5968244 DOI: 10.1159/000488237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/07/2018] [Indexed: 12/03/2022] Open
Abstract
Background Although driving by persons with dementia is an important public health concern, little is known about driving cessation in younger people with dementia. We aimed to determine the prevalence and factors affecting driving cessation in individuals with and without dementia aged under 65 years attending a memory clinic in a European setting. Methods Subjects were consecutive patients assessed at a specialist memory service at a university teaching hospital between 2000 and 2010. The data collected included demographic, clinical, standardized cognitive assessments as well as information on driving. Dementia diagnosis was made using ICD-10 criteria. Results Of the 225 people who were or had been drivers, 32/79 (41%) with young-onset dementia (YOD) stopped driving compared to 25/146 (17%) patients who had cognitive impairment due to other causes. Women were more likely to cease driving and voluntarily than men (p < 0.001). Diagnosis of YOD was associated with driving cessation (1.193, 95% CI 0.570–1.815, p ≤ 0.001), and was mediated by impairment in praxis with the highest indirect mediation effect (0.754, 95% CI 0.183–1.401, p = 0.009). Conclusions YOD diagnosis, female gender, and impairment in praxis have a higher probability for driving cessation in those under 65 years of age with cognitive impairment.
Collapse
Affiliation(s)
- Latha Velayudhan
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom.,Psychiatry for the Elderly, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Sarah Baillon
- Psychiatry for the Elderly, Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,Mental Health Services for Older People, Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Gabriela Urbaskova
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Laura McCulloch
- Psychiatry for the Elderly, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Samuel Tromans
- Mental Health Services for Older People, Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Mathew Storey
- Psychiatry for the Elderly, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - James Lindesay
- Psychiatry for the Elderly, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Sagnik Bhattacharyya
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| |
Collapse
|
26
|
Agimi Y, Albert SM, Youk AO, Documet PI, Steiner CA. Mandatory Physician Reporting of At-Risk Drivers: The Older Driver Example. THE GERONTOLOGIST 2018; 58:578-587. [PMID: 28069887 PMCID: PMC6281322 DOI: 10.1093/geront/gnw209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/23/2016] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study In a number of states, physicians are mandated by state law to report at-risk drivers to licensing authorities. Often these patients are older adult drivers who may exhibit unsafe driving behaviors, have functional/cognitive impairments, or are diagnosed with conditions such as Alzheimer's disease and/or seizure disorders. The hypothesis that mandatory physician reporting laws reduce the rate of crash-related hospitalizations among older adult drivers was tested. Design and Methods Using retrospective data (2004-2009), this study identified 176,066 older driver crash-related hospitalizations, from the State Inpatient Databases. Three age-specific negative binomial generalized estimating equation models were used to estimate the effect of physician reporting laws on state's incidence rate of crash-related hospitalizations among older drivers. Results No evidence was found for an independent association between mandatory physician reporting laws and a lower crash hospitalization rate among any of the age groups examined. The main predictor of interest, mandatory physician reporting, failed to explain any significant variation in crash hospitalization rates, when adjusting for other state-specific laws and characteristics. Vision testing at in-person license renewal was a significant predictor of lower crash hospitalization rate, ranging from incidence rate ratio of 0.77 (95% confidence interval 0.62-0.94) among 60- to 64-year olds to 0.83 (95% confidence interval 0.67-0.97) among 80- to 84-year olds. Implications Physician reporting laws and age-based licensing requirements are often at odds with older driver's need to maintain independence. This study examines this balance and finds no evidence of the benefits of mandatory physician reporting requirements on driver crash hospitalizations, suggesting that physician mandates do not yet yield significant older driver safety benefits, possibly to the detriment of older driver's well-being and independence.
Collapse
Affiliation(s)
- Yll Agimi
- Information Innovators Inc., Silver Spring, Maryland
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of
Public Health, Pennsylvania
| | - Ada O Youk
- Department of Biostatistics, Graduate School of Public Health, University of
Pittsburgh, Pennsylvania
| | - Patricia I Documet
- Department of Behavioral and Community Health Sciences, Graduate School of
Public Health, Pennsylvania
| | | |
Collapse
|
27
|
Agimi Y, Albert SM, Youk AO, Documet PI, Steiner CA. Dementia and motor vehicle crash hospitalizations: Role of physician reporting laws. Neurology 2018; 90:e808-e813. [PMID: 29386271 PMCID: PMC10681054 DOI: 10.1212/wnl.0000000000005022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 12/01/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the effect of physician reporting laws and state licensing requirements on crash hospitalizations among drivers with dementia. METHODS A study of drivers hospitalized because of vehicle crashes, identified from the State Inpatient Databases of the Agency for Healthcare Research and Quality. Multivariable logistic regression was used to examine the effect of mandatory physician reporting of at-risk drivers and state licensing requirement on the prevalence of dementia among hospitalized drivers. RESULTS Physician reporting laws, mandated or legally protected, were not associated with a lower likelihood of dementia among crash hospitalized drivers. Hospitalized drivers aged 60 to 69 years in states with in-person renewal laws were 37% to 38% less likely to have dementia than drivers in other states and 23% to 28% less likely in states with vision testing at in-person renewal. Road testing was associated with lower dementia prevalence among hospitalized drivers aged 80 years and older. CONCLUSION Vision testing at in-person renewal and in-person renewal requirements were significantly related with a lower prevalence of dementia in hospitalized older adults among drivers aged 60 to 69 years. Road testing was significantly associated with a lower proportion of dementia among hospitalized drivers aged 80 years and older. Mandatory physician driver reporting laws lacked any independent association with prevalence of dementia among hospitalized drivers.
