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PubMedDate not supplied

Systematic review of the optimal frequency of follow-up in persons with mild dementia who continue to drive.

Fitness-to-drive guidelines commonly indicate that persons with mild dementia may be safe to drive but that periodic reevaluation is required. This paper presents the findings of a systematic review of primary evidence regarding the optimal timing of follow-up in persons with mild dementia who continue to drive. A search of Medline, CINAHL, PsychInfo, AARP Ageline, and Sociofile from 1984 to 2005 was performed. No published studies focus primarily on the timing of follow-up of drivers with mild dementia. Three studies present longitudinal data that the authors reference when recommending periodicity of follow-up. This study identifies a concerning research gap in the field of dementia and driving. To provide better evidence to guide recommendations for periodicity of follow-up, 3 recommendations are proposed: (1) that prospective cohort driving research be undertaken to follow patients with mild dementia who continue to drive, (2) that data from such longitudinal research be presented as survival analyses, and (3) that existing research on the progression rates of Alzheimer disease be employed as a default until the first 2 recommendations are realized.

Aged↗
PubMed2001

The effect of state regulations on motor vehicle fatalities for younger and older drivers: a review and analysis.

Policymakers have had a long-standing interest in improving the motor vehicle safety of both younger and older drivers. Although younger and older drivers share the distinction of having more crashes and fatalities per mile driven than other age groups, the problems posed by these two groups stem from different origins and manifest in different ways. A number of state-level policies and regulations may affect the number of motor vehicle crashes and fatalities in these two high-risk groups. A critical review of the existing literature in regard to the risk factors and the effects of various policy measures on motor vehicle crashes in these two high-risk populations provides direction for policymakers and high-priority areas of interest for the research community.

Accidents, Traffic↗
PubMed2004

Epilepsy and driving in Japan.

PURPOSE: The driving regulations in Japan were amended in 2002, which lifted the absolute ban on driving by persons with epilepsy (PWE) and granted licenses to PWE after a 2-year seizure-free period. METHODS: To survey the effect of the new driving regulations, we sent questionnaires both to the driving authorities (DAs) and to doctors of the Japan Epilepsy Society (JES). RESULTS: Around 1,400 PWE legally obtained a driving license within 1 year after the amendment, licenses were rejected in 157, and 61 had the license withheld for <6 months. In most cases, the attending doctor assessed fitness for driving; 171 doctors responded to the questionnaire. One third of them commented on a positive change in attitude of PWE with respect to driving. Their main remarks included the need to shorten the seizure-free period to qualify for fitness to drive and the need for special guidelines for conditions such as rare seizure occurrence, recently diagnosed epilepsy, or reflex epilepsy. Problems of assessment identified included difficulty in deciding the time for reassessment, distress of PWE over cancellation of license, cost of the assessment, responsibility of the assessing doctors in case of seizure recurrence, and protection of privacy. They requested the DAs to promote publicity about the information and asked the JES to establish a guideline for assessing fitness to drive. CONCLUSIONS: The results highlighted the need for cooperation between the DAs and the JES for further amendment of the regulations as well as the importance of education for the public, patients, and professionals.

Accidents, Traffic↗
PubMed1998

Safe driving education programs at school: lessons from New Zealand.

The self-reported driving and passenger behaviours of senior high school students in Auckland, New Zealand, were assessed prior to and about four months after a school-based program for driver education. The intervention group (n = 176) received a program of 10, one-hour sessions dealing with knowledge, attitudes and judgements relating to safe driving. A control group (n = 146) did not receive any formal driving safety education. Analyses of pre-treatment and follow-up questionnaire responses revealed that both the intervention and control groups showed significant improvements in knowledge about safe driving over time. Males reported more risky attitudes and behaviours than females throughout the study. There were no significant differences between the intervention and control groups on any measures. In discussing these findings, particular attention is paid to the program content and the social context in which such interventions are carried out.

Adolescent↗
PubMed1995

To drive or not to drive: neuropsychological assessment for driver's license among stroke patients.

