Tools to Evaluate Cognitive Impairment

Transcription

1 Tools to Evaluate Cognitive Impairment

2 Facilitator Assistant Chief Jason Berry, Washington State Patrol and Chair, Law Enforcement Standing Committee

3 Presenters Linda Hill, University of California at San Diego Debra Carney, Driver Fitness Officer, Iowa Department of Transportation Laura Krol, Manager, Bureau of Driver Licensing, Pennsylvania Department of Transportation

4 Recognizing Cognitive Impairment in Older Road Users

5 TREDS is Training, Research and Education for Driving Safety (TREDS) Based at the UC San Diego School of Medicine; comprised of health professionals, law enforcement and safety experts Funded by California Office of Traffic Safety since 2005 Nationally recognized for its research, training programs and Screening Tool for Cognitive Impairment

6 Health and Aging Concerns Our Aging Population By 2030, one in five drivers will be over age 65 Problems related to age can include Medical conditions and medications Reduced vision Decreased strength and mobility Cognitive impairment Cognitive Impairment prevalence rises with age years: 2.4% years: 11% Over 85 years: %

7 Dementia and Driving Mild Dementia Ability to safely operate a motor vehicle may or may not be impaired Moderate Dementia Incapable of operating a motor vehicle safely

8 Multidisciplinary Approach Community Health Professionals Licensing Agency Law Enforcement

9 Health Professionals National Highway Traffic Safety Administration (NHTSA) and American Geriatrics Society (AGS) Clinician s Guide to Assessing and Counseling Older Drivers Quick screening and referral tool 9

10 Clock Examples

11 Trail Making Examples 8:50 9:27

12 Law Enforcement Development and Validation of a Roadside Tool to Assess for Disorientation

13 Dementia Red Flags Inappropriate response to overhead lights/siren Poor personal hygiene; disheveled or inappropriate clothing for existing weather conditions Difficulty finding documents Difficulty communicating; stumble over words, ramble in short, unattached, meaningless sentences

14 Tool for evaluating drivers during a roadside stop Nine questions to assess drivers for orientation to person, place and time Developed and validated at the UC San Diego School of Medicine

15 Driver Orientation Screen for Cognitive Impairment - DOSCI Rule Out Screening Questions Scoring Criteria

16 Nine Questions 7-9. What is today s date? Prompt for month, day and year Without What is state city/town day Month your looking of are the date full we are week at home of in your birth? now? is address? in watch, it? now? Month, can Answer day you and estimate must year match required; what must document; Within time Prompt match reasonable is Day for now? if correct documents not, Answer prompt proximity day, if must needed for address be plus or listed minus on documents one hour of correct Year time

17 Scoring Criteria for Officers

18 DOSCI Validation 2.5 Average Number of Questions Missed N=68 p < Control n=27 Dementia n=41 Control Average Age: 77 years Dementia Average Age: 74 years 18

19 Frequently Missed Questions Year Day Month Day of the Week Time City State Home Address DOB Number Incorrect

20 It is a screening tool to assist in the identification of cognitively impaired drivers encountered during the course of patrol duties. It is to be used as part of an officer s investigation of the totality of circumstances to determine when a driver reexamination referral to DMV should be completed.

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22 Program Evolution 2-hour POST certified curriculum Abbreviated training options 1-hour refresher 30-minute briefing Development and validation of screening tool Video demonstration of DOSCI Electronic DOSCI tool

23 Online Training Videos Driver Orientation Screen for Cognitive Impairment (10-minute video on DOSCI and smartphone app) Identifying and Referring Cognitively Impaired Drivers (30-minute video training) Recognizing Cognitive Impairment in Drivers (9-minute traffic stop video) Medical Conditions that Can Affect Driving (15-minute video on medical ) Use of DOSCI by Public Safety Dispatchers (8-minute video of 911 call)

24 Ability to Recognize Cognitive Impairment 0-49% Increase % Increase 25% 75% N = 2018 My ability to recognize cognitive impairment in older drivers has increased by %.

