More mad and more wise

doi:10.1016/j.aap.2012.01.010

Accident Analysis & Prevention

Volume 49, November 2012, Pages 263-265

https://doi.org/10.1016/j.aap.2012.01.010 Get rights and content

Abstract

It is clearly important that clinicians have appropriate assessment and management pathways when working in clinical settings where illnesses associated with cognitive impairment may impair both mobility and safety, such as memory clinics and medical services dealing with older people.

However, in wider terms, particularly in terms of an understanding of the impact of cognitive function on the whole population of older drivers, it is critical that debate on cognitive function and driving is adequately informed by the sciences of gerontology and public health, embraces a broad definition of cognitive function which recognizes both the gains and losses of ageing, recognizes the barriers and disruptive influences which may skew scientific debate, and frames such a discourse in terms of an appropriate balance between mobility and safety.

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The development of a traffic system that is age-attuned needs to take account of both mobility and safety issues, in particular in terms of interventions which lead to a change in the relative proportion of modes of transport utilized, as has been postulated for the impact of medical screening of older drivers (O׳Neill, 2012).
The development of a traffic system that is age-attuned needs to take account of both mobility and safety issues, in particular in terms of interventions which lead to a change in the relative proportion of modes of transport utilized, as has been postulated for the impact of medical screening of older drivers. Statistics for travel-related injury have been dominated by impacts between motorized vehicles and either other motorized vehicles or unprotected road users to the point of neglecting other significant forms of traffic-related injury.
This review of research in two emerging areas of concern – non-collision injuries in public transport and single pedestrian accidents – confirms that both of these causes of death and injury in traffic require further research and monitoring in traffic injury prevention. Although the research base is slender, the data is consistently suggestive of significant need for both concern and further research, and to ensure that the factors underlying these accidents are addressed so as to enhance preserved safe mobility for older Europeans.
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However, screening policies based on chronological age are widely used in most European countries and many US and Australian states (e.g. Insurance Institute for Highway Safety, 2012; Langford et al., 2004b; Meuser, 2008; Mitchell, 2008; White and O׳Neill, 2000). As noted by O׳Neill (2012a), ageism, vested interests, and biased conceptions about the ageing process can be traced in the eagerness of regulating older drivers׳ rights to drive through various screening policies. Lately, however, more evidence-based policies have been called for (Desapriya et al., 2012; O׳Neill, 2012b; Salmi et al., 2014; Siren and Meng, 2012), and the trend of measuring impact as relative to the societal investment may be reaching this policy area.
Chronological age, per se, seems to be, in the case of mature drivers, only a weak predictor of safe driving performance. However, screening policies based on chronological age are widely used. Nevertheless, lately, more evidence-based policies have been called for. In this paper we first, investigate the evidence for and against having an age-based driver screening policy in place; second, we map and compare the current driving licensing policies in European Union (EU) member states in order to examine the variation; and third, we draw conclusions based on the literature and the policy mapping and provide policy recommendations. We find no evidence from the literature demonstrating that the benefits from age-based driver screening would outweigh the disadvantages, and we find the European policies, to a large extent, coercive and not evidence based. Based on research evidence, the policies are likely to limit the mobility and potentially worsen the safety of older persons.
Comparison of driving avoidance and self-regulatory patterns in younger and older drivers
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Mobility is key to maintaining social activities in later life (Taylor & Tripodes, 2001). Puzzlingly, as those drivers who are most prone to aging-related impairments like to point out, they boast the lowest crash rates (Langford, Bohensky, Koppel, & Newstead, 2008), at least as a population, until their annual mileage becomes extremely low (Langford, Koppel, McCarthy, & Srinivasan, 2008; see also O’Neill, 2012, for discussion). Some age-related visual and cognitive impairments are not only inevitable (e.g., Deary, Johnson, & Starr, 2010), but presumably interfere with abilities that are crucial for driving safety (Anstey, Wood, Lord, & Walker, 2005; DeRaedt & Ponjaert-Kristoffersen, 2001; McGwin, Owsley, & Ball, 1998; Selander, Lee, Johansson, & Falkmer, 2011).
This study sought to ascertain whether both the avoidance of difficult driving situations and self-regulation (i.e., avoidance matched to one’s cognitive abilities) are typical of older drivers. Older and younger drivers (mean ages 71 and 30 years, respectively) self-rated their avoidance of ten specific driving situations (e.g., driving at night, in fog). Both groups also self-evaluated their physical and mental health, while we administered general (Mini-Mental State Examination) and specific (Digit Symbol Substitution Test) cognitive assessments. The older drivers reported greater avoidance of all ten situations than the younger drivers did, although the effect size remained small. There were also more correlations between self-reported driving avoidance and both health-related perceptions and objective indicators of cognitive function among older drivers, suggesting that self-regulation is a strategy that is typical of this group. Results also showed that, with the exception of the cognitive function indicators, the factors under investigation (i.e., age, driving experience, health-related perceptions) underpinned the self-regulatory patterns in different ways, depending on the drivers’ age group. Hypotheses regarding the underlying mechanisms, further factors of interest (including relevant neuropsychological tests), and alternative ways of measuring self-regulation are put forward.
Family reports of medically impaired drivers in Missouri: Cognitive concerns and licensing outcomes
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Further studies are needed to determine what are the appropriate reasons or observations that should result in a report being made and the report leading to a medical fitness-to-drive evaluation, why seniors may decide not to go through the evaluation process and the impact on health, social connectedness, and driving destinations after delicensing occurs. As the demented population grows, there is a need to strive toward a balance of achieving mobility and safety given societies' increasing transportation burden (O'Neill, 2012). Despite these limitations, the results have confirmed previous studies that would indicate that cognitive impairment is one of the major reasons for report for medical fitness-to-drive evaluation.
This study investigated reasons why older adults (n = 689) were reported to the Driver License Bureau, Missouri Department of Revenue, by family members as potentially unfit to drive with an emphasis on cognitive concerns and associated licensing outcomes. A total of 448 drivers were reported to have some cognitive issue; common symptoms included confusion, memory loss, and becoming lost while driving. Diagnostic labels (Alzheimer’s disease (AD), cognitive impairment/dementia, brain injury/insult) were listed for 365 cases. A physician evaluation is required for license review. Of those with a diagnostic label, half (51%, n = 187) failed to submit this evaluation and almost all were de-licensed immediately. Of those evaluated by a physician, diagnostic agreement between family members and physicians was high for specific conditions (100% for AD, 97% for acute brain injury), and less so for cognitive impairment/dementia (75%). This latter finding suggests that physicians and family members may understand cognitive symptoms differently. Whether cognitively impaired or not, few family reported drivers in this sample (∼2%) retained a valid license. Family members may be in the best position to recognize when medical-functional deficits impact on driving safety, and physicians and driver licensing authorities would do well to take their observations into account with respect to older driver fitness.
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View full text

More mad and more wise

Abstract

Transport. Part F: Traffic Psychol. Behav.

Accid. Anal. Prev.

Accid. Anal. Prev.

Accid. Anal. Prev.

Accid. Anal. Prev.

Wilderness Environ. Med.

Eur. Geriatr. Med.

Accid. Anal. Prev.

Accid. Anal. Prev.

Accid. Anal. Prev.

Accid. Anal. Prev.

The many faces of human ageing: toward a psychological culture of old age

Psychol. Med.

The older adult driver with cognitive impairment: it's a very frustrating life

JAMA

Physician's Guide to Assessing and Counseling Older Drivers

Wisdom in later life: ethnographic approaches

Ageing Soc.

Driving status and risk of entry into long-term care in older adults

Am. J. Public Health

The Mismeasure of Man