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Predicting safety to drive in people with dementia Nadina B Lincoln Jenny L Taylor Kristina Vella Walter P Bouman Kathryn A Radford Background Driving relies on multiple abilities, (e.g. memory, judgement, psychomotor abilities) which can be affected by dementia .

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predicting safety to drive in people with dementia

Predicting safety to drive in people with dementia

Nadina B LincolnJenny L TaylorKristina VellaWalter P BoumanKathryn A Radford

background
Background
  • Driving relies on multiple abilities, (e.g. memory, judgement, psychomotor abilities) which can be affected by dementia.
  • In the UK “If you have had, or currently suffer from a medical condition or disability that may affect your driving you must tell the Driver and Vehicle Licensing Agency (DVLA).” (http://www.dvla.gov.uk)
    • Similar procedures apply in other countries
  • There is currently a lack of consistency in how a person with dementia is declared as safe or unsafe to drive (Donnelly & Karlinsky 1990; BPS 2001)
previous work
Previous work
  • Lincoln et al. (2006) developed a cognitive test battery for predicting safety to drive in people with dementia
  • The predictive equation was 88% accurate
current study aims
Current Study - AIMS
  • To establish whether assessments found to be predictive of on-road performance in previous study are predictive in an independent sample
  • To determine whether the predictive validity can be improved by including other measures
procedure
Procedure
  • Referral: letter OR phone call
  • Invitation letter to participant: including consent form and information sheet
  • Home Visit: discuss the study and deliver assessments (1 or 2 sessions)
  • Driving Assessment: with specialised driving instructor
  • Report: to referrer, GP, and participant
assessments
Assessments
  • General level of function:MMSE
  • Attention:SDSA Dot Cancellation; Stroop
  • Executive abilities:SDSA Square Matrices & Road Sign Recognition; BADS Rule Shift & Key Search; Trail Making
  • Visuospatial perception:VOSP Incomplete Letters, Position Discrimination & Number Location
  • Memory:SORT Words Immediate; SORT Words Delayed
  • Information processing:AMIPB Info Processing A
road assessment
Road Assessment

1. Starting Precautions 13. Passing static vehicles

2. Moving Off 14. Merging with traffic stream

3. Observation at Side Junctions 15. Anticipating pedestrians

4. Observations to rear 16. Anticipating beh. of others

5. Use of Signals 17. Use of speed

6. Positioning on Road 18. Obedience of road signs

7. Cornering 19. Observing speed limits

8. Braking 20. Courtesy

9. Accelerating 21. Emergency stop

10. Overtaking 22. Reversing

11. Driving on roundabouts 23. Parking vehicle

12. Driving in traffic lanes 24. Turning right

25. Following too close

road assessment11
Road Assessment
  • Classified:
    • Definitely Safe
    • Probably Safe
    • Probably Unsafe
    • Definitely Unsafe

Recently conducted inter-rater reliability showed

100% agreement in classification between our driving

instructor and an independent instructor.

numbers referred n 122
Numbers referred (n=122)
  • Age
    • Mean = 75.3 years
    • SD = 7.27
  • Gender
    • Men (n=91), Women (n=31)
  • Type of dementia
    • Alzheimer’s: 54
    • Vascular: 27
    • Mixed Aetiology: 6
    • Lewy Body Disease: 3
    • Unknown: 32
driving outcome
Driving Outcome

Lower proportion of unsafe drivers than in previous studies

28

24

12

1

the aims
The AIMS
  • To establish whether assessments found to be predictive of on-road performance in previous study are predictive in an independent sample
  • To determine whether the predictive validity can be improved by including other measures
the aims16
The AIMS
  • To establish whether assessments found to be predictive of on-road performance in previous study are predictive in an independent sample
  • To determine whether the predictive validity can be improved by including other measures
was the old equation predictive
Was the old equation predictive?
  • 71% correctly classified

Predicted group membership (cognitive tests)

Unsafe Safe

Road Pass841

Assessment

Fail310

These individuals are those who are actually unsafe, but would have been missed by the equation

Sensitivity for safe drivers=80.4%; Specificity=25.0%; PPV=83.7%; NPV=23.1%

the aims18
The AIMS
  • To establish whether assessments found to be predictive of on-road performance in previous study are predictive in an independent sample
  • To determine whether the predictive validity can be improved by including other measures
could we produce a better equation
Could we produce a better equation?
  • From a hierarchical DFA using the original tests, plus VOSP Number Location we developed a new predictive equation
results with new equation
Results with new equation?
  • 83.9% correctly classified

Predicted group membership (cognitive tests)

Unsafe Safe

Road Pass841

Assessment

Fail 112

These individuals are less of a concern – we would simply recommend that they are tested on the road

These individuals are those who are actually unsafe, but would have been missed by the equation

Sensitivity for safe drivers=95.3%; Specificity=57.9%; PPV=83.7%; NPV=84.6%

who did the equation miss
Who did the equation miss?

Those who were actually unsafe, but predicted to be safe (n=2)

  • Often drove an automatic car (whilst in Hungary) but tested in manual which drives in UK
  • Taking anti-depressants and hypnotics, both proven to hinder driving

Two interesting points raised by two individuals:

This highlights the importance of clinician involvement

preliminary conclusion
Preliminary conclusion
  • The original equation was only moderately predictive in an independent sample
  • HOWEVER the battery of tests was still predictive
  • Further analysis is required to establish how best to combine these tests into a reliable predictive equation.
practical application
Practical Application

Diagnosed with dementia/licence for review

Cognitive Screening Assessment

Score less than a select cut-off

Score more than a select cut-off

Referred for on-road assessment at Regional Mobility Centre

Continue driving

slide24
Thank you

Any Questions?

Lincoln, N. B., Radford, K. A., Lee, E. & Reay, A. C. (2006) The assessment of fitness to drive in people with dementia. Int J Geriatr Psych, 21, 1044-1051.

for more information
For more information

E -mail

Jenny.Taylor@nottingham.ac.uk

Nadina.Lincoln@nottingham.ac.uk

Call

0115 846 7616

Address

Institute of Work, Health and Organisations, University of Nottingham, International House, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB