Geri Adler

Driving behaviors in early stage dementia: a study using in-vehicle technology

According to the Alzheimers Association (2011), (1) in 8 people age 65 and older, and about one-half of people age 85 and older, have Alzheimers disease in the United States (US). There is evidence that drivers with Alzheimers disease and related dementias are at an increased risk for unsafe driving. Recent advances in sensor, computer, and telecommunication technologies provide a method for automatically collecting detailed, objective information about the driving performance of drivers, including those with early stage dementia. The objective of this project was to use in-vehicle technology to describe a set of driving behaviors that may be common in individuals with early stage dementia (i.e., a diagnosis of memory loss) and compare these behaviors to a group of drivers without cognitive impairment. Seventeen drivers with a diagnosis of early stage dementia, who had completed a comprehensive driving assessment and were cleared to drive, participated in the study. Participants had their vehicles instrumented with a suite of sensors and a data acquisition system, and drove 1-2 months as they would under normal circumstances. Data from the in-vehicle instrumentation were reduced and analyzed, using a set of algorithms/heuristics developed by the research team. Data from the early stage dementia group were compared to similar data from an existing dataset of 26 older drivers without dementia. The early stage dementia group was found to have significantly restricted driving space relative to the comparison group. At the same time, the early stage dementia group (which had been previously cleared by an occupational therapist as safe to drive) drove as safely as the comparison group. Few safety-related behavioral errors were found for either group. Wayfinding problems were rare among both groups, but the early stage dementia group was significantly more likely to get lost.

Older Women and Driving Cessation

The purpose of this study was to understand the lived-experience of driving cessation for older women. A qualitative, collective case study method was used. From in-depth interviews of former drivers, three categories of themes emerged: driving history, the process of stopping driving, and the experience of being a non-driver. Overall, the women had felt comfortable and skilled behind the wheel and they missed driving. Adaptation came easiest to those who planned ahead for driving cessation and made the decision voluntarily. Remaining independent and mobile were important considerations in the decision to stop driving. Many of the women regularly use formal transit services although riding with friends provides a social context. Family is not the preferred choice for transportation except in an emergency or for basic care. Social workers must acknowledge the importance women place on their independence when helping them work through issues of driving cessation.

The Driver With Dementia: A Survey of Physician Attitudes, Knowledge, and Practice:

Background: One of the most difficult issues physicians must address when caring for persons with dementia is fitness to drive. The purpose of this project was to investigate the attitudes, knowledge, and practices of physicians toward drivers with dementia. Methods: A questionnaire that obtained perspectives about and experiences with drivers’ with dementia was mailed to physicians from North Carolina and South Carolina. Results: The sample was comprised of 239 physicians who worked with persons with dementia. Respondents who were aware of the Physician’s Guide to Assessing and Counseling Older Drivers, had a strong perceived role regarding driving, were older, and believed it was important to address driving were more likely to engage in driving discussions. Conclusions: Concerns associated with the driver with dementia have implications for not only patient care but also public safety. We recommend that all physicians be encouraged to address the issue and utilize existing educational materials.

Driving Decision-making in Older Adults With Dementia

Drivers with dementia, like most other drivers, are reluctant to relinquish their driving privileges, making discussions about driving cessation difficult and of great concern to family. To better understand how driving decisions are made 13 focus groups were held with 65 participants including current drivers with dementia, their spouses, and spouses of former drivers with dementia. Results documented the use of compensation strategies by drivers with dementia and their families to maintain safe driving behaviors given declining skills, identified a lack of planning for driving cessation even in light of expectations of cessation, confirmed a desire that driving decisions be a responsibility shared between families and professionals, and showed that diagnostic delays hamper families in making long-term plans. Given the desires and needs of drivers and their spouses, a shared, consistent, and unified approach to driving decisions between professionals and families is needed.