Collapse
Affiliation(s)
- Yll Agimi
- From Salient CRGT Inc. (Y.A.), Health Services, Silver Spring, MD; Departments of Behavioral and Community Health Sciences (S.M.A., P.I.D.) and Biostatistics (A.O.Y.), University of Pittsburgh, PA; Kaiser Permanente-Denver (C.A.S.), Institute for Health Research, CO; Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (C.A.S.), DHHS, Rockville, MD.
| | - Steven M Albert
- From Salient CRGT Inc. (Y.A.), Health Services, Silver Spring, MD; Departments of Behavioral and Community Health Sciences (S.M.A., P.I.D.) and Biostatistics (A.O.Y.), University of Pittsburgh, PA; Kaiser Permanente-Denver (C.A.S.), Institute for Health Research, CO; Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (C.A.S.), DHHS, Rockville, MD
| | - Ada O Youk
- From Salient CRGT Inc. (Y.A.), Health Services, Silver Spring, MD; Departments of Behavioral and Community Health Sciences (S.M.A., P.I.D.) and Biostatistics (A.O.Y.), University of Pittsburgh, PA; Kaiser Permanente-Denver (C.A.S.), Institute for Health Research, CO; Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (C.A.S.), DHHS, Rockville, MD
| | - Patricia I Documet
- From Salient CRGT Inc. (Y.A.), Health Services, Silver Spring, MD; Departments of Behavioral and Community Health Sciences (S.M.A., P.I.D.) and Biostatistics (A.O.Y.), University of Pittsburgh, PA; Kaiser Permanente-Denver (C.A.S.), Institute for Health Research, CO; Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (C.A.S.), DHHS, Rockville, MD
| | - Claudia A Steiner
- From Salient CRGT Inc. (Y.A.), Health Services, Silver Spring, MD; Departments of Behavioral and Community Health Sciences (S.M.A., P.I.D.) and Biostatistics (A.O.Y.), University of Pittsburgh, PA; Kaiser Permanente-Denver (C.A.S.), Institute for Health Research, CO; Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (C.A.S.), DHHS, Rockville, MD
| |
Collapse
|
28
|
Naidu A, McKeith IG. Driving, dementia and the Driver and Vehicle Licensing Agency: a survey of old age psychiatrists. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.30.7.265] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodWe surveyed old age psychiatrists in the north-east of England to determine what they considered relevant indicators of driving ability. The survey asked about their satisfaction with the current Driver and Vehicle Licensing Agency (DVLA) procedure of assessing competence to drive in patients with dementia and how they thought this could be improved.ResultsFifty-seven out of 76 psychiatrists (75%) responded; 26 (45%) respondents thought the forms issued by the DVLA were unsatisfactory but 32 (57%) were satisfied with the eventual decisions made about individual patients. Factors thought to be relevant indicators of driving ability were occupational therapy (n=46, 81%), neuropsychological assessments (n=43, 75%) and carer's report of driving (n=48, 84%). Factors thought not to be relevant were patient's report of driving ability (n=13, 23%) and the Mini Mental State Examination (n=21, 38%).Clinical ImplicationsThe current system for determining driving ability in people with cognitive impairment and dementia was felt to be unsatisfactory. A multidisciplinary approach and use of on-road driving assessments may improve decision-making.
Collapse
|
29
|
Vair CL, King PR, Gass J, Eaker A, Kusche A, Wray LO. Electronic Medical Record Documentation of Driving Safety for Veterans with Diagnosed Dementia. Clin Gerontol 2018; 41:66-76. [PMID: 28459309 DOI: 10.1080/07317115.2017.1312654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Many older adults continue to drive following dementia diagnosis, with medical providers increasingly likely to be involved in addressing such safety concerns. This study examined electronic medical record (EMR) documentation of driving safety for veterans with dementia (N = 118) seen in Veterans Affairs primary care and interdisciplinary geriatrics clinics in one geographic region over a 10-year period. METHODS Qualitative directed content analysis of retrospective EMR data. RESULTS Assessment of known risk factors or subjective concerns for unsafe driving were documented in fewer than half of observed cases; specific recommendations for driving safety were evident for a minority of patients, with formal driving evaluation the most frequently documented recommendation by providers. CONCLUSION Utilizing data from actual clinical encounters provides a unique snapshot of how driving risk and safety concerns are addressed for veterans with dementia. This information provides a meaningful frame of reference for understanding potential strengths and possible gaps in how this important topic area is being addressed in the course of clinical care. CLINICAL IMPLICATIONS The EMR is an important forum for interprofessional communication, with documentation of driving risk and safety concerns an essential element for continuity of care and ensuring consistency of information delivered to patients and caregivers.