Seventy-two stroke patients, 43 with right hemisphere (RHD) and 29 with left hemisphere damage (LHD), and 7 coronary infarct controls with no evidence of cerebral damage, were neuropsychologically tested as part of an assessment program for driver's license. Mean age in the group was 53 years. Stroke patients were tested on average 4 months post injury. The groups did not differ on major demographic variables except that RHD patients were more often hemiplegic than LHD patients. The test battery was factor analyzed into 4 valid principal components: (I) visual perception, (II) spatial attention, (III) visuospatial processing, and (IV) language/praxis. The presence of hemianopia (factor I) excludes driving. In addition, measures of neglect and reduced speed of mental processing from factor II, III and IV, were found to be the most discriminating variables when classifying patients for driving. Even though neglect was more frequently observed among RHD than LHD patients, the two hemisphere groups did not differ significantly in number of patients denied driving, 58% RHD compared to 41% LHD patients. The need for comprehensive neuropsychological assessment is underlined.

Adult↗
PubMedDate not supplied

Epilepsy, driving laws, and patient disclosure to physicians.

To avoid loss of driving privileges, patients with epilepsy may elect not to report seizures to their physician or to the Department of Motor Vehicles (DMV). Reporting to the physician may differ depending upon the type of law in effect, i.e., mandatory physician reporting versus patient reporting to the DMV. Nondisclosure to the physician may have important consequences with regard to seizure management. We surveyed patients at two adult seizure clinics to determine the effect of driving laws on patients' reporting to their physician. One hundred fifty-eight patients completed an anonymous questionnaire asking whether they would report a breakthrough seizure under a physician versus a patient DMV reporting system. Under patient reporting, 96% would inform their physician and 56% would report to the DMV. Under physician reporting, 84% would inform their physician. This falls to 72% when considering currently driving patients only. An additional 9-17% of patients would continue to drive with a suspended license. In all, 53% would remain driving under patient reporting and 33% under physician reporting; however, with physician reporting, half of the illegally driving patients would have compromised their medical care, potentially increasing driving risk.

Automobile Driver Examination↗
PubMedDate not supplied

Viewpoint of a driver with epilepsy.

Persons with seizure disorders are a varied group, but the group is treated indiscriminately when U.S. state laws restrict driving privileges on the basis of a seizure incident without regard for individual driving record, level of personal responsibility, or the almost insignificant danger posed to ourselves and other motorists. From the viewpoint of a driver with epilepsy, seven characteristics encompass a model driver licensing law, which would (a) be a proportionate response to the problem addressed; (b) be reasonable enough to ensure compliance; (c) empower the individual (as opposed to a medical advisory board exclusively) to participate in decisions; (d) consider each individual's circumstances; (e) be consistent with U.S. Public Law 95-602, the Rehabilitation Act of 1973; (f) be based on performance rather than on medical incident; and (g) preserve for society the benefit of every driver's fullest participation.

Accidents, Traffic↗
PubMedDate not supplied

Driving and epilepsy: a historical perspective and review of current regulations.

Historically, persons with seizures or epilepsy have been prohibited from driving automobiles or motor vehicles because of concern for public safety. Seizures have a tendency to recur and pose risks of traffic accidents, property damage, and personal injury. In our modern world, however, driving an automobile is such an economic and social necessity that a conflict results between our need to protect public safety and our responsibility to provide reasonable opportunities to drive for persons handicapped by seizures and epilepsy. Currently, there is a trend toward liberalization of driving standards for persons with epilepsy, but there is still considerable controversy regarding the specific driving restrictions necessary for persons with seizures, the way in which such policies should be administered, and the role physicians should have in the process.

Accidents, Traffic↗
PubMedDate not supplied

Epilepsy and driving: an international perspective. Joint Commission on Drivers' Licensing of the International Bureau for Epilepsy and the International League Against Epilepsy.