The Older Driver with Parkinson's Disease

Abstract This study surveyed older drivers with Parkinsons disease (PD) and a control group for the purpose of obtaining information about driving history, habits, and expectations about driving cessation. Compared to control subjects, PD drivers were more likely to have reduced their driving over the past 5 years (p = 0.002). In addition, PD drivers had significantly more crashes (p = 0.003). Not surprisingly, families of PD drivers expressed greater concern about patient driving (p = 0.0001). Because of the complexities of the issue of driving and PD, social workers have the responsibility to provide emotional and practical supports to their PD clients and family members.

Institutional Respite Care: Benefits and Risks for Dementia Patients and Caregivers

Thirty-seven dementia patients and their caregivers were studied before and after a two-week in-hospital respite stay. Institutional respite care did not alter behavior problems in dementia patients, nor did changes in performance of activities of daily living (ADLs) by Alzheimers disease (AD) patients exceed those expected from disease progression. Caregivers exhibited an improvement in burden and depression during the respite study, but levels returned to baseline following the patients return home.

Driving cessation and AD: Issues congronting patients and family

This study surveyed older drivers with Alzheimers disease (AD), collaterals familiar with the patients driving, and a control group for the purpose of obtaining information about driving habits and plans for driving cessation. Drivers with dementia are at a greater risk for getting lost and having crashes than other older drivers. Family members are concerned about crashes to the extent that they are trying to prevent the AD driver from driving. Despite their concerns, many AD drivers and their families have not made plans for driving cessation. These results can assist health care professionals in developing approaches to assist AD drivers and their families as they make the transition to non-driving status.

At-Risk Drivers with Alzheimer's Disease: Recognition, Response, and Referral

Objective. This manuscript addresses the following questions for licensing authorities: 1) Are drivers with Alzheimers disease (AD) an issue that should concern licensing authorities? 2) What critical driving skills impacted by AD should authorities recognize? 3) What should their response be? 4) Do licensing authorities have a role in providing information about or referral to community agencies that offer alternative transportation options and other services? Methods. To address issues important to licensing authorities the authors reviewed pertinent driving and dementia literature. Results. Drivers with AD have unique impairments that should be recognized and responded to early on in the disease process, with sensitivity and respect for continued mobility. As the disease progresses and they must stop driving, former drivers and their families could benefit from resource referrals that provide information about transportation alternatives and support services in their communities. Conclusions. The authors believe that drivers with AD should be a concern for licensing authorities. Licensing decisions and policies to assess and regulate drivers are in the end made individually by each state. Policymakers will make their decisions based upon current research and concerns of their constituency and need to consider a seamless approach to addressing safe mobility. Licensing authorities are an important partner along with individuals, family members, health care professionals, social service providers, researchers, and policymakers in assuring public safety and individual mobility. All of the partners should confront the concern directly—none should “look the other way.” The goal is to keep people driving safely for as long as possible. The responsibility is to recognize, respond, and refer when driving safely is no longer assured.

Caregivers Dependent upon Drivers with Dementia

This paper reports findings of a preliminary study of caregivers dependent upon drivers with dementia. Fifteen caregivers who perceived themselves as dependent upon their partner for transportation and 15 who perceived themselves as independent were surveyed. Dependent caregivers were significantly more likely to rely on the cognitively impaired driver for routine daily activities such as shopping, medical appointments, and visiting family and friends. Only 20% of the dependent caregivers believed that the driver with dementia should decrease or discontinue driving. Dependent caregivers were less likely than independent caregivers to take an active approach in encouraging driving cessation. Compared to the independent caregivers, the dependent caregivers believed that if the patient with dementia could no longer drive, it would significantly affect their quality of life. The authors discuss the issues and problems uniquely associated with the dependent caregiver.

The Driver With Dementia: A Review of the Literature

The authors review 10 studies of driving and dementia. They found poor agreement among the researchers with regard to the stage at which a patient with dementia should discontinue driving and the appropriate tools to be used for an assessment of driving skills. They make recommendations for a comprehensive driving assessment and for the clinical management of drivers with dementia. Because the impaired driver is a medical as well as a public safety concern, clinicians and policymakers must work together to address the many problems associated with this issue.