Collapse
Affiliation(s)
- Christina L Vair
- a W. G. "Bill" Heffner VA Medical Center , Salisbury , North Carolina , USA.,b VA Western New York Healthcare System, Buffalo , New York , USA
| | - Paul R King
- b VA Western New York Healthcare System, Buffalo , New York , USA
| | - Julie Gass
- b VA Western New York Healthcare System, Buffalo , New York , USA.,c The University at Buffalo, State University of New York, Buffalo , New York , USA
| | - April Eaker
- b VA Western New York Healthcare System, Buffalo , New York , USA
| | - Anna Kusche
- b VA Western New York Healthcare System, Buffalo , New York , USA
| | - Laura O Wray
- b VA Western New York Healthcare System, Buffalo , New York , USA.,c The University at Buffalo, State University of New York, Buffalo , New York , USA
| |
Collapse
|
30
|
Morrow SA, Classen S, Monahan M, Danter T, Taylor R, Krasniuk S, Rosehart H, He W. On-road assessment of fitness-to-drive in persons with MS with cognitive impairment: A prospective study. Mult Scler 2017; 24:1499-1506. [DOI: 10.1177/1352458517723991] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Cognitive impairment is common in multiple sclerosis (MS). In other populations, cognitive impairment is known to affect fitness-to-drive. Few studies have focused on fitness-to-drive in MS and no studies have solely focused on the influence of cognitive impairment. Objective: To assess fitness-to-drive in persons with MS with cognitive impairment and low physical disability. Methods: Persons with MS, aged 18–59 years with EDSS ⩽ 4.0, impaired processing speed, and impairment on at least one measure of memory or executive function, were recruited. Cognition was assessed using the Minimal Assessment of Cognitive Function battery. A formal on-road driving assessment was conducted. Chi-square analysis examined the association between the fitness-to-drive (pass/fail) and the neuropsychological test results (normal/impaired). Bayesian statistics predicting failure of the on-road assessment were calculated. Results: Of 36 subjects, eight (22.2%) were unfit to drive. Only the BVMTR-IR, measuring visual-spatial memory, predicted on-road driving assessment failure ( X2 ( df = 1, N = 36) = 3.956; p = 0.047) with a sensitivity of 100%, but low specificity (35.7%) due to false positives (18/25). Conclusion: In persons with MS and impaired processing speed, impairment on the BVMTR-IR should lead clinicians to address fitness-to-drive.
Collapse
Affiliation(s)
- Sarah A Morrow
- Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada
| | - Sherrilene Classen
- School of Occupational Therapy, Western University, London, ON, Canada/Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Miriam Monahan
- School of Occupational Therapy, Western University, London, ON, Canada/The Driver Rehabilitation Institute, Santa Rosa, CA, USA
| | - Tim Danter
- School of Occupational Therapy, Western University, London, ON, Canada/All Dominion Driver Training and Traffic Education Centres Limited, Oakville, ON, Canada
| | - Robert Taylor
- Department of Statistical and Actuarial Sciences, Western University, London, ON, Canada
| | - Sarah Krasniuk
- School of Occupational Therapy, Western University, London, ON, Canada
| | - Heather Rosehart
- Department of Clinical Neurological Sciences, London Health Sciences Center, Western University, London, ON, Canada
| | - Wenqing He
- Department of Statistical and Actuarial Sciences, Western University, London, ON, Canada
| |
Collapse
|
31
|
Fields SM, Unsworth CA. Revision of the Competency Standards for Occupational Therapy Driver Assessors: An overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations. Aust Occup Ther J 2017; 64:328-339. [DOI: 10.1111/1440-1630.12379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Sally M. Fields
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast Queensland Australia
| | - Carolyn A. Unsworth
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Department of Rehabilitation; School of Health Sciences; Jönköping University; Jönköping Sweden
- Faculty of Health Sciences; Curtin University; Bentley Western Australia Australia
| |
Collapse
|
32
|
Rudisill TM, Zhu M, Abate M, Davidov D, Delagarza V, Long DL, Sambamoorthi U, Thornton JD. Characterization of drug and alcohol use among senior drivers fatally injured in U.S. motor vehicle collisions, 2008-2012. TRAFFIC INJURY PREVENTION 2016; 17:788-95. [PMID: 27027152 PMCID: PMC5039044 DOI: 10.1080/15389588.2016.1165809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Adults 65 years of age and older comprise the fastest growing demographic in the United States. As substance use is projected to increase in this population, there is concern that more seniors will drive under the influence of impairing drugs. The purpose of this analysis was to characterize the drug and alcohol usage among senior drivers fatally injured (FI) in traffic collisions. METHODS Data from the Fatality Analysis Reporting System were analyzed from 2008 to 2012. Commonly used classes and specific drugs were explored. Rates of drug use, multiple drugs, concomitant drug and alcohol use, and alcohol use alone were generated using Poisson regression with robust error variance estimation. Rates were compared to a reference population of FI middle-aged drivers (30 to 50 years old) using rate ratios. RESULTS Drug use among FI senior drivers occurred in 20.0% of those tested. Among drug-positive FI senior drivers, narcotics and depressants were frequent. The prevalence of testing positive for any drug, multiple drugs, combined drug and alcohol, and alcohol use alone among FI seniors were 47% less (relative risk [RR] = 0.53, 95% confidence interval [CI], 0.47, 0.62), 59% less (RR = 0.41, 95% CI, 0.34, 0.51), 87% less (RR = 0.13, 95% CI, 0.09, 0.19), and 77% less (RR = 0.23, 95% CI, 0.19, 0.28), respectively, compared to FI middle-aged drivers. CONCLUSIONS Though overall drug use is less common among FI senior drivers relative to FI middle-aged drivers, driving under the influence of drugs may be a relevant traffic safety concern in a portion of this population.
