Transport, driving and ageing

Understanding the relationship between eye disease and driving in very old Australian women: a longitudinal thematic evaluation

Background

Over recent decades an increasing number of adults will retain their driver’s licenses well into their later years. The aim of this study was to understand and explore the experience of driving and driving cessation in very old Australian women with self-reported eye disease.

Methods

An interpretative qualitative study. Participants were from the Australian Longitudinal Study on Women’s Health (cohort born in 1921–26), a sample broadly representative of similarly aged Australian women. Responses to open-ended questions were analysed using an inductive thematic approach, employing a process of constant comparison.

Results

Qualitative data were from 216 older women with eye disease who made 2199 comments about driving, aged between 70 and 90 years depending on the timing of their comments. Themes included: (1) Access to treatment for eye disease promotes driving independence and quality of life; (2) Driving with restrictions for eye disease enables community engagement and (3) Driving cessation due to poor vision leads to significant lifestyle changes.

Conclusions

Key findings highlighted driving cessation, or reduction, is often attributed to deterioration in vision. The consequence is dependence on others for transport, typically children and friends. Access to successful treatment for eye disease allowed older women to continue driving. We posit that occupational therapists can play an essential role in promote driving confidence and ability as women age.

Trial registration: Not applicable.

Development of an Android-Based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) App: Mixed Methods Study

Background

Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, a paper-based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR through an Android app, which provides the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity.

Objective

This study tested the validity and reliability of a mobile app-based version of a self-report assessment for elderly persons contextualized to the South Korean culture and compared it with a paper-based test.

Methods

In this mixed methods study, we recruited and interviewed 567 elderly drivers (aged 65 years and older) between August 2018 and May 2019. For participants who provided consent, the app-based test was repeated after 2 weeks and an additional paper-based test (Driver 65 Plus test) was administered. Using the collected data, we analyzed the reliability and validity of the app-based SAFE-DR. The internal consistency of provisional items in each subdomain of the SAFE-DR and the test-retest stability were analyzed to examine reliability. Exploratory factor analysis was performed to examine the validity of the subdomain configuration. To verify the appropriateness of using an app-based test for older drivers possibly unfamiliar with mobile technology, the correlation between the results of the SAFE-DR app and the paper-based offline test was also analyzed.

Results

In the reliability analysis, Cronbach α for all items was 0.975 and the correlation of each item with the overall score ranged from r=0.520 to r=0.823; 4 items with low correlations were removed from each of the subdomains. In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing very high reliability. Exploratory factor analysis on 40 of the 44 items established 5 subdomains: on-road (8 items), coping (16 items), cognitive functions (5 items), general conditions (8 items), and medical health (3 items). A very strong negative correlation of –0.864 was observed between the total score for the app-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The app-based test was found to be reliable.

Conclusions

In this study, we developed an app-based self-report assessment tool for elderly drivers and tested its reliability and validity. This app can help elderly individuals easily assess their own driving skills. Therefore, this assessment can be used to educate drivers and for preventive screening for elderly drivers who want to renew their driver’s licenses in South Korea. In addition, the app can contribute to safe driving among elderly drivers.

Driving difficulties in patients with axial spondyloarthritis: Results from the Scotland Registry for Ankylosing Spondylitis

OBJECTIVES

To describe the driving difficulties experienced by individuals with axial spondyloarthritis (axSpA), and characterise associated clinical and sociodemographic features, and impact on work.

METHOD

The Scotland Registry for Ankylosing Spondylitis (SIRAS) is a cohort study of patients with a clinical diagnosis of axSpA. Baseline information was collected on clinical and patient-reported measures, and work participation measures (Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI: SHP)). Patient-rated difficulties with nine driving tasks were used in a factor analysis, and relationships between driving difficulty and work participation investigated.

RESULTS

718 patients provided data for analysis, of which 642 (89%) had some difficulty with at least one driving task and 72 (10%) had some difficulty with all nine tasks. Three domains of driving difficulty were identified: dynamic driving scenarios, crossing traffic, and the physical act of driving. Chronic widespread pain, knee and back pain, fatigue, high disease activity and anxiety/depression were significantly associated with reporting driving difficulties across all three domains, particularly the physical act of driving. After adjusting for socio-demographic, disease activity, physical and mental health, driving difficulties in each domain were associated with a 2-3 times increased likelihood of restricted work productivity and with an increased risk of sickness absence in the past seven days.

CONCLUSION

Driving difficulties are common in individuals with axSpA and impact on work, even after adjusting for clinical status. Improving understanding and awareness of driving disability will help direct advice and resources to enable individuals to remain independent and economically active.

