The Medically At-Risk Driver Cognitive Impairment Leads the Way

Transcription

1 The Medically At-Risk Driver Cognitive Impairment Leads the Way Bonnie M. Dobbs, PhD* and Allen R. Dobbs, PhD * University of Alberta, Edmonton, Canada DriveABLE Assessment Centres Inc. Paper presented the British Columbia Injury Prevention 2006 Conference March 1 3, Vancouver, BC

2 The Older Driver vs. The Medically At-Risk Driver Older drivers: one fastest growing segments of driving population By 2024: 1:4 drivers will be over the age of 65 Older drivers driving more and longer into old age

3 How Safe Are Older Drivers Most older drivers are safe drivers Self-regulation is common (rush hour, freeways, during inclement weather, etc.) Self-restrictions due to recognition of changes in driving ability BCAA Traffic Safety Foundation Mature Driver Program (Living Well Driving Well) Despite self-regulation, crash rates taking amount of driving into consideration are high

4 Driver Fatality Rate (per 100 million VMT) Fatality Rate Source: FARS 2001 and NHTSA 2001 Driver Age Group

5 Crash Rate by Age * Crashes /km driven Risk Medical * Taking exposure into account

6 C r a s h e s Trends in Traffic Safety < (Source FARS, )

7 Who Is Most At-Risk? Not Older Drivers but Medically At- Risk Drivers A number of chronic medical conditions put individuals at risk (those conditions can occur at any age but are more likely to occur as one gets older) Also need to take into consideration the medications that are used to treat those illnesses

8 Red Flags Red Flags* Cardiovascular disease (e.g., congestive heart failure, cardiac arrhythmia) Metabolic disease (e.g., diabetes, hypothyroidism) Cerebrovascular disease (e.g., stroke, arteriosclerosis) Renal disease (chronic renal failure) Neurological disease (e.g., head injury, Parkinson s Disease, Multiple Sclerosis, tumor, narcolepsy, sleep apnea) Dementia (e.g., Alzheimer disease, multi-infarct dementia, frontal temporal dementia, Pick s Disease) Respiratory disease (e.g., chronic obstructive pulmonary disease, respiratory failure) Psychiatric illness (e.g., schizophrenia, depression) Medications (e.g., anti-depressants, other medications having prominent central nervous system effects) *From B. Dobbs (2002) NHTSA report

9 Increased Crash Risk (At-Fault Crashes)* Visual Acuity 2.8 Diabetes 2.2 Cardiovascular 1.8 Pulmonary 2.1 Psychiatric 2.5 Epilepsy 3.0 Neurological 5.1 Cognitive Impairment 7.6 * Diller et al. (1998) (Unrestricted drivers)

10 Scope of the Problem 8% of Canadians 65+ have a dementia, another 17% have some form of cognitive impairment (CSHA, 1994) All individuals with a progressive dementia will become unsafe to drive at some point in their illness

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12 Identifying Those At-Risk Diagnosis alone insufficient for revocation of driving privileges Standard tests (e.g., MMSE) are not good predictors of driving abilities Cannot rely on patient/caregiver reports Medical conditions can be used as Red flags Conversations about driving need to start early Medical Conditions-Chronic Outcomes: decisions need to be made on an individual basis (e.g., scientifically based on-road driving assessment)

13 Warning Signs Unaware of driving errors Getting lost or confused while driving Other drivers honking Trouble navigating turns Difficulty staying in lane Missing traffic signs Near Misses Unable to keep up with speed of traffic Scrapes or Dents on Car and/or Garage

14 Support Critical in the Stopping Driving Process Insight often impaired Don t understand why driving privileges revoked Loss of driving privileges a life altering event for many-associated with reductions in mobility, independence, negative emotions Affects individuals and families

15 Driving Cessation Support Groups DCSG developed and tested over a 2 year period (funding from Alzheimer Canada) Specialized support groups specifically for loss of driving privileges effective (Dobbs et al., 2005)

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18 Conclusions Traffic safety strategies need to take into account the need for mobility and safety Goal is to promote the continued mobility of those who are safe to drive For those who are unsafe, revocation of driving privileges is needed Critical that we develop support programs and alternate means of transportation to ensure the continued mobility for those who are no longer able to drive