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PubMed2005

Night driving self-restriction: vision function and gender differences.

PURPOSE: The purpose of this study was to evaluate gender differences in the relationship between night driving self-restriction and vision function in an older population. METHODS: Night driving self-restriction patterns (assessed by questionnaire) were examined cross-sectionally in relation to age, gender, health and cognitive status, depression, and vision function in a sample of 900 elders (mean age, 76 years) living in Marin County, California. RESULTS: Of the total sample, 91% of men and 77% of women were current drivers. The mean age of the drivers was 73.3 years (range, 58-96 years). Among current drivers, women had slightly better vision function than men on most measures (low-contrast acuity, contrast sensitivity, low-contrast acuity in glare, low-contrast, low-luminance acuity, and glare recovery) but were twice as likely as men to restrict their driving to daytime. Men showed significant associations with avoidance of night driving on four spatial vision measures (high- and low-contrast acuity, low-contrast, low-luminance acuity, and contrast sensitivity). For women, in addition to these measures, a significant association was seen for low-contrast acuity in glare. Neither men nor women showed significant associations between driving restriction and performance on the other vision measures examined (glare recovery time, attentional field integrity, or stereopsis). The vision measures most predictive of self-restriction were contrast sensitivity for men and low-contrast acuity in glare for women. CONCLUSIONS: Including both cessation and self-restriction, men over age 85 years are 6.6 times more likely than women to be driving at night. For both genders, vision plays a significant role in the self-restriction decision. A higher percentage of men than women continue to drive at night with poor vision. Men's night-driving cessation was associated with contrast sensitivity and depression, whereas women's night-driving cessation was associated with low-contrast acuity in glare as well as age.

Accidents, Traffic↗
PubMed2005

Effects of age and auditory and visual dual tasks on closed-road driving performance.

PURPOSE: This study investigated how driving performance of young and old participants is affected by visual and auditory secondary tasks on a closed driving course. METHODS: Twenty-eight participants comprising two age groups (younger, mean age = 27.3 years; older, mean age = 69.2 years) drove around a 5.1-km closed-road circuit under both single and dual task conditions. Measures of driving performance included detection and identification of road signs, detection and avoidance of large low-contrast road hazards, gap judgment, lane keeping, and time to complete the course. The dual task required participants to verbally report the sums of pairs of single-digit numbers presented through either a computer speaker (auditorily) or a dashboard-mounted monitor (visually) while driving. Participants also completed a vision and cognitive screening battery, including LogMAR visual acuity, Pelli-Robson letter contrast sensitivity, the Trails test, and the Digit Symbol Substitution (DSS) test. RESULTS: Drivers reported significantly fewer signs, hit more road hazards, misjudged more gaps, and increased their time to complete the course under the dual task (visual and auditory) conditions compared with the single task condition. The older participants also reported significantly fewer road signs and drove significantly more slowly than the younger participants, and this was exacerbated for the visual dual task condition. The results of the regression analysis revealed that cognitive aging (measured by the DSS and Trails test) rather than chronologic age was a better predictor of the declines seen in driving performance under dual task conditions. An overall z score was calculated, which took into account both driving and the secondary task (summing) performance under the two dual task conditions. Performance was significantly worse for the auditory dual task compared with the visual dual task, and the older participants performed significantly worse than the young subjects. CONCLUSIONS: These findings demonstrate that multitasking had a significant detrimental impact on driving performance and that cognitive aging was the best predictor of the declines seen in driving performance under dual task conditions. These results have implications for use of mobile phones or in-vehicle navigational devices while driving, especially for older adults.

Adult↗
PubMed2004

Epilepsy and driving in Japan.

