Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-16T15:29:16.429Z Has data issue: false hasContentIssue false
  • English
  • Français

Mobility and safety issues in drivers with dementia

Published online by Cambridge University Press:  26 June 2015

David B. Carr  and
Desmond O’Neill Open the ORCID record for Desmond O’Neill [Opens in a new window]
David B. Carr*
Affiliation:
Division of Geriatrics and Nutritional Science, Department of Medicine and Neurology, Washington University in St. Louis, 660 Euclid Dr. St. Louis, MO 63110, USA
Desmond O’Neill
Affiliation:
Tallaght Hospital and Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland
*
Correspondence should be addressed to: David B. Carr, Division of Geriatrics and Nutritional Science, Department of Medicine and Neurology, Washington University in St. Louis, 660 Euclid Dr. St. Louis, MO 63110, USA. Phone: 314-286-2706; Fax: 314-286-2701. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Although automobiles remain the mobility method of choice for older adults, late-life cognitive impairment and progressive dementia will eventually impair the ability to meet transport needs of many. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the specific types of assessments that should be applied to older drivers with cognitive impairment, and no gold standard for determining driving fitness or approaching loss of mobility and subsequent counseling. Yet, clinicians are often called upon by patients, their families, health professionals, and driver licensing authorities to assess their patients’ fitness-to-drive and to make recommendations about driving privileges. We summarize the literature on dementia and driving, discuss evidenced-based assessments of fitness-to-drive, and outline the important ethical and legal concerns. We address the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and driver licensing authority referrals that may assist clinicians with an evaluation. Finally, we discuss mobility counseling (e.g. exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients’ social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety.

Keywords

older adultdementiaAlzheimer’s diseasecognitive impairmentdrivingautomobiletransportationassessment
Type
Review Article
Information
International Psychogeriatrics , Volume 27 , Special Issue 10: Psychosocial and Ethical Aspects of Dementia , October 2015 , pp. 1613 - 1622
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akinwuntan, A. E., De Weerdt, W., Feys, H., Baten, G. and Kiekens, C. (2005). The validity of a road test after stroke. Archives of Physical Medicine and Rehabilitation, 86, 421–426. doi:10.1016/j.apmr.2004.04.047.CrossRefGoogle ScholarPubMed
Albert, M. S.et al. (2011). The diagnosis of mild cognitive impairment due to alzheimer's disease: recommendations from the national institute on aging-alzheimer's association workgroups on diagnostic guidelines for alzheimer's disease. Alzheimer's and Dementia, 7, 270–279. doi:10.1016/j.jalz.2011.03.008.CrossRefGoogle ScholarPubMed
American Medical Association (1999). Impaired Drivers and Their Physicians [Online]. AMA. Available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion224.page; last accessed June 12, 2015.Google Scholar
Bbc News (September 2013). Who, what, why: How Dangerous are Elderly Drivers? [Online]. Available at: http://www.bbc.com/news/magazine-24204489; last accessed June 12, 2015.Google Scholar
Brayne, C. and Davis, D. (2012). Making alzheimer's and dementia research fit for populations. Lancet, 380, 1441–1443. doi:10.1016/S0140-6736(12)61803-0.CrossRefGoogle ScholarPubMed
Byszewski, A. M.et al. (2003). A continuing medical education initiative for canadian primary care physicians: the driving and dementia toolkit: a pre- and post-evaluation of knowledge, confidence gained, and satisfaction. Journal of the American Geriatrics Society, 51, 1484–1489. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14511173CrossRefGoogle Scholar
Carr, D. B. and Ott, B. R. (2010). The older adult driver with cognitive impairment: “It's a very frustrating life.” JAMA, 303, 1632–1641. doi:10.1001/jama.2010.481.CrossRefGoogle Scholar
Caselli, R. J. and Yaari, R. (2007). Medical management of frontotemporal dementia. American Journal of Alzheimer's Disease and Other Dementias, 22, 489–498. doi:10.1177/1533317507306654.CrossRefGoogle ScholarPubMed
