Sent: Wednesday, October 03, 2007 1:10 PM
Subject: Summary of discussion about dementia and driving initiated by John Eberhard
Hi, everyone, This discussion, initiated by John Eberhard, and the attached documents may be of interest to you. I took the liberty (I hope no one involved is upset about this...) of combining the many E-messages into one for ease of reading. And there is a cliff-hanger; I'll send any new ones in a future correspondence. Dorothy
Subject: Summary of discussion about dementia and driving initiated by John Eberhard
Hi, everyone. What follows is a very interesting discussion about the prevalence of drivers with dementia, with licenses and still driving. I took the liberty of moving the messages into one message for ease of reading. It is amazing the amount of work being done by researchers all over the world. See the referenced attachments.
From John Eberhard, Sent Thu 9/27/2007 2:22 PM:
"We have all heard about the high estimates of dementia for those over 65 - 10% among 65 year olds through 40% at 85. There are many who question these high rates. From a licensing policy area I am looking for any sources of data for those 65+ with dementia and who have a license, and still drive. I seem to remember a dementia registry that, I believe, David Drachman used in his 1993 study. Would the Health and Retirement Survey be helpful in getting information on this issue? John Eberhard 410-992-9003"
From Messinger-Rapport, Barbara RAPPORB@ccf.org Sent Thu 9/27/2007 8:17 PM:
"I don't know the answer to your specific question. However, the Evans paper of 1989 (see ref below) is consistently quoted. Keep in mind that Alz disease is a spectrum- the severely demented are often in the NH and MOST are not driving (and if they are, not for long), the very mild and mild are often safely driving; it's the ones with moderate dementia that constitute most of the high driving risk from dementia. When you account for the very long timecourse of dementia (3 to 20 years) the rate is probably accurate - but many (most?) of those are in the mild stage. bjm-r
Evans D, Funkenstein H, Albert M, Scherr P, Cook N, Chown M, et al. Prevalence of Alzheimer's disease in a community population of older persons. Higher than previously reported. JAMA 1989;262(18):2551-6."
From Des O Neill Des.ONeill@amnch.ie Sent Fri 9/28/2007 12:00 AM:
"This is a fair enough perspective: worth also noting those who consider that the prevalence of AD may be dropping in line with the fall in disability in older populations (Manton KC, Gu XL, Ukraintseva SV. Declining prevalence of dementia in the U.S. elderly population. Adv Gerontol. 2005;16:30-7.) With increasing pressure for early diagnosis, this might cancel out however by way of a paradigm of increased detection.
However, as Barbara states, the issue is function, not abnormality, and in a wide range of capacity decisions - financial, testamentary, healthcare decisions - it is function and not disease label which matters. Those of us who are in healthcare and involved with driver assessment need to continue promoting an emphasis on function and not on disease label or abnormality. Unfortunately, it is still all too common for alarmist studies to be quoted which emphasize labels or diagnosis without putting this in context of function, or of older people's well-established compensatory strategies. Regards
Holte, H. & Albrecht, M. (2004) Verkehrsteilnahme und -erleben im Strassenverkehr bei Krankheit und Medikamenteneinnamhe. Berichte der Bundesanstalt für Strassenwesen, Mensch und Sicherheit, Heft M 162. Wirtschaftsverlag NW, Bremerhaven"
From Danae Penn danae.penn@wanadoo.fr Sent Fri 9/28/2007 7:56 AM:
"John, One of the deliverables of the European IMMORTAL research project contains statistics for you: Impairments, Diseases, Age and their relative risks of accident involvement (Aug 30, 2003).
http://ec.europa.eu/transport/roadsafety/publications/projectfiles/immortal_en.htm
You can also download from this site :
Literature review of impairment and accident risk associated with ageing, illness and disease Estimation of risk involvement of several medical disorders in road accidents Medical predictors at time of licensing for traffic violations and accidents.
The Cambridge University Press magazine 'Ageing and Society' has published online the following articles :
Older people and transport : coping without a car (Dec 6, 2006) Vehicle crashworthiness and the older motorist (June 25, 2003) Outdoor mobility and leisure activities of older people (Aug 29, 2007)
The website of the European Health Expectancy Monitoring Unit is http://www.ehemu.eu/
The International Longevity Centre UK and Merck Company Foundation published a report in June 2006 on 'The State of Ageing and Health and Europe'. Part 5 of this is entitled Special Focus: Dementia, and includes a bibliography http://www.ilcuk.org.uk/files/pdf_pdf_4.pdf
On Sept 25, 2007 the European Commission adopted a Green Paper entitled 'Towards a new culture for urban mobility' (see especially pages 12-17)
http://ec.europa.eu/transport/clean/green_paper_urban_transport/index_en.htm
I hope all this helps you. Best regards, Danae"
From John Eberhard, Sent Fri 9/28/2007 8:52 AM "Thanks so much Danae. Hope things are going well with you. Also, it is newsletter time again - this applies to all of you on the cc. I have attached the last newsletter to assist you. Take care, John Eberhard" See attached file.