PURPOSE: The driving regulations in Japan were amended in 2002, which lifted the absolute ban on driving by persons with epilepsy (PWE) and granted licenses to PWE after a 2-year seizure-free period. METHODS: To survey the effect of the new driving regulations, we sent questionnaires both to the driving authorities (DAs) and to doctors of the Japan Epilepsy Society (JES). RESULTS: Around 1,400 PWE legally obtained a driving license within 1 year after the amendment, licenses were rejected in 157, and 61 had the license withheld for <6 months. In most cases, the attending doctor assessed fitness for driving; 171 doctors responded to the questionnaire. One third of them commented on a positive change in attitude of PWE with respect to driving. Their main remarks included the need to shorten the seizure-free period to qualify for fitness to drive and the need for special guidelines for conditions such as rare seizure occurrence, recently diagnosed epilepsy, or reflex epilepsy. Problems of assessment identified included difficulty in deciding the time for reassessment, distress of PWE over cancellation of license, cost of the assessment, responsibility of the assessing doctors in case of seizure recurrence, and protection of privacy. They requested the DAs to promote publicity about the information and asked the JES to establish a guideline for assessing fitness to drive. CONCLUSIONS: The results highlighted the need for cooperation between the DAs and the JES for further amendment of the regulations as well as the importance of education for the public, patients, and professionals.

Accidents, Traffic↗
PubMed2005

Drawing clocks and driving cars.

OBJECTIVE: The purpose of the study was to determine whether a new method of scoring the Clock Drawing Test (CDT) is a reliable and valid method for identifying older adults with declining driving competence. DESIGN: Prospective cohort study. SETTING: An outpatient driving evaluation clinic. PARTICIPANTS: One hundred nineteen community-dwelling, active drivers with a valid driver's license, aged 60 and older referred for driving evaluation. MAIN OUTCOME MEASURES: The CDT and a driving test using a STISIM Drive simulator. RESULTS: The CDT showed a high level of accuracy in predicting driving simulation outcome (area under the receiver-operator curve, 0.90; 95% confidence interval, 0.82 to 0.95). CDT scoring scales were comparable and all correlations between CDT scores and driving performance were negative, implying that as the CDT score decreases, the number of errors increases. Interrater reliability of CDT scores was 0.95. Subjects scoring less than 5 out of 7 points on the CDT made significantly more driving errors, hazardous and in total (P<.001). CONCLUSIONS: The CDT can help establish problems with executive function and indicate the need for a formal driving evaluation. Our CDT scoring scale is a reliable, valid, and time-effective screening tool for identifying elderly drivers in need of further evaluation.

Aged↗
PubMed1992

Driving in Alzheimer's disease.

OBJECTIVE: To determine if the impaired mental skills in Alzheimer's Disease (AD) may adversely affect driving ability. DESIGN: Retrospective survey. SETTING: The Alzheimer's Clinic of the University of Kansas Medical Center. PATIENTS: We interviewed 67 AD patients and their families and compared them with 100 elderly, non-spousal controls. MEASURES: The questionnaire was designed to obtain information on their driving habits, with emphasis placed on whether they were still driving, and the number of accidents per year for the past 10 years. RESULTS: Forty-six of the AD subjects had stopped driving because of safety concerns expressed by the subjects, their families, or health care providers, and two had stopped for other reasons. Only two of the normal controls had stopped driving (P < 0.0001, Chi-square test). Over the past 3 years, the 19 AD subjects who were still driving had 263.2 motor vehicle accidents per million vehicle miles of travel compared with 14.3 for the controls (P < 0.002, Mann-Whitney U test) and 5.7 for the general driving population age > or = 55 years (P < 0.05, Students one group, two-tailed t test). CONCLUSION: This study suggests that a significant traffic safety problem exists in subjects with AD who continue to drive. Efforts should be directed to detect patients with AD whose driving presents a traffic safety problem.

Accidents, Traffic↗
PubMed2005

Dementia and driving: autonomy versus safety.

PURPOSE: This article reviews the effects of various types of dementia on driving skills, the available assessment measures, legal considerations, and the important role played by the nurse practitioner (NP) in the process of recommending driving cessation. It provides strategies and resources that may offer guidance to NPs who are attempting to balance the continued independence of patients with dementia, as represented by driving, with the safety not only of such patients but also of the public at large. DATA SOURCES: A review of the biomedical literature, resources available on the World Wide Web, and illustrative case studies were used. CONCLUSIONS: The diagnosis of dementia alone is often insufficient to determine driver competence because the topographic losses of dementia are complex. Recognizing when cessation should occur is made more difficult because objective assessment tools do not exist to predict impaired driving skills. Recommending driving cessation at the appropriate time can be a challenge for NPs, who must balance such a significant impact on the driver's autonomy with concerns about public safety if the patient continues to drive despite progressive impairment. IMPLICATIONS FOR PRACTICE: The progressive loss of cognitive abilities in dementia presents a series of ongoing challenges for the patient throughout the disease continuum. Unfortunately, the recommendation to stop driving can present one of the more immediate issues confronting the patient, the family, and the healthcare provider. Failure to assess diminished driving skill can lead either to premature or to delayed driving cessation. Either outcome can have adverse effects on the patient, the patient's family, and public safety.