Collapse
Affiliation(s)
- Toni M. Rudisill
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, West Virginia, 26506, USA
| | - Motao Zhu
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, West Virginia, 26506, USA
- Injury Control Research Center, West Virginia University, PO BOX 9151, Morgantown, West Virginia, 26506, USA
| | - Marie Abate
- School of Pharmacy, West Virginia University, PO BOX 9520, Morgantown, West Virginia, USA
| | - Danielle Davidov
- Departments of Emergency Medicine and Social and Behavioral Sciences, PO BOX 9151, West Virginia University, Morgantown, West Virginia, 26506, USA
| | - Vincent Delagarza
- School of Medicine, West Virginia University, PO BOX 8059, Morgantown, West Virginia, 26506, USA
| | - D. Leann Long
- Department of Biostatistics, West Virginia University, PO BOX 9151, Morgantown, West Virginia, 26506, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University, PO BOX 9510, Morgantown, West Virginia, USA, 26506
| | - J. Doug Thornton
- Department of Pharmaceutical Systems and Policy, West Virginia University, PO BOX 9510, Morgantown, West Virginia, USA, 26506
| |
Collapse
|
33
|
Stern RA, Abularach LM, Seichepine DR, Alosco ML, Gavett BE, Tripodis Y. Office-Based Assessment of At-Risk Driving in Older Adults With and Without Cognitive Impairment. J Geriatr Psychiatry Neurol 2016; 29:352-360. [PMID: 27647790 DOI: 10.1177/0891988716666378] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A multitest approach is optimal for the identification of at-risk driving among older adults. This study examined the predictive validity of a combination of office-based screening tests for on-road driving performance in older adults with and without mild cognitive impairment (MCI)/dementia. METHODS Forty-four normal control, 20 participants with MCI, and 20 participants with dementia completed a battery of office-based assessments. On-road driving evaluation classified participants as not at-risk (n = 65) or at-risk drivers (n = 19). RESULTS Logistic regression revealed age and 2 tests of visual attention abilities (Useful Field of View [UFOV] Divided Attention and Neuropsychological Assessment Battery [NAB] Driving Scenes) best predicted at-risk drivers ( C statistic = 0.90); no cutoff score had both sensitivity and specificity >80%. CONCLUSIONS Future research on larger and more clinically representative neurological samples will improve understanding of the utility of the UFOV Divided Attention and NAB Driving Scenes in detecting at-risk older adult drivers in the clinic.
Collapse
Affiliation(s)
- Robert A Stern
- 1 Boston University Alzheimer's Disease and CTE Center, Boston, MA, USA.,2 Departments of Neurology, Neurosurgery, and Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Linda M Abularach
- 1 Boston University Alzheimer's Disease and CTE Center, Boston, MA, USA
| | | | - Michael L Alosco
- 1 Boston University Alzheimer's Disease and CTE Center, Boston, MA, USA
| | - Brandon E Gavett
- 3 Department of Psychology, University of Colorado at Colorado Springs, Springs, CO, USA
| | - Yorghos Tripodis
- 1 Boston University Alzheimer's Disease and CTE Center, Boston, MA, USA.,4 Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
34
|
Rudisill TM, Zhu M, Kelley GA, Pilkerton C, Rudisill BR. Medication use and the risk of motor vehicle collisions among licensed drivers: A systematic review. ACCIDENT; ANALYSIS AND PREVENTION 2016; 96:255-270. [PMID: 27569655 PMCID: PMC5045819 DOI: 10.1016/j.aap.2016.08.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 06/17/2016] [Accepted: 08/02/2016] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Driving under the influence of prescription and over-the-counter medication is a growing public health concern. A systematic review of the literature was performed to investigate which specific medications were associated with increased risk of motor vehicle collision (MVC). METHODS The a priori inclusion criteria were: (1) studies published from English-language sources on or after January 1, 1960, (2) licensed drivers 15 years of age and older, (3) peer-reviewed publications, master's theses, doctoral dissertations, and conference papers, (4) studies limited to randomized control trials, cohort studies, case-control studies, or case-control type studies (5) outcome measure reported for at least one specific medication, (6) outcome measure reported as the odds or risk of a motor vehicle collision. Fourteen databases were examined along with hand-searching. Independent, dual selection of studies and data abstraction was performed. RESULTS Fifty-three medications were investigated by 27 studies included in the review. Fifteen (28.3%) were associated with an increased risk of MVC. These included Buprenorphine, Codeine, Dihydrocodeine, Methadone, Tramadol, Levocitirizine, Diazepam, Flunitrazepam, Flurazepam, Lorazepam, Temazepam, Triazolam, Carisoprodol, Zolpidem, and Zopiclone. CONCLUSIONS Several medications were associated with an increased risk of MVC and decreased driving ability. The associations between specific medication use and the increased risk of MVC and/or affected driving ability are complex. Future research opportunities are plentiful and worthy of such investigation.