From Odenheimer, Germaine (HSC) Germaine-Odenheimer@ouhsc.edu Sent Fri 9/28/2007 9:08 AM:
"David Carr published an article that noted that 30% of patients seen in a dementia clinic continue to drive. That was what I found in my dementia clinic as well. This was included in a chapter I wrote on the subject.
Also, until people feel comfortable with functional assessments, they will always search for easier surrogates such as diagnosis or even age.
Until there are widely accepted surrogate clinical measures for APPROPRIATE road tests, (if this ever happens), there will be reluctance to accept in-office functional measures as the final word.
The use of CDR (Clinical Dementia Rating Scale) has not filtered into most clinicians' knowledge or skill set, so will not be used until and unless it becomes more widely known and used.
It is an ever complex and controversial issue. Germaine"
From RICHARD SMITH mailto:richardsmith4718@verizon.net Sent Fri 9/28/2007 9:11 AM:
"Hi John - The following is from UMTRI, in a chapter titled "Driving Cessation and Alternative Community Mobility", by David W. Eby, Lisa J. Molnar, and Joseph M. Pellerito, Jr. - they are involved in some very interesting work and you may find it useful to talk with them.
Dementia/Alzheimer's Disease
Dementia/Alzheimer's (DA) disease is characterized by intellectual deterioration in an adult, severe enough to interfere with occupational or social performance. This condition occurs almost exclusively in the older adult population. DA can be caused by a variety of medical conditions, including stroke, hypothyroidism, acquired brain injuries, brain tumors, carbon monoxide poisoning, and alcoholism. Because of variation in how DA is diagnosed, prevalence estimates range from 4% to 16% of the older adult population. Three severity stages of DA have been indexed by the Clinical Dementia Rating Scale: early, middle, and late. Progression usually spans an average of 8 years from the time symptoms first appear, although DA has been known to last as long as 25 years.
Despite, and perhaps because of, the cognitive declines caused by DA, many afflicted people continue to drive. Studies show that up to 45% of patients with DA still drive, 57-59 and the majority of these people drive alone. Evidence shows that people with DA do not change their behaviors after a crash. 59 Thus DA has severe consequences for safe driving, and therefore it is not surprising that people with DA tend to have an elevated crash risk. In one study DA drivers had 263.2 crashes per 1 million vehicle-miles of travel compared with 14.3 crashes per 1 million vehicle-miles of travel for older adult control subjects, an 18-fold increase in crash risk. Drachman and Swearer found that of 83 drivers with DA, 26% had crashes while driving after diagnosis. During the same period, only 8% of 83 matched control subjects had crashes. Because of the serious crash risk posed by drivers with DA and their inability to self-monitor and restrict driving, research efforts have focused on driving behaviors that may indicate DA. Studies have shown several driving problems associated with DA, including getting lost while driving, even in familiar areas; vehicle speed control difficulties, particularly driving consistently below posted speed limits; failure to signal lane changes; failure to check blind spots before lane changes; failure to maintain lateral lane position; running stop signs; and failure to recognize and obey traffic signs. As DA progresses these errors appear to become more frequent. Rich"
From John Eberhard, sent Fri 9/28/2007 8:55 AM:
"Thanks Des, good input. Do you. or anyone else have a copy of the Ken Manton study that you could send me. Thanks, John"
From: Tasca, Leo (MTO), sent Thursday, September 27, 2007 2:26 PM:
"John, this is the best Canadian study I am aware of...Leo" See file attached: hopkins.pdf
From Kit Mitchell kitmitch@googlemail.com
"John, For what it's worth, I attach a couple of 'Fact sheets' about dementia that Google throws up. Neither estimate the number of people with dementia who continue to drive.
The first, 'About dementia', gives much lower prevalence of dementia in the general population - 2% late 60s, 5% late 70s, 20% 80+. I guess it depends very much on definitions and level of severity at which it is considered to be present. Regards Kit" See file attached, aboutdementia.doc
From Foley, Daniel (SAMHSA/CMHS) Daniel.Foley@samhsa.hhs.gov Sent Sun 9/30/2007 1:14 PM:
"John, From the NIA Honolulu-Asia Aging Study of dementia, we estimated that about 4% of older men who were driving had very mild to mild staged dementia and that rarely were men with moderate staged dementia still driving. I'll send a pdf of the JAGS paper tomorrow along with the 1989 JAMA prevalence paper. Best regards Dan"
Hang on until the next one!
Dorothy J. A. Levitt, R.N., M.S.
Coordinator, Wise and Well Program
Erie County Department of Senior Services
95 Franklin St 13th Floor
Buffalo NY 14202
Phone: (716) 858 8081 Fax: (716) 858 7259
E: levittd@erie.gov
www.erie.gov/depts/seniorservices/health
