Automobile driving in older adults: factors affecting driving restriction in men and women

Evaluation of Psychophysical Fitness in Drivers over 65 Years of Age

BACKGROUND

The deterioration of cognitive and psychophysical ability associated with aging has an effect on road safety, especially in the driving of vehicles. The current study's main objective is to evaluate the psychophysical aptitudes in drivers over 65 years of age in a sample of drivers in Spain.

METHODS

The sample was formed of a total of 1663 drivers who attended a Driver Recognition Center. The evaluation of their psychophysical aptitudes was carried out following the Medical-Psychological Exploration Protocol for Driver Recognition Centers, edited by the Ministry of Health and the General Directorate of Traffic.

RESULTS

The results show increased restrictions in the evaluation of driving ability with age, which are especially significant after 75 years of age. Regarding sex, 70.1% of women have an approved evaluation, compared to men aged between 65-69, although from 69 onwards, the percentage of approved women decreases significantly. The loss of visual capabilities and poor performance in psycho-technical tests are the main causes associated with an evaluation with restrictions, with the number of restrictive conditions increasing with age.

CONCLUSIONS

There is an increase in the number of cases with age-related restrictions, especially in the case of women and ophthalmologic-related problems, although the majority of drivers over 65 years old continue driving, thus continuing with a practice that has been related to the well-being and quality of life of older adults.

On the importance of working memory in the driving safety field: A systematic review

In recent years, many studies have used poor cognitive functions to explain risk safety differences among drivers. Working memory is a cognitive function with information storage and attentional control that plays a crucial role in driver information processing. Furthermore, it is inextricably linked to parameters such as driving performance, driving eye movements and driving neurophysiology, which have a significant impact on drivers' risky behavior and crash risk. In particular, crash risk is a serious risk to social safety and economic development. For this reason, it is necessary to understand how risk-related working memory affects driving so that pre-driving safety pre-training programs and in-vehicle safety assistance systems for driving can be developed accordingly, contributing to the development of semi-autonomous vehicles and even autonomous vehicles. In this paper, a systematic search of the literature over the past 23 years resulted in 78 articles that met the eligibility criteria and quality assessment. The results show that higher working memory capacity, as measured neuropsychologically, is associated with more consistent and safer driving-related parameters for drivers (e.g., lane keeping) and may be related to pupil dilation during risk perception while driving, which is associated with driving outcomes (tickets, pull-overs, penalty points and fines,and driving accidents) is closely related to the perceived usefulness of the human-machine interface, reaction time, standard deviation of steering wheel corners, etc. when the autonomous driving takes over. In addition, higher working memory load interference was associated with more inconsistent and unsafe driving-related parameters (including but not limited to eye movements, electrophysiology, etc.), with higher working memory load being associated with easier driver concentration on the road, faster heart rate, lower heart rate variability, and lower oxyhemoglobin (OxyHb) and deoxyhemoglobin (DeoxyHb). Only a limited number of studies have simultaneously investigated the relationship between working memory capacity, working memory load and driving, showing an interaction between working memory capacity and working memory load on lane change initiation and lane change correctness, with working memory capacity acting as a covariate that mediated the effect of working memory load on braking reaction time. In addition, working memory-related cognitive training had a transfer effect on improving driving ability. Overall, working memory capacity determines the upper limit of the number of working memory attention resources, while working memory load occupies part of the working memory attention resources, thus influencing information perception, decision judgment, operational response, and collision avoidance in driving. Future effective interventions for safe driving can be combined with capacity training and load alerting. These findings contribute to our understanding of the role of working memory in driving and provide new insights into the design of driver safety training programs and automated driving personalized in-vehicle safety systems and roadside devices such as signage.

Association between car driving and successful ageing. A cross sectional study on the "S.AGES" cohort

BACKGROUND

Assessing successful ageing (SA) is essential to identify modifiable factors in order to enforce health promotion and prevention actions. SA comprises 3 dimensions: an active engagement with life, a low probability of disease and disease-related disability, and a high cognitive and physical functional capacity. Driving seems to be linked to SA as it is a mean to preserve social interactions and requires preserved functional and cognitive status. This study aims to investigate whether driving status can be considered a proxy of SA, by describing determinants associated with driving status in the 65+.

METHODS

This cross-sectional study is ancillary to the S.AGES (Sujets AGÉS-Aged Subjects) study, an observational prospective cohort study which included patients suffering from chronic pain, type-2 diabetes mellitus or atrial fibrillation from 2009 to 2014. SA was defined by the success of three dimensions: physiological comprised of comorbidity and autonomy scores, psychological comprised of cognitive status and emotional state, and a social dimension.

RESULTS

2,098 patients were included of whom 1,226 (58.4%) reported being drivers. 351/2,092 (16.7%) were classified as successful agers: 292/1,266 (23.8%) in the driver group vs. 59/872 (6.8%) in the non-driver group; p < .001. In the final logistic model, after adjustment for relevant variables, SA was associated with driver status OR 1.94 [1.36-2.77].

CONCLUSION

Driving may be considered as a proxy to SA: it reflects elders' independence, cognitive ability and a means to maintain social interactions. To preserve their mobility and enable them to achieve SA, regular screening of driving skills, specific rehabilitation programs are needed. Moreover development and communication on special transports services, communal rides or even driverless car to avoid apprehension around older adults driving could be solutions.

