Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-25T15:57:59.833Z Has data issue: false hasContentIssue false

Aiding medical professionals in fitness-to-drive screenings for elderly drivers: development of an office-based screening tool

Published online by Cambridge University Press:  10 December 2017

Judith H.J. Urlings*
Affiliation:
Transportation Research Institute, Hasselt University, Hasselt, Belgium
Ariane Cuenen
Affiliation:
Transportation Research Institute, Hasselt University, Hasselt, Belgium
Tom Brijs
Affiliation:
Transportation Research Institute, Hasselt University, Hasselt, Belgium
Mark Lutin
Affiliation:
Jessa Hospital, Geriatrics department, Hasselt, Belgium
Ellen M.M. Jongen
Affiliation:
Faculty of Psychology and Educational Sciences, Open University, Heerlen, the Netherlands
*
Correspondence should be addressed to: Judith H.J. Urlings, Transportation Research Institute, Hasselt University, Agoralaan Abis, 3590 Diepenbeek, Hasselt, Belgium. Phone: +32-11286906. Email: judith.urlings@happyaging.be.

Abstract

Background:

Elderly drivers are an increasing group in society. Previous research has found that functional and cognitive abilities are more important for driving abilities than biological age. In an attempt to conserve independent mobility for elderly drivers, many researchers have focused on elderly drivers diagnosed with cognitive decline (mild cognitive impairment or mild Dementia). This study is the first to focus on elderly drivers with cognitive complaints or suspected of diminished fitness to drive by an (in)formal caregiver as an at-risk group.

Methods:

The main objective of this study was to develop a fitness to drive screening tool for elderly drivers to be used in a doctor's office. Furthermore, this study investigated the additional value of driving simulator tests in the assessment of fitness to drive. Both screenings (functional abilities and driving simulator test) were benchmarked against the official Belgian fitness to drive licensing procedure.

Results:

One-hundred thirty-six elderly drivers participated in a functional abilities screening, a driving simulator assessment and an on-road driving test. Sixty-five percent of the sample was considered fit to drive. Visual acuity, physical flexibility, and knowledge of road signs were found to be the best predictive set of tests for the on-road fitness to drive outcome. A performance based driving simulator assessment increased predictive accuracy significantly.

Conclusion:

The proposed screening procedure saves part of the at-risk elderly driver population from stressful and costly on-road driving evaluations. This procedure provides more information of an individual driver's specific driving parameters. This opens doors for personalized older driver training to maintain independent mobility in later life.

