Risks and Advantages of Detecting Individuals Unfit to Drive: A Markov Decision Analysis

Leproust, S.; Lagarde, Emmanuel; Salmi, Louis Rachid

doi:10.1007/s11606-008-0777-8

Cited by 11 publications

(6 citation statements)

References 36 publications

(28 reference statements)

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“…Although increased age is associated with a higher proportion of cognitively impaired drivers, mandatory age-based driver testing has not been shown to decrease crash rates 61. Decision analysis studies have not consistently revealed the benefits of systematically screening and evaluating demented drivers 62. Cleary, more studies are needed in this area of the benefits and risks of screening for cognitively impaired older adults.…”

Section: Psychometric Testsmentioning

confidence: 99%

The Older Adult Driver With Cognitive Impairment

Carr

Ott²

2010

JAMA

189

160

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Although automobiles remain the transportation of choice for older adults, late life cognitive impairment and dementia often impair the ability to drive safely. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the assessment of older drivers with cognitive impairment, and no gold standard for determining driving fitness. Yet, clinicians are called upon by patients, their families, other health professionals, and often the Department of Motor Vehicles (DMV) to assess their patients' fitness-to-drive and to make recommendations about driving privileges. Using the case of Mr W, we describe the challenges of driving with cognitive impairment for both the patient and caregiver, summarize the literature on dementia and driving, discuss evidenced-based assessment of fitness-to-drive, and address important ethical and legal issues. We describe the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and DMV referrals that may assist with evaluation. Finally, we discuss mobility counseling (eg, exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients' social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety.

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Section: Psychometric Testsmentioning

confidence: 99%

The Older Adult Driver With Cognitive Impairment

Carr

Ott²

2010

JAMA

189

160

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“…Studies are needed to compare the benefits and costs of mandatory reporting to driver licensing authorities with voluntary reporting, although studies in other illnesses are not supportive of mandatory reporting (McLachlan et al, 2007). Decision analysis studies have not shown the benefits of systematically screening and evaluating drivers with dementia (Retchin and Hillner, 1994;Leproust et al, 2008). Some studies have noted positive impact on driving of cognitive stimulation (Edwards et al, 2005) and exercise interventions on older adults (Marmeleira et al, 2009), although these studies were not performed in patients with dementia.…”

Section: The Physician's Legal and Ethical Obligationsmentioning

confidence: 99%

Mobility and safety issues in drivers with dementia

Carr

O’Neill

2015

Int. Psychogeriatr.

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“…Recent studies as well as current models of older driver behavior all underline the fact that driving competency is multi-factorial and that the multiple factors involved interact with one another (Anstey et al, 2005;Dickerson and Bédard, 2014;Kamenhoff, 2008;Michon, 1985;Wood et al, 2008). However, the precise cognitive and motor components as well as their interactions have yet to be fully revealed (Bédard et al, 2008;Fildes 2008;Leproust et al, 2008;Wheatley and Di Stefano, 2008). Although very informative, models have failed to generate indicators of driving safety.…”

Section: Introductionmentioning

confidence: 99%