Aged↗
PubMed2000

Reliability of Snellen charts for testing visual acuity for driving: prospective study and postal questionnaire.

OBJECTIVES: To assess the ability of patients with binocular 6/9 or 6/12 vision on the Snellen chart (Snellen acuity) to read a number plate at 20.5 m (the required standard for driving) and to determine how health professionals advise such patients about driving. DESIGN: Prospective study of patients and postal questionnaire to healthcare professionals. SUBJECTS: 50 patients with 6/9 vision and 50 with 6/12 vision and 100 general practitioners, 100 optometrists or opticians, and 100 ophthalmologists. SETTING: Ophthalmology outpatient clinics in Sheffield. MAIN OUTCOME MEASURES: Ability to read a number plate at 20.5 m and health professionals' advice about driving on the basis of visual acuity. RESULTS: 26% of patients with 6/9 vision failed the number plate test, and 34% with 6/12 vision passed it. Of the general practitioners advising patients with 6/9 vision, 76% said the patients could drive, 13% said they should not drive, and 11% were unsure. Of the general practitioners advising patients with 6/12 vision, 21% said the patients could drive, 54% said they should not drive, and 25% were unsure. The level of acuity at which optometrists, opticians, and ophthalmologists would advise drivers against driving ranged from 6/9(-2) (ability to read all except two letters on the 6/9 line of the Snellen chart) to less than 6/18. CONCLUSIONS: Snellen acuity is a poor predictor of an individual's ability to meet the required visual standard for driving. Patients with 6/9 vision or less should be warned that they may fail to meet this standard, but those with 6/12 vision should not be assumed to be below the standard.

Automobile Driving↗
PubMed2006

Awareness of driving while sleepy and road traffic accidents: prospective study in GAZEL cohort.

OBJECTIVES: To examine the association between self assessed driving while sleepy and the risk of serious road traffic accidents (RTAs). DESIGN: Prospective cohort study. SETTING: France. PARTICIPANTS: 13 299 of the 19 894 living members of the GAZEL cohort, workers and recent retirees of a French national utility company followed up since 1989. MAIN OUTCOME MEASURES: Frequency of driving while sleepy in the previous 12 months, reported in 2001; rate ratios for serious RTAs in 2001-3, estimated by using generalised linear Poisson regression models with time dependent covariates. RESULTS: The risk of serious RTAs increased proportionally with the frequency of self reported driving while sleepy. After adjustment for sociodemographic characteristics, driving behaviour variables, work conditions, retirement, medical conditions and treatments, depressive symptoms, and sleep disorders, the adjusted rate ratios of serious RTAs for participants who reported driving while sleepy in the previous 12 months "a few times" or "once a month or more often" were 1.5 (95% confidence interval 1.2 to 2.0) and 2.9 (1.3 to 6.3) respectively compared with those who reported not driving while sleepy over the same period. These associations were not explained by any reported sleep disorders. CONCLUSIONS: Self assessed driving while sleepy was a powerful predictor of serious RTAs, suggesting that drivers' awareness of their sleepiness while driving is not sufficient to prevent them from having RTAs. Messages on prevention should therefore focus on convincing sleepy drivers to stop driving and sleep before resuming their journey.

Accidents, Traffic↗
PubMed2003

Persistence of effects of a brief intervention on parental restrictions of teen driving privileges.

