A Longitudinal Study Examining Self-Regulation Practices in Older Drivers with and without Suspected Mild Cognitive Impairment

Abstract

Purpose Mild cognitive impairment can impact driving performance and self-regulation practices. However, there is little evidence on how cognitive impairment may impact these self-regulation practices over a period of time. Therefore, the aim of this study was to examine changes in the number and type of situations in which older drivers with and without suspected mild cognitive impairment (MCI) self-regulate their driving over a one-year period, after accounting for relevant confounders. Participants and Methods A longitudinal cohort study involving older drivers (65+ years) from metropolitan Western Australia was interviewed by a telephone interview at baseline and one-year follow-up. The Telephone Cognitive Screen (T-CogS) was also administered to determine changes in their cognitive status. The outcome of interest was the number and type of situations older drivers self-regulated their driving. Results A total of 670 drivers were interviewed at baseline (suspected MCI: n = 227; no cognitive impairment: n = 443) and one-year follow-up (suspected MCI: n = 251; no cognitive impairment: n = 419), which provided 1340 observations. Drivers with suspected MCI increased the number of driving situations in which they self-regulated by 13% over a period of one-year compared with drivers without cognitive impairment (IRR = 1.13, 95% CI = 1.02–1.27, p = 0.025). Specifically, drivers with suspected MCI had 60% increased odds of self-regulating when “making turns across oncoming traffic” compared with drivers without cognitive impairment (unadjusted OR = 1.60, 95% CI = 1.02–2.53, p = 0.041). Other significant factors included being female (IRR = 1.87, 95% = 1.52–2.32, p = 0.001), aged 75+ years (IRR = 1.33, 95% CI = 1.10–1.60, p = 0.003), higher number of comorbidities (1–3 comorbidities: IRR = 1.26, 95% CI = 1.01–1.58, p = 0.040; 4+ comorbidities: IRR = 1.39, 95% CI = 1.08–1.78, p = 0.011), “decreased driving confidence” (IRR = 1.32, 95% CI = 1.10–1.58, p-value = 0.003) and “preference of having someone else drive” (IRR = 1.38, 95% CI = 1.12–1.70, p = 0.003). Having one or more traffic infringements was also associated with a decrease in the number of self-regulated driving situations (IRR = 0.80, 95% CI = 0.67–0.95, p = 0.011). Conclusion Over a one-year period, drivers with suspected MCI increased the number of situations in which they self-regulated their driving compared with drivers without cognitive impairment, particularly when “making turns across oncoming traffic”. Future studies should examine whether this increase in the types and number of self-regulated driving situations is enough to compensate for declines in cognition.

Metacognitive Awareness of Older Adult Drivers with Mild Cognitive Impairment: Relationships with Demographics, Subjective Evaluation of Cognition, and Driving Self-Efficacy

“…The study established a direct negative effect of age on the formation of the metacognitive feeling of certainty, indicating that older individuals diagnosed with MCI tend to exhibit less confidence in their ability to accomplish driving tasks under discussion. This finding aligns with existing literature, where age has been identified as a significant factor influencing decisions related to driving, with older age correlating with a higher likelihood of self-regulation or cessation of driving altogether [ 32 , 36 , 40 , 41 , 61 ]. The diminished certainty observed with increasing age may be attributed to a general decline in health and functional abilities typically associated with age [ 38 , 62 ].…”

“…Women seem to be more capable of recognizing changes in driving and tend to be more accurate in their self-reports, viewing driving as a mutable skill, in contrast to men, who see driving as a static skill [ 38 , 39 ]. Consequently, women may favor a metacognitive approach to their cognitive capabilities involved in driving, impacting the greater number of driving situations in which they self-regulate [ 40 , 41 , 42 ]. However, the greater discomfort and lesser need for driving may also influence women’s adoption of driving regulations rather than metacognitive awareness alone [ 43 ].…”

Revisiting Older Drivers’ Risks of At-fault Motor Vehicle Collisions in Japan

“…Stringent licensing policies are imposed on older drivers because their driving abilities could be affected by functioning difficulties as they age. However, it is reported that older drivers adjust their driving by driving less or avoiding challenging situations, compensating for their declining abilities [4][5][6] and potentially attenuating their MVC risk. Nevertheless, older drivers in Japan are not only required to take driving lessons and cognitive screening tests at their license renewal but are further encouraged to surrender their driving licenses.…”

Evaluation of Psychophysical Fitness in Drivers over 65 Years of Age

“…As a consequence, the quality of many of the skills should be measured with reliable instruments for vulnerable people [ 10 , 11 ]. These skills are also necessary as safe driving performance decreases [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ], which is reflected in crash rates and their severity. The involvement of older people in fatal accidents is estimated to increase by 155% by 2030, accounting for 54% of the total projected increase in the number of total fatal accidents [ 19 ].…”