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At least 19 recordsLinked to original sources
PubMed1976

[Transport medical aspects of comprehensive medical care of ageing citizens (author's transl)].

The transport medical aspects in providing comprehensive care for ageing citizens are discussed from the point of view of a maximum degree of integration of aged and ageing people under the socialist conditions prevailing in our country. In this connection the conditions and services to be provided by society are mentioned and the norms of behaviour in public passenger and road traffic to be observed in ageing people owing to their diminishing performance are discussed. Suggestions are put forward as to how the traffic environment can be adapted to the diminished performance of old people. Apart from this, geromedically relevant passages of the guidelines for medical and psychological examination and evaluation of vehicle operators are elucidated (Verfüngungen und Mitteilungen des Ministeriums für Gesundheitswesen, No. 18, 1973, from 19, Nov. 1973).

Aged↗
PubMed1977

[Drivers license qualification for epileptics].

The question whether a person with epilepsy qualified for a driving licence must be examined from the point of view of the individual as well as that of the community. The general public should be protected against unduly high risks from epileptic drivers, whereas the patient has a right to live as normal a life as possible, which includes driving an automobile. Too rigid criteria for obtaining the license increase the number of persons who evade medical control and drive "illegally". To require physicians to report their epileptic patients to the authorities would be counterproductive; it would also destroy the personal confidence between physician and patient which is so essential for successful treatment. Epileptic persons endanger safety on the road only slightly: 0.1-0.3% of all traffic accidents are due to epileptic seizures. In contrast, abuse of alcohol plays a major role in 6-9% of all accidents, whereas 80-90% are attributable to evident mistakes by the driver. Epileptic patients under regular medical supervision who are licenced on grounds of approved criteria do not cause more accidents than the general population. A dangerous group are, however, those with mental alterations (organic or reactive) and particularly patients with aggressive and expansive-compensatory traits, as well as those driving without permission. Prognostic criteria as to the further course of the disease are paramount for the assessment of qualification for the licence. The following rules have proved their worth: 2 years freedom from seizures (with or without therapy), no abnormalities specific for epilepsy in the EEG, no serious mental changes, regular medical supervision and treatment mus be guaranteed. Departures from these rules should be confined to exceptional cases with the consent of a physician specialized in epileptology. The same holds for admission to higher categories of driving licence, the only practical eventuality being category D (lorries), and even this only in rare cases. It will scarcely ever be possibel to licence a person who has at some time had epilepsy for professional passanger transportation. The attitude of the physician who first sees the seizure patient is often decisive. It is important that he recognizes the problem, objectively informs his patient and from the very outset gives him realistic advice in order to avoid false decisions, particularly regarding his professional career.

Accident Prevention↗
PubMedDate not supplied

To drive or not to drive: preliminary results from road testing of patients with dementia.

There has been considerable debate about whether driving privileges should be revoked from patients with a diagnosis of dementia and whether highway safety policies should come under closer scrutiny for all elderly. Two case studies are reported of patients with a diagnosis of probable Alzheimer's disease who participated in a pilot project to assess driving. Subjects underwent neurologic and neuropsychological evaluation. Caregivers were included in psychosocial assessments. Patients participated in a specially designed driving evaluation, including an actual road test. Although both patients had mild-to-moderate cognitive impairment on standard tests, one of the patients was deemed safe to drive on the road test while the other was not. These preliminary results suggest that driving skill may not be predictable solely on the basis of the office examination. A road competency test provides a more objective and direct measure on which to base a decision of such important consequence. Implications for public policy and the role for healthcare providers in this process are discussed.

Aged↗
PubMed1991

A survey of the visual acuity of Brisbane drivers.