Factors Influencing Driving following DBS Surgery in Parkinson's Disease: A Single UK Centre Experience and Review of the Literature

Parkinson's disease (PD) is a complex neurodegenerative disorder, leading to impairment of various neurological faculties, including motor, planning, cognitivity, and executive functions. Motor- and non-motor symptoms of the disease may intensify a patient's restrictions to performing usual tasks of daily living, including driving. Deep Brain Stimulation (DBS) associated with optimized clinical treatment has been shown to improve quality of life, motor, and non-motor symptoms in PD. In most countries, there are no specific guidelines concerning minimum safety requirements and the timing of return to driving following DBS, leaving to the medical staff of individual DBS centres the responsibility to draw recommendations individually regarding patients' ability to drive after surgery. The aim of this study was to evaluate factors that might influence the ability to drive following DBS in the management of PD. A total of 125 patients were included. Clinical, epidemiological, neuropsychological, and surgical factors were evaluated. The mean follow-up time was 129.9 months. DBS improved motor and non-motor symptoms of PD. However, in general, patients were 2.8-fold less likely to drive in the postoperative period than prior to surgery. Among the PD characteristics, patients with the akinetic subtype presented a higher risk to lose their driving licence postoperatively. Furthermore, the presence of an abnormal postoperative neuropsychological evaluation was also associated with driving restriction following surgery. Our data indicate that restriction to drive following surgery seems to be multifactorial rather than a direct consequence of DBS itself. Our study sheds light on the urgent need for a standardised multidisciplinary postoperative evaluation to assess patients' ability to drive following DBS.

Association of falls and fear of falling with objectively-measured driving habits among older drivers: LongROAD study

OBJECTIVE

Falls in older adults are associated with increased motor vehicle crash risk, possibly mediated by driving behavior. We examined the relationship of falls and fear of falling (FOF) with subsequent objectively measured driving habits.

METHODS

This multi-site, prospective cohort study enrolled 2990 active drivers aged 65-79 (53% female). At enrollment, we assessed falls in the past year and FOF (Short Falls Efficacy Scale-International). Driving outcomes included exposure, avoidance of difficult conditions, and unsafe driving during one-year follow-up, using in-vehicle Global Positioning System devices.

RESULTS

Past-year falls were associated with more hard braking events (HBE). High FOF was associated with driving fewer days, miles, and trips, driving nearer home and more HBE. Differences were attenuated and not significant after accounting for health, function, medications and sociodemographics.

DISCUSSION

Differences in objectively measured driving habits according to past-year fall history and FOF were largely accounted for by differences in health and medications. Rather than directly affecting driving, falls and FOF may serve as markers for crash risk and reduced community mobility due to age-related changes and poor health.

Modeling of older adults' driving exposure and avoidance using objective driving data in a naturalistic driving study

Older adults in the United States rely heavily on driving their own vehicles to commute to work, shop for groceries, and access public services. To effectively help older adults maintain mobility and independence,we need to better understand how thecognitive, visual functioning, and health declines influence their tendency to self-restrict their driving. The objective of this study is to develop a causal model to examine the effects of age, gender, household status (specifically living alone), physical, cognitive, visual abilities, and health status on older adults' driving mobility in terms of driving exposure and avoidance. Driving exposure was measured by actual driving data, whereas driving avoidance was assessed by both self-report data and actual driving exposure to challenging situations. Structural equation modeling was used to analyze data collectedin the Second Strategic Highway Research Program Naturalistic Driving Study for establishing relationships between the selected factors and mobility. The structural equation model included a total of794 participants aged 65 and over (367 or 46.22%femalesand 427 or 53.78% males). Results indicate that poorer health is associated with less driving exposure; deteriorating cognitive and physical capabilities are associated with more self-reported driving avoidance and less actual driving in challenging situations; visual function is associated with self-reported avoidance; living alone is associated with higher driving exposure in general as well as in challenging situations; self-reported driving avoidance of challenging situations has a negative association with actual driving in those same situations. The final model could be applied to predict older adults' mobility changes according to their age, gender, household status, as well as their visual, physical, cognitive and health status.

A retrospective study of spine injuries in electric bicycles related collisions

BACKGROUND

Electric bicycles related collisions could lead to severe consequences in spine injuries, while no study had comprehensively investigated the epidemiology and demography of spine injuries in electric bicycles related collisions.

QUESTIONS/PURPOSES

The aim of this study is to (1) describe the epidemiological characteristics of spine injuries in electric bicycles related collisions, (2) develop clinical guideline of spine injuries in electric bicycles related collisions and (3) support the new road safety policy for electric bicycle riders.

METHODS

A retrospective review of spine injuries in electric bicycle related collisions was performed from 86 patients in an urban trauma center between 2018 and 2020. The variables including gender, age, radiographic findings, associated injuries, neurologic injuries, treatment, average length of stay were fully collected. Chi-square test and paired sample mean t-test were used to test for statistically significant differences. All statistical analyses were performed using Statistical Product and Service Solutions 20.0.0 software. A P<0.001 was considered as significant.

RESULTS

A total of 86 cases were involved in electric bicycles related collisions lead to spine injuries. The spine injuries victims were predominantly male (79.07%) and middle-aged (41-60years, 44.19%). The most common spine injuries were L1 fractures (10.48%). The most common fracture type was AO Fracture Classification type A (71.40%). Age and multivertebral fractures had significant difference between patients who suffered from an ASOI and from those who did not (P-value: 0.005, 0.005). There was significant difference between patients who suffered from neurologic injuries and from those who did not in AO Classification, multivertebral fractures and ASOI (P-value: 0.0001, 0.001, 0.032). Age, AO Classification, multivertebral fractures, ASOI and neurologic injuries had significant difference to influence patients' ISS and ALOS.

CONCLUSIONS

Spine injuries in electric bicycles related collisions may make patients suffer from severe consequences including their potential permanent disability, economic cost, or even life safety. Patients with spine injuries in electric bicycles related collisions should be paid close attention to avoid missed diagnosis and misdiagnosis. Helmet, protective clothing or other safety gear should be required to use to provide greater protection for electric bicycle riders.

