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PubMed2006

The assessment of fitness to drive in people with dementia.

OBJECTIVE: To determine whether cognitive tests predict fitness to drive in patients with dementia. DESIGN: Two group comparison of patients with dementia and healthy elderly volunteers, and comparison of patients with dementia who were found safe to drive and those found unsafe, followed by a validation study. PARTICIPANTS: Forty-two people with dementia and 33 healthy elderly volunteers with no known memory problems who were driving. Of the 42 people with dementia 37 were assessed on the road. A second sample of 17 people with dementia was also assessed on the road. MAIN MEASURES: Stroke Drivers Screening Assessment, Mini Mental State Examination, Salford Objective Recognition Test, Stroop Test, Test of Everyday Attention, Visual Object and Space Perception Battery, Behavioural Assessment of the Dysexecutive Syndrome, Adult Memory and Information Processing Battery. RESULTS: All healthy elderly volunteers were safe to drive but 10 of the 27 patients with dementia were unsafe. Discriminant function analysis identified a combination of tests, which correctly classified 92% of drivers with dementia as safe or unsafe. Validation of this prediction on an independent sample had 59% accuracy using a cut-off of 0 but 88% accuracy using a cut-off of 5. CONCLUSIONS: Safety to drive in people with dementia could be predicted from a combination of six cognitive tests. These correctly identified 67% of safe drivers in a validation sample. This assessment could be used to identify those who need evaluation of their safety on the road.

Aged↗

PubMed2006

Effect of chronic nonmalignant pain on highway driving performance.

Most pain patients are treated in an outpatient setting and are engaged in daily activities including driving. Since several studies showed that cognitive functioning may be impaired in chronic nonmalignant pain, the question arises whether or not chronic nonmalignant pain affects driving performance. Therefore, the objective of the present study was to determine the effects of chronic nonmalignant pain on actual highway driving performance during normal traffic. Fourteen patients with chronic nonmalignant pain and 14 healthy controls, matched on age, educational level, and driving experience, participated in the study. Participants performed a standardized on-the-road driving test during normal traffic, on a primary highway. The primary parameter of the driving test is the Standard Deviation of Lateral Position (SDLP). In addition, driving-related skills (tracking, divided attention, and memory) were examined in the laboratory. Subjective assessments, such as pain intensity, and subjective driving quality, were rated on visual analogue scales. The results demonstrated that a subset of chronic nonmalignant pain patients had SDLPs that were higher than the matched healthy controls, indicating worse highway driving performance. Overall, there was a statistically significant difference in highway driving performance between the groups. Further, chronic nonmalignant pain patients rated their subjective driving quality to be normal, although their ratings were significantly lower than those of the healthy controls. No significant effects were found on the laboratory tests.

Adult↗

PubMed1998

Predicting ability to drive after stroke.

OBJECTIVE: To determine the ability of perceptual testing to predict on-road driving outcome in subjects with stroke. STUDY DESIGN: Historical cohort study of 84 individuals with stroke who completed both the perceptual testing and the on-road driving evaluation conducted in a driving evaluation service. MEASURES: Perceptual tests, such as the Motor Free Visual Perception Test (MVPT) and Trail Making B test, and an on-road driving evaluation. Based on driving behaviors, a pass or fail outcome was determined by the examiners. RESULTS: Subjects who passed the on-road evaluation had better average scores on the majority of perceptual tests compared with those who failed. The MVPT was the most predictive of on-road performance (positive predictive value=86.1%; negative predictive value=58.3%). The combination of tests resulting in the most predictive and parsimonious model was the MVPT plus Trail Making B, such that those who scored poorly on both were 22 times more likely to fail the on-road evaluation. CONCLUSION: A screening process is useful in identifying persons who are not ready to undergo an on-road driving evaluation.

Adult↗

PubMed1983

Driver casualties in Victoria (1978-1980). Predominant influences of driver inexperience and alcohol.

The driving experience and blood alcohol profiles of motor vehicle driver casualties in Victoria for the period 1978-1980 were examined. Drivers with less than five years' experience were markedly over-represented among the casualties. There was a progressive and marked decline in the number of driver casualties between each of the first five years of driving experience. First-year probationary drivers had three times the casualty involvement of drivers with five years' experience. Probationary licensed drivers, who hold approximately 13% of licenses, accounted for 28% of driver casualties. Blood alcohol levels in excess of the legal limit of 11 mmol/L (0.05 g/100 mL) were more frequent in probationary drivers than in fully licensed drivers (30.4%, compared with 24.4% in fully licensed drivers). These findings, in conjunction with the known impairment of driving skills caused even by blood alcohol levels lower than the legal limit, lead us to recommend that legislation should be enacted making it an offence for probationary license holders to drive a motor vehicle after the ingestion of alcohol. In addition, educational programmes about high-risk accident situations and the alcohol problem on the road should be instituted as an integral part of training before a driving license is issued.