Perceptions and attitudes toward risk and personal responsibility in the context of medical fitness to drive

Objective: Although there is a considerable body of literature probing the knowledge and awareness of doctors of guidelines on medical fitness to drive, little is known of knowledge and awareness of such guidelines among the general public. We investigated awareness, perceptions and attitudes among a range of adults toward risk and personal responsibility in the context of medical fitness to drive.Methods: This quasi-experimental between groups study assessed response differences between healthcare (33%) and non-healthcare professionals. Five hundred and fourteen adults (f = 342) completed a 15-item online survey, which assessed their license status, direct and secondhand experience with key medical conditions, perceptions of risk, driving intentions if advised to stop driving by a doctor and beliefs about responsibility for ensuring driver fitness.Results: Most of the participants had a driver license. Although the majority (87%) had no first-hand experience with key medical conditions contained in the Irish medical fitness to drive guidelines, two-thirds knew someone with at least one of these conditions. No participant admitted to an alcohol or drug misuse/dependence problem. Alcohol misuse/dependence and fatigue/chronic sleep loss were perceived as the greatest crash risk for drivers and for vulnerable road users. Risk perceptions in general public and the medical professionals were similar for most conditions but where they differed, the medical professionals perceived lower risk. Most respondents indicated that they would cease driving immediately if advised by their doctor for temporary and long-term conditions. No effects of age, gender, experience with medical conditions or professional status were noted on perceived intentions to cease driving. Perceptions about who is responsible for ensuring people are fit to drive fell into two categories. Drivers were perceived as chiefly responsible where alcohol, non-prescription drugs, fatigue and age were factors and doctors were identified as responsible in cases of diabetes, epilepsy, stroke, heart conditions and physical disabilities.Conclusions: These results suggest that more needs to be done to raise awareness of the risks posed by medical and other factors that reduce driver capability and also about drivers' responsibility to ensure that they are fit to drive and thus improve road safety.

Driving as a Travel Option for Older Adults: Findings From the Irish Longitudinal Study on Aging

The role of transport in the health and wellbeing of older people is increasingly recognized: driving is the main form of personal transportation across the adult life-span. Patterns of changed mobility and driving cessation are an important focus of research. We investigated cross-sectional changes in driving as the main form of transportation and the frequency of such driving. The impact of Gender and Marital Status on Driver Status was also examined along with the reasons cited for ceasing driving. The impact that Driver Status had on Quality of Life and Loneliness was also assessed. Questionnaire based data from the Irish longitudinal study on aging (TILDA), a stratified clustered sample of 8163 individuals representative of the community dwelling population aged 50 years and over between 2009 and 2011 were examined. Driving oneself was identified by 76.1% as their most frequently used form of transport. Only for 80+ participants in Rural and Urban non-Dublin was it the second most popular option, being replaced by Being driven by someone else. Less women identified Driving oneself as their most frequently used option and they experienced an almost linear decline in uptake with Age. The uptake reported by men remained high up to 69 and only after this point did it begin to decline. A greater proportion of men were Current drivers with a similar pattern being shown by women in relation to Never drivers. Irrespective of Gender, married participants were more likely to drive. A greater proportion of women cited a reason other than health for giving up driving. Three reasons for giving up were impacted by Age category of which Physical incapacity was not one. Driving status impacted positively on Quality of Life and Loneliness. The results are discussed in light of the advantages to society of older drivers continuing to drive.

Implementation and evaluation of a driving cessation intervention to improve community mobility and wellbeing outcomes for people living with dementia: study protocol of the 'CarFreeMe' for people with dementia program

Background

Giving up driving is a pivotal life event and universal challenge for people living with dementia and their families, and a complex area of clinical practice for health professionals who monitor driving cessation. The best outcomes are for individuals to plan for and eventually cease driving, however with insufficient support programs in place, many avoid the issue until it is reaches a crisis point. This program of research investigates a comprehensive support- and education-based intervention targeted at people living with dementia and their care partners who are managing driving cessation. The primary aim of this research is to determine the effectiveness of the program through a cluster randomized controlled trial.

Methods/design

The intervention (CarFreeMe) is an intensive program delivered by a trained health professional that addresses practical and emotional needs relevant to driving cessation. The seven module program is person-centred, covering awareness raising, adjustment, and practical support that is individualized according to geographic location and the particular goals and preferences of participants. A cluster randomized controlled trial will evaluate the effectiveness of the program. Evaluation will take place pre-intervention, immediately following, and three months post-intervention. Clusters are randomized to either intervention or usual treatment. Participants within clusters will be recruited via primary and secondary care clinics, community agencies, service providers, local media, social media, support groups, and word of mouth. The primary outcome measure for persons with dementia and their care partners is lifespace, collected via (i) smartphone GPS technology and (ii) self-reported number of episodes away from home (during the past week). Secondary outcomes include safe alternative transport status, wellbeing, depression, anxiety, and self-efficacy, which will be collected from dyads. Caregiving strain will be collected from care partner/family member only. A process evaluation of the intervention will also be undertaken.

Discussion

There is an urgent need for therapeutic approaches to supporting people living with dementia and their families to negotiate the complex decision making involved in deciding to change their approach to driving. The driving cessation intervention may fill an important gap in service delivery to people living with dementia who are adjusting to life without driving.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12618000388213, 15 March 2018.

Tackling Societal Challenges Related to Ageing and Transport Transition: An Introduction to Philosophical Principles of Causation Adapted to the Biopsychosocial Model

In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be addressed at different levels by adapting medication, improving physical health, modifying behaviour, adapting lifestyle, or bringing changes to the environment. This transdisciplinary approach requires an understanding of how different disciplines are linked to each other. This article reviews the philosophical principles of causality between fields and provides a framework for understanding causality within the biopsychosocial model. Understanding interlevel constraints should help practitioners overcome their differences, and favor transversal approaches to driving cessation.