This study provides longitudinal evidence for a decline in driving performance over time, primarily in early-stage DAT, and supports the need not only for driving assessments, but also for reevaluation of individuals with very mild and mild DAT.
Some SDAT subjects retain "safe" driving skills. The greater the dementia severity, the greater the likelihood of poor driving ability. Performance-based (road test) evaluations are necessary to properly determine driving skills at present, but attention and other cognitive screening measures should be developed.
The present study examined the relationship between visual attention measures and driving performance in healthy older adults and individuals with very mild and mild dementia of the Alzheimer type (DAT). Subjects were administered an on-road driving assessment and three visual attention tasks (visual search, visual monitoring, and useful field of view). The results indicated that error rate and reaction time during visual search were the best predictors of driving performance. Furthermore, visual search performance was predictive of driving performance above and beyond simple dementia severity and several traditional psychometric tests. The results suggest that general cognitive status may be useful for identifying individuals "at risk" for unsafe driving. However, measures of selective attention may serve to better differentiate safe versus unsafe drivers, especially in the DAT population.
Dementia adversely affects driving performance even in its mild stages, although some persons with DAT seem to drive safely for some time after disease onset. A traffic-interactive, performance-based road test that examines cognitive behaviors provides an accurate and reliable functional assessment of driving ability.
Schools of nursing across the country are implementing progression policies that prohibit students from graduating or from taking the nursing licensure examination, sometimes based solely on a single predictive test score. In addition, little empirical evidence exists that supports progression policies as effective in increasing a school's NCLEX-RN pass rates. This article reports on a study conducted when one school did not achieve the results they expected after implementing a progression policy. With use of logistic regression, diagnostic indexes, and other methods, reasons for the disparity between expected and observed NCLEX-RN pass rates were examined. Results revealed that the Health Education Systems, Inc. (HESI) Exit Exam was not able to accurately predict NCLEX-RN outcomes for graduates and, further, that progression policies that allow retest after retest so as to achieve a minimum score on the HESI Exit Exam are not supported empirically. Conclusions and suggestions for schools using or considering progression policies are provided.
Researchers of driving and dementia have reported that drivers with early Alzheimer's disease (AD) may continue to drive for extended periods of time, as long as their driving is evaluated or monitored. The earliest symptoms of AD are known to include loss of recent memory and the inability to recognize familiar environments. In an exploratory study, we examined 207 reports of lost drivers with dementia over 10 yr reported by newspapers and media. Seventy AD drivers were not found, 32 drivers were found dead, and 116 drivers were found alive, although of those found alive, 35 people were found injured. Miles driven and days missing were also reported in some cases, in addition to cause of death (such as drowning or exposure to weather). Becoming lost may have serious consequences. Additional research is needed in this area to more clearly understand the consequences of becoming lost while driving.
To assess the effectiveness of person-related interventions on driving ability in older adults, this literature review was completed as a part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. Nineteen articles were incorporated into the systematic review and include interventions in the following areas: visual, cognitive, and motor; educational; passengers; and medical. The results provide inconclusive evidence for the use of interventions such as the Useful Field of View training, home exercise programs, and passenger interactions. Conclusive evidence shows that older adults respond positively to programs stressing self-awareness of driving skills and that some medical interventions affect the ability to drive. Despite limitations, the studies reviewed provide useful information that deserves further exploration. Reading the literature provides therapists with knowledge that might improve client care. Learning about cutting-edge interventions and educating peers and students about evidence-based interventions may lead to safer community mobility for older adults.
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