Driving Performance in Older Adults: Current Measures, Findings, and Implications for Roadway Safety

Background and Objectives

Over 10,000 people a day turn 65 in the United States. For many older adults, driving represents an essential component of independence and is one of the most important factors in overall mobility. Recent survey studies in older adults suggest that up to 60% of older adult drivers with mild cognitive impairment, and up to 30% with dementia, continue to drive. The purpose of this review is to provide a comprehensive and detailed resource on the topics of cognition and driving for clinicians, researchers, and policymakers working on efforts related to older adult drivers.

Research Design and Methods

Publications on PubMed and Medline and discussions with experts working in geriatrics, technology, driving policy, psychology, and diverse aspects of driving performance were utilized to inform the current review.

Results

Research indicates that there is a complex and inverse correlation between multiple cognitive measures, driving performance, and risky driving behaviors. The fragmented nature of available peer-reviewed literature, and a reliance on correlative data, do not currently allow for the identification of the temporal and reciprocal nature of the interplay between cognition and driving endpoints.

Discussion and Implications

There are currently no widely accepted definitions, conceptual models, or uniform set of analyses for conducting geriatric research that is focused on driving. Establishing conventions for conducting research that harmonizes the fields of geriatrics, cognition, and driving research is critical for the development of the evidence base that will inform clinical practice and road safety policy.

Sex Differences in the Amount and Patterns of Car-Driving Exposure in Spain, 2014 to 2017: An Application of a Quasi-Induced Exposure Approach

We designed a cross-sectional study in Spain, from 2014 to 2017. Our objective was to assess sex-related differences in the amount of driving exposure of car drivers, overall and stratified by the main environment-related driving conditions. We compared the sex distribution across three populations: (1) total number of person-years aged > 18 years; (2) total number of person-years aged > 18 years holding a valid car-driving license; and (3) total number of non-responsible car drivers involved in crashes with another offending driver, stratified by different environmental variables. The quasi-induced exposure approach was applied: the non-responsible drivers were considered as representative of the entire population of drivers on the road at the place and time at which the crash occurred. We calculated the female-to-male odds ratio (OR) by comparing population 2 versus 1, and population 3 versus 2. Finally, we performed separate regression models in population 3 for each environment-related variable as the dependent variable and driver's age and sex as the independent variables. The female-to-male OR for the first comparison was 1.12, but values below 1 were found for extreme age groups. In the second comparison, an OR of 0.50 (0.49-0.51) was found, with progressively lower OR values as age increased. In population 3, women were found to drive less than men in environments known to be high risk (i.e., open roads, night-time, poor light conditions, and weekends). A significant gender gap exists in the amount and type of driving exposure. Although women obtain a driving license more frequently than men, they drive much less and tend to avoid high-risk environments. These results emphasize the need to incorporate a gender perspective in the development and implementation of road safety interventions.

Frailty and driving status associated with disability: a 24-month follow-up longitudinal study

OBJECTIVES

To examine the relationship of driving status and frailty with disability in older adults.

DESIGN

A prospective study.

SETTING AND PARTICIPANTS

The study included 8533 participants (mean age: 72.0±6.1 years (range: 60-98 years), women: 54.1%) in a community setting.

MEASURES

Driving status and frailty were assessed at baseline. The clinical definition of frailty was used according to the Japanese Cardiovascular Health Study index. Disability was prospectively determined using a record of Japanese long-term care insurance (LTCI).

RESULTS

During the follow-up period (mean duration: 23.5 months), 58 (0.7%) participants were regarded as moving out of the city, 80 (0.9%) participants had died and 311 (3.6%) participants were certified by LTCI. The proportion of disability was 1.3% among the not-frail group and 5.3% among the frail group. The proportion of disability was 2.5% in participants who were currently driving and 7.5% in those not driving. Based on frailty status and driving, participants were further classified into four groups: not frail and currently driving (n=2945), not frail and not driving (n=642), frail and currently driving (n=3598) and frail and not driving (n=1348). Compared with older adults who are not frail and driving, the combined status of frail and not driving (adjusted HR: 2.28; 95% CI: 1.47 to 3.52) and frail and driving (HR: 1.91; 95% CI: 1.30-2.81) were risk factors for disability.

CONCLUSIONS

Not driving and frail were associated with a risk of disability in community-dwelling older adults.

Planning for Driving Retirement: The Effect of Driving Perceptions, Driving Events, and Assessment of Driving Alternatives

Most older adults will eventually stop driving, but few engage in planning for driving retirement. This study assessed whether driving stress, enjoyment, confidence, concerning driving events, and assessment of driving alternatives influence planning. Demographic factors were also included. Data were collected via a mailed transportation survey, with a final sample of 551 older adults who currently drive. Linear regression analyses revealed that more driving retirement planning was associated with greater driving stress, less driving confidence, and a more positive view of driving alternatives. Driving enjoyment and recent concerning driving events were not significantly related. Among the control variables, race and income were significantly related to planning, suggesting that lower income and identifying as Black race were associated with more planning. Gender only approached significance, suggesting that females may plan more than males. Overall, these findings suggest that more driving retirement planning is warranted. Some of the groups known to be at increased risk for driving reduction and cessation plan more for that eventuality than their counterparts. Implications of the study and suggestions for future research are discussed.

