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Jun H, Liu Y, Chen E, Becker A, Mattke S. State Department of Motor Vehicles Reporting Mandates of Dementia Diagnoses and Dementia Underdiagnosis. JAMA Netw Open 2024; 7:e248889. [PMID: 38662368 PMCID: PMC11046347 DOI: 10.1001/jamanetworkopen.2024.8889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/22/2024] [Indexed: 04/26/2024] Open
Abstract
Importance With older drivers representing the fastest growing segment of the driver population and dementia prevalence increasing with age, policymakers face the challenge of balancing road safety and mobility of older adults. In states that require reporting a dementia diagnosis to the Department of Motor Vehicles (DMV), individuals with dementia may be reluctant to disclose symptoms of cognitive decline, and clinicians may be reluctant to probe for those symptoms, which may be associated with missed or delayed diagnoses. Objective To assess whether DMV reporting policies for drivers with dementia are associated with primary care clinicians' underdiagnosing dementia. Design, Setting, and Participants This cross-sectional study used data from the 100% Medicare fee-for-service program and the Medicare Advantage plans from 2017 to 2019 on 223 036 primary care clinicians with at least 25 Medicare patients. Statistical analysis was performed from July to October 2023. Exposures State DMV reporting policies for drivers with dementia. Main Outcomes and Measures The main outcome was a binary variable indicating whether the clinician underdiagnosed dementia or not. Each clinician's expected number of dementia cases was estimated using a predictive model based on patient characteristics. Comparing the estimation with observed dementia diagnoses identified clinicians who underdiagnosed dementia vs those who did not, after accounting for sampling errors. Results Four states have clinician reporting mandates, 14 have mandates requiring drivers to self-report dementia diagnoses, and 32 states and the District of Columbia do not have explicit requirements. Among primary care clinicians in states with clinician reporting mandates (n = 35 620), 51.4% were female, 91.9% worked in a metropolitan area, and 19.9% of the patient panel were beneficiaries dually eligible for Medicare and Medicaid. Among primary care clinicians in states with patient self-reporting mandates (n = 57 548), 55.7% were female, 83.1% worked in a metropolitan area, and 15.4% of the patient panel were dually eligible for Medicare and Medicaid. Among clinicians in states without mandates, 55.7% were female, 83.0% worked in a metropolitan area, and 14.6% of the patient panel were dually eligible for Medicare and Medicaid. Clinicians in states with clinician reporting mandates had an adjusted 12.4% (95% CI, 10.5%-14.2%) probability of underdiagnosing dementia compared with 7.8% (95% CI, 6.9%-8.7%) in states with self-reporting and 7.7% (95% CI, 6.9%-8.4%) in states with no mandates, an approximately 4-percentage point difference (P < .001). Conclusions and Relevance Results of this cross-sectional study of primary care clinicians suggest that mandatory DMV policies for clinicians to report patients with dementia may be associated with a higher risk of missed or delayed dementia diagnoses. Future research is needed to better understand the unintended consequences and the risk-benefit tradeoffs of these policies.