Collapse
Affiliation(s)
- Toni M Rudisill
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA; Injury Control Research Center, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - Motao Zhu
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Injury Control Research Center, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - George A Kelley
- Department of Biostatistics, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - Courtney Pilkerton
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | | |
Collapse
|
35
|
Medication use and the risk of motor vehicle collision in West Virginia drivers 65 years of age and older: a case-crossover study. BMC Res Notes 2016; 9:166. [PMID: 26979111 PMCID: PMC4791935 DOI: 10.1186/s13104-016-1974-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/03/2016] [Indexed: 02/06/2023] Open
Abstract
Background The current generation of older adults reports a higher lifetime prevalence of prescription, over-the-counter, and recreational drug use. The purpose of this analysis is to characterize the drug usage and determine the risk of motor vehicle collision associated with individual medications in a population of drivers ≥65 years. Methods A case-crossover study was conducted at West Virginia University Healthcare’s facilities using data obtained from the electronic health records (n = 611) of drivers ≥65 years admitted for medical treatment following a motor vehicle collision which occurred between Jan. 1, 2009 and June 30, 2014. Patients’ medication usage 14 days before collision were matched and compared to their medication usage during four control periods prior to collision. Odds ratios were then calculated for the most prevalent individual medications and pharmaceutical sub-classes using conditional logistic regression. Results Analgesic, cardiovascular and gastrointestinal medicines were common. Few drivers tested positive for either licit or illicit drugs. Of those testing positive for drugs, benzodiazepines and opiates were prevalent. Drivers consuming Tramadol (adjusted OR 11.41; 95 % CI 1.27, 102.15) were at a significantly increased risk of motor vehicle collision. Conclusions Older adult drivers who have a prescription for this medication may need to be aware of the potential risk. Further research is necessary in a larger, more nationally representative population.
Collapse
|
36
|
Piersma D, Fuermaier ABM, de Waard D, Davidse RJ, de Groot J, Doumen MJA, Bredewoud RA, Claesen R, Lemstra AW, Vermeeren A, Ponds R, Verhey F, Brouwer WH, Tucha O. Prediction of Fitness to Drive in Patients with Alzheimer's Dementia. PLoS One 2016; 11:e0149566. [PMID: 26910535 PMCID: PMC4766198 DOI: 10.1371/journal.pone.0149566] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/02/2016] [Indexed: 12/02/2022] Open
Abstract
The number of patients with Alzheimer’s disease (AD) is increasing and so is the number of patients driving a car. To enable patients to retain their mobility while at the same time not endangering public safety, each patient should be assessed for fitness to drive. The aim of this study is to develop a method to assess fitness to drive in a clinical setting, using three types of assessments, i.e. clinical interviews, neuropsychological assessment and driving simulator rides. The goals are (1) to determine for each type of assessment which combination of measures is most predictive for on-road driving performance, (2) to compare the predictive value of clinical interviews, neuropsychological assessment and driving simulator evaluation and (3) to determine which combination of these assessments provides the best prediction of fitness to drive. Eighty-one patients with AD and 45 healthy individuals participated. All participated in a clinical interview, and were administered a neuropsychological test battery and a driving simulator ride (predictors). The criterion fitness to drive was determined in an on-road driving assessment by experts of the CBR Dutch driving test organisation according to their official protocol. The validity of the predictors to determine fitness to drive was explored by means of logistic regression analyses, discriminant function analyses, as well as receiver operating curve analyses. We found that all three types of assessments are predictive of on-road driving performance. Neuropsychological assessment had the highest classification accuracy followed by driving simulator rides and clinical interviews. However, combining all three types of assessments yielded the best prediction for fitness to drive in patients with AD with an overall accuracy of 92.7%, which makes this method highly valid for assessing fitness to drive in AD. This method may be used to advise patients with AD and their family members about fitness to drive.
Collapse
Affiliation(s)
- Dafne Piersma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | - Anselm B. M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - Dick de Waard
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | | | - Jolieke de Groot
- SWOV Institute for Road Safety Research, The Hague, the Netherlands
| | - Michelle J. A. Doumen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | | | - René Claesen
- CBR Dutch driving test organisation, Rijswijk, the Netherlands
| | - Afina W. Lemstra
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Annemiek Vermeeren
- Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, the Netherlands
| | - Rudolf Ponds
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Frans Verhey
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Wiebo H. Brouwer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
37
|
Alosco ML, Penn MS, Spitznagel MB, Cleveland MJ, Ott BR, Gunstad J. Reduced Physical Fitness in Patients With Heart Failure as a Possible Risk Factor for Impaired Driving Performance. Am J Occup Ther 2015; 69:6902260010p1-8. [PMID: 26122681 DOI: 10.5014/ajot.2015.013573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Reduced physical fitness secondary to heart failure (HF) may contribute to poor driving; reduced physical fitness is a known correlate of cognitive impairment and has been associated with decreased independence in driving. No study has examined the associations among physical fitness, cognition, and driving performance in people with HF. METHOD Eighteen people with HF completed a physical fitness assessment, a cognitive test battery, and a validated driving simulator scenario. RESULTS Partial correlations showed that poorer physical fitness was correlated with more collisions and stop signs missed and lower scores on a composite score of attention, executive function, and psychomotor speed. Cognitive dysfunction predicted reduced driving simulation performance. CONCLUSION Reduced physical fitness in participants with HF was associated with worse simulated driving, possibly because of cognitive dysfunction. Larger studies using on-road testing are needed to confirm our findings and identify clinical interventions to maximize safe driving.