25 2014 Pilot with the Iowa Department of Transportation Why Iowa? Unique position to screen Only agency assessing drivers unless a collision occurs Has periodic contact with the same drivers In-person two year renewal for age 72+ DOSCI screening tool is similar to vision screening A research-based tool for staff to support decision making Iowa s shifting demographics support need for screening

26 Reasons for Assessment Medical and vision referrals Reexamination requests Appeals Licensing staff discretion based on customer interaction Determine hearing problem vs. confusion Family member answering all questions Unable to follow simple directions Appear to be confused Have difficulty finding documents

27 DOSCI IOWA DOT Form (10-14)

28 Nine Questions 9:46 3 9:49

29 RESULTS Based on 4444 individuals screened on 4694 occasions between November 2014 and October individuals were screened 2 to 5 times

30 Reasons for Assessment % 29.6% % % % 1.1% Re-Exam Recall Line Exam Local DT Hearing Other Reasons for Assessment = 4393

31 Number Missed per Scoring Criteria % SCORING CRITERIA 5 or more incorrect probable cognitive impairment 3-4 incorrect possible cognitive impairment 0-2 incorrect consider all circumstances % 3.2% 0 to 2 3 or 4 5 or more Number of Questions Missed n = 4694

32 DOSCI Results and Licensing Status 59% of customers that missed 3-4 DOSCI questions no longer have a license to drive 88% of customers that missed 5 or more DOSCI questions no longer have a license to drive

33 Missed Questions Today's Year 505 (10.8%) Today's Day Today's Month 351 (7.5%) 1135 (24.2%) Day of the Week 417 (8.9%) Time 442 (9.4%) City 183 (3.9%) State 45 (1.0%) Home Address 449 (9.6%) DOB 82 (1.8%) Iowa Drivers n=4694

34 Screening Administration Ease of Administration = 4.8 very difficult very easy Acceptance by Client = 4.7 not receptive very receptive Usefulness in Assessment = 3.8 not useful very useful

35 Feasibility of DOSCI Easy to learn and administer Staff familiarity decreases times Quick to administer Efficient tool Very little time for most customers Well-received by customers Minimal complaints

36 2018: DOSCI Expansion to CHP Public Safety Dispatchers Reasons for Assessment Communications Center personnel are often first contact with persons suffering from cognitive impairment 911 Operators can provide additional information to prepare officers before encounters with road users

37 Public Safety Personnel

38 Public Safety Personnel Initial Training of Dispatch Operators Briefing Session POST-certified Mental Illness Training for Dispatchers CAD Computer Aided Dispatch program

39 Contact Linda Hill, MD, MPH TREDS Program Director University of California San Diego

40 Screening Iowa Drivers for Cognitive Impairment Deb Carney Driver Fitness Officer Iowa Department of Transportation

41 Iowa Driver Demographics

42 Iowa Driver Demographics

43 Iowa Driver Demographics

44 Iowa Driver Demographics

45 Iowa Driver Demographics 52 counties 25%-30%

46 Moving Forward with DOSCI

47 Electronic DOSCI Forms

48 Electronic DOSCI Forms

49 Electronic DOSCI Forms

50 Electronic DOSCI Forms DOSCI Result Stored in EMREMS

51 Licensing Status people scored 3-4 incorrect 105 (38.9%) License suspended or denied 64 (23.7%) Voluntarily surrendered license 92 (34.1%) License renewed 9 (3.3%) Deceased

52 Licensing Status people scored 5 or more incorrect 58 (43.3%) License suspended or denied 45 (33.6%) Voluntarily surrendered license 28 (20.9%) License renewed 3 (2.2%) Deceased

53 Licensing Status - Summary 63% of customers that missed 3-4 DOSCI questions no longer have a license to drive 77% of customers that missed 5 or more DOSCI questions no longer have a license to drive