OBJECTIVE: The purpose of this study was to determine the extent to which effects of exposure to a brief intervention designed to increase parental restrictions on teen driving privileges persisted over time. DESIGN: A total of 658 parents and their 16 year old adolescents were recruited from a local motor vehicle administration (MVA) site as adolescents successfully tested for provisional licenses. At the MVA, parents completed written surveys about expected teen driving during the first month of provisional licensure. Afterwards, on weeks assigned as intervention, parents watched a video and were given the video and a driving agreement to take home. Both parents and teens completed follow up telephone interviews about communication, amounts, and limits on teen driving at one month (579 dyads), four months (529 dyads), and nine months (528 dyads). RESULTS: The results indicated that both intervention parents and teens were much more likely to report using a driving agreement at each follow up during the nine month period. Significant treatment group differences persisted for communication about driving, but effects related to limits on teen driving that were evident at one month declined over time. Reports for passenger, road, and overall limits remained significant at four months; fewer were present at nine months. There were no differences in amounts of teen driving at four or nine months. CONCLUSIONS: It is possible to reach parents through brief interventions at the MVA and successfully promote increases in initial parental restrictions on teen driving with modest persistence for at least four months.

Accidents, Traffic↗
PubMedDate not supplied

Associations of biomarkers, cognition and self-reports of sensory function with self-reported driving behaviour and confidence.

BACKGROUND: Older adults report self-regulating their driving habits but little is known about factors associated with driving habits and driving confidence. OBJECTIVE: We aimed to evaluate cognitive performance, biomarkers and self-reported sensory function as correlates of self-reported driving behaviour and confidence. METHODS: A volunteer sample of 153 drivers aged between 60 and 90 were assessed on biomarkers (vision, hearing, vibration sense, grip strength and FEV(1)), and cognitive performance. A subsample of 121 also completed a questionnaire on driving behaviour, driving confidence and self-reported sensory function. Structural equation modelling techniques were used to evaluate the relative importance of subjective and performance-based variables. RESULTS: Driving behaviour and confidence were associated with cognitive performance, biomarkers, chronological age and one question on self-rated hearing difficulty. Structural equation modelling showed that biomarkers were most important in predicting self- reported driving behaviour. CONCLUSION: These results suggest that individuals self-monitor according to their physiological well-being and report their driving behaviour accordingly.

Aged↗
PubMed2004

Is glaucoma associated with motor vehicle collision involvement and driving avoidance?

PURPOSE: To evaluate the association between the diagnosis of glaucoma and motor vehicle collision (MVC) involvement and driving avoidance in drivers aged > or =50 years. METHODS: Two groups of patients, one with glaucoma and one without, were identified in three university-affiliated eye care practices. Demographic, clinical, and driving characteristics were obtained by chart abstractions and a patient survey. Information regarding MVC involvement was obtained from police records. RESULTS: Patients with glaucoma were less likely (relative risk [RR], 0.67; 95% confidence interval [CI], 0.47-0.97) to be involved in collisions than patients without glaucoma. There was no difference between the at-fault crash rates of the patients with glaucoma and those without (RR, 1.22; 95% CI, 0.67-2.22). Patients with glaucoma had significantly higher levels of avoidance for driving at night (odds ratio [OR], 2.06; 95% CI, 1.11-3.82), driving in fog (OR, 3.80; 95% CI, 1.93-7.48), driving in the rain (OR, 2.99; 95% CI, 1.32-6.76), driving during rush hour (OR, 2.24; 95% CI, 1.16-4.34), driving on the highway (OR, 2.81; 95% CI, 1.19-6.64), and high density driving (OR, 2.88; 95% CI, 1.28-6.46). These associations were adjusted for demographic and medical characteristics as well as visual acuity. CONCLUSIONS: Older persons with glaucoma drive at least as safely as, if not more safely than, older persons without glaucoma.

Accidents, Traffic↗
PubMed2006

Prediction of driving after stroke: a prospective study.

BACKGROUND: The process of determining whether patients with stroke should drive again often involves off-road evaluations and road tests that usually take about 2 to 3 h to complete. OBJECTIVES: This prospective study sought to identify the combination of tests that best predicts fitness to drive after stroke. The main aim was to develop a short and predictive predriving assessment battery. METHODS: Sixty-eight consecutive stroke patients were studied who performed a mandatory predriving assessment at the Belgian Road Safety Institute, Brussels, within 18 months. Performance in a predriving assessment included medical examination (when needed), visual and neuropsychological evaluations, and an on-road test. Based on these assessments, a physician, psychologist, and the driving safety expert who administered the tests decided if a subject was either "fit to drive,""temporarily unfit to drive," or "unfit to drive." RESULTS: Logistic regression analysis revealed a combination of visual neglect, figure of Rey, and on-road tests as the model that best predicted (R(2) = 0.73) fitness to drive after stroke. Using a discriminant function that included the 3 tests of the logistic model, the fitness to drive judgments of 59 (86.8%) subjects were correctly predicted. The sensitivity and specificity of the predictions were 79.4% and 94.1%, respectively. CONCLUSION: Fitness to drive after stroke can be predicted from performance on a few road-related tests with a high degree of accuracy. However, some individuals require extended assessments and further tests.