Individuals with a history of seizures may be granted driving privileges if the risks of future seizure while driving are relatively low. Different nations have defined these risks in a wide variety of ways. Some countries, e.g., Japan, Greece, Brazil, India, and Russia, preclude driving after a single seizure. Other countries, such as Canada and the United States, allow driving < or = 3 months after certain types of seizures. A Joint Commission of the International Bureau for Epilepsy/International League Against Epilepsy has summarized regulations in several countries. From a consideration of medical literature and existing practices, a series of proposed guidelines for driving and epilepsy is recommended. In general, these guidelines suggest use of a seizure-free interval, generally 1-2 years but less in particular instances, to determine fitness to drive. Required physician reporting is discouraged, but physicians should report patients whom they believe pose a danger to themselves and to public safety. Individualized consideration should be given to special circumstances that may modify a general driving prohibition. Education and information programs are necessary for medical and regulatory authorities to develop a rational approach to driving and epilepsy worldwide.

Accidents, Traffic↗
PubMedDate not supplied

Epilepsy and driving regulations in Wisconsin.

Driving regulations in the state of Wisconsin have evolved. In 1987, changes in these regulations focused the problem on loss of consciousness and bodily control of drivers rather than on specific diagnostic entities such as epilepsy or diabetes mellitus. Current Wisconsin law encompasses loss of consciousness or events affecting bodily control, no matter what the cause. Current regulations balance individual needs with the needs of safety for society. Neurologists are encouraged to become involved to keep the process of regulation current with the dynamic changes in medical care and in transportation technology (e.g., air bags, roll bars, etc.).

Accidents, Traffic↗
PubMedDate not supplied

Development and application of medical guidelines for drivers in the state of Maine.

In 1984, the Medical Advisory Board for the state of Maine realized that uniform criteria with regard to physical, emotional, and mental competence to operate a motor vehicle were nonexistent. This resulted in confusion and inevitable inequities. The burden of determining one's ability to operate a motor vehicle safely was left with the individual physician, who often had to defend a stand without adequate guidelines. In addition, the impaired driver was frequently not reported because of fear of liability and breach of confidentiality. Being aware of these deficiencies, the Medical Advisory Board (MAB) decided to develop a reasonable uniform standard to be applied in the state. The first step was to draft nonliability legislation. The second step was to draft Driver Impairment Profiles. Care has been taken to insure that functionally impaired drivers are granted driving privileges consistent with the fullest extent of their ability to operate a motor vehicle safely. The guidelines identify impairments that post unacceptable driving risks. Most important, the decision to allow operation of a motor vehicle is now shifted to the Division of Motor Vehicles (DMV), with the physician supplying the pertinent medical information on the reporting form.

Automobile Driver Examination↗
PubMedDate not supplied

Driving and epilepsy: changing the law in Maryland.

The Epilepsy Association of Maryland, an affiliate of the Epilepsy Foundation of America (EFA), recognized that the Maryland state regulations and laws on driving licensing restricted the rights of individuals with epilepsy. After identifying the problem, the Association determined the needed changes and planned a legislative strategy to accomplish the change. Once the change was achieved, the Association planned and executed steps necessary for successful implementation of the change.

Accidents, Traffic↗
PubMed2000

Should patients with psychogenic nonepileptic seizures be allowed to drive?

PURPOSE: To investigate the risk of driving accidents in patients with psychogenic nonepileptic seizures. METHODS: First, a survey was conducted in 82 physician-members of the American Epilepsy Society to determine what they recommend in patients with psychogenic seizures in regard to driving privileges. Second, we studied a population of 20 patients with proven psychogenic nonepileptic seizures diagnosed by prolonged EEG-video monitoring. We obtained the patients' driving records from the Wisconsin Department of Transportation. We used 1991 Wisconsin crash data as the reference year. We compared the expected number of motor vehicle crashes with the observed number of crashes. chi2 with Yates' correction for continuity was used to test for statistical significance. RESULTS: Of the 82 physicians questioned, 37 (45%) responded. Among respondents, the distribution was as follows: 49% applied the same restrictions as for patients with epilepsy; 32% did not place patients under any restrictions; and 19% decided on a case-by-case basis. The total number of reported crashes in the sample was eight, with no fatal crashes. This was not statistically significant (corrected chi2, 0.53) compared with the expected number of motor vehicle crashes for the sample. CONCLUSIONS: This small series does not support the use of driving restrictions for patients with psychogenic nonepileptic seizures.

