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Driving and dementia in older adults

In the city of Durham, North Carolina during the year 2007 there were 1,121 crashes that involved drivers over the age of 64 with just two fatalities. When looking at the fact that there were only 10,287 total accidents it means that more than 10% of all accidents occurred with drivers who were over the age of 64 and with the total fatalities numbering eleven, that means that nearly 20% of the fatalities occurred when one of the drivers was over the age of 64.

It is questionable that the idea of someone suffering from dementia would make it harder for them to drive and with the percentages being as high as they are for this age could it is arguable that someone who has dementia would be at more of a risk of having a fatal accident than someone who was not suffering from Alzheimer’s disease or dementia (“North…” 1). “The automobile is a primary mode of transportation for older adults in the United States” (Meuser 680).

An agency could research the number of crashes and fatalities for an area based on the number of people who were known to have AD as well as those who are over the age of 64. In the past there has not been a proper response or a way to reduce the risk of harm to those who are suffering from dementia and driving. There have not been ways for the state to study driving records or for them to administer testing for these abilities or deficits (“North…” 1). “People with early dementia probably will not have any problem driving.

After awhile, they might get lost easily, especially in new areas. As time goes on, they might have problems like forgetting to move to the correct lane for a turn, not being able to watch the road and listen to the radio at the same time, and not being able to stop suddenly. This is when the driver with dementia becomes dangerous” (“Driving with…” 1). There have been numerous studies and there is a lot of information available on the topic of driving with dementia as it has become an increasing problem with a high number of accidents resulting in fatalities.

In the end there are a lot of things that researchers and information put out there by medical groups agree on and that are what will be provided in the following. Some of the main things that need to be of concern are watching for the warning signs of dementia. Also watching to see if the person is currently someone who one would feel comfortable riding with and being in a vehicle with as chances are if one does not feel safe than there is a reason for these feelings (“Driving with…” 1-2). There are many warning signs of there being driving problems.

These warning signs include: decrease in confidence while driving, difficulty turning to see when backing up, riding the break, easily distracted while driving, other drivers often honk horns, incorrect signaling, difficulty parking within a defined space, hitting curbs, scrapes or dents on the car mailbox or garage, increased agitation or irritation when driving, failure to notice activity on the side of the road, failure to notice traffic signs, trouble navigating turns, driving at inappropriate speeds, not anticipating potential dangerous situations, uses a copilot, bad judgment on making left hand turns, near misses, delayed response to unexpected situations, moving into wrong lane, difficultly maintaining lane position, confusion at exits, ticketed moving violations or warnings, getting lost in familiar places, car accident, failure to stop at a stop sign or red light, confusing the gas and brake pedals, stopping in traffic for no apparent reason (“Warning…. ” 1).

“As a result of changes in the brain caused by the disease, a person with AD may exhibit problems with reacting fast, making decisions, perception, multi-tasking, and memory. All of these can result in impaired driving” (Erten-Lyons 4). One medical document that was featured in American Family Physician was an article entitled “Older Adult Drivers with Cognitive Impairment. ” This article was written about the idea and principle that as things progress with dementia it will not be uncommon for drivers to have to pass medical examinations or for medical doctors to have to follow up with things and decide in part when someone is no longer available to drive. This article was written by a group of MDs at Washington University in St Louis School of Medicine, St Louis Missouri.

One of the main points in the article is the idea that: “In patients who continue to drive, physicians should assess pertinent cognitive domains, determine the severity and etiology of the dementia, and screen for risky driving behaviors” (Carr 1). The article focuses on medical doctors being involved in the decision of whether or not an older adult has the ability to drive or not. This includes the older adult being able to manage driving safely. The idea is that when there is a cognitive impairment, including impairment in one of the following areas short term memory, attention, orientation, judgment and problem solving skills, and visuospatial skills. There are many studies that speculate just how many drivers are suffering from dementia.

