Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility

Abstract

BackgroundDriving is related to social participation; therefore older drivers may be reluctant to cease driving. Continuation of driving has also been reported in a large proportion of patients with cognitive impairment. The aim of this study is to investigate whether patients with cognitive impairment adhere to driving cessation advice after a fitness-to-drive assessment and what the consequences are with regard to mobility.MethodsPatients with cognitive impairment (n = 172) participated in a fitness-to-drive assessment study, including an on-road driving assessment. Afterwards, patients were advised to either continue driving, to follow driving lessons, or to cease driving. Approximately seven months thereafter, patients were asked in a follow-up interview about their adherence to the driving recommendation. Factors influencing driving cessation were identified using a binary logistic regression analysis. Use of alternative transportation was also evaluated.ResultsRespectively 92 and 79% of the patients adhered to the recommendation to continue or cease driving. Female gender, a higher Clinical Dementia Rating-score, perceived health decline, and driving cessation advice facilitated driving cessation. Patients who ceased driving made use of less alternative modes of transportation than patients who still drove. Nonetheless, around 40% of the patients who ceased driving increased their frequency of cycling and/or public transport use.ConclusionsAdherence to the recommendations given after the fitness-to-drive assessments was high. Female patients were in general more likely to cease driving. However, a minority of patients did not adhere to driving cessation advice. These drivers with dementia should be made aware of the progression of their cognitive impairment and general health decline to facilitate driving cessation. There are large differences in mobility between patients with cognitive impairment. Physicians should discuss options for alternative transportation in order to promote sustained safe mobility of patients with cognitive impairment.

Predicting On-Road Driving Skills, Fitness to Drive, and Prospective Accident Risk in Older Drivers and Drivers with Mild Cognitive Impairment: The Importance of Non-Cognitive Risk Factors

“…Healthy older drivers 27 Aging is associated with increasing cognitive, 28 motor, and sensory impairments. These impairments 27,28], avoidance behavior [19,29,30], relatives' reports of unsafe driving [19,31], the number of accidents in the past years [19,27,32], and reduced driving practice [19,33,34]. Moreover, visual impairments [35][36][37][38], impaired cervical spine mobility [20, 39,40], and other indicators of poor physical health status [20, 28,41] were reported to be relevant pre- Table 1 The most robust evidence-based cognitive and non-cognitive predictors of practical driving behavior in healthy older drivers and drivers with MCI nitive and non-cognitive risk factors (Table 1) in a previous study [30].…”

Driving-Related Adverse Events in the Elderly Men: A Population-Based Prospective Cohort Study

“…This is in line with previous studies showing that the MMSE was insensitive to the risk of unsafe driving 31 and that the items of the MMSE were relatively less associated with driving ability. 14,32 Currently, there are no specific guidelines regarding aptitude tests for the renewal of driver's license in older drivers in 7 The Korea Road Traffic Authority provides cognitive function tests for the purpose of education of older drivers, but these include only evaluations of attention and visuospatial function, not memory function tests. Since performance on the WLMT, which evaluate learning ability and working memory, was associated with the risk of risky driving in the present study, screening instruments to verify driving fitness may need to include more questions on memory functions.…”

“…However, their results were inconsistent. 13,14 Moreover, the impact of memory decline on driving has been barely studied in the elderly despite the fact that memory decline is one of the representative symptoms in the cognitively impaired older individuals. In addition, their study samples were relatively small, ranging from 50 to 400, and mostly consisted of cognitively impaired elderly.…”

Driving Assessment for Persons with Dementia: How and when?

“…Three primary observational studies compared simulated driving with on-road driving assessment [15,54,84]. All three studies used TRIP scoring system as an outcome measure for the on-road assessment and the following outcome measures for driving simulator assessment: minimum speed when approaching an intersection with traffic lights, number of collisions, the deceleration of the rear car after merging and time headway directly after merging.…”