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Affiliation(s)
- Hankyung Jun
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ying Liu
- The USC Brain Health Observatory, University of Southern California, Los Angeles
| | - Emily Chen
- The USC Brain Health Observatory, University of Southern California, Los Angeles
| | - Andrew Becker
- The USC Brain Health Observatory, University of Southern California, Los Angeles
| | - Soeren Mattke
- The USC Brain Health Observatory, University of Southern California, Los Angeles
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de Almeida WM, Quintas JL, Trindade IOA, Pitta LSR, Louzada LL, Nóbrega OT, Camargos EF. Diagnosis of Alzheimer's dementia and vehicle driving restriction: a scoping review. Psychogeriatrics 2024; 24:138-144. [PMID: 37990411 DOI: 10.1111/psyg.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/22/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
There are doubts about vehicle driving restriction for patients with Alzheimer's disease. A scoping review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-ScR) methodology. Relevant databases were searched for articles published between 2000 and 2022 in English, Spanish, or Portuguese. Articles were included if they specifically addressed driving, risk of accidents, permission or licence to drive a motor vehicle in a context of important cognitive decline, or if addressed traffic legislation on driving and dementia. Twenty-three articles were selected for full reading, six of which were observational studies and only one with an interventionist method. All articles were carried out in high-income countries such as the UK, the US, and Australia. As a conclusion, there is no psychometric test in the literature sensitive enough to assess vehicle driving competence in older adults with cognitive deficits. Based on selected studies, there is no robust evidence to make recommendation for or against the cessation of vehicular driving for patients with mild cognitive decline or with mild dementia. In some situations, vehicle driving cessation can impact patients and their families. In addition, legal regulations regarding vehicle driving for older adults and people with dementia are scarce worldwide. Despite the scarcity of studies addressing the theme of vehicle driving in the context of dementia, there is some level of consensual reasoning that patients with moderate to severe dementia should halt driving activities, but the same does not apply for patients with mild levels of cognitive impairment, including mild dementia.
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Affiliation(s)
| | - Juliana Lima Quintas
- Hospital of the University of Brasilia (HUB), Medical Centre for the Aged, Brasília, Brazil
| | | | | | - Luciana Lilian Louzada
- Hospital of the University of Brasilia (HUB), Medical Centre for the Aged, Brasília, Brazil
| | - Otávio Toledo Nóbrega
- Hospital of the University of Brasilia (HUB), Medical Centre for the Aged, Brasília, Brazil
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CR-IUGM), Montreal, Quebec, Canada
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Toups R, Chirles TJ, Ehsani JP, Michael JP, Bernstein JPK, Calamia M, Parsons TD, Carr DB, Keller JN. Driving Performance in Older Adults: Current Measures, Findings, and Implications for Roadway Safety. Innov Aging 2022; 6:igab051. [PMID: 35028434 DOI: 10.1093/geroni/igab051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Robert Toups
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Theresa J Chirles
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Johnathon P Ehsani
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeffrey P Michael
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Matthew Calamia
- Department of Clinical Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Thomas D Parsons
- Department of Psychology, University of North Texas, Denton, Texas, USA.,Computational Neuropsychology and Simulation Laboratory, University of North Texas, Denton, Texas, USA
| | - David B Carr
- Department of Medicine and Neurology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jeffrey N Keller
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
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Ma T, Chee JN, Hanna J, Al Jenabi N, Ilari F, Redelmeier DA, Elzohairy Y. Impact of medical fitness to drive policies in preventing property damage, injury, and death from motor vehicle collisions in Ontario, Canada. J Safety Res 2020; 75:251-261. [PMID: 33334484 DOI: 10.1016/j.jsr.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/12/2019] [Accepted: 09/03/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Drivers with medical conditions and functional impairments are at increased collision risk. A challenge lies in identifying the point at which such risk becomes unacceptable to society and requires mitigating measures. This study models the road safety impact of medical fitness-to-drive policy in Ontario. METHOD Using data from 2005 to 2014, we estimated the losses to road safety incurred during the time medically-at-risk drivers were under review, as well as the savings to road safety accrued as a result of licensing decisions made after the review process. RESULTS While under review, drivers with medical conditions had an age- and sex-standardized collision rate no different from the general driver population, suggesting no road safety losses occurred (RR = 1.02; 95% CI: 0.93-1.12). Licensing decisions were estimated to have subsequently prevented 1,211 (95% CI: 780-1,730) collisions, indicating net road safety savings resulting from medical fitness to drive policies. However, more collisions occurred than were prevented for drivers with musculoskeletal disorders, sleep apnea, and diabetes. We theorize on these findings and discuss its multiple implications. CONCLUSIONS Minimizing the impact of medical conditions on collision occurrence requires robust policies that balance fairness and safety. It is dependent on efforts by academic researchers (who study fitness to drive); policymakers (who set driver medical standards); licensing authorities (who make licensing decisions under such standards); and clinicians (who counsel patients on their driving risk and liaise with licensing authorities). Practical Applications: Further efforts are needed to improve understanding of the effects of medical conditions on collision risk, especially for the identified conditions and combinations of conditions. Results reinforce the value of optimizing the processes by which information is solicited from physicians in order to better assess the functional impact of drivers' medical conditions on driving and to take suitable licensing action.
