Can Older Adults with Dementia Continue to Drive? More Study is Needed

Newswise, October 9, 2016--How do you know when it's time for an older adult with mild dementia to stop driving? Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. It can impact a person's ability to drive safely.

Although all people with dementia will have to stop driving eventually, each case can be unique based on the individual. According to a new study published in the Journal of the American Geriatrics Society, we still need to explore mental or physical tests that can best predict when people with dementia should stop driving.

People with dementia are between two and eight times more likely than adults of the same age without dementia to be involved in car accidents. Since dementia makes it difficult for people to evaluate their own ability to drive safely, furthermore, the decision about when to stop driving must be based on objective tests.

To determine which kinds of tests best evaluate driving safety, researchers from Macquarie University in Sydney, Australia, reviewed 28 studies that investigated the relationship between driving and cognitive function in people with dementia.

The study was the first of its kind to examine drivers with dementia and which existing tests might be most helpful in assessing their driver safety.

The researchers reviewed studies that examined various testing methods, including mental status tests, on-road assessments, tests using computerized and simulated driving, and those using motor vehicle crash data.

The researchers determined that current testing procedures are only about 77 percent accurate for predicting how safely people with dementia can drive.

They concluded that better, more accurate testing tools are needed to assess whether or not people with dementia can continue to drive safely. In the interim, older adults and caregivers should continue to work closely with their healthcare professionals when it comes to safe driving. Doctors, nurses, social workers, and other experts can evaluate your abilities and help you transition to driver retirement when the time is right.

Driving, Dementia – Assessing Safe Driving in High-Risk Older Adults

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. 

Independence and Mobility Key for Older Drivers Report Finds

 Newswise, February 21, 2016 — The majority of older drivers want to continue driving as long as they are able to safely, according to a report written by a University of Warwick academic.

The report, called Keeping Older Drivers Safe and Mobile, was commissioned by the Institute of Advanced Motorists (IAM).

More than 2,600 drivers and ex-drivers between the ages of 55 and 101 were surveyed in the report which was written by Dr Carol Hawley from Warwick Medical School, University of Warwick.

Although the report found 84% of driver respondents rated their driving ability as good to excellent and 86% rated their confidence as a driver as good to excellent, there were some factors which would persuade them to give up their car keys.

Dr Hawley said: “According to the survey most current drivers would consider giving up driving if they had a health condition or a health professional advised them to stop driving.

“General practitioners, doctors and opticians/optometrists are the most influential people to give advice on giving up driving.”

Given the reasons why older people value driving, it is no surprise that older people are reluctant to give up their vehicles.

Some 82% said that driving was ‘very or extremely important’ to them, and women were significantly more likely to rate driving as ‘extremely important’ than men.

The top five reasons why older drivers wanted to keep driving were:

Reason	Frequency	Percentage Of Survey
1. Independence	422	18.0
2. Convenience	416	17.7
3. Mobility/getting around	203	8.7
4. Freedom	202	8.6
5. Lack of public transport	148	6.3

Despite their determination to keep driving, the majority were in favour of measures to increase their safety on the roads including retesting and checking of various aspects of drivers’ health and competence to remain behind the wheel.

Almost 60% said drivers should retake the driving test every five years after age 70, 85% said drivers should pass an eyesight test every five years once they have reached 70, and more than half said that drivers aged around 70 should be required to have a medical examination.

Sarah Sillars, chief executive officer of the IAM, said: “A driving licence is a passport to freedom for all ages but particularly so for older drivers. As grandparents it’s about helping their family access jobs, education and childcare as well as keeping themselves independent and mobile. The psychological impact of a giving up a driving licence shouldn’t be underestimated.

“Reaction times and physical mobility are affected by age and all drivers need to make an informed decision about when to give up. We need to make it as easy as possible for mature drivers to make that choice armed with the full facts and all the support they need.

“While some might need to accept the decision they cannot keep driving safely on the road, we believe some are pushed into giving up before they really need to. A professional opinion counts for a lot, and there are many organisations that offer advisory voluntary assessments that will give an older driver the confidence they need to enjoy many more years of happy motoring – including ourselves.”

Prescription Sleep Medicine Linked to Motor Vehicle Collisions in Older Adults and Women

Newswise, February 21, 2016--A recent study by University of Alabama at Birmingham student assistant John Booth, III, and UAB Department of Epidemiology Professor and Vice Chair Gerald McGwin, Ph.D., published in Sleep Medicine linked the use of prescription sleep medicines containing zolpidem among aged drivers and the incidence of motor vehicle collisions.

