Senior Driving

Summary of discussion about dementia and driving initiated by John Eberhard

2007-10-03T10:33:00.001-07:00

From: Levitt, Dorothy levittd@erie.gov
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

Recent news articles

2007-10-02T15:05:00.001-07:00

From: Levitt, Dorothy levittd@erie.gov
Sent: Thursday, August 23, 2007 3:22 PM

Hi, everyone, I'm experimenting with searching for current news articles about older drivers. Here are a few for your consideration. I'll try to develop my skills in summarizing them better next time. I got the hang of that about half way through. So, here goes for a first effort.

http://www.smh.com.au/news/national/nrma-stands-up-for-elderly-drivers/2007/08/19/1187462091908.html
"NRMA stands up for elderly drivers" from the Sydney Morning Herald, Aug 20, 2007

http://www.heraldtribune.com/article/20070816/NEWS/708160349
"Frail drivers, few alternatives" from the Miami Herald Tribune, Aug 16, 2007

http://www.delmarvanow.com/apps/pbcs.dll/article?AID=/20070729/LIFESTYLE/707290306/1024
"Results of a Salisbury study could be critical for a nation of aging drivers"

http://www.kswo.com/Global/story.asp?S=6943641
"Elderly driver causes accident"

This headline should be "driver with suspected dementia and alcohol use was in a crash"; this is an example of how a situation is reported with a misleading emphasis, perpetuating beliefs that prevent helpful problem-solving.

http://www.democratandchronicle.com/apps/pbcs.dll/article?AID=/20070815/LIVING01/708150316/-1/COLUMNS
"Health checkup: Older drivers", article by Dr. Stephen Ryan in the Rochester Democrat & Chronicle, just to the east of us! And they included a link to our Help Network web site.

http://www.middletownjournal.com/hp/content/oh/story/news/local/2007/07/26/hjn072607crashfolo2.html
"Car accidents involving seniors on rise in county, 45 percent of Butler County's traffic fatalities involved seniors over age of 70" by Matt Cunningham July 26, 2007, Middletown Journal

http://www.streetsblog.org/2007/08/22/breaking-carnage-driver-on-sidewalk-at-court-and-degraw/
"Breaking Carnage: Driver on Sidewalk at Court and Degraw"
Take time to read the comments. They are a reflection of the filters used when people learn about a crash involving an older driver.

http://www.roanoke.com/extra/wb/128521
"Back to (driving) school", from Roanoke.com: about driver rehab and some good examples of successful rehab.

And from safetylit.com :
Journal Article The effect of yellow light onset time on older and younger drivers' perception response time (PRT) and intersection behavior. Caird JK, Chisholm SL, Edwards CJ, Creaser JI. Transp Res F Traffic Psychol Behav 2007; 10(5): 383-396. Correspondence: unavailable Affiliation: Cognitive Ergonomics Research Laboratory (CERL), University of Calgary, Canada; Virginia Tech. Transportation Institute, Blacksburg, VA, USA; ITS Institute, Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, USA (jkcaird@ucal DOI: 10.1016/j.trf.2007.03.002 (Copyright © 2007, Elsevier Publishing) To understand why older drivers are over-represented in intersection crashes, this study sought to describe the intersection performance of older and younger drivers when traffic lights changed from green to yellow at the last second. Using a moderate-fidelity driving simulator, time to stop line (TSL) at yellow onset was manipulated as drivers approached intersections at 70 km/h (42 mph). Seventy-seven participants, approximately balanced for gender and age group, volunteered from the age categories of 18 to 24, 25 to 35, 55 to 64, and 65+. Driver decisions to stop or go were predicted using a logistic regression model with time to stop line as the single significant predictor. There were no age differences in perception response time (PRT). Older drivers approached intersections at a lower velocity and stopped more accurately than younger drivers. For those drivers who chose to go through the yellow light, speed profiles across the intersection and intersection clearance indicate that older drivers are more likely to be in the intersection when the light changed to red. A PRT of 1.0 s for yellow signal phasing was sufficient for all age groups.

Dorothy

Good Going - Transportation options in Western New York

2007-10-02T14:54:00.001-07:00

From: Levitt, Dorothy levittd@erie.gov
Sent: Tuesday, August 28, 2007 2:14 PM

http://www.goodgoingwny.com/

"The Greater Buffalo-Niagara Regional Transportation Council has created a new way for travelers and other ride-seekers to find transportation alternatives. This secure and easy-to-use website provides information on smarter travel options - including carpooling, taking the bus/rail, and bicycling."

According to the third quarter 2007 GBNRTC Newsletter (p. 6), the site "…uses sophisticated GIS mapping systems showing ways to find compatible partners for commuter ride sharing that would save money and reduce emissions while presserving privacy. The web site also illustrates public transit and bicycling alternatives."

This site was launched on May 4 when Al Gore was in town.
Dorothy