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Affiliation(s)
- Tracey Ma
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada; The University of New South Wales, School of Population Health, Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Justin N Chee
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada.
| | - Joshua Hanna
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada
| | - Nadia Al Jenabi
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada
| | - Frances Ilari
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada
| | - Donald A Redelmeier
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Yoassry Elzohairy
- Ontario Ministry of Transportation, Safety Program Development Branch, Research and Evaluation Office, Toronto, Canada
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Davis J, Hamann C, Butcher B, Peek-Asa C. The Medical Referral Process and Motor-Vehicle Crash Risk for Drivers with Dementia. Geriatrics (Basel) 2020; 5:geriatrics5040091. [PMID: 33202718 PMCID: PMC7709686 DOI: 10.3390/geriatrics5040091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/31/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
Cognitive and physical impairment can occur with dementia and reduce driving ability. In the United States, individual states have procedures to refer and evaluate drivers who may no longer be fit to drive. The license review process is not well understood for drivers with dementia. This study uses comprehensive data from the Iowa Department of Transportation to compare the referral process for drivers with and without dementia from January 2014 through November 2019. The likelihood of failing an evaluation test was compared between drivers with and without dementia using logistic regression. The risk of motor-vehicle crash after referral for review of driving ability was compared using a Cox proportional hazard model. Analysis controlled for the age and sex of the referred driver. Drivers with dementia performed worse on all tests evaluated except the visual screening test. After the referral process, the risk of crash was similar between those with and without dementia. Drivers with dementia were denied their license more frequently than referred drivers without dementia. However, drivers with dementia who successfully kept their license as a result of the license review process were not at an increased risk of crash compared to other referred drivers.
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Affiliation(s)
- Jonathan Davis
- University of Iowa Injury Prevention Research Center, 2190 Westlawn, Iowa City, IA 52242, USA; (C.H.); (B.B.); (C.P.-A.)
- Correspondence:
| | - Cara Hamann
- University of Iowa Injury Prevention Research Center, 2190 Westlawn, Iowa City, IA 52242, USA; (C.H.); (B.B.); (C.P.-A.)
- Department of Epidemiology, College of Public Health, University of Iowa, 145 North Riverside Drive, Iowa City, IA 52242, USA
| | - Brandon Butcher
- University of Iowa Injury Prevention Research Center, 2190 Westlawn, Iowa City, IA 52242, USA; (C.H.); (B.B.); (C.P.-A.)
- Department of Biostatistics, College of Public Health, University of Iowa, 145 North Riverside Drive, Iowa City, IA 52242, USA
| | - Corinne Peek-Asa
- University of Iowa Injury Prevention Research Center, 2190 Westlawn, Iowa City, IA 52242, USA; (C.H.); (B.B.); (C.P.-A.)