Charlton, J.et al. (2010). Influence of chronic illness on crash involvement of motor vehicle drivers: 2nd. Report No. 300. Clayton, Australia: Monash University Accident Research Centre. Accessed from http://www.monash.edu.au/miri/research/reports/muarc300.html; last accessed June 12, 2015.Google Scholar
Cox, D. J., Quillian, W. C., Thorndike, F. P., Kovatchev, B. P., and Hanna, G. (1998). Evaluating driving performance of outpatients with alzheimer disease. The Journal of the American Board of Family Practice/American Board of Family Practice, 11, 264–271. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9719348.CrossRefGoogle ScholarPubMed
De Raedt, R. and Ponjaert-Kristoffersen, I. (2000). Can strategic and tactical compensation reduce crash risk in older drivers? Age and Ageing, 29, 517–521. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11191244.CrossRefGoogle ScholarPubMed
De Simone, V., Kaplan, L., Patronas, N., Wassermann, E. M. and Grafman, J. (2007). Driving abilities in frontotemporal dementia patients. Dementia and Geriatric Cognitive Disorders, 23, 1–7. doi:10.1159/000096317.CrossRefGoogle ScholarPubMed
Dobbs, B. M., Harper, L. A. and Wood, A. (2009). Transitioning from driving to driving cessation: the role of specialized support groups for individuals with dementia. Topics in Geriatric Rehabilitation, 25, 73–86.CrossRefGoogle Scholar
Duchek, J. M.et al. (2003). Longitudinal driving performance in early-stage dementia of the alzheimer type. Journal of the American Geriatrics Society, 51, 1342–1347. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14511152.CrossRefGoogle ScholarPubMed
Edwards, J. D., Wadley, V. G., Vance, D. E., Wood, K., Roenker, D. L. and Ball, K. K. (2005). The impact of speed of processing training on cognitive and everyday performance. Aging and Mental Health, 9, 262–271. doi:10.1080/13607860412331336788.CrossRefGoogle ScholarPubMed
Edwards, J. D., Lunsman, M., Perkins, M., Rebok, G. W. and Roth, D. L. (2009). Driving cessation and health trajectories in older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 64, 1290–1295. doi:10.1093/gerona/glp114.CrossRefGoogle ScholarPubMed
Fitten, L. J.et al. (1995). Alzheimer and vascular dementias and driving: a prospective road and laboratory study. JAMA, 273, 1360–1365. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7715061.CrossRefGoogle ScholarPubMed
Foley, D. J., Masaki, K. H., Ross, G. W. and White, L. R. (2000). Driving cessation in older men with incident dementia. Journal of the American Geriatrics Society, 48, 928–930. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10968296.CrossRefGoogle ScholarPubMed
Foley, D. J., Heimovitz, H. K., Guralnik, J. M. and Brock, D. B. (2002). Driving life expectancy of persons aged 70 years and older in the united states. American Journal of Public Health, 92, 1284–1289. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12144985.CrossRefGoogle ScholarPubMed
Fonda, S. J., Wallace, R. B. and Herzog, A. R. (2001). Changes in driving patterns and worsening depressive symptoms among older adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 56, S343–S351. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11682595.CrossRefGoogle ScholarPubMed
Freeman, E. E., Gange, S. J., Muñoz, B. and West, S. K. (2006). Driving status and risk of entry into long-term care in older adults. American Journal of Public Health, 96, 1254–1259. doi:10.2105/AJPH.2005.069146.CrossRefGoogle ScholarPubMed
Freund, B. (2006). Office-based evaluation of the older driver. Journal of the American Geriatrics Society, 54, 1943–1944. doi:10.1111/j.1532-5415.2006.00966.x.CrossRefGoogle ScholarPubMed
Freund, B., Gravenstein, S., Ferris, R. and Shaheen, E. (2002). Evaluating driving performance of cognitively impaired and healthy older adults: a pilot study comparing on-road testing and driving simulation. Journal of the American Geriatrics Society, 50, 1309–1310. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12133033.CrossRefGoogle ScholarPubMed
Frittelli, C.et al. (2009). Effects of alzheimer's disease and mild cognitive impairment on driving ability: a controlled clinical study by simulated driving test. International Journal of Geriatric Psychiatry, 24, 232–238. doi:10.1002/gps. 2095.CrossRefGoogle ScholarPubMed