Collapse
Affiliation(s)
- Michael L Alosco
- Michael L. Alosco, MA, is Doctoral Student, Department of Psychological Sciences, Kent State University, Kent, OH
| | - Marc S Penn
- Marc S. Penn, MD, PhD, is Director of Research, Summa Cardiovascular Institute, Akron, OH
| | - Mary Beth Spitznagel
- Mary Beth Spitznagel, PhD, is Assistant Professor, Department of Psychology, Kent State University, Kent, OH
| | - Mary Jo Cleveland
- Mary Jo Cleveland, PhD, is Geriatrician, Center for Senior Health, Summa Health System, Akron, OH
| | - Brian R Ott
- Brian R. Ott, MD, is Director, The Alzheimer's Disease & Memory Disorders Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - John Gunstad
- John Gunstad, PhD, is Associate Professor, Department of Psychology, Kent State University, Kent, OH;
| |
Collapse
|
38
|
Abstract
Dementia raises many ethical issues. The present review, taking note of the fact that the stages of dementia raise distinct ethical issues, focuses on three issues associated with stages of dementia's progression: (1) how the emergence of preclinical and asymptomatic but at-risk categories for dementia creates complex questions about preventive measures, risk disclosure, and protection from stigma and discrimination; (2) how despite efforts at dementia prevention, important research continues to investigate ways to alleviate clinical dementia's symptoms, and requires additional human subjects protections to ethically enroll persons with dementia; and (3) how in spite of research and prevention efforts, persons continue to need to live with dementia. This review highlights two major themes. First is how expanding the boundaries of dementias such as Alzheimer's to include asymptomatic but at-risk persons generate new ethical questions. One promising way to address these questions is to take an integrated approach to dementia ethics, which can include incorporating ethics-related data collection into the design of a dementia research study itself. Second is the interdisciplinary nature of ethical questions related to dementia, from health policy questions about insurance coverage for long-term care to political questions about voting, driving, and other civic rights and privileges to economic questions about balancing an employer's right to a safe and productive workforce with an employee's rights to avoid discrimination on the basis of their dementia risk. The review highlights these themes and emerging ethical issues in dementia.
Collapse
|
39
|
Chacko EE, Wright WM, Worrall RC, Adamson C, Cheung G. Reactions to driving cessation: a qualitative study of people with dementia and their families. Australas Psychiatry 2015; 23:496-9. [PMID: 26104777 DOI: 10.1177/1039856215591326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A proportion of older people with mild dementia are safe to drive. However, driving cessation is recommended at some point as the disease progresses. Driving cessation can have significant psychological and social consequences on people with dementia and their carers. This paper aims to explore the psychosocial and adjustment issues following driving cessation for people with dementia and their supporters. METHOD Participants and their supporters were interviewed within 1 month of driving-cessation advice, and again 6 months later. Issues associated with driving cessation were explored in semi-structured interviews. RESULTS Seven participants and their supporters were recruited. This has generated a total of 22 transcripts for qualitative analysis including follow-up interviews. For those who could remember the details of driving cessation, most were unhappy with the decision. Carers who were supportive of driving cessation questioned the legality of it. Most participants minimised the impact of their driving cessation on their supporters. Most supporters were negatively affected by the decision. CONCLUSIONS The preliminary findings highlight the need for a more comprehensive process for driving cessation in those with dementia, with closer links to regulatory bodies, and increased support for their families/carers.
Collapse
Affiliation(s)
- Emme Elizabeth Chacko
- Consultant Psychiatrist, Mental Health Services for Older People, Auckland District Health Board, Auckland, and; Honorary Senior Lecturer, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | | | - Richard Charles Worrall
- Consultant Psychiatrist/ Clinical Director, Mental Health Services for Older People, Auckland District Health Board, Auckland, New Zealand
| | - Carole Adamson
- Senior Lecturer, School of Counselling, Human Services & Social Work, University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Consultant Psychiatrist, Mental Health Services for Older People, Auckland District Health Board, Auckland, and; Senior Lecturer, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| |
Collapse
|
40
|
Wheatley CJ, Carr DB, Marottoli RA. Consensus statements on driving for persons with dementia. Occup Ther Health Care 2015; 28:132-9. [PMID: 24754761 DOI: 10.3109/07380577.2014.903583] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The presence of dementia can have a profound effect on a person's capacity for driving, and will lead to eventual cessation of driving and reliance on alternative transportation options. This paper offers evidence and discussion that affirm eight consensus statements related to drivers with dementia and the impact of dementia on the driving task. These statements offer guidance for occupational therapy practitioners when addressing driving and community mobility, a valued instrumental task of daily living.
Collapse
Affiliation(s)
- Carol J Wheatley
- 1Department of Outpatient Rehabilitation, MedStar Good Samaritan Hospital, 5601 Loch Raven Blvd , Baltimore, Maryland , USA
| | | | | | | | | | | |
Collapse
|
41
|
Vaughan L, Hogan PE, Rapp SR, Dugan E, Marottoli RA, Snively BM, Shumaker SA, Sink KM. Driving with Mild Cognitive Impairment or Dementia: Cognitive Test Performance and Proxy Report of Daily Life Function in Older Women. J Am Geriatr Soc 2015; 63:1774-82. [PMID: 26338449 DOI: 10.1111/jgs.13634] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate associations between proxy report of cognitive and functional limitations and cognitive performance and current or former driving status in older women with mild cognitive impairment (MCI) and all-cause dementia. DESIGN Cross-sectional data analysis of retrospectively identified older women with adjudicated MCI and all-cause dementia in the Women's Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes (WHIMS-ECHO). SETTING Academic medical center. PARTICIPANTS Women (mean age ± standard deviation 83.7 ± 3.5) adjudicated with MCI or dementia during Year 1, 2, 3, or 4 of the WHIMS-ECHO follow-up period (N = 385). MEASUREMENTS The telephone-administered cognitive battery included tests of attention, verbal learning and memory, verbal fluency, executive function, working memory, and global cognitive function plus self-report measures of depressive symptomatology. The Dementia Questionnaire (DQ) was administered to a knowledgeable proxy (family member, friend). RESULTS Sixty percent of women with MCI and 40% of those with dementia are current drivers. Proxy reports of functional limitations in instrumental activities of daily living (IADLs) are associated with current driving status in women with MCI, whereas performance-based cognitive tests are not. In women with dementia, proxy reports of functional limitations in IADLs and performance-based cognitive tests are associated with current driving status, as expected. CONCLUSION These findings have clinical implications for the importance of evaluating driving concurrently with other instrumental functional abilities in MCI and dementia. Additional work is needed to determine whether proxy report of cognitive and functional impairments should help guide referrals for driving assessment and rehabilitation or counseling for driving transition.