Accidents, Traffic↗

PubMed2007

Perception, attitudes and beliefs, and openness to change: implications for older driver education.

With a rapidly aging population, strategies for improving driver safety are beginning to emerge that focus on changing driving behaviors and knowledge. We examined the perceptions of risk, beliefs and attitudes, and openness to change of 86 older participants voluntarily attending a driver education program. It appeared that most people attending these sessions were not necessarily concerned about their own driving, safety or abilities, but were interested in maintaining mobility. They were conservative and reasonably consistent in their attitudes toward traffic regulations and safe driving practices. Some gender differences emerged with more men than women being resistant to changing their driving habits, more men than women reporting that they drive after consuming alcohol and more women than men identifying a role for their families in decision-making regarding driving cessation. This suggests that educational material may need to be targeted differently for men and women. It is anticipated that psychosocial factors related to driving such as driver perception, beliefs and openness to change will be useful for maximizing the fit between education program content and outcomes.

Age Factors↗

PubMed1991

Attention and driving skills in aging and Alzheimer's disease.

The number of older drivers with dementia is rising with the aging of the adult population. A public health issue is growing because of concerns about the motor vehicle accident risk posed by drivers with dementia of the Alzheimer's type (DAT) and other progressive, degenerative dementias. However, little is known about the specific perceptual/cognitive deficits contributing to impaired driving in DAT. The present paper proposes, on both theoretical and empirical grounds, that attentional skills in relation to driving should be examined in older adults with and without DAT. Such investigations should focus on normal older adults and those in the mild, early stages of dementia because the latter are the most likely among the dementia population to be still driving. Evidence is presented indicating (1) that motor vehicle accident rates are related to performance on information-processing measures of different components of attention; (2) that this relationship is greatest for measures of the switching of selective attention and less for that of divided and sustained attention (vigilance); and (3) that many of these same attentional functions, and particularly the switching of visual selective attention, are impaired in the early stages of DAT and thus may contribute to increased accident risk. Further studies of cognitive and driving performance in older drivers are necessary to establish that the attentional impairments found in mild DAT contribute to increased accident risk. Implications of these findings for driver assessment, education, and training are discussed.

Age Factors↗

PubMed1985

Teenage driver licensing in relation to state laws.

Previous studies have shown that delaying licensure reduces motor vehicle injuries. This study examined the relationship between licensing laws and the timing of obtaining drivers licenses. The states studied have various laws, including minimum licensing ages of 15, 16 and 17; minimum learners permit ages of 15 and 16; and teenage night driving curfews. A questionnaire survey of 52,304 students was conducted in 75 high schools during the spring of 1983. The schools were selected from Orange County, California; rural Colorado; and most or all of Louisiana, Michigan, Mississippi, New Jersey and New York. The results indicated that the minimum age of licensure has obvious strong effects in delaying licensure. Setting the learners permit age later also apparently delays licensure. The night driving curfew in New York State (9 p.m.-5 a.m.) is seen by students as a factor in their decisions to delay obtaining licenses; Louisiana's 11 p.m.-5 a.m. curfew has a much smaller effect, if any.

Accidents, Traffic↗

PubMed1992

Driving evaluation after traumatic brain injury.

Traumatic closed head injury results in a variety of cognitive and behavioral deficits that may be difficult to assess fully. Adequately evaluating driving safety is a common and important problem for health care professionals. The purpose of this study was to examine the relationship between standardized measures of cognitive function and measures of driving performance in patients with closed head injuries and in their age-matched relative or friend cohorts. Thirteen patients were evaluated. They had each sustained a closed head injury (followed by more than 1 h of coma) 3 to 6 months before testing. Their scores were analyzed along with those of seven cohorts. Assessments of cognitive function and behind-the-wheel driving performance were conducted by examiners blinded to subjects' group membership and medical condition. There was a significant relationship (r = 0.44) between the sum of rated scores of the Tactual Performance Test and Trail Making Test and the global pass/fail ratings of the behind-the-wheel driving test, but it was not related to the driving performance score. The difference between the verbal and performance IQs, and the difference between the block design and other performance tests of the Wechsler Adult Intelligence Scale-Revised were also not significantly related to driving performance. These results suggest that tests of cognitive function alone are not adequate to predict driving performance, and should be used along with standardized driving performance evaluations before recommendations are made.