Type
Original Research Article
Copyright
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adler, G. and Kuskowski, M. (2003). Driving cessation in older men with dementia. Alzheimer Disease & Associated Disorders, 17, 6871.Google Scholar
Adrian, J., Postal, V., Moessinger, M., Rascle, N. and Charles, A. (2011). Personality traits and executive functions related to on-road driving performance among older drivers. Accident Analysis & Prevention, 43, 16521659.Google Scholar
Aksan, N., Hacker, S. D., Sager, L., Dawson, J., Anderson, S. and Rizzo, M. (2016). Correspondence between simulator and on-road drive performance: implications for assessment of driving safety. Geriatrics, 1, 8.Google Scholar
Ariën, C. et al. (2015). Processing driving simulator data before statistical analysis by means of interpolation and a simple integral formula. In Radwan, E. and Abdel-Aty, M. (eds.) Proceedings of the 2015 Road Safety & Simulation International Conference, Orlando, FL, October 6-8, 2015 (pp. 756769).Google Scholar
Ball, K. et al. (2006). Can high-risk older drivers be identified through performance-based measures in a department of motor vehicles setting?. Journal of the American Geriatrics Society, 54, 7784.Google Scholar
Ball, K., Edwards, J. D., Ross, L. A. and Mcgwin, G. (2010). Cognitive training decreases motor vehicle collision involvement of older drivers. Journal of the American Geriatrics Society, 58, 21072113.Google Scholar
Ball, K. and Owsley, C. (1993). The useful field of view test: a new technique for evaluating age-related declines in visual function. Journal of the American Optometric Association, 64, 7179.Google Scholar
Bennett, J. M., Chekaluk, E. and Batchelor, J. (2016). Cognitive tests and determining fitness to drive in dementia: a systematic review. Journal of the American Geriatrics Society.Google Scholar
Bowers, A. R. et al. (2013). Can we improve clinical prediction of at-risk older drivers?. Accident Analysis & Prevention, 59, 537547.Google Scholar
Carr, D. B., Barco, P. P., Wallendorf, M. J., Snellgrove, C. A. and Ott, B. R. (2011). Predicting road test performance in drivers with dementia. Journal of the American Geriatrics Society, 59, 21122117.Google Scholar
Clarnette, R. M., Almeida, O. P., Forstl, H., Paton, A. and Martins, R. N. (2001). Clinical characteristics of individuals with subjective memory loss in Western Australia: results from a cross-sectional survey. International Journal of Geriatric Psychiatry, 16, 168174.Google Scholar
Cuenen, A. (2016). Investigating Both Ends of the Driver Age Spectrum: Assessment of Driving Behavior and Evaluation of Traffic Safety Interventions. Doctoral thesis. Hasselt, Belgium: Hasselt University.Google Scholar
Dawson, J. D., Anderson, S. W., Uc, E. Y., Dastrup, E. and Rizzo, M. (2009). Predictors of driving safety in early Alzheimer disease. Neurology, 72, 521527.Google Scholar
Dawson, J. D., Uc, E. Y., Anderson, S. W., Johnson, A. M. and Rizzo, M. (2010). Neuropsychological predictors of driving errors in older adults. Journal of the American Geriatrics Society, 58, 10901096.Google Scholar
De Raedt, R. and Ponjaert-Kristoffersen, I. (2001). Predicting at-fault car accidents of older drivers. Accident Analysis & Prevention, 33, 809819.Google Scholar
Devlin, A., Mcgillivray, J., Charlton, J., Lowndes, G. and Etienne, V. (2012). Investigating driving behaviour of older drivers with mild cognitive impairment using a portable driving simulator. Accident Analysis & Prevention, 49, 300307.Google Scholar
Dobbs, A. (1997). Evaluations for At-Risk Experienced Drivers. Edmonton, Alberta: DriveABLE Testing, Ltd.Google Scholar
Duncan, P. W., Weiner, D. K., Chandler, J. and Studenski, S. (1990). Functional reach: a new clinical measure of balance. Journal of gerontology, 45, M192M197.Google Scholar
Edwards, J. D. et al. (2009). The longitudinal impact of cognitive speed of processing training on driving mobility. The Gerontologist, 49, 485494.Google Scholar
Eurostat (2015). People in the EU: who are we and how do we live? Luxembourg: Publications Office of the European Union.Google Scholar
Folstein, M. F., Folstein, S. E. and Mchugh, P. R. (1975). ‘Mini mental state’ A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.Google Scholar
Freund, B., Colgrove, L. A., Burke, B. L. and Mcleod, R. (2005). Self-rated driving performance among elderly drivers referred for driving evaluation. Accident Analysis & Prevention, 37, 613618.Google Scholar
Freund, B., Gravenstein, S., Ferris, R. and Shaheen, E. (2002). Evaluating driving performance of cognitively impaired and healthy older adults: a pilot study comparing on-road testing and driving simulation. Journal of the American Geriatrics Society, 50, 13091310.Google Scholar
Frittelli, C. et al. (2009). Effects of Alzheimer's disease and mild cognitive impairment on driving ability: a controlled clinical study by simulated driving test. International Journal of Geriatric Psychiatry, 24, 232238.Google Scholar
Fuermaier, A. B. et al. (2016). Assessing fitness to drive–a validation study on patients with mild cognitive impairment. Traffic Injury Prevention, 18, 145149.Google Scholar
Gopinath, B. et al. (2015). A comparison of health outcomes in older versus younger adults following a road traffic crash injury: a cohort study. PLoS One, 10, e0122732.Google Scholar
Grace, J., Amick, M. M., D'abreu, A., Festa, E. K., Heindel, W. C. and Ott, B. R. (2005). Neuropsychological deficits associated with driving performance in Parkinson's and Alzheimer's disease. Journal of the International Neuropsychological Society, 11, 766775.Google Scholar
