Assessment Of Older Drivers Research Articles

Assessment of Older Drivers’ Hazard Perception Using a Head-Mounted Display

Assessment of Older Drivers’ Hazard Perception Using a Head-Mounted Display

Attitude of Swiss general practitioners to mandatory training in assessing fitness to drive of older drivers.

In Switzerland, drivers over the age of 75 must undergo a medical assessment of their fitness to drive every 2 years. This assessment is usually carried out by a general practitioner (GP). Since 2016, physicians require official accreditation (so-called level 1 competence) to perform these examinations. This can be obtained either by self-declaration of competence or by attending an accredited training course. Little is known about the Swiss GPs' views on this regulation. In this study, we investigated the attitude of GPs towards these modalities. A questionnaire was mailed to 2372 GPs in a large part of German-speaking Switzerland, 1198 of whom completed and returned the questionnaire. The anonymised data were analysed by descriptive statistics (frequencies, percentages) to summarise participant demographics and agreement with attitudinal statements. The response rate was 50.5%. Sociodemographic data (age, gender, settlement area) of the participating GPs corresponded to those of the Swiss medical statistics. The majority (93.1%) of respondents worked in an outpatient setting, 6.9% in the inpatient sector. Overall, 34.4% of the GPs completed a training course and 47.7% submitted a self-declaration in order to acquire level 1 competence. Older and more experienced physicians had made more use of the self-declaration option. 58.1% of the respondents would like to retain the existing regulations. Of the respondents who had attended a training course, 51.7% considered themselves more competent in the assessment of older drivers after the training, and 76.1% would like to maintain the course duration of 1 day. Of the physicians surveyed, 70.8% were of the opinion that level 1 examinations are a useful screening tool for older drivers who are unfit to drive, and 78.4% agreed that MFTD (medical fitness to drive) examinations of older drivers should be performed by GPs. In Switzerland, the currently existing regulation for acquiring level 1 competence is widely accepted by GPs. Almost all respondents considered that they have sufficient knowledge to assess MFTD. However, the majority of GPs who had attended the training course indicated they have benefited from it. Periodic assessment of MFTD of older drivers was considered useful and should preferably be performed by GPs. These results show that the periodic assessment of older drivers' MFTD practised in Switzerland is well accepted.

Physicians’ views on the usefulness of practical tools for assessing the driving ability of older drivers: a cross-sectional study

ObjectiveWe aimed to explore Swiss physicians’ views on the usefulness of a self-administered questionnaire completed by older drivers before the consultation and a reference guide summarising current Swiss guidelines on...

Driving assessment of older drivers

Driving assessment of older drivers

Consensus statements on the assessment of older drivers.

BackgroundThe rapidly increasing number of older drivers is accentuating the challenges in concurrently identifying older drivers posing an unacceptable risk if they continue to drive, while not discriminating against those capable of safely driving. Attendees of an invitational meeting about the assessment of older drivers were asked to participate in a modified Delphi process designed to develop consensus statements on the assessment of older drivers.MethodsForty-one non-student symposium attendees were invited to participate in two rounds of a survey, in which they were asked to indicate their level of agreement (or disagreement) on a five-point Likert scale to a series of statements about the assessment of older drivers. Consensus was defined as 80% + of respondents either agreeing or disagreeing with a statement.ResultsMore than one-half (n = 23) completed the first round of the survey and 12 participated in the second. There was consensus on the need for a modifiable, fair, rational, and widely accessible multi-step approach to the assessment of older drivers. This would require the engagement and support of physicians and other health-care practitioners in identifying and reporting medically at-risk drivers of any age. At a societal level, alternatives to driving a personal motor vehicle should be developed.ConclusionsAn on-going dialogue about this complex issue is required. Decisions should be based on explicitly stated principles and informed by the best available evidence.

Driving assessment for maintaining mobility and safety in drivers with dementia.

Demographic changes are leading to an increase in the number of older drivers: as dementia is an age-related disease, there is also an increase in the numbers of drivers with dementia. Dementia can impact on both the mobility and safety of drivers, and the impact of formal assessment of driving is unknown in terms of either mobility or safety. Those involved in assessment of older drivers need to be aware of the evidence of positive and negative effects of driving assessment. Cognitive tests are felt by some authors to have poor face and construct validity for assessing driving performance; extrapolating from values in one large-scale prospective cohort study, the cognitive test that most strongly predicted future crashes would, if used as a screening tool, potentially prevent six crashes per 1000 people over 65 years of age screened, but at the price of stopping the driving of 121 people who would not have had a crash. 1. to assess whether driving assessment facilitates continued driving in people with dementia;2. to assess whether driving assessment reduces accidents in people with dementia. 1. to assess the quality of research on assessment of drivers with dementia. ALOIS, the Cochrane Dementia Group's Specialized Register was searched on 13 September 2012 using the terms: driving or driver* or "motor vehicle*" or "car accident*" or "traffic accident*" or automobile* or traffic. This register contains records from major healthcare databases, ongoing trial databases and grey literature sources and is updated regularly. We sought randomised controlled trials prospectively evaluating drivers with dementia for outcomes such as transport mobility, driving cessation or motor vehicle accidents following driving assessment. Each review author retrieved studies and assessed for primary and secondary outcomes, study design and study quality. No studies were found that met the inclusion criteria. A description and discussion of the driving literature relating to assessment of drivers with dementia relating to the primary objectives is presented. In an area with considerable public health impact for drivers with dementia and other road users, the available literature fails to demonstrate the benefit of driver assessment for either preserving transport mobility or reducing motor vehicle accidents. Driving legislation and recommendations from medical practitioners requires further research that addresses these outcomes in order to provide the best outcomes for both drivers with dementia and the general public.

The Addenbrooke's Cognitive Examination Revised as a potential screening test for elderly drivers

Considerable research has shown that neuropsychological tests are predictive of real-world driving ability. The Mini-Mental State Examination (MMSE) is a brief cognitive test that has been commonly used in the assessment of older drivers. However, this test has inherent problems that limit its validity to evaluate cognitive abilities related to driving and to screen for driving impairments in non-demented people. Therefore, it is useful to test new screening instruments that may predict potential unsafe drivers who require an in-depth neuropsychological assessment in a specialised centre. To date, the utility of the Addenbrooke's Cognitive Examination Revised (ACE-R) as an indicator of driving ability has not been established. In the current study, fifty older drivers (mean age=73.1years) who were referred for a psychological assessment, the protocol of which included the ACE-R, underwent an on-road driving test. Using linear discriminant analyses, the results highlighted the higher classification accuracy of the ACE-R compared to the MMSE score, particularly for detecting unsafe drivers. Measures of visuospatial and executive functions, which are not incorporated in the MMSE score, had an incremental value in the prediction of driving ability. This emerging brief cognitive test may warrant additional study for use in the fitness to drive assessment of older adults.

Age differences in simulated driving performance: Compensatory processes

In the context of driving, the reported experiment examines compensatory processes for age-related declines in cognitive ability. Younger (26–40 years) and older (60+ years) participants (n=22 each group) performed a car following task in a driving simulator. Several performance measures were recorded, including assessments of anticipation of unfolding traffic events. Participants also completed a range of measures of cognitive ability – including both fluid and crystallised abilities. Three examples of age-related compensation are reported: (i) older drivers adopted longer headways than younger drivers. Data were consistent with this being compensation for an age-related deficit in complex reaction time; (ii) older drivers with relatively higher cognitive ability anticipated traffic events more frequently, whereas the reverse pattern was found for younger drivers; and, (iii) older drivers with greater crystallised ability were less reliant on spatial ability to maintain lane position. Consistent with theories of ‘cognitive reserve’, interactions between crystallised ability and age for self-report workload suggested that compensation for age-related cognitive ability deficits required investment of additional effort. Results are considered in the context of the prospects of further assessment of older drivers.

Assessment of older drivers in New Zealand: The current system, research and recommendations

The purpose of this article is to clarify the current New Zealand driving licensing requirements for older adults and to provide practical recommendations for those health professionals who make decisions regarding driving ability in older adults. Health professionals involved in the assessment of older drivers were asked to clarify areas where more efficient use could be made of assessment resources. A review of driving literature was performed to find specific factors associated with increased risk of negative driving outcomes in older adults. Particular attention was paid to the suitability of different types of on-road assessment for certain patient groups, the effect of specific diseases and medications on driving safety, and the effect of cognitive impairment. A list of seven recommendations were compiled which include a focus on appropriate on-road driving assessment referral, driver refresher courses, cognitive screening for those presenting for licence renewal and sensitive broaching of the topic of driving cessation.

The Older Adult Driver With Cognitive Impairment

Although automobiles remain the transportation of choice for many older adults, late-life cognitive impairment and dementia often impair the ability to drive safely. However, there is no commonly used method of assessing dementia severity in relation to driving, no consensus on the assessment of older drivers with cognitive impairment, and no gold standard for determining driving fitness. Yet clinicians are called on by patients, their families, other health professionals, and often their state's Department of Motor Vehicles to assess their patients' fitness to drive and to make recommendations about driving privileges. This article describes the challenges of driving with cognitive impairment for both the patient and caregiver, summarizes the literature on dementia and driving, discusses evidence-based assessment of fitness to drive, and addresses important ethical and legal issues. It also describes the role of physician assessment, referral for neuropsychological testing, screening for functional ability, tools to assess dementia severity, driving evaluation clinics, and Department of Motor Vehicles referrals that may assist with evaluation. Lastly, it discusses mobility counseling (eg, exploration of transportation alternatives), because health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance patients' social connectedness and quality of life while meeting their psychological and medical needs and maintaining personal and public safety.

Vision assessment of older drivers for relicensure

Vision assessment of older drivers for relicensure

Computerized Maze Navigation and On-Road Performance by Drivers With Dementia

This study examined the ability of computerized maze test performance to predict the road test performance of cognitively impaired and normal older drivers. The authors examined 133 older drivers, including 65 with probable Alzheimer disease, 23 with possible Alzheimer disease, and 45 control subjects without cognitive impairment. Subjects completed 5 computerized maze tasks employing a touch screen and pointer as well as a battery of standard neuropsychological tests. Parameters measured for mazes included errors, planning time, drawing time, and total time. Within 2 weeks, subjects were examined by a professional driving instructor on a standardized road test modeled after the Washington University Road Test. Road test total score was significantly correlated with total time across the 5 mazes. This maze score was significant for both Alzheimer disease subjects and control subjects. One maze in particular, requiring less than 2 minutes to complete, was highly correlated with driving performance. For the standard neuropsychological tests, highest correlations were seen with Trail Making A (TrailsA) and the Hopkins Verbal Learning Tests Trial 1 (HVLT1). Multiple regression models for road test score using stepwise subtraction of maze and neuropsychological test variables revealed significant independent contributions for total maze time, HVLT1, and TrailsA for the entire group; total maze time and HVLT1 for Alzheimer disease subjects; and TrailsA for normal subjects. As a visual analog of driving, a brief computerized test of maze navigation time compares well to standard neuropsychological tests of psychomotor speed, scanning, attention, and working memory as a predictor of driving performance by persons with early Alzheimer disease and normal elders. Measurement of maze task performance appears to be useful in the assessment of older drivers at risk for hazardous driving.

Assessment of older drivers: Relationships among on-road errors, medical conditions and test outcome

Problem: It is essential that driver licensing authorities have a valid and reliable system for evaluating older drivers' continuing competency; road tests are usually required as part of such a system. This study sought to find information about the nature of driving errors made during license review tests, and about relationships between error type and test outcome for older drivers. Method: Data from licensing authority files from 533 road tests during a 12-month period were analyzed; medical and other referral information was included. Average driver age was 76 years. Performance scores were generated for intersection negotiation, lane changing, low speed manoeuvres, positioning and speed control, safety margin, and car control. Results: Logistic regression analysis showed that test outcome was well predicted by a subset of driving performance scores; adding driver age to the model explained very little variance. Age alone was strongly associated with outcome. Relationships between referral information and test outcome are also reported. Impact: Results highlight several factors relevant to the development of more valid and reliable road tests for older drivers.