Health-related quality of life among community-dwelling people aged 80 years and over: a cross-sectional study in France

Background

The proportion of people living to a very old age is continuously increasing. One of the possibilities explored in policies and services to meet this health and societal challenge is to encourage the very old to continue living at home. This initiative is in line with the wishes of most elderly people. However, owing to the great changes that occur during old age attention should be paid to health-related quality of life (HRQoL). The aims of this study were to assess HRQoL in French community-dwelling people aged 80 years and over and to investigate the sociodemographic and health characteristics and life events associated with HRQoL.

Methods

A cross-sectional study was conducted in France to assess the HRQoL of people aged 80 years or more living at home. All people recruited were sent a letter explaining the aim of the study and requesting their consent to take part. Those who accepted then received a series of sociodemographic and medical questionnaires, a questionnaire concerning life events of the previous 12 months and the LEIPAD questionnaire, which assesses HRQoL in elderly people.

Results

The data of 184 participants (54.9% female) with a mean age of 83.9 years (almost 40% older than 85 years), were analysed. Low scores, indicating better HRQoL, were obtained on the ‘Self-Care’ and ‘Depression and Anxiety’ scales with 50.9 and 40.8% of responders, respectively, having the minimum score of zero. The highest score was found on the ‘Sexual Functioning’ scale, with 59.1% of participants having the maximum score of 100. Elderly females declared a significantly less satisfactory HRQoL. Deteriorating health, an unsatisfactory environment, not being able to drive, perceived modest income and financial worries negatively affected HRQoL.

Conclusion

Identifying factors in our study that are potential determinants of HRQoL would be of direct benefit for individuals. Concrete public policy initiatives concerning means of transport, living environment and financial resources could then be implemented to improve the HRQoL of very old community-dwelling individuals.

How Accumulated Wealth Affects Driving Reduction and Cessation

Background and Objectives

Older adults can expect to live between 6 and 10 years after they give up driving, but driving reduction and cessation (DRC) are not equally experienced by all groups. Individual characteristics such as poor health, impaired vision, older age, and female gender are known to affect DRC. Using cumulative disadvantage theory as a guide, this study assessed the role played by wealth in DRC among older adults.

Research Design and Methods

Data from the National Health and Aging Trends Study were analyzed using multinomial logistic regression techniques. This allowed for the effect of each predictor on the odds of engagement in a given driving status (full driving, driving reduction [DR], and driving cessation [DC]) to be compared to each of the others.

Results

The final sample included 6,387 participants. After controlling for the effect of covariates, less wealth was associated with higher odds of DR compared to full driving, DC compared to full driving, and DC compared to DR. Confirming previous research, several other factors were also significantly related to driving status including age, health, vision, gender, race, education, relationship status, household size, and work status.

Discussion and Implications

The influence of wealth on driving status among older adults represents another disadvantage unequally distributed to some in older adulthood. Those with less wealth will have fewer resources to meet their mobility needs using alternatives and may already be facing additional financial constraints due to worse health and other challenges associated with lower socioeconomic status.

Barriers and facilitators to social participation after driving cessation among older adults: A cohort study

BACKGROUND

Driving cessation is a challenging transition for older drivers. It is indeed often associated with reduced mobility, loss of autonomy and poor quality of life, as in individuals with acquired disabilities. We examined factors that inhibit or facilitate out-of-home occupations after driving cessation (shopping, visiting/helping friends/family, leisure, and associative activities) in older adults, with particular focus on the role of anticipation.

METHODS

This longitudinal study was conducted with the SAFE MOVE cohort (n=1014 drivers aged≥70 years). Socio-demographic, health, cognitive, mobility and out-of-home occupations data were collected at home at baseline and by a postal questionnaire at 2-year follow-up.

RESULTS

In total, 48 (5%) participants stopped driving between baseline and follow-up, at a mean age of 81.8 years; 71% of drivers who stopped reported that driving cessation affected their out-of-home occupations. Participation in social occupations started to decline before driving cessation. Retired drivers were older, had poorer health, poorer cognitive abilities, drove less at baseline but used more public transportation than active drivers. As compared with participants who did not consider driving cessation at baseline, those who did were more likely to expect a better quality of life in the event of driving cessation and to use public transportation at baseline and follow-up despite their older age and poorer health.

CONCLUSION

Some factors associated with reduced social participation and driving cessation are inevitable, such as health status. However, other factors may facilitate maintenance of social participation, including anticipation of driving cessation and mobility habits. Our findings highlight the need for appropriate interventions that are widely available to older drivers before driving cessation occurs and for public policy actions facilitating alternative transport systems.

Driver Self-Regulation Practices in Older Drivers with and Without Mild Cognitive Impairment

Objective

To assess the impact of cognitive, socio-demographic and driving-related characteristics on self-regulation practices in older drivers with mild cognitive impairment (MCI) (determined by the Telephone Cognitive Screen (T-CogS) score), compared with drivers with no cognitive impairment.

Design, Setting, Participants

A cross-sectional study collected information from 362 drivers with MCI and 611 drivers with no cognitive impairment, who were aged 65+ years, and were living in Western Australia between November 2018 and February 2019.

Measurements

Self-reported self-regulation driving practices.

Results

The majority of drivers with MCI (62.4%) and those with no cognitive impairment (57.1%) reported self-regulating their driving in at least one situation, in the past three months. The most common situations that both groups of drivers self-regulated in were “driving at night in the rain”, “parallel parking”, and “driving when raining”. Drivers with MCI were only significantly more likely to self-regulate when “making turns across oncoming traffic” and “driving at night”. They also had 39% greater odds of self-regulating in at least one driving situation, compared with drivers with no cognitive impairment (OR: 1.39, 95% CI=1.04–1.85, p=0.02). Females also had 2.3 times greater odds of self-regulating (OR=2.34, 95% CI=1.76–3.12, p<0.001). Drivers aged 75+ years had 1.6 times greater odds of self-regulating, compared with drivers aged 65–69 years (OR=1.58, 95% CI=1.12–2.23, p=0.01).