Hjorthol, R. J., Levin, L. and Sirén, A. (2010). Mobility in different generations of older persons: the development of daily travel in different cohorts in Denmark, Norway and Sweden. Journal of Transport Geography, 18, 624633.Google Scholar
Hoggarth, P. A., Innes, C. R., Dalrymple-Alford, J. C. and Jones, R. D. (2013). Predicting on-road assessment pass and fail outcomes in older drivers with cognitive impairment using a battery of computerized sensory-motor and cognitive tests. Journal of the American Geriatrics Society, 61, 21922198.Google Scholar
Jones, K., Rouse-Watson, S., Beveridge, A., Sims, J. and Schattner, P. (2012). Fitness to drive: GP perspectives of assessing older and functionally impaired patients. Australian Family Physician, 41, 235.Google Scholar
Kay, L. G., Bundy, A. C. and Clemson, L. M. (2009). Predicting fitness to drive in people with cognitive impairments by using drivesafe and driveaware. Archives of Physical Medicine and Rehabilitation, 90, 15141522.Google Scholar
Kolasinski, E. M. (1995). Simulator sickness in virtual environments. DTIC Document.Google Scholar
Lindeboom, J. and Jonker, C. (1989). Amsterdamse Dementie Screeningstest. Lisse, The Netherlands: Swets & Zeitlinger.Google Scholar
Martin, A. J., Marottoli, R. and O'neill, D. (2013). Driving assessment for maintaining mobility and safety in drivers with dementia. Cochrane Database Systematic Review, 8, CD006222.Google Scholar
Mathias, J. and Lucas, L. (2009). Cognitive predictors of unsafe driving in older drivers: a meta-analysis. International Psychogeriatrics, 21, 637653.Google Scholar
Michon, J. A. (1985). A critical view of driver behavior models: what do we know, what should we do?. In Human Behavior and Traffic Safety. New York, NY: Springer.Google Scholar
Musselwhite, C. B. and Shergold, I. (2013). Examining the process of driving cessation in later life. European Journal of Ageing, 10, 89100.Google Scholar
Ott, B. R. et al. (2013). Assessment of driving-related skills prediction of unsafe driving in older adults in the office setting. Journal of the American Geriatrics Society, 61, 11641169.Google Scholar
Paez, A., Scott, D., Potoglou, D., Kanaroglou, P. and Newbold, K. B. (2007). Elderly mobility: demographic and spatial analysis of trip making in the Hamilton CMA, Canada. Urban Studies, 44, 123146.Google Scholar
Pavlou, D., Beratis, I., Papadimitriou, E., Antoniou, C., Yannis, G. and Papageorgiou, S. (2016). Which are the critical measures to assess the driving performance of drivers with brain pathologies?. Transportation Research Procedia, 14, 43934402.Google Scholar
Pelli, D. and Robson, J. (1988). The Design of a New Letter Chart for Measuring Contrast Sensitivity. Citeseer: Clinical Vision Sciences.Google Scholar
Petersen, (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183194.Google Scholar
Piersma, D. et al. (2016). Prediction of fitness to drive in patients with alzheimer's dementia. PLoS One, 11, e0149566.Google Scholar
Podsiadlo, D. and Richardson, S. (1991). The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142148.Google Scholar
Radford, K. A. and Lincoln, N. B. (2004). Concurrent validity of the stroke drivers screening assessment. Archives of Physical Medicine and Rehabilitation, 85, 324328.Google Scholar
Rapoport, M. J. et al. (2007). Sharing the responsibility for assessing the risk of the driver with dementia. Canadian Medical Association Journal, 177, 599601.Google Scholar
Reisberg, B. and Gauthier, S. (2008). Current evidence for subjective cognitive impairment (SCI) as the pre-mild cognitive impairment (MCI) stage of subsequently manifest Alzheimer's disease. International Psychogeriatrics, 20, 116.Google Scholar
Reisberg, B., Shulman, M. B., Torossian, C., Leng, L. and Zhu, W. (2010). Outcome over seven years of healthy adults with and without subjective cognitive impairment. Alzheimer's & Dementia, 6, 1124.Google Scholar
Rey, A. (1941). L'examen psychologique dans les cas d'encéphalopathie traumatique.(Les problems.). Archives de Psychologie.Google Scholar
Spannhorst, S., Toepper, M., Schulz, P., Wenzel, G., Driessen, M. and Kreisel, S. (2016). Advice for elderly drivers in a german memory clinic: a case report on medical, ethical and legal consequences. Geriatrics, 1, 9.Google Scholar
Staplin, L., Gish, K. W., Lococo, K. H., Joyce, J. J. and Sifrit, K. J. (2013). The Maze Test: a significant predictor of older driver crash risk. Accident Analysis & Prevention, 50, 483489.Google Scholar
Teasdale, N. et al. (2016). Drivers with amnestic mild cognitive impairment can benefit from a multiple-session driving simulator automated training program. Journal of the American Geriatrics Society I, 64, e16e18.Google Scholar
Uc, E. Y., Rizzo, M., Anderson, S. W., Shi, Q. and Dawson, J. D. (2005). Driver landmark and traffic sign identification in early Alzheimer's disease. Journal of Neurology, Neurosurgery & Psychiatry, 76, 764768.Google Scholar
Wadley, V. G. et al. (2009). Mild cognitive impairment and everyday function: an investigation of driving performance. Journal of Geriatric Psychiatry and Neurology, 22, 8794.Google Scholar
Wechsler, D. (1997). WAIS-III: Administration and scoring manual: Wechsler adult intelligence scale, Psychological Corporation.Google Scholar
Wood, J. M. (2002). Age and visual impairment decrease driving performance as measured on a closed-road circuit. Human Factors: The Journal of the Human Factors and Ergonomics Society, 44, 482494.Google Scholar
Wood, J. M., Horswill, M. S., Lacherez, P. F. and Anstey, K. J. (2013). Evaluation of screening tests for predicting older driver performance and safety assessed by an on-road test. Accident Analysis & Prevention, 50, 11611168.Google Scholar
Youden, W. J. (1950). Index for rating diagnostic tests. Cancer, 3, 3235.Google Scholar