The Mini‐Mental State Examination, Clinical Factors, and Motor Vehicle Crash Risk

Joseph, Philip; O’Donnell, Martin; Teo, Koon; Gao, Peggy; Anderson, Craig S.; Probstfield, Jeffrey L.; Bosch, Jackie; Khatib, Rasha; Yusuf, Salim

doi:10.1111/jgs.12936

Cited by 29 publications

(43 citation statements)

References 32 publications

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“…The two other studies reported modestly greater risk of a crash‐related injury after a fall that may have been due to chance (summary risk estimate = 1.34, 95% CI = 0.94–1.92; Q = 0.11, P = .74; I 2 = 0%) (Figure ). The other study reported a significant association between a fall in the prior year and death or hospitalization resulting from a MVC in which the subject was driving (adjusted hazard ratio = 3.12, 95% CI = 1.71–5.69).…”

Section: Resultsmentioning

confidence: 94%

“…Figure shows the numbers of records identified, screened, and retrieved in full text and the number of studies determined to meet inclusion criteria. All 15 eligible studies were published English‐language journal articles, including 10 cohort studies, two case‐control studies, and three cross‐sectional studies (Supplementary Table ) . One study each was conducted in Canada, France, and 40 countries and the rest in the United States.…”

Section: Resultsmentioning

confidence: 99%

“…The mechanisms underlying these relationships are unclear. There may be underlying factors that adversely affect functional abilities, causing falls and MVCs, but falls were significantly associated with crashes even in included studies that adjusted for neuromuscular function, vision, cognitive ability, 19 and other chronic health conditions, suggesting that falls may act independently to impair drivers’ functioning, increasing crash risk. Given the nature of the evidence identified, the associations may also result at least partly from confounding or bias.…”

Section: Discussionmentioning

confidence: 99%

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Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta‐Analysis

Scott

Rogers

Betz

et al. 2017

J American Geriatrics Society

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Background/Objectives Driving is an important indicator of mobility and well-being for older adults. Prior work suggests falls are associated with an increased risk of adverse driving outcomes. We examined associations between falls and subsequent motor vehicle crashes (MVCs), crash-related injuries, driving performance and driving behavior. Design Systematic review and meta-analysis. Participants Observational studies including adult drivers aged 55 and older or with mean age of at least 65. Measurements Two authors independently extracted study and participant characteristics, exposures and outcomes and assessed risk of bias. Pooled risk estimates for MVCs and MVC-related injuries were calculated using random-effects models. Other results were synthesized narratively. Results From 3286 potentially eligible records, 15 studies (N=27 to 17,349 subjects) met inclusion criteria. Risk of bias was low to moderate, except for cross-sectional studies (n=3) which all had a high potential for bias. A fall history was associated with a significantly increased risk of subsequent MVC (summary risk estimate=1.40; 95%CI: 1.20, 1.63; I2=28%, N=5 studies). One study found a significantly increased risk of MVC-related hospitalizations and deaths after a fall (hazard ratio=3.12; 95%CI: 1.71, 5.69). Evidence was inconclusive regarding an association of falls with driving cessation and showed no association with driving performance or behavior. Conclusion Falls in older adults appear to be a risk marker for subsequent MVCs and MVC-related injury. Given the nature of the evidence, which is limited to observational studies, the identified associations may also result at least partly from confounding or bias. Further research is needed to clarify the mechanisms linking falls to increased crash risk and develop effective interventions to ensure driving safety in older adults with a history of falls.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta‐Analysis