Conclusion

Older drivers with MCI were more likely to self-regulate their driving, compared to drivers with no cognitive impairment, particularly in complex driving situations. This suggests that some drivers with MCI may be able to recognize their cognitive limitations and adjust their driving accordingly. However, several drivers with MCI, particularly males, did not self-regulate their driving. This highlights the importance of advising patients about the impact of MCI on driving ability, suitable self-regulation strategies, as well as monitoring their driving ability.

Comparison between elderly and young drivers' performances on a driving simulator and self-assessment of their driving attitudes and mastery

Elderly people are often considered dangerous drivers due to a decline in visual exploration and cognitive functions. The purpose of this study was to look into 18 young (between 21 and 35  years old) and 12 elderly (between 65 and 78 years old) drivers' behaviour. We compared their self-assessment of driving as well as their visual and cognitive competencies. Then we assessed their driving competencies and self-regulation practices by using different scenarios on a driving simulator. These scenarios were designed to test drivers in situations that were intended to solicit the cognitive competencies identified as problematic for elderly drivers (attention, executive functions: anticipation, planning, mental flexibility). Results showed that, although elderly drivers did not always perform as well as young drivers, they could put in place compensatory strategies which may reduce their risk of being injured and future research should explore ways of enhancing those strategies. In particular, more should be done in order to strengthen elderly's understanding regarding their driving difficulties and help them set up coping methods with respect to these difficulties.

Chronic medical conditions and their association with crash risk and changes in driving habits: a prospective study of the GAZEL cohort

OBJECTIVES

To assess crash risk and driving habits associated with chronic medical conditions among drivers entering old age.

DESIGN

Prospective cohort study.

SETTING

French cohort GAZEL.

PARTICIPANTS

12 460 drivers in the analysis of road traffic crash, among whom 11 670 completed the follow-up period (2007-2014). We assessed driving cessation among 11 633 participants over the same period, and mileage and driving avoidance among the 4973 participants who returned a road safety questionnaire in 2015.

MAIN OUTCOME MEASURES

Yearly occurrence of at least one road crash as a driver; time to driving cessation; mileage; driving avoidance: at night, with bad weather, in heavy traffic, with glare conditions, over long distances.

RESULTS

Several potentially risky conditions (angina, myocardial infarction, coronary disease; stroke; nephritic colic, urinary stones; glaucoma) were associated with lower mileage and/or driving avoidance and did not increase crash risk. Neither driving avoidance nor lower mileage was found for other conditions associated with an increased crash risk: hearing difficulties (adjusted OR 1.19, 95% CI 1.06 to 1.34); joint disorders (1.17, 95% CI 1.06 to 1.30). Depression, anxiety and stress was associated with an increased crash risk (1.23, 95% CI 1.01 to 1.49) despite increased driving avoidance. Parkinson's disease was associated with driving cessation (adjusted HR 32.61, 95% CI 14.21 to 65.17).

CONCLUSIONS

Depending on their condition, and probably on the associated risk perception, drivers entering old age report diverse driving habits. For example, hearing difficulties is a frequent condition, rarely considered a threat to road safety, and nonetheless associated with an increased crash risk.

Mild Cognitive Impairment and Caregiver Burden: A 3-Year-Longitudinal Study

OBJECTIVES

Mild cognitive impairment (MCI) is common, affecting 10%-35% of people over 65, and poses unique challenges for patients and their caregivers. Comparatively little research has examined caregiver burden in this population, with longitudinal research, in particular, lacking. We examined caregiver burden in a sample of people with MCI over 3 years.

DESIGN

Three-year observational study.

SETTING

Nine memory clinics in Australia.

PARTICIPANTS

One-hundred-and-eighty-five people with MCI and their caregivers.

MEASUREMENTS

Measures of caregiver burden, cognition, function, neuropsychiatric symptoms, driving status, and medication use were completed with patients and their caregivers at regular intervals over a 3-year period.

RESULTS

Between 21.1% and 29.5% of caregivers reported a clinically significant level of burden over the study. Patients' higher levels of neuropsychiatric symptoms, lower functional ability, and lack of driving ability, and caregivers' employment were associated with greater caregiver burden over time. Caregiver burden did not increase over time when controlling for patient and caregiver characteristics.

CONCLUSIONS

High levels of caregiver burden are present in a significant proportion of caregivers of people with MCI. Clinical characteristics of patients - including severity of neuropsychiatric symptoms and functional impairment - and the employment status of caregivers predict burden. Such characteristics may help identify caregivers at greater risk of burden to target for intervention.

Validation of the French version of the LEIPAD in community-dwelling people aged 80 years and above

Background

Few studies have addressed health-related quality of life in community-dwelling individuals aged 80 years and above and very few self-assessment quality of life questionnaires have been formally validated in these populations. This study aimed to validate a French version of the LEIPAD, a self-administered questionnaire assessing the health-related quality of life of people aged 80 years and over.

Method

A cross-sectional study of people aged 80 years and over living at home in France was conducted. All subjects recruited were sent a letter explaining the study and requesting their consent to take part. Those who accepted then received the questionnaires, including the LEIPAD, which assesses health-related quality of life in the subjects aged 65 years and above. We assessed its psychometric properties: data completeness, score distribution, floor and ceiling effects, internal consistency, item-total correlations, inter-scale correlations, reliability and convergent validity with the Medical Outcome Study Short-Form 36 (SF-36).