Adolescent↗

PubMed2006

Practicing in relation to the outcome of the driving test.

In Sweden, a written and a driving test must be passed for licensure, and these two examinations are the only means of verifying that learner drivers have acquired the competencies stipulated in the national curriculum. The present study investigated 18-24-year olds regarding the effects of personal background and mode of driver education instruction on the outcome of the driving test. This was done by analysing the following for individual subjects: data on practicing obtained using a questionnaire, and test results of license tests. The results suggest that among the candidates under study, there are equal opportunities in the context of obtaining a driver's license independent of a person's background. The rate of passing was higher for those who started behind-the-wheel training at 16 and applied to take the driving test via a driving school, than for those who started the training at an older age and applied to take the test in person. It was also found that the probability of passing the test was greater if there is successful cooperation between learner and driving school instructor, and if a large proportion of the training been devoted to the task speed adaptation.

Adolescent↗

PubMed2002

[Driving capacity of diabetics against the background of legal principles].

Within the conversion of the 2nd Council Directive on Driving Licences of the Council of the European Communities (91/439/EEC) into national law, changes became necessary to the Road Traffic Act (StVG) and a new Driving Licence Ordinance (FeV) was created which has been in force since 01.01.1999 (Federal Law Gazette, 1998, Part I No. 55, 26. August 1998). Both in Annex III of the EC Directive and in Annex 4 of the Driving Licence Ordinance, statements are made with regard to the driving capability of diabetics. Besides this legal basis for evaluating capacity to drive a motor vehicle, the appraisal guidelines (Begutachtungs-Leitlinien zur Kraftfahrereignung) established in commission of the German Federal Ministry of Transport, Building and Housing are to be understood as a set of rules which are outside the framework of actual legal statute as such and which are intended to support assessors in making decisions in individual cases. When considering whether an appraisal of driving capacity has to take place, in particular a difference is made between the different classes of vehicle. For motor cycles and passenger cars (Classes A and B), it will also be the case in future that a medical examination will only be ordered if there is a specific reason. Apart from this, only a sight test is necessary, as has been the practice up to now. In the case of lorries and buses (Classes C and D) and the licence for transportation of passengers (on a commercial basis) there will be an initial appraisal, as has also been the case up to now, and there will also be repeat appraisals. This is new for Class C, where up to the present there has only been an initial appraisal. The basic principle which applies is that the driving licence authority has the duty to instigate appraisal of the driving capacity of an applicant for a driving licence or of the holder of a driving licence if there is justified doubt about the driving capacity of the person concerned.

Automobile Driver Examination↗

PubMed2005

[Driving habits of patients with glaucoma].

BACKGROUND: Central visual field defects due to glaucoma are common, increasing with old age. Impaired visual processing, for instance caused by glaucoma, may play a role in the aetiology of car accidents involving older drivers which can result in personal injury. Mandatory eye exams with assessment of the visual field in elderly people holding a driving licence will become more and more important, especially in a continuously ageing and increasingly mobile population. MATERIALS AND METHODS: In this prospective study, 80 patients with overt glaucoma and 52 patients without glaucoma, all holders of a valid driving licence, were enrolled. For each patient, the best corrected visual acuity was recorded and an examination of the central visual field was performed with automatic perimetry. In addition, a detailed questionnaire about the current driving habits of the patient was requested. RESULTS: In summary, 29 patients (36 %; 95 % CI: 26 - 48 %) of 80 glaucoma patients were driving a motor vehicle with binocular congruent scotomata within the central 30 degrees visual field, which is not sufficient to meet current legal requirements in Austria. In addition, 3 out of 29 impaired patients had a visual acuity that was below the mandatory legal requirements. A total of 39 patients (49 %; 95 % CI: 37 - 60 %) of the glaucoma patients fulfilled legal requirements. Examination of these patients showed only monocular or binocular central visual field defects that were not congruent. However, 12 (15 %; 95 % CI: 8 - 25 %) patients were holders of a valid driving licence, but had stopped driving some time ago. Based on the prevalence of glaucoma and the number of driving licence holders, the projected number of actively driving glaucoma patients who do not meet the legal requirements regarding the visual field is probably around 15,400 (7,400 - 29,500) in Austria and around 163,500 (79,000 - 313,500) in Germany. CONCLUSIONS: Time limits for the validity of the driving licence within the European Community have been set. In addition, the legal requirements for driving a motor vehicle should also be clearly defined, especially the requirements regarding the visual field and the acceptable dimensions of central scotomata. In addition, a mandatory eye exam for older drivers to be performed by ophthalmologists should be considered in order to detect persons posing a safety risk in traffic.

