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Development of a decision-making tool for reporting drivers with mild dementia and mild cognitive impairment to transportation administrators

Published online by Cambridge University Press:  22 March 2017

Duncan H. Cameron
Affiliation:
McMaster University, Hamilton, Ontario, Canada
Carla Zucchero Sarracini
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Linda Rozmovits
Affiliation:
Private practice, Toronto, Ontario, Canada
Gary Naglie
Affiliation:
Baycrest Health Sciences, Toronto, Ontario, Canada
Nathan Herrmann
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Frank Molnar
Affiliation:
The Ottawa Hospital, Ottawa, Ontario, Canada
John Jordan
Affiliation:
Western University, London, Ontario, Canada
Anna Byszewski
Affiliation:
The Ottawa Hospital, Ottawa, Ontario, Canada
David Tang-Wai
Affiliation:
University Health Network, Toronto, Ontario, Canada
Jamie Dow
Affiliation:
Société de l'assurance automobile du Québec, Québec, Québec, Canada
Christopher Frank
Affiliation:
Providence Care, Kingston, Ontario, Canada
Blair Henry
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Nicholas Pimlott
Affiliation:
Women's College Hospital, Toronto, Ontario, Canada
Dallas Seitz
Affiliation:
Providence Care, Kingston, Ontario, Canada
Brenda Vrkljan
Affiliation:
McMaster University, Hamilton, Ontario, Canada
Rebecca Taylor
Affiliation:
Baycrest Health Sciences, Toronto, Ontario, Canada
Mario Masellis
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Mark J. Rapoport*
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
*
Correspondence should be addressed to: Mark J. Rapoport, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. Phone: (416) 480-4085; Fax: (416) 480-5318. Email: Mark.Rapoport@sunnybrook.ca.

Abstract

Background:

Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators.

Methods:

A multi-faceted, computerized decision support tool was developed, using a systematic literature and guideline review, expert opinion from an earlier Delphi study, as well as qualitative interviews and focus groups with physicians, caregivers of former drivers with dementia, and transportation administrators. The tool integrates inputs from the physician-user about the patient's clinical and driving history as well as cognitive findings, and it produces a recommendation for reporting to transportation administrators. This recommendation is translated into a customized reporting form for the transportation authority, if applicable, and additional resources are provided for the patient and caregiver.

Conclusions:

An innovative approach was needed to develop the DD-DT. The literature and guideline review confirmed the algorithm derived from the earlier Delphi study, and barriers identified in the qualitative research were incorporated into the design of the tool.