Collapse
Affiliation(s)
- Leslie Vaughan
- Department of Social Sciences and Health Policy, Wake Forest University, Winston-Salem, North Carolina
| | - Patricia E Hogan
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Stephen R Rapp
- Department of Social Sciences and Health Policy, Wake Forest University, Winston-Salem, North Carolina.,Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Elizabeth Dugan
- Department of Gerontology, McCormack Graduate School for Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts
| | - Richard A Marottoli
- School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Beverly M Snively
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Sally A Shumaker
- Department of Social Sciences and Health Policy, Wake Forest University, Winston-Salem, North Carolina
| | - Kaycee M Sink
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| |
Collapse
|
42
|
Piersma D, de Waard D, Davidse R, Tucha O, Brouwer W. Car drivers with dementia: Different complications due to different etiologies? TRAFFIC INJURY PREVENTION 2015; 17:9-23. [PMID: 25874501 DOI: 10.1080/15389588.2015.1038786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Older drivers with dementia are an at-risk group for unsafe driving. However, dementia refers to various etiologies and the question is whether dementias of different etiology have similar effects on driving ability. METHODS The literature on the effects of dementia of various etiologies on driving ability is reviewed. Studies addressing dementia etiologies and driving were identified through PubMed, PsychINFO, and Google Scholar. RESULTS AND CONCLUSIONS Early symptoms and prognoses differ between dementias of different etiology. Therefore, different etiologies may represent different likelihoods with regard to fitness to drive. Moreover, dementia etiologies could indicate the type of driving problems that can be expected to occur. However, there is a great lack of data and knowledge about the effects of almost all etiologies of dementia on driving. One could hypothesize that patients with Alzheimer's disease may well suffer from strategic difficulties such as finding a route, whereas patients with frontotemporal dementia are more inclined to make tactical-level errors because of impaired hazard perception. Patients with other dementia etiologies involving motor symptoms may suffer from problems on the operational level. Still, the effects of various etiologies of dementias on driving have thus far not been studied thoroughly. For the detection of driving difficulties in patients with dementia, structured interviews with patients but also their family members appear crucial. Neuropsychological assessment could support the identification of cognitive impairments. The impact of such impairments on driving could also be investigated in a driving simulator. In a driving simulator, strengths and weaknesses in driving behavior can be observed. With this knowledge, patients can be advised appropriately about their fitness to drive and options for support in driving (e.g., compensation techniques, car adaptations). However, as long as no valid, reliable, and widely accepted test battery is available for the assessment of fitness to drive, costly on-road test rides are inevitable. The development of a fitness-to-drive test battery for patients with dementia could provide an alternative for these on-road test rides, on condition that differences between dementia etiologies are taken into consideration.
Collapse
Affiliation(s)
- Dafne Piersma
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Dick de Waard
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Ragnhild Davidse
- b SWOV Institute for Road Safety Research , The Hague , The Netherlands
| | - Oliver Tucha
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| | - Wiebo Brouwer
- a Clinical and Developmental Neuropsychology, University of Groningen , Groningen , The Netherlands
| |
Collapse
|
43
|
Carter K, Monaghan S, O'Brien J, Teodorczuk A, Mosimann U, Taylor JP. Driving and dementia: a clinical decision pathway. Int J Geriatr Psychiatry 2015; 30:210-6. [PMID: 24865643 PMCID: PMC4305213 DOI: 10.1002/gps.4132] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 03/26/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to develop a pathway to bring together current UK legislation, good clinical practice and appropriate management strategies that could be applied across a range of healthcare settings. METHODS The pathway was constructed by a multidisciplinary clinical team based in a busy Memory Assessment Service. A process of successive iteration was used to develop the pathway, with input and refinement provided via survey and small group meetings with individuals from a wide range of regional clinical networks and diverse clinical backgrounds as well as discussion with mobility centres and Forum of Mobility Centres, UK. RESULTS We present a succinct clinical pathway for patients with dementia, which provides a decision-making framework for how health professionals across a range of disciplines deal with patients with dementia who drive. CONCLUSIONS By integrating the latest guidance from diverse roles within older people's health services and key experts in the field, the resulting pathway reflects up-to-date policy and encompasses differing perspectives and good practice. It is potentially a generalisable pathway that can be easily adaptable for use internationally, by replacing UK legislation for local regulations. A limitation of this pathway is that it does not address the concern of mild cognitive impairment and how this condition relates to driving safety.