54 Safe Driving Basics (SDB)

55 Safe Driving Basics (SDB) Implementation Fall, 2015 Referrals for reexamination Appeals Voluntary screening available

56 Safe Driving Basics (SDB) Laptop/tablet Portable Tent mode Touch screen Removes keyboard Finger/Stylus Headphones

57 Safe Driving Basics (SDB)

58 Safe Driving Basics (SDB) Visual Search A 90 seconds allowed Must pass all exercises

59 Safe Driving Basics (SDB) Visual Search B 180 seconds allowed Must pass all exercises

60 Safe Driving Basics (SDB) Visualizing Missing Information Can miss 4 of 11 Must pass all exercises

61 Safe Driving Basics (SDB) Route Planning Removed Drawing on the screen

62 Safe Driving Basics (SDB) Visual Processing Speed Removed

63 Safe Driving Basics (SDB) Visual Processing Speed/Divided Attention Removed

64 Safe Driving Basics (SDB) Visual Processing Speed/Divided Attention Removed Length Driver frustration

65 Safe Driving Basics (SDB) Removed exercises to reduce: Time - 15 minute screening Complex instructions Unsatisfactory attempts

66 Safe Driving Basics (SDB)

67 Safe Driving Basics (SDB) SDB results stored in EMREMS:

68 Safe Driving Basics Needs Medical Report

69 Safe Driving Basics (SDB)

70 Safe Driving Basics (SDB) Small number of drivers cannot use it Physical issues, tremors Language barrier Reading glasses

71 Safe Driving Basics (SDB) Increases health care professional s awareness of cognitive issues Increase in referrals to driver evaluation programs Iowa plans to continue using DOSCI and Safe Driving Basics

72 Thank you! Debra Carney Driver Fitness Officer Driver & Identification Services Iowa Department of Transportation

73 Pennsylvania Department of Transportation Cognitive Impairment and Driving Laura Krol Driver Safety Division Manager

74 Mature Driver Stats in PA 2,150,000 Number of Drivers 65+ in PA 2,100,000 2,115,442 2,050,000 2,000,000 1,950,000 1,900,000 1,901,546 1,934,397 1,850,000 1,865,494 1,800,000 1,816,186 1,750,000 1,700,000 1,650,

75 PA Initiatives in Mature Driver Safety Law Enforcement Reports Request for Driver Evaluation DOCSI Family/Friend Reports Drivers not meeting medical standards can turn their driver s license in and obtain a Free ID Card.

76 Law Enforcement Recommendation Form - DL-118 The Law Enforcement Recommendation Form is Pennsylvania s reporting mechanism for SUSPECTED medical concerns. This form is completed for any driver that a Law Enforcement Officer feels may not be safe behind the wheel.

77 DOSCI Permission Allows PennDOT understand the driver s condition at the time of the interaction. Screening Tool - Not used for Diagnostic Purposes

78 Data on Law Enforcement Reports About 70% of reports received from law enforcement are for drivers % 25% 20% 15% 10% Reports Received from Law Enforcement Where Cognitive Impairment was Suspected 19% 23% 25% 5% 0%

79 Training of Law Enforcement 2016 and 2017 PA Highway Safety Conferences Partnering with the Pennsylvania State Police to Educate their officers Partnering with PA s Highway Safety Office grantee network. Train the Trainer session

80 PA Initiatives in Mature Driver Safety Mature Driver Re-Examination Program A proactive approach to determine a driver s medical qualifications for the safe operation of a motor vehicle. Medical Reporting Program * Medical Advisory Board * Health Care Community

81 What About Non-Compliance? If medical information requested is not received, the Medical Unit will Suspend an individual s full driving privilege until the driver complies with our request.

82 Mature Driver Initiatives Mature Driver Safety Project - Focus Groups - Revision/creation of Mature Driver Materials

83 PA Initiatives in Mature Driver Safety Mature Driver Improvement Program: AAA, AARP, Safe2Drive, and Seniors for Safe Driving Shared Ride Program

84 Keeping our Mature Drivers Safe As They Age Encourage Seniors to consider advanced vehicle safety features Resource: The National Safety Council s website - Driving - Self Regulation Encourage Doctors to talk about their patients driving habits Including what Rx s they are taking and how they may affect their driving. Resource AAA s website CAR FIT

85 Mature Driver Safety Challenges Proactive Communications Sometimes difficult and emotional Planning for transportation needs as drivers age. Allow Mature Drivers to continue driving as long as safely possible. Encouraging Mature Drivers to make the decision to Retire from driving before PennDOT has to take action.

86 Presentation Wrap-Up: Thank you! Laura Krol

87 Up Next 5:30 pm - 6:30 pm Welcome Reception South Convention Lobby, Tower Building, 2nd Level