Some studies even suggest that as much as 30% of older adults who have dementia are still driving and that as much as “4% of male drivers older than 75 years have dementia. ” It is anticipated that in the future this is going to be a much longer problem as there is said to be an increase by the 2020 to 30 million older adult drivers up from the 13 million that there are today (Carr 1). This article suggests that “even without a crash or subsequent injury all older adults with dementia eventually must stop driving. ” This is where this article is encouraging family physicians and medical practitioners to stand up and take a role in the process of having someone deemed as unable to drive.

This article encourages that there are indicators of unsafe driving include: crashes, dents on car, difficulty understanding traffic signs, driving too fast or too slow, failure to notice street signs, getting lost in familiar areas, indecent gestures or horn honking from other drivers, miscalculating speed and distances, “near misses,” poor judgment, tickets for traffic violations, and/or tunnel vision. The family physician should take into account several things when looking at whether or not someone is able to drive. The thing that a physician should be looking at include the driving history, assessment of cognitive domains, assessment of dementia and a medication review (Carr 1-3). The article also encourages that there be performance-based road testing available so that there is less of a chance of those who are suffering from dementia to pass the test and get their driver’s licenses in the first place.

They also encourage an overall office protocol being in place for all family physicians’ offices as well as for there to be resources available for caregivers and family. This article does indicate that it would be important for there to be more studies on this subject as it has not been studied enough for there to be a definitive answer (Carr 3-6). In the article “Simulated Car Crashes at Intersections in Driver’s with Alzheimer Disease. ” Michael Rizzo, MD talks about the dangers of driver’s suffering from Alzheimer disease driving in busy areas. The contributing writers included Michael Rizzo, MD who works for the University of Iowa, Department of Neurology.

As an MD who specializes in neurological disorders, Rizzo would be able to provide insight into the problems that those who are suffering from Alzheimer’s might have. Daniel V McGehee is the Director of the Human Factors and Vehicle Safety Research Program at the University of Iowa. As the director, Mr McGehee is experienced in finding out information about the safety of motorists and therefore his research on the topic is very relevant. Jeffery Dawson is from the University of Iowa, College of Public Health and Biostatistics. Since he is a specialist in biostatistics therefore he would be able to give credible information on the topic of dementia.

Steven N Anderson is working for the Department of Biological Screening for Abbot Laboratories in Abbot Park, Illinois. This means that he would be able to give useful information about the things that are available for those who have dementia (Rizzo 1). The article is about the affects of Alzheimer’s disease (dementia) on a driver’s ability to operate a motor vehicle safely. Much research and analysis went into this study. A group of thirty elderly drivers, with the average age of 72, were subjected to a battery of cognitive ability examinations, MRI’s and driving ability using a “state of the art” driving simulator. These elderly drivers were selected on a random basis through volunteers to the study.

Of the thirty participants there was a control group of eighteen drivers who were known to have a probably onset of AD (Alzheimer’s disease) were included. Information regarding the AD participants was obtained from a registry in the Alzheimer’s Disease Research Center in the Department of Neurology, at the University of Iowa. Participants were excluded from the control group if they had a known history of alcoholism, stroke, depression, vestibular disease, and motion sickness (Rizzo 1-4). According to the National Highway Traffic Safety Administration, drivers who are 65-69 are twice as likely to become involved in fatal accidents involving multiple vehicles as drivers aged 40-49.

The NHTSA also points out that drivers 65 years of age and older have the second highest fatality rate, (per mile driven); second only to drivers 15-24 years of age. In fact the fatality rate among drivers 80 years or older is actually higher than drivers under the age of 24 (Rizzo 1-4). The study identified the adverse effects of Alzheimer’s disease (dementia) on a driver’s ability to navigate through a hazardous situation. It brought to light important knowledge that could eventually improve everyone’s safety on public streets and highways. However, it fails to consider the life-altering effects it could have on older drivers by potentially limiting their ability to continue living self-sufficient and mobile.