Adolescent↗

PubMed2006

Impact of Georgia's Teenage and Adult Driver Responsibility Act.

STUDY OBJECTIVE: In 1997, the Georgia General Assembly enacted the Teenage and Adult Drivers Responsibility Act (TADRA), a comprehensive legislative package that attempted to reduce fatal crashes of teenaged drivers by introducing graduated driver's licensing, "zero tolerance" of underage impaired drivers, and automatic license revocation for speeding greater than 25 miles per hour over the posted limit and other dangerous driving behaviors. To determine whether TADRA reduced teen driving fatalities, we examine fatal crash rates involving various age groups before versus after the law was enacted. METHODS: Data from the Fatal Accident Reporting System were used to calculate annualized fatal crash rates of various age groups of drivers during an 11-year interval 5 1/2 years before TADRA was enacted and 5 1/2 years afterwards. To identify potential historical effects, Georgia's experience was compared to that of Alabama, South Carolina, and Tennessee, states that did not adopt equally comprehensive legislation during the study period. RESULTS: During the preenactment period, 317 Georgia drivers aged 16 were involved in a fatal crash (57/100,000 person-years) compared to 230 in the postenactment period (36/100,000 person-years; risk ratio [RR] 0.63; 95% confidence interval 0.53 to 0.75). Speed-related fatal crashes were cut by 42%, and alcohol-related fatal crashes decreased nearly 60%, without displacing fatal crashes to older age groups. These reductions greatly exceeded those noted in 2 of 3 comparison states and the nation overall. CONCLUSION: TADRA markedly reduced fatal crash rates among 16-year-old Georgia drivers. Fatal crashes were not displaced to older age groups.

Accidents, Traffic↗

PubMed1998

How good are we at assessing driving visual fields in diabetics?

PURPOSE/BACKGROUND: Following laser panretinal photocoagulation (PRP) for proliferative diabetic retinopathy, patients are at risk of failing the UK driving visual field test due to loss of peripheral field. Although a definition of the minimum field requirement exists, differences in its interpretation may influence whether fields pass or fail. Currently it is not known how fields are interpreted in practice nor to what extent this affects failure rates. METHODS: Uniocular and binocular Esterman visual fields from 60 diabetic patients following PRP were examined both by the chairman of the Visual Standards Sub-Committee of the Royal College of Ophthalmologists and separately by four consultant ophthalmologists. The results were analysed (1) to assess the extent of agreement and (2) to identify, from the chairman's results, the field deficits that are still compatible with passing. RESULTS: Agreement was generally good for binocular fields but was only moderate for uniocular fields. In up to 15% of binocular fields and 43% of uniocular fields the chairman's decision was different from that of the consultants. Several key aspects of the field that influence a pass/fail decision are identified. CONCLUSIONS: Substantial differences in the assessment of driving visual fields following RPR currently exist between consultants and the chairman of the Visual Standards Sub-Committee. Using the information presented here to guide assessment it is now possible to reduce this variation.

Automobile Driver Examination↗

PubMed2004

The use of a cognitive battery to predict who will fail an on-road driving test.

OBJECTIVES: There is a growing need to find a valid and reliable neuropsychological battery to screen out those people who are clearly unsafe to drive following brain injury or pathology, and thus alleviate the need to refer for an on-road assessment. DESIGN: A battery of cognitive tests fine-tuned for their relevance to driving was examined in terms of its sensitivity and specificity for predicting who would fail an on-road test following brain injury or pathology. METHOD: Performance on the battery was compared to the results of an on-road driving test in a consecutive series of 142 clients referred to a driving assessment centre following brain injury or pathology. The group represented diverse neurological conditions which affect brain functioning. RESULTS: The overall accuracy rate of the battery in predicting a fail on-road was 92% and in predicting a pass on road was 71%. It was more accurate for those under 70 with 100% accuracy in predicting a fail on-road and 85% accuracy in predicting a pass on-road, but less accurate for those aged 70 or above with 85% accuracy in predicting a fail on-road and 37% accuracy in predicting a pass on-road. CONCLUSION: The battery is a useful tool in helping to determine whether someone is safe to drive following brain injury but needs to be used with far more caution for the older driver.

Adult↗

PubMed1995

The New Zealand graduated driver licensing system: teenagers' attitudes towards and experiences with this car driver licensing system.