Results

The results obtained from 184 older people (mean age of 83.9 years, standard deviation 3.3) showed very good acceptability (missing data between 1.1% and 11.4% for LEIPAD scales) Factor analysis of the instrument confirmed the multi-dimensional structure in seven independent scales similar to the original version. Good internal consistency (Cronbach’s alpha ranging from 0.68 to 0.87) and strong test-retest reliability of the LEIPAD scales (intraclass correlation coefficients ranging from 0.77 to 0.95) were found. Convergent validity with the SF-36 showed moderate to strong correlations, consistent with the hypotheses stated.

Conclusions

The validation of this specific questionnaire will make it possible to investigate individually the health-related quality of life of French older people living at home and will enable French-speaking investigators to contribute to national and international research projects.

Self-reported health conditions and related driving reduction in older drivers

We surveyed self-reported lifetime health conditions (using National Health and Aging Trends Study questions) and related driving reduction in a large multi-site older driver cohort (n = 2990) from the AAA Longitudinal Research on Aging Drivers (LongROAD) Study's baseline assessment. Those reporting reduced driving (n = 337) largely attributed reduction to musculoskeletal (29%), neurologic (13%), and ophthalmologic (10%) conditions. Women reported health condition-related driving reduction more often than men (14% versus 8%, p<.001). Mobility affects well-being; health professionals should consider that health conditions may cause older adults to reduce driving. Gender differences deserve attention in future research and education efforts.

Driving cessation over a 24-year period: Dementia severity and cerebrospinal fluid biomarkers

INTRODUCTION

With 36 million older adult U.S. drivers, safety is a critical concern, particularly among those with dementia. It is unclear at what stage of Alzheimer's disease (AD) older adults stop driving and whether preclinical AD affects driving cessation.

METHODS

Time to driving cessation was examined based on Clinical Dementia Rating (CDR) and AD cerebrospinal fluid biomarkers. 1795 older adults followed up to 24 years received CDR ratings. A subset (591) had cerebrospinal fluid biomarker measurements and was followed up to 17 years. Differences in CDR and biomarker groups as predictors of time to driving cessation were analyzed using Kaplan-Meier curves and Cox proportional models.

RESULTS

Higher CDR scores and more abnormal biomarker measurements predicted a shorter time to driving cessation.

DISCUSSION

Higher levels of AD biomarkers, including among individuals with preclinical AD, lead to earlier driving cessation. Negative functional outcomes of preclinical AD show a nonbenign phase of the disease.

Acute coronary syndromes occurring while driving: frequency and patient characteristics

Background

Acute coronary syndrome (ACS) may occur during any human activity, including driving. The objectives of this study were to report the frequency of ACS occurring while driving, clarify patient characteristics, and analyze the behavioral patterns of drivers who sustained ACS.

Methods

A single-center, retrospective observational study was conducted using prospectively acquired data. Among 1605 ACS patients admitted between January 2011 and December 2016, 65 (60 men/5 women) patients who sustained ACS while driving were identified. Clinical variables were compared between these 65 patients and 1540 patients who sustained ACS while performing other activities. Furthermore, multivariable regression analysis was performed to identify variables associated with ACS.

Results

The frequency of ACS occurring while driving was 4.0% (65/1605). Compared with patients who sustained ACS while performing other activities, those who sustained ACS while driving were significantly younger (66.2 ± 13.0 vs. 57.5 ± 12.2 years, p < 0.001) and more likely to smoke (34.2 vs. 60.0%, p < 0.001). Multivariable regression analysis showed that age (OR 0.961; 95% CI 0.940–0.982) and current smoking (OR 1.978; 95% CI 1.145–3.417) were associated with ACS. While 55 drivers (85%) who remained conscious after ACS could seek medical attention without causing accidents, the other 10 (15%) who sustained cardiac arrest caused accidents.

Conclusions

The association between current smoking and ACS occurring while driving suggests that smoking cessation is advised for smokers who drive from the standpoint of driving safety. We expect that prospective studies be conducted to verify our findings and identify individuals at risk for ACS while driving.

Electronic supplementary material

The online version of this article (10.1186/s12199-017-0689-5) contains supplementary material, which is available to authorized users.

Gender effect on driving cessation in pre-dementia and dementia phases: results of the 3C population-based study

OBJECTIVES

Aging entails deterioration in sensory, physical, and cognitive functions, raising doubt in the driving capacity of older drivers, especially when the deficits are severe, as in dementia. Many older drivers, especially women, adapt their driving habits in order to compensate for these deficits and eventually stop driving. The present prospective study assessed driving cessation in men and women throughout the dementia process, including a 2-year pre-dementia phase.

METHODS

The study was based on a three-city cohort of subjects who were aged 65 years and older in 2000 and followed for more than 10 years. Active dementia detection was conducted at each follow-up. The probability of driving cessation was assessed in men and women during the 2-year pre-dementia phase and until 5 years after diagnosis.

RESULTS

In the 2-year pre-dementia phase, both men and women ceased driving earlier than drivers with no central nervous system pathology (p < 0,001), and women ceased driving earlier than men. A total of 45% of men and 74% of women had already ceased driving at dementia diagnosis. In contrast, the probability of cessation within 3 years after diagnosis was similar between men and women.

CONCLUSION

The study showed that, in this French urban population, few demented drivers, especially women, were still driving after diagnosis. Those who continued to drive 3 years after the diagnosis all had Alzheimer-type dementia. There is certainly a need for physicians to help these drivers to adapt their driving activity to their deficits and to prepare them to stop driving. Copyright © 2016 John Wiley & Sons, Ltd.

Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta-Analysis

OBJECTIVES

To examine associations between falls and subsequent motor vehicle crashes (MVCs), crash-related injuries, driving performance, and driving behavior.