Fuller, R. (2005). Towards a general theory of driver behaviour. Accident Analysis and Prevention, 37, 461–472. doi:10.1016/j.aap.2004.11.003.CrossRefGoogle ScholarPubMed
George, S., Clark, M. and Crotty, M. (2007). Development of the adelaide driving self-efficacy scale. Clinical Rehabilitation, 21, 56–61. doi:10.1177/0269215506071284.CrossRefGoogle ScholarPubMed
Hetland, A. and Carr, D. B. (2014). Medications and impaired driving. The Annals of pharmacotherapy, 48, 494–506. doi:10.1177/1060028014520882.CrossRefGoogle ScholarPubMed
Hill, R. D., Storandt, M. and LaBarge, E. (1992). Psychometric discrimination of moderate senile dementia of the alzheimer type. Archives of Neurology, 49, 377–380. doi:10.1001/archneur.1992.00530280065023.CrossRefGoogle ScholarPubMed
Hopkins, R. W., Kilik, L., Day, D. J., Rows, C. and Tsenq, H. (2004). Driving and dementia in ontario: a quantitative assessment of the problem. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 49, 434–438. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15362247.CrossRefGoogle ScholarPubMed
Hunt, L. A., Murphy, C. E., Carr, D., Duchek, J. M., Buckles, V. and Morris, J. C. (1997). Reliability of the washington university road test: a performance-based assessment for drivers with dementia of the alzheimer type. Archives of Neurology, 54, 707–712. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9193205.CrossRefGoogle Scholar
Iverson, D. J., Gronseth, G. S., Reger, M. A., Classen, S., Dubinsky, R. M., Quality Standards Subcomittee of the American Academy of Neurology. (2010). Practice parameter update: evaluation and management of driving risk in dementia: report of the quality standards subcommittee of the american academy of neurology. Neurology, 74, 1316–1324. doi:10.1212/WNL.0b013e3181da3b0f.CrossRefGoogle Scholar
Johnson, D. K., Storandt, M., Morris, J. C. and Galvin, J. E. (2009). Longitudinal study of the transition from healthy aging to alzheimer disease. Archives of Neurology, 66, 1254–1259. doi:10.1001/archneurol.2009.158.CrossRefGoogle ScholarPubMed
Joseph, P. G.et al. (2014). The Mini-Mental State Examination, clinical factors, and motor vehicle crash risk. Journal of the American Geriatrics Society, 62, 1419–1426. doi:10.1111/jgs.12936.CrossRefGoogle ScholarPubMed
Kanne, S. M., Balota, D. A., Storandt, M., McKeel, D. W. Jr., and Morris, J. C. (1998). Relating anatomy to function in alzheimer's disease: neuropsychological profiles predict regional neuropathology 5 years later. Neurology, 50, 979–985. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9566382.CrossRefGoogle ScholarPubMed
Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R. and Schimmel, H. (1983). Validation of a short orientation-memory-concentration test of cognitive impairment. The American Journal of Psychiatry, 140, 734–739. Available at: http://www.ncbi.nlm.nih.gov/pubmed/6846631.Google Scholar
Kelly, R., Warke, T. and Steele, I. (1999). Medical restrictions to driving: the awareness of patients and doctors. Postgraduate Medical Journal, 75, 537–539. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10616686.CrossRefGoogle ScholarPubMed
Kemper, S., LaBarge, E., Ferraro, F. R., Cheung, H., Cheung, H. and Storandt, M. (1993). On the preservation of syntax in alzheimer's disease: evidence from written sentences. Archives of Neurology, 50, 81–86. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8418805.CrossRefGoogle ScholarPubMed
Korner-Bitensky, N., Bitensky, J., Sofer, S., Man-Son-Hing, M. and Gelinas, I. (2006). Driving evaluation practices of clinicians working in the united states and canada. The American Journal of Occupational Therapy, 60, 428–434. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16915873.CrossRefGoogle ScholarPubMed
Langford, J., Methorst, R. and Hakamies-Blomqvist, L. (2006). Older drivers do not have a high crash risk–a replication of low mileage bias. Accident Analysis and Prevention, 38, 574–578. doi:10.1016/j.aap.2005.12.002.CrossRefGoogle Scholar
Leproust, S., Lagarde, E. and Salmi, L.-R. (2008). Risks and advantages of detecting individuals unfit to drive: a markov decision analysis. Journal of General Internal Medicine, 23, 1796–803. doi:10.1007/s11606-008-0777-8.CrossRefGoogle ScholarPubMed