“Due to the side effects of such drugs — including drowsiness upon waking and impaired coordination, current zolpidem users age 80 and older, as well as those who are female, experienced higher rates of MVCs than nonusers,” said Booth, a Ph.D. candidate in UAB’s Department of Epidemiology.

“We recommend that health care practitioners consider proposing behavioral treatment before prescribing zolpidem to restore sleep in women and patients over age 80 to reduce the risk of MVCs associated with this prescription drug.”

In the overall sample, the unadjusted 5-year motor vehicle collision rate was 46 percent higher for current zolpidem users versus nonusers.

More specifically, the unadjusted 5-year motor vehicle collision rate was 65 percent higher for females and 23 percent higher in males who used zolpidem. For those 80 years of age and older, the unadjusted 5-year motor vehicle collision rate was 124 percent higher for zolpidem users compared with nonusers.

According to the National Institutes of Health National Center for Complementary and Integrative Health, possible treatment alternatives to sleep medications include relaxation techniques, melatonin supplements, mind and body approaches such as meditation, as well as stimulus control such as consistent sleep schedules, and avoiding caffeine and alcohol.

A total of 2,000 north central Alabama zolpidem users, age 70 and up, who had driven within the previous three months and held a valid driver’s license were studied.

The researchers evaluated each participant’s five-year MVC history, obtained from the Alabama Department of Public Safety, and then estimated at-fault MVC rate ratios by comparing zolpidem users’ and nonusers’ data in age- and sex-defined subgroups.

Mature Drivers Favour Checks on Over 70s, New Study Finds

Publisher’s Note:  Although this survey was taken outside the US, we publish it here as the US faces challenges of an Aging Population—including driving and transportation for older persons

Newswise, February 5, 2016 — The majority of older drivers are in favour of tighter rules on checking the health and suitability of over-70s to drive – even if those checks could take them off the road themselves – according to a new report. T

he Institute of Advanced Motorists (IAM) worked with Dr Carol Hawley at Warwick Medical School, the University of Warwick, to survey more than 2,600 drivers and former drivers on their opinions, habits and motoring history.

The first major survey of its kind for two decades, Keeping Older Drivers Safe and Mobile, found more than half of over 70s demonstrate that they self-regulate to stay safe, by avoiding driving in challenging situations like busy traffic, after dark, in rush hour or bad weather.

While mature drivers travel significantly fewer miles than other age groups, 84% of them rated their driving ability as ‘good to excellent’ and only 6% had ever considered giving up driving.

Despite that a very high proportion of respondents were in favour of measures to increase their safety on the roads. Dr Hawley said: “Almost 60% of those questioned said drivers should retake the driving test every five years after age 70, 85% said drivers should pass an eyesight test every five years once they have reached 70, and more than half said that drivers aged around 70 should be required to have a medical examination.”

Dr Hawley worked with Professor Elizabeth Maylor in the University’s Psychology Department who provided access to the Warwick University research volunteer panel which provided nearly all of the respondents. Of those questioned 94% agreed that GPs should be required to inform patients if their medical condition may affect their fitness to drive and half agreed that a flexible licensing system should be introduced which could restrict types of roads and conditions for some older drivers.

The IAM’s survey found respondents wanted some rules to extend further than older drivers – 84% agreed that all drivers should pass an eyesight test every 10 years after first passing, regardless of their age.

The report also found just how important driving is to this group. Some 82% said that driving was very or extremely important to them, a figure that increases for women. Independence and convenience were cited as the main reasons for wanting to continue driving.

The number of drivers over the age of 70 is set to double over the next 20 years and with more than one million licence holders over the age of 80, there is a pressing need for enlightened policies and practical actions to help them keep safe and competently mobile for as long as possible.

Sarah Sillars, IAM chief executive officer, said: “Driving is about so much more than getting from A to B and nowhere is this more apparent than in this age group. It helps maintain self-esteem and freedom and is essential for combatting social isolation.

“There are certain issues that affect mature drivers more so than other groups however, such as reductions in mobility and a slowdown in reaction times. The great news from this survey is that mature drivers themselves are aware of the risks and support action to review their safety.

“Voluntary self-assessment and better education via GPs are important techniques for helping drivers understand how long they can continue to drive safely for. And for those needing a confidence boost or a little extra reassurance on today’s busy roads, the IAM’s Mature Driver Assessment could be something to think about.”