Newswise, July 8, 2016 — Driving is possibly one of the most
complex procedures humans engage in on a regular basis. Operating a motor
vehicle involves a wide range of cognitive processes that require the ability
to judge distances, manage multiple stimuli simultaneously, react quickly in an
emergency, maintain attention for long periods of time, and correctly interpret
traffic signs and signals.
Today, almost half of all drivers on the roadways are over the
age of 65 and this number is projected to increase to 77 percent in the next 30
years. Adults over the age of 65 have the highest crash rate per mile compared
to any other age group, and older driver fatalities are highest in Florida,
California and Texas.
Driving also requires physical skills that are affected by
age-related changes like deteriorating vision, decreasing hearing, and
diminishing motor reflexes, coordination, and strength as well as effects from
medications used for a number of conditions.
Older adult drivers are frequently aware of these physical
changes and do take precautions. But what about older adult drivers with
declining cognition who can’t make this determination on their own?
With the decline of cognitive processes in older adults due to
Alzheimer’s disease (AD) and other forms of dementia, there is heightened
concern for public safety and unsafe driving in this population.
A researcher in the Christine E. Lynn College of Nursing at
Florida Atlantic University and a collaborator have just published an article
in the journal Public Health Nursing that sheds light on the cognitive factors
that inhibit effective driving as well as recognizing older adults who may be
at risk for unsafe driving.
“It is important to note that it’s not a person’s chronological
age itself that puts the older driver at increased risk for driving accidents,
but rather the changes in functionality and skills needed for safe driving,”
said Lisa Kirk Wiese, Ph.D., first author and an assistant professor in FAU’s
Christine E. Lynn College of Nursing.
Memory plays a significant role in driving competence. At a
basic level, memory provides drivers with the knowledge of how to operate a
motor vehicle; turning the key in the ignition, shifting gears, and
distinguishing the brake from the gas pedal.
Drivers also need to remember their destination so that they
don’t get lost. Studies have shown that there is a 62 percent increase in
errors among individuals with AD, most notably in the attention skills of
driving straight and in making left-hand turns.
They also have pathological changes in visual processing
areas, which significantly impacts visual processing, and consequently, driving
performance.
“Drivers with dementia and even their caregivers may lack the
insight needed to limit and eventually discontinue driving,” said Wiese.
“They might say something along the lines of ‘I have never had
an accident,’ which is then confirmed by their loved one, and both are in
denial that they could be an unsafe driver.”
Wiese and co-author Logan Wolff, in the College of Psychology
at Nova Southeastern University, note that self-rated methods for older drivers
at risk are not effective because they may be overconfident and lack insight
into their perceived versus actual driving abilities.
The authors suggest a three-pronged approach to testing for
safety in older adult drivers, which include a patient assessment and
medication review; a computerized simulation using a touch screen interface,
and a road test with a certified road test examiner.
“The task of identifying and helping older adults who are
unaware of decline in cognition impacting road safety can be overwhelming for
family members, “said Wiese.
“Nurses who care for older adults in public health settings
can play a vital role in understanding and identifying the cognitive mechanisms
that inhibit effective driving and help to identify older adults who may be at
risk for unsafe driving, and who would benefit from a driving evaluation.”
FAU’s Louis and Anne Green Memory and Wellness Center operated
by the College of Nursing provides a comprehensive driving evaluation that
includes tests of vision, physical functioning and cognitive skills required
for safe driving.
In addition, an on-road test in a dual-controlled vehicle is
given, which was developed for the purpose of detecting driving errors made by
cognitively impaired drivers. At the conclusion of the testing session, results
and recommendations are provided, and if needed, options for alternative
transportation and supportive services are discussed at length.
“Our driving evaluation program is one of several
comprehensive services we provide to individuals with memory disorders and
their families,” said María Ordóñez, DNP, ARNP, GNP-BC, director of the Louis
and Anne Green Memory and Wellness Center and an assistant professor in FAU’s
College of Nursing.
“We are committed to helping our clients function at their
personal best to maximize their quality of life and to respond to their unique
needs with caring, expertise, and compassion.”
FAU’s College of Nursing is internationally known for its
commitment to nursing as a discipline focused on nurturing the wholeness of
persons and the environment through Caring. The College advances Caring
knowledge through education, practice, research and scholarship to transform
care locally, nationally and globally. Currently, the College of Nursing offers
bachelor’s, master’s, DNP and Ph.D. degree programs with approximately 1,600
nursing students enrolled in its programs. For more information, visit www.nursing.fau.edu.
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