Lesikar, S. E., Gallo, J. J., Rebok, G. W. and Keyl, P. M. (2002). Prospective study of brief neuropsychological measures to assess crash risk in older primary care patients. The Journal of the American Board of Family Practice/American Board of Family Practice, 15, 11–19. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11841134.Google ScholarPubMed
Marmeleira, J. F., Godinho, M. B. and Fernandes, O. M. (2009). The effects of an exercise program on several abilities associated with driving performance in older adults. Accident Analysis and Prevention, 41, 90–97. doi:10.1016/j.aap.2008.09.008.CrossRefGoogle ScholarPubMed
Marottoli, R. A., de Leon, C. F. M., Glass, T. A., Williams, C. S., Cooney, L. M. Jr., and Berkman, L. F. (2000). Consequences of driving cessation: decreased out-of-home activity levels. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 55, S334–S340. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11078110.CrossRefGoogle ScholarPubMed
Martin, A. J., Marotolli, R. and O'Neill, D. (2009). Driving assessment for maintaining mobility and safety in drivers with dementia. Cochrane Database Syst Rev, Cd006222. doi:10.1002/14651858.CD006222.pub2.CrossRefGoogle ScholarPubMed
Mckhann, G. M.et al. (2011). The diagnosis of dementia due to alzheimer's disease: recommendations from the national institute on aging-alzheimer's association workgroups on diagnostic guidelines for alzheimer's disease. Alzheimer's & Dementia, 7, 263–269. doi:10.1016/j.jalz.2011.03.005.CrossRefGoogle ScholarPubMed
Mclachlan, R. S., Starreveld, E. and Lee, M. A. (2007). Impact of mandatory physician reporting on accident risk in epilepsy. Epilepsia, 48, 1500–1505. doi:10.1111/j.1528-1167.2007.01051.x.CrossRefGoogle ScholarPubMed
Meuser, T. M., Carr, D. B., Berg-Weger, M., Niewoehner, P. and Morris, J. C. (2006). Driving and dementia in older adults: implementation and evaluation of a continuing education project. The Gerontologist, 46, 680–687. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17050760.CrossRefGoogle ScholarPubMed
Mezuk, B. and Rebok, G. W. (2008). Social integration and social support among older adults following driving cessation. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 63, S298–S303. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18818450.CrossRefGoogle ScholarPubMed
Middleton, H., Westwood, D., Robson, J. and Kok, D. (2005). Assessment and decision criteria for driving competence in the elderly. In Underwood, G. (ed.), Traffic and Transport Psychology: Theory and Application. London: Elsevier; 101–113.Google Scholar
Miller, D. J. and Morley, J. E. (1993). Attitudes of physicians toward elderly drivers and driving policy. Journal of the American Geriatrics Society, 41, 722–724. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8315181.CrossRefGoogle ScholarPubMed
Molnar, F. J., Patel, A., Marshall, S. C., Man-Son-Hing, M. and Wilson, K. G. (2006). Clinical utility of office-based cognitive predictors of fitness to drive in persons with dementia: a systematic review. Journal of the American Geriatrics Society, 54, 1809–1824. doi:10.1111/j.1532-5415.2006.00967.x.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The clinical dementia rating (cdr): current version and scoring rules. Neurology, 43, 2412–2414. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8232972.CrossRefGoogle ScholarPubMed
Morris, J. C.et al. (1989). The consortium to establish a registry for alzheimer's disease (cerad). Part i. Clinical and neuropsychological assessment of alzheimer's disease. Neurology, 39, 1159–1165. Available at: http://www.ncbi.nlm.nih.gov/pubmed/2771064.Google Scholar
Nourhashemi, F., Ousset, P. J., Gillette-Guyonnet, S., Cantet, C., Andrieu, S. and Vellas, B. (2008). A 2-year follow-up of 233 very mild (cdr 0.5) alzheimer's disease patients (real.Fr cohort). International Journal of Geriatric Psychiatry, 23, 460–465. doi:10.1002/gps.1904.CrossRefGoogle ScholarPubMed
Odenheimer, G. L. (1993). Dementia and the older driver. Clinics in Geriatric Medicine, 9, 349–364. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8504384.CrossRefGoogle ScholarPubMed
Odenheimer, G. L., Beaudet, M., Jette, A. M., Albert, M. S., Grande, L. and Minaker, K. L. (1994). Performance-based driving evaluation of the elderly driver: safety, reliability, and validity. Journal of gerontology, 49, M153–M159. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8014389.CrossRefGoogle ScholarPubMed