Adult↗
PubMed1999

Driving is more than pedal pushing.

The purpose of this study was to determine the usefulness of neuropsychological assessment for predicting driving competency (as opposed to driving skill). Participants were divided into 2 groups, currently driving and not currently driving, based on patient and family member reports of driving ability. In addition, driving participants were only included if there had been no accidents or driving-related injuries in the past year. Stepwise discriminant function analysis was utilized to identify measures that were predictive but not redundant, thereby resulting in a shortened battery. The discriminant function analysis was able to correctly classify 94.4% of the overall sample. A factor analysis was used to identify the constructs that comprised the final short battery. In conclusion, this study demonstrated that a short neuropsychological battery was able to identify individuals who were competent to drive and those who were not competent to drive.

Activities of Daily Living↗
PubMed2006

Driving aggression in forensic and non-forensic populations: relationships to self-reported levels of aggression, anger and impulsivity.

A series of four questionnaires - the Buss-Perry Aggression Questionnaire (AQ), the Barratt Impulsivity Scale (BIS-11), the Driving Anger Scale (DAS) and a Driving Violence Inventory (DVI) - were administered to a sample of 473 British drivers consisting of undergraduates (N=185), members of the public (N=106) and offenders (N=182) serving sentences in closed prisons in England (violent=82, non-violent=100). Offenders consistently rated acts of driving aggression as less severe compared with other drivers. Offender attributions of driving violence differed to other drivers in that they were equally likely to perceive obscene gesturing as high or low intensity responses; they also viewed assault as a high intensity response whereas members of the public rated it more severely. Trait levels of anger and aggression were the predictors of driving violence in all groups but previous aggressive behaviour was only a predictor for the offenders. Gender and age were found to be predictors of aggressive driving in non-offenders. Even with the effects of age controlled, offenders (and violent offenders in particular) scored higher on measures of driving anger and aggression. These data suggest that offenders differ in their perceptions of aggressive behaviours experienced in everyday driving and as a consequence are more likely to commit acts that other drivers perceive as violent. As offenders are known to display similar perceptual biases in other domains, identified as precursors to their aggressive behaviour, it seems likely that experience effects (as reflected in the trait measures) underpin differences in driving aggression between offenders and non-offenders.

Adolescent↗
PubMed2006

Predictors of driving cessation in mild-to-moderate dementia.

BACKGROUND: Although physicians in most provinces are mandated to report patients whose driving ability is impaired by illness, little is known about dementia-related factors associated with driving cessation. The purpose of our study was to explore factors that may affect the likelihood of driving cessation in a sample of elderly, community-dwelling patients with dementia. METHODS: A 3-year prospective study, the Canadian Outcomes Study in Dementia (COSID) has enrolled 883 patients with mild-to-moderate dementia at 32 centres across Canada. Assessment tools included the Mini-Mental State Examination (MMSE) for cognition, the Global Deterioration Scale (GDS) for staging (severity), the Functional Autonomy Measurement System (SMAF) for function, and the Neuropsychiatric Inventory (NPI) for behaviour. Factors associated with the decision to quit driving after the baseline assessment were tested with Cox survival analysis. RESULTS: Of 719 subjects who were or had been drivers, 203 (28.2%) were still driving at baseline. Over an observation period that averaged 23 months, 97 (48.5%) of 200 patients quit driving. Factors predictive of driving cessation included GDS (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.15-2.45), MMSE score (HR 0.90, 95% CI 0.83-0.97) and NPI findings (HR 1.63 for presence of > or = 3 behaviours, 95% CI 1.01-2.62). Among the NPI behaviours, when they were analyzed separately, agitation led to a decreased likelihood of driving cessation (p = 0.019), whereas apathy (p = 0.031) and hallucinations (p = 0.050) led to an increased likelihood. INTERPRETATION: Cognitive impairment and behaviours such as agitation, apathy and hallucinations were significant predictors of driving cessation in patients with a mild to moderate degree of dementia. These findings should be considered when one counsels patients and their families.

