Developing referral and reassessment criteria for drivers with dementia

Abstract

Background and Aims:Determining if a person with dementia should be referred for a driver assessment, at what stage of the illness and how often to repeat this are difficult decisions for health professionals. The aims of this study were to develop criteria for driver assessment referral and to explore the value of routine reassessment for drivers with dementia. Methods and Results: Twenty participants with a diagnosis of dementia were recruited from a memory clinic and underwent a standard occupational therapy driver assessment and reassessment 6 months later. Fifteen failed the initial assessment but 10 went on to pass local area assessments. Some participants in the early stages of the disease failed. Five of the nine participants suitable for reassessment at 6 months also failed. Conclusion:The results confirmed that routine referral following the diagnosis of dementia is appropriate. Change in performance was noted at reassessment, confirming that 6 months between assessments is an appropriate timeframe.

Using Social Judgment Theory to Study Occupational Therapists’ Use of Information When Making Driver Licensing Recommendations for Older and Functionally Impaired Adults

“…A DATOT first conducts a clinic-based assessment that considers the client's current pattern of driving and need to drive; driving history; and emotional, sensory, cognitive, and physical functioning. If appropriate, this assessment may be followed by an on-road or behind-the-wheel evaluation of the client's driving performance in a dual-controlled vehicle (Lovell & Russell, 2005;Pellerito, 2005;Stav, 2004). Following assessment, the DATOT recommends a course of action-for example, that the client continue to drive, receive some kind of intervention such as driver edu-cation or retraining to improve skills, receive training in the use of adaptive equipment, or relinquish driving (Stav, 2004).…”

“…The instructions asked participants to rank order the cues from 1 to 12, with each number used only once, and to leave blank any cue the respondent did not consider in decision making. The instructions also reminded participants that, although the importance of each factor might vary depending on the particular client and his or her circumstances, they should Akinwuntan et al, 2002;Brouwer, Withaar, Tant, & van Zomeren, 2002;Stav, 2004 Driver behavior Checking mirror; signaling before turning; negotiating intersections; impulsive, disinhibited, risky, or aggressive behaviors Galski, Ehle, & Williams, 1997;Lovell & Russell, 2005;OT Australia-Victoria, 1998 Road law/road craft knowledge Following road signs and signals at traffic circles and intersections, self-selected following distance, off-road slide, penand-paper test performance Lovell & Russell, 2005;OT Australia-Victoria, 1998 Physical skills Moving the body, range of motion, gross muscle strength, fine coordination, grip strength Akinwuntan et al, 2002;Marottoli, 1993;Sims, Owsley, Allman, Ball, & Smoot, 1998;Stav, 2004 Vehicle handling skills Managing the car controls, steering skill, braking speed, lane changing Brouwer et al, 2002;OT Australia-Victoria, 1998 Age Akinwuntan et al, 2002 Cognitive and perceptual skills Insight, ability to use feedback and learn, concentration, memory, reaction times, decision making (e.g., at traffic circles), complex problem solving, absence of hallucinations Akinwuntan et al, 2002;Austroads, 2003;Brouwer et al, 2002;De Raedt & Ponjaert Kristoffersen, 2000Galski et al, 1997;Hunt, 1993;Marottoli, 1993;Stutts, Stewart, & Martell, 1998 Current driving needs Where the client will drive, how often, when the client wants to drive, presence of others when driving OT Australia-Victoria, 1998; Stav, 2004 Residence Rural or metropolitan Pellerito, 2005;Stav, 2004 Sensory functions Sensation, hearing (e.g., responding to a siren), and vision (observation of road signs; client must have at least 6/12 vision for driving) …”

Driving Assessment for Persons with Dementia: How and when?

“…Only five observational studies included dementia subtypes other than AD [ 45 , 50 , 54 , 58 , 59 ]. One meta-analysis also included studies with different dementia subtypes, but results were not analyzed for individual etiologies [ 87 ].…”

“…Seven primary studies and one meta-analysis assessed driving behaviors in different stages of dementia. Three studies used the MMSE to quantify stages of dementia [56,58,60], six studies used the CDR score [51][52]56,60,63,87], and one study used other scores [50][51][52]. Results varied according to the measurement used.…”

Driving Difficulties Among Patients with Alzheimer’s Disease and Other Neurodegenerative Disorders

“…In addition, in qualitative reports, strategic driving errors were found in all diagnostic groups, in particular when patients with neurodegenerative disorders were asked to navigate themselves in complex traffic situations, and when they were driving for a longer period of time. The latter findings indicate that the on-road driving assessment should last at least around 40-45 minutes and must include complex traffic situations and navigation by the patient to assess fitness to drive [6,42,43]. The large variety of driving errors committed by patients with neurodegenerative disorders suggests that many different driving behaviors, at all levels of driving, must be judged during on-road driving assessments before grounded pass/fail decisions can be made.…”