Orriols, L.et al. (2009). The impact of medicinal drugs on traffic safety: a systematic review of epidemiological studies. Pharmacoepidemiology and drug safety, 18, 647–658. doi:10.1002/pds.1763.CrossRefGoogle ScholarPubMed
Ott, B. R.et al. (2005). Clinician assessment of the driving competence of patients with dementia. Journal of the American Geriatrics Society, 53, 829–833. doi:10.1111/j.1532-5415.2005.53265.x.CrossRefGoogle ScholarPubMed
Ott, B. R., Festa, E. K., Amick, M. M., Grace, J., Davis, J. D. and Heindel, W. C. (2008a). Computerized maze navigation and on-road performance by drivers with dementia. Journal of Geriatric Psychiatry and Neurology, 21, 18–25. doi:10.1177/0891988707311031.CrossRefGoogle ScholarPubMed
Ott, B. R.et al. (2008b). A longitudinal study of drivers with alzheimer disease. Neurology, 70, 1171–1178. doi:10.1212/01.wnl.0000294469.27156.30.CrossRefGoogle ScholarPubMed
Papa, M.et al. (2014). Comorbidities and crash involvement among younger and older drivers. PloS one, 9, e94564. doi:10.1371/journal.pone.0094564.CrossRefGoogle ScholarPubMed
Perkinson, M. A.et al. (2005). Driving and dementia of the alzheimer type: beliefs and cessation strategies among stakeholders. The Gerontologist, 45, 676–685. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16199403.CrossRefGoogle ScholarPubMed
Persson, D. (1993). The elderly driver: deciding when to stop. The Gerontologist, 33, 88–91. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8440507.CrossRefGoogle ScholarPubMed
Redelmeier, D. A., Yarnell, C. J., Thiruchelvam, D. and Tibshirani, R. J. (2012). Physicians’ warnings for unfit drivers and the risk of trauma from road crashes. The New England Journal of Medicine, 367, 1228–1236. doi:10.1056/NEJMsa1114310.CrossRefGoogle ScholarPubMed
Reger, M. A., Welsh, R. K., Watson, G. S., Cholerton, B., Baker, L. D. and Craft, S. (2004). The relationship between neuropsychological functioning and driving ability in dementia: a meta-analysis. Neuropsychology, 18, 85–93. doi:10.1037/0894-4105.18.1.85.CrossRefGoogle ScholarPubMed
Retchin, S. M. and Hillner, B. E. (1994). The costs and benefits of a screening program to detect dementia in older drivers. Medical Decision Making, 14, 315–324. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7808207.CrossRefGoogle ScholarPubMed
Rizzo, M., McGehee, D. V., Dawson, J. D. and Anderson, S. N. (2001). Simulated car crashes at intersections in drivers with alzheimer disease. Alzheimer Disease and Associated Disorders, 15, 10–20. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11236820.CrossRefGoogle ScholarPubMed
Sanders, N.et al. (2006). Eu medril project: medical testing for the driving licence: report No. Final Report. Brussels: Cieca. Available at: http://www.cieca.eu/download.asp?file=1FinalReportMEDRIL.pdf; Accessed 14 April 2015Google Scholar
Stern, R. A.et al. (2008). At the crossroads: development and evaluation of a dementia caregiver group intervention to assist in driving cessation. Gerontology & Geriatrics Education, 29, 363–382. doi:10.1080/02701960802497936.CrossRefGoogle ScholarPubMed
Stutts, J. C., Stewart, J. R. and Martell, C. (1998). Cognitive test performance and crash risk in an older driver population. Accident Analysis and Prevention, 30, 337–346. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9663293.CrossRefGoogle Scholar
US Department of Transportation (2010). Highway statistics 2009 [Online]. Washington, DC: Federal Highway Administration. Available at: http://www.fhwa.dot.gov/policyinformation/statistics/2009/dl22.cfm; last accessed 25 February 2011.Google Scholar
Wadley, V. G.et al. (2009). Mild cognitive impairment and everyday function: an investigation of driving performance. Journal of Geriatric Psychiatry and Neurology, 22, 87–94. doi:10.1177/0891988708328215.CrossRefGoogle ScholarPubMed
Whelihan, W. M., DiCarlo, M. A. and Paul, R. H. (2005). The relationship of neuropsychological functioning to driving competence in older persons with early cognitive decline. Archives of Clinical Neuropsychology, 20, 217–228. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15770793.CrossRefGoogle ScholarPubMed