Type
Protocol-only paper
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Alzheimer Society of Canada (2009). Rising Tide: Impact of Dementia on Canadian Society. Toronto, Canada: Alzheimer Society of Canada.Google Scholar
American Association of Motor Vehicle Administrators (2009). Driver Fitness Medical Guidelines. Arlington, USA: American Association of Motor Vehicle Administrators.Google Scholar
American Medical Association (2010). Physician's Guide to Assessing and Counseling Older Drivers, 2nd edn. Chicago, USA: American Medical Association.Google Scholar
Anderson, S. W., Aksan, N., Dawson, J. D., Uc, E. Y., Johnson, A. M. and Rizzo, M. (2012). Neuropsychological assessment of driving safety risk in older adults with and without neurologic disease. Journal of Clinical and Experimental Neuropsychology, 34, 895905.Google Scholar
Austroads (2012). Assessing Fitness to Drive for Commercial and Private Vehicle Drivers, 4th edn. Sydney, Australia: Austroads.Google Scholar
Brashler, R. et al. (2016). Time to make a call? The ethics of mandatory reporting. Physical Medicine and Rehabilitation, 8, 6974.Google Scholar
Byszewski, A., Aminzadeh, F., Robinson, K., Molnar, F. and Dalziel, W. (2011). The Driving and Dementia Toolkit for Persons with Dementia and their Caregivers. Ottawa, Canada: The Regional Geriatric Program of Eastern Ontario.Google Scholar
Byszewski, A. M. et al. (2003). A continuing medical education initiative for Canadian primary care physicians: the driving and dementia toolkit: a pre- and postevaluation of knowledge, confidence gained, and satisfaction. Journal of the American Geriatrics Society, 51, 14841489.Google Scholar
Canadian Council of Motor Transport Administrators (2013). Determining Driver Fitness in Canada, 13th edn. Ottawa, Canada: Canadian Council of Motor Transport Administrators.Google Scholar
Canadian Medical Association (2012). Canadian Medical Association Driver's Guide: Determining Medical Fitness to Operate Motor Vehicles, 8th edn. Ottawa, Canada: Canadian Medical Association.Google Scholar
Carr, D. B., Barco, P. P., Wallendorf, M. J., Snellgrove, C. A. and Ott, B. R. (2011). Predicting road test performance in drivers with dementia. Journal of the American Geriatrics Society, 59, 21122117.CrossRefGoogle ScholarPubMed
Chihuri, S. et al. (2016). Driving cessation and health outcomes in older adults. Journal of the American Geriatrics Society, 64, 332341.Google Scholar
Corbett, A. and Ballard, C. (2011). Information provision services in dementia care. International Journal of Older People Nursing, 6, 217226.Google Scholar
Devlin, A., McGillivray, J., Charlton, J., Lowndes, G. and Etienne, V. (2012). Investigating driver behavior of older drivers with mild cognitive impairment using a portable simulator. Accident Analysis & Prevention, 49, 300307.Google Scholar
Drachman, D. A. and Swearer, J. M. (1993). Driving and Alzheimer's disease: the risk of crashes. Neurology, 43, 2448.Google Scholar
Driver Vehicle Licensing Agency (2009). At a Glance Guide to the Current Medical Standards of Fitness to Drive. London, UK: Department for Transport.Google Scholar
Duchek, J. M. et al. (2003). Longitudinal driving performance in early-stage dementia of the Alzheimer type. Journal of the American Geriatrics Society, 51, 13421347.Google Scholar
Eby, D. W., Silverstein, N. M., Molnar, L. J., LeBlanc, D. and Adler, G. (2012). Driving behaviours in early stage dementia: a study using in-vehicle technology. Accident Analysis & Prevention, 49, 330337.Google Scholar
Foley, D. J., Masaki, K. H. and Ross, G. W. (2000). Driving cessation in older men with incident dementia. Journal of the American Geriatrics Society, 48, 928930.Google Scholar
Fox, G. K., Bowden, S.C., Bashford, G. M. and Smith, D. S. (1997). Alzheimer's disease and driving: prediction and assessment of driving performance. Journal of the American Geriatrics Society, 45, 949953.CrossRefGoogle ScholarPubMed
Friedland, R. P. et al. (1988). Motor vehicle crashes in dementia of the Alzheimer's type. Annals of Neurology, 24, 782786.CrossRefGoogle Scholar
Garg, A. X. et al. (2005). Effects of computerized clinical depression support systems on practitioner performance and patient outcomes: a systematic review. The Journal of the American Medical Association, 293, 12231238.Google Scholar
Gilley, D. W. et al. (1991). Cessation of driving and unsafe motor vehicle operation by dementia patients. Archives of Internal Medicine, 151, 941946.Google Scholar
Hebert, L. E., Scherr, P. A., Bienias, J. L., Bennett, D. A. and Evans, D. A. (2003). Alzheimer disease in the US population: prevalence estimates using the 2000 census. Archives of Neurology, 60, 11191122.CrossRefGoogle ScholarPubMed
Herrmann, N. et al. (2006). Predictors of driving cessation in mild-to-moderate dementia. Canadian Medical Association Journal, 175, 591595.Google Scholar
Horvath, K. J. et al. (2011). Dissemination strategies: the evolution of learning resources on the evaluation of delirium, dementia, and depression. Gerontology & Geriatrics Education, 32, 8092.Google Scholar
Hunt, L., Morris, J. C., Edwards, D. and Wilson, B. S. (1993). Driving performance in persons with mild senile dementia of the Alzheimer type. Journal of the American Geriatrics Society, 41, 747753.CrossRefGoogle ScholarPubMed