Accidents, Traffic↗
PubMed1992

Driving in Alzheimer's disease.

OBJECTIVE: To determine if the impaired mental skills in Alzheimer's Disease (AD) may adversely affect driving ability. DESIGN: Retrospective survey. SETTING: The Alzheimer's Clinic of the University of Kansas Medical Center. PATIENTS: We interviewed 67 AD patients and their families and compared them with 100 elderly, non-spousal controls. MEASURES: The questionnaire was designed to obtain information on their driving habits, with emphasis placed on whether they were still driving, and the number of accidents per year for the past 10 years. RESULTS: Forty-six of the AD subjects had stopped driving because of safety concerns expressed by the subjects, their families, or health care providers, and two had stopped for other reasons. Only two of the normal controls had stopped driving (P < 0.0001, Chi-square test). Over the past 3 years, the 19 AD subjects who were still driving had 263.2 motor vehicle accidents per million vehicle miles of travel compared with 14.3 for the controls (P < 0.002, Mann-Whitney U test) and 5.7 for the general driving population age > or = 55 years (P < 0.05, Students one group, two-tailed t test). CONCLUSION: This study suggests that a significant traffic safety problem exists in subjects with AD who continue to drive. Efforts should be directed to detect patients with AD whose driving presents a traffic safety problem.

Accidents, Traffic↗
PubMed1992

The effect of age on driving skills.

OBJECTIVE: To assess the effect of age on driving skills independent of the limitations related to disease or dementia. DESIGN: Prospective comparison of driving skills across three age groups. SETTING: A university-based research study of student and university-affiliated volunteers. PARTICIPANTS: Healthy elderly (age 65+), teen-age (age 18-19), and young adult drivers (age 25-35). Twenty subjects in each age group were recruited after meeting entry criteria for the study. MAIN OUTCOME MEASURES: Total error count and score on the Miller Road Test, a standardized road test developed by the Division of Bus and Traffic Safety in North Carolina. RESULTS: The elderly were found to have fewer errors than either of the two younger groups of drivers (P = 0.0013). Specific driving skills were judged to be either superior or unchanged in the elderly subjects in comparison to their younger counterparts. CONCLUSIONS: Road test skills appear to be well preserved in the healthy elderly population. More road test studies are needed on elderly individuals with mental and physical impairments to determine if road tests can play a role in identifying the driver at high risk for a crash.

Adolescent↗
PubMed2000

Knowledge, attitudes, and practices of geriatricians regarding patients with dementia who are potentially dangerous automobile drivers: a national survey.

OBJECTIVES: To determine geriatrician knowledge regarding how to prevent a patient with dementia who is a potentially dangerous driver from driving and to determine their willingness to recommend license revocation against the wishes of both the patient and the patient's family. Included is a comparison of responses from geriatricians in California, where related legislation has existed for a decade, with responses from geriatricians from all other US states combined. DESIGN: Survey sample. SETTING: Geriatric practices. PARTICIPANTS: Probability sample of 467 geriatricians. MAIN OUTCOME MEASURES: Survey responses. RESULTS: More than 28% of all geriatricians (95% CI, 24.3%-32.7%) do not know how to report patients with dementia who are potentially dangerous drivers. A 22% difference (95% CI, 13.9%-30.8%) exists between California geriatricians and those in all other US states. More than 75% (95%, CI, 71.5%-79.5%) of all geriatricians agreed that physicians are responsible for reporting patients. More than 86% (95% CI, 83.2%-89.6%) of all geriatricians would contact state authorities despite the objections of the patient, and 72.9% (95% CI, 68.7%-77.1%) would contact authorities despite the objections of the patient's family. CONCLUSIONS: Although most geriatricians will act to protect the public from patients with dementia who are potentially dangerous drivers, many do not know how to report these drivers. Legislation can improve a physician's ability to report patients with dementia who are potentially dangerous drivers.

Accidents, Traffic↗