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, 145 North Riverside Drive, Iowa City, IA 52242, USA
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Barco PP, Wallendorf M, Rutkoski K, Dolan K, Rakus D, Johnson A, Carr DB. Validity and Reliability of the Traffic Sign Naming Test (TSNT) and Written Exam for Driving Decisions (WEDD) as Measures of Fitness to Drive Among Older Adults. Am J Occup Ther 2020; 74:7403205090p1-7403205090p10. [PMID: 32365315 DOI: 10.5014/ajot.2020.034389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapists need valid and reliable tools to help determine fitness to drive of older drivers with medical conditions such as dementia. OBJECTIVE To establish the validity and reliability of the Traffic Sign Naming Test (TSNT) and Written Exam for Driving Decisions (WEDD) as measures of fitness to drive of adults with and without dementia. DESIGN Cross-sectional. SETTING Washington University Medical School in St. Louis in collaboration with the Rehabilitation Institute of St. Louis. PARTICIPANTS Older drivers diagnosed with dementia (n = 130) and without dementia (n = 34). Drivers with dementia required a physician referral indicating a medical need for a driving evaluation, a diagnosis of dementia, and an Alzheimer Detection 8 score of 2. Drivers without dementia were required to be age 55 yr or older and not meet criteria for dementia. OUTCOMES AND MEASURES Participants completed a comprehensive driving evaluation (CDE) that included clinical measures of vision, motor, and cognition; TSNT; and WEDD. The outcome measure was performance on a standardized on-road assessment. RESULTS The TSNT's interrater reliability was determined to be strong (κ = .80). The TSNT and WEDD demonstrated convergent validity with cognitive measures (p < .001) and discriminant validity with visual and motor measures in the CDE. The TSNT (area under the curve [AUC] = .74) and WEDD (AUC = .71) had fair ability to predict failure on a standardized on-road assessment. CONCLUSION AND RELEVANCE TSNT and WEDD are recommended for use by occupational therapists in combination with other performance measures when determining fitness to drive or need for a CDE. WHAT THIS ARTICLE ADDS The TSNT and WEDD can be included as screening tools (in addition to other performance measures) to assist clinicians in determining which clients need to be referred for a CDE. The TSNT and WEDD can also be included as part of a CDE to assist driving rehabilitation specialists in making final recommendations regarding fitness to drive. The scores generated from the TSNT and WEDD address driving knowledge in a way that may be more understandable to clients and more relatable to skills needed to actually drive.
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Affiliation(s)
- Peggy P Barco
- Peggy P. Barco, OTD, BSW, OTR/L, SCDCM, CDRS, FAOTA, is Associate Professor, Program in Occupational Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO;
| | - Michael Wallendorf
- Michael Wallendorf, PhD, is Research Statistician, Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Kathleen Rutkoski
- Kathleen Rutkoski, OTR/L, is Research Assistant, Program in Occupational Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kathleen Dolan
- Kathleen Dolan, OT/L, is Occupational Therapist, Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Danielle Rakus
- Danielle Rakus, MSOT, OTR/L, is Occupational Therapist, Cheyenne Regional Medical Center Acute Rehab Unit, Cheyenne, WY
| | - Ann Johnson
- Ann Johnson is Clinical Research Coordinator, Center for Clinical Studies, Washington University School of Medicine, St. Louis, MO
| | - David B Carr
- David B. Carr, MD, is Professor, Department of Medicine and Neurology, Washington University School of Medicine, St. Louis, MO
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Doucette ML, Dayton H, Lapidus G, Borrup KT, Campbell BT. Firearms, Dementia, and the Clinician: Development of a Safety Counseling Protocol. J Am Geriatr Soc 2020; 68:2128-2133. [PMID: 32356587 DOI: 10.1111/jgs.16450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Using available literature, our aim was to design a firearm safety counseling protocol tool for dementia patients. DESIGN We conducted a literature review on firearm safety counseling by healthcare providers using several databases to inform the creation of our evidence-based protocol. SETTING Roughly 5.7 million Americans currently live with some form of dementia with approximately 60% of persons with dementia (PWD) owning a firearm. The mental deterioration associated with dementia creates an opportunity for firearm abuse, misuse, and injury. Patient and family safety counseling from a healthcare provider is one potential opportunity for reducing the level of danger. This literature review identifies the available clinical guidelines for firearm safety for PWD and creates a firearm safety counseling protocol based on existing literature. PARTICIPANTS Persons with dementia and their families or care takers. MEASUREMENTS Databases were searched using variations of the terms "Firearms," "Dementia," and "Alzheimer's disease." Studies were included for review if they provided either recommendations or guidelines for healthcare provider's counseling around firearm safety for PWD or their families. RESULTS Search terms yielded 456 articles, of which 12 met inclusion criteria. Using the available literature, we developed a firearm safety counseling protocol that provides measurable means to assess risk and offer harm mitigation strategies for patients and their families. Mitigation strategies are based on Clinical Dementia Rating scale assessment at time of patient interaction and results of risk assessment. CONCLUSION Providing standardized and effective clinical guidelines to healthcare providers who interact with firearm-owning PWD can act as a means to reduce firearm injury and violence. The protocol proposed in this article needs further testing and validation to determine if it will help reduce firearm-related events in PWD.