Iverson, D. J., Gronseth, G. S., Reger, M. A., Classen, S., Dubinsky, R.M. and Rizzo, M. (2010). Practice parameter update: evaluation and management of driving risk in dementia: report of the quality standards subcomittee of the american academy of neurology. Neurology, 74, 13161324.Google Scholar
Kawano, N. et al. (2012). Effects of mild cognitive impairment on driving performance in older drivers. Journal of the American Geriatrics Society, 60, 13791381.CrossRefGoogle ScholarPubMed
Liddle, J., Bennet, S., Allen, S., Lie, D. C., Standen, B. and Pachana, N. A. (2013). The stages of driving cessation for people with dementia: needs and challenges. International Psychogeriatrics, 25, 20332046.Google Scholar
Liddle, J., Gustafsson, L., Mitchell, G. and Pachana, N. A. (2017). A difficult journey: reflections on driving and driving cessation from a team of clinical researchers. Gerontologist, 57, 8288. doi: 10.1093/geront/gnw079. Epub 2016 Apr 21.CrossRefGoogle ScholarPubMed
Liddle, J., Turpin, M., Carlson, G. and McKenna, K. (2008). The needs and experiences related to driving cessation for older people. British Journal of Occupational Therapy, 71, 379388.Google Scholar
Lucas-Blaustein, M. J. et al. (1988). Driving in patients with dementia. Journal of the American Geriatrics Society, 36, 10871091.Google Scholar
Lyman, S., Ferguson, S., Braver, E. and Williams, A. (2002). Older driver involvements in police reported crashes and fatal crashes: trends and projections. Injury Prevention, 8, 116120.CrossRefGoogle ScholarPubMed
Meuser, T. M., Carr, D. B., Berg-Weger, M., Niewoehner, P. and Morris, J. C. (2006). Driving and dementia in older adults: implementation and evaluation of a continuing education project. Gerontologist, 46, 680687.Google Scholar
Molnar, F., Marshall, S. C., Man-Son-Hing, M., Wilson, K. G., Byszewski, A. M. and Stiell, I. (2007). Acceptability and concurrent validity of measure to predict older driver involvement in motor vehicle crashes: an emergency department pilot case-control study. Accident Analysis & Prevention, 39, 10561063.CrossRefGoogle ScholarPubMed
New Zealand Transport Agency (2009). Medical Aspects of Fitness to Drive: A Guide for Medical Practitioners. Palmerston North, New Zealand: New Zealand Transport Agency.Google Scholar
Not If But When (2013). Helping drivers with dementia hang up the keys 2013. Available at: http://nibw.ca/; last accessed 18 July 2016.Google Scholar
O'Connor, M. G., Kapust, L. R., Lin, B., Hollis, A. M. and Jones, R. N. (2010). The 4Cs (crash history, family concerns, clinical condition, and cognitive functions): a screening tool for the evaluation of the at-risk driver. Journal of the American Geriatrics Society, 58, 11041108.Google Scholar
Ott, B. R., Papandonatos, G. D., Davis, J. D. and Barco, P. P. (2012). Naturalistic validation of an on-road driving test of older drivers. Human Factors, 54, 663667.Google Scholar
Rapoport, M. J. et al. (2007). Sharing the responsibility for assessing the risk of the driver with dementia. Canadian Medical Association Journal, 177, 599601.Google Scholar
Rapoport, M. J. et al. (2014a). Research letter. Physician sex is a predictor of reporting drivers with mild cognitive impairment and mild dementia to transportation authorities. Journal of the American Geriatrics Society, 62, 201202.Google Scholar
Rapoport, M. J. et al. (2014b). Developing physician consensus on the reporting of patients with mild cognitive impairment and mild dementia to transport authorities in a region with mandatory reporting. American Journal of Geriatric Psychiatry, 22, 15301543.Google Scholar
Redelmeier, D. A., Vinkatesh, V. and Stanbrook, M. B. (2008). Mandatory reporting by physicians of patients potentially unfit to drive. Open Medicine, 2, e8e17.Google Scholar
Road Safety Authority (2010). Medical Aspects of Driver Licensing: A Guide for Registered Medical Practitioners, 3rd edn. Ballina, Ireland: Road Safety Authority.Google Scholar
Seiler, S. et al. (2012). Driving cessation and dementia: results of the prospective registry on dementia in Austria. PLoS One, 7, e52710.Google Scholar
Singapore Medical Association (2011). Medical Guidelines on Fitness to Drive, 2nd edn. Singapore: Singapore Medical Association.Google Scholar
Stern, R. A. et al. (2008). At the crossroads: development and evaluation of a dementia caregiver group intervention to assist in driving cessation. Gerontology & Geriatrics Education, 29, 363382.Google Scholar
Thomas, D. C. et al. (2006). Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians. Journal of the American Geriatrics Society, 54, 16101618.Google Scholar
Vrkljan, B. H., Myers, A. M., Crizzle, A. M., Blanchard, R. A. and Marshall, S. C. (2013). Evaluating medically at-risk drivers: a survey of assessment practices in Canada. Canadian Journal of Occupational Therapy, 80, 295303.Google Scholar
Watanabe, T., Konagaya, Y., Yanagi, T., Miyao, M., Mukai, M. and Shibayama, H. (2012). Study of daily driving characteristics of individuals with dementia using video-recording driving recorders. Journal of the American Geriatrics Society, 60, 13811383.CrossRefGoogle ScholarPubMed
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