American Academy of Neurology position statement on physician reporting of medical conditions that may affect driving competence

Bacon, David; Fisher, Russell S.; Morris, Jenny; Rizzo, Matthew; Spanaki, Marianne

doi:10.1212/01.wnl.0000259514.85579.e0

Cited by 63 publications

(35 citation statements)

References 5 publications

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“…Referring physicians were more likely to overestimate the patient’s fitness to drive, which was consistent with previous studies suggesting that physicians are hesitant to give an unfavorable recommendation due to fear of harming the doctor-patient relationship [36], ambiguous fitness to drive criteria [36], uncertainty in legal and ethical obligations [37], and potential lawsuits [38]. Awareness of these factors implies a need to develop more objective and clinician-friendly tools for fitness to drive evaluation.…”

Section: Discussionsupporting

confidence: 86%

The Impact of Advanced Age on Driving Safety in Adults with Medical Conditions

et al. 2018

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Background: Adults aged 85 and older, often referred to as the oldest-old, are the fastest-growing segment of the population. The rapidly increasing number of older adults with chronic and multiple medical conditions poses challenges regarding their driving safety. Objective: To investigate the effect of advanced age on driving safety in drivers with medical conditions. Methods: We categorized 3,425 drivers with preexisting medical conditions into four age groups: middle-aged (55–64 years, n = 1,386), young-old (65–74 years, n = 1,013), old-old (75–84 years, n = 803), or oldest-old (85 years and older, n = 223). All underwent a formal driving evaluation. The outcome measures included fitness to drive recommendation by the referring physician, comprehensive fitness to drive decision from an official driving evaluation center, history of motor vehicle crashes (MVCs), and history of traffic violations. Results: The oldest-old reported more cardiopulmonary and visual conditions, but less neurological conditions than the old-old. Compared to the middle-aged, the oldest-old were more likely to be considered unfit to drive by the referring physicians (odds ratio [OR] = 4.47, 95% confidence interval [CI] 2.20–9.10) and by the official driving evaluation center (OR = 2.74, 95% CI 1.87–4.03). The oldest-old reported more MVCs (OR = 2.79, 95% CI 1.88–4.12) compared to the middle-aged. Conclusion: Advanced age adversely affected driving safety outcomes. The oldest-old are a unique age group with medical conditions known to interfere with safe driving. Driving safety strategies should particularly target the oldest-old since they are the fastest-growing group and their increased frailty is associated with severe or fatal injuries due to MVCs.

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Section: Discussionsupporting

confidence: 86%

The Impact of Advanced Age on Driving Safety in Adults with Medical Conditions

et al. 2018

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“…In order to resume driving after a stroke, most stroke survivors will need medical clearance from their physician [2]. When in doubt, physicians refer to a fitness-to-drive evaluation that typically involves the assessment of visual, motor, and cognitive status and, in most cases, a practical road test [3]. Although road tests may suffer from limitations including lack of standardization of the road course and psychometric properties of the on-road checklists [4], it is recognized in most countries as the de facto standard to determine the fitness-to-drive condition.…”

Section: Introductionmentioning

confidence: 99%

On-Road Driving Impairments and Associated Cognitive Deficits After Stroke

2014

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Background: Little is known about the critical on-road driving skills that get affected after a stroke. The purpose of this study was to investigate the key on-road driving impairments and their associated cognitive deficits after a stroke. A second aim was to investigate if lateralization of stroke impacts results of the cognitive and on-road driving tests. Methods: In this cross-sectional study, 99 participants with a first-ever stroke who were actively driving prior to stroke underwent a cognitive battery and a standardized road test that evaluated 13 specific on-road driving skills. These on-road driving skills were mapped onto an existing, theoretical framework that categorized the on-road items into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving skills. The total score on the road test and the on-road decision, made by a certified fitness-to-drive expert, decided the main outcome. The critical on-road driving skills predicting the on-road decision were identified using logistic regression analysis. Linear regression analysis was employed to determine the cognitive impairments leading to poor total on-road scores. Analyses were repeated for right- and left-sided strokes. Results: In all, 37 persons scored poorly on the road test. These participants performed worse in all hierarchic clusters of on-road driving. Performances on the operational cluster and the visuo-integrative cluster best predicted on-road decisions (R² = 0.60). ‘Lane changing' and ‘understanding, insight, and quality of traffic participation' were the critical skill deficits leading to poor performance on the road test (R² = 0.65). Divided attention was the main determinant of on-road scores in the total group (R² = 0.06). Participants with right-sided stroke performed worse on visual field, visual neglect, visual scanning, visuo-constructive skills, and divided attention compared with those with left-sided stroke. Divided attention was the main determinant of total on-road scores in the right-sided stroke group (R² = 0.10). A combination of visual scanning, speed of processing, and executive dysfunction yielded the best model to predict on-road scores in left-sided strokes (R² = 0.46). Conclusions: Poor performance in the road test after stroke is determined by critical operational and visuo-integrative driving impairments. Specific and different driving evaluation and training programs are needed for right- and left-sided strokes.