Accidents, Traffic↗
PubMed1989

An investigation of factors related to intoxicated driving behaviors among youth.

This study assessed the prevalence of driving under the influence of alcohol and marijuana among a sample of 18 and 21 year olds and examined the across-time relationships between intoxicated driving and consumption, risk-taking/impulsive orientation, negative intrapersonal state, stress and use of alcohol and other drugs to cope with problems. Self-report data were collected from 556 men and women, ages 18 and 21, at two points in time. The data indicated that at least a minimum level of drinking and driving, as well as smoking marijuana and driving, is engaged in at least once for the majority of youth. Correlations between eight driving behaviors and consumption variables indicated that frequency of substance use was strongly related to frequency of driving while intoxicated (DWI). Regression analyses revealed that coping use of substances was the strongest predictor of driving under the influence. A path model examining the effect of stress, negative states and risk-taking orientations (T1) on driving under the influence as mediated through coping use (T2) was tested. Results showed that risk-taking orientation was the strongest predictor of DWI, both directly and indirectly (as mediated through coping use). Findings suggest that impaired driving may be part of a global syndrome of risk-taking behavior and is an activity engaged in most often by those who frequently use alcohol and other drugs to cope with problems.

Accidents, Traffic↗
PubMed1997

Legal and social control of alcohol-impaired driving in California: 1983-1994.

OBJECTIVE: This research was designed to provide information on the legal and social forces that influence change in control of alcohol-impaired driving. METHOD: Attitudes, perceptions and behaviors concerning drinking and driving for California drivers in 1994 (n = 608) were compared to similar information collected from California drivers in 1983 and 1986 (n = 291) through random-digit-dialing telephone interviews. RESULTS: Self-reported drinking-driving violations showed a substantial decline, paralleling the well-documented drop in alcohol-related traffic crashes during this time span. A large reduction in drinking before driving was reported for all age groups, men and women, and for both heavy drinkers and light drinkers. There was evidence of an increase in the levels of both general deterrence and general prevention. Increased external control was reflected in greater knowledge of drinking-driving laws and trends toward an increased expectation that violations would be followed by unpleasant consequences. Strong gains in creating a social norm for control of alcohol-impaired driving were indicated by perceptions that friends and relatives were more likely to disapprove of driving after drinking, observations of more control of drinking by drivers at occasions where alcohol is served and an increase in the view that it is morally wrong to drive after heavy drinking. CONCLUSIONS: California has made substantial progress in efforts to control alcohol-impaired driving, through increases in both general deterrence (fear of punishment) and general prevention (moral inhibitions and socialization of preventive habits), especially the latter.

Adult↗
PubMed2004

Associations between adolescent drinking and driving involvement and self-reported risk and protective factors in students in public schools in Washington State.

OBJECTIVE: This study examines associations between self-reported drinking and driving or being a passenger of a drinking driver and risk and protective factors in a general population of adolescents. METHOD: We used a two-staged sampling procedure to survey 2,955 students in Washington State public schools in Grades 9-12. Students were asked if they were a passenger of, or had been, a drinking driver in the previous month. They were also asked about individual, parent, school and community risk and protective factors. Comparisons were made using hierarchical polychotomous logistic regression, entering age and gender and parent, school and community protective factors at the first step and individual risk factors at the second step. RESULTS: Driving after drinking in the previous month was reported by 12.1% of respondents and riding with a drinking driver was reported by an additional 17.6% of respondents. At the first step, driving after drinking was more likely and riding with a drinking driver was less likely among youth who were age 16 or older, and male students were more likely than female students to report driving after drinking. Parent, school and community support were each significantly associated with less driving after drinking, and school support was significantly associated with less riding with drinking drivers. At the second step, higher quantity and frequency of drinking, more smoking cigarettes and drug use and less seat belt use were each associated with both drinking and driving and riding with drinking drivers. Gun carrying was also associated with driving after drinking. CONCLUSIONS: Drinking and driving behaviors were associated with risk and protective factors in the community, school, family and individual. Pilot prevention programs should test the effectiveness of reducing drinking and driving involvement by addressing such factors.

Accidents, Traffic↗