OBJECTIVE: To conduct a survey of the visual acuity of a group of Brisbane Drivers. SETTING: The outpatient department of the Princess Alexandra Hospital, Brisbane. PARTICIPANTS: Five hundred and three subjects drawn from patients, visitors and staff attending the outpatient department on 10 working days from December 5 to December 16, 1988. MAIN OUTCOME MEASURES: Subjects' age, driver's licence details and driving history were gathered by questionnaire. Visual acuity was assessed with the aid of a Snellen chart. RESULTS: Nearly 6% of the survey group had visual acuity worse than 6/12; 15% had never had their eyes tested other than for licensing purposes; 21% stated that their last ophthalmic or optometric examination was more than five years previously; and 8% failed to meet the Queensland visual acuity requirements for their class of licence. CONCLUSIONS: The monocular driver is not detected by current licence testing procedures in Queensland. Many licence holders do not meet the present visual acuity criteria of the Queensland Department of Transport.

Accidents, Traffic↗
PubMed1990

[Regulation for medical-psychologic examination of drunk drivers].

The author gives some further arguments for the truth of the critical review by Müller on the present legal situation of the medical-psychological examination of first-time drunken drivers by order (Blutalkohol 27, 116). He demands: Every person who applies for a driver's licence and whose former driving licence has been withdrawn should (after a screening of his person) be obliged to present a short expert opinion by a medical-psychological examination department, which gives hints on the further procedure before he is permitted to get a new driver's licence. The same procedure should be in force for persons who apply for a driver's licence on probation, if their former driving licence on probation has been withdrawn. Post-schooling, which is included in the law on driving licences, should not be carried through, if it is evidently hopeless. A certification on the participation in post-schooling course within the scope of the driver's licence on probation should not be given, if the aims of the course are evidently not within reach.

Accidents, Traffic↗
PubMed1991

Attention and driving skills in aging and Alzheimer's disease.

The number of older drivers with dementia is rising with the aging of the adult population. A public health issue is growing because of concerns about the motor vehicle accident risk posed by drivers with dementia of the Alzheimer's type (DAT) and other progressive, degenerative dementias. However, little is known about the specific perceptual/cognitive deficits contributing to impaired driving in DAT. The present paper proposes, on both theoretical and empirical grounds, that attentional skills in relation to driving should be examined in older adults with and without DAT. Such investigations should focus on normal older adults and those in the mild, early stages of dementia because the latter are the most likely among the dementia population to be still driving. Evidence is presented indicating (1) that motor vehicle accident rates are related to performance on information-processing measures of different components of attention; (2) that this relationship is greatest for measures of the switching of selective attention and less for that of divided and sustained attention (vigilance); and (3) that many of these same attentional functions, and particularly the switching of visual selective attention, are impaired in the early stages of DAT and thus may contribute to increased accident risk. Further studies of cognitive and driving performance in older drivers are necessary to establish that the attentional impairments found in mild DAT contribute to increased accident risk. Implications of these findings for driver assessment, education, and training are discussed.

Age Factors↗
PubMed1992

Driving evaluation after traumatic brain injury.

Traumatic closed head injury results in a variety of cognitive and behavioral deficits that may be difficult to assess fully. Adequately evaluating driving safety is a common and important problem for health care professionals. The purpose of this study was to examine the relationship between standardized measures of cognitive function and measures of driving performance in patients with closed head injuries and in their age-matched relative or friend cohorts. Thirteen patients were evaluated. They had each sustained a closed head injury (followed by more than 1 h of coma) 3 to 6 months before testing. Their scores were analyzed along with those of seven cohorts. Assessments of cognitive function and behind-the-wheel driving performance were conducted by examiners blinded to subjects' group membership and medical condition. There was a significant relationship (r = 0.44) between the sum of rated scores of the Tactual Performance Test and Trail Making Test and the global pass/fail ratings of the behind-the-wheel driving test, but it was not related to the driving performance score. The difference between the verbal and performance IQs, and the difference between the block design and other performance tests of the Wechsler Adult Intelligence Scale-Revised were also not significantly related to driving performance. These results suggest that tests of cognitive function alone are not adequate to predict driving performance, and should be used along with standardized driving performance evaluations before recommendations are made.

Adolescent↗
PubMed1990

Driving safety after brain damage: follow-up of twenty-two patients with matched controls.