Collapse
Affiliation(s)
- Kirsty Carter
- Institute for Ageing and Health, Newcastle UniversityNewcastle upon Tyne, UK,Correspondence to: K. Carter, E-mail:
| | | | - John O'Brien
- Department of Psychiatry, University of CambridgeCambridge, UK
| | - Andrew Teodorczuk
- Institute for Ageing and Health, Newcastle UniversityNewcastle upon Tyne, UK
| | - Urs Mosimann
- Department of Old Age Psychiatry, University Hospital of PsychiatryBern, Switzerland
| | - John-Paul Taylor
- Institute for Ageing and Health, Newcastle UniversityNewcastle upon Tyne, UK
| |
Collapse
|
44
|
Driving after traumatic brain injury: evaluation and rehabilitation interventions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014; 2:176-183. [PMID: 25436178 DOI: 10.1007/s40141-014-0055-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The ability to return to driving is a common goal for individuals who have sustained a traumatic brain injury. However, specific and empirically validated guidelines for clinicians who make the return-to-drive decision are sparse. In this article, we attempt to integrate previous findings on driving after brain injury and detail the cognitive, motor, and sensory factors necessary for safe driving that may be affected by brain injury. Various forms of evaluation (both in clinic and behind-the-wheel) are discussed, as well as driver retraining and modifications that may be necessary.
Collapse
|
45
|
Neuropsychological Performance, Brain Imaging, and Driving Violations in Multiple Sclerosis. Arch Phys Med Rehabil 2014; 95:1818-23. [DOI: 10.1016/j.apmr.2014.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/14/2014] [Accepted: 05/27/2014] [Indexed: 01/13/2023]
|
46
|
Joseph PG, O'Donnell MJ, Teo KK, Gao P, Anderson C, Probstfield JL, Bosch J, Khatib R, Yusuf S. The Mini-Mental State Examination, Clinical Factors, and Motor Vehicle Crash Risk. J Am Geriatr Soc 2014; 62:1419-26. [DOI: 10.1111/jgs.12936] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Philip G. Joseph
- Population Health Research Institute; Hamilton Health Sciences; McMaster University; Hamilton Ontario Canada
| | - Martin J O'Donnell
- HRB Clinical Research Facility Galway; National University of Ireland; Galway Ireland
| | - Koon K. Teo
- Population Health Research Institute; Hamilton Health Sciences; McMaster University; Hamilton Ontario Canada
| | - Peggy Gao
- Population Health Research Institute; Hamilton Health Sciences; McMaster University; Hamilton Ontario Canada
| | - Craig Anderson
- George Institute for Global Health; Royal Prince Alfred Hospital; University of Sydney; Sydney New South Wales Australia
| | | | - Jackie Bosch
- Population Health Research Institute; Hamilton Health Sciences; McMaster University; Hamilton Ontario Canada
| | - Rasha Khatib
- Population Health Research Institute; Hamilton Health Sciences; McMaster University; Hamilton Ontario Canada
| | - Salim Yusuf
- Population Health Research Institute; Hamilton Health Sciences; McMaster University; Hamilton Ontario Canada
| |
Collapse
|
47
|
|
48
|
Manipulations to reduce simulator-related transient adverse health effects during simulated driving. Med Biol Eng Comput 2014; 52:601-10. [DOI: 10.1007/s11517-014-1162-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/19/2014] [Indexed: 12/01/2022]
|
49
|
Driving competences and neuropsychological factors associated to driving counseling in multiple sclerosis. J Int Neuropsychol Soc 2014; 20:555-65. [PMID: 24867442 DOI: 10.1017/s1355617714000368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Multiple Sclerosis (MS) significantly impacts daily living activities, including car driving. To investigate driving difficulties experienced with MS, we compared 50 MS patients with minor or moderate disability and 50 healthy controls (HC) using computerized driving tests (the ASDE driver test and the Useful Field of View (UFOV) test) and neuropsychological tests. Inclusion criteria included being active drivers. We evaluated whether cognitive deterioration in MS is associated with the results of driving tests by comparing MS patients without cognitive deterioration with HC. The results indicated that the MS patients performed worse than the HCs in attention, information processing, working memory and visuomotor coordination tasks. Furthermore, MS patients with cognitive impairments experienced more difficulties in the driving tests than did the non-impaired MS patients. Motor dysfunction associated with MS also played an important role in this activity. The results of this study suggest that MS should be assessed carefully and that special emphasis should be placed on visuomotor coordination and executive functions because patients with minor motor disability and subtle cognitive impairments can pass measures predictive of driving safety.
Collapse
|
50
|
Olsen K, Taylor JP, Thomas A. Mild cognitive impairment: safe to drive? Maturitas 2014; 78:82-5. [PMID: 24709165 DOI: 10.1016/j.maturitas.2014.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/10/2014] [Indexed: 11/29/2022]
Abstract
Driving is an important aspect of daily living and for many older people provides autonomy and psycho-social benefits. Cognitive impairment has been found to impact driving skills at the level of dementia, however, uncertainty remains around the impact of a diagnosis of the pre-dementia condition mild cognitive impairment. Current official guidelines are unclear, and assessment of fitness to drive can be problematical. This editorial examines current official guidance available to the clinician and problems with existing assessment as well as the current position of research specifically into MCI and driving, and considers future direction for research in this field.
Collapse
Affiliation(s)
- Kirsty Olsen
- Institute for Ageing & Health, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, England, United Kingdom.
| | - John-Paul Taylor
- Institute for Ageing & Health, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, England, United Kingdom.
| | - Alan Thomas
- Institute for Ageing & Health, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, England, United Kingdom.
| |
Collapse
|