DESIGN

Systematic review and metaanalysis.

PARTICIPANTS

Observational studies including drivers aged 55 and older or with a mean age of 65 and older.

MEASUREMENTS

Two authors independently extracted study and participant characteristics, exposures, and outcomes and assessed risk of bias. Pooled risk estimates for MVCs and MVC-related injuries were calculated using random-effects models. Other results were synthesized narratively.

RESULTS

From 3,286 potentially eligible records, 15 studies (N = 27-17,349 subjects) met inclusion criteria. Risk of bias was low to moderate, except for cross-sectional studies (n = 3), which all had a high potential for bias. A fall history was associated with a significantly greater risk of subsequent MVC (summary risk estimate = 1.40, 95% confidence interval (CI) = 1.20-1.63; I²  = 28%, N = 5 studies). One study found a significantly greater risk of MVC-related hospitalizations and deaths after a fall (hazard ratio = 3.12, 95% CI = 1.71-5.69). Evidence was inconclusive regarding an association between falls and driving cessation and showed no association between falls and driving performance or behavior.

CONCLUSION

Falls in older adults appear to be a risk marker for subsequent MVCs and MVC-related injury. Given the nature of the evidence, which is limited to observational studies, the identified associations may also result at least partly from confounding or bias. Further research is needed to clarify the mechanisms linking falls to crash risk and to develop effective interventions to ensure driving safety in older adults with a history of falls.

Stroke while driving: Frequency and association with automobile accidents

Background Cardiovascular events while driving have occasionally been reported. In contrast, there have been few studies on stroke while driving. Aim The objectives of this study were to (1) report the frequency of stroke while driving and (2) evaluate its association with automobile accidents. Methods Clinical data prospectively acquired between January 2011 and December 2016 on 2145 stroke patients (1301 with ischemic stroke, 585 with intracerebral hemorrhage, and 259 with subarachnoid hemorrhage) were reviewed to identify patients who sustained a stroke while driving. The ratio of driving to performing other activities was evaluated for each stroke type. Furthermore, the drivers' response to stroke was reviewed to understand how automobile accidents occurred. Results Among the 2145 patients, 85 (63 ischemic stroke, 20 intracerebral hemorrhage, and 2 subarachnoid hemorrhage) sustained a stroke while driving. The ratio of driving to performing other activities was significantly higher in ischemic stroke (4.8%) than in intracerebral hemorrhage (3.4%) or subarachnoid hemorrhage (0.8%). A majority of drivers either continued driving or pulled over to the roadside after suffering a stroke. However, 14 (16%) patients were involved in automobile accidents. In most patients, an altered mental status due to severe stroke was the presumed cause of the accident. Conclusion Stroke occurred while driving in 4.0% of all strokes and accidents occurred in 16% of these instances.

The influence of age-related health difficulties and attitudes toward driving on driving self-regulation in the baby boomer and older adult generations

Our study aimed to determine how age- and disease-related difficulties were associated with attitudes and beliefs about driving self-regulation in men and women in the baby boomer and older generations. Three hundred and ninety-nine men (n=204) and women (n=195) aged between 48 and 91 years participated in a cross-sectional study of Australian drivers. Demographic characteristics and measures of driving confidence, driving difficulty and driving self-regulation; perceptions of visual, physical and cognitive capacity; and attitudes and beliefs about driving were obtained. Driving self-regulation in men and women was explained by different mechanisms. For men, self-report of visual and cognitive difficulties and poor driving confidence predicted driving self-regulation. For women, negative attitudes toward driving mediated the associations found between health-related difficulties and driving self-regulation. Barriers to driving self-regulation were not associated with the driving self-regulatory practices of men or women. Regardless of generation, women reported poorer driving confidence, greater driving difficulty and more driving self-regulation than men. We concluded that age- and disease-related difficulties are related to increasing driving self-regulation in mature men and women. These results indicate that different pathways are needed in models of driving self-regulation for men and women regardless of generational cohort.

Risk Factors for Malnutrition among Older Adults in the Emergency Department: A Multicenter Study

BACKGROUND

Among older adults, malnutrition is common, often missed by healthcare providers, and influences recovery from illness or injury.

OBJECTIVE

To identify modifiable risk factors associated with malnutrition in older patients.

DESIGN

Prospective cross-sectional multicenter study.

SETTING

3 EDs in the South, Northeast, and Midwest.

PARTICIPANTS

Non-critically ill, English-speaking adults aged ≥65 years.

MEASUREMENTS

Random time block sampling was used to enroll patients. The ED interview assessed malnutrition using the Mini Nutritional Assessment Short-Form. Food insecurity and poor oral health were assessed using validated measures. Other risk factors examined included depressive symptoms, limited mobility, lack of transportation, loneliness, and medication side effects, qualified by whether the patient reported the risk factor affected their diet. The population attributable risk proportion (PARP) for malnutrition was estimated for each risk factor.

RESULTS

In our sample (n = 252), the prevalence of malnutrition was 12%. Patient characteristics associated with malnutrition included not having a college degree, being admitted to the hospital, and residence in an assisted living facility. Of the risk factors examined, the PARPs for malnutrition were highest for poor oral health (54%; 95% CI 16%, 78%), food insecurity (14%; 95% CI 3%, 31%), and lack of transportation affecting diet (12%; 95% CI 3%, 28%).

CONCLUSION

Results of this observational study identify multiple modifiable factors associated with the problem of malnutrition in older adults.

The role of navigation instruction at intersections for older drivers and those with early Alzheimer's disease

AIMS

Our purpose was to explore the effect of navigation instruction on older drivers' driving performance at left turn intersections. Left turns at intersections are particularly complex because they require many perceptive and cognitive abilities under considerable time pressure.