OBJECTIVES: This study examined the attitudes of teenagers towards the New Zealand graduated driver licensing system (GDLS), and the extent to which it affected them. METHOD: Teenagers, who are members of a longitudinal study of a birth cohort, were interviewed at 15 years of age when the GDLS was first introduced and before they had begun licensure, and again at 18 years of age after they had experience with this licensing system. RESULTS: At both ages the majority (over 70%) agreed with the driving restrictions imposed by this system. After experience with the restrictions, however, significantly more reported being affected a lot by them, than had expected to be at age 15. This was especially true of the restrictions on the carrying of passengers and the night time curfew (10 pm - 5 am). However, few reported that they were affected by the alcohol restriction. Sixty eight per cent of those with a graduated licence reported breaking at least one of the conditions, most frequently carrying passengers. Very few were penalised by the police for this. CONCLUSIONS: Generally these young drivers were positively disposed towards the driving restrictions, but noncompliance was common. A full evaluation of all aspects of this licensing system is recommended.

Accidents, Traffic↗

PubMed2006

Prediction of driving after stroke: a prospective study.

BACKGROUND: The process of determining whether patients with stroke should drive again often involves off-road evaluations and road tests that usually take about 2 to 3 h to complete. OBJECTIVES: This prospective study sought to identify the combination of tests that best predicts fitness to drive after stroke. The main aim was to develop a short and predictive predriving assessment battery. METHODS: Sixty-eight consecutive stroke patients were studied who performed a mandatory predriving assessment at the Belgian Road Safety Institute, Brussels, within 18 months. Performance in a predriving assessment included medical examination (when needed), visual and neuropsychological evaluations, and an on-road test. Based on these assessments, a physician, psychologist, and the driving safety expert who administered the tests decided if a subject was either "fit to drive,""temporarily unfit to drive," or "unfit to drive." RESULTS: Logistic regression analysis revealed a combination of visual neglect, figure of Rey, and on-road tests as the model that best predicted (R(2) = 0.73) fitness to drive after stroke. Using a discriminant function that included the 3 tests of the logistic model, the fitness to drive judgments of 59 (86.8%) subjects were correctly predicted. The sensitivity and specificity of the predictions were 79.4% and 94.1%, respectively. CONCLUSION: Fitness to drive after stroke can be predicted from performance on a few road-related tests with a high degree of accuracy. However, some individuals require extended assessments and further tests.

Adult↗

PubMed2000

Relation of useful field of view and other screening tests to on-road driving performance.

The purpose of this study was to examine the value of a clinical driving assessment battery in predicting performance on an on-road driving test. 43 participants referred to the Bryn Mawr Rehab Adapted Driving Program for evaluation of driving ability underwent an evaluation consisting of a predriver screening and an on road driving test. The predriver screening included a vision screening, a reaction rime task, a split-attention task, the Hooper Visual Organization Test, verbal and symbolic sign recognition, and assessment of Useful Field of View. Logistic regression analyses were applied to identify which predriver screening variables could be used to predict outcome on the on road driving test (pass/fail); UFOV was that best single predictor. The addition of screening tests beyond UFOV alone did not increase predictive validity. These findings suggest that UFOV may serve as an indicator of the need for further driving assessment.

Age Factors↗

PubMed2005

Neuropsychological deficits associated with driving performance in Parkinson's and Alzheimer's disease.

Neuropsychological and motor deficits in Parkinson's disease that may contribute to driving impairment were examined in a cohort study comparing patients with Parkinson's disease (PD) to patients with Alzheimer's disease (AD) and to healthy elderly controls. Nondemented individuals with Parkinson's disease [Hoehn & Yahr (H&Y) stage I-III], patients with Alzheimer's disease [Clinical Demetia Rating scale (CDR) range 0-1], and elderly controls, who were actively driving, completed a neuropsychological battery and a standardized road test administered by a professional driving instructor. On-road driving ability was rated on number of driving errors and a global rating of safe, marginal, or unsafe. Overall, Alzheimer's patients were more impaired drivers than Parkinson's patients. Parkinson's patients distinguished themselves from other drivers by a head-turning deficiency. Drivers with neuropsychological impairment were more likely to be unsafe drivers in both disease groups compared to controls. Compared to controls, unsafe drivers with Alzheimer's disease were impaired across all neuropsychological measures except finger tapping. Driving performance in Parkinson's patients was related to disease severity (H&Y), neuropsychological measures [Rey Osterreith Complex Figure (ROCF), Trails B, Hopkins Verbal List Learning Test (HVLT)-delay], and specific motor symptoms (axial rigidity, postural instability), but not to the Unified Parkinson Disease Rating Scale (UPDRS) motor score. Multifactorial measures (ROCF, Trails B) were useful in distinguishing safe from unsafe drivers in both patient groups.

Accidents, Traffic↗