Scott

Rogers

Betz

et al. 2017

J American Geriatrics Society

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“…For example, practice parameters provided by the American Academy of Neurology propose the use of global cognitive measures such as the MiniMental Status Examination (MMSE) and the Clinical Dementia Rating Scale (CDR), and a family/caregiver questionnaire of driving history, for identifying patients at risk of unsafe driving (Iverson et al, 2010), with only slightly different protocols suggested by other groups (Canadian Medical Association, 2006;Australian and New Zealand Society for Geriatric Medicine, 2010). Critically, most recommended measures are either not validated against on-road performance, or have poor evidence of association with driving safety risk (Odenheimer et al, 1994;Reger et al, 2004;Crizzle et al, 2012;Joseph et al, 2014). Furthermore, recommendations are not consistent, with some guidelines suggesting a diagnosis of early dementia is sufficient to enforce driving retirement (Iverson et al, 2010;Austroads, 2012), while others suggest this is not sufficient evidence for license cancellation (Australian and New Zealand Society for Geriatric Medicine, 2010).…”

Section: Clinical Judgment Of Driving Capacity Without Objective Assementioning

confidence: 99%

“…For example, a large Canadian study (n = 17,538) found that the MMSE did not predict crashes over two years of follow-up (Joseph et al, 2014). Generic tools and dementia screening instruments do not assess the specific deficits that cause drivers to become unsafe.…”

Section: Cognitive Functionmentioning

confidence: 99%

Road safety in an aging population: risk factors, assessment, interventions, and future directions

Anstey

Eramudugolla

Ross

et al. 2016

Int. Psychogeriatr.

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With the number of older drivers projected to increase by up to 70% over the next 20 years, preventing injury resulting from crashes involving older drivers is a significant concern for both policy-makers and clinicians. While the total number of fatal crashes per annum has steadily decreased since 2005 in Australia, the rate of fatalities has demonstrated an upward trend since 2010 in drivers aged 65 years and above (8.5 per 100,000), such that it is now on par with the fatality rate in drivers aged 17–25 years (8.0 per 100,000) (Austroads, 2015). Similar statistics are reported for the United States (NHTSA, 2012), implying there is a need for better identification of those older drivers who are unsafe and implementation of strategies that can enhance mobility while maximizing road safety.

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Alzheimer’s disease and driving: review of the literature and consensus guideline from Belgian dementia experts and the Belgian road safety institute endorsed by the Belgian Medical Association

et al. 2017

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Alzheimer's disease (AD) is a highly prevalent condition and its prevalence is expected to further increase due to the aging of the general population. It is obvious that the diagnosis of AD has implications for driving. Finally, driving discussions are also emotionally charged because driving is associated with independence and personal identity. However, it is not clear how to implement this in clinical practice and the Belgian law on driving is rather vague in its referral to neurodegenerative brain diseases in general nor does it provide clear-cut instructions for dementia or AD compared to for example driving for patients with epilepsy and as such does not prove to be very helpful. The present article reviews what is known from both literature and existing guidelines and proposes a consensus recommendation tailored to the Belgian situation agreed by both AD experts and the Belgian Road Safety Institute endorsed by the Belgian Medical Association. It is concluded that the decision about driving fitness should be considered as a dynamic process where the driving fitness is assessed and discussed early after diagnosis and closely monitored by the treating physician. The diagnosis of AD on itself definitely does not imply the immediate and full revocation of a driving license nor does it implicate a necessary referral for a formal on-road driving assessment. There is no evidence to recommend a reduced exposure or a mandatory co-pilot. A MMSE-based framework to trichotomise AD patients as safe, indeterminate or unsafe is presented. The final decision on driving fitness can only be made after careful history taking and clinical examination, neuropsychological, functional and behavioral evaluation and, only for selected cases, a formal assessment of driving performance.

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The Mini‐Mental State Examination, Clinical Factors, and Motor Vehicle Crash Risk

Abstract: In a population of frequent drivers, the MMSE does not predict MVCs. Other clinical factors have a stronger association with MVC risk.

Cited by 29 publications

References 32 publications

Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta‐Analysis

Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta‐Analysis

Road safety in an aging population: risk factors, assessment, interventions, and future directions

Alzheimer’s disease and driving: review of the literature and consensus guideline from Belgian dementia experts and the Belgian road safety institute endorsed by the Belgian Medical Association

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