METHODS

Fifty-four participants were recruited: 18 drivers with early-stage Alzheimer's disease (AD), 18 neurologically healthy older drivers and 18 younger individuals. Various cognitive processes were measured, and 9 left turn maneuvers with or without navigation instruction were evaluated during an in-traffic road test. The psychomotor, planning and decision-making components involved in left turn were also analyzed closely.

RESULTS

Only older drivers (both healthy drivers and those with AD) were negatively affected by navigation instruction during the maneuver. The planning and decision-making components were more likely to be affected by the navigation instruction.

CONCLUSION

This finding highlights the importance of carefully considering the use of navigation instructions when developing navigation systems. Adapting this instruction is necessary to simplify our understanding of the real-world driving environment and to avoid increasing the cognitive load of older drivers.

Associations Between Health and Driving in an Older Adult Cohort in Rancho Bernardo

OBJECTIVE

The purpose of this study was to identify the associations between health and health care utilization with driving patterns in a cohort of older adults.

METHOD

In 2012, a total of 1,826 surviving participants in the Rancho Bernardo cohort were sent a health and driving pattern survey; 1,277 were returned.

RESULTS

The majority of the respondents (1,151, 91%) were still driving. Older age, female sex, hospitalizations, emergency department (ED) visits and physical therapy visits, neurological disease, depression, limited vision, and limited hearing were associated with non-driving status. A total of 809 (71%) of drivers reported no citations or crashes in the last 5 years.

DISCUSSION

The vast majority of older drivers in this cohort continued to drive, and did so safely. Health care utilization, medications, medical conditions, and self-assessment of health were associated with non-driving status. Prospective studies are needed to clarify the temporal relationships between these factors.

Measuring situational avoidance in older drivers: An application of Rasch analysis

Situational avoidance is a form of driving self-regulation at the strategic level of driving behaviour. It has typically been defined as the purposeful avoidance of driving situations perceived as challenging or potentially hazardous. To date, assessment of the psychometric properties of existing scales that measure situational avoidance has been sparse. This study examined the contribution of Rasch analysis to the situational avoidance construct. Three hundred and ninety-nine Australian drivers (M=66.75, SD=10.14, range: 48-91 years) completed the Situational Avoidance Questionnaire (SAQ). Following removal of the item Parallel Parking, the scale conformed to a Rasch model, showing good person separation, sufficient reliability, little disordering of thresholds, and no evidence of differential item functioning by age or gender. The residuals were independent supporting the assumption of unidimensionality and in conforming to a Rasch model, SAQ items were found to be hierarchical or cumulative. Increased avoidance was associated with factors known to be related to driving self-regulation more broadly, including older age, female gender, reduced driving space and frequency, reporting a change in driving in the past five years and poorer indices of health (i.e., self-rated mood, vision and cognitive function). Overall, these results support the use of the SAQ as a psychometrically sound measure of situational avoidance. Application of Rasch analysis to this area of research advances understanding of the driving self-regulation construct and its practice by drivers in baby boomer and older adult generations.

Mobility behaviour and driving status of patients with mental disorders - an exploratory study

BACKGROUND

Driving is an important activity of daily life and an integral part of mobility. However, impact of mental illness on road mobility is widely unexplored.

METHOD

Driving status in 1497 psychiatric inpatients (PPs) and a clinical control group of 313 neurological inpatients (NPs) was investigated using a brief questionnaire.

RESULTS

67% of PPs (89% NPs) reported to have a valid driver's licence and 77% of them (92% NPs) reported to regularly use their cars. Within driver's license holders, patients with organic mental disorder (32%), substance dependence (37%) and psychotic disorder (40%) had the lowest proportion of current drivers. Higher educational qualification (odds ratio [OR] from 2.978 to 17.036) and being married/partnered (OR 3.049) or divorced (OR 4.840) significantly advanced the probability of possession of a driving license. Predictive factors for driving cessation were being female, an older age, drawing a pension and having an organic mental disease or schizophrenic disorder.

CONCLUSION

Mental disease has a negative impact on driving status and this is especially true for illnesses frequently being accompanied by distinct cognitive impairments. Factors predicting road mobility elucidate the strong relationship with psychosocial status indicating that recovery of driving competence should be an integral goal of treatment strategies.

Longitudinal Associations Between Changes in Physical Function and Driving Mobility Behaviors of Older Adults

OBJECTIVES

To examine time-varying correlations between multiple indices of physical function and driving mobility in older adults across five years.

DESIGN

Longitudinal.

PARTICIPANTS

Older drivers aged 65-91 (M = 73.6 ± 5.78) who were randomly assigned to the no-contact control arm of the Advanced Cognitive Training for Independent and Vital Elderly study (N = 598).

MEASUREMENTS

The driving mobility outcomes were self-reported driving space, driving exposure, driving frequency, and weekly mileage assessed at baseline, and first, second, third, and fifth follow-up visits. Physical functioning measures included grip strength, the Turn360 test, and self-reported physical function. Multilevel models examined relationships between changes in physical functioning and driving mobility outcomes over five years.

RESULTS

Driving space and driving frequency decreased over time, especially for older individuals. Changes in physical function were positively related to changes in driving mobility after controlling for demographics, attrition, baseline cognitive function and visual acuity, and changes in general health. Patterns of associations varied depending on the specific physical function measure and mobility outcome.

CONCLUSIONS

The findings highlight the time-varying nature of the relationships between physical functioning and driving mobility. Further research is needed to fully understand dynamic associations between driving mobility and key components of mobility that vary over time.