The Driving Competence of 90-Year-Old Drivers: From a Hospital-Based Driving Clinic

Hollis, Ann M.; Lee, Athene; Kapust, Lissa Robins; Phillips, Laura Kristine; Wolkin, Jennifer; O’Connor, Margaret

doi:10.1080/15389588.2013.777957

Cited by 10 publications

(10 citation statements)

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“…The other main finding is the importance of the MMSE orientation subtest in the identification of NCI people who failed the road test. Of note, this finding is consistent with data from a study of the “oldest‐old” (90‐ to 97‐year‐old) drivers that revealed low scores on orientation were associated with increased driving risk . A mild decline in orientation in the NCI group may represent a clinically significant change.…”

Section: Discussionsupporting

confidence: 88%

“…Of note, this finding is consistent with data from a study of the "oldest-old" (90-to 97-year-old) drivers that revealed low scores on orientation were associated with increased driving risk. 19 A mild decline in orientation in the NCI group may represent a clinically significant change. It may be that orientation questions provide unique information for people who are otherwise cognitively intact, and failure on this item may be the harbinger of incipient dementia.…”

Section: Discussionmentioning

confidence: 99%

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Use of the MMSE in the Prediction of Driving Fitness: Relevance of Specific Subtests

O’Connor

Duncanson

Hollis

2019

J American Geriatrics Society

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OBJECTIVES To examine the association between performance on subtests of the Mini‐Mental State Examination (MMSE) and driving competence in people with cognitive impairment (CI) as well as those with no cognitive impairment (NCI). DESIGN Retrospective observational study. SETTING Participants referred for a DriveWise evaluation at Beth Israel Deaconess Medical Center in Boston, Massachusetts, were included in the study. PARTICIPANTS A total of 419 participants referred for a DriveWise evaluation was studied. The average age of the sample was 77.69 years. In this study, people with an MMSE score lower than 25 were included in the CI group; 41% of participants had CI. MEASUREMENTS All participants underwent mental status screening with the MMSE, and all underwent a 45‐minute road test modeled after the Washington University Road Test adapted for use in Boston streets. RESULTS In both groups, poor road test performance was associated with low scores on the MMSE. In drivers with CI, MMSE total score and performance on the attention subtest were significantly lower for those who failed the road test. In drivers with NCI, the MMSE total score and orientation subtests were significantly lower for those who failed the road test. CONCLUSIONS Clinicians working with older people should know that the MMSE is an effective tool to screen for driving safety, but MMSE subtests are differentially sensitive to driving safety in people with and without CI. Poor performance on specific MMSE subtests may prompt further evaluation of driving competence with a road test. J Am Geriatr Soc 67:790–793, 2019.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Use of the MMSE in the Prediction of Driving Fitness: Relevance of Specific Subtests

O’Connor

Duncanson

Hollis

2019

J American Geriatrics Society

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“…The TMTs have been shown to be significantly correlated with impaired driving on road tests by older drivers. [4][5][6][7][8][9][10][11][12][13][14][15][16] They are also widely used in clinical settings as screening measures for driving impairment in older drivers with and without cognitive impairment, 17,18 having been recommended for this purpose in the past by the American Medical Association. 19 The TMTs have other attractive features as potential screening tests, including their brevity (each test part taking <5 minutes), ease of administration (as pencil-and-paper tasks), low cost, and availability in the public domain.…”

mentioning

confidence: 99%

“…The TMTs have been shown to be significantly correlated with impaired driving on road tests by older drivers . They are also widely used in clinical settings as screening measures for driving impairment in older drivers with and without cognitive impairment, having been recommended for this purpose in the past by the American Medical Association .…”

mentioning

confidence: 99%

Clinical Utility of the Trail‐Making Test as a Predictor of Driving Performance in Older Adults

Papandonatos

Ott

Davis

et al. 2015

J American Geriatrics Society

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OBJECTIVES To assess the clinical utility of trail making tests as screens for impaired road-test performance. DESIGN We performed secondary analyses on three separate data sets from previously published studies of impaired driving in older adults using comparable road test designs and outcome measures. SETTING Two academic driving specialty clinics. PARTICIPANTS A total of 392 older drivers (303 with cognitive impairment and 89 controls) from Rhode Island and Missouri. MEASUREMENTS Standard operating characteristics were evaluated for Trail Making Test Part A (TMT-A), and Part B (TMT-B), as well as optimal upper and lower test cut points that could be useful in defining groups of drivers with indeterminate likelihood of impaired driving, who would most benefit from further screening or on-road testing. RESULTS Discrimination remained relatively high (>70%), when cut points for trail making tests derived from Rhode Island data were applied to Missouri data, but calibration was poor (p<.01). TMT-A provided the best utility for determining a range of scores (68–90 sec) for which additional road testing would be indicated in general practice settings. TMT-B was limited by a high frequency of cognitively-impaired participants unable to perform the test within the allotted time (>25%). Mere inability to complete the test in a reasonable time frame, e.g., TMT-A>48 sec or TMT-B>108 sec, may still be a useful tool in separating Unsafe from Safe/Marginal drivers in such samples. CONCLUSION Trail making tests (particularly TMT-A) may be useful as screens for driving impairment in older drivers in general practice settings, where most people are still safe drivers, but more precise screening measures need to be analyzed critically in a variety of clinical settings for testing cognitively-impaired older drivers.

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“…A previous study examining driving competence in the oldest-old suggested potential differences in cognitive functions associated with on-road driving performance [15]. Hence, there is a need to understand how advanced age influences all aspects of safe driving, including MVCs, traffic violations, and fitness to drive, especially among those with medical conditions.…”

Section: Introductionmentioning

confidence: 99%

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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The Driving Competence of 90-Year-Old Drivers: From a Hospital-Based Driving Clinic

Abstract: Drivers age 90 and above were at no greater driving risk than those one decade younger. MMSE orientation questions may be useful to assist in identifying which oldest old drivers could benefit from a comprehensive driving evaluation including an on-road test.

Cited by 10 publications

References 50 publications

Use of the MMSE in the Prediction of Driving Fitness: Relevance of Specific Subtests

Use of the MMSE in the Prediction of Driving Fitness: Relevance of Specific Subtests

Clinical Utility of the Trail‐Making Test as a Predictor of Driving Performance in Older Adults

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

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