Selections from current literature. Assessment of older drivers.

The ability to travel hither and yon whenever and without dependence on others has become synonymous with independence, autonomy, dignity, self-esteem and the automobile. Losing the ability to drive in today’s modern societies may have serious psychosocial ramifications with potential subsequent adverse biomedical consequences for individuals already facing many losses on the one hand, while sustained driving by the driving impaired increases the likelihood of injuries, hospitalizations and death, on the other. The number of older drivers has and will increase dramatically as populations worldwide continue to age. Family physicians are often approached by family regarding concerns of hazards posed by continued and often insistent driving of older loved ones who are felt to be too functionally impaired to drive. We have been ill equipped and trained to offer counsel, and frequently wonder as to whether this is indeed a problem that is ours to solve. While most governmental agencies deem driving licensure as a privilege and not a right, they have done little to clarify such privilege, nor have they offered guidance one might deem of use in the context of the physician‐patient dyad. The purpose of this article is to review the current literature as it pertains to the pressing problem of clinician involvement. It is an attempt to facilitate the practitioner’s balance as advocate for patient, family and society in the context of biomedical, psychological and sociological variables.

Assessment of Older Drivers

As concern increases about the safety of the aging driver, it is clear that the principal goal of assessment is to identify the unsafe driver and provide effective medical and rehabilitative services to enable the resumption of safe driving. When adequate restorative therapy is not possible, it is necessary to restrict or revoke the privilege of driving. Assessment also can reassure the safe older driver that he or she can continue operating a motor vehicle without restrictions. The process of assessing the older driver is best accomplished through the collaboration of health professionals and governmental agencies. The former identify and treat, if possible, medical conditions that may pose threats to safe driving; the latter establish guidelines of competency for driving tasks. These roles are complementary, although the settings and methods for these assessments are different. Moreover, the responsibilities of the physician and other health care professionals extend beyond the decision regarding driving and must consider the individual needs for driving, as well as the ramifications associated with its cessation.

The Effect of Smoking on Elderly Drivers

To the Editor.— Underwood's article 1 on health factors in the assessment of older drivers is most timely. In addition to their neuropsychiatric and physical deficits, medications and alcohol may further impair the performance of elderly drivers. Unfortunately, Underwood does not mention tobacco. Smoking, especially while driving, should also be considered a risk factor. In addition to nicotine, cigarette smoke contains a number of toxic components including hydrocyanic acid, acrolein, and carbon monoxide. 2 The adverse central nervous system and cardiovascular effects of cigarette smoking are generally dose related. 3 In a closed vehicle, especially if more than one person is smoking, the concentration of these toxins could reach substantial levels. Furthermore, the act of smoking may of itself distract the driver. While smoking may adversely affect a driver at any age, the elderly would seem to be more susceptible. I would appreciate learning if Underwood is aware of any

The Effect of Smoking on Elderly Drivers-Reply

In Reply.— I appreciate Sataline's interest in my recent article on the clinical assessment of older drivers. He raises some interesting and clinically relevant concerns related to the possible adverse impact of smoking on driving performance. My review of the literature on the effects of tobacco use on driving performance did not identify definitive and conclusive evidence supporting the role of smoking as an independent risk factor for motor vehicle crashes and crash-related injuries. However, there are numerous possible mechanisms for direct and indirect effects of smoking to increase crash risks for individual drivers. As Sataline notes, the act of smoking (including the lighting and extinguishing of cigarettes and smoke-induced eye irritation and coughing spells) may decrease attention to the road. The use of cellular car telephones (increasingly popular since the mid-1980s and now present in at least 4 million automobiles, according to recent estimates) would be expected to interfere