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“…A single physician's judgment and conviction on this matter may not provide an adequate assessment (8). In addition, holding a single physician responsible for such a decision may disrupt patientdoctor relationship due to the patient's voluntary omission of certain clinical information (9). Therefore, healthcare workers need fair, objective criterion when cooperating with authorities on assessment of a patient's suitability for driving (1,7,10).…”

Section: Introductionmentioning

confidence: 99%

Parkinson hastalığında sürücülük

Özdilek¹,

Uç²

2014

tnd

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Even though drivers with Parkinson's disease (PD) are considered at higher for accidents due to associated visual, cognitive impairments as well as sleeping and movement disorders, no epidemiologic relationship between PD and accidents has been established. However, drivers with PD have been found to cease driving earlier than healthy controls of similar age. The medical diagnosis or the physician's evaluation alone is not enough to decide driving fitness in drivers with PD. Evaluation of movement, cognitive and visual skills and traffic and driving simulation tests help to assess driving performance, however there are no wellestablished and standardized methods and guidelines to determine driver fitness in PD in Turkey or worldwide. Components of driving skills and evaluation of driving performance in PD along with the description of the status of driving research and assessments in Turkey and proposals to advance driving assessment in Turkey will be discussed in our manuscript. Developing a standardized evaluation methods and a multidisciplinary decision process for the patients with a neurodegenerative disease is very important to maintain their safe vehicular mobility for a long time. (Turkish Journal of Neurology 2014; 20:64-71) Key Words: Parkinson's disease, driving, driving tests Parkinsonlu sürücüler yaşadıkları görsel, bilişsel, uyku ve hareket bozukluklarına bağlı olarak kazalar için daha riskli olarak düşünülse de, Parkinson hastalığı (PH) ile kazalar arasında açık bir epidemiyolojik ilişki henüz ortaya konamamıştır. Ancak, kontrol grubuna göre daha erken sürücülüğü bırakma eğiliminde oldukları saptanmıştır. Salt tıbbi tanı veya doktor değerlendirmesi PH'da sürücülük yeterliliğine karar vermede yeterli değildir. Hareket, bilişsel ve görsel yetenekleri değerlendirme, trafik ve sürüş simülasyon testleri PH'da sürücülük performansını anlamaya yardım ederler. Ancak bunun için bizim ülkemizde ve tüm dünyada yerleşmiş standart bir yaklaşım henüz yoktur. Bu yazıda sürüş yeteneğinin bileşenleri ile PH'da sürücülüğün değerlendirilmesi çalışmalar eşliğinde tartışılacak ve bizim ülkemizdeki durum ve iyileştirilebilmesi için neler yapılabileceğinin üzerinde durulacaktır. Nörodejeneratif bir hastalığın varlığında hastanın hareketliliğini ve özgürlüğünü mümkün olan en uzun süreç boyunca temin etme noktasında, standart test yöntemlerin kullanılması ve belli uzmanların oluşturduğu bir ekibin verdiği doğru değerlendirme ve kararlar çok büyük önem arz etmektedir.

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American Academy of Neurology position statement on physician reporting of medical conditions that may affect driving competence

Cited by 63 publications

References 5 publications

The Impact of Advanced Age on Driving Safety in Adults with Medical Conditions

The Impact of Advanced Age on Driving Safety in Adults with Medical Conditions

On-Road Driving Impairments and Associated Cognitive Deficits After Stroke

Parkinson hastalığında sürücülük

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