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Affiliation(s)
- Mitchell L Doucette
- Department of Health Sciences, Eastern Connecticut State University, Willimantic, Connecticut, USA.,Injury Prevention Center, Connecticut Children's & Hartford Hospital, Hartford, Connecticut, USA
| | - Harrison Dayton
- Department of Health Sciences, Eastern Connecticut State University, Willimantic, Connecticut, USA
| | - Garry Lapidus
- Injury Prevention Center, Connecticut Children's & Hartford Hospital, Hartford, Connecticut, USA.,School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Kevin T Borrup
- Injury Prevention Center, Connecticut Children's & Hartford Hospital, Hartford, Connecticut, USA.,School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Brendan T Campbell
- Injury Prevention Center, Connecticut Children's & Hartford Hospital, Hartford, Connecticut, USA.,School of Medicine, University of Connecticut, Farmington, Connecticut, USA.,Pediatric Surgery, Connecticut Children's Medical Center, Hartford, Connecticut, USA
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Willems LM, Reif PS, Knake S, Hamer HM, Willems C, Krämer G, Rosenow F, Strzelczyk A. Noncompliance of patients with driving restrictions due to uncontrolled epilepsy. Epilepsy Behav 2019; 91:86-89. [PMID: 29752000 DOI: 10.1016/j.yebeh.2018.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 03/31/2018] [Accepted: 04/13/2018] [Indexed: 11/26/2022]
Abstract
Epilepsies are a common and chronic neurological disorder characterized by sustained risk of recurrent seizures. Because of paroxysmal and often unpredictable occurrence of seizures, patients with uncontrolled epilepsy are subject to disease-specific restrictions in daily life, such as their career choice or specific work limitations. According to German law and many other European and international guidelines, driving is strictly prohibited in patients with uncontrolled epilepsy so as to increase active and passive safety in public road traffic. Nevertheless, a significant percentage of patients probably do not comply with these legal restrictions and drive on a regular basis. For this study, we analyzed a representative German cohort with 302 patients (mean age: 45.0 years ± 16.4; 48% male) with established epilepsy to identify the number of patients driving without permission. Overall, 58.6% (n = 177) of patients had a driving license, 71.1% (n = 69/97) of patients were in seizure remission, and 52.7% (n = 108/205) of patients had uncontrolled epilepsy. Among patients in seizure remission, 54.6% (n = 53/97) reported regular driving while, among patients with uncontrolled epilepsy, 15.1% (n = 31/205) reported driving on a regular basis. No patient in the cohort stated driving without a valid license. Permanent employment, freelance work, the absence of a relevant disability, and living alone were identified as significant risk factors, which underlines the already existing evidence for the importance of a possible restricted access to the labor market as motive for disregarding legal driving restrictions. In our opinion, specialized and generally available social counseling with a special focus on vocational and career guidance is urgently needed to improve compliance with epilepsy-caused driving restrictions and the underlying reasons for violating these rules. In addition, more effort has to be spent on improving diagnostics and treatment of epilepsy to reduce the number of patients with uncontrolled seizures. Comprehensive introduction of self-driving vehicles may also help to improve mobility of patients with refractory epilepsy.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Hajo M Hamer
- Epilepsy Center Erlangen and Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | | | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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