Nor does it address the possible effects and added burdens it could create for families of older drivers who would have to make difficult decisions about accommodations for their loved ones. The author does point out that while the research is from a limited scope (focuses only on crashes involving Alzheimer’s drivers) it may be helpful in preventing what amounts to age discrimination. In other words, creating more stringent state road examinations could expose only those persons who are in fact cognitively impaired (Rizzo 1-4). In the experiment the thirty participants operated a simulated vehicle on a virtual highway. In this experiment the task was to maneuver a vehicle through an intersection where another driver triggered a legal incursion by committing a stop sign violation.

Given time-to-intersection (TTI) of less than four seconds, the driver had to maneuver their vehicle to avoid colliding with the vehicle in their path. A standard time that most normal drivers were able to avoid a collision with was a time of 3. 6 seconds. Of the thirty participants, 33% or six of the drivers who had confirmed AD collided with the encroaching vehicle. Factors predictive of collisions at intersections in “at risk” drivers with cognitive impairments in the current study were also predictive of crashes in an earlier collision avoidance study. The distinguishing differences were the type of demands placed upon the drivers in the given situations (Rizzo 1-4).

Although Rizzo defends the small number of participants in his study, however it could be argued that a greater number of participants are needed in order to have a true understanding of the issue. Regardless the results show that most AD drivers (12 or the 18) did not crash and demonstrated fair vehicular control in the intersection incursion scenario. The results suggest that some individuals with mild dementia are capable of driving until their cognitive impairments progress to a level that makes them unfit to drive (Rizzo 1-4). The study was conducted as a legitimate study of significant importance. It brings to light the need to improve state road examinations for all drivers in an effort to identify persons who do not have the physical or cognitive ability to function on our public streets and highways.

This should be tempered with a degree of consideration and “common sense” for all people regardless of age. Road examinations should be administered only when proven scientific and fair. They should clearly identify persons who are demonstratively deficient of the required ability to drive, without unfairly discriminating against an entire population of older citizens (Rizzo 1-4). Many different studies have been conducted on this subject. One such study developed some of the following results. “We were surprised that there was no difference in the psychometric profiles of current and past drivers with dementia of the Alzheimer’s type. We predicted that those drivers who stopped driving would have more impairment in speeded and visuospatial tasks.

In addition, we found no differences in tests of executive function” (Carr and Shead). The question that remains that needs to be answered is whether or not someone who has dementia should be driving? “The question is: at what point is someone unable to drive safely? ” (“Assessing…” 1). The idea that those who have dementia should not be driving will be further researched and tested to see if in reality, someone who is suffering from dementia is really more of a road hazard than someone who is not suffering from dementia. The research would be conducted for the city of Durham, North Carolina and would include testing for cognitive studies as well as driving simulations.

The research would also look into past driving histories of these drivers and what, if any problems that they have had. This research will hope to answer the questions that are present about the possibilities of those who are suffering from dementia not being able to drive and will formulate a set example of what the city of Durham could do in order to be able to decide if someone should or should not drive. “’All people with Alzheimer’s will eventually be unable to drive,’ said Robert Stern, co-director of Boston University’s Alzheimer’s Disease Clinical and Research Program. ‘That does not mean they can’t drive early on in the disease. Everyone has a different course. It steals cognitive skills at a different pace’” (“Driving and…” 1).

The data that will be used in the research is both information gathered from the North Carolina crash website as well as further information gathered about dementia and the subject of dementia and driving. Research will be gathered from a variety of sources including non-profit organizations that are centered on research for those suffering from Alzheimer’s disease. Other things could be to interview the drivers and to have them do the testing to see if this would have made a difference in who was being allowed to drive at this time. One of the reasons that this research is so important is that “this disease is not like other changes in later life that affect driving.

” The changes that greatly affect driving in Alzheimer’s disease include problems with “judgment, multi-tasking, slowed reaction times, impaired spatial skills, and other cognitive deficits” (“Why…” 1). In conclusion there are many organizations which are available to help and address any concerns that there might be about dementia and driving.


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