Driving after brain damage is a vital issue, considering the large number of patients who suffer from cerebrovascular and traumatic encephalopathy. The ability to operate a motor vehicle is an integral part of independence for most adults and so should be preserved whenever possible. The physician may estimate a patient's ability to drive safely based on his own examination, the evaluation of a neuropsychologist, and a comprehensive driving evaluation--testing, driving simulation, behind-the-wheel observation--with a driving specialist. This study sought to evaluate the ability of brain-damaged individuals to operate a motor vehicle safely at follow-up. These patients had been evaluated (by a physician, a neuropsychologist, and a driving specialist) and were judged able to operate a motor vehicle safely after their cognitive insult. Twenty-two brain-damaged patients who were evaluated at our institution were successfully followed up to five years (mean interval of 2.67 years). Patients were interviewed by telephone. Their driving safely was compared with a control group consisting of a close friend or spouse of each patient. Statistical analysis revealed no difference between patient and control groups in the type of driving, the incidence of speeding tickets, near accidents, and accidents, and the cost of vehicle damage when accidents occurred. The patient group was further divided into those who had, and those who had not experienced driving difficulties so that initial neuropsychologic testing could be compared. No significant differences were noted in any aspect of the neuropsychologic test battery. We conclude that selected brain-damaged patients who have passed a comprehensive driving assessment as outlined were as fit to drive as were their normal matched controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1992

Physicians, elderly drivers, and dementia.

In western countries, the proportion of drivers who are elderly is increasing rapidly; over a quarter of the driving population will be 55 years of age or older by the year 2000. Although elderly drivers tend to drive less and may avoid night driving, the number of car accidents and the severity of injuries sustained in such accidents by distance driven increases strikingly after the age of 65. But how can doctors identify those elderly drivers who are a danger to themselves and others? And, once they are identified, how should clinicians balance the effects of removing a driving licence, which may greatly affect a patient's lifestyle, against public safety and breach of confidentiality if the patient refuses to give up his or her licence voluntarily? Medical decisions about illnesses that predispose to loss of consciousness are fairly clear-cut, but normal ageing processes and dementia can be much more difficult to identify and to assess; moreover, there seems little correlation between tests of mental performance and driving ability. Comparisons between practices in different countries may provide some answers, but the introduction of modified driving tests for elderly drivers with some evidence of mild impairment but who wish to retain their driving licence should be considered.

Accidents, Traffic↗
PubMed1975

Mental illness and simulated driving: before and during treatment.

By use of a car simulator we have tested the driving behaviour of 46 inpatients before and during treatment. On the basis of the presence of psychotic symptoms the patients were divided into a psychotic and a non-psychotic group and matched according to age, sex, and driving experience. Before treatment the psychotic group had a statistically significant prolongation of brake time in such a way that their performance deteriorated more markedly over trials. During treatment there was no statistically significant difference between the two groups, indicating that antipsychotic drugs given to psychotic patients do not impair their driving, but on the contrary increase the vigilance.

Adult↗
PubMed1991

The car use of young drivers with spina bifida and hydrocephalus.

This study aimed to collect information on the car use and driving experiences of drivers with spina bifida and hydrocephalus and their disabled and able-bodied peers. A questionnaire was completed by 36 drivers with spina bifida and hydrocephalus (SBH) and two control groups, 36 able-bodied (AB) drivers and 14 drivers with cerebral palsy (CP). Results indicated that although those with SBH and CP took longer to learn to drive than their AB peers and reported more difficulties during the tuition period, the nature of the difficulties experienced were the same for all groups. In the first year of driving those with SBH and CP reported a lower weekly mileage but a higher number of accidents than their able-bodied peers. The SBH group were also less likely to travel on unfamiliar routes and reported greater difficulties with route planning and route following. Many drivers from both disabled and able-bodied groups reported difficulties with parking and reversing during the first year of driving and would have welcomed advice in these (and other) areas. Many SBH and CP drivers were unable to use service stations independently due to physical difficulties, and some would have liked advice on how to use the equipment. Although most drivers considered that being able to drive had given them more freedom and independence, the provision of on-going advice and training was needed to develop driving skills in the early years as a qualified driver.

Adolescent↗