Comparison of the SIMARD MD to Clinical Impression in Assessing Fitness to Drive in Patients with Cognitive Impairment

Wernham, Madelaine; Jarrett, Pamela; Stewart, Connie; Macdonald, Elizabeth; MacNeil, Donna; Hobbs, Cynthia

doi:10.5770/cgj.17.100

Cited by 9 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In many jurisdictions, physicians are responsible for determining and reporting on medical fitness to drive, yet the research shows that they are often not comfortable assessing driving safety because they lack the appropriate tools and guidelines to do so confidently. 57 –59 Although follow-up research is needed, these results suggest that measures of attention and visual processing could be particularly useful for professionals who are often responsible for determining fitness to drive, yet lack the instruments that would allow them to identify specific cognitive and visual deficits related to driving with exactitude. The exploration and identification of such tools will aid professionals to comfortably make this determination.…”

Section: Discussionmentioning

confidence: 99%

Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer’s Disease

Yamin

Stinchcombe

Gagnon

2015

Am J Alzheimers Dis Other Demen

View full text Add to dashboard Cite

This study sought to predict driving performance of drivers with Alzheimer's disease (AD) using measures of attention, visual processing, and global cognition. Simulated driving performance of individuals with mild AD (n = 20) was contrasted with performance of a group of healthy controls (n = 21). Performance on measures of global cognitive function and specific tests of attention and visual processing were examined in relation to simulated driving performance. Strong associations were observed between measures of attention, notably the Test of Everyday Attention (sustained attention; r = -.651, P = .002) and the Useful Field of View (r = .563, P = .010), and driving performance among drivers with mild AD. The Visual Object and Space Perception Test-object was significantly correlated with the occurrence of crashes (r = .652, P = .002). Tests of global cognition did not correlate with simulated driving outcomes. The results suggest that professionals exercise caution when extrapolating driving performance based on global cognitive indicators.

show abstract

Section: Discussionmentioning

confidence: 99%

Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer’s Disease

Yamin

Stinchcombe

Gagnon

2015

Am J Alzheimers Dis Other Demen

View full text Add to dashboard Cite

show abstract

“…have done a prospective comparison of the SIMARD MD to overall clinical impression of driving fitness. (1) On the education side of things, Moorhouse and Hamilton have prospectively examined the effect of a campaign designed to address perceived barriers to assessing driving by primary care providers. (2) Hogan et al ., after a modified Delphi procedure, present consensus statements on assessing driving fitness in older adults.…”

mentioning

confidence: 99%

Precipitating and Predisposing Events and Symptoms For Admission to Assisted Living or Nursing Home Care

Rockwood¹,

Richard²,

Garden³

et al. 2013

Can Geri J

View full text Add to dashboard Cite

BackgroundIn Canada, the rise of private-pay assisted living facilities is changing the long-term care landscape. Even so, few clinical implications of having these facilities in the spectrum of care have been studied. Our objective was to compare events and symptoms that might predispose and precipitate a move of older adults to assisted living or to a nursing home.MethodsCross-sectional, descriptive Nova Scotia survey of residents and family members on admission. Health-care use and dementia diagnosis were recorded from the admission record. Dementia was staged using the Global Deterioration Scale and the Dependence Scale. The SymptomGuide, a standardized dementia symptom inventory, was used to assay which symptoms were most influential in the decision to seek long term care. Caregiver stress was elicited by a self-report questionnaire.ResultsOf 353 people admitted during the enrolment period, 174 (49%) took part in the survey. Most (97; 55.7%) were involved in a move from the community to a nursing home, 54 (31.0%) from the community to assisted living, and 23 (13.2%) from assisted living to a nursing home. In each setting, dementia was the commonest predisposing factor (seen in >90%) with a precipitating event seen in 120 (69%) people. The precipitating events included a medical illness (n = 97; 55%) or caregiver illness, death or move (33; 19%). Dependence was associated with place of care, with more severely impaired people more commonly represented in people who moved to nursing homes.ConclusionsPeople move from the community chiefly due to dementia, and often with a precipitant. Compared with a move to assisted living, moving to nursing homes generally indicates greater dependence, and typically worse dementia severity. Even so, assisted-living facilities are not just for the “worried well”, but are used by people with dementia, caregiver stress, and recent hospitalization.

show abstract

“…Scoring in the indeterminate range was near a 50% chance of passing/failing the road test, similar to the findings of prior studies. ( 18 , 20 ) The high misclassification error rate, regardless of the cut-point used, is further evidenced by the limited AUC (.692). The data show that the SIMARD-MD does not have the ability to accurately distinguish between safe and unsafe drivers, and should not be used as a sole screening tool in drivers with cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

“…In a different study, Bédard and colleagues ( 19 ) concluded that the SIMARD-MD was vulnerable to an education bias, and may create a structural inequity by failing to account for education in the interpretation of the test results. Moreover, Wernham and colleagues ( 20 ) found no association between SIMARD-MD scores of clients with cognitive impairment and the clinical impressions of their geriatricians regarding fitness-to-drive, further questioning the validity of the test results.…”

Section: Introductionmentioning

confidence: 99%

The SIMARD-MD is not an Effective Driver Screening Tool for Determining Fitness-To-Drive

et al. 2021

View full text Add to dashboard Cite

Background Studies have reported poor sensitivity and specificity of the Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers, a modification of the DemTech (SIMARD-MD) to screen for drivers with cognitive impairment. The purpose of this study was to determine whether the SIMARD-MD can accurately predict pass/fail on a road test in drivers with cognitive impairment (CI) and healthy drivers. Methods Data from drivers with CI were collected from two comprehensive driving assessment centres (n=86) and compared with healthy drivers (n=30). All participants completed demographic measures, clinical measures, and a road rest (pass/fail). Analyses consisted of correlations between the SIMARD-MD and the other clinical measures, and a receiver-operating-characteristic (ROC) curve to determine the predictive ability of the SIMARD-MD. Results All healthy drivers passed the road test compared with 44.2% of the CI sample. On the SIMARD-MD, the CI sample scored significantly worse than healthy drivers (p < .001). The ROC curve showed the SIMARD-MD, regardless of any cut-point, misclassified a large number of CI individuals (AUC=.692; 95% CI = 0.578, 0.806). Conclusions Given the high level of misclassification, the SIMARD-MD should not be used with either healthy drivers or those with cognitive impairment for making decisions about driving.

show abstract

Comparison of the SIMARD MD to Clinical Impression in Assessing Fitness to Drive in Patients with Cognitive Impairment

Cited by 9 publications

References 20 publications

Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer’s Disease

Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer’s Disease

Precipitating and Predisposing Events and Symptoms For Admission to Assisted Living or Nursing Home Care

The SIMARD-MD is not an Effective Driver Screening Tool for Determining Fitness-To-Drive

Contact Info

Product

Resources

About